United Nations ESCAP The Asian and Pacific Decade of Persons with Disabilities 1993 - 2002 Resource Materials

The situation of disabled persons in the Asian and Pacific Region

INTRODUCTION
I.PREVALENCE OF DISABILITY
I-A.Magnitude and distribution
I-B. Causes of disability : implications for prevention
II.ASIAN AND PACIFIC DECADE OF DISABLED PERSONS, 1993-2002
II-A. Legislation and policy milieu
II-B. National coordination committees on disability (NCCDs)
II-C. Access to rehabilitation services
II-D. Freedom of movement: the built environment, public transport systems and assistive devices
II-E. Education, training and employment
II-F. Self-help organizations of people with disabilities and NGO support
III.WAY FORWARD
III-A. Conclusion of the Asian and Pacific Decade of Disabled Persons, 1993-2002B.
III-B. Policy framework beyond the Asian and Pacific Decade of Disabled Persons

INTRODUCTION

It is estimated that there are 240 to 300 million persons with disabilities in the Asian and Pacific region, two thirds of disabled persons worldwide. Persons with disabilities constitute the most marginalized group in the Asian and Pacific region. Women and girls with disabilities are most excluded from society and also from mainstream gender equality programmes. Children and youth with disabilities face overwhelming barriers to participation in education and skill development programmes. Most disabled persons are poor, but few poverty alleviation programmes include provisions for their participation.

Many persons with disabilities are multiply handicapped by social, economic, cultural and physical conditions. Together, these conditions constitute barriers to disabled persons’ freedom of movement and access to full participation in society. These barriers include also the stigma of disability, poor understanding of the abilities and aspiration of disabled persons, lack of rehabilitation and support services, and a negation of the rights of persons with disabilities. Physical environments are suited only to the physically able, and access to information challenges many disabled persons.

Generally, this situation prevails in much of the region, despite increasing global-level attention to the issue of disability over the past two decades. This paper will focus on the situation of persons with disabilities and some achievements in the context of the Asian and Pacific Decade of Disabled Persons, 1993-2002. The goal of equalization of opportunities for persons with disabilities will be discussed with reference to the prevailing conditions of poverty and social exclusion which affect the lives of so many people with disabilities living in the Asian and Pacific region. Suggestions for future policy direction, including formulation of a strategic framework for continued action to promote the full participation and equalization of opportunities of people with disabilities beyond the end of the current Decade, will be made.

I. PREVALENCE OF DISABILITY

I-A. Magnitude and distribution

I-A-1. Disability statistics

(a) Lack of uniform definitions : root cause of variability of estimates

There is wide variation in the estimated disability rates reported by the developed and developing countries. The variation depends, to a large extent, on the definitions of disability used, which either expand or limit the disability groups covered in the survey. For example, Australia’s 1993 survey indicated that persons with a disability comprise 18 per cent of its population. New Zealand's first national household survey (1996) yielded a disability rate of 19.1.

In contrast, China's (1987) and Pakistan's (1984-85) sample surveys both indicate a 4.9 per cent disability rate. India's disability rate from its 1981 national sample survey is 1.8 per cent. The 1991 National Sample Survey of India, covering four disabilities (visual, hearing, speech and locomotor), yielded a prevalence rate of 1.9 per cent. A separate 1991 national sample survey of persons with delayed mental development in India yielded an estimate of 3 per cent of the population aged 0 to 14. Variations in survey outcome highlight a common problem. The operational definitions used pertain to the purpose for which data is collected, i.e., the answer depends on why the question is posed.[1]

Since common definitions and classifications of disability are not uniformly applied by countries, international comparisons of disability data are not meaningful. This calls for greater inter-country effort to adopt internationally agreed concepts, definitions, scope and classifications, possibly including survey methodologies, techniques and questionnaires.

Present policies and programmes suffer from a dearth of disability data and the inadequacy of existing data. In the majority of the countries and areas of the ESCAP region, it is difficult to ascertain the prevalence of disability, let alone estimate disability trends at the beginning of the twenty-first century, even with availability of the projected population data.

I-A-2. Spatial distribution of disability

Today, the majority of the region’ persons with disabilities live in the rural areas. However, in keeping with the region’s urbanization trend, it is expected that, by 2020, with an urbanization level of 55 per cent, the spatial distribution of persons with disabilities will be more evenly balanced between the rural and urban areas. This will be especially true of Bangladesh, China, India, Indonesia and Pakistan. Together, these countries, Japan included, will continue in 2020 to be home to some 80 per cent of the region’s total population and two-thirds of the urban population.[2] It is, therefore, important that the social development response to disability covers both rural and urban areas.

I-B. Causes of disability : implications for prevention

The prevalence of disability in the first decades of the twenty-first century will, to a large extent, be determined by a nexus of economic, environmental, physical and social conditions. The macro-level political decisions which affect the gaps between the rich and the poor will similarly shape the patterns and prevalence of disability. To the extent that these conditions and decisions are man-made, many types of disability are preventable. In that sense, there is a global social responsibility for the occurrence of disability and for the life circumstances of persons with disabilities.

I-B-1. Macro-economic conditions[3]

The prevalence and patterns of disability are affected by the state of health of individuals, and by the social (families and communities) and physical environments which sustain them. Personal, family and environmental health is, in turn, strongly influenced by economic trends, including the trends in the prevalence of poverty and inequity. In looking into the future, it is useful to note the key trends already in place. Inequitable economic and social policies are contributing to patterns and prevalence of disability and will do so in the foreseeable future.

In the past two decades, the well-being of people at the local level has been increasingly influenced by macro-level decisions. The gap between the rich and the poor has been widening at an accelerating rate. Earlier achievements in health and quality of life in the 1950s and 1970s have suffered slow-downs and reversals. The basic needs approach to development of the 1950s and 1970s has been replaced by a development paradigm based on economic efficiency-oriented globalization, which measures human progress largely in terms of economic growth and down plays human and environmental costs. To maximize profits, production is located wherever wages are lowest, work and environmental safety measures weakest, and where workers are least likely to organize for healthier working conditions and fairer wages. These factors are conducive to higher rates of accidents, poisoning from toxins, loss of hearing and vision, and health deterioration.

Structural adjustment programmes (SAPs) designed by the international financial institutions have had a negative impact on the health, nutrition and quality of life of the poorest and most vulnerable members of society, including persons with disabilities. It is argued that temporary hardships are necessary to achieve economic recovery. However, the impact of such hardships on the poorest people in society is far different from that on the affluent. These lessons are relevant for many economies of the region which are confronted with the need to adopt strategies for economic recovery.

I-B-2. Nutritional deficiency

This century has seen substantial progress toward producing more food that reaches many more people.[4] This despite unprecedented population growth and a quadrupling of major disasters. In theory, the world produces enough food for everyone. Yet problems remain concerning equitable distribution to those in need of food.

About half the developing countries in the region are at risk of nutrition-related disabilities (stunting of mental and physical development) associated with food deficit. Common micronutrient deficiencies which will continue to affect disability will include:

Vitamin A deficiency	blindness;
Vitamin B complex deficiency	beri-beri (inflammation or degeneration of the nerves, digestive system and heart), pellagra (central nervous system and gastro-intestinal disorders, skin inflammation) and anaemia;
Vitamin D deficiency	rickets (soft and deformed bones);
Iodine deficiency	slow growth, learning difficulties, intellectual disabilities, goitre;
Iron deficiency	anaemia, which impedes learning and activity, and is a cause of maternal mortality;
Calcium deficiency	osteoporosis (fragile bones)

By far the greatest number of chronically undernourished people, 512 million (of the global 1996 total of 800 million), are found in South and South-East Asia. The rate of growth in world food production has been slowing for three decades and is expected to continue to decelerate. At the present rate, by the year 2010, there could still be some 680 million chronically undernourished people[5] whose disabilities are likely to have roots in micronutrient deficiencies.

Future food security will depend mainly on increasing agricultural productivity rather than on extending the area under cultivation.[6] With intensive poverty alleviation schemes, a lowering of this type of disability may be expected, but the numbers affected by nutritional deficits will still be daunting. Those most vulnerable to inadequate diets will be girl children, women and older persons. As a consequence of inadequate diets, overall resistance to infectious diseases will be lowered. In the case of women, reproductive and fetal health will also be compromised.

I-B-3. Weapons and violence

(a) Landmines[7]

The large-scale production, sales and deployment of landmines are a cause of disability which has escalated in recent years. Although euphemistically termed “anti-personnel mines”, the vast majority of the region’s mine victims are not combat soldiers but civilians, mostly children and women in poverty.

Many landmines are designed to disable rather than to kill. Some are made to resemble toys and attractive items such as colourful pens or women’s make-up kits. In the strategic manoeuvres of low-intensity conflict, mines which permanently disable large numbers of people exert greater physical, economic, environmental and psycho-social stress on a society and on a government than would weapons which kill outright. Mines are used to deny access to or use of farmland, irrigation channels, roads, waterways and public utilities. Thus they threaten food security and disrupt social services.[8] Buried mines can remain active for over 50 years.[9] Even if no more were to be laid, in parts of the region where they have been laid (e.g., Afghanistan and Cambodia), they will continue to maim well into the twenty-first century.

It is estimated that 110 million active mines are scattered in 70 countries with an equal number stockpiled.[10] For every mine cleared, 20 are laid. In 1994, approximately 100,000 were removed, while two million were laid. It costs about 100 times more to remove one mine than to produce it. Under current conditions, it would take more than 1,100 years to clear the entire world of mines provided that no more are planted.[11]

Seeds of hope lie in a growing worldwide movement to curb the further production and sale of landmines. As of 4 December 1997, 19 ESCAP members and associate members have joined as signatories to the Convention on the Prohibition of the Use, Stockpiling, Production and Transfer of Anti-Personnel Mines and on Their Destruction. However, the arms industries are a powerful lobby influencing political decisions. Compared with the size of arms trade investments, a pittance is spent on defusing landmines. This means that well into the twenty-first century, amputations will be common among survivors in countries infested with mines.

(b) Guns

In all its forms, violence has increased dramatically worldwide in recent decades.[12] The increasing availability of all types of guns has fundamentally altered the consequences of conflict and crime. There is no indication that countries of the region will take specific steps to restrict access to weapons. In this context, the twenty-first century may well witness a dramatic increase in spinal cord injury and other forms of trauma from an increase in acts of homicide involving gun use. From data on violent deaths, it may be surmised that young males aged 15 to 34 are likely to be most vulnerable.

I-B-4. Some other causes

(a) Rapid modernization

The rapid and profound changes sweeping through the Asia-Pacific region as countries within it modernize already means changes in the disability profile. Mental disabilities, such as depression, alcohol dependence and schizophrenia, have been seriously underestimated by traditional approaches that take into account only death and not disability.[13] WHO projections show that, by 2020, psychiatric and neurological conditions could manifest a bigger proportional increase than that for cardiovascular diseases.[14] With the epidemiological transition already under way in developing countries of the region, ‘newer’ diseases such as heart disease, cancer and mental disorders will become even more prevalent as sources of disabling effects on populations.[15]

With the rise in smoking and environmental pollution, disabilities associated with chronic non-specific lung disease (e.g., bronchitis, emphysema and asthma) are expected to increase significantly.[16] Similarly with increases in the sources of noise pollution and the absence of regulatory controls, the overall level of noise pollution that people are exposed to from birth onwards will also increase. This will have implications for rising levels of deafness and hearing impairment.

(b) Road accidents

Road traffic accidents in developing countries have received relatively little attention from public health experts. Yet by 2020, road traffic accidents will be ranked as the third leading cause of disease burden measured in disability-adjusted life years.[17] Quadriplegia, paraplegia, brain damage and behavioural disorders are among the disabilities common among survivors of such accidents. Most at risk in those accidents to come will be men aged 15 to 44.

Road accidents cause annual losses to the economies of the developing countries of the region which are estimated to be around US$ 20 billion per year. With the present growth in vehicle fleet (15-18 per cent per annum in some countries; 268 per cent in Thailand and 700 per cent in the Republic of Korea between 1982 and 1992) and increases in road connectivity and populations throughout the region, the number of road accidents will continue to rise, unless dramatic action is taken to curb the increase.[18]

If current trends in increasing vehicles and road connectivity persist, it is estimated that, in 10 years, there will be 450,000 road accident deaths per year, with millions more disabled from injuries each year. Improvements in vehicle design and medical facilities, as well as stronger enforcement of regulations concerning the compulsory use of seat belts (car use) and helmets (motorcycle use), and restrictions on alcohol consumption and other substance abuse combined with driving, will mean greater chances of survival from road accidents, and these should therefore be encouraged.

By the simple fact of the ageing of populations, disabilities associated with increasing longevity will increase. In some societies of the region, persons born with disabilities will survive for far longer than their predecessors in the present century. Ageing-related disabilities include blindness, deafness, musculoskeletal diseases, and mental disorders. Most of the chronic, degenerative, non-communicable diseases are diseases of the second half of human life.[19] Alzheimer’s disease is the most common form of dementia in older persons. Some 5 to 10 per cent of populations over age 65 show signs of Alzheimer’s disease.[20] About 10 per cent of those affected by the disease may have symptoms from the fifth decade of life. Up to 50 per cent of those aged over 85 suffer from dementia; of these, about 60 to 70 per cent have Alzheimer’s disease.[21] The disease is characterized by progressive mental deterioration, with confusion and forgetfulness being early signs. This disease has profound care implications for the ageing societies of the Asia-Pacific region, particularly those also characterized by high rates of marital breakdown, family nuclearization and single children.

Disability caused by musculoskeletal diseases (often referred to as chronic rheumatic diseases) covers about 200 conditions which affect joints, bones, soft tissues and muscles. Prevalent among them will be rheumatoid arthritis and osteoporosis. Among populations with a long life expectancy, cancer is much more important than other diseases which have disabling consequences. As tobacco consumption is increasing in many developing countries, lung cancer, the most common of cancers, seems certain to continue to grow in epidemic proportions.[22]

II. ASIAN AND PACIFIC DECADE OF DISABLED PERSONS, 1993-2002

At the end of the United Nations Decade of Disabled Persons (1983-1992), the Economic and Social Commission for Asia and the Pacific (ESCAP), through its resolution 48/3 adopted at its forty-eighth session in 1992, proclaimed the Asian and Pacific Decade of Disabled Persons, 1993-2002, with a view to giving fresh impetus to the implementation of the World Programme of Action concerning Disabled Persons in the ESCAP region beyond 1992. It would also strengthen regional cooperation to resolve issues affecting the achievement of the goals of the World Programme of Action, especially those concerning the full participation and equality of persons with disabilities.

The Proclamation on the Full Participation and Equality of People with Disabilities in the Asian and Pacific Region was adopted at the Meeting to Launch the Asian and Pacific Decade of Disabled Persons, in Beijing, in December 1992. As of September 2001, forty-one governments in the ESCAP region have joined as signatory to the Proclamation to express their commitment to the promotion of the full participation and equality as well as improvement of lives of persons with disabilities in the region.

To achieve the objectives of the Asian and Pacific Decade of Disabled Persons, an agenda for action was needed that translated the World Programme of Action concerning Disabled Persons into an agenda for the Asian and Pacific region, in response to the review and appraisal of the achievements of the United Nations Decade of Disabled Persons, 1983-1992, in the Asian and Pacific region.

The Agenda for Action for the Asian and Pacific Decade of Disabled Persons, endorsed at the forty-ninth Commission session in 1993, consists of 12 major policy categories. These include: National coordination; Legislation; Information; Public awareness; Accessibility and communication; Education; Training and employment; Prevention of causes of disabilities; Rehabilitation services; Assistive devices; Self-help organizations; Regional cooperation.

Each of the policy categories contains a list of areas of concern of direct relevance to the development of policies in support of the full participation and equality of people with disabilities in Asia and the Pacific. The Agenda for Action provides the basis for a regional initiative aimed at realizing the full participation and equality of persons with disabilities, which comprise the objectives of the Asian and Pacific Decade of Disabled Persons. Furthermore, the agenda for action is to be viewed in the context of the World Programme of Action concerning Disabled Persons and other relevant United Nations international instruments, mandates and recommendations.

Since the inception of the Asian and Pacific Decade, ESCAP has been conducting reviews of the progress in achieving the Decade goals, in particular, the implementation of the Agenda for Action for the Asian and Pacific Decade of Disabled Persons. The 73 targets for the implementation of the Agenda for Action for the Asian and Pacific Decade of Disabled Persons were adopted at the regional meeting to review progress of the Decade in Bangkok in July 1995. The review of progress was again undertaken by the meeting of senior officials in Seoul in September 1997. In November 1999, a regional forum reviewed, revised and strengthened the targets. It adopted 107 strengthened targets for action for the Asian and Pacific Decade of Disabled Persons.

The Agenda for Action and the Targets for the Implementation of the Agenda for Action for the Asian and Pacific Decade of Disabled Persons have become effective policy tools for the Governments in the ESCAP region to guide their policies and the implementation of programmes concerning persons with disabilities. The multisectoral approach, which is reflected in the 12 policy categories in the Agenda for Action, has been well accepted by member- and associate-member governments in the ESCAP region.

A review of progress towards the achievement of the targets of the Agenda for Action is presented in Tables (see Appendix). Countries and territories have been divided into sub-regional groupings. Data are based on country reports prepared for the regional review meetings held in 1997 and 1999, as well as responses to the recently conducted regional survey on the implementation of the Agenda for Action for the Asian and Pacific Decade of Disabled Persons. The data are not comprehensive, but indicate that some measures had been taken, and progress achieved, by Governments of the ESCAP region in the following areas: national coordination, legislation and policy, training and employment, prevention of causes of disabilities, and self-help organizations of disabled persons. The table shows subregional imbalance in the implementation of the Decade Agenda for Action. Developing countries in the North and Central Asian subregion and in the Pacific subregion seem to have been slow in their implementation of the Decade Agenda for Action. This can be explained to a large extent in terms of the length of time that countries have been engaged with the Decade programme. Of the 41 member and associate member states who have signed the Proclamation, 10 have done so since 1997. Eight of these countries and territories are from the Pacific subregion, and two from North and Central Asia. Of the countries and territories which have not yet signed, seven are Pacific nations, and a further seven from North and Central Asia.

Now let us review the major areas under the Decade Agenda for Action.

II-A. Legislation and policy milieu

As of November 2001, 41 Governments of the Asia-Pacific region have joined as signatories to the Proclamation on the Full Participation and Equality of People with Disabilities in the Asian and Pacific Region. The disability legislation of some countries in the region is directly linked to the signing of the Proclamation by the governments concerned.

Since the inception of the Decade, nine Governments in the region passed comprehensive legislation to protect the rights of persons with disabilities, while seven others were in various stages of adoption, formulation and planning such legislation. The nine Governments include Bangladeshi, Fiji, Hong Kong China, India, Indonesia, Mongolia, New Zealand, Sri Lanka and Viet Nam. In the same period, countries which had already adopted such legislation enacted additional laws and regulations or amended existing ones to further protect the rights of persons with disabilities in specific areas crucial to the equalization of opportunities. Those include the Hearing Services Administration Act in Australia (1997), amendment in the Custom Duty Law (China, 1998), the Mental Health Ordinance (Hong Kong China, 1997), revised Law concerning Mental Health and Welfare for Mentally Disabled Persons (Japan, 1995), the Law for Promoting Businesses that Facilitate the Use of Communications and Broadcast Services by the Physically Disabled (Japan, 1993), the Disaster Measures Basic Law (Japan, 1995), Transport Accessibility Improvement Law (Japan, 2000), Special Education Promotion Law (Republic of Korea, 1994), Employment Promotion Act for Disabled Persons (Republic of Korea, 1995), Convenience Promotion Law for Disabled, Elderly, and Pregnant Women (Republic of Korea, 1997). Among these are numerous regulations revised to include mandatory requirements for the implementation of specific measures covering areas such as employment, electronic communication, access to the built environment and public transport, positive mass media portrayal of persons with disabilities, closed captioning (for deaf persons), vending in public places, and compulsory purchase of a percentage of products and services from persons with disabilities who are in self- or supported employment.

In consonance with the endeavours on legislative measures, the Decade also witnessed a remarkable blossoming of policy and plan measures to secure the full participation and equality of persons with disabilities. In various countries, there are examples of such endeavours with regard to education, welfare planning, rehabilitation and other disability services, and anti-discrimination.

The ownership of the Decade is clearly with the Governments and people of the Asia-Pacific region. Those directly concerned with the well-being of the most vulnerable group in society, particularly people with disabilities themselves, have seized the opportunity presented by the Decade to introduce new legislation and policy measures and to amend earlier ones to strengthen the legal and policy framework to protect the rights of persons with disabilities.

II-B. National coordination committees on disability (NCCDs)

National coordination bodies have existed since preparations for the commemoration of the International Year of Disabled Persons (IYDP, 1981). Responding to the Decade call to action, many governments have reconstituted their coordination bodies or established new ones as national coordination committees on disability (NCCDs), in the implementation of the Decade Agenda for Action. While they are known by a variety of names, and have their respective priorities, NCCDs provide a structure for dialogue and cooperation on disability matters involving diverse government departments, ministries, semi-autonomous bodies, private sector entities, NGOs and subject experts, including persons with disabilities. NCCDs have a crucial role in policy and programme development, as well as in ensuring implementation with the adequate participation of people with disabilities.

As of November 2001, 24 Governments in the Asian and Pacific Region had formed national coordination bodies on disability. Among them 19 national coordination bodies were established or revitalized during the Asian and Pacific Decade of Disabled Persons. They include the most populous countries in the region as well as least developed and island developing countries. Efforts, including legislative measures, are under way in six countries concerning the establishment of NCCDs. In some countries, disability-related coordination functions are subsumed under existing national mechanisms for social services. In view of the low status of welfare ministries, to which NCCDs tend to be attached, unless NCCDs are established with statutory authority to undertake coordination, it is extremely difficult for NCCDs to coordinate ministries which consider themselves above such coordination.

Many NCCDs have a large but unbalanced membership of government departments and NGOs, especially organizations of people with disabilities. In nearly all cases, the membership of NCCDs includes people with disabilities. However, the gender balance is overwhelmingly in favour of men. There is also a need for the broader participation of diverse disability groups in NCCD concerns.

A bureaucratic approach to comprehensive coverage of policy areas has led to a proliferation of committees and subcommittees in the structure of many NCCDs. But, the majority of these may never have met, let alone initiated action on their mandated areas of responsibility. A related problem is the low level of participation in NCCD meetings. Even when attendance is high, meaningful decisions cannot easily be reached when many representatives have been assigned on an ad hoc basis and are not vested with authority to make commitments on behalf of their respective agency or organization.

The prospects for the full participation and equality of people with disabilities will, to a great extent, depend on the effectiveness of NCCDs (or their equivalent bodies). If the prospects are to be optimistic, NCCDs have to break attitudinal barriers in each sector and at each level of society, for positive change to occur.

II-C. Access to rehabilitation services

There is a chasm between the recent legislation and policy measures, on the one hand, and the real life situation of persons with disabilities at the family and community level, on the other. Today, a common problem is that there are too few rehabilitation personnel. Among them, even fewer are willing to work in the service of communities with limited ability to pay. A large part of the problem arises from the non-participatory manner in which rehabilitation services still tend to be organized, and from perceptions of persons with disabilities. Services for persons with disabilities tend to be separate from the whole range of services provided as a matter of course to all citizens. This is because services for persons with disabilities are largely regarded as charitable provisions rather than as citizenship entitlements. Many of the NGOs which help meet the need for services are indeed registered charities and have a strong tradition of paternalistic and disempowering treatment of persons with disabilities as recipients who should be grateful. Under these circumstances, persons with disabilities and their families are seldom consulted as equal partners in a problem-solving approach to rehabilitation.

The common pattern of rehabilitation service provision is an uneven one. Most rehabilitation services are still urban and institution-focused, although a distinct effort is beginning to emerge in favour of better rural access, with a stronger emphasis on community-based and family-centred services. In many countries, contrary to official policy, in practice there is a gender bias favouring the access that disabled men and boys have to rehabilitation.

Over the course of the past 20 years, the developing countries of the region have generated a wealth of experience in ways of meeting the seemingly impossible challenge of rehabilitation service delivery in a context of resource constraint and profound ignorance, fear and superstition concerning persons with disabilities. In that period, much has been discussed and tried in the name of community-based rehabilitation (CBR).

The successes, as well as the numerous failures, have yielded valuable lessons. Efforts have begun to reconceptualize CBR as a community development strategy that involves integrating the issues faced by persons with disabilities in community development. This reconceptualization is in keeping with a growing understanding, within the disability movement, of disability as a development issue, not a medical one. The future direction of access to rehabilitation services is contained in a growing trend towards a plurality of approaches, driven by the demand for services, as well as practical conditions and the kind of resources which are locally available. There will be stronger emphasis on the inclusion of persons with disabilities in society in a variety of roles, including those of decision-makers, key actors and leaders.

Since the inception of the Asian and Pacific Decade of Disabled Persons, CBR approach has become the major rehabilitation approach in the developing countries of the region. At least 15 governments in the region indicated that CBR programmes are their integral part of rehabilitation services: Bangladesh, China, Cambodia, Hong Kong China, India, Indonesia, Islamic Republic of Iran, Malaysia, Mongolia, Myanmar, Nepal, Philippines, Sri Lanka, Thailand and Viet Nam.

II-D. Freedom of movement: the built environment, public transport systems and

assistive devices

Access to the built environment and appropriate assistive devices are two complementary physical means of enabling people with disabilities to move about outside of their homes. Both of these, together with a positive social milieu that welcomes disabled persons’ participation in community life, combine to form the essential core of what makes or mars their freedom of movement.

II-D-1. Building-transport linkage

Physical barriers that exist represent ignorance, unwillingness, or both, on the part of those involved in the design and management of the built environment. The ignorance is of the universal benefits of accessibility. The unwillingness is a serious attitudinal barrier towards addressing the needs of unglamorous groups like people with disabilities and older persons. However, those societies which are ageing ahead of others have begun to realize the wisdom of including barrier-free design in the built environment.

In the urban environment, it is common to feel a sense of danger at crossings and when boarding or leaving modes of public transport. The weariness of traversing the distance between transport drop-off points and building entrances is another hidden cost of user-hostile environments. There is a large group of people who manage to negotiate the built environment, but do so with difficulty and frustration. In addition to older persons and persons with disabilities, this group of access-disadvantaged persons includes parents with toddlers, prams and strollers, commuters, shoppers and travellers carrying heavy loads, as well as people who, despite temporary frailty, have to move around in the built environment. Universal accessibility or inclusive design considers the functional requirements of such users. If the design is applied, its outcome is an environment which, by meeting the standards of safety, usability and convenience for disabled persons, also benefits everyone in society.

In the area of barrier-free environments, Australia, Hong Kong China, Japan, New Zealand and Singapore have established legislation and regulations to ensure that new public buildings comply access standards and requirements. Enforcement mechanism of the laws and regulations had been well placed. China, India, Malaysia, Philippines, Republic of Korea and Thailand had enacted or improved laws and regulations on accessibility and access standards, and are ready to enforce those legislation and standards. Bangladesh, Macau China, Papua New Guinea and Viet Nam have enacted access standards or established codes, however, they have not been implemented or just introduced and are waiting to be enforcement.

Newly developed rail mass transit systems in developing countries of the region began to include accessible features. China, Malaysia, Philippines and Thailand have incorporated access features fully or partially in their light-railway or underground railway systems.

II-D-2. Assistive devices

Assistive devices are items that directly enable people with disabilities to participate in activities of daily life. By empowering people with disabilities to live with dignity as equal members of society, they make possible freedom and independence which enhance participation and quality of life.[23]

The need for assistive devices in the Asia-Pacific region is largely unmet. This gap is worst in the rural areas. Production and distribution tend to be concentrated in major urban centres. In the coming decades, the situation is expected to improve, but not uniformly.

For the majority of people with disabilities in the region, there will be a continuing need for simple solutions. In the case of devices for persons with mobility disabilities and low vision persons, most devices will continue to be made at the level of small community workshops which are organized for the indigenous production of culturally-appropriate, high-quality and low-cost assistive devices.

Some developing governments in the region provide limited subsidies and limited free assistive devises. Many NGOs are actively involved in production and dissemination of assistive devises in the developing countries of the region. Some governments in the region have established production and dissemination systems of assistive devices operated by a government or NGOs to systematically produce and disseminate devices (Cambodia, China, India, Malaysia, Sri Lanka and Thailand).

II-E. Education, training and employment

II-E-1. Education

Many international declarations and proclamations (e.g., Salamanca Statement and Education for All) have been made recognizing the rights of children, youth and adults with disabilities to equal educational opportunities in mainstream educational settings wherever possible. However, only 2 to 5 per cent of children and youth with disabilities in developing countries receive any types of education.

Special schools, all urban-based and with limited coverage, have long existed in many countries of the region. Serious policy concern aimed at addressing the education and vocational training needs of all children and youth with disabilities is quite new in most developing countries of the region. The Decade initiative has stimulated a questioning of the impact (on children and youth with disabilities) of actions taken in the name of Education for All (1990) and the Convention on the Rights of the Child (1990).

Integrated education is emerging as an approach to address this concern. Internationally, inclusive education is a term now increasingly used to describe broader integration efforts. The goals of inclusive education are defined with reference to the long-term goal of an inclusive society in which mainstream schools accommodate the diverse needs of all children, including those with disabilities.[24]

The nascent policy thrust towards including children with disabilities in mainstream schools, with mobile services for the home-based education of extensively disabled children, is a critical first step. The existence of a clear position by education policy makers helps to increase awareness among school authorities and teachers. It facilitates openness to change and a willingness to experiment.[25] These are important qualities in the search for unconventional but appropriate ways of helping students with diverse disabilities to acquire problem-solving skills and to apply them in exams. The introduction of inclusive education is an opportunity for overall improvement of the educational environment and for upgrading the relevance of teacher training to learning needs.

Some developing countries in the region have substantial schemes for expanding enrollment, especially in areas where this has not occurred. One such scheme emphasizes expanded coverage of rural children with mild to moderate disabilities through funding support for community mobilization, removal of physical barriers, in-service teacher training, and resource support. Other countries plan to pay special attention to the education of women and girls with disabilities, especially in the rural areas.

In view of the strong interest among many governments in opening up educational opportunities for persons with disabilities, there is urgent need to build capacity and experiences in inclusive education, drawing from indigenous cultural resources. The nature of change required involves a long-term process during which the search for culturally-appropriate solutions will be marked by many difficulties. Inclusion will succeed if everyone is committed to the education of all children, including those with disabilities.[26] Inclusive education demands the full commitment of society - community support, political will and resources to enhance teaching skills (regular and special), curricula, materials and the accessibility of facilities.

II-E-2. Training and employment

As with all other areas concerning the equalization of opportunities for people with disabilities, there is tremendous variation in the pattern and pace of change in employment promotion. Increasing globalization is sharpening awareness of the need for skills relevant to rapidly changing labour market opportunities. While many vocational training centres do not see it as their responsibility to monitor the relevance of their programmes, some are beginning to review their vocational skills curricula, to enhance the development of related skills that are important for securing and keeping jobs (e.g., inter-personal skills, and job application, self-organization and information gathering skills).

(a) Training

Some countries in the region plan large-scale expansion of vocational training opportunities for persons with disabilities, including through building more specialized training facilities. In the training of vocational rehabilitation and job placement personnel, more serious attention will need to be directed towards addressing the attitudinal barriers that they pose towards people with disabilities. Unless there is an immediate shift in focus to the quality of the personnel responsible and to close scrutiny of the effectiveness of actions taken, expansion of infrastructure using prevailing conventional approaches may well lead to expansion of failure.

Major efforts are under way in some countries to promote the enrollment of persons with disabilities in regular vocational training establishments, with measures being introduced to improve accessibility. This is an important development as the quality of training in regular establishments surpasses that in most specialized centres for disabled persons. In some countries, particular emphasis is placed on improving opportunities for women and girls, and persons with locomotor disabilities.

(b) Employment

Although data from developing countries are scarce, the little existing information shows that disabled people are much less likely to be engaged in economic activity than the rest of the population.27

Quota measures are a predominant means of promoting the employment of persons with disabilities in the region (India, Japan, Republic of Korea, Sri Lanka, Thailand). Many countries with quota systems do not have effective enforcement mechanisms. Campaigns to encourage implementation of quota measures and schemes which accord wide public recognition to employers of persons with disabilities work well in support of more basic actions on training and placement. Greater efforts are, however, still needed to ensure the continuing relevance of disabled people’s skills, and the provision of ongoing support for job retention, their known positive qualities as employees (for example, greater concentration, loyalty, ability to work hard and staying power) may not suffice in times of economic downturn[28].

Closely associated with conventional rehabilitation systems are sheltered workshops. In many ways, conventional sheltered workshops are bastions of the charity approach which does not recognize people with disabilities as citizens with rights to decision-making and self-determination. People with disabilities tend to stay in them once they enter, often with poor prospects of learning new skills in line with market changes, and receiving adequate labour protection. There is growing pressure on those workshops to change and to provide opportunities for disabled workers to move into less supported forms of work. A new model is the community workshop which has emerged to meet the socio-economic needs of young, extensively disabled graduates of special schools or classes, who cannot be employed in the open labour market. Such workshops tend to be established at the community level by parents and other voluntary groups, with local government support.

An emerging alternative to segregated training and sheltered workshops is supported employment. It involves on-job training by employers or with personal support in the workplace by job coaches from a specialist-training centre. Other types of professional staff support involve regular visits by resource persons to workplaces to resolve any problems which might arise. Under supported employment, the employer pays the disabled worker. If the worker’s productivity is lower than that of non-disabled workers, in some countries, public authorities make up for the shortfall through a subsidy.

II-F. Self-help organizations of people with disabilities and NGO support

Disability is a development issue because prevailing attitudes dehumanize people with disabilities.[29] If born disabled, disabled persons never acquire a sense of self-worth. If disability occurs later in life, self-esteem is soon crushed. There is strength in being disabled together with others. That strength gives people with disabilities the confidence to change the common condition of being dehumanized and marginalized. Organizations of people with disabilities are run by self-motivated persons with disabilities to assist disabled peers in taking charge of their lives. They differ from rehabilitation service delivery NGOs, which are run by non-disabled persons. The organizations of persons with disabilities are of two types: cross-disability and single-disability.

Single-disability organizations usually focus on meeting the needs of their own disability group. Thus for blind persons’ organizations, employment promotion is a major concern, while the expansion of sign language interpretation services is a key concern of deaf persons’ organizations. Single-disability organizations are effective in representing the views of particular disability groups which may not receive the same attention in a cross-disability setting. Generally, single-disability organizations tend to operate at the national and provincial-/or State-level, with little presence in villages.

Although cross-disability organizations are relative new comers, several have a large membership, with full- and part-time staff. Many operate as national-level federations of both single- and cross-disability member organizations. At the local level, cross-disability groups are emerging in both developing and developed countries.

Cross-disability organizations are likely to be umbrella organizations in respective countries. Their functions focus on advocacy, information dissemination and national coordination of their number organizations, many of them are single disability organizations.

Following are the major international organizations of self-help organizations: Disabled Peoples’ International, World Blind Union and World Federation of the Deaf. In the Asian and Pacific region, 16 countries have national affiliates of the above-mentioned three international organizations. Fourteen governments have national affiliates of one or two international organizations. These figures indicate a strong existence of self-help movements of persons with disabilities in the Asia and the Pacific region.

lll. WAY FORWARD

lll-A. Conclusion of the Asian and Pacific Decade of Disabled Persons, 1993-2002

The Asian and Pacific Decade of Disabled Persons will be concluded in December 2002. Toward the conclusion of the Decade, a regional exercise to measure the achievements during the Decade was proposed by the second session of the Thematic Working Group on Disability-related Concerns (TWGDC), held in May 2001, Bangkok. As the final review of the achievements of the goals of the Decade, ESCAP will organized the high-level intergovernmental meeting to conclude the Asian and Pacific Decade of Disabled Persons in Otsu, Shiga Prefecture, Japan, from 25 to 28 October 2002. The Government of Japan will host the high-level meeting, which will be held in conjunction with the International Forum on Disabilities to Mark the End Year of the Asian and Pacific Decade of Disabled Persons (15 to 23 October 2002 in Sapporo and Osaka, Japan).

The high-level intergovernmental meeting will:

- Review the achievement of the goals of the Asian and Pacific Decade of Disabled Persons, in particular fulfillment of the 107 strengthened targets for the Agenda for Action for the Asian and Pacific Decade of Disabled Persons, 1993-2002;

- Consider a framework for action beyond the Asian and Pacific Decade of Disabled Persons.

III-B. Policy framework beyond the Asian and Pacific Decade of Disabled Persons

There has been a voice among a non-governmental circle to advocate the extension of the Asian and Pacific Decade of Disabled Persons for another decade. Although there have been some significant achievements during the Asian and Pacific Decade of Disabled Persons, it is felt that the Asian economic crisis during the second half of the Decade has severely affected the implementation of the Decade Agenda for Action. There is the further realization that some countries and territories in the ESCAP region have not yet signed the Proclamation on the Full Participation and Equality of People with Disabilities in the Asian and Pacific Region, and many of those which have, have signed it recently and are still in the early stages of addressing the rights and needs of persons with disabilities in terms of the blueprint for development provided by the 12 policy areas of the Agenda for Action. There has been a consensus among the governments as well as NGOs in the region that the Decade Agenda for Action and its targets should remain the guiding framework for disability policies in the Asian and Pacific region.

A framework for action beyond the Asian and Pacific Decade will be discussed in the high-level meeting in 2002. Some core issues may be identified for consideration for discussion at the meeting.

III-B-1. More focused approach to implement the Agenda for Action

As indicated above, there seems to have some imbalance in the implementation of activities among the 12 different policy areas under the Agenda for Action. To fulfill the strengthened targets in a balanced manner as well as to make substantive impacts on the lives of persons with disabilities in the region, it may be necessary to prioritize areas among the 12 policy categories. Those selected policy areas may include:

- Access to the built environment and to information and communication technology (ICT)

- Education, and training and employment

- Income maintenance and social security

Inaccessibility to the built environment, including public transport system, is still the major barrier which prevents persons with disabilities from actively participating in social and economic activities in the countries of the region. The recent introduction of the universal design concept to the attention of architects, urban planners and policy-makers may stimulate the promotion of inclusive and cost-effective measures to solve not only inaccessible physical environments but also the issue of social exclusion. Access of disabled persons, in particular with sensory and mental impairments to information through ICT, particularly through the Internet, will become a serious issue, even more so than access to the physical environment, as the role of ICT, particularly the Internet, in the information society will rapidly increase in the 21st century. To prevent widening of the digital divide for disabled persons, policy action has to be taken to include accessibility requirements for and training needs of disabled persons in the mainstream ICT policy and programmes.

At the same time, access to education, training and employment opportunities is vital for children and youth with disabilities as well as disabled adult to participate fully in social and economic activities in 21st century. The issue of access to education for children with disabilities is one of crucial importance, as indicators from several sources suggest that between only 2 ? 5 per cent of children and youth are currently receiving any education. Lack of access to vocational training, employment and non-traditional income generation opportunities contributes significantly to the large numbers of persons with disabilities living in poverty. Measures for income maintenance and social security should include people with disabilities to protect their social and economic rights in society. Policies and strategies to bring people with disabilities into the social and economic mainstream are increasingly seen as superior from an economic perspective because they have the power to increase the economic contributions of people with disabilities, and reduce the cost of alternative means of support and care.

III-B-2. Strengthened subregional cooperation

As indicated earlier, there seems substantive imbalance among the subregions within the ESCAP region in the implementation of the Decade Agenda for Action. There may be common issues shared by governments in the same subregion. For example, countries and territories in the Pacific subregion face similar difficulties in providing services to disabled persons, many of who live in small remote outer islands. In this connection, efforts may be made to strengthen subregional cooperation to share knowledge and experience and to facilitate mutual support in implementing the Agenda for Action within the subregional grouping.

III-B-3. Broad human rights based approach to respond to the full participation and

equality of people with disabilities

Disability issues have been gradually shifting from a welfare approach to a broad human rights approach. Governments in the region, e.g., China, India and the Philippines, have enacted rights-based legislation for people with disabilities. A broad human rights based approach will thus become a common policy direction among the Governments of the region. Discussion on the elaboration of an international convention on the rights of all people with disabilities is expected to be on the agenda for many regional and national conferences, meetings and workshops. At the same time, a new focus may be placed on the presentation of disability issues within broad efforts to promote the rights of other groups, such as women and children. Such a viewpoint stresses that the advancement of the human rights for people with disabilities, as well as other groups, comprises an essential prerequisite for the promotion of human rights for all. The two approaches of advancing disability issues in mainstream policy initiatives and disability-specific policy comprise two essential elements of the human rights approach.[30] A highly significant extension of this line of thinking can be seen in the increasing concern that disability issues must be included within mainstream development policy. This position is being expressed in recent statements from both the World Bank and the Asian Development Bank. The latter has recently generated a project to investigate how this might best be achieved. The imperative is derived from the realization that the issue of poverty reduction cannot be addressed without including concern for the situation of persons with disabilities.

[1] Kaye, H. S, e.d. The Future of Disability Statistics: Proceedings of the First National Disability Statistics and Policy Forum, University of California, San Francisco, 9 August 1997).

[2] ESCAP, State of Urbanization in Asia and the Pacific 1993 (ST/ESCAP/1300), chap. II, p. 6.

[3] This subsection on macro-economic conditions is drawn from David Werner, “Planning for disability-related needs in the Asia-Pacific region during the next decades: the need for far-reaching analysis”, paper commissioned by ESCAP as an input for the preparation of this chapter.

[4] FAO, Fighting Hunger and Malnutrition (Rome, 1996), p.3.

[5] Ibid., p.15.

[6] Ibid., p.13.

[7] Unless otherwise stated, information on landmines is drawn from David Werner, ... op. cit.

[8] “Land Mine Facts” (http://www.un.org/Dept/Landmine/factsh.html).

[9] “Land Mine Facts”, op.cit.

[10] “The Landmine Problem” (http://www.waf.org/library/index.html).

[11] “Land Mine Facts“, op.cit.

[12] World Health Organization, The World Health Report 1997 - executive summary (Geneva, 1997).