Disability-Inclusive
Development:
Regional Perspectives in
Latin America and the
Caribbean
Diane Alméras
Contents
I.
Regional follow-up of CRPD
II. Availability of disability statistics in LAC
III. Policy priorities: autonomy, independence
and care
I. Regional follow-up of CRPD
• Thirty countries out of 33 have signed and/or ratified the
Convention, of which 22 have signed and 20 ratified its Optional
Protocol.
• Most governments have established a national mechanism
responsible for the follow-up of the Convention and are creating a
growing body of national policies as well as of specific and generic
legislation.
• Few of them can demonstrate that these mechanisms and policy
instruments were elaborated with the active participation of
representatives of the organizations of persons with disability.
• ECLAC’s contribution is oriented toward awareness raising, research
and access to knowledge.
• Actual priorities of the Regional Commission are 1) measuring the
scale of disability; 2) gathering information to assess national policy
proposals; 3) promoting social inclusion and autonomy and 4)
support the formulation of a first regional agenda.
II. Availability of disability statistics in LAC
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In spite of the increased activity of statistics collection, available data are
not entirely comparable between countries and still presents difficulties
for generating a reliable prevalence rate in the region, especially in the
Caribbean.
Estimates vary according to the degree of disability assessed using the
questions contained in the various measurement instruments: censuses,
household surveys or specialized surveys.
According to the latest available data from 33 countries, between 2000
and 2011, 66 millions persons were living in some form of disability in
Latin America and the Caribbean. More updated (unavailable) figures
could easily exceed the 85 millions estimated by the World Bank.
Over 12% of the population —5.4% in the Caribbean and 12.4% in Latin
America— lives with some form of disability, although the criteria used
to compile data is different depending of the countries.
Regional Perspectives in Latin America and the Caribbean
Diane Alméras
Implementation of the recommendations of
the Washington Group on Disability Statistics
• Countries which have already conducted their census for this round have
all used the new approach with exception of Ecuador (2010), albeit with a
few changes or using yes/no responses instead of including the four
degrees of severity:
• Latin America: Argentina (2010), Brazil (2010), Costa Rica (2011), Mexico
(2011), Panama (2010) and Uruguay (2011)
• The Caribbean: Anguilla (2011), Antigua and Barbuda (2011), Aruba
(2010), Belize (2010), British Virgin Islands (2010), Dominica (2011),
Grenada (2011), Montserrat (2011), Saint Kitts and Nevis (2011), Saint
Lucia (2010), Saint Vincent and the Grenadines (2011) and Trinidad and
Tobago (2011).
• Methodological differences have a direct impact on figures and caution
must be exercises when making comparisons.
Scale of disability in Latin America and the Caribbean
• Disability is more prevalent in countries with an older population.
Based on estimates from UNFPA, the over-60 population currently
makes up 10% of the total population of LAC and is expected to
reach 20% shortly.
• In over half the countries, disabilities are much more prevalent
among women than among men, especially when aged 60 and over.
• Population groups which are most economically and socially
vulnerable exhibit higher rates of disability: rural-dwellers,
indigenous peoples and Afro-descendants in Latin America, and
those with lower incomes.
• These groups register both a higher incidence of disability an a
greater degree of disability owing to a lack of timely care:
households where there a more persons with disabilities also lack
resources of access to services.
Latin America and the Caribbean (31 countries):
prevalence of disability by sex (Number per thousand)
Latin America and the Caribbean (29 countries):
Population ageing and Disability
Persons with disabilities are more concentrated in older and low-income
populations: prevalence of disability (all types) by age group and income
quintile in Chile, Costa Rica and Mexico
(Per 1,000 inhabitants)
III. Policy priorities: autonomy, independence and care
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Care policies for persons with disabilities should be geared towards
enhancing their autonomy and dignity.
Assistance and care requirements for persons with disabilities are
rising in the region as well as the rest of the world. Reasons include:
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Demographic transition, with its rising incidence of chronic and
degenerative diseases
Medical advances are boosting catastrophic injury survival rates
Unhealthy lifestyles
Poverty which continues to rise in absolute numbers if not in percentages
in our region
Armed conflicts, urban violence and gender violence are also important
causes of disability
Lack of policies for prevention and timely assistance
Social inequalities are heightened by a lack of appropriate services
since care and rehabilitation are often complex, costly and, when
provided privately, available only for a small proportion of population.
The concept of disability and care is evolving
Biomedical model
Consequences of
the illness as a personal
problem
Adaptation to the
new situation
Rehabilitation and
daily needs care
Social
model
Functional autonomy
model
The consequences are not a
characteristic of
the person, but rather
changes in the way
they interact with the
environment
The consequence is a complex
interaction between altered
health and environmental
factors
Social integration of people
who suffer the
consequences
of an illness
Building capacities
Individual treatments and
social action for personal and
environmental change
Quality assistance and support
to guarantee
the right to exercise
personal autonomy
Living independently and being included
in the community (Article 19 of CRPD)
• Autonomy refers to the ability to live in community with little
or no help from others albeit with assistive technologies
• Independence is understood as the ability to take decisions
and be responsible for their consequences according to
personal preferences and environmental requirements, even
if someone else’s help and support is needed.
• Independent living includes family and community support,
residential support services, respite services, information and
advice.
• The need for support services is determined by individual
functioning, health conditions, stage of life cycle and
environmental factors.
Living with different types and levels of disability
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The same types of disability are prevalent throughout the 21 Latin American
and Caribbean countries:
• Visual impairment and trouble walking, going up stairs or moving the
lower extremities are the most common disabilities, followed by:
• Speech and hearing impairments in Latin America;
• Mental impairments that have an impact on behaviour and reduced
dexterity for self-care and using objects in the Caribbean.
Persons with a visual disability have less difficulty in entering the school
system and the labour force. Next come persons with auditory and motor
disabilities.
Persons with impairments in cognitive and mental functions have fewer
opportunities for social integration and difficulties in looking after
themselves.
Available data confirm the rising incidence of multiple disability over the life
cycle, which creates additional care problems, both because different kinds
of support are needed and the growing dependence of these persons.
Living and care arrangements
• Percentage of persons with disabilities who live alone is particularly high.
• The majority receive care and support from immediate family, especially
women.
• This situation takes an heavy toll on the family’s emotional and financial wellbeing and highlights the shortfall in the supply of care services provided by
the State, the market and civil society organizations.
• Increasing number of countries of ALC are rolling out government
programmes that provide support to family care-givers, home-care services
and support for independent living.
• Actual public and private services in the region include help for shopping,
cleaning and cooking and companionship.
• Some countries now offer a basic level of medical care in the home as well as
the provision of technical aids and varying degrees of economic assistance to
help pay for care, rehabilitation services and home adaptation.
Accessibility as a barrier to independent living
• Accessibility must be framed in terms of not only physical access,
but all barriers that either restrict or prevent persons with
disabilities from participating in society, including access to
information and attitudinal behaviours.
• Access must be viewed as multidimensional and cross cutting,
which spans a broad range of support and services including access
to education, employment, health, family, social and recreational
participation.
• Physical environment is often a barrier to the physical mobility of
persons with disabilities, in particular the absence of adequate
transportation, ramps and special parking facilities.
• Architecture design often serve to restrict access to buildings,
private and public spaces and services, including courts of law,
police stations and polling stations.
Autonomy and protection of economic
and social rights
• Persons with disabilities are overrepresented in the figures on poverty,
unemployment, low educational achievement and discrimination.
• Access to inclusive education, employment and social security
coverage for persons with disabilities should be viewed within the
framework of social care governance.
• In addition to social inclusion, school attendance helps develop the
capacity to express oneself and make decisions.
• Paid work is a source of empowerment and autonomy.
• Greater functional autonomy and independence allows for a greater
capacity for self-care and defending our human rights.
• Public policies and interventions that are centered on solidarity, care,
respect of human rights and autonomy are both an ethical and
practical imperative.