Category in Determining Eligibility or Benefits

298 | Revisiting Targeting in Social Assistance

BOX 5.5

Challenges and Considerations around Disability as a Category in Determining Eligibility or Benefits

Disability is complicated first and foremost because of the range and depth of impacts it can have on all sorts of aspects of the lives of people who live with one or more disabilities, but also because of the social policy initiatives meant to improve their capabilities.

The Convention on the Rights of Persons with Disabilities (UN 2006) recognizes persons with disabilities as individuals “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.”a The degree to which an impairment affects the ability to carry out daily activities and work depends not only on the severity of the impairment, but also the demands of the environment and specific activities. Using a wheelchair is a much larger barrier when the built environment is full of stairs and narrow doorways than when universal design elements are ubiquitous. The demands of the workplace can matter powerfully as well—a person with a blurring in the center of their visual field will find the impairment a greater barrier to work in needlecraft or neurosurgery than to work in modeling or psychotherapy.

The full agenda for disability inclusion is many faceted: prevention and rehabilitation to minimize impairments; accessibility in the built environment, transportation, and information and communications technology to minimize the barriers for those with impairments; inclusive education and training to maximize the skill sets of people living with disability; societal and employer attitudes attuned to abilities and problem solving about barriers; and so forth.

Income support via social assistance is important in two ways. When efforts toward disability inclusion have been inadequate to result in employment or earnings sufficient for independence for the person with a disability, then income support may take the form of income replacement. Even when barriers to employment have been addressed, social assistance can be an important income supplement to help mitigate the extra costs of living with disability, for example, for medical care and perhaps assistive devices, extra costs for mobility, sometimes the expenses (explicit or implicit) of caregivers, and so forth.b While calibrating support to help move people into work will need to be customized to the individual and context, benefits for the extra costs of

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Choosing among Targeting Methods | 299

BOX 5.5 (continued)

basic life might be thought of as more categorical, but a disability assessment is needed.

A disability assessment is a field of endeavor at least as complex as that of quantifying the economic dimensions of welfare, with equal concerns about errors of exclusion and inclusion. Thus, it is the subject of other books and studies. WHO and World Bank (2011) cover the standards for the International Classification of Functioning of Disability and Health (WHO 2001). Bickenbach et al. (2015) discuss how the standards are moving into social protection policy globally. World Bank (2020a, 2020b) provides case studies of Latvia and Lithuania. United Nations (2015) presents the report of the Special Rapportuer on the Rights of Persons with Disability and Social Protection.

The World Health Survey estimates a prevalence of disability in 2004 of about 15 percent, ranging from 12 percent in higher income countries to 18 percent in lower income countries. This figure refers to adults who experienced significant functioning difficulties in their everyday lives. The prevalence of disability in lower income countries among people ages 60 years and older, for instance, was 43 percent, compared with 30 percent in higher income countries. The average prevalence rate for adults with very significant difficulties was estimated at 2.2 percent. The Global Burden of Disease studies come out in the same ballpark. Mitra et al. (2021) look at 21 low- and middle-income countries with information collected using the Washington Group Short Set questions. They find that the median prevalence stands at 10 percent among adults ages 15 and older, and that 23 percent of households have a member living with disability. It is generally agreed that prevalence is higher among the poor because poverty exposes people to many risks that can result in disability and people with disabilities face barriers to employment (WHO and World Bank 2011). Moreover, not allowing for the extra costs of disability can underestimate poverty among those with disabilities and for a nation as a whole. Zaidi and Burchardt (2005) estimate that taking such costs into account would raise the poverty rate among pensioners in the United Kingdom by 18 percentage points and overall by 3 percentage points.

a. UN Convention on the Rights of Persons with Disabilities, article 1, https:// www.un.org/development/desa/disabilities/convention-on-the-rights-of -persons-with-disabilities/article-1-purpose.html. b. Estimating the extra costs of disability is a nascent field. Methods, data, and definitions differ, and studies are rare, especially in developing countries. Mitra et al. (2017) provide a good review. Estimates of such differential costs in lowermiddle-income countries are in the range of 8 percent in China, 9–12 percent in Vietnam, and 14 percent in Bosnia and generally much higher in Ireland, Spain, the United Kingdom, and the United States, on the order of 11–70 percent, depending on the degree of disability and family configuration.