Bulletin of the World Health Organization

Disabled often among the ‘poorest of poor’

1 April 2005

An Oscar-winning Spanish film about a quadriplegic may raise awareness about disability, but much more is needed to galvanize international efforts to support people with disabilities, 80% of whom live in poor countries.

“My first group came from the United States. When I met them at the airport I was stunned — there were three people in wheelchairs,” Yelena Popova, a Moscow tourist guide, still raises her eyebrows in amazement as she remembers her experience eight years ago.

“I thought to myself: ‘God, I don’t think I have seen that many people in wheelchairs in Moscow in my entire life. What am I going to do with them?’

Yelena is a young, well-educated and liberal-minded person. Her bewilderment at the fact that disabled people go on tourist trips just like anyone else is a stark reminder of the contrast in attitudes towards people with disabilities in developed and developing countries.

Some 600 million people in the world experience disabilities of various kinds and the vast majority, or 80%, of them live in low-income countries, according to WHO. More often than not they are among the poorest of the poor, forced to spend their lives struggling to survive in a world where finding food and shelter is a challenge.

Their functional limitations lead to social exclusion, unequal rights and limited opportunities.

Despite collective and private efforts to prevent disability, the number of disabled people on the planet is on the rise, boosted by malnutrition, non-infectious and congenital diseases, war injuries, HIV/AIDS, chronic conditions, substance abuse and environmental damage. Population growth and life-prolonging medical advances also account for much of the increase.

People with mobility-related impairments are usually the most visible among the disabled but many activists believe that mental health conditions are by far the most likely to lead to social exclusion.

“These people need help most,” said Tatyana Kirillova, a disability activist in the central Russian city of Volgograd and herself the mother of two children with severe mobility-related and mental impairments. “Doctors put a big cross on them right from the start. Maternity nurses go out of their way to convince mothers to give up babies if they have Down syndrome.”

While the trend in wealthier countries is towards more community-based care, many low-income states still try to lock up people with disabilities at home or in specialized institutions and these people are often regarded as second-class citizens who can hardly hope for more than to be the passive recipients of aid.

The Russian Federation, a middle-income country riding the tide of massive oil revenues, is just one example of how far many societies still have to go to match their good intentions to ease the plight of the disabled with deeds.

The country has a first-rate disability law guaranteeing social security assistance to people with disabilities as well as unrestricted access to public transportation, government buildings, sports activities and a free education.