summary world report on disability 2011 who world bank accessible en

8/6/2019 Summary World Report on Disability 2011 Who World Bank Accessible En

http://slidepdf.com/reader/full/summary-world-report-on-disability-2011-who-world-bank-accessible-en 1/24

WORLD REPORTON DISABILITY

S U M M A R Y



© World Health Organization 2011

All rights reserved. Publications of the World Health Organization are available on the WHO web site(www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia,1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]).Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercialdistribution – should be addressed to WHO Press through the WHO web site (http://www.who.int/about/licensing/copyright_form/en/index.html).

The designations employed and the presentation o the material in this publication do not imply the expression o any opinion whatsoever on the part o the World Health Organization concerning the legal status o any country,territory, city or area or o its authorities, or concerning the delimitation o its rontiers or boundaries. Dotted lineson maps represent approximate border lines for which there may not yet be full agreement.

The mention o specifc companies or o certain manuacturers’ products does not imply that they are endorsed orrecommended by the World Health Organization in preerence to others o a similar nature that are not mentioned.Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

All reasonable precautions have been taken by the World Health Organization to veriy the inormation containedin this publication. However, the published material is being distributed without warranty of any kind, eitherexpressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In noevent shall the World Health Organization be liable for damages arising from its use.

Printed in Malta

http://www.who.int/

mailto:[email protected]

http://www.who.int/about/licensing/copyright_form/en/index.html




mailto:[email protected]

http://www.who.int/



Foreword

Disability need not be an obstacle to success. I have had motor neurone disease or practically allmy adult lie. Yet it has not prevented me rom having a prominent career in astrophysics and ahappy amily lie.

Reading the World report on disability, I nd much o relevance to my own experience. I havebenetted rom access to rst class medical care. I rely on a team o personal assistants who makeit possible or me to live and work in comort and dignity. My house and my workplace have beenmade accessible or me. Computer experts have supported me with an assisted communicationsystem and a speech synthesizer which allow me to compose lectures and papers, and to commu-nicate with dierent audiences.

But I realize that I am very lucky, in many ways. My success in theoretical physics has ensuredthat I am supported to live a worthwhile lie. It is very clear that the majority o people with dis-abilities in the world have an extremely difcult time with everyday survival, let alone productiveemployment and personal ullment.

I welcome this rst World report on disability. Tis report makes a major contribution to our

understanding o disability and its impact on individuals and society. It highlights the dierentbarriers that people with disabilities ace – attitudinal, physical, and nancial. Addressing thesebarriers is within our reach.

In act we have a moral duty to remove the barriers to participation, and to invest sufcient und-ing and expert ise to unlock the vast potential o people with disabilities. Governments throughoutthe world can no longer overlook the hundreds o millions o people with disabilities who are deniedaccess to health, rehabilitation, support, education and employment, and never get the chance toshine.

Te report makes recommendations or action at the local, national and international levels.It will thus be an invaluable tool or policy-makers, researchers, practitioners, advocates and vol-unteers involved in disability. It is my hope that, beginning with the Convention on the Rights of

Persons with Disabilities, and now with the publication o the World report on disability, this century will mark a turning point or inclusion o people with disabilities in the lives o their societies.

Proessor Stephen W Hawking



Preface

More than one billion people in the world live with some orm o disability, o whom nearly 200million experience considerable diculties in unctioning. In the years ahead, disability will be aneven greater concern because its prevalence is on the rise. Tis is due to ageing populations and thehigher risk o disability in older people as well as the global increase in chronic health conditionssuch as diabetes, cardiovascular disease, cancer and mental health disorders.

Across the world, people with disabilities have poorer health outcomes, lower education achieve-ments, less economic participation and higher rates o poverty than people without disabilities. Tisis partly because people with disabilities experience barriers in accessing services that many o ushave long taken or granted, including health, education, employment, and transport as well asinormation. Tese diculties are exacerbated in less advantaged communities.

o achieve the long-lasting, vast ly better development prospects that lie at the heart o the 2015Millennium Development Goals and beyond, we must empower people living with disabilities andremove the barriers which prevent them participating in their communities; getting a quality edu-cation, fnding decent work, and having their voices heard.

As a result, the World Health Organization and the World Bank Group have jointly producedthis World Report on Disability to provide the evidence or progressive policies and programmesthat can improve the lives o people with disabilities, and acilitate implementation o the UnitedNations Convention on the Rights o Persons with Disabilities, which came into orce in May 2008.Tis landmark international treaty reinorced our understanding o disability as a human rightsand development priority.

Te World Report on Disability suggests steps or all stakeholders – including governments,civil society organizations and disabled people’s organizations – to create enabling environments,develop rehabilitation and support services, ensure adequate social protection, create inclusivepolicies and programmes, and enorce new and existing standards and legislation, to the benefto people with disabilities and the wider community. People with disabilities should be central to

these endeavors.Our driving vision is o an inclusive world in which we are al l able to live a lie o health, com-ort, and dignity. We invite you to use the evidence in this report to help this v ision become a reality.

Dr Margaret ChanDirector-GeneralWorld Health Organization

Mr Robert B Zoellick PresidentWorld Bank Group

5



Summary

Disability is part o the human condition – almost everyone will be temporarily or permanently impaired at some point in lie, and those who survive to old agewill experience increasing diculties in unctioning. Disability is complex, andthe interventions to overcome the disadvantages associated with disability aremultiple and systemic – varying with the context.

Te United Nations Convention on the Rights o Persons with Disabilities (CRPD), adopted in 2006, aims to “promote, protect and ensure the ull and equalenjoyment o all human rights and undamental reedoms by all persons with dis-abilities, and to promote respect or their inherent dignity”. It reects the majorshi in global understanding and responses towards disability.

Te World report on disability assembles the best available scientic inorma-tion on disability to improve the lives o people with disabilities and acilitateimplementation o the CRPD. It aims to: ■ Provide governments and civil society with a comprehensive analysis o

the importance o disability and the responses provided, based on the bestavailable evidence. ■ Recommend national and international action.

Te International Classifcation o Functioning, Disability and Health (ICF),adopted as the conceptual ramework or this Report, denes disability as anumbrella term or impairments, activity limitations, and participation restric-tions. Disability reers to the negative aspects o the interaction between individu-als with a health condition (such as cerebral palsy, Down syndrome, depression)and personal and environmental actors (such as negative attitudes, inaccessibletransportation and public buildings, and limited social supports).

What do we know about disability?

Higher estimates o prevalenceMore than a billion people are estimated to live with some orm o disability, orabout 15% o the world’s population (based on 2010 global population estimates).Tis is higher than previous World Health Organization estimates, which daterom the 1970s and suggested around 10%.



According to the World Health Survey around 785 million (15.6%) persons 15years and older live with a disability, while the Global Burden o Disease estimatesa gure o around 975 million (19.4%) persons. O these, the World Health Survey estimates that 110 million people (2.2%) have very signicant diculties in unc-tioning, while the Global Burden o Disease estimates that 190 million (3.8%) have“severe disability” – the equivalent o disability inerred or conditions such asquadriplegia, severe depression, or blindness. Only the Global Burden o Disease measures childhood disabilities (0–14 years), which is estimated to be 95 million(5.1%) children, o whom 13 million (0.7%) have “severe disability”.

Growing numbersTe number o people with disabilities is growing. Tis is because populations areageing – older people have a higher risk o disability – and because o the globalincrease in chronic health conditions associated with disability, such as diabetes,cardiovascular diseases, and mental illness. Chronic diseases are estimated toaccount or 66.5% o all years lived with disability in low-income and middle-income countries (1). Patterns o disability in a particular country are inuencedby trends in health conditions and trends in environmental and other actors –such as road trac crashes, natural disasters, conict, diet, and substance abuse.

Diverse experiencesStereotypical views o disability emphasize wheelchair users and a ew other“classic” groups such as blind people and dea people. However, the disability experience resulting rom the interaction o health conditions, personal actors,and environmental actors varies greatly. While disability correlates with disad-

vantage, not all people with disabilities are equally disadvantaged. Women withdisabilities experience gender discrimination as well as disabling barriers. Schoolenrolment rates difer among impairments, with children with physical impair-ments generally aring better than those with intellectual or sensory impairments.Tose most excluded rom the labour market are oen those with mental healthdiculties or intellectual impairments. People with more severe impairmentsoen experience greater disadvantage, as shown by evidence ranging rom ruralGuatemala (2) to Europe (3).

Vulnerable populationsDisability disproportionately afects vulnerable populations. Results rom the

World Health Survey indicate a higher disability prevalence in lower income coun-tries than in higher income countries. People rom the poorest wealth quintile,women, and older people also have a higher prevalence o disability (4). Peoplewho have a low income, are out o work, or have low educational qualications areat an increased risk o disability. Data rom the Multiple Indicator Cluster Surveys in selected countries show that children rom poorer households and those inethnic minority groups are at signicantly higher risk o disability than otherchildren (5).

World report on disability



What are the disabling barriers?

Te CRPD and the ICF both highlight the role o the environment in acilitatingor restricting participation or people with disabilities. Tis Report documentswidespread evidence o barriers, including the ollowing. ■ Inadequate policies and standards. Policy design does not always take into

account the needs o people with disabilities, or existing policies and stand-ards are not enorced. For example, or inclusive education policies, a reviewo 28 countries participating in the Education or All Fast rack InitiativePartnership ound that 18 countries either provided very litt le detail o theirproposed strategies to include children with disabilities in schools or did notreer to disability or inclusion at all (6 ). Te common gaps in education policy include a lack o nancial and other targeted incentives or children withdisabilities to attend school as well as a lack o social protection and supportservices or children with disabilities and their amilies.

■ Negative attitudes. Belies and prejudices constitute barriers to education,employment, health care, and social participation. For example, the attitudeso teachers, school administrators, other children, and even amily mem-bers afect the inclusion o children with disabilities in mainstream schools.Misconceptions by employers that people with disabilities are less productivethan their non-disabled counterparts, and ignorance about available adjust-ments to work arrangements limits employment opportunities.

■ Lack of provision of services. People with disabilities are particularly vulner-able to deciencies in services such as health care, rehabilitation, and supportand assistance. Data rom our Southern Arican countries ound that only

26–55% o people received the medical rehabilitation they needed; 17–37%received the assistive devices they needed; 5–23% received the vocationaltraining they needed; and 5–24% received the welare services they needed(7 –10). Research in Uttar Pradesh and amil Nadu states o India ound thataer cost, the lack o services in the area was the second most requent reasonor people with disabilities not using health acilities (11).

■ Problems with service delivery . Poor coordination o services, inadequatestang, and weak staf competencies can afect the quality, accessibility, andadequacy o services or persons with disabilities. World Health Survey datarom 51 countries revealed that people with disabilities were more than twiceas likely to report nding health care provider skills inadequate to meet their

needs, our times more likely to be treated badly and nearly three times morelikely to be denied needed health care. Many personal support workers arepoorly paid and have inadequate training. A study in the United States o America ound that 80% o social care workers had no ormal qualicationsor training (12).

■ Inadequate funding . Resources allocated to implementing policies and plansare oen inadequate. Te lack o efective nancing is a major obstacle tosustainable services across all income settings. For example, in high-incomecountries, between 20% and 40% o people with disabilities generally do not

Summary



have their needs met or assistance with everyday activities (13–18). In many low-income and middle-income countries governments cannot provide ade-quate services and commercial service providers are unavailable or not aford-able or most households. Analysis rom the 2002–04 World Health Survey across 51 countries showed that people with disabilities had more dicultiesthan people without disabilities in obtaining exemptions rom or reductionsin health care costs.

■ Lack of accessibility . Many built environments (including public accommoda-tions) , transport systems and inormation are not accessible to all. Lack o accessto transportation is a requent reason or a person with disability being discour-aged rom seeking work or prevented rom accessing health care. Reports romcountries with laws on accessibility, even those dating rom 20 to 40 years ago,conrm a low level o compliance (19–22). Little inormation is available in acces-sible ormats, and many communication needs o people with disabilities areunmet. Dea people oen have trouble accessing sign language interpretation: asurvey o 93 countries ound that 31 countries had no interpreting service, while30 countries had 20 or ewer qualied interpreters (23). People with disabilitieshave signicantly lower rates o inormation and communication technology use than non-disabled people, and in some cases they may be unable to accesseven basic products and services such as telephones, television, and the Internet.

■ Lack of consultation and involvement. Many people with disabilities areexcluded rom decision-making in matters directly afecting their lives, orexample, where people with disabilities lack choice and control over how sup-port is provided to them in their homes.

■ Lack of data and evidence. A lack o rigorous and comparable data on dis-

ability and evidence on programmes that work can impede understandingand action. Understanding the numbers o people with disabilities and theircircumstances can improve eforts to remove disabling barriers and provideservices to allow people with disabilities to participate. For example, bettermeasures o the environment and its impacts on the diferent aspects o dis-ability need to be developed to acilitate the identication o cost-efectiveenvironmental interventions.

How are the lives o people with disabilities aected?

Te disabling barriers contribute to the disadvantages experienced by people

with disabilities.

Poorer health outcomesIncreasing evidence suggests that people with disabilities experience poorer levelso health than the general population. Depending on the group and setting, per-sons with disabilities may experience greater vulnerability to preventable second-ary conditions, co-morbidities, and age-related conditions. Some studies have alsoindicated that people with disabilities have higher rates o risky behaviours suchas smoking, poor diet and physical inactivity. People with disabilities also have ahigher risk o being exposed to violence.




Unmet needs or rehabilitation services (including assistive devices) can result inpoor outcomes or people with disabilities including deterioration in general healthstatus, activity limitations, participation restrictions and reduced quality o lie.

Lower educational achievementsChildren with disabilities are less likely to start school than their peers with-out disabilities, and have lower rates o staying and being promoted in schools.Education completion gaps are ound across all age groups in both low-incomeand high-income countries, with the pattern more pronounced in poorer coun-tries. Te diference between the percentage o disabled children and the percent-age o non-disabled children attending primary school ranges rom 10% in Indiato 60% in Indonesia. In secondary education the diference in attendance rangesrom 15% in Cambodia to 58% in Indonesia (24). Even in countries with highprimary school enrolment rates, such as those in eastern Europe, many childrenwith disabilities do not attend school.

Less economic participationPeople with disabilities are more likely to be unemployed and generally earnless even when employed. Global data rom the World Health Survey show thatemployment rates are lower or disabled men (53%) and disabled women (20%)than or non-disabled men (65%) and women (30%). A recent study rom theOrganization or Economic Co-operation and Development (OECD) (25) showedthat in 27 countries working-age persons with disabilities experienced signicantlabour market disadvantage and worse labour market outcomes than working-age persons without disabilities. On average, their employment rate, at 44%, was

over hal that or persons without disability (75%). Te inactivity rate was about2.5 times higher among persons without disability (49% and 20%, respectively).

Higher rates o povertyPeople with disabilities thus experience higher rates o poverty than non-disa-bled people. On average, persons with disabilities and households with a disabledmember experience higher rates o deprivations – including ood insecurity, poorhousing, lack o access to sae water and sanitation, and inadequate access tohealth care – and ewer assets than persons and households without a disability.

People with disabilities may have extra costs or personal support or or medi-cal care or assistive devices. Because o these higher costs, people with disabili-

ties and their households are likely to be poorer than non-disabled people withsimilar income. Disabled people in low-income countries are 50% more likely toexperience catastrophic health expenditure than non-disabled people (4).

Increased dependency and restricted participationReliance on institutional solutions, lack o community living and inadequate ser-

vices leave people with disabilities isolated and dependent on others. A survey o 1505 non-elderly adults with disability in the United States ound that 42%reported having ailed to move in or out o a bed or a chair because no one wasavailable to help (26 ). Residential institutions are reported to be responsible or

Summary



a lack o autonomy, segregation o people with disabilities rom the wider com-munity, and other human rights violations.

Most support comes rom amily members or social networks. But exclu-sive reliance on inormal support can have adverse consequences or caregivers,including stress, isolation, and lost socioeconomic opportunities. Tese dicul-ties increase as amily members age. In the United States members o amilies o children with developmental disabilities work ewer hours than those in otheramilies, are more likely to have le their employment, have more severe nancialproblems, and are less likely to take on a new job.

Addressing barriers and inequalities

Tis Report synthesizes the best available scientic evidence on how to overcomethe barriers which people with disabilities ace in health, rehabilitation, supportand assistance, environments, education, and employment. While detailed inor-mation can be ound in the chapters o the Report, the review here provides direc-tion or improving the lives o persons with disabilities in line with the CRPD.

Addressing barriers to health careMaking al l levels o existing health care systems more inclusive and making publichealth care programmes accessible to people with disabilities will reduce healthdisparities and unmet need. A variety o approaches have been used in main-stream health care settings to overcome physical, communication and inorma-tion barriers such as structural modications to acilities, using equipment withuniversal design eatures, communicating inormation in appropriate ormats,

making adjustments to appointment systems and using alternative models o service delivery. Community-based rehabilitation has been successul in less-resourced settings at acilitating access or disabled people to existing services andin screening and promoting preventive health care services. In high-income coun-tries disability access and quality standards have been incorporated into contractswith public, private, and voluntary service providers. Such measures as targetingservices, developing individual care plans, and identiying a care coordinator canreach people with complex health needs and hard-to-reach groups. People withdisabilities should receive services rom primary care teams, but specialist ser-

vices, organizations, and institutions should be available when needed to ensurecomprehensive health care.

o improve health service provider attitudes, knowledge, and skills, educa-tion or health-care proessionals needs to contain relevant disability inorma-tion. Involving people with disabilities as providers o education and training canimprove knowledge and attitudes. Te empowerment o people with disabilities tobetter manage their own health through sel-management courses, peer support,and inormation provision has been efective in improving health outcomes andcan reduce health care costs.

A range o nancing options has the potential to improve coverage andafordability o health care services. Tese include ensuring that insurance and




copayments or health services are afordable or people with disabilities. Forpeople with disabilities who do not have other means o nancing health care ser-

vices, reducing out-o-pocket payments, and providing income support to meetthe indirect costs can improve the use o health care services. Financial incentivescan encourage health care providers to improve services. In developing countrieswith efective primary care and disbursement mechanisms, targeted conditionalcash transers linked to the use o health care may improve use o services.

Addressing barriers to rehabilitationRehabilitation is a good investment because it builds human capacity. It shouldbe incorporated into general legislation on health, employment, education, andsocial services and into specic legislation or people with disabilities. Policy responses should emphasize early intervention, the benets o rehabilitation topromote unctioning in people with a broad range o health conditions, and theprovision o services as close as possible to where people live.

For established services the ocus should be on improving eciency andefectiveness, by expanding coverage and improving quality and afordability. Inless-resourced settings the ocus should be on accelerating the supply o servicesthrough community-based rehabilitation, complemented by reerrals to second-ary services. Integrating rehabilitation into primary and secondary health caresettings can improve availability. Reerral systems between diferent modes o service delivery (inpatient, outpatient, home-based care) and levels o healthservice provision (primary, secondary, and tertiary care acilities) can improveaccess. Rehabilitation interventions delivered in communities are an importantpart o the continuum o care.

Increasing access to assistive technology increases independence, improvesparticipation, and may reduce care and support costs. o ensure that assis-tive devices are appropriate, they need to suit both environment and user andbe accompanied by adequate ollow-up. Access to assistive technologies can beimproved by pursuing economies o scale, manuacturing and assembling prod-ucts locally, and reducing import taxes.

Given the global lack o rehabilitation proessionals, more training capacity is needed. Mixed or graded levels o training may be required. Te complex-ity o working in resource-poor contexts demands university or strong technicaldiploma education. Mid-level training programmes can be a rst step to addressgaps in rehabilitation personnel in developing countries or to compensate or di-

culties in recruiting higher level proessionals in developed countries. rainingcommunity-based workers can address geographical access and respond to work-orce shortages and geographical dispersion. Using mechanisms and incentives toretain personnel can provide continuity o service.

Financing strategies, in addition to those or overcoming barriers in healthcare, include the redistribution or reorganization o existing services (or example,rom hospital to community-based services, international cooperation (includingrehabilitation in aid or humanitarian crises), public-private partnerships, andtargeted unding or poor people with disabilities.

Summary



Addressing barriers to support and assistance servicesransitioning to community living, providing a range o support and assistanceservices, and supporting inormal caregivers will promote independence andenable people with disabilities and their amily members to participate in eco-nomic and social activities.

Enabling people with disabilities to live in the community requires that they be moved out o institutions and supported by a range o support and assistanceservices in their communities – including day care, oster care, and home sup-port. Countries need to plan adequately or the transition to a community-basedservice model, with sucient unding and human resources. Community ser-

vices, i well planned and resourced, have better outcomes but may not be cheaper.Government can consider a variety o nancing measures including contractingout services to private providers, ofering tax incentives, and devolving budgets topeople with disabilities and their amilies or direct purchases o services.

Promising government strategies include developing air disability assess-ment procedures and clear eligibility criteria; regulating service provision -including setting standards and enorcing them; unding services or people withdisabilities who cannot aford to purchase services; and, where needed, providingservices directly. Coordination between the health, social and housing sectors canensure adequate support and reduce vulnerability. Service outcomes can improvewhen providers are accountable to consumers and their relationship is regulatedthrough a ormal service arrangement; when consumers are involved in decisionson the type o support; and when services are individualized rather than “one sizets all” agency-based controlled services. raining or support workers and userscan improve service quality and user experience.

In low-income and middle-income countries, supporting service provisionthrough civil society organizations can expand the coverage and range o services.Community-based rehabilitation programmes have been efective in deliveringservices to very poor and underserved areas. Inormation provision, nancialsupport, and respite care will benet inormal carers, who provide most o thesupport or people with disabilities worldwide.

Creating enabling environmentsRemoving barriers in public accommodations, transport, inormation, andcommunication will enable people with disabilities to participate in education,employment, and social lie, reducing their isolation and dependency. Across

domains, key requirements or addressing accessibility and reducing negativeattitudes are access standards; cooperation between the public and private sector;a lead agency responsible or coordinating implementation; training in accessibil-ity; universal design or planners, architects, and designers; user participation;and public education.

Experience shows that mandatory minimum standards, enorced throughlegislation, are required to remove barriers in buildings. A systematic evidence-based approach to standards is needed, relevant to diferent settings and includ-ing participation rom people with disabilities. Accessibility audits by disabled




people’s organizations can encourage compliance. A strategic plan with priori-ties and increasingly ambitious goals can make the most o limited resources.For example, initially targeting accessibility in new public buildings – the 1%extra cost o access compliance in new buildings is cheaper than adapting existingbuildings, then expanding the coverage o laws and standards to include accessimprovements in existing public buildings.

In transport the goal o continuity o accessibility throughout the travel chaincan be achieved by determining initial priorities through consultations withpeople with disabilities and service providers; introducing accessibility eaturesinto regular maintenance and improvement projects; and developing low-costuniversal design improvements that result in demonstrable benets to a widerange o passengers. Accessible bus rapid transit systems are increasingly beingadopted in developing countries. Accessible taxis are an important part o anintegrated accessible transportation system because they are demand-responsive.raining or transport staf is also required, together with government undingo reduced or ree ares or people with disabilities. Pavements, curb cuts (ramps),and pedestrian crossings improve saety and ensure accessibility.

Ways orward in inormation and communication technology include rais-ing awareness, adopting legislation and regulations, developing standards, andofering training. Services such as telephone relay, captioned broadcasting, signlanguage interpreting, and accessible ormats or inormation will acilitate par-ticipation by people with disabilities. Improved inormation and communicationtechnology accessibility can be achieved by bringing together market regulationand antidiscrimination approaches, along with relevant perspectives on consumerprotection and public procurement. Countries with strong legislation and ollow-

up mechanisms tend to achieve higher levels o inormation and communicationtechnology access, but regulation needs to keep pace with technological innovation.

Addressing barriers to educationTe inclusion o children with disabilities in mainstream schools promotes uni-

versal primary completion, is cost-efective and contributes to the elimination o discrimination.

Including children with disabilities in education requires changes to systemsand schools. Te success o inclusive systems o education depends largely ona country’s commitment to adopt appropriate legislation; provide clear policy direction; develop a national plan o action; establish inrastructure and capacity

or implementation; and benet rom long-term unding. Ensuring that childrenwith disabilities can have the same standard o education as their peers oenrequires increased nancing.

Creating an inclusive learning environment will assist all children in learningand achieving their potential. Education systems need to adopt more learner-cen-tred approaches with changes in curricula, teaching methods and materials, andassessment and examination systems. Many countries have adopted individualeducation plans as a tool to support the inclusion o children with disabilities ineducational settings. Many o the physical barriers that children with disabilities

Summary



ace in education can easily be overcome with simple measures such as changingthe layout o classrooms. Some children wil l require access to additional supportservices including specialist education teachers, classroom assistants, and therapy services.

Appropriate training o mainstream teachers can improve teacher condenceand skills in educating children with disabilities. Te principles o inclusion shouldbe built into teacher training programmes and accompanied by other initiativesthat provide teachers with opportunities to share expertise and experiences aboutinclusive education.

Addressing barriers to employmentAntidiscrimination laws provide a starting point or promoting the inclusion o people with disabilities in employment. Where employers are required by law tomake reasonable accommodations – such as making recruitment and selectionprocedures accessible, adapting the working environment, modiying workingtimes, and providing assistive technologies – these can reduce employment dis-crimination, increase access to the workplace, and change perceptions about theability o people with disabilities to be productive workers. A range o nancialmeasures, such as tax incentives and unding or reasonable accommodations,can be considered to reduce additional costs that would otherwise be incurred by employers and employees.

In addition to mainstream vocational training, peer training, mentoring, andearly intervention show promise in improving disabled people’s skills. Community-based rehabilitation can also improve skills and attitudes, support on-the-jobtraining, and provide guidance to employers. User-controlled disability employ-

ment services have promoted training and employment in several countries.For people who develop a disability when employed, disability management pro-grammes – case management, education o supervisors, workplace accommodation,early return to work with appropriate supports – have improved the rates o return towork. For some people with disabilities, including those with signicant dicultiesin unctioning, supported employment programmes can acilitate skill developmentand employment. Tese programmes may include employment coaching, special-ized job training, individually tailored supervision, transportation, and assistivetechnology. Where the inormal economy predominates, it is important to promotesel-employment or people with disabilities and acilitate access to microcreditthrough better outreach, accessible inormation and customized credit conditions.

Mainstream social protection programmes should include people with dis-abilities, while supporting their return to work. Policy options include separat-ing the income support element rom the one to compensate or the extra costsincurred by people with disabilities such as the cost o travel to work and o equip-ment; using time-limited benets; and making sure it pays to work.




Recommendations

While many countries have started taking action to improve the lives o peoplewith disabilities much remains to be done. Te evidence in this Report suggeststhat many o the barriers people with disabilities ace are avoidable and that thedisadvantages associated with disability can be overcome. Te ollowing nine rec-ommendations or action are cross-cutting, guided by the more specic recom-mendations at the end o each chapter.

Implementing them requires involving diferent sectors – health, education,social protection, labour, transport, housing – and diferent actors – governments,civil society organizations (including disabled persons organizations), proession-als, the private sector, disabled individuals and their amilies, the general public,the private sector, and media.

It is essential that countries tailor their actions to their specic contexts.Where countries are limited by resource constraints, some o the priority actions,particularly those requiring technical assistance and capacity building, can beincluded within the ramework o international cooperation.

Recommendation 1: enable access to allmainstream systems and services

People with disabilities have ordinary needs – or health and well-being, or eco-nomic and social security, to learn and develop skills. Tese needs can and shouldbe met through mainstream programmes and services.

Mainstreaming is the process by which governments and other stakeholders

address the barriers that exclude persons with disabilities rom participating equally with others in any activity and service intended or the general public, such as educa-tion, health, employment, and social services. o achieve it, changes to laws, policies,institutions, and environments may be indicated. Mainstreaming not only ulls thehuman rights o persons with disabilities, it also can be more cost-efective.

Mainstreaming requires a commitment at all levels – considered across all sec-tors and built into new and existing legislation, standards, policies, strategies, andplans. Adopting universal design and implementing reasonable accommodationsare two important approaches. Mainstreaming also requires efective planning,adequate human resources, and sucient nancial investment – accompanied by specic measures such as targeted programmes and services (see recommendation

2) to ensure that the diverse needs o people with disabilities are adequately met.

Recommendation 2: invest in specifc programmesand services or people with disabilities

In addition to mainstream services, some people with disabilities may requireaccess to specic measures, such as rehabilitation, support services, or training.

Summary



Rehabilitation – including assistive technologies such as wheelchairs or hearingaids – improves unctioning and independence. A range o well-regulated assis-tance and support services in the community can meet needs or care, enablepeople to live independently and participate in the economic, social, and culturallives o their communities. Vocational rehabilitation and training can open labourmarket opportunities.

While there is a need or more services, there is also a need or better, moreaccessible, exible, integrated and well coordinated multidisciplinary services,particularly at times o transition such as between child and adult services.Existing programmes and services need to be reviewed to assess their peror-mance and make changes to improve their coverage, efectiveness and eciency.Te changes should be based on sound evidence, appropriate to the culture andother local contexts, and tested locally.

Recommendation 3: adopt a nationaldisability strategy and plan o action

A national disability strategy sets out a consolidated and comprehensive long-term vision or improving the well-being o persons with disabilities and shouldcover both mainstream policy and programme areas and specic services orpersons with disabilities. Te development, implementation, and monitoring o anational strategy should bring together the ull range o sectors and stakeholders.

Te plan o action operationalizes the strategy in the short and the medium term by laying out concrete actions and timelines or implementation, dening targets, assign-ing responsible agencies, and planning and allocating needed resources. Te strategy

and action plan should be inormed by a situation analysis, taking into account actorssuch as the prevalence o disability, needs or services, social and economic status,efectiveness and gaps in current services, and environmental and social barriers.Mechanisms are needed to make it clear where the responsibility lies or coordina-tion, decision-making, regular monitoring and reporting, and control o resources.

Recommendation 4: involve people with disabilities

People with disabilities oen have unique insights about their disability and theirsituation. In ormulating and implementing policies, laws, and services, peoplewith disabilities should be consulted and actively involved. Disabled people’s

organizations may need capacity building and support to empower people withdisabilities and advocate or their needs.People with disabilities are entitled to control over their lives and thereore

need to be consulted on issues that concern them directly – whether in health,education, rehabilitation, or community living. Supported decision-making may be necessary to enable some individuals to communicate their needs and choices.




Recommendation 5: improve human resource capacity

Human resource capacity can be improved through efective education, training,and recruitment. A review o the knowledge and competencies o staf in relevantareas can provide a starting point or developing appropriate measures to improvethem. Relevant training on disability, which incorporates human rights princi-ples, should be integrated into current curricula and accreditation programmes.In-service training should be provided to current practitioners providing andmanaging services. For example, strengthening the capacity o primary health-care workers, and ensuring availability o specialist staf where required, contrib-ute to efective and afordable health care or people with disabilities.

Many countries have too ew staf working in elds such as rehabilitation andspecial education. Developing standards in training or diferent types and levelso personnel can assist in addressing resource gaps. Measures to improve staf retention may be relevant in some settings and sectors.

Recommendation 6: provide adequateunding and improve aordability

Adequate and sustainable unding o publicly provided services is needed toensure that they reach all targeted beneciaries and that good quality servicesare provided. Contracting out service provision, ostering public-private partner-ships, and devolving budgets to persons with disabilities or consumer-directedcare can contribute to better service provision. During the development o thenational disability strategy and related action plans, the afordability and sustain-

ability o the proposed measures should be considered and adequately unded.o improve the afordability o goods and services or people with disabili-ties and to ofset the extra costs associated with disability, consideration shouldbe given to expanding health and social insurance coverage, ensuring that poorand vulnerable people with disabilities benet rom poverty-targeted saety netprogrammes, and introducing ee-wavers, reduced transport ares, and reducedimport taxes and duties on durable medical goods and assistive technologies.

Recommendation 7: increase publicawareness and understanding

Mutual respect and understanding contribute to an inclusive society. Tereore it is vital to improve public understanding o disability, conront negative perceptions, andrepresent disability airly. Collecting inormation on knowledge, belies, and attitudesabout disability can help identiy gaps in public understanding that can be bridgedthrough education and public inormation. Governments, voluntary organizations,and proessional associations should consider running social marketing campaignsthat change attitudes on stigmatized issues such as HIV, mental illness, and leprosy.Involving the media is vital to the success o these campaigns and to ensuring thedissemination o positive stories about persons with disabilities and their amilies.

Summary



Recommendation 8: improve disability data collection

Internationally, methodologies or collecting data on people with disabilities needto be developed, tested cross-culturally, and applied consistently. Data need to bestandardized and internationally comparable to benchmark and monitor progresson disability policies and on the implementation o the CRPD nationally andinternationally.

Nationally, disability should be included in data collection. Uniorm deni-tions o disability, based on the ICF, can allow or internationally comparabledata. As a rst step, national population census data can be collected in line withrecommendations rom the United Nations Washington Group on Disability andthe United Nations Statistical Commission. A cost-efective and ecient approachis to include disability questions – or a disability module – in existing samplesurveys. Data also need to be disaggregated by population eatures to uncoverpatterns, trends and inormation about subgroups o persons with disabilities.

Dedicated disability surveys can also gain more comprehensive inormationon disability characteristics, such as prevalence, health conditions associated withdisability, use o and need or services, quality o lie, opportunities, and rehabili-tation needs.

Recommendation 9: strengthen andsupport research on disability

Research is essential or increasing public understanding about disability issues,inorming disability policy and programmes, and eciently allocating resources.

Tis Report recommends areas or research on disability including the impacto environmental actors (policies, physical environment, attitudes) on disability and how to measure it; the quality o lie and well-being o people with disabilities;what works in overcoming barriers in diferent contexts; and the efectiveness andoutcomes o services and programmes or persons with disabilities.

A critical mass o trained researchers on disability needs to be built. Research skillsshould be strengthened in a range o disciplines, including epidemiology, disability stud-ies, health, rehabilitation, special education, economics, sociology, and public policy.International learning and research opportunities, linking universities in developingcountries with those in high-income and middle-income countries, can also be useul.

Translating recommendations into action

o implement the recommendations, strong commitment and actions are requiredrom a broad range o stakeholders. While national governments have the mostsignicant role, other players also have important roles. Te ollowing highlightssome o the actions that the various stakeholders can take.




Governments can: ■ Review and revise existing legislation and policies or consistency with the

CRPD; review and revise compliance and enorcement mechanisms. ■ Review mainstream and disability-specic policies, systems, and services to

identiy gaps and barriers and to plan actions to overcome them. ■ Develop a national disability strategy and action plan, establishing clear lines

o responsibility and mechanisms or coordination, monitoring, and report-ing across sectors.

■ Regulate service provision by introducing service standards and by monitor-ing and enorcing compliance.

■ Allocate adequate resources to existing publicly unded services and appro-priately und the implementation o the national disability strategy andplan o action.

■ Adopt national accessibility standards and ensure compliance in new build-ings, in transport, and in inormation and communication.

■ Introduce measures to ensure that people with disabilities are protectedrom poverty and benet adequately rom mainstream poverty alleviationprogrammes.

■ Include disability in national data collection systems and provide disability-disaggregated data wherever possible.

■ Implement communication campaigns to increase public knowledge andunderstanding o disability.

■ Establish channels or people with disabilities and third parties to lodge com-plaints on human rights issues and laws that are not implemented or enorced.

United Nations agencies and development organizations can: ■ Include disability in development aid programmes, using the twin-track approach.

■ Exchange inormation and coordinate actions – to agree on priorities or ini-tiatives, to learn lessons and to reduce duplication o efort.

■ Provide technical assistance to countries to build capacity and strengthenexisting policies, systems and services – or example, by sharing good andpromising practices.

■ Contribute to the development o internationally comparable researchmethodologies.

■ Regularly include relevant disability data into statistical publications.

Disabled people’s organizations can: ■ Support people with disabilities to become aware o their rights, to live inde-

pendently, and to develop their skills. ■ Support children with disabilities and their amilies to ensure inclusion in

education. ■ Represent the views o their constituency to international, national, and local

decision-makers and service providers, and advocate or their rights.

Summary



■ Contribute to the evaluation and monitoring o services, and collaboratewith researchers to support applied research that can contribute to servicedevelopment.

■ Promote public awareness and understanding about the rights o persons withdisabilities – or example, through campaigning and disability-equality training.

■ Conduct audits o environments, transport, and other systems and servicesto promote barrier removal.

Service providers can: ■ Carry out access audits, in partnership with local disability groups, to identiy

physical and inormation barriers that may exclude persons with disabilities. ■ Ensure that staf are adequately trained in disability, implementing training

as required and including service users in developing and delivering training. ■ Develop individual service plans in consultation with disabled people, and

their amilies where necessary. ■ Introduce case management, reerral systems, and electronic record-keeping

to coordinate and integrate service provision. ■ Ensure that people with disabilities are inormed o their rights and the mech-

anisms or complaints.

Academic institutions can: ■ Remove barriers to the recruitment and participation o students and staf

with disabilities. ■ Ensure that proessional training courses include adequate inormation about

disability, based on human rights principles.

■ Conduct research on the lives o persons with disabilities and on disablingbarriers, in consultation with disabled people’s organizations.

Te private sector can: ■ Facilitate employment o persons with disabilities, ensuring that recruitment

is equitable, that reasonable accommodations are provided, and that employ-ees who become disabled are supported to return to work.

■ Remove barriers o access to micronance, so that persons with disabilitiescan develop their own businesses.

■ Develop a range o quality support services or persons with disabilities andtheir amilies at diferent stages o the lie cycle.

■ Ensure that construction projects, such as public accommodations, ocesand housing include adequate access or persons with disabilities. ■ Ensure that inormation and communication technology products, systems,

and services are accessible to persons with disabilities.

Communities can: ■ Challenge and improve their own belies and attitudes. ■ Promote the inclusion and participation o disabled people in their community. ■ Ensure that community environments are accessible or people with disabili-

ties, including schools, recreational areas, and cultural acilities. ■ Challenge violence against and bullying o people with disabilities.




People with disabilities and their families can: ■ Support other people with disabilities through peer support, training, inor-

mation, and advice. ■ Promote the rights o persons with disabilities within their local communities. ■ Become involved in awareness-raising and social marketing campaigns. ■ Participate in orums (international, national, local) to determine priorities

or change, to inuence policy, and to shape service delivery. ■ Participate in research projects.

Conclusion

Te CRPD established an agenda or change. Tis World report on disability documents the current situation or people with disabilities. It highlights gapsin knowledge and stresses the need or urther research and policy development.Te recommendations here can contribute towards establishing an inclusive andenabling society in which people with disabilities can ourish.

Reerences1. The global burden o disease: 2004 update. Geneva, World Health Organization, 2008.

2. Grech S. Living with disability in rural Guatemala: exploring connections and impacts on poverty.

International Journal o Disability, Community and Rehabilitation , 2008, 7(2) (http://www.ijdcr.ca/

VOL07_02_CAN/articles/grech.shtml, accessed 4 August 2010).

3. Grammenos S. Illness, disability and social inclusion. Dublin, European Foundation for the

Improvement of Living and Working Conditions, 2003 (http://www.eurofound.europa.eu/pub-

docs/2003/35/en/1/ef0335en.pdf , accessed 6 August 2010)

4. World Health Survey . Geneva, World Health Organization, 2002–2004 (http://www.who.int/health-info/survey/en/, accessed 9 December 2009)

5. United Nations Children’s Fund, University of Wisconsin. Monitoring child disability in developing

countries: results rom the multiple indicator cluster surveys. New York, United Nations Children’s

Fund, 2008.

6. Bines H, Lei P, eds. Education’s missing millions: including disabled children in education through

EFA FTI processes and national sector plans. Milton Keynes, World Vision UK, 2007 (http://www.

worldvision.org.uk/upload/pdf/Education%27s_Missing_Millions_-Main_Report.pdf , accessed

22 October 2009).

7. Eide AH et al. Living conditions among people wi th activity limitations in Zimbabwe: a representative

regional survey . Oslo, SINTEF, 2003a (http://www.safod.org/Images/LCZimbabwe.pdf , accessed 9

November 2009).

8. Eide AH, van Rooy G, Loeb ME. Living conditions among people with activity lim itations in Namibia: a

representative, national study . Oslo, SINTEF, 2003b (http://www.safod.org/Images/LCNamibia.pdf ,accessed 9 November 2009).

9. Loeb ME, Eide AH, eds. Living conditions among people with activit y limitations in Malawi: a national

representative study . Oslo, SINTEF, 2004 (http://www.safod.org/Images/LCMalawi.pdf , accessed 9

November 2009).

10. Eide A, Loeb M. Living conditions among people with activity limitations in Zambia: a national rep-

resentative study . Oslo, SINTEF, 2006 (http://www.sintef.no/upload/Helse/Levek%C3%A5r%20

og%20tjenester/ZambiaLCweb.pdf , accessed 15 February 2011).

11. People with disabilities in India: rom commitments to outcomes. Washington, DC, World Bank, 2009.

12. McFarlane L, McLean J. Education and training for direct care workers. Social Work Education,

2003,22:385-399. doi:10.1080/02615470309140

Summary

http://www.ijdcr.ca/VOL07_02_CAN/articles/grech.shtml


http://www.eurofound.europa.eu/pubdocs/2003/35/en/1/ef0335en.pdf


http://www.who.int/healthinfo/survey/en/


http://www.worldvision.org.uk/upload/pdf/Education%27s_Missing_Millions_-Main_Report.pdf


http://www.safod.org/Images/LCZimbabwe.pdf

http://www.safod.org/Images/LCNamibia.pdf

http://www.safod.org/Images/LCMalawi.pdf

http://www.sintef.no/upload/Helse/Levek%C3%A5r%20og%20tjenester/ZambiaLCweb.pdf


http://dx.doi.org/10.1080/02615470309140

http://dx.doi.org/10.1080/02615470309140



http://www.safod.org/Images/LCMalawi.pdf

http://www.safod.org/Images/LCNamibia.pdf

http://www.safod.org/Images/LCZimbabwe.pdf











13. Testing a disability question or the census. Canberra, Family and Community Statistics Section,

Australian Bureau of Statistics, 2003.

14. Disability, ageing and carers: summary o fndings, 2003 (No. 4430.0). Canberra, Australian Bureau of

Statistics, 2004 (http://tinyurl.com/ydr4pbh, accessed 9 December 2009).

15. Disability supports in Canada, 2001: participation and activity limitation survey . Ottawa, Statistics

Canada, 2001 (http://www.statcan.ca/english/freepub/89-580-XIE/help.htm, accessed 30 August2007).

16. Supports and services or adults and children ag ed 5–14 with disabilities in Canada: an analysis o data

on needs and gaps. Ottawa, Canadian Council on Social Development, 2004 (http://www.socialun-

ion.ca/pwd/title.html, accessed 30 August 2007).

17. Living with disability in New Zealand: a descriptive analysis o results rom the 2001 Household Disability

Survey and the 2001 Disability Survey o Residential Facilities . Wellington, New Zealand Ministry of

Health, 2004 (http://www.moh.govt.nz/moh.nsf/238fd5fb4fd051844c256669006aed57/8fd2a692

86cd6715cc256f33007aade4?OpenDocument, accessed 30 August 2007).

18. Kennedy J. Unmet and under met need for activities of daily living and instrumental activities of

daily living assistance among adults with disabilities: estimates from the 1994 and 1995 disability

follow-back surveys. Medical Care, 2001,39:1305-1312. doi:10.1097/00005650-200112000-00006

PMID:11717572

19. Regional report o the Americas 2004 . Chicago, IL, International Disability Rights Monitor, 2004

(http://www.idrmnet.org/content.cfm?id=5E5A75andm=3, accessed 9 February 2010).

20. Regional report o Asia 2005. Chicago, IL, International Disability Rights Monitor, 2005 (http://www.

idrmnet.org/content.cfm?id=5E5A75andm=3, accessed 9 February 2010).

21. Regional report o Europe 2007 . Chicago, IL, International Disability Rights Monitor, 2007 (http://

www.idrmnet.org/content.cfm?id=5E5A75andm=3, accessed 9 February 2010).

22. Michailakis D. Government action on disability policy: a global survey . Stockholm, Institute on

Independent Living, 1997 (http://www.independentliving.org/standardrules/UN_Answers/

UN.pdf , accessed 10 February 2010).

23. Haualand H, Allen C. Dea people and human rights. Helsinki, World Federation of the Deaf and

Swedish National Association of the Deaf, 2009.

24. Filmer D. Disability, poverty, and schooling in developing countries: results from 14 household

surveys. The World Bank Economic Review , 2008,22:141-163. doi:10.1093/wber/lhm021

25. Sickness, disability and work: breaking the ba rriers. A synthesis o fndings across OECD countries. Paris,

Organisation for Economic Co-operation and Development, 2010.

26. Understanding the health-care needs and experiences o people with disabilities . Menlo Park, CA,

Kaiser Family Foundation, 2003.


http://tinyurl.com/ydr4pbh

http://www.statcan.ca/english/freepub/89-580-XIE/help.htm

http://www.socialunion.ca/pwd/title.html


http://www.moh.govt.nz/moh.nsf/238fd5fb4fd051844c256669006aed57/8fd2a69286cd6715cc256f33007aade4?OpenDocument


http://dx.doi.org/10.1097/00005650-200112000-00006

http://www.ncbi.nlm.nih.gov/pubmed/11717572

http://www.idrmnet.org/content.cfm?id=5E5A75andm=3





http://www.independentliving.org/standardrules/UN_Answers/UN.pdf


http://dx.doi.org/10.1093/wber/lhm021

http://dx.doi.org/10.1093/wber/lhm021








http://www.ncbi.nlm.nih.gov/pubmed/11717572

http://dx.doi.org/10.1097/00005650-200112000-00006





http://www.statcan.ca/english/freepub/89-580-XIE/help.htm

http://tinyurl.com/ydr4pbh

summary world report on disability 2011 who world bank accessible en

Documents