This report provides a systematic analysis of the disability questions in national censuses and household surveys globally from 2009 to 2018 and for 41 countries. It also presents nationally representative estimates of disability prevalence and 27 socioeconomic indicators disaggregated across disability status where disability is measured through questions in national census or household surveys on functional difficulties (e.g. seeing, hearing) that are considered internationally comparable.
One in four countries have national censuses or surveys that have no disability-related question at all. The general question “Do you have a disability?” remains commonly found in censuses and surveys, although it does not produce meaningful and internationally comparable data.
Forty seven percent of countries have functional difficulty questions in at least the four core domains as recommended for censuses (seeing, hearing, walking, cognition), including 18% of countries with datasets with the internationally tested Washington Group Short Set of questions.
In the 41 countries with microdata under study in this report, functional difficulties are not rare among adults and their households. Across countries, the median share of the adult population with any functional difficulty stands at 12.6%, while the median share of households with adults with functional difficulty is at 27.8%. Functional difficulties tend to be more common in rural areas, among older individuals and women.
Seeing and walking difficulties are the most common functional difficulties, followed by hearing and cognitive difficulties.
For countries with a graded answer scale for functional difficulties, having some difficulty is more common than at least a lot of difficulty.
Education, Health, Work and Standard of Living
There are inequalities associated with functional difficulties in terms of education, health, work and standard of living. A disability gap represents a significant disadvantage for persons with functional difficulties compared to persons with no functional difficulty. This report consistently found across countries a disability gap in terms of educational attainment, literacy, food insecurity, exposure to shocks, asset and cell phone ownership, health expenditures and multidimensional poverty. This gap persists even though adults with functional difficulties are more likely to receive social protection.
For a majority of countries, there is a disability gap for the employment-population ratio, the youth idle rate, the share of adults in informal work, living conditions (water, sanitation, electricity, clean fuel, adequate housing) and domestic violence. No pattern was found for family planning and the share of workers in manufacturing or managerial positions.
While persons with functional difficulties are disproportionately more likely to be multidimensionally poor, not all persons with functional difficulties are poor. Having a functional difficulty is not synonymous with being poor but increases the odds of being multidimensionally poor, even in the poorest countries.
For many countries and indicators, there is a graded association between functional difficulty and disadvantage. For instance, for multidimensional poverty, in all but three countries, persons with some functional difficulties are on average worse off than persons with no difficulty, but better off than persons who experience at least a lot of difficulty. For educational attainment, a gradient is found for all countries.
While inequalities are found for all types of functional difficulties, the largest gaps are for adults with self-care and communication difficulties.
For some indicators, functional difficulties interact with gender, age, and location (rural vs urban) so that there are pronounced intersectional disadvantages. For instance, for education, women had relatively larger disability gaps compared to men, while for work it is the opposite.
Implications For Data Collection
Disability remains absent or inadequate questions continue to be used in many countries and datasets. Functional difficulty questions should become standard in censuses and household surveys, as well as in the monitoring systems of NGOs and governments, to inform the development of disability-inclusive policies and programs. The use of the WGSS in surveys and monitoring systems would provide some of the necessary data for this monitoring to become feasible. The 2020 Census round is an opportunity to collect data on disability.
Given the positive relationship found between the severity of functional difficulties and the magnitude of the disability gap, answers to survey or census questions should avoid yes/no answers to functional difficulty questions.
While this report documents inequalities, it does not provide pathways to explain them. Information is lacking and data is needed on resources, structural factors (e.g., social norms, attitudes, and physical environment) and on health conditions which may lead to functional difficulties and/or deprivations. Data collection efforts that collect information on environmental factors such as the Model Disability Survey (e.g. Cieza et al 2018) are steps in this direction.
Implications For Data Analysis And Research
This report demonstrates that for many countries, measuring disability inequalities is feasible. More work is needed to analyze data on functional difficulties in general, and by exploiting the richness of graded answer scales, in particular. The recommendation by the Washington Group to separate in analyses persons with at least a lot of difficulty, on the one hand, from persons with some and no difficulty, on the other, seems problematic: this report has shown that persons with some difficulty are at risk of deprivations. Analyses should try to incorporate the degree of functional difficulties through different categories as in this report (disaggregation b) or a functional score rather than a simple binary (Loeb 2020; Mitra 2018).
A measure of functional difficulties should be included as a standard correlate in studies of poverty, inequalities or wellbeing. It would be inconceivable not to include age, sex, or marital status variables as correlates.
There is also a need to disaggregate poverty statistics or the MPI and more broadly relevant SDG indicators of the 2030 Agenda according to levels of functional difficulties.
This report shows higher health care out of pocket costs experienced by households with functional difficulties. This is consistent with a growing literature on the extra costs of living of households with disabilities (Banks et al 2021; Mitra et al 2017). Poverty statistics based on consumption expenditures such as the $1.90 a day do not seem adequate to capture the situation of persons with disabilities given potential extra costs of living associated with disability.
More specific policy implications need further analysis at the country level. For instance, to come up with policy insights in countries with low employment population ratios for persons with functional difficulties, one needs to conduct a root cause analysis. It could be due to how the underlying health conditions or impairments reduce the productivity of persons with functional difficulties for the types of jobs that are available. Another reason could be a lack of access to assistive devices. It could be due to structural factors, for instance, a physically inaccessible work environment and transportation systems or negative social attitudes in the community towards disability. Once the underlying causes for low employment rates among persons with functional difficulties are identified, it then becomes feasible to develop evidence-based programs and policies. The results and data presented in this report show the need for such analysis.
Implications For Policy
Disability measured through four to six questions on functional difficulties is not rare. The scope to prevent functional difficulties through the removal of environmental barriers, or access to health care and rehabilitation services needs policy attention in public health.
Disability measured through functional difficulties is highly correlated with deprivations and poverty, whether material or multidimensional. Although most of the countries under study have ratified the CRPD and some have national disability policies and legislations, more policy work is needed to curb the inequalities across functional status shown in this report. Current economic systems and societies fail to provide ways to include persons with functional difficulties.
Despite social protection programs in some of the countries under study, including cash transfer programs, inequalities across functional difficulty status are stark. The exact impact of social protection programs related to disability needs to be assessed.
The results also show that disability is a crosscutting, not a specialist, issue. Disability needs to be considered in policies related to aging, gender, health and poverty. The findings imply that disability should not be seen as a policy issue that is the luxury of high-income and aging economies.
The findings provide evidence to demand interventions and policies for the rights and the wellbeing of persons with functional difficulties. This is particularly important in the context of the pandemic where inequalities may have been exacerbated (e.g. Suraweera et al 2021). To address disability inequalities, interventions in education, social protection programs, healthcare coverage, and labor market interventions are necessary. This report highlights some of the gaps that need to be closed to make true on Agenda 2030’s pledge to ‘leave no one behind’.