S

Social Determinants of Disability-

based Disadvantage:

Fostering Capabilities in Solomon

Islands

Research team:

Dr Alexandra Gartrell, Professor Lenore Manderson, Dr Megan

Jennaway

Judy Fangalasuu, Simon Dolaiano and Savina Nonegbatu

Implementing rights-based approaches

Socio-cultural attitudes to disability in Solomon Islands:

Identifying culturally appropriate solutions to disadvantage

Disability, culture, social circumstances and

rights

Tension between constitutional rights and

traditional beliefs

S “All citizens are entitled to same

rights, privileges and benefits”

(Article 61).

S Greatest barriers:

“Traditional and religious belief

systems, negative attitudes and a

lack of understanding about

impairments” (Stubbs et al 2005,

Miller 2007).

Disability as a development and rights issue

S CRPD signed in 2008

S National Disability Policy

2005-2010

S Aims to develop appropriate

legal and social protection

S Low government priority

S Lack of recurrent budget

S National Coordinating Council

for Disability never been

established.

Social and political invisibility of disability

Solomon Islands

S 552, 267 people settled in more

than 5000 villages, across 350

inhabited islands

S 22.7% live below national

poverty line (ADB 2010)

S 85% live in rural areas and

practice subsistence agriculture

S Rapid economic growth (9% in

2011)

S High population growth (2.3%)

S Low per capita income ($1782)

Cultural attitudes toward disability:

“Something for the parents to worry about”.

S Sign of ancestor curse, kastom

or black magic

S Violation of taboo

S Exclusion explained by inability

to contribute to household

economy, not by cultural beliefs

Methodology

• Ethnographic approach

• 3 rural field sites

• Double/triple disadvantage of

rural areas

• Field site selection

Fieldwork

• Pilot

• 3 blocks of fieldwork

• October 2011 – June 2012

• Recruitment: CBR worker and

Co-Researcher social networks

Participants

• 50 people with disability

• 13 in Takwa

• 16 in Malu’u

• 21 in Isabel

• 28 women

• 22 men

• 38 key informants

Age distribution

• 24% of interviewees were

between 21 and 30 years

of age

• 64% of interviewees were

under the age of 40

• 18% of interviewees were

between 61 and 70 years

of age

Impairments

S Mobility 21

S Multiple disorders 12

S Sensory 10

S Psychological 4

S Nervous system disorders 3

North Malaita: Takwa and Malu’u

S Coastal communities characterised

by swidden agriculture inland,

fishing and gardening

S Takwa residents more connected to

the water and fishing

S Predominant economic activity in

Malu’u is gardening, suggesting a

more recent migration from the

mountainous inland (Hogbin 1939);

Isabel

• The island of Santa Isabel lies

directly to the north of Malaita

• Forested, mountainous island

with very little flat land.

• Traditional patterns of

subsistence: fishing and some

gardening along the coast and

swidden cultivation inland.

• Strong population drift away

from the centre and towards

the coast

Starting with families

S Assumption of extended family

systems in non-Western societies,

particularly subsistence economies

S Embedded in government, donor, aid

and development agency thinking and

debate in regard to disability

S Communal, inter-dependent, co-

resident, cooperative

S Extended family as foundation of

social cohesion in Pacific

Patrilineal and matrilineal systems of descent

S Patrilineal system: out marriage of

daughters into wife-taking clans,

along with the introduction of wives

from wife-yielding clans

S Settlement patterns based on

several co-resident patrilocal clans

or extended family

S Affect on family-based forms of

support available to people with

disabilities

Bilateral basis of community affiliation

S Customary social practices

subordinate to economic

pragmatism

S Secondary inheritance rights

(traced through

mothers/fathers) strategically

deployed to access coast land

Key findings 1: Limited support for people with

disabilities and their households

S Majority of PWDs live with one

or more family members

S Support of one or at most two of

these.

S One case of PWD living alone.

S People with disabilities and their

households have very little

support from extended family

members, irrespective of

matrilineal or patrilineal context.

Key findings 1

S In principle relatives available to help with care for a

person with disability

S No specific cultural mechanism to ensure this

actually occurs outside of the neighbourhood

S Few extended family members provide support from

a distance in all three field sites

S No specific family visits for purpose of respite or

other disability related support

Overtaxed carers

S The burden of care for a family

member with a disability devolves to

only one or two highly overtaxed

household members and/or

immediate family members living

adjacent (‘the local family circle’),

S Carers are effectively taken out of

household economic production.

S Siblings taken out of school

Emily and her family

S 30 year old woman developed

epilepsy after birth of second

child

S 6 children under 12 years

S Little family support despite

living amongst husband’s kin

S No help from her natal family –

isolated and excluded

S Husband sole support

Social determinants of household wellbeing

S Structures of social hierarchy

determine social conditions in

which people grow, live, work and

age (Marmot 2007).

S Differences in wellbeing reflect

inherent structural features of

society (land ownership and descent

systems, gendered power relations,

rural-urban inequities)

S Social determinants approach used

to understand compound and

multiple disadvantages

Determinant 1: Social gradient

S Poor rural economic prospects for

salaried employment and cash

income

S Greater material hardship (food

insecurity, poor housing, lack of

access to safe water and

sanitation), violence

S Health and education (4.3% and

5.2% of GDP)

S Accumulate over life course

S Structural determinants

Determinant 2: Secure economic foundation

S Security of land ownership,

economic wellbeing, and the

associated material and social

assurance and confidence

S Angela: family live on Crown

land surround by patrilineal

estate

S Material and social resources to

support her inclusion

S Cash income

S Status within the Church

Living as outsiders

S 40% of cases

S Secondary and tertiary claims

S Carrie: patrilineal land to which

she has secondary rights to

occupy and garden

S Primary gardener, carer and

income earner

S Active in community

S Presence of other determinants

Determinant 3: Inclusive early life

S Weak land claims, poor

economic status – energy for

care traded-off against

livelihood activities

S Labour poor households

children and people with

disabilities vulnerable to

neglect and shame

S Christian and Justine:

secondary claim to land

Determinant 4 – Contribution to the household

economy

S Absence of government and

community support

S Self-worth, efficacy and wellbeing

enhanced with contribution and living

situations are better

S Education, vocational training key but

poor access: poverty, attitudes,

physical access

S Dependency and long term

vulnerability

S Ofata and Eddie

Determinant 5: Stigma and social exclusion

S Even with contribution and as primary support for family,

stigma persists

S Denial of socially expected status, denied decision-making

and norms of reciprocity

S Joseph – denied use of resources – canoes and knifes

S James – contributions never reciporcated

Determinant 6 - Gender

S Gendered power relations in both patrilineal and matrilineal

systems, undermine women’s security and wellbeing

S Dependency, vulnerability and no choices

S Women choosing not to marry

S Emily – triple burden

S Frances: patrlineal systems doubly disadvantage women

Determinant 7: Social support and accumulated

disadvantage

S Social capital and presence of

carers key to wellbeing of

elderly with disabilities

S Care for the elderly is expected

Key finding 2: Presence of several social

determinants most likely to foster inclusive

environments

S Families with positive presence

of several social determinants

have greater material, social

and emotional resources

S Meaningful lives typified with

inclusion and dignity

S If absent, compound

disadvantages which amplify

across the life course

Key findings 3: Disability overly determines

choice

S Opportunities are withheld or

granted exceptionally

S A minority develop their

capabilities and fulfil their

aspirations.

S Life choices and possibilities

are shaped by negative cultural

attitudes and socio-economic

determinants

Poverty of opportunity and achievement

S Equality of possibility depends

upon individual and household

engagement with local

institutions to build capabilities

and functioning in daily

activities that they value.

S Demonstrated agency and

initiate is likely to be supported

by others within and beyond the

immediate household and by

government and church-based

institutions.

Current sources of village-based support

S Extremely limited

S Government and NGO reach to village level poor

S CBR worker – an irregular visitor but in some cases key

to providing adapted devices

S Mothers Union (Anglican) and Dorcas (STA) – irregular

visits by village women to PWD and the elderly (ranging

from monthly to every couple of months, to annual visits)

S food, soap, clothing and sometimes cash (a few

dollars)provided

Local social institutions

S Specific and targeted

assistance, delivered under the

guidance of people with

disabilities is required

S Inclusive processes are critical

S Local social institutions such

the Church and schools are key

to the provision of such

assistance

Opportunistic

linkages

• CBR worker linking in with

Agricultural Extension officers

and other Ministry of Health

village visits

• Particularly in areas where boat

access is required

• Train staff in disability

awareness

Building on existing social infrastructure

S Awareness raising and training

by people with disabilities

(PWDSI)

S Church

S School

S Health Centre

Micro-enterprise

development run by

and for people with

disabilities

• Social determinant amenable to

change

• Core group of PWD, all trained at

Bethesta, travelling around

villages in Isabel doing awareness

raising

• Built training centre where PWD

will consult with other PWD,

design and build locally

appropriate devices