The first ever World report on disability, produced jointly by WHO and the World Bank, suggests that more than a billion people in the world today experience disability. People with disabilities have generally poorer health, lower education achievements, fewer economic opportunities and higher rates of poverty than people without disabilities. This is largely due to the lack of services available to them and the many obstacles they face in their everyday lives. The report provides the best available evidence about what works to overcome barriers to health care, rehabilitation, education, employment, and support services, and to create the environments which will enable people with disabilities to flourish. The report ends with a concrete set of recommended actions for governments and their partners.
Disability can be conceptualized on a continuum from minor difficulties in functioning to major impacts on a person’s life. Countries are increasingly switching to a continuum approach to measurement, where estimates of prevalence of disability – and functioning – are derived from assessing levels of disability in multiple domains. Estimates vary according to where the thresholds on the continuum of disability are set, and the way environmental influences are taken into account. Disaggregating these data further by sex, age, income, or occupation is important for uncovering patterns, trends, and other information about “subgroups” of people experiencing disability.
Data on all aspects of disability and contextual factors are important for constructing a complete picture of disability and functioning. Without information on how particular health conditions in interaction with environmental barriers and facilitators affect people in their everyday lives, it is hard to determine the scope of disability. People with the same impairment can experience very different types and degrees of restriction, depending on the context. Environmental barriers to participation can differ considerably between countries and communities.
Based on 2010 population estimates – 6.9 billion with 5.04 billion 15 years and over and 1.86 billion under 15 years – and 2004 disability prevalence estimates (World Health Survey and Global Burden of Disease) there were around 785 (15.6%) to 975 (19.4%) million persons 15 years and older living with disability. Of these, around 110 (2.2%) to 190 (3.8%) million experienced significant difficulties in functioning. Including children, over a billion people (or about 15% of the world’s population) were estimated to be living with disability.
Estimates of the prevalence of children with disabilities vary substantially depending on the definition and measure of disability. As presented above, the Global Burden of Disease estimates the number of children aged 0–14 years experiencing “moderate or severe disability” at 93 million (5.1%), with 13 million (0.7%) children experiencing severe difficulties. In 2005 the United Nations Children’s Fund (UNICEF) estimated the number of children with disabilities under age 18 at 150 million.
Children who screened positive for increased risk of disability were also more likely than others:
- to come from poorer households;
- to face discrimination and restricted access to social services, including early-child- hood education;
- to be underweight and have stunted growth;
- to be subject to severe physical punishment from their parents.
(UNICEF, 2008)
The Report focuses on measures to improve accessibility and equality of opportunity; promoting participation and inclusion; and increasing respect for the autonomy and dignity of persons with disabilities.
- Chapter 1 defines terms such as disability, discusses prevention and its ethical considerations, introduces the International Classification of Functioning, Disability and Health (ICF) and the CRPD, and discusses disability and human rights, and disability and development.
- Chapter 2 reviews the data on disability prevalence and the situation of people with disabilities worldwide, including for children.
- Chapter 3 explores access to mainstream health services for people with disabilities. Chapter 4 discusses rehabilitation, including therapies and assistive devices.
- Chapter 5 investigates support and assistance services, including a section on deinstitutionalization for both adults and children with disabilities.
- Chapter 6 explores inclusive environments, both in terms of physical access to buildings, trans- port, and so on, but also access to the virtual environments of information and communication technology.
- Chapter 7 discusses education, including inclusive education for children.
- Chapter 8 reviews employment for people with disabilities.
Each chapter includes recommendations, which are also drawn together to provide broad policy and practice considerations in Chapter 9.