Roughly 15 percent of the world’s population has a physical or mental disability. In the U.S., laws like the Americans With Disabilities Act improve access and increase participation, but in developing countries, people with disabilities are often ignored in policy discussions. Kojo explores the new World Report on Disability and examines how disability issues are being integrated into broader approaches to international development.

Transcript

  • 13:06:42

    MR. KOJO NNAMDIFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. It's an eye-popping statistic about disability around the globe. Fifteen percent of the world, more than a billion people, live with some form of physical or mental disability according to the first worldwide survey of disability in over 40 years. But what does that really mean? Hundreds of millions of people live with some sort of medical impairment, whether it's limited mobility or sight or hearing. But disability is really a lived experience. Schools they can't attend, newspapers and other media they can't read. Transportation networks they can't use.

  • 13:07:38

    MR. KOJO NNAMDIAfter decades of legal challenges and grass roots activism, many of those barriers have been successfully challenged here in the United States. But in many developing countries, they persist. This hour we're exploring disability and global development. Joining us in our Washington studio is Judith Heumann, special advisor for International Disabilities Rights with the U.S. Department of State. She previously served as director of the Department on Disabilities Services for the District of Columbia. Judy Heumann, good to see you again.

  • 13:08:11

    MS. JUDITH HEUMANNNice to see you again.

  • 13:08:13

    NNAMDIAlso with us in studio is Charlotte McClain-Nhlapo, coordinator of the Office of Disability Inclusive Development with the Unites States Agency for International Development. Charlotte McClain-Nhlapo, thank you so much for joining us.

  • 13:08:28

    MS. CHARLOTTE MCCLAIN-NHLAPOThank you, Kojo. Good to be here.

  • 13:08:30

    NNAMDIAlso with us in studio is Tamar Manuelyan Atinc, vice president for human development with the World Bank. Tamar, thank you for joining us.

  • 13:08:40

    MS. TAMAR MANUELYAN ATINCThank you, Kojo. It's good to be here.

  • 13:08:42

    NNAMDIJoining us from studios in Geneva, Switzerland is Tom Shakespeare, technical officer with the Department of Violence and Injury Prevention and Disability with the World Health Organization. Tom, thank you for joining us.

  • 13:08:57

    MR. TOM SHAKESPEAREGood afternoon and thank you.

  • 13:08:58

    NNAMDIIt's a conversation that you can join too by calling 800-433-8850 or going to our website, kojoshow.org. Are you a person with a disability? Have you lived or traveled in a developing country? How did your experience compare with the U.S.? 800-433-8850. You can send us a tweet @kojoshow.

  • 13:09:19

    NNAMDILast month, the World Health Organization and the World Bank released new statistics on global disability. I mentioned some aspect of those statistics earlier. In the U.S., there are physical signs of progress in terms of addressing access and other disabilities issues. We've got Braille on our elevator buttons, ramps at building entrances, traffic signals that beep for people can't see. But when you're talking about people with disabilities in a developing country, that kind of infrastructure is probably not realistic in a place like the Congo or even a place like the Philippines. Charlotte, does this conversation look different in a developing country compared to a developed country?

  • 13:10:01

    MCCLAIN-NHLAPOYes, it does and I think you're right that much of it has to do with the fact that infrastructure's often not accessible to persons with disabilities. But I think beyond that, very often in developing countries, there is a gap in terms of the necessary legislative and policy frameworks. And I think that that's really an important issue. Having those frameworks becomes very important. I would say another gap is that in many developing countries, we don't have a robust enough of a civil society of persons with disabilities engaged. And I think that, for me, those are some of the blocks that need to be in place in order to ensure inclusion of persons with disabilities.

  • 13:10:47

    MCCLAIN-NHLAPOI think a very important issue in that regard is the issue around of attitudinal barriers. How people with disabilities are perceived in developing countries. And that, for me, begs the question for ensuring that we're really beginning to increase knowledge and get people to understand that disability really is part of our human condition.

  • 13:11:12

    NNAMDIEven though these statistics indicate that there are large numbers of people with disabilities in developing countries, if you travel or spend time in those countries, you may not see people with disabilities. It might be because, well, we really aren't looking or it might be because you can't see all this disability, but it's also because -- isn't it they are not visible in civic life, at least as visible as they could be, Judy?

  • 13:11:37

    HEUMANNI think you do see disabled people when you travel. In many countries, they may be the beggars, they may be the people crawling on the street. But people are there. They're not out and about in the community like they are here in the United States and other countries, but I think, as you said, people may not wish to look at the individuals that they're seeing. But in many countries, when you leave airports, the first people you do see our people who are beggars outside of the airports. I also want to get back to the question that you'd asked a few minutes ago. I believe that it's important for people in the United States to remember what it was like 30, 40, 50 years ago.

  • 13:12:21

    HEUMANNFor someone, myself, being 63 years old, what I remember about the United States as I was growing up is there was really no accessibility. We had no access wheel buses, we had no schools that were accessible. Discrimination against disabled people in employment was quite rampant and there was very little that could be done about it. So when we talk about work going on in other countries that are not yet at the level that we are in the U.S., I think it's very important for us to recognize that, A, we still have a lot more to do and, B, we've really had to do a lot of work over the last -- more than 50 years.

  • 13:12:56

    HEUMANNCharlotte's point about the need to have an important -- a strong civil society is very important. I think that's what we've seen in the United States and in countries all over the whole world as progress has been made. Disability organizations have emerged and have really become empowered. I think when we look at the report one of the important aspects of this report is that it's really looking at moving away from the medical model of disability and moving towards the social model or the Disability Rights model. And I think when we see that model being implemented in countries where civil societies are becoming stronger, that's when we begin to slowly see change.

  • 13:13:36

    NNAMDITamar, care to comment at all?

  • 13:13:38

    ATINCYes, I agree with the comments that Charlotte and Judith have made. Many of them speak to -- because of the level of income in many countries in the developing world, they're less able to provide an enabling environment to people with impairment. Along with that, of course, goes the points made about civil society not being as active as it could be. So that ends up meaning that the gap between the capabilities of people with impairment and their actual performance ends up being higher in developing countries and that makes it a development issue, which concerns us working in the World Bank in fighting poverty.

  • 13:14:22

    ATINCOne other point I wanted to make about the difference between disability in a poor country context versus in richer countries is, I think people are more likely to suffer from preventable disability in poorer countries and this we know from the Disability Report. For every age group, there's a higher likelihood of disability in poor countries than in rich ones. It's in poor countries that children are malnourished, that mothers suffer from illness at childbirth, if they manage to survive that, where 90 percent of vision impairment resides, where people are more likely to maimed by workplace related injuries, road accidents and mine explosions.

  • 13:15:11

    ATINCSo the important point here is that there's a link between preventable disability and a country's income level, which makes this a significant development issue.

  • 13:15:22

    NNAMDITom Shakespeare, can you talk a little bit about how this report that we've all been referring to was put together?

  • 13:15:28

    SHAKESPEARECertainly, I can. It took a long time, Kojo. It's a big report. It's not just statistics on prevalence, but it has chapters on how often rehabilitation, education, employment and so forth. It was 370 different people around the world who contributed from about 70 to 80 countries. There was regional consultation meetings in four different regions of the world. We really tried to get out there here from people how it was in their lives. Disabled people obviously were front and center to the whole thing as editors, as authors, as reviewers and so forth.

  • 13:16:04

    SHAKESPEARESo we really wanted it to be participative and we really wanted it to be accessible. This report is in Braille. It's in accessible PDF format. It's an easy read for people with intellectual disability. We really want this report to make a difference wherever people are in the world. And I just want to say one thing, I wouldn't want to challenge anything that my colleagues around your table has said, but this story isn't over in the United States of America. The unemployment of disabled people is twice that of disabled people. So attitudinal problems are in the U.S. or the UK, where I come from, as well as in low-income countries. So we've all got work to do. No one country has got it right.

  • 13:16:43

    NNAMDI800-433-8850 is the number in case you'd like to join this conversation on disability and global development. Here is Ray in College Park, Md. Ray, you're on the air. Go ahead, please.

  • 13:16:56

    RAYYes, hi. I was wanting your guests to comment on something I noticed when I visited China last year. I was in Beijing, one of the largest cities in the world, and I didn't see a single person in a wheelchair in that entire city. And I noticed that, you know, maybe midway through my stay there and then I noticed that, well, there's no curb cuts in that whole city that I could see. And I was wondering if China just has no disabled people or, you know, what's going on there? And if anybody could comment on that and I'll take my comment off the air.

  • 13:17:32

    NNAMDII'll start with you, Charlotte.

  • 13:17:33

    MCCLAIN-NHLAPOWell, Ray, I've actually been to China and I use a wheelchair. It wasn't really...

  • 13:17:37

    NNAMDIHe didn't see you.

  • 13:17:40

    MCCLAIN-NHLAPOI have to say that the first time I went, I found that the city wasn't terribly accessible. But as there was a buildup towards the Olympic Games, the city became more and more accessible so I found that I was actually able to move around, at least downtown Beijing.

  • 13:17:58

    MCCLAIN-NHLAPOBut I think it goes back to the earlier comment, and that is that where you don't have an enabling environment, where you don't have infrastructure that's accessible to persons with disabilities, where you have negative attitudes, where you have low literacy, where you have -- where you don't have engagement of persons with disabilities, you just don't see them in the community. I mean, of course, there are people with disabilities in China and there are some very active organizations of people with disabilities in China, I might add.

  • 13:18:30

    NNAMDITom Shakespeare, Brazil is rapidly becoming a global economic power to the point that it might not even be accurate to call it a developing country anymore. But there are certainly aspects of being a developing country in Brazil and I've seen a number of articles about a Brazilian city called, I think, Curitiba, can you talk about that?

  • 13:18:49

    SHAKESPEAREThat's right. Curitiba is, right, just next to Sao Paulo, which your listeners will have heard of. And what's brilliant about that city is that they've shown that even in a middle income country, not a rich country, you can get accessibility a much better, pretty right, what we call universal design, the idea that we can design transport systems to be accessible to the full range of the population, happens in Curitiba.

  • 13:19:13

    SHAKESPEAREThey have a bus rapid transport system. It's not high-cost, but it is high accessibility. And, you know, this makes it easy for everybody because if you think about a busy bus interchange, everybody's getting off the bus, they're getting on the bus. Whether you're old, young, with or without shopping, with or without children or in a wheelchair or not, you need to be on a transfer quickly and that's what they've achieved in Curitiba.

  • 13:19:36

    SHAKESPEARESo it really is an example and it's one that loads of places are taking up. Dar es Salaam in Tanzania, many cities in South America are taking up this idea that we can design, as we develop cities and infrastructure, to be accessible to all. So it's a good story, but, you know, you could go to Deli Metro, that's accessible now, you know. It's not just Washington. You can see a lot of good examples showing what can be done.

  • 13:20:02

    NNAMDITamar, 2015 looms large for the millennium development goals. The International Community identified binding antipoverty targets for countries around the world. How do disability rights issues fit within that framework?

  • 13:20:17

    ATINCIt's a very good point, Kojo, that you make as we approach the year 2015, which is the deadline for the attainment of the millennium development goals. And among those, we have the ones related to the reduction of poverty, clearly addressing the needs of the disabled population so that they can contribute fully to their communities and societies is a very important one. Poverty reduction involves reaching out to every single individual in society to ensure that they reach their potential.

  • 13:20:52

    ATINCOne very sobering statistic that has recently come out in the last world development report on conflict and fragility is that not a single country that has been affected by conflict has attained a single one of the MDDs. And I have to believe that disability that results from conflict has to be one of the important determinants of that statistic. So clearly, working on disability, ensuring that people meaningfully contribute to their societies and are gainfully employed is going to be an important way (unintelligible) .

  • 13:21:30

    NNAMDISpeaking of working on disability, both you, Judy Heumann and you, Charlotte McClain-Nhlapo, I'd like to talk a little bit about what it is you actually do.

  • 13:21:43

    HEUMANNWell, first I want to say something about Brazil very quickly. Brazil is an excellent example of how when civil society and government work collaboratively together, you can see some very meaningful changes. There's a very strong disability rights movement in many of the cities in Brazil. And you see that also across many of the countries in Latin America. They have national committees on disability. They have centers for independent living and various other organizations. So I think the theme of where do we begin to see change really is very much when we do see a stronger disability rights community.

  • 13:22:19

    HEUMANNWhat I'm doing at the State Department, this position was created by the President in 2009 when the U.S. agreed to sign the Convention on the Rights of Persons with Disabilities. And now, we're moving forward on a treaty package to move to the Senate in the near future. My position is really to help expand the knowledge of disability across the State Department and to increase the work that we're doing. So that at the country level, the embassies will be engaging more with the disability community, becoming more knowledgeable about what the problems and changes are that need to be made.

  • 13:22:55

    HEUMANNWe're integrating disabled people into issues like the secretary's policy on youth. The State Department has a program where we bring people from overseas to the United States. There are increasing numbers of disabled people who are coming to the U.S. to learn about what is going on both in policy and with civil society organizations. And our ultimate objective is to work on the inclusion of disability across our diplomacy and foreign policy agenda.

  • 13:23:23

    NNAMDIAnd Charlotte.

  • 13:23:24

    MCCLAIN-NHLAPOI just wanted to say one thing about the millennium development goals, and I think that there's one particular goal, the goal on education, which is the goal to reach universal primary education. And I think, for me, that is one of those goals that really begs for inclusion because there's no way we can talk about universal primary education if we're not including 10 to 15 percent of children with disabilities. So for me, that's just a very important goal and I think that it's important to think about disability in terms of all of the eight goals that are set out within the millennium development goals. Kojo, in terms of what I do...

  • 13:23:59

    NNAMDIYes.

  • 13:24:00

    MCCLAIN-NHLAPOLike Judy's position, my position is a position that was stood up by the Obama Administration. It's the Office for Disability Inclusive Development and I'm the coordinator. And my role is to elevate disability within USAID and really to try and ensure that disability inclusive development becomes part of the agency's DNA so that everything that we're doing includes disability. But this requires for us to support pilot projects, standalone projects that show that disability and the inclusion of persons with disabilities can work.

  • 13:24:43

    MCCLAIN-NHLAPOAnd then, in addition to that, to make sure that all of the policies that we're developing are inclusive of people with disabilities. So the new education strategy that was stood up in February this year talks to the issue of learners with disabilities. We're looking at a new policy on youth and gender and we would want to ensure that people with disabilities are included in those policies.

  • 13:25:08

    MCCLAIN-NHLAPOSo my role is to provide the technical assistance in the agency, to provide the leadership. And I think being a person with a disability is also very important within that role because it shows that I have that lived experience. I understand some of the issues. This is not to suggest that people without disabilities don't understand the issues, but I think my presence in the agency is very important.

  • 13:25:33

    NNAMDIHave to take a short break. When we come back, we will continue this conversation on development -- global development and disability. You can still call us, 800-433-8850. Are you a person with a disability? Have you lived or traveled in a developing country? What was that experience like? How did it compare with being here in the U.S.? 800-433-8850. Send us a Tweet @kojoshow. E-mail to kojo@wamu.org or go to our website kojoshow.org where you will find links to the aforementioned report. As a matter of fact, join the conversation there. I'm Kojo Nnamdi.

  • 13:27:45

    NNAMDIYou're joining a conversation on disability and global development with Tom Shakespeare, technical officer with the Department of Violence and Injury Prevention and Disability with the World Health Organization. He joins us from studios in Geneva, Switzerland. The World Health Organization and the World Bank recently released the World Report on Disability. Joining us in our Washington studio is Tamar Manuelyan Atinc, vice president for Human Development with the World Bank.

  • 13:28:13

    NNAMDIJudy Herman -- Judith Heumann, special advisor for International Disability Rights with the U.S. Department of State. Judy previously served as Director of the Department on Disability Services for the District of Columbia. And Charlotte McClain-Nhlapo, coordinator in the Office of Disability Inclusive Development with the United States Agency for International Development. We're taking your calls at 800-433-8850. Here is Megan (sp?) in Washington D.C. Megan, you're on the air. Go ahead, please.

  • 13:28:44

    MEGANHi, thanks for taking my question. I was calling to ask your guests to say a little more about education and how you make sure we reach disabled kids in developing countries. I think anybody that's worked overseas, when you go into villages and you get out of the streets and you go into a small home, whether it's, you know, urban or rural, you find these children and they've been left out. I know that the fast track initiative over at the World Bank tries to encourage these countries and they do national plans for education and to dedicate money and services and resources for reaching these kids. But what could they recommend that would be specific?

  • 13:29:17

    NNAMDIIt seems everyone agrees that disability issues are essential for meeting those -- millennium development goal number two, which is achieve universal primary education. In many parts of the world children with disability are not afforded the opportunity to go to school and that can have all sorts of cascading effects. Judy, let's start with you.

  • 13:29:36

    HEUMANNWe need to make sure that as policies are being developed at the governmental levels that disabled children are clearly a part of the goals and objectives of the government. I think it's also very important that we're helping parents learn about the fact that their children with disabilities have a right to go to school and...

  • 13:29:56

    NNAMDIBecause for you, getting into elementary school was, as they say, a trip.

  • 13:30:01

    HEUMANNRight. So as you remember, my story was I didn't get to go to school when I was five years old because the school was able to deny me the right to go to school. And it was the result of my parents and other parents who really worked with the school systems and fought with the school systems to make those types of changes.

  • 13:30:20

    HEUMANNIn the United States, we have programs which support parents and help them learn about what their rights are so they can become more effective advocates with their children. We certainly are seeing in countries around the world, through organizations like Inclusion International, which has a very strong emphasis on working with parents at the country level to help them fight for their rights for education of disabled children.

  • 13:30:44

    HEUMANNI also think that the donors, like the United States and the World Bank and others, need to be, on a regular basis, discussing the fact that we expect disabled children to be a part of the reforms that are going on within countries. That also means that we have to help make sure that teachers are learning how to work effectively with children who have different disabilities. But one of the issues that we've addressed a number of times in the program so far are basic issues around accessibility. So accessibility in sharing that a school is built so that a disabled child can get into it. A door which is wide enough and possibly having a ramp, if there's a need for that, is not expensive, but the community needs to see that the education of those children is important.

  • 13:31:29

    NNAMDITom Shakespeare, some of the assistive technologies available to someone in the West would be prohibitively expensive in a developing country. For example, last year, we did a show on accessible technology design and we learned that the iPhone is an incredibly powerful tool for people with sight disabilities, but you can't expect to have a blind person in the Congo with an iPhone, could you?

  • 13:31:53

    SHAKESPEAREWell, not yet. Although obviously, as you know, many people in the developing world are using mobile phones in all sorts of ways to promote their access to the economy and so forth. So it may not be too far off. But just to sort of reinforce this point about education, one of the things we find is that even in countries, which have a good level of child -- children going to school, say Bolivia where 98 percent of children go to school, under 40 percent of disabled children go to school. And in Tunisia, over 80 percent of children who are not disabled go to school, but less than 25 percent children who are disabled.

  • 13:32:28

    SHAKESPEARESo we've absolutely got to answer this. And I think that one of the problems is that often there is a lack of policy. So, for example, for nondisabled children, it's the ministry of education who's in charge. For disabled children, it's the ministry of social welfare. We need to ensure that everybody understands how important education is for disabled kids and that includes training teachers.

  • 13:32:50

    SHAKESPEAREThere's some really good new examples of how teachers in countries like Ethiopia can be trained to include disabled children in their classes so they're not prejudiced against the blind child or the deaf child who they previously had no idea how to teach. They can, with simple instruction methods, be enabled to be included. I think this point about accessible schools is so important so is the idea of trying to support children in the classroom.

  • 13:33:19

    SHAKESPEAREWhen you've got classrooms of 70 or 80 kids, as you do in some African countries, you can't just dump a disabled kid there and expect them to thrive. We need to ensure that parents or other community members are there to help support them. And that's why Judy's points about involving families and involving communities is so important.

  • 13:33:37

    NNAMDICharlotte, you have been looking, the State Department has also been looking, it's my understanding, at the issue of appropriate assistive technology.

  • 13:33:44

    MCCLAIN-NHLAPOYes. And I think as Tom mentions, I think, you know, we're going to see -- we're going to a space where it will be more affordable for people to access technologies. But I think we also need to think about how we can promote the production of technologies in developing countries. And I think that that's beginning to happen. That's certainly happening in India and that's an area that I think we could begin to support.

  • 13:34:13

    HEUMANN(word?) the Perkins School for the Blind is doing a lot of work in Africa and Latin America. And one of the issues they are working on is supporting the employment of disabled individuals in the area of technology for blind people. There's some very good work that's going on now with the United States Department of Education in the area of technology. We met with a number of people last week who are doing both domestic and international work.

  • 13:34:38

    HEUMANNAnd work in the area -- like Book Share, which is a very low cost way of getting books to blind individuals in countries is available now. And what we're trying to do is expand the program. But as Tom was saying, as the technology is being developed in many countries, particularly when it's produced locally, the insurance that accessibility is something which is built in to the development of that technology is very important. And that's one thing that we've seen in a number of countries. As the inclusion of disabled people becomes a part of what's happening, the inclusion of accessible technology, whatever level it is within their government, within their country, is becoming more of a reality.

  • 13:35:23

    NNAMDIGot to get back to the phones, but, Tamar, when we talk about the challenge of serving and empowering people with sight or with hearing disabilities, we're talking about a community that needs very specific discreet remedies. It can be something as simple as printing HIV Aids pamphlets in Braille or conducting some public health trainings in sign language. The report that we're talking about cites projects in Tanzania and Mozambique that are doing just that.

  • 13:35:49

    ATINCAbsolutely right, Kojo. And I wanted to chime in and say all these points that have been made about motivating families, involving the private sector in technology solutions, training teachers to be able to work with children with disabilities and improving the accessibility of buildings and infrastructure are essential. On the accessibility point, the point about universal design that Tom made, I just wanted to say that if that is done with new infrastructure, the costs are really minimal. We don't have a lot of information on this. But the information that we have from richer countries suggest that the costs would be an extra 1 percent of the total cost of the investment if this is done early on, as opposed to retrofitting later on.

  • 13:36:34

    ATINCI wanted to give you the example of a project in which we're involved in in Bangladesh, where we're supporting the government in setting up integrated disability service centers. These are essentially one-stop shops for people with disabilities to get access to a range of services, including children that have sight impairment. And it is through this center that they get access to hearing aids and educational aids, such as Braille textbooks that you mentioned.

  • 13:37:06

    ATINCThe same projects, in addition to having these centers at the districts, also provides for mobile vans that are fully equipped with the equipment to be able to reach out to the children that are not able to come to the center itself. But -- so it's the mobile outreach so that they can canvas and help the disabled population in the broader community.

  • 13:37:30

    NNAMDIYou made reference to human development and that seems to be a framework put forth by a number of development thinkers associated with scholars like Amartya Sen. The idea is that development should be thought of less about statistics and more about expanding the abilities of individuals. That's what we're talking about here, isn't it?

  • 13:37:48

    ATINCWe're talking about expanding the capabilities of individuals and ensuring that they have an enabling environment that allows them to deliver on those capabilities. And that's...

  • 13:38:00

    NNAMDIHere is...

  • 13:38:00

    ATINCYes.

  • 13:38:01

    NNAMDIGo ahead, please.

  • 13:38:02

    ATINCAnd that happens with providing them with access to services that everybody has. And it means having access to education services, health services, water and sanitation services. And in addition to that, as we mentioned, there are a number of specific services that the disabled population needs in order to meaningfully contribute to society.

  • 13:38:23

    NNAMDIOn...

  • 13:38:24

    HEUMANNThe dis -- I'm sorry.

  • 13:38:24

    NNAMDIGo ahead, please, Judy.

  • 13:38:26

    HEUMANNI think, you know, where we're going is we need to see the disability rights movement as a movement. And we need to see the importance of the voices of disabled people as paramount in the discussions and the development of what's going on. Services are very important within countries. And the way those services are provided and having the voices of disabled people included is very important. But I think one of the important parts about the report is that it moves us away from the medical model to the social model and to the rights model. And I think the rights model is imperative in order to really be able to address many of the issues that we've been discussing.

  • 13:39:01

    HEUMANNYou know, think of the women's movement being run by men. The disability movement needs to be run by disabled people.

  • 13:39:06

    MCCLAIN-NHLAPOAnd I think -- Kojo, if I may, I think it's important to recognize that there are some really good examples in that regard. I mean, I think if we look at South Africa and we look at the role that organizations of persons with disabilities have played there, we really can learn a lot from there. I think if you look at the formation of policy in South Africa, you will see that there has been a footprint of persons with disabilities in the development of that policy. If you look at Parliament, Parliament has at least 15 members -- persons with disabilities in the South African Parliament. So you have voice and I think that this is really important.

  • 13:39:40

    MCCLAIN-NHLAPOThe model that has been set up in government to support disability includes people with disabilities. And this is something that's been replicated in a number of countries in Africa.

  • 13:39:51

    ATINCKojo, we have learned that throughout development projects the involvement of the beneficiary is key to a successful outcome. And I think that is equally, if not more the case, when it comes to interventions that are designed to help address the needs of the disabled population.

  • 13:40:08

    NNAMDITom Shakespeare, we've heard a number of times in this discussion about moving the disability model from the medical model to the social model. In the preparation of this report, was there a conscious effort to do that?

  • 13:40:21

    SHAKESPEAREThere was indeed. That may be surprising, given that I'm speaking from the World Health Organization. But the WHO recognizes the social determinants of health and the sort of conceptual basis for this report is the international classification of functioning disability and health, which makes quite clear that the environment plays a huge role in the experience of disability.

  • 13:40:43

    SHAKESPEAREIf you like, disability's the interaction between having an impairment, a health condition, and the context in which you'll find yourself, the environment that you're trying to negotiate. So the environment may support you or it may exclude you and that might be physical barriers, information barriers, poverty due to discrimination in employment or it may be the attitudes of others. So that's absolutely essential to this report and it's also essential to the convention on the rights of persons with disabilities, which is the sort of moral compass of this report and on -- depends obviously the work that my colleagues in Washington are also doing.

  • 13:41:19

    SHAKESPEAREAnd both stress that it's an interaction. We can obviously try and prevent health conditions which cause problems. We should do that. That's what all my colleagues in WHO are busy beavering away doing. But there will always be disabled people. We live in aging populations. More and more people are going to be disabled, therefore, we have to ensure that the barriers to their inclusion are removed. And people are getting that message, not just in the disability movement, also at the heart of the WHO, which is good news.

  • 13:41:46

    NNAMDIHere is Stephanie in Washington, D.C. Stephanie, your turn.

  • 13:41:51

    STEPHANIEYes, hi. I'm an international lawyer and human rights lawyer and I know several of your guests well, especially Judy and Charlotte. And I just wanted to raise one point that I think really needs to be focused. I think we had a little bit of discussion about it, but I think Judy and I, I think, both know that from our experiences we find now that as more and more people with disabilities, in the United States any way, are receiving education in conjunction with nondisabled students. So we notice that as people become -- as we work more and more with younger people, there's more acceptance of disability and more understanding of the issues that are concerned with that.

  • 13:42:36

    STEPHANIEBut this also, I think, can be an effective strategy in terms of using development policies and programs when they're implemented overseas that are not necessarily disability focused, but to always make a vigorous effort to ensure that persons with disabilities are included. One example -- I do a lot of work on women's issues with respect to disability and one example is -- for example, the State Department has a wonderful program to provide cell phones to women, especially in conflict environments. And as you were pointing out, with things like the iPhone and other simple technologies that are not as fancy as an iPhone, but there are ways to make cell phones accessible to persons with disabilities

  • 13:43:22

    STEPHANIEBut as I understand, that program doesn't include those kinds of cell phones so that women with disabilities, who could really benefit from both the safety aspects that cell phones provide in those environments, as well as the economic empowerment aspects that flow from those -- the provision of those, you know, women with disabilities aren't included. Similarly, and for example, just general economic empowerment training development programs, if women with disabilities are sitting at the same table with women without disabilities, you also engender that same familiarity and that same comfort that can really manifest itself in dramatic policy changes so that people aren't hidden. And I would just like to hear all of your guests talk a little bit --

  • 13:44:08

    NNAMDIAs briefly as possible, please. First you, Charlotte.

  • 13:44:12

    MCCLAIN-NHLAPOWell, I mean, I think Stephanie raises an important point. I mean, I think the point is that if you're going to provide services to women, you should be providing services to women with disabilities. If you're going to empower women, you should make sure that you include women with disabilities in that process. And I mean, I think that that's absolutely essential. I think one of the interesting things is that very often women with disabilities have not been necessarily part of the mainstream women empowerment programs. And so there has to be a concerted effort when we go out there to make sure that we are including women with disabilities in all of the projects that we're doing.

  • 13:44:47

    MCCLAIN-NHLAPOAnd I think it's also very exciting because we're seeing increasingly a number of very strong women with disabilities from the developing world who are out there, who are beginning to insist that their voice is heard at the table. But a lot of work needs to continue in this regard.

  • 13:45:05

    NNAMDIWell, a lot of what we're talking about is exporting know-how and best practices from the developed world to developing countries. But are we also exporting values? Put another way, is there a danger here that we're guilty of a kind of cultural imperialism? It seems like the challenge is figuring out ways to help people with disabilities find their own voice and their own sense of identity. I'd like to hear what you have to say about that, Tom.

  • 13:45:32

    SHAKESPEAREWell, one of the points -- I think there is a danger and I think one of the points is that in the high-income countries we tend to be very individualist. We talk about, you know, for example, independent living all the time and paying for our own personal assistants so we can be independent and selfish like everybody else. Of course, in most of the world, families are the heart of the community and people don't see or find it necessary to be independent. They want to be interdependent. They want to be playing a part in their society, but with their family.

  • 13:46:00

    SHAKESPEAREAnd I think sometimes, in my experience, high income disability activists kinda overlook that 'cause for many of us, the family is the people we're trying to break away from. We don't want our parents or whoever telling us what to do anymore. And I think you have to understand in other parts of the world that message may not be so acceptable.

  • 13:46:19

    NNAMDIGot to take a short break. When we come back, we will continue this conversation on disability and global development. If you've called, stay on the line, we'll try to get to your call. Otherwise, you can go to our website, kojoshow.org, join the conversation there or send us a Tweet @kojoshow. I'm Kojo Nnamdi.

  • 13:48:12

    NNAMDIWelcome back to our conversation on disability and global development. We're talking with Charlotte McClain-Nhlapo, coordinator in the Office of Disability Inclusive Development with the United States Agency for International Development. Judith Heumann, a special advisor for International Disability Rights with the U.S. Department of State. Tamar Manuelyan Atinc is vice president for Human Development with the World Bank. And Tom Shakespeare is Technical Officer with the Department of Violence and Injury Prevention and Disability at the World Health Organization.

  • 13:48:42

    NNAMDIWhen we took that break, we were having a conversation about whether or not we were indulging in a kind of cultural imperialism by, I guess, sending our own values about disability to other countries, exporting them. And, Judy, you wanted to continue that conversation.

  • 13:48:59

    HEUMANNYeah, I'd like to say that if people want to look at the Convention on the Rights of Persons with Disabilities and look particularly at Article 3, which talks about general principles, I think it's very important to realize that disabled people around the world want the same thing. How we get it will be different depending on our country and the period of time that we're in, the economic development of the country itself.

  • 13:49:22

    HEUMANNBut if you look at issues like independent living, as Tom was discussing, countries have been developing this approach, which is really one where disabled people are empowered to take responsibility for their own lives. They've been -- disabled people have been developing these programs as they see appropriate for their countries. But now, there are independent living centers in Pakistan, in Indonesia, in South Korea, all throughout Latin America. And people develop these programs as is fit for the culture of the country.

  • 13:49:53

    HEUMANNBut at the end of the day, people want dignity, individual autonomy. They want to end discrimination. They want to be able to be full participants in their communities. And how they go about it will differ. And they look to different -- we look to countries in Africa and Latin America and Asia to get knowledge about how they're working on issues. And individuals from different countries look to us and other countries also.

  • 13:50:19

    NNAMDIYou mentioned the 2008 U.N. Convention on the Rights of Persons with Disabilities. It came into force in 2008. We've signed it, but the U.S. has not ratified it. Where do we stand right now?

  • 13:50:30

    HEUMANNThe ratification package is being completed and it's going to move forward over the next couple of months. The president is very supportive of this happening.

  • 13:50:38

    NNAMDIIs this the kind of issue that is likely to be subject to the divisiveness and partisanship that we've been seeing on Capitol Hill?

  • 13:50:45

    HEUMANNWe're hoping not because disability in the U.S., as in many other countries, has been very bipartisan. And the convention itself very much embraces many of the principles that we've developed in the United States through laws like the Americans with Disabilities Act. So we're hoping, as this moves forward, that it will not be partisan in nature.

  • 13:51:07

    NNAMDIWe got this e-mail from Katy who says, "How does the State Department accommodate employees with disabilities overseas?" Charlotte?

  • 13:51:17

    MCCLAIN-NHLAPOI'm going to ask Judy to answer that question (unintelligible) ...

  • 13:51:19

    HEUMANNI'm with State.

  • 13:51:20

    MCCLAIN-NHLAPO...she's with State.

  • 13:51:20

    NNAMDIOkay.

  • 13:51:21

    MCCLAIN-NHLAPOBut before I do that, I just wanted to say something following on the discussion that Tom and Judy were talking about around cultural -- how we reach this. And I think we have to recognize that there is -- we don't have a one-size-fits-all. I think in many African countries and many Asian countries, community-based rehabilitation is an approach that's been used, working in communities, ensuring that services and empowerment happens within the community amongst community members.

  • 13:51:51

    MCCLAIN-NHLAPOSo I think it's important for us to be flexible around how we work towards participation. It will be different from country to country. And I'll hand over to Judy to speak about...

  • 13:52:02

    NNAMDIJudy.

  • 13:52:03

    MCCLAIN-NHLAPO...the State Department.

  • 13:52:04

    HEUMANNSo the State Department in our human resources office has a reasonable accommodations program and that office has responsibility to work with employees who have -- who are -- with people who are applying for positions within the State Department if they need accommodations to apply. And if a person has been accepted in a position -- and I think as the question I was asking, what is done for people overseas. So frequently a staff member from State may travel overseas to look at the post that the person is going to be going to, to help address issues of accessibility within the embassy and within housing and to help ensure that the person will be able to make a smooth transition.

  • 13:52:48

    HEUMANNChanges can be made in the physical environment. Services for people who are blind are provided. People can get readers and sign language interpreters and other types of accommodations.

  • 13:52:59

    NNAMDIAnd, Tamar, we got this e-mail from Megan who says, "I was wondering if you could discuss hidden disabilities? Not all disabilities are obvious, including learning or emotional disabilities. How do mental health issues factor into this discussion?"

  • 13:53:14

    ATINCA very important point. I think we have a tendency to focus on the visible disabilities and the visible barriers to the engaging of people with impairment. But really difficult issues are around mental health. The capacity of systems in particular in developing countries to include children with mental disabilities is quite difficult and is quite stretched. So that is an area where also stigma and discrimination tends to be more prevalent.

  • 13:53:46

    ATINCI think in developed countries we've made considerable progress on dealing with visible disability issues and making transport and infrastructure accessible. And there's a lot that the developing world can learn from that and overcome also some of the financial constraints that they face. But on the mental health site, there are severe difficulties, both in the developed world and in the developing world.

  • 13:54:10

    MCCLAIN-NHLAPOAnd I would argue that one of the issues that we need to be addressing is that the development institutions ourselves need to be looking at putting more focus on helping to ensure that individuals who acquire mental health disabilities are getting appropriate services. It's a major issue in countries around the world and we know that we need to be doing more in that regard to be able to provide technical assistance. Again, to be able to support people who themselves have mental health disabilities and learning disabilities and other types of disabilities so they can be meaningful partners in these discussions.

  • 13:54:43

    NNAMDITom Shakespeare, I'd like to swing back to the health axis for a while again. This is a public health and public policy issue that is likely to demand more attention in the coming decades. One of the interesting drivers here is, well, affluence. The report basically paints a picture of people in the developing world beginning to develop diabetes, heart disease and other afflictions that can end up leading to some sort of disability. The other major driver is that the entire global population is getting older, aren't we?

  • 13:55:12

    SHAKESPEAREAbsolutely right. And obviously there's a demographic transition in low-income countries away from infectious diseases -- less people die of infectious diseases -- towards lifestyle diseases. But also I just read a paper just this morning from China showing that -- China's made tremendous progress in reducing the toll of infectious diseases. But now birth abnormalities, birth anomalies are very significant (word?) . Half of all childhood disability is caused by birth anomalies. So the patent of disability changes as our country changes.

  • 13:55:45

    SHAKESPEAREAnd ironically, in some ways, healthcare increases the amount of disability. We're having, for example, children surviving who are born prematurely, half of whom probably will be disabled. We're having people living longer with HIV, which is fantastic, with the ART, many of whom live with some measure of functional loss. We're having people, as you say, living longer into old age, many of whom will have dementia and macular degeneration.

  • 13:56:11

    SHAKESPEARESo ironically, the better healthcare we have, the more disabled people we have. But that just shows why removing barriers to participation is so important. As I said earlier, we're never going to eliminate disability, though we should try to reduce it. But what we can do is to make a world which is inclusive of all disabled people.

  • 13:56:29

    NNAMDIAnd finally, here is Lawrence in Washington, D.C. Lawrence, you're on the air. You only have about a minute left.

  • 13:56:35

    LAWRENCEYeah, I just was -- there are a lot of different factors to consider in implementing some of the recommendations in the report. I was wondering if the guests could think about what the one thing is that they would say we could do to assure implementation of the goals of the report and to ensure that people with disabilities across the world are included and involved in these issues. Thank you.

  • 13:56:58

    NNAMDICharlotte.

  • 13:56:59

    MCCLAIN-NHLAPOLawrence, that's a great question. And I think if there was one that I would select, I would say it's absolutely essential that we include persons with disabilities in all the programs and policies that we develop. Because I think by doing that, we then cast the net out and then we will see people actually come to the table. I think it's really important that we begin to work at mainstreaming disability, integrating disability into all that we do.

  • 13:57:28

    NNAMDIAnd I'm afraid that's all the time we have. Thank you for your call, Lawrence. Charlotte McClain-Nhlapo is coordinator in the Office of Disability Inclusive Development with the United States Agency for International Development. Charlotte, thank you for joining us. Judy Heumann, a special advisor for International Disability Rights with the U.S. Department of State. Judy Heumann, good to see you again.

  • 13:57:49

    NNAMDIAnd Tamar Manuelyan Atinc is vice president for Human Development with the World Bank. Thank you for joining us. And Tom Shakespeare is technical officer with the Department of Violence and Industry (sic) Prevention and Disability with the World Health Organization

  • 13:58:02

    NNAMDI"The Kojo Nnamdi Show" is produced by Brendan Sweeney, Michael Martinez, Ingalisa Schrobsdorff and Tayla Burney with assistance from Kathy Goldgeier, Elizabeth Weinstein, Menghan Hu and Caitlin Langfitt. The Managing Producer is Diane Vogel. The Engineer today, Tobey Schreiner and A.C. Valdez has been on the phones. Thank you all for listening. I'm Kojo Nnamdi.

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