While not all people with disabilities are poor, it is increasingly recognised that ‘disability is an important issue in poverty reduction and poverty alleviation efforts’ (Groce et al., 2011, p. 1493). A small but growing body of evidence is providing specific information about the association between disability and poverty, especially multi-dimensional poverty (Groce et al., 2011, pp. 1496, 1502; Mitra et al., 2013, p. 3).
Data are showing that people with disabilities in low- and middle-income countries are ‘poorer than their nondisabled peers in terms of access to education, access to healthcare, employment, income, social support and civic involvement’ (Groce et al., 2011, p. 1496). For example, a study using internationally comparable data from fifteen developing countries found that in most countries, disability is ‘significantly associated with higher multidimensional poverty as well as lower educational attainment, lower employment rates, and higher medical expenditures’ (Mitra et al., 2013, p. 1). A recent systematic review of the relationship between disability and poverty in low- and middle-income countries also noted that ‘the majority of studies (78 of 97-80 per cent) found a positive, statistically significant association between disability and economic poverty’ (Morgon Banks & Polack, 2014, p. ii).
A study of poverty and disability in Afghanistan and Zambia found ‘evidence of lower access to healthcare, education and labour market for people with disabilities, whatever is the disability status, but poverty measured by an asset index is not statistically different between people with and without disabilities’ (Trani & Loeb, 2012, p. S19). It should be noted, however, that most families in these countries own very few assets (Trani & Loeb, 2012, p. S31). Other studies find similarly inconclusive results on the association between disability and household income or household consumption expenditures (Rischewski et al., 2008; WHO & World Bank, 2011, p. 40; Mitra et al., 2013).
The links between poverty and disability
Where does the association between poverty and disability come from? It is often stated that disability is ‘both a cause and consequence of poverty’ and poverty and disability ‘reinforce each other, contributing to increased vulnerability and exclusion’ (DFID, 2000, pp. 1, 2; Trani & Loeb, 2012, p. S19). However, the dynamics among the causal factors driving this disability–poverty nexus are under-researched (Groce et al., 2011, pp. 1493, 1495; Mitra et al., 2013, pp. 1-3; Morgon Banks & Polack, 2014, p. i; Mont, 2014, p. 24). This is partly the result of the lack of a consistent measure of disability (Groce et al., 2011, pp. 1494, 1500; Mitra et al., 2013, p. 1).
Disability → poverty
Disability accentuates poverty because the systemic institutional, environmental and attitudinal barriers that people with disabilities encounter in their daily lives result in their entrenched social exclusion and their lack of participation in society (Groce et al., 2011, p. 1497). This leads to:
- discrimination, social marginalisation and isolation;
- insufficient access to education, adequate housing, nutritious food, clean water, basic sanitation, healthcare and credit;
- lack of ability to participate fully in legal and political processes; and
- lack of preparation for and meaningful inclusion in the workforce (Woodburn, 2013, p. 80; Groce et al., 2011, p. 1497).
Additional costs of disability
Disability can reduce people’s earning potential. Yet someone with a disability ‘might need a higher income to achieve the same level of functioning as a nondisabled person’ to meet additional costs resulting from disability (e.g. cost of assistive devices or personal support) (Groce et al., 2011, p. 1502; Mitra et al., 2013, p. 2; WHO & World Bank, 2011, pp. 10, 43). There are very few studies that estimate the direct costs of disability. Direct costs may be low due to the unavailability of services and goods (e.g. medical care, assistive devices), which may in turn limit opportunities and wellbeing. Poor people with disabilities are less likely to earn their way out of poverty as a result of the work and education related barriers they face (Heymann et al., 2014, p. 3).
Poverty → disability
Poverty increases the likelihood of disability: chronically poor people are often at risk of ill health and injuries, which may lead to disability (Groce et al., 2011, p. 1498; Mitra et al., 2013, p. 2). Poverty is associated with malnutrition, inadequate access to public health services (e.g. immunisation), poor living conditions (e.g. lack of safe water), and environmental exposures (e.g. unsafe work environments), which can lead to health conditions which result in disability (Mitra et al., 2013, p. 2). The poor who become disabled are likely to descend further into poverty, with a significant effect on their entire household (Groce et al., 2011, p. 1498).
Diverse economic experiences
Evidence from different countries is diverse, as the particular education facilities, labour market, and social protection available in a given context can influence whether disability leads to poverty (Mitra et al., 2013, p. 2; WHO & World Bank, 2011, p. 40).
Where persons with disabilities face social marginalisation and lack of access to education, employment, healthcare, legal representation and credit, they may be more marginalised if improving economic conditions allow others to improve their quality of life (Groce et al., 2011, p. 1507). One study found that the difference in economic wellbeing across disability status appears to be more often significant in middle-income countries compared to low-income countries (Mitra et al., 2013, p. 7). Another study also found that the disability gap in employment (people with disabilities have lower employment rates than people without disabilities) is more common in middle-income than low-income countries (Mizunoya & Mitra, 2013, p. 38).
Differences can also be found within countries. In Vietnam, ‘districts with better healthcare and infrastructure, such as roads and health services, show less of a link between disability and poverty’ (Mont & Nguyen, 2013). Some argue that the political ideology of a country can affect people with disabilities’ experience of poverty (Gill & Schlund-Vials, 2014).
Different types of impairments, age of acquisition, gender, ethnicity and rural or urban location all affect how people with disabilities experience poverty (Groce et al., 2011, pp. 1502-1503). For instance, a study using internationally comparable data of fifteen developing countries found that among people with disabilities, ‘persons aged 40 and above and persons with multiple disabilities were more likely to be multi-dimensionally poor’ (Mitra et al., 2013, p. 1). Children with disabilities are disproportionally likely to live in poverty (HI & STC, 2011, p. viii; Trani et al., 2013, p. 404; Trani & Cannings, 2013, p. 58). A study in Afghanistan found that girls with disabilities were more deprived on all dimensions of multidimensional poverty than boys with disabilities (Groce et al., 2011, p. 1503). People with mental illness face higher levels and intensity of poverty, partly as a result of stigma and prejudice (CCDRP, 2013, p. 1; Trani & Loeb, 2012, p. S32). Studies indicate that ‘women with disabilities are more likely to be affected by poverty than men with disabilities, and that unmarried women are the most vulnerable to poverty’ (Groce et al., 2011a, p. 17). In contrast, in some countries, men who have been disabled by war are considered heroes and ‘often escape poverty through privileged access to land, employment and public facilities’ (Trani & Loeb, 2012, p. S32).
Family and household poverty
Some studies have found that households with disabled family members had a lower mean income and fewer assets than households without, although the evidence is mixed (Groce et al., 2011, pp. 1501, 1503; Mitra et al., 2013, p. 3; Woodburn, 2013, p. 80; WHO & World Bank, 2011, p. 10). There are three categories of cost associated with disability at the household level:
- direct costs – including medical treatment and travel costs;
- opportunity costs as a result of lost income; and
- indirect costs relating to the provision of ‘care’ provided by family or community members
(Groce et al., 2011, p. 1503; UNICEF, 2013, p. 14).
Those caring for children or adults with disabilities are generally female. They often give up income-generating activities in order to stay at home and provide support (Cordier, 2014, p. 554; Groce & Kett, 2014, p. 6; ESCAP, 2012, p. 15). A study of disability and poverty in Asia and the Pacific also finds that in households where people with disabilities support dependents, they are unable to earn enough to fulfil those support responsibilities (ESCAP, 2012, p. 6).
These studies establish that ‘the root cause of the problem is not the person with a disability, but the social marginalisation, and lack of access to basic resources such as education, employment, healthcare and social support systems that link disability and poverty at the household level’ (Groce et al., 2011, pp. 1503-1504).
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