What Constitutes a Disability?

1. What Constitutes a Disability? Presenter: KAREN SABA Saba@mindspring.com

2. Presentation Overview • Compare the ways developing societies have recognize disability issues. • Examine how the Global North has succeeded in mainstreaming persons with disabilities. • Consider how World Bank could create adequate, sustainable programs within the different economic and social factors of the Global South.

3. Lenses for Conceptualizing Disability • Cultural Identity - In general how does culture affect one’s own identity and self-worth? • Government Intervention- How can governmental systems assist PWD? • Poverty - Poverty and Disability – which came first? • Disability – How can it be managed? • Foreign Aid - Should the WB focus on social, economic, and/or medical? • Modernization - Technological advances, and their implication of on the disabled?

4. Cultural Identity • Like other minorities, the disability population rises against the status quo whenever they cannot access the same rights as the rest of the population. • One can presume the alienation of this population occurs more in homogenous societies or societies that are intolerant to people who have “different abilities.” • Burgess: The resurgence of ethnicity: a Myth or reality

5. Government Interventions • Capitalist Systems usually have rehabilitation programs that help disabled people adapt themselves to the needs of the organization. • Weberian Philosophy: workers adapt to the anatomy of the organization because bureaucracy is always readjusting in order to be effective. • Socialist Systems usually have quotas to ensure that organizations hire people with disabilities. • Marxist philosophy: bureaucracy would organize around the “administration of things” not “the administration of people.” • Fisher and Sirianni: Critical Studies in Organization and Bureaucracy

6. Poverty • Many disability causing diseases thrive within poor communities – where health services are nonexistent. • Three factors leading from disability to poverty: • loss of income; • incurred cost resulting from medical and equipment expenses; • and marginalization due to physical or attitudinal barriers, and lack of social services. • Elwan: Poverty and disability: A Survey of literature

7. Managing the Disabled The argument against the medical model in managing the disabled: • Reduces the disabled to a mere receptacle of health care which encourages patronizing attitudes. • Produces an industry of professionals for whom its interest is perpetuate the dependency of the disabled on healthcare providers. “Donor Dependency System.” • Tandon: Sustainable Development and persons with Disabilities

8. Foreign Aid (Including WB Loans) • Some societies concentrate on fixing the body through operations because foreign aid makes it easier to get such services. • Buying proper “assistive technology” may be more expensive then an operation because it is not foreign aid funded. • On the other hand, some indigenous societies have the latest in “assistive technology” thanks to foreign aid. • Huckenberry: Moving violations,Chapter 18

9. Modernization • Technology produces new ethical dilemmas for progressive societies. • Technology allows the West the choice of giving birth to handicapped children; but indigenous societies have the freedom from making that choice all together. • Dettwyler: Dancing Skeletons

10. Does the life of disabled people improves as a society develops?

11. Rostow’s Linear Stages Theories (a framework) • Traditional Society • The Preconditions for Take Off Stage • The Take Off Stage • The Drive to Maturity Stage • The High Mass-Consumption Stage

12. Traditional Society • People with “ impairments” are unable to produce, • their chance for survival is reduced because agricultural production is limited to only those who produce it. • Therefore “people with impairment” are thought to be invalids.

13. The Preconditions for Take Off Stage • A welfare system begins to address the needs of the children: • Society pays more attention to those with impairments. • bringing attention to the needs of the “invalids” as well.

14. The Take Off Stage • People with impairments lag behind. • Investment is spent on technology not on the improvement of social conditions for workers or the community. • Increase of impairment due to deterioration of social and working conditions.

15. The Take Off Stage (Cont.) Stratification • The minority becomes divided into two groups • Developmental Disabilities population- childhood disabilities • General Disabilities-those that are qualified for workers compensation services and other state resources, such as war veterans.

16. The Take Off Stage (Cont.) • The US, USSR and Europe experienced this stage during the industrial revolution and prior to WWII; • Seen as an fiscally sound policy, the institutional movement begins . • Today, many developing nations are in this situation. • They have strong good policy to enhance the life of disabled veterans, but • The developmental disability population is not appropriately served by the educational system; • resulting in the creation of special separate programs usually privately funded

17. The Drive to MaturityStage; • Services and employment disability policies blooms. Approaches included: (usually) • Rehabilitation and training (Capitalist Ideology) • Quota system (Socialist Ideology) • Disability-run state enterprises (Communism Ideology) • Regulations are no longer geared towards the disabled veterans but also those with work injuries.

18. The High Mass-Consumption Stage • We begin to see the mainstreaming of disabled people. • The increase in technology • A better welfare system • Cheap access to durable goods • Enabling disabled people to become assets - as productive members of society.

19. US Leads with ADA • Clearly the US is leading the world in this stage, • Only country in the world with a non-discrimination law (ADA) that asserts the right for people with disabilities to use “Assistive technology” at work . • Although the European Union is in the process of adopting similar measurements.

20. The Outcome of Development • Disability is a relative term.The concept of disability varies according to the prevalent mode of economic production. • In the US education and analytical skills are necessary to achieve economic stability. • Those with limited analytical skills may be perceived as disabled. • On the other hand, those with physical disability may be considered as invalids in an agriculture society that demands strong physical capability.

21. Disability Perception • Generally: • Global North - Identifies a disability based on “the skill one is unable to do.” • Global South - Identifies a disability based on the “part of the body that malfunctions.” • Research should concentrate more on defining the required daily tasks, then consider those who cannot perform them as disabled.

22. Measuring Disability The two widely recognized indicators contradict. • ICIDH (The International Classification of Functioning, Disability and Health) measures how people live and function with their health condition. (in population percentage) • Percentage of the disability population is higher in the North. • DALE (Disability Adjusted Life Expectancy) predicts that having a disability hinders one’s ability from living a fully productive life. (in age lost) • Population dies earlier because of disability, in the South

23. Based on the ability to contribute to the development of a society, one can often use the following categories. Invalid - is a burden on society. Severely Disabled - is unable to contribute to society but is not seen as a burden on the community Functionally Disabled - contributes in a limited way Noticeable Disability - can equally contribute to society but society has doubt on his/her ability. Not Normal - The disability is unnoticed by society because the person has the ability to contribute to society Categorizing Disability in Degrees

24. Categories for Defining Disability Programs (Amy Wilson)

25. Medical Model • NGOs that provide prosthetics to victims of war • Services that promote the institutionalization of people with mental disabilities. • Draw-backs • Are expensive to maintain and unsustainable. • May perpetuates the dependency of the disabled on healthcare providers.

26. Rehabilitation Program • Generally, NGOs that promote these programs are not consumer controlled. • The service providers are usually physical, speech or occupational therapists whose main goal is to improve the condition of the disability. • Conductive Education is a rehabilitation program popular in the Global South.

27. Social/Cultural Model • NGOs of PWD work alongside policy makers to enhance housing, education, and employment programs/regulation. • Society takes into consideration the needs of disabled people and accommodate their needs through inclusive legislation and budget allocation to implement laws – such as: • Americans with Disability Act. • Education for All concept.

28. Sustainable Programs All Three Models are Complementary • The medical model would be more effective if it is accompanied by a rehabilitation process and if it is accommodated by society. • Similarly, it is economically rational for society to accommodate those with impaired conditions when they cannot be treated by medicine.

29. What does that means in comparison to gender issues? • Empowering women does not mean teaching them how to cook. • The WB looks at education, equality and …… • When doing disability and development one should not only look at it from a medical view. • Fixing the crippled body does not nessessarely mean economic empowerment.

30. Realities of North vs. South • The North- due to good governance, modernization, and economic growth it succeeded in • Transforming the services from the medical model to a social/cultural system of mainstreaming. • The South-lacks Governance, Resources, and Systematic Policy Implementation – • As a result, the medical model becomes the only means of services to people with disabilities.

31. Missed Opportunity • Ironically,it is cheaper and easier to integrate the needs of PWD at the infrastructure stage in the Global South. • It’s much easier to design a ramp into a new facility than to retrofit an existing building. • In existing infrastructures, it is more expensive to retrofit in the effort to accommodate PWD.

32. Recommendations for the WB • Develop programs that compliment the local production Mode, because each phase of economic growth modifies the concept of disability. • Develop statistics that concentrate on defining the daily tasks of each society and consider those who can not perform them as disabled. • Promote the three Models of disability programs simultaneously because it is the most efficient way of mainstreaming PWD.

33. Thank you