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World Report on Disability (WHO)

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Abstract

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. This pioneering World report on disability will make a significant contribution to implementation of the Convention on the Rights of Persons with Disabilities. At the intersection of public health, human rights and development, the report is set to become a "must have" resource for policy-makers, service providers, professionals, and advocates for people with disabilities and their families.
WORLD REPORT
ON DISABILITY
WHO Library Cataloguing-in-Publication Data
World report on disability 2011.
1.Disabled persons - statistics and numerical data. 2.Disabled persons - rehabilitation. 3.Delivery of health care.
4.Disabled children. 5.Education, Special. 6.Employ ment, Supported. 7.Health polic y. I.World Health Organization.
ISBN 978 92 4 156418 2 (NLM classification: HV 1553)
ISBN 978 92 4 068521 5 (PDF)
ISBN 978 92 4 068636 6 (ePUB)
ISBN 978 92 4 068637 3 (Daisy)
© World Health Organization 2011
All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be
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whether for sale or for noncommercial distribution – should be addressed to WHO Press through the WHO web site (http://
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The designations employed and the presentation of the material in this publication do not imply the expression of any opinion
whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of
its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border
lines for which there may not yet be full agreement.
The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or
recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and
omissions excepted, the names of proprietary products are distinguished by initial capital letters.
All reasonable precautions have been taken by the World Health Organization to verif y the information contained in this
publication. However, the published material is being distributed without warranty of any kind, either expressed or implied.
The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health
Organization be liable for damages arising from its use.
Printed in Malta
iiiiii
Contents
Foreword ix
Preface xi
Acknowledgements xiii
List of contributors xv
Introduction xxi
Understanding disability 1
What is disability? 3
Environment 4
The diversity of disability 7
Prevention 8
Disability and human rights 9
Disability and development 10
Disability – a global picture 19
Measuring disability 21
Prevalence of disability – difficulties in functioning 24
Country-reported disability prevalence 25
Global estimates of disability prevalence 25
Health conditions 32
Trends in health conditions associated with disability 32
Demographics 34
Older persons 34
Children 36
The environment 37
Health conditions are affected by environmental factors 37
Disability and poverty 39
Developed countries 39
Developing countries 39
Needs for services and assistance 40
iv
Costs of disability 42
Direct costs of disability 43
Indirect costs 44
Conclusion and recommendations 44
Adopt the ICF 45
Improve national disability statistics 45
Improve the comparability of data 46
Develop appropriate tools and fill the research gaps 46
General health care 55
Understanding the health of people with disabilities 57
Primary health conditions 57
Risk of developing secondary conditions 58
Risk of developing co-morbid conditions 59
Greater vulnerability to age-related conditions 59
Increased rates of health risk behaviours 59
Greater risk of being exposed to violence 59
Higher risk of unintentional injury 60
Higher risk of premature death 60
Needs and unmet needs 60
Addressing barriers to health care 62
Reforming policy and legislation 65
Addressing barriers to financing and affordability 66
Addressing barriers to service delivery 70
Addressing human resource barriers 77
Filling gaps in data and research 80
Conclusion and recommendations 81
Policy and legislation 82
Financing and affordability 82
Service delivery 82
Human resources 83
Data and research 83
Rehabilitation 93
Understanding rehabilitation 95
Rehabilitation measures and outcomes 95
Rehabilitation medicine 97
Therapy 100
Assistive technologies 101
Rehabilitation settings 101
Needs and unmet needs 102
Addressing barriers to rehabilitation 103
Reforming policies, laws, and delivery systems 104
National rehabilitation plans and improved collaboration 105
Developing funding mechanisms for rehabilitation 106
v
Increasing human resources for rehabilitation 108
Expanding education and training 110
Training existing health-care personnel in rehabilitation 111
Building training capacity 112
Curricula content 112
Recruiting and retaining rehabilitation personnel 112
Expanding and decentralizing service delivery 114
Coordinated multidisciplinary rehabilitation 114
Community-delivered services 114
Increasing the use and affordability of technology 117
Assistive devices 117
Telerehabilitation 118
Expanding research and evidence-based practice 119
Information and good practice guidelines 120
Research, data, and information 121
Conclusion and recommendations 121
Policies and regulatory mechanisms 122
Financing 122
Human resources 122
Service delivery 122
Technology 123
Research and evidence-based practice 123
Assistance and support 135
Understanding assistance and support 138
When are assistance and support required? 139
Needs and unmet needs 139
Social and demographic factors affecting demand and supply 140
Consequences for caregivers of unmet need for formal support services 141
Provision of assistance and support 142
Barriers to assistance and support 144
Lack of funding 144
Lack of adequate human resources 144
Inappropriate policies and institutional frameworks 145
Inadequate and unresponsive services 145
Poor service coordination 145
Awareness, attitudes, and abuse 147
Addressing the barriers to assistance and support 147
Achieving successful deinstitutionalization 147
Creating a framework for commissioning effective support services 149
Funding services 149
Assessing individual needs 150
Regulating providers 151
Supporting public-private-voluntary services 151
vi
Coordinating flexible service provision 152
Building capacity of caregivers and service users 155
Developing community-based rehabilitation and
community home-based care 156
Including assistance and support in disability policies and action plans 156
Conclusion and recommendations 157
Support people to live and participate in the community 157
Foster development of the support services infrastructure 157
Ensure maximum consumer choice and control 158
Support families as assistance and support providers 158
Step up training and capacity building 158
Improve the quality of services 159
Enabling environments 167
Understanding access to physical and information environments 170
Addressing the barriers in buildings and roads 172
Developing effective policies 173
Improving standards 173
Enforcing laws and regulations 175
The lead agency 175
Monitoring 175
Education and campaigning 176
Adopting universal design 177
Addressing the barriers in public transportation 178
Improving policies 179
Providing special transport services and accessible taxis 179
Universal design and removing physical barriers 180
Assuring continuity in the travel chain 182
Improving education and training 183
Barriers to information and communication 183
Inaccessibility 184
Lack of regulation 185
Cost 185
Pace of technological change 186
Addressing the barriers to information and technology 186
Legislation and legal action 186
Standards 188
Policy and programmes 189
Procurement 190
Universal design 191
Action by industry 191
Role of nongovernmental organizations 192
vii
Conclusion and recommendations 193
Across domains of the environment 193
Public accommodations – building and roads 194
Transportation 194
Accessible information and communication 195
Education 203
Educational participation and children with disability 206
Understanding education and disability 209
Approaches to educating children with disabilities 210
Ou t co m es 211
Barriers to education for children with disabilities 212
System-wide problems 212
School problems 215
Addressing barriers to education 216
System-wide interventions 217
School interventions 220
The role of communities, families, disabled people,
and children with disabilities 223
Conclusion and recommendations 225
Formulate clear policies and improve data and information 226
Adopt strategies to promote inclusion 226
Provide specialist services, where necessary 227
Support participation 227
Work and employment 233
Understanding labour markets 236
Participation in the labour market 236
Employment rates 237
Types of employment 238
Wages 239
Barriers to entering the labour market 239
Lack of access 239
Misconceptions about disability 240
Discrimination 240
Overprotection in labour laws 240
Addressing the barriers to work and employment 240
Laws and regulations 240
Tailored interventions 241
Vocational rehabilitation and training 245
Self-employment and microfinance 247
Social protection 248
Working to change attitudes 249
viii
Conclusion and recommendations 250
Governments 251
Employers 251
Other organizations: NGOs including disabled people’s organizations,
microfinance institutions, and trade unions 252
The way forward: recommendations 259
Disability: a global concern 261
What do we know about people with disabilities? 261
What are the disabling barriers? 262
How are the lives of people with disabilities affected? 263
Recommendations 263
Recommendation 1: Enable access to all mainstream policies,
systems and services 264
Recommendation 2: Invest in specific programmes and
services for people with disabilities 265
Recommendation 3: Adopt a national disability strategy and
plan of action 265
Recommendation 4: Involve people with disabilities 265
Recommendation 5: Improve human resource capacity 266
Recommendation 6: Provide adequate funding and
improve affordability 266
Recommendation 7: Increase public awareness and
understanding of disability 267
Recommendation 8: Improve disability data collection 267
Recommendation 9: Strengthen and support research on disability 267
Conclusion 268
Translating recommendations into action 268
Technical appendix A 271
Technical appendix B 281
Technical appendix C 287
Technical appendix D 295
Technical appendix E 299
Glossary 301
Index 311
ix
Foreword
Disability need not be an obstacle to success. I have had motor neurone disease for practically all
my adult life. Yet it has not prevented me from having a prominent career in astrophysics and a
happy family life.
Reading the World report on disability, I nd much of relevance to my own experience. I have
benetted from access to rst class medical care. I rely on a team of personal assistants who make
it possible for me to live and work in comfort and dignity. My house and my workplace have been
made accessible for me. Computer experts have supported me with an assisted communication
system and a speech synthesizer which allow me to compose lectures and papers, and to commu-
nicate with dierent audiences.
But I realize that I am very lucky, in many ways. My success in theoretical physics has ensured
that I am supported to live a worthwhile life. It is very clear that the majority of people with dis-
abilities in the world have an extremely dicult time with everyday survival, let alone productive
employment and personal fullment.
I welcome this rst World report on disability. is report makes a major contribution to our
understanding of disability and its impact on individuals and society. It highlights the dierent
barriers that people with disabilities face – attitudinal, physical, and nancial. Addressing these
barriers is within our reach.
In fact we have a moral duty to remove the barriers to participation, and to invest sucient fund-
ing and expertise to unlock the vast potential of people with disabilities. Governments throughout
the world can no longer overlook the hundreds of millions of people with disabilities who are denied
access to health, rehabilitation, support, education and employment, and never get the chance to shine.
e report makes recommendations for action at the local, national and international levels.
It will thus be an invaluable tool for policy-makers, researchers, practitioners, advocates and vol-
unteers involved in disability. It is my hope that, beginning with the Convention on the Rights of
Persons with Disabilities, and now with the publication of the World report on disability, this century
will mark a turning point for inclusion of people with disabilities in the lives of their societies.
Professor Stephen W Hawking
xi
Preface
More than one billion people in the world live with some form of disability, of whom nearly 200
million experience considerable diculties in functioning. In the years ahead, disability will be an
even greater concern because its prevalence is on the rise. is is due to ageing populations and the
higher risk of disability in older people as well as the global increase in chronic health conditions
such as diabetes, cardiovascular disease, cancer and mental health disorders.
Across the world, people with disabilities have poorer health outcomes, lower education
achievements, less economic participation and higher rates of poverty than people without
disabilities. This is partly because people with disabilities experience barriers in accessing
services that many of us have long taken for granted, including health, education, employment,
and transport as well as information. These difficulties are exacerbated in less advantaged
communities.
To achieve the long-lasting, vastly better development prospects that lie at the heart of the 2015
Millennium Development Goals and beyond, we must empower people living with disabilities and
remove the barriers which prevent them participating in their communities; getting a quality edu-
cation, nding decent work, and having their voices heard.
As a result, the World Health Organization and the World Bank Group have jointly produced
this World Report on Disability to provide the evidence for innovative policies and programmes
that can improve the lives of people with disabilities, and facilitate implementation of the United
Nations Convention on the Rights of Persons with Disabilities, which came into force in May 2008.
is landmark international treaty reinforced our understanding of disability as a human rights
and development priority.
e World Report on Disability suggests steps for all stakeholders – including governments,
civil society organizations and disabled people’s organizations – to create enabling environments,
develop rehabilitation and support services, ensure adequate social protection, create inclusive
policies and programmes, and enforce new and existing standards and legislation, to the benet
of people with disabilities and the wider community. People with disabilities should be central to
these endeavors.
Our driving vision is of an inclusive world in which we are all able to live a life of health, com-
fort, and dignity. We invite you to use the evidence in this report to help this vision become a reality.
Dr Margaret Chan
Director-General
World Health Organization
Mr Robert B Zoellick
President
World Bank Group
xiii
Acknowledgements
The World Health Organization and the World Bank would like to thank
the more than 370 editors, contributors, regional consultation partici-
pants, and peer reviewers to this Report from 74 countries around the
world. Acknowledgement is also due to the report advisors and editors,
WHO regional advisors, and World Bank and WHO staff for offering
their support and guidance. Without their dedication, support, and
expertise this Report would not have been possible.
e Report also beneted from the eorts of many other people, in par-
ticular, Tony Kahane and Bruce Ross-Larson who edited the text of the main
report, and Angela Burton who developed the alternative text and assisted
with the references. Natalie Jessup, Alana Ocer, Sashka Posarac and Tom
Shakespeare who prepared the nal text for the summary and Bruce Ross-
Larson who edited the summary report.
Thanks are also due to the following: Jerome Bickenbach, Noriko
Saito Fort, Szilvia Geyh, Katherine Marcello, Karen Peffley, Catherine
Sykes, and Bliss Temple for technical support on the development of the
Report; Somnath Chatterji, Nirmala Naidoo, Brandon Vick, and Emese
Verdes for analysis and interpretation of the World Health Survey; Colin
Mathers and Rene Levalee for the analysis of the Global Burden of Disease
study; and to Nenad Kostanjsek and Rosalba Lembo for the compilation
and presentation of the country-reported disability data. The Report ben-
efited from the work of Chris Black, Jean-Marc Glinz, Steven Lauwers,
Jazz Shaban, Laura Sminkey, and Jelica Vesic for media and communica-
tion; James Rainbird for proofreading and Liza Furnival for indexing;
Sophie Guetaneh Aguettant and Susan Hobbs for graphic design; Omar
Vulpinari, Alizée Freudenthal and Gustavo Millon at Fabrica for crea-
tive direction, art direction and photographs of cover design and images
for chapter title pages; Pascale Broisin and Frédérique Robin-Wahlin for
coordinating the printing; Tushita Bosonet for her assistance with the
cover; Maryanne Diamond, Lex Grandia, Penny Hartin for feedback on
the accessibility of the Report; Melanie Lauckner for the production of
the Report in alternative formats; and Rachel Mcleod-Mackenzie for her
administrative support and for coordinating the production process.
xiv
World report on disability
For assistance in recruiting narrative contributors, thanks go to the
Belize Council for the Visually Impaired, Shanta Everington, Fiona Hale,
Sally Hartley, Julian Hughes, Tarik Jasarevic, Natalie Jessup, Soja Korac,
Ingrid Lewis, Hamad Lubwama, Rosamond Madden, Margie Peden, Diane
Richler, Denise Roza, Noriko Saito Fort, and Moosa Salie.
e World Health Organization and the World Bank also wish to thank
the following for their generous nancial support for the development, trans-
lation, and publication of the Report: the Governments of Australia, Finland,
Italy, New Zealand, Norway, Sweden, and the United Kingdom of Great
Britain and Northern Ireland; CBM International; the Japan International
Cooperation Agency; and the multidonor trust fund, the Global Partnership
on Disability and Development.
xv
Contributors
Editorial guidance
Editorial Committee
Sally Hartley, Venus Ilagan, Rosamond Madden, Alana Ocer, Aleksandra
Posarac, Katherine Seelman, Tom Shakespeare, Sándor Sipos, Mark
Swanson, Maya omas, Zhuoying Qiu.
Executive Editors
Alana Ocer (WHO), Aleksandra Posarac (World Bank).
Technical Editors
Tony Kahane, Bruce Ross-Larson.
Advisory Committee
Chair of Advisory Committee: Ala Din Abdul Sahib Alwan.
Advisory Committee: Amadaou Bagayoko, Arup Banerji, Philip Craven,
Mariam Doumiba, Ariel Fiszbein, Sepp Heim, Etienne Krug, Brenda
Myers, Kicki Nordström, Qian Tang, Mired bin Raad, José Manuel Salazar-
Xirinachs, Sha Zukang, Kit Sinclair, Urbano Stenta, Gerold Stucki, Tang
Xiaoquan, Edwin Trevathan, Johannes Trimmel.
Contributors to individual chapters
Introduction
Contributors: Alana Ocer, Tom Shakespeare.
Chapter 1: Understanding disability
Contributors: Jerome Bickenbach, eresia Degener, John Melvin, Gerard
Quinn, Aleksandra Posarac, Marianne Schulze, Tom Shakespeare, Nicholas
Watson.
Boxes: Jerome Bickenbach (1.1), Alana Ocer (1.2), Aleksandra Posarac,
Tom Shakespeare (1.3), Marianne Schulze (1.4), Natalie Jessup, Chapal
Khasnabis (1.5).
xvi
Chapter 2: Disability – a global picture
Contributors: Gary Albrecht, Kidist Bartolomeos, Somnath Chatterji,
Maryanne Diamond, Eric Emerson, Glen Fujiura, Oye Gureje, Soewarta
Kosen, Nenad Kostanjsek, Mitchell Loeb, Jennifer Madans, Rosamond
Madden, Maria Martinho, Colin Mathers, Sophie Mitra, Daniel Mont,
Alana Ocer, Trevor Parmenter, Margie Peden, Aleksandra Posarac,
Michael Powers, Patricia Soliz, Tami Toroyan, Bedirhan Üstün, Brandon
Vick, Xingyang Wen.
Boxes: Gerry Brady, Gillian Roche (2.1), Mitchell Loeb, Jennifer Madans
(2.2), omas Calvot, Jean Pierre Delomier (2.3), Matilde Leonardi, Jose
Luis Ayuso-Mateos (2.4), Xingyang Wen, Rosamond Madden (2.5).
Chapter 3: General health care
Contributors: Fabricio Balcazar, Karl Blanchet, Alarcos Cieza, Eva Esteban,
Michele Foster, Lisa Iezzoni, Jennifer Jelsma, Natalie Jessup, Robert Kohn,
Nicholas Lennox, Sue Lukersmith, Michael Marge, Suzanne McDermott,
Silvia Neubert, Alana Ocer, Mark Swanson, Miriam Taylor, Bliss Temple,
Margaret Turk, Brandon Vick.
Boxes: Sue Lukersmith (3.1), Liz Sayce (3.2), Jodi Morris, Taghi Yasamy,
Natalie Drew (3.3), Paola Ayora, Nora Groce, Lawrence Kaplan (3.4), Sunil
Deepak, Bliss Temple (3.5), Tom Shakespeare (3.6).
Chapter 4: Rehabilitation
Contributors: Paul Ackerman, Shaya Asindua, Maurice Blouin, Debra
Cameron, Kylie Clode, Lynn Cockburn, Antonio Eduardo DiNanno,
Timothy Elliott, Harry Finkenugel, Neeru Gupta, Sally Hartley, Pamela
Henry, Kate Hopman, Natalie Jessup, Alan Jette, Michel Landry, Chris Lavy,
Sue Lukersmith, Mary Matteliano, John Melvin, Vibhuti Nandoskar, Alana
Ocer, Rhoda Okin, Penny Parnes, Wesley Pryor, Georey Reed, Jorge
Santiago Rosetto, Grisel Roulet, Marcia Scherer, William Spaulding, John
Stone, Catherine Sykes, Bliss Temple, Travis reats, Maluta Tshivhase,
Daniel Wong, Lucy Wong, Karen Yoshida.
Boxes: Alana Ocer (4.1), Janet Njelesani (4.2), Frances Heywood (4.3),
Donata Vivanti (4.4), Heinz Trebbin (4.5), Julia D’Andrea Greve (4.6), Alana
Ocer (4.7).
Chapter 5: Assistance and support
Contributors: Michael Bach, Diana Chiriacescu, Alexandre Cote, Vladimir
Cuk, Patrick Devlieger, Karen Fisher, Tamar Heller, Martin Knapp, Sarah
Parker, Gerard Quinn, Aleksandra Posarac, Marguerite Schneider, Tom
Shakespeare, Patricia Noonan Walsh.
Boxes: Tina Minkowitz, Maths Jesperson (5.1), Robert Nkwangu (5.2),
Disability Rights International (5.3).
World report on disability
xvii
Chapter 6: Enabling environments
Contributors: Judy Brewer, Alexandra Enders, Larry Goldberg, Linda
Hartman, Jordana Maisel, Charlotte McClain-Nhlapo, Marco Nicoli, Karen
Peey, Katherine Seelman, Tom Shakespeare, Edward Steinfeld, Jim Tobias,
Dia hua Yu.
Boxes: Edward Steinfeld (6.1), Tom Shakespeare (6.2), Asiah Abdul Rahim,
Samantha W hybrow (6.3), Binoy Acharya, Geeta Sharma, Deepa Sonpal (6.4),
Edward Steinfeld (6.5), Katherine Seelman (6.6), Hiroshi Kawamura (6.7).
Chapter 7: Education
Contributors: Peter Evans, Giampiero Grio, Seamus Hegarty, Glenda
Hernandez, Susan Hirshberg, Natalie Jessup, Elizabeth Kozleski, Margaret
McLaughlin, Susie Miles, Daniel Mont, Diane Richler, omas Sabella.
Boxes: Susan Hirshberg (7.1), Margaret McLaughlin (7.2), Kylie Bates, Rob
Regent (7.3), Hazel Bines, Bliss Temple, R.A. Villa (7.4), Ingrid Lewis (7.5).
Chapter 8: Work and employment
Contributors: Susanne Bruyère, Sophie Mitra, Sara VanLooy, Tom
Shakespeare, Ilene Zeitzer.
Boxes: Susanne Bruyère (8.1), Anne Hawker, Alana Ocer, Catherine Sykes
(8.2), Peter Coleridge (8.3), Cherry ompson-Senior (8.4), Susan Scott
Parker (8.5).
Chapter 9: The way forward: recommendations
Contributors: Sally Hartley, Natalie Jessup, Rosamond Madden, Alana
Ocer, Sashka Posarac, Tom Shakespeare.
Boxes: Kirsten Pratt (9.1)
Technical appendices
Contributors: Somnath Chatterji, Marleen De Smedt, Haishan Fu, Nenad
Kostanjsek, Rosalba Lembo, Mitchell Loeb, Jennifer Madans, Rosamond
Madden, Colin Mathers, Andres Montes, Nirmala Naidoo, Alana Ocer,
Emese Verdes, Brandon Vick.
Narrative contributors
e report includes narratives with personal accounts of the experiences of
people with disabilities. Many people provided a narrative but not all could
be included in the report. e narratives included come from Australia,
Bangladesh, Barbados, Belize, Cambodia, Canada, China, Egypt, Haiti,
India, Japan, Jordan, Kenya, the Netherlands, Palestinian Self-Rule Areas,
Panama, the Russian Federation, the Philippines, Uganda, the United
Kingdom of Great Britain and Northern Ireland, and Zambia. Only the
rst name of each narrative contributor has been provided for reasons of
condentiality.
Contributors
xviii
Peer reviewers
Kathy Al Ju’beh, Dele Amosun, Yerker Anderson, Francesc Aragal, Julie
Babindard, Elizabeth Badley, Ken Black, Johannes Borg, Vesna Bosnjak, Ron
Brouillette, Mahesh Chandrasekar, Mukesh Chawla, Diana Chiriacescu,
Ching Choi, Peter Coleridge, Ajit Dalal, Victoria de Menil, Marleen De
Smedt, Shelley Deegan, Sunil Deepak, Maryanne Diamond, Steve Edwards,
Arne Eide, James Elder-Woodward, Eric Emerson, Alexandra Enders, John
Eriksen, Haishan Fu, Marcus Fuhrer, Michelle Funk, Ann Goerdt, Larry
Goldberg, Lex Grandia, Pascal Granier, Wilfredo Guzman, Manal Hamzeh,
Sumi Helal, Xiang Hiuyun, Judith Hollenweger, Mosharraf Hossain, Venus
Ilagan, Deborah Iyute, Karen Jacobs, Olivier Jadin, Khandaker Jarulul
Alam, Jennifer Jelsma, Steen Jensen, Nawaf Kabbara, Lissa Kauppinen,
Hiroshi Kawamura, Peter Kercher, Chapal Khasnabis, Ivo Kocur, Johannes
Koettl, Kalle Könköllä, Gloria Krahn, Arvo Kuddo, Gaetan Lafortune,
Michel Landry, Stig Larsen, Connie Lauren-Bowie, Silvia Lavagnoli, Axel
Leblois, Matilde Leonardi, Clayton Lewis, Anna Lindström, Gwynnyth
Lleweyllyn, Mitchell Loeb, Michael Lokshin, Clare MacDonald, Jennifer
Madans, Richard Madden, andi Magagu la, Dipendra Manocha, Charlotte
McClain-Nhlapo, John Melvin, Cem Mete, Susie Miles, Janice Miller,
Marilyn Moat, Federico Montero, Andres Montes, Asenath Mpatwa,
Ashish Mukerjee, Barbara Murray, David Newhouse, Penny Norgrove,
Helena Nygren Krug, Japheth Ogamba Makana, omas Ongolo, Tanya
Packer, Trevor Parmenter, Donatella Pascolini, Charlotte Pearson, Karen
Peey, Debra Perry, Poul Erik Petersen, Immaculada Placencia-Porrero,
Adolf Ratzka, Suzanne Reier, Diane Richler, Wachara Riewpaiboon, Tom
Rikert, Alan Roulstone, Amanda Rozani, Moosa Salie, Mohammad Sattar
Dulal, Duranee Savapan, Shekhar Saxena, Walton Schlick, Marguerite
Schneider, Marianne Schultz, Kinnon Scott, Tom Seekins, Samantha Shann,
Owen Smith, Beryl Steeden, Catherine Sykes, Jim Tobias, Stefan Trömel,
Chris Underhill, Wim Van Brakel, Derek Wade, Nicholas Watson, Ruth
Watson, Mark Wheatley, Taghi Yasamy, Nevio Zagaria, Ilene Zeitzer, Ruth
Zemke, Dahong Zhuo.
Additional contributors
Regional consultants
WHO African Region/Eastern Mediterranean Region
Alice Nganwa Baingana, Betty Babirye Kwagala, Moussa Charafeddine,
Kudakwashe Dube, Sally Hartley, Syed Jaar Hussain, Deborah Oyuu
Iyute, Donatilla Kanimba, Razi Khan, Olive Chifefe Kobusingye, Phitalis
Were Masakhwe, Niang Masse, Quincy Mwya, Charlotte McClain-Nhlapo,
Catherine Naughton, William Rowland, Ali Hala Ibrahim Sakr, Moosa
Salie, Alaa I. Sebeh, Alaa Shukrallah, Sándor Sipos, Joe Ubiedo.
World report on disability
xix
WHO Region of the Americas
Georgina Armstrong, Haydee Beckles, Aaron Bruma, Jean-Claude Jalbert,
Sandy Layton, Leanne Madsen, Paulette McGinnis, Tim Surbey, Corey
Willet, Valerie Wolber t, Gary L. A lbrecht, Rica rdo Rest repo A rbelaez, Martha
Aristizabal, Susanne Bruyere, Nixon Contreras, Roberto Del Águila, Susan
Hirshberg, Federico Montero, Claudia Sánchez, Katherine Seelman, Sándor
Sipos, Edward Steinfeld, Beatriz Vallejo, Armando Vásquez, Ruth Warick,
Lisbeth Barrantes, José Luís Di Fabio, Juan Manuel Guzmán, John Stone.
WHO South-East Asia Region/Western Pacific Region
Tumenbayar Batdulam, Amy Bolinas, Kylie Clode, David Corner, Dahong
Zhuo, Michael Davies, Bulantrisna Djelantik, Mohammad Abdus Sattar
Dulal, Betty Dy-Mancao, Fumio Eto, Anne Hawker, Susan Hirshberg,
Xiaolin Huang, Venus Ilagan, Yoko Isobe, Emmanuel Jimenez, Kenji Kuno,
Leonard Li, Rosmond Madden, Charlotte McClain-Nhlapo, Anuradha
Mohit, Akiie Ninomiya, Hisashi Ogawa, Philip O’Keefe, Grant Preston,
Wachara Riewpaiboon, Noriko Saito, Chamaiparn Santikarn, Mary Scott,
Sándor Sipos, Catherine Sykes, Maya omas, Mohammad Jashim Uddin,
Zhuoying Qiu, Filipinas Ganchoon, Geetika Mathur, Miriam Taylor, John
Andrew Sanchez.
The WHO Regional Office for European Region
Viveca Arrhenius, Jerome Bickenbach, Christine Boldt, Matthias
Braubach, Fabrizio Cassia, Diana Chiriacescu, Marleen De Smedt, Patrick
Devlieger, Fabrizio Fea, Federica Francescone, Manuela Gallitto, Denise
Giacomini,Donato Greco, Giampiero Grio, Gunnar Grimby, Ahiya Kama ra,
Etienne Krug, Fiammetta Landoni, Maria G. Lecce, Anna Lindström,
Marcelino Lopez, Isabella Menichini, Cem Mete, Daniel Mont, Elisa Patera,
FrancescaRacioppi, Adolf Ratzka, Maria Pia Rizzo, Alan Roulstone, Tom
Shakespeare, Sándor Sipos, Urbano Stenta, Raaele Tangorra, Damjan Tatic,
Donata Vivanti, Mark Wheatley.
None of the experts involved in the development of this Report declared
any conict of interest.
Contributors
xxi
Introduction
Many people with disabilities do not have equal access to health care, edu-
cation, and employment opportunities, do not receive the disability-related
services that they require, and experience exclusion from everyday life
activities. Following the entry into force of the United Nations Convention
on the Rights of Persons with Disabilities (CRPD), disability is increasingly
understood as a human rights issue. Disability is also an important develop-
ment issue with an increasing body of evidence showing that persons with
disabilities experience worse socioeconomic outcomes and poverty than
persons without disabilities.
Despite the magnitude of the issue, both awareness of and scientic
information on disability issues are lacking. ere is no agreement on de-
nitions and little internationally comparable information on the incidence,
distribution and trends of disability. ere are few documents providing a
compilation and analysis of the ways countries have developed policies and
responses to address the needs of people with disabilities.
In response to this situation, the World Health Assembly (resolution
58.23 on “Disability, including prevention, management and rehabilitation”)
requested the World Health Organization (WHO) Director-General to
produce a World report on disability based on the best available scientic
evidence. e World report on disability has been produced in partnership
with the World Bank, as previous experience has shown the benet of col-
laboration between agencies for increasing awareness, political will and
action across sectors.
e World report on disability is directed at policy-makers, practition-
ers, researchers, academics, development agencies, and civil society.
Aims
e overall aims of the Report are:
To provide governments and civil society with a comprehensive descrip-
tion of the importance of disability and an analysis of the responses pro-
vided, based on the best available scientic information.
Based on this analysis, to make recommendations for action at national
and international levels.
xxii
Scope of the Report
e 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 denes
terms such as disability, discusses prevention and its ethical considerations,
introduces the International Classication 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 prev-
alence and the situation of people with disabilities worldwide. 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 a<