DISABILITY AND POVERTY
IN DEVELOPING
COUNTRIES
D a n i el M o n t
Le o n a rd Ch e shire
D i s abilit y a n d
In c l usive
D eve lopment
Ce n t re
UCL
Ja n ua r y 17 , 2 01 3
WHAT ARE DISABILIT Y AND POVERT Y?
DISABILITY
POVERTY
?
?
DISABILITY
POVERTY
The ability to be a full member of society
HOW DO WE MEASURE THESE?
DISABILITY
?
POVERTY
?
OFTEN DISABILIT Y MEASUREMENT IS POOR
AND/OR NOT STANDARDIZED
Country
United States
Canada
Brazil
Ethiopia
Chile
India
Census Rate of
Disability
19.4
18.5
14.5
3.8
2.2
2.1
HOW SHOULD WE MEASURE DISABILIT Y?
DISABILITY
Impairments
Difficulties in
undertaking basic
activities – e.g.,
walking, seeing,
hearing,
remembering,
communicating
Environment
OVERALL PREVALENCE
Region
World
High Income Countries
Percent with moderate or
severe disability
15.3
15.4
Africa
Americas
South East Asia
European
Eastern Mediterranean
Western Pacific
15.3
14.1
16.0
16.4
14.0
15.0
Source: WHO/World Bank World Report on Disability 2011
AS INCOME RISES…
Factors decreasing
disability
 Better nutrition
 Better health care
 Safer living and
working conditions
 More accessible
environments
 Better access to
rehabilitation
Factors increasing
disability
 Increased life expectancy
 People surviving
previously fatal injuries
and diseases
“We are in transition to a
world where disability is
the dominant concern as
opposed to premature
death”
Christopher Murray, Global
Burden of Disease Study 2012
MEASURING POVERT Y
 Consumption expenditures associated with minimum
standard of living
 Income a poor measure in developing countries
because of home production, bartering, and lack of
records
 Asset indices
 Easier to measure, harder to hide
 Multidimensional measures
 Degree of deprivation in key areas, such as
education, health, living arrangements, sanitation,
etc.
EMPIRICAL RELATION BET WEEN DISABILIT Y
AND POVERT Y
Study of 15 developing countries using the
World Health Survey (Mitra, Posarac, and Vick 2011)
 High quality data on disability based on functionality
 Data on poverty indicators
Often sources do not have both types of data.
DISABILIT Y AND POVERT Y
Asset Indicators
 Disability higher in the bottom quintile in 11 countries
(statistical significance in 5)
Consumption (excluding health expenditures)
 Poverty significantly higher among disabled people in 4
countries
Multi-Dimensional Indicators
 Average deprivations higher among disabled people in 11 of 14
countries
 Number of deprivations – Employment, Education, Per Capita
Expenditures, Health Ratio, Electricity, Water, Toilet, Floor,
Cooking, Assets
DISABILITY AND EXCLUSION
Education
Employment
 Less likely to start or
complete education
 Bigger correlation
than socio-economic
status or gender (Filmer
 Less likely to be
employed
 More likely to be selfemployed
 Employment ratio in
low income countries
is .82 for males, .64
for females (WHO/World
2008)
 51 Country study –
ratio of completed
primary school is .83
for males, .79 for
females. (WHO/World Bank
2011)
Bank 2011)
PROBLEMS WITH SIMPLE CORRELATION OF
DISABILIT Y AND POVERT Y MEASURES
 Extra costs of disability
 Medical expenditures, transportation, housing, assistive devices,
rehabilitation services, etc.
 Date of onset
 Does disability occur in post-earning years, or at least late enough for
assets or skills to have been accumulated?
 Family formation
 Are disabled people more likely to be living with extended family?
Important because poverty is usually a household measure.
 Link between income and self-reporting of
difficulties
 Higher income more likely to report more mild functional difficulties
(Scott and Mete 2008)
VIETNAM CASE STUDY
 2006 VHLSS has data on functional difficulties
 Six domains: Vision, Hearing, Mobility, Cognition, Communication,
Self-Care
 Scaled responses: No Difficulty, A Little Difficulty, A Lot of Difficulty,
Unable to Do
 High quality data on consumption
Mont and Cuong, WBER 2011
PREVALENCE
 15.7% had difficulty in at least one functional
domain
 For technical reasons having to do with vision
questions, the definition of disability was changed to
exclude people with mild vision problems but no
other difficulties
 Using low threshold – 7.6% prevalence
 Using high threshold – 3.6% prevalence
DISABILIT Y PREVALENCE BY
EXPENDITURE QUINTILE
Quintile
Poorest
Near Poorest
Middle
Near Richest
Richest
Low Threshold
8.13
7.87
7.53
7.01
7.28
High Threshold
4.19
3.75
3.71
3.10
3.30
ACCOUNTING FOR EXTRA COSTS OF
DISABILIT Y
 Zaidi/Burchardt Methodology (2005)
 Create Asset Index
 Regress asset index on income, disability, other explanatory
variables
 Dif ference in assets because of dif ference in costs of
disability
EXTRA COSTS OF DISABILIT Y
 Poverty line should be adjusted 11 .5% higher
 These are estimates of the actual extra expenditures.
Expenditures could rise as more services and devices become
available. Though presumably there will be extra benefits to
those expenditures.
POVERT Y RATES BY DISABILIT Y STATUS
Characteristic
Non-Disabled
People
Disabled People
Adjusted Poverty
Line - Disabled
People
All
15.09
17.16
22.31
Male
14.60
17.46
22.55
Female
15.57
16.94
22.13
Age 5-18
19.29
31.08
36.24
Age 19-40
15.14
24.72
31.42
Age 41-62
9.93
11.90
15.28
Older than 62
14.45
17.01
22.82
Urban
3.61
5.53
6.63
Rural
19.32
21.44
28.09
REGRESSION ANALYSIS
 Age of Onset
 Low vs. High Threshold
 Explanatory Variables – rural/urban, family
structure, region of residence, household head’s age
and education
 District Level fixed effects
 Controls for things like epidemics and natural disasters that
can impact both poverty and disability
COEFFICIENTS ON DISABILIT Y VARIABLE IN
CONSUMPTION EXPENDITURE REGRESSION
Coefficient
Low Threshold
Onset before age 18
Onset after age 18
High Threshold
Onset before age 18
Onset after age 18
* 99% confidence level
-.13*
-.04*
-.13*
-.01
EDUCATION AND EMPLOYMENT
 Disabled children 41% to 47% less likely to attend
school
 Disabled people work less – especially if disabled
prior to age 18
 Disabled adults in a household significantly reduce
non-disabled children’s school attendance (Cuong and
Mont, for thcoming)
SUMMARY OF RESULTS
 Care must be taken in measuring disability
 Extra costs of disability must be taken into account
when examining poverty
 Age of onset is very important when looking at the
impacts of disability
 Overall, disabled people are poorer and face
significant barriers to employment and education