Disability in the Developing World
DR. Z UYANGAA*
MONGOLIA*
Abstract
There are estimated 500 million people with disability in the world and at least 70% of disabled people live in developing regions. As many as 50% of disabilities are directly linked to poverty and are preventable. "Disability" is a relative term (restriction of the ability to perform a normal human activity), and its measurements is beset with problems, including the lack of reliability and validity of the instruments, most of which are poorly standardized and produce non-comparable estimates.

Correlation between disability and age, education, income, ethnicity, living arrangements, and gender can not determine causality - not only does disability add to the risk of poverty, but conditions of poverty add to the risk of disability. Poor households do not have adequate food, basic sanitation, and access to preventive health care. They live in lower quality housing, and work in more dangerous occupations. Malnutrition can cause disability as well as increase susceptibility to other disabling diseases. Disabled people have been estimated to make up 15 to 20 per cent of the poor in developing countries, and the disabled poor tend to be regarded in their own communities as the most disadvantaged.

In general, rural disability rates appear higher than urban rates. Disability rates for women seem to be higher than those of men in developed countries, and lower in developing countries. For the childbearing age groups, female rates tend to be slightly higher, possibly because of ill-health resulting from too many pregnancies, inadequate health and medical care, and poor nutrition.

There are several statistics, regarding the disability issue in Mongolia. According to the data from Ministry of Health and Social Welfare, there are around 115 000 (4,8% of the total population) people with disability in Mongolia. The unemployment rate of PWDs is therefore extremely high at 87%. 50% of people with disabilities live in poverty and 60% of them are women.

Analysis of case studies in some developing countries shows that higher disability rates are associated with higher illiteracy, poor nutritional status, lower inoculation and immunization coverage, lower birth weight, higher unemployment and underemployment rates, and lower occupational mobility.

Accidents and conflict are also an important cause of disability, especially in developing countries. Those who are already disabled, or become disabled during a conflict, are particularly vulnerable to deteriorating health under the severe conditions caused by war. Health care and social assistance systems break down, and some normally treatable conditions can become disabling. Much of the psychological disability brought on by conflict related trauma often remains undiagnosed and unrecorded.

Exclusion and marginalization reduce the opportunities for the disabled to contribute productively to the household and community, and increase the risk of falling into poverty. Attitudinal barriers as well as physical barriers, such as the lack of adequate or appropriate transportation, physical inaccessibility, and lack of learning opportunities, can affect access to education and employment opportunities, reducing the opportunities for income enhancement as well as social participation. In some communities, disabled girls receive less care and food, and have less access to health care and rehabilitation services and fewer education and employment opportunities. They also tend to have lower marriage prospects than disabled men, and can be at risk of being abused physically and mentally.

Much of the literature on policies for the disabled in developed countries focuses on the adequacy of existing income support programs, whereas in many developing countries, income maintenance schemes, and even reserved employment schemes, have limited applicability where there is no effective labor market. Efforts have to remain focused on prevention and rehabilitation in developing countries, and particularly in lower income countries, disabled people have to rely to a large extent on informal systems for support. The detrimental effects of broadly applied institutionalization policies are recognized, and there is an emphasis on integrating the disabled into existing programs, appropriate technology, self-reliant schemes, and participatory approaches, including community based rehabilitation (SBR). Increased public effort is needed, particularly in strengthening preventive measures, promoting maternal and child health care, and primary health care, including immunization programs, but also in making information on prevention, treatment, and rehabilitation more widely available.

Because little basic research appears to have been done on disability in developing countries, further investigation is indicated in several areas, including: search for additional data sources and existing analysis to allow more detailed examination of poverty related factors such as income, education, employment, access to services, in developing countries, and a focused study of gender, disability and poverty.
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