REGIONAL TRENDS IMPACTING
ON THE SITUATION OF PERSONS WITH DISABILITIES
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SUMMARY
As the Asian and Pacific Decade of Disabled
Persons, 1993-2002, draws to a close, it is
recognized that many gains have been achieved
in creating an awareness of the issues affecting
people with disabilities in the Asian and
Pacific region and of the need to address
them. However, despite the achievements of
the Decade, persons with disabilities remain
the single largest sector of those least-served
and most discriminated against in almost all
States in the region, both developed and developing.
Much remains to be done to ensure the full
participation and equality in the development
process of persons with disabilities in the
region.
The present document outlines three current
trends having an impact on the situation of
people with disabilities – education,
information and communications technology
(ICT) developments and poverty. In each of
these areas, there are challenges that need
to be overcome in order to ensure that people
with disabilities are not pushed to the margins
of society, unable to contribute to or benefit
from education, ICT and poverty alleviation
programmes. It is hoped that the extension
of the Asian and Pacific Decade of Disabled
Persons for another 10 years will complete
the achievement of the Decade goal of full
participation and equality of people with
disabilities. |
Introduction
1. By its resolution 48/3 of 23 April 1992, ESCAP
proclaimed 1993-2002 the Asian and Pacific Decade
of Disabled Persons, in order to give impetus to
the implementation of the World Programme of Action
concerning Disabled Persons in the region. As the
Decade draws to a close, it is recognized that many
gains have been achieved in creating awareness about
the situation of persons with disabilities in the
Asian and Pacific region and the need to address
the issues affecting their full participation and
equality in the development process. Notably, there
has been progress at the national and subnational
levels where implementation of a variety of measures
for equalization is under way. These include legislation,
promotion of barrier-free environments, community-based
rehabilitation services, education and training
and employment. People with disabilities are increasingly
active in contributing to the planning and implementation
of programmes relating to such measures.
2. However, despite these achievements, persons
with disabilities remain the single largest sector
of those least-served and most discriminated against
in almost all States in the region, both developed
and developing. Persons with disabilities have been
prevented from accessing entitlements, freely available
to other members of society, to health services,
education, employment, community participation and
other basic social and political rights and services.
Failure to access these services, and to have their
voices heard, has resulted in economic and social
exclusion for persons with disabilities and their
families, prejudice, rejection and ultimately, lives
lived in poverty. The number of persons with disabilities
continues to increase with population growth and
other factors such as war and other forms of violence,
inadequate medical care and natural and other disasters.
Of particular note is population ageing in many
societies in the region and the related rise in
ageing-specific disabilities.
3. There are a number of key areas that require
ongoing critical action if the region is to satisfactorily
achieve the inclusion of people with disabilities
in society and in all mainstream development programmes
in order to reach the Decade goal of full participation
and equality of people with disabilities. Not surprisingly,
many of the people with disabilities are poor; poverty
and social exclusion are inextricably linked. The
overwhelming majority of people with disabilities
in the ESCAP region live in rural areas where the
services needed to help them are unavailable. Additionally,
a major cause of poverty is the lack of employment.
People with disabilities remain disproportionately
unemployed. Efforts have been made in many parts
of the ESCAP region to improve the participation
rate but a major obstacle to gaining - and retaining
– employment is lack of access to education.
People with disabilities are confronted with social
exclusion from their earliest years because of existing
social and physical barriers. The educational systems
fail to offer any education to the majority of children
with disabilities and of those who do have access
to education, few receive inclusive education in
the mainstream school environment. Additionally,
a significant issue in this area that still has
to be addressed is the accessibility of people with
disabilities to new and emerging information technologies
through computer literacy.
4. The following chapters outline some current
trends impacting on people with disabilities. Given
that the lack of education is one of the main factors
leading to social exclusion and poverty, this theme
will be looked at first. This will be followed by
chapters related to trends in ICT development and
poverty. It is hoped that the extension of the Asian
and Pacific Decade of Disabled Persons for another
10 years will complete the achievement of the Decade
goal of full participation and equality of people
with disabilities.
I. EDUCATION
5. The education of children and youth with disabilities
remains one of the most serious challenges facing
Governments in the Asian and Pacific region. Evidence
from the review of national progress in the implementation
of the Agenda for Action for the Asian and Pacific
Decade of Disabled Persons suggests that less than
10 per cent of children and youth with disabilities
have access to any form of education (ESCAP, 2002a).
Evidence presented by the United Nations Children’s
Fund (UNICEF) (1999), Jonsson and Wiman (2001) and
Jones (2001) suggest that the figure may be even
lower in many developing countries. This situation
compares with an enrolment rate of more than 70
per cent in primary education for non-disabled children
and youth in the region. The target of the Agenda
for Action for the Asian and Pacific Decade of Disabled
Persons to increase the enrolment of children and
youth with disabilities to close the gap between
their current level of enrolment and the net enrolment
rate of non-disabled children in each respective
country or area in the ESCAP region has not been
met.
6. Education is a basic human right and all children,
including children with disabilities, have a right
to education. This right has been enshrined in the
Universal Declaration of Human Rights, the Convention
on the Rights of the Child, the World Declaration
on Education for All, the Dakar Framework for Action
on education for all and the millennium development
goals. The Convention on the Rights of the Child
is the most widely ratified human rights treaty
in the history of the United Nations and has been
ratified by all countries and areas in the Asian
and Pacific region. It mandates that States make
primary education compulsory and available free
to all children on the basis of equal opportunity,
with protection from all kinds of discrimination,
including discrimination on the basis of disability.
It also requires that children with disabilities
have access to and receive education in a manner
conducive to the child’s achieving the fullest
possible social integration and individual development.
7. Lack of adequate education remains the key risk
factor for poverty and exclusion of all children,
both those with disabilities and the non-disabled.
For children with disabilities, however, the risk
of poverty owing to lack of education is even higher
than for children without disabilities. Exclusion
from education for children and youth with disabilities
results in exclusion from opportunities for further
personal development, particularly diminishing their
access to vocational training, employment, income
generation and business development. It limits participation
in and contribution to family, social and community
activities and obligations. Failure to access education
and training prevents the achievement of economic
and social independence and increases vulnerability
to long-term, life-long poverty in what can become
a self-perpetuating, inter-generational cycle. Children
with disabilities who are denied access to an education
almost inevitably become an economic burden on society
and on their families.
8. Barriers to the full participation of children
with disabilities in education in the Asian and
Pacific region are many and include actions, or
the lack of action, by the international community,
Governments, non-governmental organizations (NGOs),
communities and organizations of persons with disabilities.
The education for all initiative, launched at the
World Conference on Education for All at Jomtien,
Thailand, in March 1990, and reaffirmed and strengthened
by the World Education Forum, held at Dakar in April
2000, has never emphasized children with disabilities
as a priority target group for action in education
for all initiatives. The result is that, 12 years
after the initiative was launched, only 7 Governments
in the region reported specifically including children
with disabilities in national plans on education
for all. A World Bank initiative inviting 23 countries
to join the education for all fast track to help
developing countries to meet the millennium development
goal of ensuring that every girl and boy complete
a full course of primary school education by 2015
is thus unlikely to improve the educational situation
of children with disabilities.
9. Governments of the region, signatory to the
above-mentioned conventions and declarations, have
been slow to take action to fulfil their obligations
to ensure access to education for children with
disabilities. Twenty Governments reported that they
have passed, or plan to pass, legislation mandating
education for all children but prevailing discriminatory
attitudes towards persons with disabilities at all
levels of society work against the enforcement of
access to education for children with disabilities.
Data collection on children with disabilities is
limited and they are seldom specifically represented
in national statistics on educational attendance
and attainment, further preventing any monitoring
of their progress into and within the educational
system. This lack of information contributes to
the continued neglect of the rights of children
with disabilities and explains in part the minimal
rate of progress that has been achieved towards
their enrolment in schools during the Decade.
10. The most common form of educational provision
for children with disabilities in the region has
been in segregated special schools. These are mostly
located in urban areas and have limited capacity.
Many are run by NGOs, with or without government
financial support. In the Standard Rules on the
Equalization of Opportunities for Persons with Disabilities
and the Salamanca Statement and Framework for Action
on Special Needs Education it is stated that integrated
or inclusive education, with access to education
in the regular local neighbourhood or community
school, provides the best opportunity for the majority
of children and youth with disabilities to receive
an education, including those in rural areas. It
is acknowledged that in some instances special education
may currently be the most appropriate form of education
but it should be aimed at preparing students for
education in the general system. In 2002, 27 Governments
reported increased access to regular schools for
children and youth with disabilities, in a trend
that should significantly boost their rate of enrolment
in education within the region during the next decade.
In 1997, Turkey passed progressive legislation mandating
the right of children and youth with disabilities
to benefit from early intervention, preschool, primary
and secondary education in mainstreamed settings.
11. Early intervention, including early detection
and identification during the first four years of
life, is particularly critical for infants with
disabilities and their families. Support and training
for families gives them the skills to help their
children develop as fully as possible. Failure to
identify infants and young children early and to
provide intervention and support to parents and
caregivers results in secondary disabling conditions
which further limit the child’s capacity to
benefit from educational opportunities. More than
20 Governments reported that they have or intend
to establish early intervention services. This is
an area where multisectoral collaboration is essential,
involving health, education, social welfare and
community development. The most effective means
of providing these services may be within a community-based
rehabilitation approach, applicable in both urban
and rural settings, with parents and community members
serving as resources in implementation.
12. Improving the quality of education is relevant
in both special and regular schools if children
with disabilities are to receive an education which
is appropriate, enables them to achieve satisfactory
outcomes and participate fully in their communities.
Some major barriers to the provision of quality
education in all educational contexts include lack
of early identification and intervention services,
negative attitudes and exclusionary policies and
practices towards children with disabilities. Further
barriers relate to inadequate teacher training,
particularly for teachers in inclusive regular schools
who are expected to teach children with a wide range
of abilities, lack of support systems for teachers,
lack of appropriate teaching materials and devices
and failure to make modifications to the school
environment to make it fully accessible. Children
in special schools may receive a limited curriculum
that does not prepare them for vocational training
or an integrated life in the wider community. Many
of these barriers can be overcome through deliberate
policy, planning, implementation strategies and
allocation of resources to include children and
youth with disabilities in all national education
development initiatives.
13. Steps need to be taken to prepare the school
system for inclusive education, with a clear understanding
that every child has a right to attend school and
that it is the responsibility of the school to accommodate
differences. Educational administrators, school
administrators, teachers and the community need
training to change attitudes and increase sensitization
to the idea that children with disabilities can
be educated together with non-disabled children.
Awareness of their children’s right to education
needs to be raised in families of children with
disabilities. Teacher training is the most important
component of change, ensuring that all teachers
develop attitudes and skills to equip them to teach
children with diverse abilities in regular community
schools. Training should further prepare teachers
to develop flexible and adaptable curricula, individualized
and child-centred teaching techniques and appropriate
monitoring and assessment procedures. Systems of
support need to be developed, including resource
centres and specialist teachers, in rural and urban
areas and appropriate and accessible teaching materials,
equipment and devices need to be made available.
Schools need to be made progressively barrier-free.
14. There are many examples of inclusive policies
being implemented in schools in countries and areas
in the region, including in China, India and the
Lao People’s Democratic Republic, among others.
These examples need to be shared systematically
on a subregional and regional basis to increase
educational access and positive educational outcomes
for children with disabilities in the Asian and
Pacific region during the next decade.
II. INFORMATION AND COMMUNICATION TECHNOLOGY
15. ICT has become one of the main drivers of economic
growth and the expansion of information-communication
networks. Since the mid-1990s, the Internet and
wireless communications technology – all of
which comprise modern ICT – have generated
unprecedented cross-border flows of information,
investment, industry and individuals. ICT is so
much a part of everyday activities that it is regarded
as indispensable for public, business and personal
productivity and daily pursuits.
16. There has been much progress worldwide in ICT
development in the last 10 years, which has opened
up more opportunities for people with disabilities,
especially in matters of networking, solidarity,
employment and independent living. Deaf people and
people with visual impairment have easier and more
frequent access to information and communication
via e-mail and other augmentative communications
products for the deaf and speech synthesizer, text-magnifier
and screen reader programmes for those who are visually
impaired. Those who have lost the use of or have
difficulty using an upper limb can now make use
of voice navigation software and deaf-blind persons
can now utilize refreshable Braille screen readers.
The Digital Accessible Information System (DAISY),
poised to be the next generation of the worldwide
standard of the digital talking book, is also bridging
the information gap between the blind/print-disabled
and non-disabled people. Additionally, there are
adapted input devices for people with physical disabilities,
hearing aids and alert systems for the hearing impaired
and interactive learning software for children with
special needs. These assistive computer technologies
facilitate access to employment opportunities at
different levels. Some people with disabilities
have become experts in designing barrier-free/universal
design computer programmes or promising entrepreneurs
building on their computer skills and knowledge
and their own experiences as consumers with disabilities.
17. The United Nations Development Programme reports
that ICT can provide developing countries with unprecedented
opportunities to meet vital developmental goals
such as poverty reduction, basic healthcare and
education far more effectively than before. This
seems to indicate the greater potential ICT has
in the region.
18. Across the world, however, there is a growing
concern about what is called the “digital
divide” – a reference to the gaps in
access to ICT between individuals, groups, countries
and areas. In a global society that is becoming
increasingly dependent on technology and knowledge,
exclusion particularly threatens the ICT “have-nots”
that are denied access to ICT and the skills and
knowledge that accompany it. People with disabilities
in the Asian and Pacific region still face multiple
barriers in accessing ICT and the skills and knowledge
that are required to benefit from it. Even when
and where there are available ICT hardware and software,
people with disabilities face problems of accessibility
ranging from physical barriers to the lack of assistive
computer technology and inaccessible multimedia
design.
19. For many people with disabilities in this region,
the basic problem is the absence or the lack of
the infrastructure to support ICT development, access
and use – such as electricity, telecommunications,
hardware and software. The problem is especially
acute in rural areas in the region where a majority
of people with disabilities live. About 70 to 80
per cent of people with disabilities in the Asian
and Pacific region live in rural areas in developing
countries which lack sufficiently extensive and
affordable ICT infrastructure. Even in an industrialized
country such as Japan, Internet accessibility for
people with disabilities is significantly lower
than for non-disabled people. Thirty-four per cent
of the general population has access to the Internet
in contrast to 11 per cent of those who are deaf/hard
of hearing, 8 per cent of those who have physical
disabilities and 3 per cent of those who are blind/visually
impaired. In other countries, Internet access fees
are disproportionately higher than the daily cost
of living. In Myanmar, for instance, where the average
household income is US$ 20, the cost of Internet
access is about US$ 9 dollars per hour. Even with
DAISY, which is being increasingly publicized, little
attention is given to whether or not blind people,
as consumers of such technology, are able to access
the available DAISY production/playback software
programmes affordably.
20. Another challenge is the lack of accessible
web design and assistive computer technology to
accompany the rapid developments in ICT. The transformation
of the Internet from a text-based medium to a multimedia
environment, for instance, is causing problems for
people with disabilities. With a text-based medium,
people with visual disabilities could use screen
readers to access the Internet but the predominant
graphical web pages that characterize current Internet
traffic pose a barrier. People with learning, cognitive
or hearing disabilities are also experiencing difficulties
with assistive computer technology that cannot help
them conduct web transactions because the new Internet
environment does not accommodate the functionality
needs of accessible design.
21. People with disabilities still face many obstacles
in the job market of an increasingly digitalized
economy. One reason is the lack of skills and understanding
of ICT applications. This reflects the generally
low-level of education received by many people with
disabilities either as a result of poverty or poor
access to education. People with disabilities are
likely to have restricted access to digital technology
and knowledge just as they are less likely to have
access to basic social services. The ICT market
tends to design, develop and distribute products
and knowledge for the benefit of the better educated,
wealthier and technologically literate consumers
that create the demand and can afford the products.
22. There is also a lack of statistical and qualitative
data regarding ICT development and its impact on
people with disabilities. This lack of data poses
a challenge to policy makers to identify accurately
the nature and extent of the problem and implement
effective solutions. These are some of the many
challenges that need to be overcome in order to
ensure that ICT development does not push people
with disabilities to the margins of society, unable
to contribute to or benefit from the many advantages
of the digital economy.
III. POVERTY AND DISABILITIES
23. The nature, extent, linkages and trends of poverty
and disability have not been sufficiently or systematically
examined for a number of reasons. Only very recently
has the issue of disability been addressed within
the context of studies on poverty. Additional reasons
include the differences in survey design, definitional
issues in statistical analysis, concepts and methods
of poverty and disability research and, relatedly,
the lack of comparable or reliable data on the incidence,
distribution and trends of disability, including
the nature and extent of poverty vis-à-vis
people with disabilities. Additionally, the lack
of available data on poverty and disability reflects
the exclusion of the experience of people with disabilities.
What little research does exist has been done mainly
by non-disabled academics. There has been little
opportunity for disabled people, let alone those
living in chronic poverty themselves, to influence
the agenda.
24. The information on poverty and disability that
is available, mainly from case studies and anecdotal
evidence, shows that there are a disproportionate
number of people with disabilities in all countries
who are living in extreme or chronic poverty. People
with disabilities are also very vulnerable to poverty,
if they are not already living in poverty. Their
vulnerability and poverty are multidimensional:
their employment and income levels are much lower
compared with the non-disabled population; they
are deprived or excluded from participation and
opportunities open to others; they are discriminated
against because of institutional, social and cultural
biases which restrict their access to basic services,
human capital and productive assets; and they are
often excluded and disempowered in their societies.
25. It is estimated that about 400 million of the
world’s more than 600 million persons with
disabilities live in the Asian and Pacific region,
with a very high percentage in South and South-East
Asia (ESCAP, 2002b). Close to 200 million have severe
or moderate disabilities and need specific assistive
devices in order to participate in the life of their
communities. About 70 to 80 per cent of people with
disabilities live in rural areas many of them below
the poverty line.
26. In general, people with disabilities are estimated
to make up 15 to 20 per cent of the poor in developing
countries. In some communities, people with disabilities
are regarded as the most disadvantaged by others
in the community and it is frequently observed that
in low-income countries, the poor with disabilities
are among the poorest of the poor.
27. Accurate and reliable data on the unemployment
rate for people with disabilities are not available
for most countries and areas in the Asian and Pacific
region but available anecdotal evidence suggests
that people with disabilities are extremely underrepresented
in employment. Where figures are available on the
unemployment rate for people with disabilities in
industrialized countries, the International Labour
Organization (ILO) has shown that the unemployment
rate has been twice or even three times that of
non-disabled people (ILO, 1984). In Japan, the employment
rate of people with disabilities is disproportionately
low. For instance, a Japanese white paper on disability
shows that disabled employees constitute only 1.49
per cent of total employees in private companies.
The government quota requirement for people with
disabilities is 2.1 per cent. When disabled people
are employed, there is a greater tendency for them
to be underemployed relative to their levels of
training (Neufeldt and Albright, 1998).
28. Disability is both a cause and a consequence
of poverty. Poor families often do not have land
to grow food, have insufficient income to meet their
basic needs, have inadequate shelter, sustenance
and sanitation and have limited access to health
care. Family members often become ill and some of
the diseases are potentially disabling. Mothers
have low birth-weight babies who are more at risk
of developing disabilities than healthy babies.
Malnutrition in its various forms is a cause of
disability as well as a contributory factor in other
ailments that increase susceptibility to other disabling
conditions. Moreover, given the links between child
malnutrition and impaired intellectual development,
the large at-risk population is of concern. It is
estimated that currently 515 million Asians are
chronically undernourished, accounting for about
two thirds of the world’s hungry people. Child
malnutrition exacts its highest toll in the Asian
and Pacific region (ESCAP, 2002b).
29. Those who already have disabilities, or who
acquired disabilities during a conflict, are particularly
vulnerable to deteriorating health under the severe
conditions caused by war and conflict. Based on
figures from a study carried out in 206 communities,
including Afghanistan and Cambodia, landmine incident
rates in the surveyed areas ranged from 1.9 per
cent in Afghanistan to about 0.5 per cent in Mozambique
(Andersson and others, 1995). Disability rates,
measuring only the survivors, were about 0.9 per
cent in both Afghanistan and Cambodia. About 6 per
cent of households were affected by landmine accidents.
In some parts of Afghanistan, the proportion was
as high as 22 per cent. These conditions result
in physical and psychiatric disabilities which increase
the risk of poverty.
30. Studies have identified three types of factors
which can make people with disabilities, or families
having people with disabilities, worse off: (a)
loss of income; (b) additional costs resulting from
the disability; and (c) marginalization or exclusion
from services and/or social and community activities
(Elwan, 1999). The extra costs directly related
to the disability include such things as medical
expenses, equipment, adaptations to housing and
specialized services. These can be considerable.
A survey of people with disabilities in India found
that the direct cost of treatment and equipment
varied from three days’ to two years’
income, with a mean of two months. Surveys of four
countries in 1995 found that between 12 and 60 per
cent of landmine victims had to sell assets to meet
their medical bills and 61 per cent of Cambodian
landmine victims were forced into debt to pay for
medical care (Andersson and others, 1995). On a
related point, a study in New Zealand found that
housing/accommodation was a ‘trigger’
in the life of a person with disabilities: if housing
was not organized and stable, other factors were
likely to be unstable and the risk of poverty higher,
regardless of the severity of the disability (Elwan,
1999).
31. In developing countries, disabled people are
often seen as the most disadvantaged by those in
their own communities. Local people in Asia ranked
disabilities at the top of a list of 14 ‘ill-being’
criteria -- ranked second was being widowed and
third was lacking land (Helander, 1995). Several
researchers point out that people with disabilities,
particularly in developing countries, are often
the victims of negative social attitudes and are
subject to being stigmatized and neglected and the
result sometimes is the exacerbation of the disabling
condition or the onset of new disabling conditions.
In some cases, people with disabilities are particularly
subject to abuse, either physical or social/mental/psychological.
Exclusion and marginalization reduce the opportunities
for people with disabilities to contribute productively
to the household and the community and increase
the risk of falling into poverty. UNICEF points
out that some 150 million children with disabilities
lack access to child care services, schools, recreation
and other social services and are likely to remain
illiterate and untrained and ultimately join the
unemployed.
32. Access to rehabilitation and other services
for people with disabilities is very limited in
developing countries. Only a small fraction of people
with disabilities in rural areas has access to government
or NGO programmes and the majority is profoundly
socially excluded (Harriss-White and Subramanian,
1999). In many poor communities, particularly in
rural areas, access is likely to be constrained
by lack of information, lack of local services and
the cost of travel. ESCAP notes that rehabilitation
services in the region’s developing countries
are still inadequate and poorly coordinated and
that commuting to rehabilitation centres poses serious
difficulties for women and girls with disabilities
and is expensive for their families in terms of
money, time and effort. UNICEF has reported that
women and children receive less than 20 per cent
of rehabilitation services.
33. People with disabilities are by definition
more vulnerable than most other groups. Children
with disabilities may never develop their full potential.
Early intervention services and support for families
of children with disabilities are not well developed
in the region and often non-existent in rural and
poor urban areas. As stated earlier, their access
to schools is extremely limited. Women with disabilities
are more disadvantaged than men with disabilities,
as they experience discrimination on three counts:
as women, as women with disabilities, and, frequently,
by living in poverty. A study by ESCAP (1995) notes
that the difficulties faced by girls with disabilities
can start at birth and that if girls with disabilities
are allowed to survive, they can face discrimination
within the family, receive less care and food and
be left out of family interactions and activities.
They also have less access to health care and rehabilitation
services and fewer opportunities for education and
employment. Girls and women with disabilities are
at high risk of being abused physically and mentally,
sometimes by those within the household. Abuse from
outside the family is often unreported because of
the additional shame to the family, which is already
stigmatized for having a daughter with disabilities.
These problems are exacerbated in rural areas.
34. The combined effect of disability and poverty
prevents persons with disability from accessing
any opportunities for personal development or contributing
to the societies in which they live. They become
trapped in a situation of total disempowerment,
unable to make decisions or control any aspect of
their lives. Urgent measures are needed to reverse
this situation in the Asian and Pacific region during
the next decade.
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