1. UnIversal accessIbIlIty: MaIn concepts and deMographIc conteXt

Accessibility in the built environment enables persons with disabilities (PWDs) to carry out their daily activities and to participate safely, independently, with confidence, and with dignity in any social activity, work, education, etc.).

The concept of accessibility may appear to be simple or intuitive, but despite the word being known and in common use, no unambiguous definition of it exists3. The Vietnamese Law on Persons with Disabilities, provides the following definition:

“ accessibility means to ensure persons with disabilities can use public facilities, transportation, information technology, cultural services, sports, tourism and other appropriate services to integrate into the community”.

(Clause 8, Article 2, Law on Persons with Disabilities)

However, PWDs are not the only ones who can benefit from accessible built environments. Therefore, the definition can become more inclusive to encapsulate all beneficiaries, such as the definition proposed by the European Concept of Accessibility (CCPT, 1996)4:

European Concept of Accessibility, 1996.

Taking this concept to its wider expression we can define what is known as the Universal Accessibility (UA) paradigm. It refers to accessibility everywhere, accessibility for everyone, and accessibility at all times.

The idea of UA aims to produce environments, products, services and systems that can be used by all members of society (including the disabled, older people, parents with strollers, children, people carrying loads and luggage, those who are obese, people who are unusually tall or short, etc.), in order to avoid any form of exclusion and provide full personal autonomy for everyone without distinctions.

The World Bank Disability Inclusion and Accountability Framework states that “lack of accessibility hinders participation in the job market and in social and civic activities. This results in disadvantage and vulnerable situations for persons with disabilities, leading to disproportionate rates of poverty, deprivation, and exclusion. Accessible urban environments also benefit other population groups, including older persons and children”5 .

A key element of UA is Universal Design, a concept proposed in the 1990s by Ronald Mace, which dictates that when developing products, environments and services, we must consider from the initial design and to the maximum extent possible, the span of abilities of all citizens, and not just the average person6. Seven

3 Iwarsson,S & Stahl, A. (2003). Accessibility, usability and universal design: positioning and definition of concepts describing person-environment relationships. Disability and Rehabilitation, 25, 57-66 4 CCPT (1996) Concepto Europeo de Accesibilidad (European Concept for Accessibility) [English translation). Spanish version of CEAPAT, IMSERSO: Madrid 5 World Bank Disability Inclusion and Accountability Framework 2018,

boX 1.1 the prIncIples of UnIversal desIgn

Developed in 1997 by the Centre of Universal Design in North Carolina, USA

principle one Equitable Use. The design is useful and marketable to any group of users.

principle two Flexibility in Use. The design accommodates a wide range of individual preferences and abilities.

principle three Simple and Intuitive. Use of the design is easy to understand, regardless of the user’s experience, knowledge, language skills, or current concentration level.

principle four Perceptible Information. The design communicates necessary information effectively to the user, regardless of ambient conditions or the user’s sensory abilities.

principle five Tolerance for Error. The design minimizes hazards and the adverse consequences of accidental or unintended actions.

principle six Low Physical Effort: The design can be used effectively and comfortably and causing minimal fatigue.

principle seven Size and Space for Approach and Use. Appropriate size and space is provided for approach, reach, manipulation, and use regardless of the user’s body size, posture, or mobility.

principles were developed in 1997 that any universal design must follow, as shown below.

These principles, mostly addressed to planners and designers, are to be included from the start in the design of any new space, product, or service. However, in order to reach UA, the following also have to be taken into consideration: • Specific adaptations (for all that has been put in place without accessibility considerations); • Financial aid (such as concessionary fares in transportation); • Assistive technologies and products (such as wheelchairs or hearing aids); and • Specialized services or support and other personal services (such as personal assistance).

In the urban context, UA is a useful tool for all citizens because it guarantees equal access to public environments and transport, regardless of any permanent or temporary limitations, and at the same time increases usability. Achieving UA in cities requires, in the first place, to focus on the design of public access elements, such as pathways, pedestrian crossings, spaces for public gatherings, public buildings, and transportation infrastructure.

At the same time, cross-cutting dimensions of accessibility, (such as regulations, standards, awareness raising or training) need to be considered in all interventions and policies, as they are a prerequisite to fully accessible design and services.

6 ‘Design of products and environments to be usable by all people to the greatest extent possible, without the need for adaptation or of specialized design’. Mace, R. 2008. About UD. The Centre for Universal Design

The idea of disability refers to the interaction between the features of the human body and the features of the society in which an individual exists7. It is an umbrella term for impairments, activity limitations and participation restrictions, resulting from a negative interaction between an individual (with a specific health condition) and that individual’s contextual factors (environmental factors—that is the physical environment an individual interacts with, including infrastructure—and personal factors).

The importance of environmental factors as determinants of health and disability has been recognized by the World Health Organization (WHO)8 since 2001. The relationship between built environment and health has been widely studied during recent years; while in the field of disability the different legal, technical and policy orientations have supported a rights-based approach through the so-called “Social Model of Disability” and the United Nations Convention of the Rights of People with Disabilities (UNCRPD). This global convention was signed by Vietnam in 2007 and ratified in 2015.

The UNCRPD states that persons with disabilities “include those who have long-term physical, mental, intellectual or sensory impairments which, in interaction with various barriers, may hinder their full and effective participation in society on an equal basis with others”. Furthermore, it states that no policies or decisions that affect the interests and participation of PWDs in society, and that of their representatives, can be made without their consultation. An idea that was summed up in the expression: “nothing about us without us”.

In addition to those considered as PWDs, whenever other users of UA are considered (such as older people who are frail, pregnant women, parents with small children, passengers with luggage, visitors or tourists and people with temporary impairments such as a broken leg, etc.), they will be referred to as persons with reduced Mobility (PRMs).

According to WHO9 the average preva¬lence rate of disabilities in the adult population of the world (aged 18 years and over), was 15.6 percent in 2002–04.

In Vietnam, different statistical studies offer differing figures of the prevalence of disability depending on how disability is measured. According to the 2006 Vietnam Household Living Standards Survey (VHLSS), the disabled population constitutes 15.3 percent of all Vietnamese. The Ministry of Labour, Invalids and Social Affairs (MOLISA), made an estimation that by 2018 the country would include around 8 million PWDs aged five and over, accounting for 7.8 percent of the population10. Recently, in January 2019, the General Statistics Office and UNICEF published their estimations from the 2016–17 survey, where they estimated that 7.06 percent of the Vietnamese population aged two and over— about 6.2 million people— have disabilities. From this survey, a total of almost 12 million people are estimated to live in a family with a disabled member.

7 Petchey OL1, Gaston KJ. (2006) Functional diversity: back to basics and looking forward. Ecol Lett. 2006 Jun;9(6):741-58 8 WHO (2003) International Classification of Functioning, Disability and Health, (ICF) 9 WHO, 2011, World Report on Disability. Result from the World Health Survey in 59 countries 10 58%, of them would be female and 28.3% children. It also estimated that of the total number of PWDs nationwide, 29% are people with severe or exceptionally severe disabilities

These variations in the disability rate mostly result from the use of different methods of measurement: data collection methods, classification of the types of disabilities, etc., as well as from bias introduced in the interviewing process. However, according to Phan (2017)11 “whether it is 7.8% or 15.3%, Vietnam’s disability rate is among the highest in the region and is expected to rise due to social development causes, accidents and environmental pollution”.

Regarding the internal differences in the prevalence of disabilities, they are substantial when comparing regions and provinces. According to the 2016 Vietnam National Survey on PWD, the Mekong Delta Region (MDR) is the region of the country with the second highest percentage of disabled people aged two years old and over (7.54 percent), surpassing the national average of 7.06 percent. According to the same Survey, 21.09 percent of the MDR households have at least a member with disabilities.

A breakdown of the main types of disabilities in Vietnam and the MDR is presented in the following table (table 1.1).

table 1.1: certified pWds by type of disability

41.3% 8.3% 6.6%

With respect to the social condition of households with disabilities, around 75 percent of them are in rural areas, 32.5 percent are poor and 51.2 percent have difficulties in caring for PWDs in their daily life (according to an investigation by MOLISA in 2009). Around 80 percent of PWDs in urban areas and 70 percent in rural areas are dependent on their families, their relatives or social allowance, while only 11 percent of the total can live independently.

Also relevant is the fact that disability is more prevalent amongst women. They spend more time in the home and neighborhood than men, so they are more directly exposed to the hazards of poor sanitation or disease, as well as having a longer life expectancy.

29.1%

14.5%

0.2%

48.1% 7.6% 6.4% 21.9% 10.7% 5.3%

Vietnam National Survey on PWD, 2016.

11 Phan, Giang. (2017), Understanding CRPD implementation in Vietnam. In D.L. Cogburn, T.K. Reuter: Making Disability Rights Real in Southeast

Asia. Maryland, Lexington Books.

Older people are considered direct beneficiaries of most accessibility interventions due to the progressive increase and prevalence of illness, frailty and disability during the Third Age (the term is used to describe the period of life above the age of 65).

However, being 65 or over does not necessarily mean having a disability, so discretion is needed that is respectful towards this group of the population’s diverse health and functional condition.

Vietnam is one of the fastest aging countries in Asia. Data by HelpAge12 shows that by 2050, the number of people 60 years and over will grow from 12.3 percent in 2019 to around 27.2 percent of the population—almost 30 million people. The median age in the country will increase from 28.5 in 2010 to 36.7 by 2030 and 42.4 by 2050 (UN population projections, 2018). Vietnam’s population is expected to surpass 106 million by 2030 (see figure 1.1).

figure 1.1: expected evolution of main age cohorts in vietnam until 2100

Both men and women are living longer in Vietnam. While women are expected to outlive men by 9.2 years, the number of years spent in poor health—the gap between life expectancy and healthy life expectancy— is greater for women (10.2 years) than for men (7.5 years)14. Furthermore, the trend will continue as recent population data shows that the country is reaching the end of its ‘demographic transition’, a process marked by three emerging characteristics: decreasing fertility rates, decreasing mortality rates, and increasing life expectancy. As a result of this process, the child population has declined, and the working-age population and elderly populations have increased15 .

In fact, compared to other societies, Vietnam will become an aged country in a shorter time. It took France 115 years to move from a proportion of 65+ of 7 to 14 percent. The same process took USA 69 years and Japan and China 26 years. But, for Vietnam it will take only 20 years16. Consequently, the oldage dependency ratio (Age 65 or over / Age 15–64) is expected to almost triple between 2019 and 2050 from 11.4 percent to 32.8 percent.

Considering the high reliance of older persons on family support in traditional societies like Vietnam, those demographic changes will demand important reforms to cope with income and health risks of older people in the near future. And this will need to include UA improvements to help them maintain independence and access to services and support.

Source: United Nations (2018) 13

12 Ibídem 13 United Nations, Department of Economic and Social Affairs, Population Division, Probabilistic population projections based on the world population prospects: the 2017 revision, http://esa.un.org/unpd/wpp (18 October 2018) 14 HelpAge International (2018). Trends in aging and health. Vietnam. http://ageingasia.org/age¬ing-population-vietnam/ Accessed Oct 01 2019 15 The Aging population in Viet Nam: Current status, prognosis, and possible policy responses. Available from:https://www.researchgate.net/ publication/230750835_The_Aging_population_in_Viet_Nam_Current_status_prognosis_and_possible_policy_responses [accessed Oct 22 2019]. 16 Long Thanh Giang (2011) The Aging population in Viet Nam: Current status, prognosis, and possi¬ble policy responses. UNFPA. United Nations Vietnam