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Current situation
There is a large and growing number of persons with disabilities
in the world today. The estimated figure of 500 million is confirmed by the results of
surveys of segments of population, coupled with the observations of experienced
investigators. In most countries, at least one person out of 10 is disabled by physical,
mental or sensory impairment, and at least 25 per cent of any population is adversely
affected by the presence of disability.
The causes of impairments vary throughout the world, as do the prevalence and
consequences of disability. These variations are the result of different socio-economic
circumstances and of the different provisions that each society makes for the well-being
of its members.
A survey carried out by experts has produced the estimate of at least 350 million
disabled persons living in areas where the services needed to assist them in overcoming
their limitations are not available. To a large extent, disabled persons are exposed to
physical, cultural and social barriers which handicap their lives even if rehabilitation
assistance is available
Many factors are responsible for the rising numbers of disabled persons and the
relegation of disabled persons to the margin of society. These include:
- Wars and the consequences of wars and other forms of violence and destruction, poverty,
hunger, epidemics and major shifts in population;
- A high proportion of overburdened and impoverished families, and overcrowded and
unhealthy housing and living conditions;
- Populations with a high proportion of illiteracy and little awareness of basic social
services or of health and education measures;
- An absence of accurate knowledge about disability, its causes, prevention and treatment;
this includes stigma, discrimination and misconceived ideas on disability;
- Inadequate programmes of primary health care and services;
- Constraints, including a lack of resources, geographical distance and physical and
social barriers, that make it impossible for many people to take advantage of available
services;
- The channelling of resources to highly specialized services that are not relevant to the
needs of the majority of people who need help;
- The absence or weakness of an infrastructure of related services for social assistance,
health, education, vocational training and placement;
- Low priority in social and economic development for activities related to equalization
of opportunities, disability prevention and rehabilitation;
- Industrial, agricultural and transportation-related accidents;
- Natural disaster and earthquake;
- Pollution of the physical environment;
- Stress and other psycho-social problems associated with the transition from a
traditional to a modern society;
- The imprudent use of medication, the misuse of therapeutic substances and the illicit
use of drugs and stimulants;
- The faulty treatment of injured persons at the time of a disaster, which can be the
cause of avoidable disability;
- Urbanization and population growth and other indirect factors.
The relationship between disability and poverty has been clearly established. While the
risk of impairment is much greater for the poverty-stricken, the converse is also true.
The birth of an impaired child, or the occurrence of disability in the family, often
places heavy demands on the limited resources of the family and strains on its morale,
thus thrusting it deeper into poverty. The combined effect of these factors results in
higher proportions of disabled persons among the poorest strata of society. For this
reason, the number of affected families living at the poverty level steadily increases in
absolute terms. The negative impact of these trends seriously hinders the development
process.
Existing knowledge and skills could prevent the onset of many impairments and
disabilities, could assist affected people in overcoming or minimizing their disabilities,
and could enable nations to remove barriers which exclude disabled persons from everyday
life.
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The problems of disability in developing countries need to be
specially highlighted. As many as 80 per cent of all disabled persons live in isolated
rural areas in the developing countries. In some of these countries, the percentage of the
disabled population is estimated to be as high as 20 and, thus, if families and relatives
are included, 50 per cent of the population could be adversely affected by disability. The
problem is made more complex by the fact that, for the most part, disabled persons are
also usually extremely poor people. They often live in areas where medical and other
related services are scarce, or even totally absent, and where disabilities are not and
cannot be detected in time. When they do receive medical attention, if they receive it at
all, the impairment may have become irreversible. In many countries, resources are not
sufficient to detect and prevent disability and to meet the need for the rehabilitation
and supportive services of the disabled population. Trained personnel, research into newer
and more effective strategies and approaches to rehabilitation and the manufacturing and
provision of aids and equipment for disabled persons are quite inadequate.
In such countries, the disability problem is further compounded by the population
explosion, which inexorably pushes up the number of disabled persons in both proportional
and absolute terms. There is, thus, an urgent need, as the first priority, to help such
countries to develop demographic policies to prevent an increase in the disabled
population and to rehabilitate and provide services to the already disabled.
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The consequences of deficiencies and disablement are particularly
serious for women. There are a great many countries where women are subjected to social,
cultural and economic disadvantages which impede their access to, for example, health
care, education, vocational training and employment. If, in addition, they are physically
or mentally disabled, their chances of overcoming their disablement are diminished, which
makes it all the more difficult for them to take part in community life. In families, the
responsibility for caring for a disabled parent often lies with women, which considerably
limits their freedom and their possibilities of taking part in other activities.
For many children, the presence of an impairment leads to rejection or isolation from
experiences that are part of normal development. This situation may be exacerbated by
faulty family and community attitudes and behaviour during the critical years when
children's personalities and self-images are developing.
In most countries the number of elderly people is increasing, and already in some as
many as two thirds of disabled people are also elderly. Most of the conditions which cause
their disability (for example, arthritis, strokes, heart disease and deterioration in
hearing and vision) are not common among younger disabled people and may require different
forms of prevention, treatment, rehabilitation and support services.
With the emergence of "victimology" as a branch of criminology, the true
extent of injuries inflicted upon the victims of crime, causing permanent or temporary
disablement, is only now becoming generally known.
Victims of torture who have been disabled physically or mentally, not by accident of
birth or normal activity, but by the deliberate infliction of injury, form another group
of disabled persons.
There are over 10 million refugees and displaced persons in the world today as a result
of man-made disasters. Many of them are disabled physically and psychologically as a
result of their sufferings from persecution, violence and hazards. Most are in third-world
countries, where services and facilities are extremely limited. Being a refugee is in
itself a handicap, and a disabled refugee is doubly handicapped.
Workers employed abroad often find themselves in a difficult situation associated with
a series of handicaps resulting from differences in environment, lack or inadequate
knowledge of the language of the country of immigration, prejudice and discrimination,
lack or deficiency of vocational training, and inadequate living conditions. The special
position of migrant workers in the country of employment exposes them and their families
to health hazards and increased risk of occupational accidents which frequently lead to
impairment or disability. The situation of disabled migrant workers may be further
aggravated by the necessity for them to return to the country of origin, where, in most
cases, special services and facilities for the disabled are very limited.
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There is a steady growth of activities to prevent impairment,
such as the improvement of hygiene, education and nutrition; better access to food and
health care through primary health care approaches, with special attention to mother and
child care; counselling parents on genetic and prenatal care factors; immunization and
control of diseases and infections; accident prevention; and improving the qual- ity of
the environment. In some parts of the world, such measures have a significant impact on
the incidence of physical and mental impairment.
For a majority of the world's population, especially those living in countries in the
early stages of economic development, these preventive measures effectively reach only a
small proportion of the people in need. Most developing countries have yet to establish a
system for the early detection and prevention of impairment through periodic health
examinations, particularly for pregnant women, infants and young children.
In the Leeds Castle Declaration on the Prevention of Disablement of 12 November 1981,
an international group of scientists, doctors, health administrators and politicians
called attention to, among others, the following practical measures to prevent
disablement:
- Impairment arising from malnutrition, infection and neglect could be prevented by
inexpensive improvement in primary health.
- Many disabilities of later life can be postponed or averted. There are promising lines
of research for the control of hereditary and degenerative conditions.
- Disability need not give rise to handicap. Failure to apply simple remedies very often
increases disability, and the attitudes and institutional arrangements of society increase
the chance of disability placing people at a disadvantage. Sustained education of the
public and of professionals is urgently needed.
- Avoidable disability is a prime cause of economic waste and human deprivation in all
countries, industrialized and developing. This loss can be reduced rapidly.
- The technology which will prevent or control most disablement is available and is
improving. What is needed is commitment by society to overcome the problems. The priority
of existing national and international health programmes must be shifted to ensure the
dissemination of knowledge and technology.
- Although technology for preventive and remedial control of most disabilities exists, the
remarkable recent progress in biomedical research promises revolutionary new tools which
could greatly strengthen all interventions. Both basic and applied research deserve
support over the coming years.
It is becoming increasingly recognized that programmes to prevent impairment or to
ensure that impairments do not escalate into more limiting disabilities are less costly to
society in the long run than having to care later for disabled persons. This applies, for
instance, not least to occupational safety programmes, a still neglected field of concern
in many countries.
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Rehabilitation services are often provided by specialized
institutions. However, there exists a growing trend towards placing greater emphasis on
the integration of services in general public facilities.
There has been an evolution in both the content and the spirit of the activities
described as rehabilitation. Traditional practice viewed rehabilitation as a pattern of
therapies and services provided to disabled persons in an institutional setting. Often
under medical authority. This is gradually being replaced by programmes which, while still
providing qualified medical, social and pedagogical services, also involve communities and
families and help them to support the efforts of their disabled members to overcome the
disabling effects of impairment within a normal social environment. Increasingly it is
being recognized that even severely disabled persons can, to a great extent, live
independently if the necessary support services are provided. The number requiring care in
institutions is much smaller than had previously been assumed and even they can, to a
great-extent, live a life that is independent in its essential elements.
Many disabled persons require technical aids. In some countries the technology needed
to produce such items is well developed, and highly sophisticated devices are manufactured
to assist the mobility, communication and daily living of disabled individuals. The costs
of such items are high, however, and only a few countries are able to provide such
equipment.
Many people need simple equipment to facilitate mobility, communication and daily
living. Such aids are produced and available in some countries. In many other countries,
however, they cannot be obtained because of a lack of their availability and/or of high
cost. Increasing attention is being given to the design of simpler, less expensive
devices, with local methods of production which are more easily adapted to the country
concerned, more appropriate to the needs of most disabled persons and more readily
available to them.
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