WORLD REPORT ON DISABILITY

WORLD REPORT
ON DISABILITY


WHO Library Cataloguing-in-Publication Data
World report on disability 2011.
1.Disabled persons - statistics and numerical data. 2.Disabled persons - rehabilitation. 3.Delivery of health care.
4.Disabled children. 5.Education, Special. 6.Employment, Supported. 7.Health policy. I.World Health Organization.
ISBN 978 92 4 156418 2
ISBN 978 92 4 068521 5 (PDF)
ISBN 978 92 4 068636 6 (ePUB)
ISBN 978 92 4 068637 3 (Daisy)

(NLM classification: HV 1553)

© World Health Organization 2011
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Printed in Malta


Contents

Forewordix
Preface

xi

Acknowledgementsxiii
List of contributors

xv

Introduction

xxi

Understanding disability
1
What is disability?
3
Environment4
The diversity of disability
7
Prevention8
Disability and human rights
9

Disability and development
10
Disability – a global picture
19
Measuring disability
21
Prevalence of disability – difficulties in functioning
24
Country-reported disability prevalence
25
Global estimates of disability prevalence
25
Health conditions
32
Trends in health conditions associated with disability
32
Demographics34
Older persons
34
Children36
The environment
37
Health conditions are affected by environmental factors
37
Disability and poverty
39
Developed countries
39
Developing countries
39

Needs for services and assistance
40

iii


Costs of disability
Direct costs of disability
Indirect costs
Conclusion and recommendations
Adopt the ICF
Improve national disability statistics
Improve the comparability of data
Develop appropriate tools and fill the research gaps
General health care
Understanding the health of people with disabilities
Primary health conditions
Risk of developing secondary conditions
Risk of developing co-morbid conditions
Greater vulnerability to age-related conditions
Increased rates of health risk behaviours
Greater risk of being exposed to violence
Higher risk of unintentional injury
Higher risk of premature death
Needs and unmet needs
Addressing barriers to health care
Reforming policy and legislation
Addressing barriers to financing and affordability
Addressing barriers to service delivery
Addressing human resource barriers

Filling gaps in data and research
Conclusion and recommendations
Policy and legislation
Financing and affordability
Service delivery
Human resources
Data and research

42
43
44
44
45
45
46
46
55
57
57
58
59
59
59
59
60
60
60
62
65
66

70
77
80
81
82
82
82
83
83

Rehabilitation
93
Understanding rehabilitation
95
Rehabilitation measures and outcomes
95
Rehabilitation medicine
97
Therapy100
Assistive technologies
101
Rehabilitation settings
101
Needs and unmet needs
102
Addressing barriers to rehabilitation
103
Reforming policies, laws, and delivery systems
104
National rehabilitation plans and improved collaboration

105
Developing funding mechanisms for rehabilitation
106

iv


Increasing human resources for rehabilitation
108
Expanding education and training
110
Training existing health-care personnel in rehabilitation
111
Building training capacity
112
Curricula content
112
Recruiting and retaining rehabilitation personnel
112
Expanding and decentralizing service delivery
114
Coordinated multidisciplinary rehabilitation
114
Community-delivered services
114
Increasing the use and affordability of technology
117
Assistive devices
117
Telerehabilitation118

Expanding research and evidence-based practice
119
Information and good practice guidelines
120
Research, data, and information
121
Conclusion and recommendations
121
Policies and regulatory mechanisms
122
Financing122
Human resources
122
Service delivery
122
Technology123
Research and evidence-based practic
123
Assistance and support
Understanding assistance and support
When are assistance and support required?
Needs and unmet needs
Social and demographic factors affecting demand and supply
Consequences for caregivers of unmet need for formal support services
Provision of assistance and support
Barriers to assistance and support
Lack of funding
Lack of adequate human resources
Inappropriate policies and institutional frameworks
Inadequate and unresponsive services

Poor service coordination
Awareness, attitudes, and abuse
Addressing the barriers to assistance and support
Achieving successful deinstitutionalization
Creating a framework for commissioning effective support services
Funding services
Assessing individual needs
Regulating providers
Supporting public-private-voluntary services

135
138
139
139
140
141
142
144
144
144
145
145
145
147
147
147
149
149
150
151

151

v


Coordinating flexible service provision
Building capacity of caregivers and service users
Developing community-based rehabilitation and
community home-based care
Including assistance and support in disability policies and action plans
Conclusion and recommendations
Support people to live and participate in the community
Foster development of the support services infrastructure
Ensure maximum consumer choice and control
Support families as assistance and support providers
Step up training and capacity building
Improve the quality of services

152
155
156
156
157
157
157
158
158
158
159

Enabling environments
167
Understanding access to physical and information environments
170
Addressing the barriers in buildings and roads
172
Developing effective policies
173
Improving standards
173
Enforcing laws and regulations
175
The lead agency
175
Monitoring175
Education and campaigning
176
Adopting universal design
177
Addressing the barriers in public transportation
178
Improving policies
179
Providing special transport services and accessible taxis
179
Universal design and removing physical barriers
180
Assuring continuity in the travel chain
182
Improving education and training

183
Barriers to information and communication
183
Inaccessibility184
Lack of regulation
185
Cost185
Pace of technological change
186
Addressing the barriers to information and technology
186
Legislation and legal action
186
Standards188
Policy and programmes
189
Procurement190
Universal design
191
Action by industry
191
Role of nongovernmental organizations
192

vi


Conclusion and recommendations
193
Across domains of the environment

193
Public accommodations – building and roads
194
Transportation194
Accessible information and communication
195
Education
203
Educational participation and children with disability
206
Understanding education and disability
209
Approaches to educating children with disabilities
210
Outcomes211
Barriers to education for children with disabilities
212
System-wide problems
212
School problems
215
Addressing barriers to education
216
System-wide interventions
217
School interventions
220
The role of communities, families, disabled people,
and children with disabilities
223

Conclusion and recommendations
225
Formulate clear policies and improve data and information
226
Adopt strategies to promote inclusion
226
Provide specialist services, where necessary
227
Support participation
227
Work and employment
233
Understanding labour markets
236
Participation in the labour market
236
Employment rates
237
Types of employment
238
Wages239
Barriers to entering the labour market
239
Lack of access
239
Misconceptions about disability
240
Discrimination240
Overprotection in labour laws
240

Addressing the barriers to work and employment
240
Laws and regulations
240
Tailored interventions
241
Vocational rehabilitation and training
245
Self-employment and microfinance
247
Social protection
248
Working to change attitudes
249

vii


Conclusion and recommendations
250
Governments251
Employers251
Other organizations: NGOs including disabled people’s organizations,
microfinance institutions, and trade unions
252
The way forward: recommendations
259
Disability: a global concern
261
What do we know about people with disabilities?

261
What are the disabling barriers?
262
How are the lives of people with disabilities affected?
263
Recommendations263
Recommendation 1: Enable access to all mainstream policies,
systems and services
264
Recommendation 2: Invest in specific programmes and
services for people with disabilities
265
Recommendation 3: Adopt a national disability strategy and
plan of action
265
Recommendation 4: Involve people with disabilities
265
Recommendation 5: Improve human resource capacity
266
Recommendation 6: Provide adequate funding and
improve affordability
266
Recommendation 7: Increase public awareness and
understanding of disability
267
Recommendation 8: Improve disability data collection
267
Recommendation 9: Strengthen and support research on disability
267
Conclusion268

Translating recommendations into action
268
Technical appendix A

271

Technical appendix B

281

Technical appendix C

287

Technical appendix D

295

Technical appendix E

299

Glossary301
Index311

viii


Foreword

Disability need not be an obstacle to success. I have had motor neurone disease for practically all
my adult life. Yet it has not prevented me from having a prominent career in astrophysics and a
happy family life.
Reading the World report on disability, I find much of relevance to my own experience. I have
benefitted from access to first class medical care. I rely on a team of personal assistants who make
it possible for me to live and work in comfort and dignity. My house and my workplace have been
made accessible for me. Computer experts have supported me with an assisted communication
system and a speech synthesizer which allow me to compose lectures and papers, and to communicate with different audiences.
But I realize that I am very lucky, in many ways. My success in theoretical physics has ensured
that I am supported to live a worthwhile life. It is very clear that the majority of people with disabilities in the world have an extremely difficult time with everyday survival, let alone productive
employment and personal fulfilment.
I welcome this first World report on disability. This report makes a major contribution to our
understanding of disability and its impact on individuals and society. It highlights the different
barriers that people with disabilities face – attitudinal, physical, and financial. Addressing these
barriers is within our reach.
In fact we have a moral duty to remove the barriers to participation, and to invest sufficient funding and expertise to unlock the vast potential of people with disabilities. Governments throughout
the world can no longer overlook the hundreds of millions of people with disabilities who are denied
access to health, rehabilitation, support, education and employment, and never get the chance to shine.
The report makes recommendations for action at the local, national and international levels.
It will thus be an invaluable tool for policy-makers, researchers, practitioners, advocates and volunteers involved in disability. It is my hope that, beginning with the Convention on the Rights of
Persons with Disabilities, and now with the publication of the World report on disability, this century
will mark a turning point for inclusion of people with disabilities in the lives of their societies.
Professor Stephen W Hawking

ix



Preface

More than one billion people in the world live with some form of disability, of whom nearly 200
million experience considerable difficulties in functioning. In the years ahead, disability will be an
even greater concern because its prevalence is on the rise. This is due to ageing populations and the
higher risk of disability in older people as well as the global increase in chronic health conditions
such as diabetes, cardiovascular disease, cancer and mental health disorders.
Across the world, people with disabilities have poorer health outcomes, lower education
achievements, less economic participation and higher rates of poverty than people without
disabilities. This is partly because people with disabilities experience barriers in accessing
services that many of us have long taken for granted, including health, education, employment,
and transport as well as information. These difficulties are exacerbated in less advantaged
communities.
To achieve the long-lasting, vastly better development prospects that lie at the heart of the 2015
Millennium Development Goals and beyond, we must empower people living with disabilities and
remove the barriers which prevent them participating in their communities; getting a quality education, finding decent work, and having their voices heard.
As a result, the World Health Organization and the World Bank Group have jointly produced
this World Report on Disability to provide the evidence for innovative policies and programmes
that can improve the lives of people with disabilities, and facilitate implementation of the United
Nations Convention on the Rights of Persons with Disabilities, which came into force in May 2008.
This landmark international treaty reinforced our understanding of disability as a human rights
and development priority.
The World Report on Disability suggests steps for all stakeholders – including governments,
civil society organizations and disabled people’s organizations – to create enabling environments,
develop rehabilitation and support services, ensure adequate social protection, create inclusive
policies and programmes, and enforce new and existing standards and legislation, to the benefit
of people with disabilities and the wider community. People with disabilities should be central to
these endeavors.
Our driving vision is of an inclusive world in which we are all able to live a life of health, comfort, and dignity. We invite you to use the evidence in this report to help this vision become a reality.
Dr Margaret Chan
Director-General
World Health Organization

Mr Robert B Zoellick
President
World Bank Group

xi



Acknowledgements

The World Health Organization and the World Bank would like to thank
the more than 370 editors, contributors, regional consultation participants, and peer reviewers to this Report from 74 countries around the
world. Acknowledgement is also due to the report advisors and editors,
WHO regional advisors, and World Bank and WHO staff for offering
their support and guidance. Without their dedication, support, and
expertise this Report would not have been possible.
The Report also benefited from the efforts of many other people, in particular, Tony Kahane and Bruce Ross-Larson who edited the text of the main
report, and Angela Burton who developed the alternative text and assisted
with the references. Natalie Jessup, Alana Officer, Sashka Posarac and Tom
Shakespeare who prepared the final text for the summary and Bruce RossLarson who edited the summary report.
Thanks are also due to the following: Jerome Bickenbach, Noriko
Saito Fort, Szilvia Geyh, Katherine Marcello, Karen Peffley, Catherine
Sykes, and Bliss Temple for technical support on the development of the
Report; Somnath Chatterji, Nirmala Naidoo, Brandon Vick, and Emese
Verdes for analysis and interpretation of the World Health Survey; Colin
Mathers and Rene Levalee for the analysis of the Global Burden of Disease
study; and to Nenad Kostanjsek and Rosalba Lembo for the compilation
and presentation of the country-reported disability data. The Report benefited from the work of Chris Black, Jean-Marc Glinz, Steven Lauwers,
Jazz Shaban, Laura Sminkey, and Jelica Vesic for media and communication; James Rainbird for proofreading and Liza Furnival for indexing;

Sophie Guetaneh Aguettant and Susan Hobbs for graphic design; Omar
Vulpinari, Alizée Freudenthal and Gustavo Millon at Fabrica for creative direction, art direction and photographs of cover design and images
for chapter title pages; Pascale Broisin and Frédérique Robin-Wahlin for
coordinating the printing; Tushita Bosonet for her assistance with the
cover; Maryanne Diamond, Lex Grandia, Penny Hartin for feedback on
the accessibility of the Report; Melanie Lauckner for the production of
the Report in alternative formats; and Rachel Mcleod-Mackenzie for her
administrative support and for coordinating the production process.

xiii


World report on disability

For assistance in recruiting narrative contributors, thanks go to the
Belize Council for the Visually Impaired, Shanta Everington, Fiona Hale,
Sally Hartley, Julian Hughes, Tarik Jasarevic, Natalie Jessup, Sofija Korac,
Ingrid Lewis, Hamad Lubwama, Rosamond Madden, Margie Peden, Diane
Richler, Denise Roza, Noriko Saito Fort, and Moosa Salie.
The World Health Organization and the World Bank also wish to thank
the following for their generous financial support for the development, translation, and publication of the Report: the Governments of Australia, Finland,
Italy, New Zealand, Norway, Sweden, and the United Kingdom of Great
Britain and Northern Ireland; CBM International; the Japan International
Cooperation Agency; and the multidonor trust fund, the Global Partnership
on Disability and Development.

xiv


Contributors

Editorial guidance
Editorial Committee

Sally Hartley, Venus Ilagan, Rosamond Madden, Alana Officer, Aleksandra
Posarac, Katherine Seelman, Tom Shakespeare, Sándor Sipos, Mark
Swanson, Maya Thomas, Zhuoying Qiu.

Executive Editors

Alana Officer (WHO), Aleksandra Posarac (World Bank).

Technical Editors

Tony Kahane, Bruce Ross-Larson.

Advisory Committee

Chair of Advisory Committee: Ala Din Abdul Sahib Alwan.
Advisory Committee: Amadaou Bagayoko, Arup Banerji, Philip Craven,
Mariam Doumiba, Ariel Fiszbein, Sepp Heim, Etienne Krug, Brenda
Myers, Kicki Nordström, Qian Tang, Mired bin Raad, José Manuel SalazarXirinachs, Sha Zukang, Kit Sinclair, Urbano Stenta, Gerold Stucki, Tang
Xiaoquan, Edwin Trevathan, Johannes Trimmel.

Contributors to individual chapters
Introduction

Contributors: Alana Officer, Tom Shakespeare.

Chapter 1: Understanding disability

Contributors: Jerome Bickenbach, Theresia Degener, John Melvin, Gerard
Quinn, Aleksandra Posarac, Marianne Schulze, Tom Shakespeare, Nicholas
Watson.
Boxes: Jerome Bickenbach (1.1), Alana Officer (1.2), Aleksandra Posarac,
Tom Shakespeare (1.3), Marianne Schulze (1.4), Natalie Jessup, Chapal
Khasnabis (1.5).

xv


World report on disability

Chapter 2: Disability – a global picture

Contributors: Gary Albrecht, Kidist Bartolomeos, Somnath Chatterji,
Maryanne Diamond, Eric Emerson, Glen Fujiura, Oye Gureje, Soewarta
Kosen, Nenad Kostanjsek, Mitchell Loeb, Jennifer Madans, Rosamond
Madden, Maria Martinho, Colin Mathers, Sophie Mitra, Daniel Mont,
Alana Officer, Trevor Parmenter, Margie Peden, Aleksandra Posarac,
Michael Powers, Patricia Soliz, Tami Toroyan, Bedirhan Üstün, Brandon
Vick, Xingyang Wen.
Boxes: Gerry Brady, Gillian Roche (2.1), Mitchell Loeb, Jennifer Madans
(2.2), Thomas Calvot, Jean Pierre Delomier (2.3), Matilde Leonardi, Jose
Luis Ayuso-Mateos (2.4), Xingyang Wen, Rosamond Madden (2.5).

Chapter 3: General health care

Contributors: Fabricio Balcazar, Karl Blanchet, Alarcos Cieza, Eva Esteban,
Michele Foster, Lisa Iezzoni, Jennifer Jelsma, Natalie Jessup, Robert Kohn,

Nicholas Lennox, Sue Lukersmith, Michael Marge, Suzanne McDermott,
Silvia Neubert, Alana Officer, Mark Swanson, Miriam Taylor, Bliss Temple,
Margaret Turk, Brandon Vick.
Boxes: Sue Lukersmith (3.1), Liz Sayce (3.2), Jodi Morris, Taghi Yasamy,
Natalie Drew (3.3), Paola Ayora, Nora Groce, Lawrence Kaplan (3.4), Sunil
Deepak, Bliss Temple (3.5), Tom Shakespeare (3.6).

Chapter 4: Rehabilitation

Contributors: Paul Ackerman, Shaya Asindua, Maurice Blouin, Debra
Cameron, Kylie Clode, Lynn Cockburn, Antonio Eduardo DiNanno,
Timothy Elliott, Harry Finkenflugel, Neeru Gupta, Sally Hartley, Pamela
Henry, Kate Hopman, Natalie Jessup, Alan Jette, Michel Landry, Chris Lavy,
Sue Lukersmith, Mary Matteliano, John Melvin, Vibhuti Nandoskar, Alana
Officer, Rhoda Okin, Penny Parnes, Wesley Pryor, Geoffrey Reed, Jorge
Santiago Rosetto, Grisel Roulet, Marcia Scherer, William Spaulding, John
Stone, Catherine Sykes, Bliss Temple, Travis Threats, Maluta Tshivhase,
Daniel Wong, Lucy Wong, Karen Yoshida.
Boxes: Alana Officer (4.1), Janet Njelesani (4.2), Frances Heywood (4.3),
Donata Vivanti (4.4), Heinz Trebbin (4.5), Julia D’Andrea Greve (4.6), Alana
Officer (4.7).

Chapter 5: Assistance and support

Contributors: Michael Bach, Diana Chiriacescu, Alexandre Cote, Vladimir
Cuk, Patrick Devlieger, Karen Fisher, Tamar Heller, Martin Knapp, Sarah
Parker, Gerard Quinn, Aleksandra Posarac, Marguerite Schneider, Tom
Shakespeare, Patricia Noonan Walsh.
Boxes: Tina Minkowitz, Maths Jesperson (5.1), Robert Nkwangu (5.2),
Disability Rights International (5.3).

xvi


Contributors

Chapter 6: Enabling environments

Contributors: Judy Brewer, Alexandra Enders, Larry Goldberg, Linda
Hartman, Jordana Maisel, Charlotte McClain-Nhlapo, Marco Nicoli, Karen
Peffley, Katherine Seelman, Tom Shakespeare, Edward Steinfeld, Jim Tobias,
Diahua Yu.
Boxes: Edward Steinfeld (6.1), Tom Shakespeare (6.2), Asiah Abdul Rahim,
Samantha Whybrow (6.3), Binoy Acharya, Geeta Sharma, Deepa Sonpal (6.4),
Edward Steinfeld (6.5), Katherine Seelman (6.6), Hiroshi Kawamura (6.7).

Chapter 7: Education

Contributors: Peter Evans, Giampiero Griffo, Seamus Hegarty, Glenda
Hernandez, Susan Hirshberg, Natalie Jessup, Elizabeth Kozleski, Margaret
McLaughlin, Susie Miles, Daniel Mont, Diane Richler, Thomas Sabella.
Boxes: Susan Hirshberg (7.1), Margaret McLaughlin (7.2), Kylie Bates, Rob
Regent (7.3), Hazel Bines, Bliss Temple, R.A. Villa (7.4), Ingrid Lewis (7.5).

Chapter 8: Work and employment

Contributors: Susanne Bruyère, Sophie Mitra, Sara VanLooy, Tom
Shakespeare, Ilene Zeitzer.
Boxes: Susanne Bruyère (8.1), Anne Hawker, Alana Officer, Catherine Sykes
(8.2), Peter Coleridge (8.3), Cherry Thompson-Senior (8.4), Susan Scott

Parker (8.5).

Chapter 9: The way forward: recommendations

Contributors: Sally Hartley, Natalie Jessup, Rosamond Madden, Alana
Officer, Sashka Posarac, Tom Shakespeare.
Boxes: Kirsten Pratt (9.1)

Technical appendices

Contributors: Somnath Chatterji, Marleen De Smedt, Haishan Fu, Nenad
Kostanjsek, Rosalba Lembo, Mitchell Loeb, Jennifer Madans, Rosamond
Madden, Colin Mathers, Andres Montes, Nirmala Naidoo, Alana Officer,
Emese Verdes, Brandon Vick.

Narrative contributors

The report includes narratives with personal accounts of the experiences of
people with disabilities. Many people provided a narrative but not all could
be included in the report. The narratives included come from Australia,
Bangladesh, Barbados, Belize, Cambodia, Canada, China, Egypt, Haiti,
India, Japan, Jordan, Kenya, the Netherlands, Palestinian Self-Rule Areas,
Panama, the Russian Federation, the Philippines, Uganda, the United
Kingdom of Great Britain and Northern Ireland, and Zambia. Only the
first name of each narrative contributor has been provided for reasons of
confidentiality.

xvii

World report on disability

Peer reviewers

Kathy Al Ju’beh, Dele Amosun, Yerker Anderson, Francesc Aragal, Julie
Babindard, Elizabeth Badley, Ken Black, Johannes Borg, Vesna Bosnjak, Ron
Brouillette, Mahesh Chandrasekar, Mukesh Chawla, Diana Chiriacescu,
Ching Choi, Peter Coleridge, Ajit Dalal, Victoria de Menil, Marleen De
Smedt, Shelley Deegan, Sunil Deepak, Maryanne Diamond, Steve Edwards,
Arne Eide, James Elder-Woodward, Eric Emerson, Alexandra Enders, John
Eriksen, Haishan Fu, Marcus Fuhrer, Michelle Funk, Ann Goerdt, Larry
Goldberg, Lex Grandia, Pascal Granier, Wilfredo Guzman, Manal Hamzeh,
Sumi Helal, Xiang Hiuyun, Judith Hollenweger, Mosharraf Hossain, Venus
Ilagan, Deborah Iyute, Karen Jacobs, Olivier Jadin, Khandaker Jarulul
Alam, Jennifer Jelsma, Steen Jensen, Nawaf Kabbara, Lissa Kauppinen,
Hiroshi Kawamura, Peter Kercher, Chapal Khasnabis, Ivo Kocur, Johannes
Koettl, Kalle Könköllä, Gloria Krahn, Arvo Kuddo, Gaetan Lafortune,
Michel Landry, Stig Larsen, Connie Lauren-Bowie, Silvia Lavagnoli, Axel
Leblois, Matilde Leonardi, Clayton Lewis, Anna Lindström, Gwynnyth
Lleweyllyn, Mitchell Loeb, Michael Lokshin, Clare MacDonald, Jennifer
Madans, Richard Madden, Thandi Magagula, Dipendra Manocha, Charlotte
McClain-Nhlapo, John Melvin, Cem Mete, Susie Miles, Janice Miller,
Marilyn Moffat, Federico Montero, Andres Montes, Asenath Mpatwa,
Ashish Mukerjee, Barbara Murray, David Newhouse, Penny Norgrove,
Helena Nygren Krug, Japheth Ogamba Makana, Thomas Ongolo, Tanya
Packer, Trevor Parmenter, Donatella Pascolini, Charlotte Pearson, Karen
Peffley, Debra Perry, Poul Erik Petersen, Immaculada Placencia-Porrero,
Adolf Ratzka, Suzanne Reier, Diane Richler, Wachara Riewpaiboon, Tom
Rikert, Alan Roulstone, Amanda Rozani, Moosa Salie, Mohammad Sattar
Dulal, Duranee Savapan, Shekhar Saxena, Walton Schlick, Marguerite

Schneider, Marianne Schultz, Kinnon Scott, Tom Seekins, Samantha Shann,
Owen Smith, Beryl Steeden, Catherine Sykes, Jim Tobias, Stefan Trömel,
Chris Underhill, Wim Van Brakel, Derek Wade, Nicholas Watson, Ruth
Watson, Mark Wheatley, Taghi Yasamy, Nevio Zagaria, Ilene Zeitzer, Ruth
Zemke, Dahong Zhuo.

Additional contributors
Regional consultants

WHO African Region/Eastern Mediterranean Region
Alice Nganwa Baingana, Betty Babirye Kwagala, Moussa Charafeddine,
Kudakwashe Dube, Sally Hartley, Syed Jaffar Hussain, Deborah Oyuu
Iyute, Donatilla Kanimba, Razi Khan, Olive Chifefe Kobusingye, Phitalis
Were Masakhwe, Niang Masse, Quincy Mwya, Charlotte McClain-Nhlapo,
Catherine Naughton, William Rowland, Ali Hala Ibrahim Sakr, Moosa
Salie, Alaa I. Sebeh, Alaa Shukrallah, Sándor Sipos, Joe Ubiedo.

xviii


Contributors

WHO Region of the Americas
Georgina Armstrong, Haydee Beckles, Aaron Bruma, Jean-Claude Jalbert,
Sandy Layton, Leanne Madsen, Paulette McGinnis, Tim Surbey, Corey
Willet, Valerie Wolbert, Gary L. Albrecht, Ricardo Restrepo Arbelaez, Martha
Aristizabal, Susanne Bruyere, Nixon Contreras, Roberto Del Águila, Susan
Hirshberg, Federico Montero, Claudia Sánchez, Katherine Seelman, Sándor
Sipos, Edward Steinfeld, Beatriz Vallejo, Armando Vásquez, Ruth Warick,
Lisbeth Barrantes, José Luís Di Fabio, Juan Manuel Guzmán, John Stone.

WHO South-East Asia Region/Western Pacific Region
Tumenbayar Batdulam, Amy Bolinas, Kylie Clode, David Corner, Dahong
Zhuo, Michael Davies, Bulantrisna Djelantik, Mohammad Abdus Sattar
Dulal, Betty Dy-Mancao, Fumio Eto, Anne Hawker, Susan Hirshberg,
Xiaolin Huang, Venus Ilagan, Yoko Isobe, Emmanuel Jimenez, Kenji Kuno,
Leonard Li, Rosmond Madden, Charlotte McClain-Nhlapo, Anuradha
Mohit, Akiie Ninomiya, Hisashi Ogawa, Philip O’Keefe, Grant Preston,
Wachara Riewpaiboon, Noriko Saito, Chamaiparn Santikarn, Mary Scott,
Sándor Sipos, Catherine Sykes, Maya Thomas, Mohammad Jashim Uddin,
Zhuoying Qiu, Filipinas Ganchoon, Geetika Mathur, Miriam Taylor, John
Andrew Sanchez.
The WHO Regional Office for European Region
Viveca Arrhenius, Jerome Bickenbach, Christine Boldt, Matthias
Braubach, Fabrizio Cassia, Diana Chiriacescu, Marleen De Smedt, Patrick
Devlieger, Fabrizio Fea, Federica Francescone, Manuela Gallitto, Denise
Giacomini,Donato Greco, Giampiero Griffo, Gunnar Grimby, Ahiya Kamara,
Etienne Krug, Fiammetta Landoni, Maria G. Lecce, Anna Lindström,
Marcelino Lopez, Isabella Menichini, Cem Mete, Daniel Mont, Elisa Patera,
FrancescaRacioppi, Adolf Ratzka, Maria Pia Rizzo, Alan Roulstone, Tom
Shakespeare, Sándor Sipos, Urbano Stenta, Raffaele Tangorra, Damjan Tatic,
Donata Vivanti, Mark Wheatley.
None of the experts involved in the development of this Report declared
any conflict of interest.

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Introduction

Many people with disabilities do not have equal access to health care, education, and employment opportunities, do not receive the disability-related
services that they require, and experience exclusion from everyday life
activities. Following the entry into force of the United Nations Convention
on the Rights of Persons with Disabilities (CRPD), disability is increasingly
understood as a human rights issue. Disability is also an important development issue with an increasing body of evidence showing that persons with
disabilities experience worse socioeconomic outcomes and poverty than
persons without disabilities.
Despite the magnitude of the issue, both awareness of and scientific
information on disability issues are lacking. There is no agreement on definitions and little internationally comparable information on the incidence,
distribution and trends of disability. There are few documents providing a
compilation and analysis of the ways countries have developed policies and
responses to address the needs of people with disabilities.
In response to this situation, the World Health Assembly (resolution
58.23 on “Disability, including prevention, management and rehabilitation”)
requested the World Health Organization (WHO) Director-General to
produce a World report on disability based on the best available scientific
evidence. The World report on disability has been produced in partnership
with the World Bank, as previous experience has shown the benefit of collaboration between agencies for increasing awareness, political will and
action across sectors.
The World report on disability is directed at policy-makers, practitioners, researchers, academics, development agencies, and civil society.

Aims
The overall aims of the Report are:
■■ To provide governments and civil society with a comprehensive description of the importance of disability and an analysis of the responses provided, based on the best available scientific information.
■■ Based on this analysis, to make recommendations for action at national
and international levels.
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World report on disability

Scope of the Report
The Report focuses on measures to improve accessibility and equality of
opportunity; promoting participation and inclusion; and increasing respect
for the autonomy and dignity of persons with disabilities. Chapter 1 defines
terms such as disability, discusses prevention and its ethical considerations,
introduces the International Classification of Functioning, Disability and
Health (ICF) and the CRPD, and discusses disability and human rights, and
disability and development. Chapter 2 reviews the data on disability prevalence and the situation of people with disabilities worldwide. Chapter  3
explores access to mainstream health services for people with disabilities.
Chapter 4 discusses rehabilitation, including therapies and assistive devices.
Chapter 5 investigates support and assistance services. Chapter 6 explores
inclusive environments, both in terms of physical access to buildings, transport, and so on, but also access to the virtual environments of information and communication technology. Chapter  7 discusses education, and
Chapter  8 reviews employment for people with disabilities. Each chapter
includes recommendations, which are also drawn together to provide broad
policy and practice considerations in Chapter 9.

Process
The development of this Report has been led by an Advisory Committee and
an Editorial Board, and has taken over three years. WHO and the World
Bank acted as secretariat throughout this process. Based on outlines prepared by the Editorial Board, each chapter was written by a small number
of authors, working with a wider group of experts from around the world.
Wherever possible, people with disabilities were involved as authors and
experts. Nearly 380 contributors from various sectors and all the regions of
the world wrote text for the report.
The drafts of each chapter were reviewed following input from regional
consultations organized by WHO Regional Offices, which involved local
academics, policy-makers, practitioners, and people with disabilities. During
these consultations, experts had the opportunity to propose overall recommendations (see Chapter 9). The complete chapters were revised by editors
on the basis of human rights standards and best available evidence, subjected

to external peer review, which included representatives of disabled people’s
organizations. The text was finally reviewed by the World Bank and WHO.
It is anticipated that the recommendations in this Report will remain
valid until 2021. At that time, the Department of Violence and Injury
Prevention and Disability at WHO headquarters in Geneva will initiate a
review of the document.

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Introduction

Moving forward
This World report on disability charts the steps that are required to improve
participation and inclusion of people with disabilities. The aspiration of
WHO, the World Bank, and all the authors and editors of this World report
on disability is that it contributes to concrete actions at all levels and across
all sectors, and thus helps to promote social and economic development
and the achievement of the human rights of persons with disabilities
across the world.

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Chapter 1
Understanding disability