Daniel Mont

Leonard Cheshire Disabi l i ty and Inclusive Development Centre

UCL

January 17, 2013

DISABILITY AND POVERTY

IN DEVELOPING

COUNTRIES

WHAT ARE DISABILITY AND POVERTY?

DISABILITY

?

POVERTY

?

DISABILITY

POVERTY

The ability to be a full member of society

HOW DO WE MEASURE THESE?

DISABILITY

?

POVERTY

?

Country Census Rate of

Disability

United States 19.4

Canada 18.5

Brazil 14.5

Ethiopia 3.8

Chile 2.2

India 2.1

OFTEN DISABILITY MEASUREMENT IS POOR

AND/OR NOT STANDARDIZED

HOW SHOULD WE MEASURE DISABILITY?

DISABILITY

Difficulties in

undertaking basic

activities – e.g.,

walking, seeing,

hearing,

remembering,

communicating

Impairments Environment

Region Percent with moderate or

severe disability

World 15.3

High Income Countries 15.4

Africa 15.3

Americas 14.1

South East Asia 16.0

European 16.4

Eastern Mediterranean 14.0

Western Pacific 15.0

Source: WHO/World Bank World Report on Disability 2011

OVERALL PREVALENCE

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

AS INCOME RISES…

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.

MEASURING POVERTY

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.

EMPIRICAL RELATION BETWEEN DISABILITY

AND POVERTY

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 POVERTY

Education Less likely to start or

complete education

Bigger correlation than socio-economic status or gender (Filmer 2008)

51 Country study – ratio of completed primary school is .83 for males, .79 for females. (WHO/World Bank 2011)

Employment Less likely to be

employed

More likely to be self-employed

Employment ratio in low income countries is .82 for males, .64 for females (WHO/World Bank 2011)

DISABILITY AND EXCLUSION

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)

PROBLEMS WITH SIMPLE CORRELATION OF

DISABILITY AND POVERTY MEASURES

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

VIETNAM CASE STUDY

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

PREVALENCE

Quintile Low Threshold High Threshold

Poorest 8.13 4.19

Near Poorest 7.87 3.75

Middle 7.53 3.71

Near Richest 7.01 3.10

Richest 7.28 3.30

DISABILITY PREVALENCE BY

EXPENDITURE QUINTILE

Zaidi/Burchardt Methodology (2005)

Create Asset Index

Regress asset index on income, disability, other explanatory

variables

Difference in assets because of dif ference in costs of

disability

ACCOUNTING FOR EXTRA COSTS OF

DISABILITY

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.

EXTRA COSTS OF DISABILITY

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

POVERTY RATES BY DISABILITY STATUS

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

REGRESSION ANALYSIS

Coefficient

Low Threshold

Onset before age 18 -.13*

Onset after age 18 -.04*

High Threshold

Onset before age 18 -.13*

Onset after age 18 -.01 * 99% confidence level

COEFFICIENTS ON DISABILITY VARIABLE IN

CONSUMPTION EXPENDITURE REGRESSION

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)

EDUCATION AND EMPLOYMENT

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

SUMMARY OF RESULTS