According to the United Nations (UN), about 10 per cent of the world's population have a disability, while the World Bank (WB) estimates that one fifth of the world's poorest people have a disability. As such, not only do people with disabilities experience disproportionately high rates of poverty, but being poor increases the likelihood of disability. Those living in chronic poverty often have limited access to land, healthcare, nutritious food, shelter, education and employment. Furthermore, people in chronic poverty often live and work in hazardous conditions. All of these factors can predispose to disability.

The World Bank estimates that persons with disabilities comprise about 20% of the poorest of the poor. The relationship has often been described in the literature as a vicious circle, with poverty leading to disability, and disability leading to, and deepening poverty (DFID).

The Poverty and Disability Cycle
	Discrimination in all aspects of life Lack of access to education and training Exclusion from the job market Lack of access to information Higher vulnerability in conflict situations and natural disasters Difficulties for accessing food, water and sanitation Lack of access to rehabilitation/habilitation to achieve independent living Lack of voice/influence/choices
DISABILITY		POVERTY
	Lack of access to Information and preventative and maternal healthcare Food security, safe water and sanitation Increased exposure to disease, and lack of access to qualify curative, habilitative and rehabilitation services Increased occupational risks/dangerous employment Higher vulnerability in conflict situations and natural disasters/increased risk of injury/disabilit

It is not the disability per se creating poverty and dependency in people with disabilities, but their exclusion from mainstream social, economic and political opportunities. Persons with disabilities require more human and financial resources from their families and communities to support daily needs and activities, such as mobility, communication, medicines, transport to school or technical devices. Besides the direct cost related to his or her impairment, persons with disabilities are often unable to go to school, contribute to the livelihood of the family or interact with their communities. The burden of a disabled family member is borne by the whole family.

A review of the literature on the relationship between poverty and disability reveals the following facts:
Persons with disabilities comprise 20% of the 'poorest of the poor' in the world (WB)

• At least 70% of persons with disabilities live in developing regions (UN)
• Only 2% of persons with disabilites have access to rehabilitation and appropriate basic services (UNHCHR)
• Only 1-2% of children with disabilities in developing countries receive education (UN)
• Mortality of children with disabilities can be as high as 80% even in countries where overall under-five mortality is below 20% (UK DFID)
• Persons with disabilities are extremely vulnerable in situations of conflict (UK DFID)
• The special needs of persons with disabilities are often overlooked in relief operations (UK DFID)
• Over 30% of all impairments are caused by malnutrition and infectious diseases (UN)
• There are approximately 15,000-20,000 new landmine casualties each year, survivors of landmine explosions often have long term disabilities (ICBL)

Disability Leads to Poverty and Deepens Poverty at the Individual and Family Level, at the Community Level, and at the Global Level:

Communities and governments have felt little or no responsibility to deal with the challenges faced by people with disabilities and their families. Therefore disability is rarely seen as a matter of public policy and duty. In the majority of cases in developing countries, when services for people with disabilities do exist, they are funded by a small segment of the NGO donor community.

However, disability impacts all levels of society from the family, community, national and global level.

Disability and Poverty at the Individual Level –

• People living in poor communities are more at risk of impairment leading to disability because of lack of access to adequate nutrition, preventative, curative and maternal health care, water and sanitation, safe employment or security in conflict and natural disasters.
• An adult or child living with a disability is likely to be discriminated against and denied their right to education which leads to exclusion from the social and economic life of the community and eventual unemployment, which deepens poverty. Importantly, persons with disabilities rarely get the opportunity to voice their views and influence decisions affecting their lives. Being excluded from development programs provides difficulties for people with disabilities in breaking out of the circle of poverty and disability.

Disability and Poverty at the Family and Community Level –

• It is estimated that one out of four persons has a family member with a disability; the lives of 25% of the population in the Asia-Pacific region are believed to be impacted by disability. Rates of poverty are known to be higher in households with a person with disability. Household members spend time and money taking care of their family member who needs personal assistance and has not had access to support services or rehabilitation which would lead to independent living. Family members may be kept from economic activities, school etc (WB 2007).

Disability and Poverty at the Global Level –

• In 1993, the UN estimated that 25% of the entire population is adversely affected as a result of disabilities. World Bank studies estimated the global GDP loss due to disability from $1.71 trillion to $2.23 trillion annually and that developing countries experience from 12 to 20% of their population as non-productive due to disability (WB 2007).

Development is not a simple matter of charity, but a right. Defined this way, all individuals have a claim, or legal entitlement, and someone else holds a corresponding duty or legal obligation to provide this development. This obligation transcends from the international level, through the national level, the organization level, and to the community level. 

The need to include persons with disabilities in the world’s development mainstream is evident. As a result, for the first time the United Nations Convention on the Rights of Persons with Disabilities (CRPD) emphasizes the need for development programs to be inclusive and accessible. The development of these programs should be done in consultation with organizations of persons with disabilities. Only when such mainstreaming is unable to adequately address the needs of persons with disabilities should the conventional approach of developing specialized programs be adopted (OHCHR 2007). The twin-track approach to development addresses the distinction between mainstreamed and specialized programs.

Twin-Track Approach to Disability and Development:

The so-called ‘twin-track approach’ is based on similar gender models with the focus on both mainstreaming and empowerment of persons with disabilities. This could be an effective tool for creating an enabling environment. This model, as illustrated by DFID (2007) is shown below:
 

A twin-track approach to disability and development
Addressing inequalities between disabled and non-disabled persons in all strategic areas of our work		Supporting specific initiatives to enhance the empowerment of disabled people
Equality of rights and opportunities for disabled people

Mainstreaming disability in the development agenda is a strategy for achieving equality for persons with disabilities. While there is no officially accepted definition of mainstreaming disability, the basic principles described by the UN Division for the Advancement of Women of the Department of Economic and Social Affairs and adapted for disability are listed as: (UNESCO)

1. Responsibility for implementing the mainstreaming strategy is system-wide, and rests at the highest levels within agencies.
2. Adequate accountability mechanisms for monitoring progress need to be established. Initial identification of issues and problems across all areas of activity should be such that differences and disparities between persons with and without disabilities can be diagnosed.
3. Clear political will and allocation of adequate resources for mainstreaming – including additional financial and human resources, if necessary – are important for translation of the concept into practice.
4. Disability mainstreaming requires that efforts be made to broaden the equitable participation of persons with disabilities at all levels of decision-making.
5. Mainstreaming does not replace the need for targeted, disability-specific policies and programs, and positive legislation; nor does it do away with the need for disability units for focal points.