Mainstreaming community based rehabilitation in primary health care in Bosnia‐Herzegovina

There are over 600 million disabled people and over 20% of the world population is impacted by disability. However, the strategies for including disabled people in the process of reform of developing countries have been rarely considered. The paucity of research is striking. Mainstreaming Community Based Rehabilitation (CBR) in Bosnia‐Herzegovina is one example where the needs of disabled people were a development priority and research was conducted to evaluate this experience. The research demonstrated that unlike the pre‐war environment, disabled people are increasingly active members of the community. The significance is that the needs of disabled people were ‘targeted’ and CBR was ‘mainstreamed’ in the primary health care system creating opportunities for sustained development. CBR is contributing to the citizenship of disabled people. This partnership project set the stage for the continued development of disability policies. These are important lessons.     

Explanatory models for disability: perspectives of health providers working in Malawi

Health providers’ understanding of disability determines how disabled people are treated, and hence it is imperative to address conceptualisations of disability, as this will contribute to better opportunities and realisation of human rights for disabled people. This article will use data from a qualitative study exploring conceptualisations of disability by 22 health service providers from the total health care system in Malawi, including the professional sector (e.g. medical doctors and nurses) and the folk sector (healers and indigenous practices). We will discuss how these perceptions influence the lives of disabled people, using the case of a health service user with physical and speech impairment as an example. Our data show that health providers largely conceptualise disability according to the medical model for disability, contributing to the exclusion of disabled people. The bio-psycho-social model for disability, largely absent as an explanatory model for disability among our informants, is the most inclusive and rights based.     

Disabled People,Health Professionals and the Social Model of Disability: Can there be a research relationship?

The social model of disability is proposed as an alternative to models that have viewed disability as an individual, rather than a socio-political issue. The use of this model to guide both research theory and practice is proposed in order to equalise research power relationships, and involve and empower disabled people. Health professionals have traditionally reinforced the medical model of disability in both research and practice, and this has been seen as contributing to the oppression and marginalisation of disabled people. If the social model is to achieve wider dissemination, it would appear important to develop a dialogue between disabled people and health professionals. However, because of negative perceptions it can be difficult for health professionals to find an appropriate position in relation to disabled people, research and the social model of disability. While not denying the past, it appears essential to look at ways in which disabled people and health professionals can work together to overcome the oppression and marginalisation that has been linked to the provision of health services.     

‘Unjust,inhumane and highly inaccurate’: the impact of changes to disability benefits and services – social media as a tool in research and activism

This article details research carried out as part of an MA in Social Research at the University of Leeds (UK). The research was concerned with two key issues: documenting the impact of recent cuts in benefits and services on disabled people; and the role of disabled people’s organisations in responding to this impact. It also explored the use of social media in recruiting research participants. Working with Hammersmith and Fulham Action on Disability, the experiences of 95 disabled people were gathered using focus groups and an online questionnaire distributed via social media. The use of social media to gather participants is something I felt was particularly interesting in relation to disabled people, especially in light of social media’s role in current disability rights campaigns, and a method I feel should be explored further.     

Children’s conceptions of the word ‘disabled’: a phenomenographic study

The aim of this study was to investigate the qualitative differences in children’s conceptions of the word ‘disabled’. Two hundred and thirty children, aged 7–12 years of age, were instructed to make a drawing of what came into their minds when they heard the word ‘disabled’. A brief written commentary on their drawing was also requested. The drawings and comments showed that the children had a positive attitude towards the word ‘disabled’. They drew and commented that a disability had medical causes, a technical device was a prerequisite for disabled people, a disability had social consequences and that a disabled person needed support. The children also explained that there were obstacles which impaired disabled people’s performance of activities. Access to some environments and being an active part of society was limited for some disabled people.     

New policies,old ideas: the question of disability assessment systems and social policy

This paper reports on qualitative content analysis research and critically analyzes the state’s intention to use the International Classification of Functioning, Disability and Health as a tool to develop a national disability assessment system that will guide social policy developments, and particularly the allocation of pensions and benefits to disabled people. The work uses Cyprus as an example, and reviews the most important issues arising from a recent study prepared by the Department for Social Inclusion of Persons with Disabilities. The most important points stemming from the analysis are grouped and discussed in such a way as to shed light upon the most controversial aspects of the proposed assessment system, such as the definition of disabled people in national laws, and the implications of associating social policy with the assessment of disability and functioning. The discussion addresses issues that are of interest at international level.     

Do public representatives in local governments know about “disability rights” in Pakistan? An awareness assessment case from Southern Punjab

Local self-government systems have been adopted in many countries to supervise local interests in development and provide a range of goods and services to localities. It is believed that awareness of certain issues itself guides duty-bearers to reshape and divert development in a certain direction. In Pakistan, elected representatives in district governments are the key duty-bearers at the local level. Hence, their awareness is indispensable to decision-making for local development and, thus, it is pertinent to assess it from a disability rights perspective. In-depth information collected from two districts has reflected that most of the public representatives are ill-informed about disability, day-to-day problems of disabled persons and their rights, which results in inadvertently disability-biased local development planning. An overriding impression gained from the results is that raising elected representatives’ awareness on disability and the rights of disabled people is imperative to embracing disability rights practice in local development.     

Globalising accessibility: drawing on the experiences of developed countries to enable the participation of disabled people in Zambia

This paper explores the accessibility situation in a developing country such as Zambia. The global view of accessibility for disabled people is provided to examine the accessibility situation in developed and developing countries, highlighting the role of the environment in achieving rights for disabled people. Recognition of disability rights relating to accessible built environments is a necessary element to ensure their participation. Limited disability research, lack of disability policies and systems, evaluation of disability rights and support from developed countries have been cited as contributing to the non-recognition of disability rights and low participation by disabled people in Africa. An international perspective of disability, accessibility and participation and the experiences of developed countries are examined and their potential for advancing accessible built environments for participation in developing countries considered. However, accessibility concepts, having been developed in western countries, are presented with caution acknowledging the geographical, social–cultural and economic differences that exist.     

Tensions and unity in the struggle for citizenship: Swedish disability rights activists claim ‘Full Participation! Now!’

This article analyses the claims of contemporary disability rights activists mobilising in a context where de facto second-class citizenship co-exists with legal and political declarations about the rights of disabled people. As an empirical case, it focuses on the blog ‘Full Participation.Now’, which was initiated by disability rights activists in Sweden. Drawing upon citizenship research, the article points to the tensions and dilemmas featuring the bloggers’ demand for participation and equality, as well as the challenges relative to their struggle. Although the bloggers formulate contrasting arguments, the article highlights that the activists share a common aspiration for ‘full citizenship’.     

Social Rights and Disability: the language of 'rights' in community care policies

Social rights and disability: the language of 'rights' in community care policies. The paper argues that what disabled people mean when they speak of 'rights' is relatively under-developed with regard to health and social services. Furthermore, while a claim of 'rights' is typically presented as a fairer alternative to the needs-based character of welfare policies, how such an approach would change the delivery of health and social care is unclear. The paper draws on a landmark test case in community care to explore the problems of a rights-based approach to social justice for disabled people. It demonstrates the weaknesses of rights, especially the more problematic 'social rights', and urges caution in seeking solutions to social problems through the courts. It ends by suggesting that, given the anecdotal evidence about local authorities' tightening their eligibility criteria in the light of the 'Gloucestershire case', that limits on coverage may be the trade-off for implementing rights.     

Integrating people with disabilities: their right – our responsibility

A full understanding of disability recognizes that it has a powerful human rights dimension and is often associated with social exclusion, and increased exposure and vulnerability to poverty. Disability is a human rights issue. The World Bank (1999) report points out that one in five of the world’s poorest are disabled, for whom access to basic rights is a daily struggle. Though arising from physical or intellectual impairment, disability has social implications as well as health ones. In most countries, government services for disabled people are still small‐scale rehabilitation projects separated from the rest of the community. People with disabilities are amongst the poorest of the poor. Barriers built by disability and poverty can only be removed by the concerted and integrated effort of the government, NGOs, corporates, movie mughals and educational institutions. It is the duty of the rest of society to acknowledge the rights of the poor and the disabled. This can no longer be treated as philanthropy but is a responsibility.     

‘A frog in a well’: the exclusion of disabled people from work in Cambodia

Based on ethnographic research conducted in north‐west Cambodia in 2000–2001, this paper examines why disabled people experience systematic marginalisation in the labour market. Although there are no official data on the relationship between disability and employment status in Cambodia, this research suggests that disabled people are more likely than their able‐bodied counterparts to be unemployed, in low status occupations, earn less or be out of the labour market altogether. Consequently, disabled people are more likely to live in poverty, experience social isolation and poor mental health. I argue that disabled people’s social status effectively shapes their work patterns through (mis)conceptions that associate ‘disability’ with ‘inability’ to work and to be employable. This paper illustrates how geographical processes fix disabled people in their socio‐spatial place, which together with ideological and structural inequalities distinguish and entrench their poverty from that of other social groups.     

The Disability Rights Movement in Japan: past, present and future

This paper introduces the history of the modern disability rights movement in Japan, which has been a driving force for change in social norms and policies, and for improving the lives of disabled persons and their families. It presents the traditional social norms and policies that resulted in the confinement of disabled people in their parents' homes and in institutions, a radical movement of people with cerebral palsy active in 1960-1980s, the emergence of the independent living movement in 1980s, and the current disability rights movement and its future challenges. This paper is based on a review of documents and on interviews conducted during the spring of 2000 in Japan with disability rights advocates and personnel working for centres for independent living.     

Using participatory and creative methods to facilitate emancipatory research with people facing multiple disadvantage: a role for health and care professionals

Participatory and creative research methods are a powerful tool for enabling active engagement in the research process of marginalised people. It can be particularly hard for people living with multiple disadvantage, such as disabled people from ethnic minority backgrounds, to access research projects that are relevant to their lived experience. This article argues that creative and participatory methods facilitate the co-researchers’ engagement in the research process, which thus becomes more empowering. Exploring the congruence of these methods with their professional ethos, health and care professionals can use their skills to develop them further. Both theory and practice examples are presented.     

Pushing the boundaries of our understanding of disability and violence: voices from the Global South (Guyana)

Our knowledge about disabled people’s lives is largely based on research in the Global North. This article considers disability and violence in the Global South, specifically in Guyana. It aims to push conceptual and empirical boundaries of our understanding of violence and disability. Conceptually, it argues for a social model materialist theory of disability attuned to how material barriers to disabled people’s inclusion in society and space are reproduced through processes of exclusion unfolding across geographic scales ranging from the global, to the inter-personal and intra-personal. It argues that Lacanian psycho-analytic theory provides a complimentary lens for understanding why people engage in acts that construct disabled people as ‘deserving’ of violence. Empirically, the article broadens our understanding of disability and violence by focusing on poverty, violence as a cause of impairment and disability, and disabled women’s and men’s experiences of violence in a majority world context.     

From multiple barriers to a co-prosperity society: the development of a legal system for disabled people in China

Abstract

The legal system for disabled people has progressed significantly since China’s government signed the United Nations Convention on the Rights of Persons with Disabilities 10 years ago. The newly released ‘New Progress in the Legal Protection of Human Rights in China’ has attracted widespread attention because it advocates that the protection of human rights for disabled people should be reflected not only in legislative and judicial aspects but also in administrative sectors and international affairs. This article explains that the legal system involving dozens of laws and decrees in China aims to break through multiple barriers experienced by disabled persons and is beneficial to building a co-prosperity society in China. With the vigorous development of the international disability rights movement, ways to seize domestic and international opportunities to build a disabled-friendly social atmosphere deserve additional research.     

The exclusion of older people in disability activism and policies — A case of inadvertent ageism?

Using Sweden as a case, the article discusses the tendency within disability activism and policies to overlook elderly people. From an analysis of a major Swedish government investigation on disability it is clear that disability policies in Sweden have come to rest upon stereotyped age norms that divide the life course into set stages, and there has been a tendency to define elderly disabled people as elderly rather than disabled. It is argued that this exclusion is partly the result of a successful endeavor to provide disabled people of younger ages with rights that are typical of non-disabled citizens. Justice and equality have been defined in comparison to citizens of similar ages: children, youth and adults of “active age”. Based on the analysis of the paper it is argued that activities of movements struggling to liberate oppressed populations may contribute to ageism, and that anti-ageist research must go beyond the idea that ageism is a simple matter of attitudes towards older people.     

Developing a model of disability that focuses on the actions of disabled people

Disabled people, writers on disability and disability activists stress the importance of disabled people being included in all aspects of society. I argue that a major omission from this inclusiveness is that no current model of disability focuses on the impact of the actions of disabled people on disability. Disabled people are not passive bystanders, powerless to reduce the restrictions of disability. On the contrary, we are central to actively limiting its constraints. I develop a model of disability, called ‘active’, which focuses on the effects on disability of the individual and collective actions of disabled people. I describe published findings which indicate that engaging in self-help, using support groups and deploying assistive technology can all reduce the limitations of disability. Recent increases in the number of disability support groups and developments in assistive technology have substantially augmented the potential for disabled people to combat the effects of disability.     

Personal and Political: A Feminist Perspective on Researching Physical Disability

Feminist theory and methodology have much to offer in understanding how disability research has been experienced as alienated research by disabled people. However, feminist research has failed to apply its principles to disability and disabled women's subjective reality has found no place in mainstream feminist work. The paper identifies the challenges for feminism in addressing the interests and reality of disabled women, asserting that it is not helpful to focus on 'double disadvantage'. Disability research itself has much to learn from feminist methodology, in particular the principle of making the personal political. The role of non-disabled researchers as allies of disabled people is discussed, and the importance of research which turns the spotlight on the way in which non-disabled society oppresses disabled people. Finally, it is asserted that disability research and politics are of general relevance because the experience of disability is an integral part of a society characterised by fundamental inequalities and ideologies which divide people against each other.     

"Women and disability don't mix]" Double discrimination and disabled women's rights

Oxfam's experience with groups of disabled people has revealed that gender affects how disabled people are treated in various cultures. This experience runs counter to the often voiced (even by a consultant hired by Oxfam) assumption that gender analysis serves only to confuse any analysis undertaken of disability-based circumstances. This assumption is echoed in the disability movement itself where activists fear fragmentation through the introduction of gender analysis. Thus, gender is not yet understood as a factor which affects every aspect of life including race, class, ethnicity, caste, and disability. Because 75% of the 250 million disabled women in the world live in developing countries, development programs must consider the specific needs and rights of disabled women who suffer from double discrimination and are more likely than disabled men to live impoverished and isolated lives which lead to depression and despair. In many societies, disabled women, but not disabled men, lose their rights to marriage, family life, education, and health care. Mothers of disabled children are stigmatized, and fathers tend to "blame" defective genes on the mothers and to ignore their disabled offspring. These factors combine to make it difficult to improve the status and livelihoods of disabled women through development work. Disabled women activists have also voiced complaints about their lack of access to the preparatory meetings for the Fourth UN Women's Conference, but disabled women intend to use the Conference to lobby for their rights and to call for scrutiny of health policies which discriminate against the disabled.