Executive summary

Disability prevalence

Disability is not rare. An estimated one billion people or around 15 per cent of the world have some form of disability (WHO & World Bank, 2011). Disability is more common in low- and middle-income countries than in high-income countries, and among older age groups (WHO & World Bank, 2011; Mitra & Sambamoorthi, 2014). Disability is something everyone is likely to experience, either permanently or temporarily, at some point in their life (WHO & World Bank, 2011). People with disabilities are diverse and not defined by their disability.

The current situation of people with disabilities

Disability does not necessary imply limited well-being and poverty. Yet, there is growing evidence that disability and poverty are highly correlated, especially multi-dimensional poverty (Groce et al., 2011; Mitra et al., 2013). Disability is both a cause and consequence of poverty, and poverty and disability reinforce each other, contributing to increased vulnerability and exclusion (DFID, 2000; Trani & Loeb, 2012).

Data show that people with disabilities in low- and middle-income countries are poorer than their nondisabled peers in terms of access to education, healthcare, employment, income, justice, social support and civic involvement (Groce et al., 2011; WHO & World Bank, 2011; Heymann et al., 2014; Mitra, 2014; Morgon Banks & Polack, 2014; Brooks et al., 2013), and are more likely to experience multiple deprivations (Mitra et al., 2013).They encounter inaccessible transport, infrastructure and digital technology (WHO & World Bank, 2011; DESA, 2013). Children and adults with disability are at a higher risk of physical, sexual and other forms of violence (Hughes et al., 2012; UNICEF, 2013; Ortoleva & Lewis, 2012).

People with disabilities are often excluded from disaster management and risk reduction processes (UNISDR, 2014; Smith et al., 2012), and are disproportionately affected by conflict and disasters (Mitchell & Karr, 2014; Smith et al., 2012; WRC, 2015). Humanitarian response is often inaccessible (UNISDR, 2014, p. 4; Kett & Twigg, 2007; WRC, 2008; Mitchell & Karr, 2014).

The exclusion of people with disabilities has significant economic as well as social costs, caused by losses in productivity and human potential (DFID, 2000; Morgon Banks & Polack, 2014).

Diverse experiences of disability

Intersecting inequalities and personal factors may influence the experience of disability and not all people with disabilities are equally disadvantaged (WHO & World Bank, 2011):

• Women with disabilities often experience double discrimination that can extend to all areas of life (DESA, 2011; DFID, 2000; Morgon Banks & Polack, 2014; Ortoleva & Lewis, 2012; WHO & World Bank, 2011; HRW, 2012).
• Children with disabilities are amongst the most marginalised and discriminated against children in the world (HI & STC, 2011; Trani et al., 2013; Trani & Cannings, 2013).
• Older people with disabilities are disproportionately poor (Masset & White, 2004).
• People who experience mental health conditions or intellectual impairments appear to be more disadvantaged in many settings than those who experience physical or sensory impairments (WHO & World Bank, 2011; Inclusion Intl., 2006).
• People with invisible disabilities often face significant discrimination (Yeo & Moore, 2003).

Barriers to disability inclusion

The evidence makes it clear that these inequalities are a result of barriers, rather than any inherent limitations of people with disabilities (Heymann et al., 2014; Groce et al., 2011; Morgon Banks & Polack, 2014; Groce & Kett, 2014; Groce & Bakhshi, 2011; Bruijn et al., 2012; WHO & World Bank, 2011). Barriers to disability inclusion include:

• attitudinal barriers
• environmental barriers
• institutional barriers
• ‘internalised’ barriers
• lack of participation
• inadequate data, statistics and evidence on what works
• inaccurate concerns over cost / difficulty of disability inclusion.

Attitudes are one of the greatest obstacles to achieving equality of opportunity and social integration (Wapling & Downie, 2012; UNICEF, 2013; Heymann et al., 2014; Bruijn et al., 2012). The lack of rigorous and comparable data, combined with lack of evidence on programmes that work, often impedes understanding and action on disability inclusion (WHO & World Bank, 2011).

The impact of disability inclusion

Some evidence and estimates indicate that disability inclusion could lead to increased earnings and labour productivity; increased tax revenues; improved individual and family well-being; and wider societal benefits through a more inclusive and accessible society for all (Lamicchane, 2015; Morgon Banks & Polack, 2014; Heymann et al., 2014; Grider & Wydick, 2015; WRC, 2015; WHO & World Bank, 2011).

Disability inclusive development/ humanitarian response approaches

Disability inclusive development/humanitarian response approaches need not be costly or complicated and include:

• mainstreaming (DESA, 2011; Coe & Wapling, 2010; Bruijn et al., 2012);
• the ‘twin track approach’ (DFID, 2000; Al Ju’beh, 2015);
• raising awareness and changing attitudes/behaviours (Coe & Wapling, 2010; Coe, 2012; UNICEF, 2013; Bruijn et al., 2012);
• comprehensive accessibility and Universal Design (DESA, 2013; WHO & World Bank, 2011);
• reasonable accommodation (UNCRPD, 2006);
• participation (DESA, 2011; Al Ju’beh, 2015; Coe & Wapling, 2010; Bruijn et al., 2012; CBM, 2012; Smith et al., 2012; NCG, 2012; DESA, 2011);
• rights-based initiatives (DESA, 2011; Wapling & Downie, 2012; Al Ju’beh, 2015; NCG, 2012);
• community-based rehabilitation (CBR) (Mauro et al., 2014; Biggeri et al., 2014);
• inclusive education (Bakhshi et al., 2013; WHO & World Bank, 2011);
• inclusive livelihood approaches (Mont, 2014; Mitra, 2014); and
• ‘Building back better’ after emergencies (Mitchell & Karr, 2014).

Organisational change is needed for the successful inclusion of people with disabilities in development/humanitarian projects (Bruijn et al., 2012; Wapling & Downie, 2012; Coe & Wapling, 2010).

Inclusive approaches are more cost-effective than separate piecemeal disability interventions (Walton, 2012; Bruijn et al., 2012). The costs associated with including people with disabilities are far outweighed by the long-term financial benefits to individuals, families and society (CBM, 2012).

Tools to monitor and evaluate the impact of disability inclusion include the UN-endorsed Washington Group Short Set of Questions. People with disabilities can participate in the collection and analysis of data.

Most work on disability inclusion is framed around the UN Convention on the Rights of Persons with Disabilities. Looking towards the future, the new Sustainable Development Goals pledge to leave no one behind and directly mention people with disabilities under five of the 17 goals.

However, it is still rare for international development initiatives to systematically include disability in all aspects of all programmes (Groce et al., 2011).

State of the evidence

Lack of definitional clarity, robust statistics and limited attention to, or funding for, disability research in international development has resulted in a limited evidence base and gaps in evidence in all the different sectors (Groce et al., 2011, p. 1495). There is growing evidence on the association between disability and multidimensional poverty and inequalities. However, more research is needed, especially into the exact nature of the relationship, its dynamics and causalities, and the impact of intersectionality.

The evidence is often nuanced and context dependent. There is often strong anecdotal evidence available, but few randomised control trials, or rigorous quantitative or qualitative evidence-based studies.

There is more evidence on the impact of exclusion than inclusion, as exclusion is often still the default position. While there are many examples of best practice, there are very few rigorous or external evaluations of what works (and what does not) in disability inclusive development / humanitarian response approaches. More practical tools are needed, and appropriate and effective benchmarks and indicators for evaluating disability inclusion.

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