Poverty and Disability Around the World

Poverty is a complex issue which  has dramatic effects throughout the lifetime. When disability is added into the equation (see Poverty and Disability) the effects on persons with disabilities (PWDs) are compounded. Before investigating the impact of poverty in Uganda in greater detail it is interesting to see the effects of poverty on PWDs in other similar nations. 

The World Bank report Disability and Poverty in Developing Countries: A Snapshot from the World Health Survey (WHS) 2011 provides an overview of some of the most important issues for PWDs. The report notes that there are many factors involved in disability and poverty and it is important to understand the country where where poverty is to be tackled. Disability and poverty may arise because of many factors which include:

(i) the ways how the underlying health conditions reduce the productivity of disabled people for the types of jobs that are available in the labor market; (ii) the lack of access to assistive devices or personal assistance; (iii) contextual factors, for instance, a physically inaccessible work environment or negative attitudes with respect to the ability to work of persons with disabilities; and/or (iv) the rules related to disability benefits which may create incentives for disabled people to drop out of the labor market. Once the main causes for low employment rates for persons with disabilities in a particular country are better understood, it becomes possible to introduce adequate, and preferably evidence-based, programs and policies to promote employment among persons with disabilities. 

The report surveyed 15 countries and notes that there are large discrepancies in the numbers of PWDs reported. Disability rates vary from 3% in Lao to 16% in Bangladesh. However the report does offer some interesting results. A selection from the results is given here:

In each of the 15 countries, disability prevalence is found to be higher among women than men. For most countries, the gender gap, i.e. the difference in disability prevalence between females and males is between three and five percentage points. The gender gap is the largest in Bangladesh: disability prevalence stands at 23 percent among women, compared to 10 percent among men, which gives a gender gap of 13 percentage points...
In 11 out of the 15 countries under study, disability prevalence is higher in rural areas than in urban centers. A higher prevalence in rural areas has been found in earlier studies in developing countries (for example, World Bank 2009 for India), but further research is needed to understand if this is a systematic finding...

Ugandan patients at the Out-Patient Department of Apac Hospital in northern Uganda. The majority are mothers of children under 5 years old with malaria.

The report notes that measuring disability by economic status was only significant in 3 out of the 15 countries studied. However:

When poverty status is measured using the PPP (purchasing power parity see Overview of Poverty in Uganda for an explanation) US$1.25 a day international poverty line, disability prevalence is significantly higher among the poor than the nonpoor in four countries: Malawi, Zambia, the Philippines, and Brazil. When poverty status is measured using the PPP US$2 a day international poverty line, disability prevalence is higher in all countries except Pakistan and the Dominican Republic. However, the difference is significantly different from zero in only three countries: Zambia, Lao PDR, and Brazil. When poverty is measured through a multidimensional measure, disability prevalence among the poor, i.e. persons who experience multiple deprivations is significantly higher in 11 out of 14 countries included in this analysis (Table 4.3, Disability Prevalence (Base Measure) among Working-Age Individuals, by Poverty Status). Here, disability prevalence rate among the poor ranges from a low of 3.5 percent in Lao PDR to a high of 29.5 percent in Mauritius. In several countries (Kenya, Bangladesh, and Brazil), disability prevalence among the multi-dimensionally poor is close to two times higher than among the non-poor. The disparity in disability prevalence is the most pronounced in Mauritius, where prevalence among the multi-dimensionally poor is three times higher than among the non-poor. Overall, it can be said that there are significant disparities in disability prevalence in most countries by poverty status, when poverty is measured multi-dimensionally.

Persons with disabilities have significantly less years in education than nondisabled people. The percentage of people that have completed primary school education is also significantly lower for PWDs. When combining education and employment factors the following results are noted:

Overall, the estimates suggest that in most of the countries included in the study, persons with disabilities as a group have significantly lower educational attainment than persons without disabilities. Comparatively, they have fewer years of education and lower primary school completion rates. Similarly, they have lower employment rates than persons without disabilities. In majority (60 percent) of the countries the difference in employment rates to the detriment of disabled people was statistically significant.

With the results above in mind a picture of disability begins to emerge based on the multidimensional statistical analysis:

• First, looking across all five dimensions of economic well-being explored in this study (education, employment, assets/living conditions, household expenditures, and household expenditures on health care), one finds in all the countries that persons with disabilities as a group are significantly worse off in two or more dimensions in 14 out of 15 countries.
• Second, disability is significantly associated with multidimensional poverty in 11 to 14 of the 14 developing countries under study. In other words, persons with disabilities are more likely to experience multiple deprivations than persons without disabilities. This result holds when different multi-dimensional poverty measures and poverty thresholds (within and across dimensions) are used.
• Third, at the individual level, in most of the countries included in the study, persons with disabilities have lower educational attainment and experience lower employment rates than persons without disabilities. In education, they have fewer years of education and lower primary school completion rates. Similarly, they have lower employment rates than persons without disabilities. In a majority (60 percent) of the countries the difference in employment rates to the detriment of disabled people was statistically significant.
• Fourth, at the household level, in most of the countries (11 out of 15), households with disabilities have a significantly lower mean asset index. Also, a higher percentage of households with disabilities belong to the bottom asset quintile; this difference was statistically significant in six out of 14 countries. Households with disabilities, on average, also report spending a higher proportion of their expenditure on health care: the mean ratio of health to total household expenditures was significantly higher for households with disabilities in two thirds of the countries.
• Fifth, descriptive statistics suggest that in most countries households with disabilities are not worse off when their well-being is measured by mean non-health PCE (per capita expenditure). Similar results were obtained for the poverty headcount, gap, and severity based on the PCE as welfare aggregate. This result should be treated with caution given that it might be influenced by the limitations of the WHS sampling design when it comes to identify the disability status of a household and its small set of questions on expenditures.

Poverty when combined with disability becomes a multifaceted complex system. Various factors like education, employment, assets and living conditions, household expenditures, and household expenditures on health care interact with disability compounding the effects of poverty. The evidence from this 15 nation study is by no means consistent across all nations. However it is clear that poverty interacts with disability in a detrimental way. Any attempted solution to poverty must be tailored to the needs of the PWDs, there is no one size fits all remedy.