The evolution of disability
To understand how disability is currently viewed, it is helpful to look at the way the concept of disability has evolved over time. Historically, disability was largely understood in mythological or religious terms, e.g. persons with disabilities were considered to be possessed by devils or spirits; disability was also often seen as a punishment for past wrongdoing. These views are still present today in many traditional societies. In the nineteenth and twentieth century's, developments in science and medicine helped to create an understanding that disability has a biological or medical basis, with impairments in body function and structure being associated with different health conditions. This medical model views disability as a problem of the individual and is primarily focused on cure and the provision of medical care by professionals.
Later, in the 1960s and 1970s, the individual and medical view of disability was challenged and a range of social approaches were developed, e.g. the social model of disability. These approaches shifted attention away from the medical aspects of disability and instead focused on the social barriers and discrimination that persons with disabilities face. Disability was redefined as a societal problem rather than an individual problem and solutions became focused on removing barriers and social change, not just medical cure. Central to this change in understanding of disability was the disabled people's movement, which began in the late 1960s in North America and Europe and has since spread throughout the world. Disabled people's organisations are focused on achieving full participation and equalisation of opportunities for, by and with persons with disabilities. They played a key role in developing the Convention on the Rights of Persons with Disabilities (1), which promotes a shift towards a human rights model of disability.
There are many different definitions of disability. The Convention on the Rights of Persons with Disabilities states that disability is an evolving concept and results from the interaction between persons with impairments and attitudinal and environmental barriers that hinders their full and effective participation in society on an equal basis with others(1).
People's experiences of disability are extremely varied. There are different kinds of impairments and people are affected in different ways. Some people have one impairment, others multiple; some are born with an impairment, while others may acquire an impairment during the course of their life. For example, a child born with a congenital condition, such as cerebral palsy, a young soldier who loses his leg to a landmine, a middle-aged woman who develops diabetes and loses her vision, an older person with dementia may all be described as people who have disabilities. The Convention on the Rights of Persons with Disabilities describes persons with disabilities as those who have long-term physical, mental, intellectual or sensory impairments(1).
Globally, the most common causes of disability include: chronic diseases (e.g. diabetes, cardiovascular disease and cancer); injuries (e.g. due to road traffic accidents, conflicts, falls and landmines); mental health problems; birth defects; malnutrition; and HIV/AIDS and other communicable diseases (3). It is very difficult to estimate the exact number of people living with disabilities throughout the world, however the number is increasing due to factors such as population growth, increase in chronic health conditions, the ageing of populations, and medical advances that preserve and prolong life (3). Many low and middle-income countries face a double burden, i.e. they need to address both traditional problems, such as malnutrition and infectious diseases, and new problems, such as chronic conditions.
The following statistics illustrate the situation facing persons with disabilities across the globe:
- Approximately 10-15% of the world's population lives with a disability (4)
- Persons with disabilities constitute the world's largest minority (5).
- An estimated 80% of persons with disabilities live in developing countries (5).
- An estimated 15-20% of the world's poorest people are disabled (6).
- No rehabilitation services are available to persons with disabilities in 62 countries (7).
- Only 5-15% of persons with disabilities can access assistive devices in the developing World (8).
- Children with disabilities are much less likely to attend school than others. (9).
- Persons with disabilities tend to experience higher unemployment and have lower earnings than people without disabilities (10)
- Persons with disabilities often die prematurely
- For every person who has impairment and/or disability, 4 to 5 other family members are also affected- particularly in developing countries where families tend to be larger and more interdependent.
Poverty is both a cause and consequence of disability (12): poor people are more likely to become disabled, and disabled people are more likely to become poor. Poverty has many aspects and is more than just a lack of money or income - Poverty erodes or nullifies economic and social rights such as the right to health, adequate housing, food and safe water, and the right to education (11). While not all persons with disabilities are poor, in low-income countries persons with disabilities are over-represented among the poorest (1). DFID estimates that more than 50% of the impairments that result in people being included in current disability prevalence rates are preventable and directly linked to underdevelopment i.e., poverty. People with inadequate resources tend to have lower awareness and understanding of disability and access to basic health care services which lead to a greater risk of developing an impairment. Poverty also reinforces negative attitudes towards persons with disabilities, acting as a barrier to inclusion and service delivery and transforming impairments into disabilities.
Persons with disabilities are often neglected, discriminated against and excluded from mainstream development initiatives, and find it difficult to access health, education, housing and livelihood opportunities. This results in greater poverty or chronic poverty, isolation, and even premature death. The costs of medical treatment, physical rehabilitation and assistive devices also contribute to the poverty cycle of many persons with disabilities.
Addressing disability is a concrete step to reducing the risk of poverty in any country. At the same time, addressing poverty reduces disability. This link was recognised in 2009, when the UN General Assembly adopted a resolution on Realising the Millenium Development Goals for Persons with Disabilities recognising that inclusion of persons with disabilities in mainstream development is essential for achievement of the Millennium Development Goals which aim among other things to eradicate extreme poverty and hunger and provide universal primary education, all by the target date of 2015 (13). As poverty clearly must be eliminated to achieve a better quality of life for persons with disabilities, CDD's programs aims to reduce poverty by ensuring that health, education and livelihood opportunities are accessible to persons with disabilities.
Inclusive development is that which includes and involves everyone, especially those who are marginalised and often discriminated against (16). Persons with disabilities and their family members, particularly those living in rural or remote communities or urban slums, often do not benefit from development initiatives and therefore disability inclusive development is essential to ensure that they can participate meaningfully in development processes and policies (17).
Mainstreaming (or including) the rights of persons with disabilities in the development agenda is a way to achieve equality for persons with disabilities (18). To enable persons with disabilities to contribute to creating opportunities, share in the benefits of development, and participate in decision-making, a twin-track approach is required which ensures that (i) disability issues are actively considered in mainstream development work, and (ii) more focused or targeted activities for persons with disabilities are implemented where necessary (12).
Human rights and development are closely linked human rights are a fundamental part of development, and development is a way to realise these human rights (27). Human rights are internationally agreed standards which apply to all human beings (22) and which are affirmed in the Declaration of Human Rights, adopted by all Member States of the United Nations in 1948 (24), as well as in other international human rights treaties. Everybody is equally entitled to their human rights e.g. the right to education and the right to adequate food, housing and social security regardless of nationality, place of residence, sex, national or ethnic origin, colour, religion, or other status (23).
On 13 December 2006, the UN General Assembly adopted the Convention on the Rights of Persons with Disabilities (1) which does not create any new rights for persons with disabilities they have the same human rights as any other person within the community but instead makes the existing rights inclusive of, and accessible to, persons with disabilities. The purpose of the Convention is to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity (1 [Article 1]). The Convention covers a number of key areas, such as accessibility, personal mobility, education, health, rehabilitation and employment, and outlines measures State Parties must undertake to ensure the rights of persons with disabilities are realized.
|Convention on the Rights of Persons with Disabilities, Article 3: General Principles (1)|
a. Respect for inherent dignity, individual autonomy including the freedom to make one's own choices, and independence of persons
c. Full and effective participation and inclusion in society
d. Respect for difference and acceptance of persons with disabilities as part of human diversity and humanity
e. Equality of opportunity
g. Equality between men and women
h. Respect for the evolving capacities of children with disabilities and respect for the right of children with disabilities to preserve their identities.
Bangladesh is a developing country located in South Asia and is home to approximately 160 million people. It is a country of widespread poverty, with 44.3 % of the population living below the poverty line, inadequate health, education, and social security services, low employment and at high risk from natural disasters, particularly flooding. Estimates indicate that 10% of the population ie 16 million people are living with a disability and these are one of the most vulnerable groups as they receive little or no assistance.
Government and not for profit organisations deliver development programs to address the situation in the country but still only reach a small proportion of the population. For many years, persons with disabilities were excluded from these services particularly in rural and remote areas which are difficult to reach due to poor roads, the large number of waterways in the country and Bangladesh's proneness to flooding and any services that existed tended to focus on delivering limited specialised services or on those living in urban areas. The disability issue was often not addressed within general development programs, largely due to lack of knowledge and understanding of how to address their needs within development programs, the negative general public perception of disability and scarce resources.
This led to the creation of CDD in 1996 focused on an ambitious and revolutionary strategy to include persons with disabilities within mainstream development efforts, by ensuring their needs are integrated into all phases of the planning of development interventions. CDDâ€™s strategy also emphasises the importance of simultaneously removing other barriers to inclusion such as negative misperceptions of disability, lack of physical accessibility, difficulties in communicating and the low level of skill, confidence and leadership capacity of persons with disabilities themselves.
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