Disability and Poverty in the Global South

Renegotiating Development in Guatemala

Shaun Grech

• Publisher: Palgrave Macmillan
• Year: 2015
• Print ISBN: 9781349558735, 9781137307972
• eBook ISBN: 9781137307989
• Topic: Ciencias sociales
• Subtopic: Economía del desarrollo

Drawing from long term ethnographic work and practice in Guatemala, this incisive and interdisciplinary text brings in perspectives from critical disability studies, postcolonial theory and critical development to explore the various interactions and dynamics between disability and extreme poverty in rural areas.

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Disability, Poverty and Development: Mapping the Terrain

International development meets disability: (dis)encounters

Numbers remain a powerful force in a world compelled to simplify and contain life’s nuances and complexities. They are work, money and power for those producing them, but they can also be strong political tools for action. The urge to enumerate has not spared disability in the attempt to make it epistemologically, discursively and practically manageable. The much-anticipated World Report on Disability, published by the World Bank and WHO in 2011, estimates that some 15 per cent of the world’s population, or rather some 1 billion people, are disabled people. Following the lead from earlier WHO figures, the report states that around 80 per cent of these are located in the so-called global South. Many are said to be women, the bulk living in rural areas, often in conditions of intense poverty.

The reality, though, is that no one really knows how many disabled people there are in the world, perhaps not even in a single country, or the extent of the poverty they experience. We most probably never will, because disability means different things to different people across cultures,¹ histories, contexts, bodies, spaces and places. We don’t really know what we are measuring or how to measure it (disability or poverty), because this depends on who is asking what, and what he or she values and prioritises. Methods also vary. Standardisation is, in fact, as hard as it is problematic, and perhaps it is unreal or impossible See Eide (forthcoming) for more on critical issues in disability statistics.² Life itself conspires against standardisation, and numbers are ultimately just that … numbers. They, too, despite the positivist claims to the contrary, are imbued with subjectivity.

Still, and even without precise numbers, what we do know is perhaps all we need to know and what we’ve known all along: there are many disabled people in the world, and there will always be; most may be located in the global South with numbers rising for very obvious reasons (violence, conflict, malnutrition, accidents, natural disasters, environmental degradation and the list goes on), reasons the global North may have more than a cursory responsibility for – historically too; a substantial number of disabled people in parts of this Southern space are living in a poverty that has long colonial and historical lineages; life remains tough for many disabled people in a world replete with disablism.

The subject of disability in the global South lingered on the fringes of or outside research and practice right up till the end of the 1990s, with published work on the subject (and I mean that written in English) very scarce right up till then. The attention to disability in these spaces has come largely through the efforts of those seeking to create linkages between disability and international development. In fact more recently, the term ‘disability and development’ has come to stand in as referent for ‘global disability’ or ‘disability in the global South’, a ‘new’ field of thought and practice. Some took the task of linking the two very seriously, carving out careers as academics, consultants, activists and practitioners. Taking inspiration from or perhaps copying the earlier gender-mainstreaming discourse popular among development circles, these parties started calling for ‘disability mainstreaming’, a project aimed ambitiously at infusing disability within all areas and aspects of development (see Miller and Albert, 2005). Increasing literature, much of which grey literature and organisational reports, emerged to support the idea that disability is not only related to but also cross-cuts the broader development agenda. Donors, development agencies and international organisations picked up some of this discourse, at times conveniently so, publishing the odd document linking disability and development, speculating why disability is relevant to or should be included in their work (see for example DFID, 2000; GTZ, 2006). Others published some or other disability policy in theory guiding their work (see Lord et al., 2010). The disability/development connection garnered more visibility through some notable initiatives in recent years. The UN Convention on the Rights of Persons with Disabilities (CRPD), which came into force in 2008, provided quite some impetus in outlining the rights violations of disabled people. Article 32 of the CRPD provides for issues concerning development cooperation, suggesting the need to make development inclusive by providing a comprehensive framework for governments. The Word Report on Disability, published in late 2011, a joint effort by the WHO and the World Bank, was another notable output. While not a legal document, and while it may take a while to see if and how this report will contribute (if at all) to the well-being of disabled people in practice, it still goes some way towards rendering disability more visible, especially to global policy makers and institutions. It also devotes substantial importance to the assumed disability/development nexus, dedicating a whole section to the subject, recommending perhaps predictably enough (among other things), the need to mainstream disability.

Overall, the arguments suggesting why disability must be included or rather mainstreamed in development have been pretty consistent over the past ten or so years, including the assumed connections between disability and the MDGs; linkages with the rights-based approach; economic arguments; and, more importantly, the oft-mentioned bind between disability and poverty. I briefly map out each of these below.

From the MDGs to Post-2015

The Millennium Development Goals (MDGs) went quite some way in informing development discourse, policy and practice for the past 15 years, though not without criticism. Notwithstanding the fact that disability was not mentioned in any of these eight goals, those lobbying stressed that disability not only cross-cut but was ubiquitous in every single one of them (see for example Groce and Trani, 2009). Disabled people were said to be disproportionately disadvantaged in most, or all, of these areas and consequently would have impacted their achievement or otherwise, the implication being that addressing their needs and including them was a practical but also political matter of urgency. The fact, though, that the MDGs made no reference to disability remained a permanent reminder that disability was a very low priority in the development agenda. In addition, numerous problems have and continue to haunt these targets, influencing how realistic this disability/MDGs linkage was in the first place. Many of the MDGs are off track even at their close, and much of the poverty reduction that did happen, and was celebrated, has frequently been accompanied by profound inequality, with serious repercussions for those in dire poverty, including disabled people. Other concerns have been raised among various critics, including a top-down orientation; Western understandings of well-being, the measures to be taken to achieve this and the indicators to monitor progress; an exclusive focus on those easier to lift out of poverty; and an implementation process notoriously insensitive to the complexity, heterogeneity and nuances of contexts and cultures. Furthermore, the focus on quantifiable indicators has meant that other important but not easily quantified objectives, such as equality and distribution, were consistently bypassed by these indicators not disaggregated by gender, race or, in this case, disability. Perhaps some of the major criticisms of these MDGs came from Saith (2007), who alerted us to numerous shortcomings and potential dangers: the use and abuse of statistics and misrepresentation of outcomes by international organisations and governments to justify the strategies adopted (too often neoliberal, many times harmful to the poor); poor data availability and quality; and the failure to adequately represent dimensions of well-being. Critically, the MDGs appeared to locate development problems squarely in the global South, to be resolved exclusively through standardised targets and measures dictated by global North nations with little or no consultation. A few years back, Barton (2004) observed how the MDGs were in practice becoming another form of conditionality like Structural Adjustment Programmes (SAPs). Antrobus (2004:14) also questioned how possible it was to achieve the MDGs when neoliberal prescriptions continued to leave governments with no funds to invest in poverty reduction and the other targets. Unfortunately, while reference has too frequently been made to the need to include disability in these goals, the MDGs themselves have hardly, if ever, been placed under a critical lens by those doing the lobbying. This is a critical void when disability has almost invariably been excluded in broader critiques of the MDGs in development literature and by those addressing their impacts on other populations, including women, children and ethnic minorities. It is an even more serious issue when the new goals for post-2015 are negotiated (see below), and lessons should be usefully drawn upon to, at the very least, ensure disabled people are protected as they confront these generalised, generalising and perhaps ableist goals, the desires and ‘strategies’ of those running the corridors of power.

The rights-based discourse

While some stressed the MDGs, others created linkages with development by capitalising on the broader shift towards a rights-based approach in development (RBA) in the 1990s (see GIZ and CBM, 2012). Founded on the premise that poverty is a violation of human rights rather than a question of charity, the RBA promotes instead a human-centred development focusing on people and their equal choices and opportunities. Attention is therefore directed towards issues of discrimination, equality and equity, to be addressed through measures promoting advocacy and empowerment. In this case, so-called ‘vulnerable groups’, their needs and inclusion in the development process are prioritised. This approach bears strong similarities to that espoused by the disability movement. With respect to disability in development, attention therefore shifts from solely focusing on prevention and rehabilitation towards equal rights and participation in all spheres of life. The move towards a rights-based approach has, to an extent, provided a platform for disabled people and their organisations to engage in some dialogue with the development sector in the attempt to politicise disability as a question of human rights. The rights-based approach in development, though, has not been without its critics, from within development or from the peripheries. Much of this critique of the RBA has various serious implications for disabled people: lack of guidelines on how to implement it; implementation problems, including cultural and contextual insensitivity; lack of government funds, strategy and commitment and ineffective monitoring and enforcement (Uvin, 2004); the problem of universality versus cultural relativism (Hansen and Sano, 2006); power biases towards the global North and cultural imperialism (Grech, 2009; Katsui, 2012; Soldatic and Grech, 2014); and the lack or absence of poor people in the design and implementation of policies and poverty-reduction strategies (Hickey and Mohan, 2004). But, and yet again, a critique of the rights-based approach and how it interacts with and impacts disability, if it does at all, comes up short in disability and development circles, a critique all too relevant as the CRPD gains ground, at least discursively (see below).

The economic argument

While the connections with the MDGs and the RBA remained consistent among some, others resorted to the all-too-familiar economic argument, stressing how the exclusion of disabled people, in particular from employment, comes at a high economic cost for households and hence economies at large. Disabled people, therefore, are said to become ‘an economic burden both on the family and ultimately on the state by increasing the general level of poverty’ (Coleridge, 2007:113). This argument is similar to the 1970s’ Women in Development (WID) approach, which sought to highlight to policy makers the perceived ‘inefficiencies’ of women’s abandoned economic contributions to development. And rather suspicious guesstimates followed. A World Bank study claimed that the GDP lost to disability was between US$1.3 trillion and US$1.9 trillion or 5.3 per cent and 6.97 per cent of total global GDP (Metts, 2000). In a 2011 document entitled The Great Push: Investing in Mental Health, the WHO claimed that ‘given the pervasive nature of mental illnesses, inaction results in higher cost and lower productivity’ followed by the presentation of generalised/ing ‘data’ that in the UK, ‘one survey showed that people with psychosis took an average of 45 days a year off work’. In another of these haphazardly written offerings (WHO, 2013:1), it goes on to restate how ‘mental health impedes an individual’s capacity to realize their potential, work productively, and make a contribution to their community’. Those lobbying to push disability into development have been and continue to be unreflective and uncritical, perhaps scared of criticising the WHO and its daunting presence and authority as the purveyor of health talk and practice, but also funding. This ableist discourse, not least the problematising of disabled bodies and minds as unproductive—more aptly as a social and economic burden—continues unabated, unquestioned and unchallenged. Fewer still see the profound contradictions imbuing this discourse when these same parties talk about rights, empowerment and community, for example in Community-Based Rehabilitation (CBR) (see below).

Disability and poverty

The most frequent and conspicuous argument for disability mainstreaming, though, has been and continues to be the reference to an assumed relationship between disability and poverty, one often described as a mutually reinforcing cycle (see for example Groce et al., 2011; Palmer, 2012). The main tenet is simple: life in poverty increases the likelihood of or vulnerability to impairment, while disability enhances the likelihood of poverty and/or intensifies it. The assumption of a disability and poverty relationship has and continues to serve well the basic argument of lobbyists: if international development is concerned with poverty and its alleviation, and if disabled people are among the poorest, then development cannot possibly exclude disabled people. Poverty can indeed lead to impairment through various channels, and these include malnutrition, inadequate health care, unassisted births, accidents, natural disasters, violence and conflict (including landmines), HIV/AIDS, inadequate infrastructure and unsafe transport and unsanitary living and working conditions among many others.³ The notion of a disability and poverty cycle suggests in turn that disability shifts poverty. Two emerging arguments have featured prominently in the disability and development literature. First of all, disabled people are said to fall deeper into poverty not necessarily because of their impairment but on account of exclusion. This approach borrows from the hegemonic materialist social model of disability dichotomising disability and impairment (see Oliver, 1990).⁴ This statement is illustrative: ‘an individual who is born with or who becomes disabled is more likely to be poor, not because of their disability but rather because that individual faces social marginalization…’ (Groce et al., 2012:9). The second argument is that disabled people are among the poorest of the poor in their respective communities, an argument bearing strong similarities to discourse in development asserting the feminisation of poverty. See Chant (2010) for a critical reading. The World Report on Disability (WHO and World Bank, 2011) claims that 82 per cent of disabled people in the global South live in conditions of poverty.⁵

The assumption of this poverty and disability relationship echoed far and wide, re-emerging in more documents with sometimes speculative numbers highlighting barriers in a range of areas, such as social protection (see Mitra, 2010) and employment. As many as 80 to 90 per cent of disabled people in the global South are said to be unemployed (Berman Bieler, 2006). While the rhetoric of ‘inclusive education’ and ‘education for all’ have contributed to positive shifts in discourse and policy, in practice, some 90 per cent of disabled children, especially girls, do not attend school in the global South. Many hail from indigenous and rural areas. Overall, these figures are perhaps unsurprising when one considers that globally, 61 million children of primary school age are out of school, the majority in the global South (UNESCO, 2012). Disabled people face other barriers including to health and rehabilitation, the latter said to reach less than 2 per cent in these contexts (WHO and World Bank, 2011). That disability and poverty are deeply connected has become a reasonably obvious notion even without a sound research base and critical analysis (see below). Still, this discourse has done much to support the very basic consideration that disabled people may, after all, be considered ‘legitimate’ poor in development practice. The linkages between disability and poverty are the main object of this book and will be critically explored in depth in the chapters that follow.

Beyond the rhetoric: disjuncture

Despite the enthusiastic efforts, though, what has driven and continues to drive the lobby is the fact that in practice, disability continues to be relegated to the peripheries or excluded from mainstream development policy, research and programmes. Riddell (2010) estimates that less than 5 per cent of overseas development assistance (ODA) is allocated to disability. International organisations, just like neoliberal universities, follow the scent of money, and the truth is that disability is not a sexy subject. The hierarchical relationship between donor and recipient is important here,⁶ a Faustian pact where priority areas are determined by donors, and where loyalty and accountability point upwards towards those holding the purse strings and rarel...

Table of contents

• Cover
• Title
• Copyright
• Contents
• List of Figures and Maps
• Acknowledgements
• Terminology
• List of Acronyms and Abbreviations
• 1 Disability, Poverty and Development: Mapping the Terrain
• 2 Guatemala: Landscapes
• 3 Disability in the Spaces of Poverty: Critical Theoretical Introductions
• 4 Disability and Poverty: Connections and Transitions
• 5 Disability and Poverty: Connections and Transitions Part 2
• 6 The Disabled Family: From Survival Struggles to Collective Impoverishment
• 7 (Un)transforming Structures: The Institutional Framework
• 8 Final Reflections
• Notes
• References
• Index