By Abdulrahman Isah Abubakar, Global Advisor for Billion Strong

Abstract

The purpose of this article is to analyze and discuss the various barriers that pose a hindrance to Disability Inclusion. The paper examines the conceptual framework of Persons with Disabilities (PWDs) using several views like the charity, medical, social, human rights, and interactional models. Also, secondary data was used for writing this article.

Keywords: Barriers, Disability, Inclusion, Persons with Disabilities (PWDs).

Introduction

Disability is not rare. An estimated one billion people, or around 15% of the world’s population, have some form of disability (WHO & World Bank, 2011). Disability is more common in low- and middle-income countries than high-income countries and among older age groups (WHO & World Bank, 2011; Mitra & Sambamoorthi, 2014). Disability is something everyone is likely to experience, either permanently or temporarily, at some point in their life (WHO & World Bank, 2011). People with disabilities are diverse and not defined by their disability.

Globally, persons with disabilities are facing numerous barriers related to education, healthcare services, employment/workplace, and social and political participation. Likewise, persons with disabilities face physical and social barriers that hinder their access to services or prevent them from enjoying their rights. The design and construction of indoor and outdoor facilities can prevent them from going to school and hospitals, shopping, gaining access to police services, and finding or keeping a job. Footpaths, parks, and public transportation may also be inaccessible, preventing some persons with disabilities from enjoying the most basic elements of participation in social life.

Persons with disabilities also face communication barriers—that is, physical and virtual challenges in accessing and sharing information. Assistive technology enables people to live healthy, productive, and independent lives but is far from available to all. It is estimated, for example, that 360 million people globally have moderate to profound hearing loss, yet hearing aid production meets less than 10% of the need (WHO, 2016). Digital technologies can also break down traditional barriers to communication and information. However, evidence suggests that the level of use of information and communications technology (ICT) by persons with disabilities is significantly lower than among persons without a disability (CBM, 2012). In some cases, they may be unable to access even basic products and services, such as telephones, television, and the Internet. Stigma and discrimination touch nearly all aspects of the lives of persons with disabilities. They are present at the interpersonal and institutional levels through laws and customs that systematically marginalize such persons with disabilities and can prevent them from obtaining employment, accessing services, and making friends. Expectations for academic and career success by persons with disabilities are often unfairly lowered due to different barriers. Parents may keep children with disabilities out of school for fear of abuse (Smith, Jolley & Schmidt, 2014). If they attend school, children with disabilities are also subject to negative attitudes and bullying (UN, 2014).

Therefore, this paper examines the various barriers to ‘Disability Inclusion’ in the sense that attitudinal, architectural/physical, communication, and institutional (law, policy & program) barriers are intensively analyzed and discussed.

Persons with Disabilities (PWDs)

Disability is part of the human condition. Everyone is likely to experience it, either permanently or temporarily, at some point in their life (WHO & World Bank, 2011). People with disabilities are diverse and not defined by their disability (WHO & World Bank, 2011). Disabilities may be visible or invisible, and onset can occur at birth, during childhood, working age, or old age.

There is no single definition of disability (Mitra, 2006). Defining disability is complicated as it is ‘complex, dynamic, multi-dimensional and contested’ (WHO & World Bank, 2011). The UN Convention on the Rights of Persons with Disabilities (UNCRPD) (2006) recognizes that “disability is an evolving concept” and “Persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others” (UNCRPD, 2006).

Different models of disability view how disability is understood and acted upon and can be categorized as follows:

Charity model

The charity model of disability focuses on the individual and tends to view people with disabilities as passive victims ‒ objects of pity who need care and whose impairment is their main identifier (Al Ju’beh, 2015).

Medical model

The medical (or biomedical) model of disability considers ‘disability a problem of the individual that is directly caused by a disease, an injury, or some other health condition and requires medical care in the form of treatment and rehabilitation’ (Mitra, 2006). It assumes that addressing the medical ailment will solve the ‘problem’ ‒ that disability must be fixed or cured (Al Ju’beh, 2015). This model is widely criticized on different grounds, including for not considering the important roles of environmental and social barriers (Mitra, 2006 & Rimmerman, 2013).

Social model

The social model of disability developed as a reaction to the individualistic approaches of the charitable and medical models (Al Ju’beh, 2015 & Rimmerman, 2013). It is human rights-driven and socially constructed (Woodburn, 2013). It sees disability as created by the social environment, which excludes people with impairments from full participation in society as a result of attitudinal, environmental, and institutional barriers (Mitra, 2006). It emphasizes society adapting to include people with disabilities by changing attitudes, practices, and policies to remove barriers to participation, but also acknowledges the role of medical professionals (DFID, 2000 & Al Ju’beh, 2015). However, the social model has been criticized for ignoring the personal impact of disability and for its emphasis on individual empowerment, which may be contrary to more collective social customs and practices in many developing countries (Al Ju’beh, 2015 & Rimmerman, 2013).

Human rights model

This model of disability is based on the social model and also seeks to transform unjust systems and practices. It takes the UNCRPD as its main reference point and sees people with disabilities as the ‘central actors in their own lives as decision makers, citizens and rights holders’ (Al Ju’beh, 2015).

The social and human rights models form the basis of many disability policies and practices (Kett & Twigg, 2007). As development professionals may identify with the individual models of disability, it is important not to alienate them when introducing them to disability as a human rights issue, but to ‘help [them] to see that barriers are a more helpful and respectful lens with which to view disability’ (Al Ju’beh, 2015).

Interactional model

The Interactional model recognizes that disability should be seen as neither purely medical nor purely social, as people with disabilities can experience problems arising from the interaction of their health condition with the environment (WHO & World Bank, 2011).

The most commonly used interactional model is the model underlying the International Classification of Functioning, Disability and Health (ICF) (WHO & World Bank, 2011). This views disability as arising from the negative interaction between health conditions and the context – including environmental factors (products and technology; the natural and built environment; support and relationships; attitudes; services, systems, and policies) and personal factors (e.g. age, sex, motivation, and self-esteem) (WHO & World Bank, 2011).

The ICF represents a workable compromise between medical and social models due to its greater recognition of the impact of environmental and structural factors on disability (WHO & World Bank, 2011). However, it has been ‘severely criticized by prominent members of the disability movement, in the belief that it does not analyze exclusion and discrimination of people with disabilities’ (Groce et al., 2011 & Al Ju’beh, 2015).

Disability Inclusion

Disability Inclusion seeks to include people with disabilities in all spheres of life for societal development by recognizing their ability and potential, valuing and respecting their contributions and perspectives, honoring their dignity, and effectively responding to their needs for functional gifts. Unlike ‘Disability Segregation,’ ‘Disability Inclusion’ promotes an integrated, mainstreaming, and inclusive society to benefit persons with disabilities and the community (Berman-Bieler, 2008).

Disability Inclusion means: i) being accepted and recognized as an individual beyond the disability; ii) having positive personal relationships with family, friends, and acquaintances; iii) being involved in the development process of a society; iv) having appropriate reasonable accommodations for all persons with different abilities (Rimmerman, 2013).

Disability Inclusion Barriers

Disability Inclusion Barriers are obstacles and hindrances, internally or externally, visible or invisible, that prevent or deny persons with disabilities from fully participating in society in every aspect of life. Some of those Barriers are either created intentionally or accidentally. Various barriers hinder Disability Inclusion, and they can be broadly categorized into the following:

1. Attitudinal Barrier
2. Physical Barriers
3. Communication Barriers
4. Institutional Barriers

Attitudinal barriers

Attitudinal barriers are behaviors, perceptions, and assumptions that discriminate against persons with disabilities. These barriers often emerge from a lack of understanding, which can lead people to ignore, judge, or have misconceptions about a person with a disability (Heymann et al., 2014; Bruijn et al., 2012).

Attitudinal barriers, which result in stigmatization and discrimination, deny people with disabilities their dignity and potential and are one of the greatest obstacles to achieving equality of opportunity and social integration (Wapling & Downie, 2012; UNICEF, 2013). Negative attitudes create a disabling environment across all domains. They are often expressed through the inability of the non-disabled to see past the impairment, discrimination, fear, bullying, and low expectations of people with disabilities (DFID, 2000; WHO & World Bank, 2011; UNICEF, 2013).

Attitudes towards people with disabilities in low- and middle-income countries can be more extreme and the degree of stigma and shame can be higher than in high-income contexts (Mont, 2014). These attitudes can arise as a result of ‘misconceptions, stereotypes, and folklore linking disability to punishment for past sins, misfortune or witchcraft.’ Multiple and intersectional discrimination can intensify attitudinal barriers. Development organizations’ staff may also have negative attitudes towards people with disabilities (Bruijn et al., 2011).

According to Groce & Kett (2014), one of the most significant barriers to effective participation and inclusion of persons with disabilities are negative attitudes and stereotypes. Society often sees persons with disabilities as incapable, dependent, or weak; on the other hand, the community may see them as inspirational, heroic, or superhuman. This perpetuates their segregation and exclusion from society. Examples of attitudinal barriers include:

1. A school director who believes that persons with intellectual impairments are disruptive and will be incapable of learning and thus makes these students/children feel unwelcome creates a barrier for persons with disabilities to enter school and learn.
2. A health-care worker who thinks that women with disabilities are not or should not be sexually active and thus does not provide them with family planning services creates a barrier for women with disabilities to access health care.

Physical Barriers

Inaccessible environments create disability by creating barriers to participation and inclusion (Bruijn et al., 2012). Physical obstacles in the natural or built environment ‘prevent access and affect opportunities for participation’ (DFID, 2000; WHO & World Bank, 2011).

According to Rimmerman (2013), Physical barriers are barriers linked to the physical and built environment and cover a huge range of barriers that prevent equal access, such as stairs/steps, narrow corridors and doorways, curbs, inaccessible toilets, inaccessible housing, poor lighting, poor seating, broken lifts or poorly managed street and public spaces.

Burns et al. (2014) opined that physical barriers fall into structural barriers, obstacles in natural or artificial environments that prevent access or hinder persons with disabilities from moving around independently. Structural barriers include a health clinic with steps at the entrance, pathways without tactile guide markers, narrow doorways, and squat-style toilets that create barriers for persons with physical and vision impairment.

In addition, architectural barriers are elements of buildings or outdoor spaces that create barriers to persons with disabilities. These barriers relate to factors such as the design of a building’s stairs or doorways, the layout of rooms, or the width of halls and sidewalks. Examples of architectural or physical barriers include:

1. Sidewalks and doorways that are too narrow for a wheelchair, scooter, or walker.
2. Desks are too high for a person using a wheelchair or other mobility device.
3. Poor lighting that makes it difficult to see for a person with low vision or a person who lip-reads.
4. Doorknobs that are difficult to grasp for a person with arthritis.

Likewise, transportation barriers are due to inadequate transportation facilities and services that interfere with a person’s ability. Examples of transportation barriers include:

1. Lack of access to accessible or convenient transportation for people who are not able to drive because of vision, physical or cognitive impairments, and
2. Public transportation may be unavailable or at inconvenient distances or locations.
3. Lack of reserved spaces in public vehicles or inconvenience with the entrance of shared cars.

Communication Barriers

Inaccessible communication systems prevent access to information, knowledge, and participation opportunities. Problems with information service delivery also restrict the participation of people with disabilities (WHO & World Bank, 2011).

According to Burns et al. (2014), communication barriers may be experienced by persons with difficulties in seeing, hearing, speaking, reading, writing, and understanding. These persons often communicate in different ways to persons without disabilities; if adaptations are not made, they may be unable to understand or convey information. Examples of communication barriers include:

1. A document in a small and unclear font and without raised dots (Braille) creates a barrier for persons with visual impairments
2. A workshop/ seminar/ lecture/ conference/ summit using spoken communications without providing sign language interpretation creates a barrier for persons with hearing impairments.
3. A health clinic with high service counters and patient information desks creates a barrier for persons with physical impairment who use wheelchairs.

Institutional barriers

Institutional barriers include laws, policies, programs, strategies, or practices that discriminate against people with disabilities (WHO & World Bank, 2011). For example, a study of five Southeast Asian countries found that electoral laws do not specifically protect the political rights of persons with disabilities. At the same time, ‘some banks do not allow visually impaired people to open accounts, and HIV testing centers often refuse to accept sign language interpreters due to confidentiality policies’ (PPUA Penca, 2013). Many countries still have restrictive laws, particularly affecting people with psychosocial or intellectual disabilities. Discrimination may not be intended, but systems can indirectly exclude people with disabilities by not taking their needs into account (WHO & World Bank, 2011).

According to Burns et al. (2014), institutional barriers are often created when there is no legal framework for disability inclusion or when existing laws and regulations, such as those that require programs, policies, and activities to be inclusive and accessible to persons with disabilities and make ‘reasonable accommodation’ for their specific needs, are poorly enforced. Institutional barriers are difficult to identify because they are often entrenched within social and cultural norms. Examples of the institutional obstacles include:

1. A school that does not adhere to the global system and national policy of identifying and responding to children’s diverse needs by, for instance, developing individual education plans and providing classroom assistants or other supports creates barriers for children with disabilities to attend school and learn.
2. A microfinance program requiring potential recipients to meet a minimum high school education level to be eligible for a loan creates barriers for persons with disabilities who cannot attend mainstream schools and sit for completion exams to participate in the program.

Conclusion

The physical, mental, intellectual, or sensory impairments plus barriers hinder the full and effective participation of persons with disabilities in society and open the way to social exclusion and discrimination. The perception of people towards persons with disabilities as a group in need of charity still underpins Disability Inclusion. In other words, many are based on the belief that such persons with disabilities lack ability and are dependent, unable to contribute to society or the workplace fully. Many persons with disabilities are excluded from societal participation, particularly in developing countries. Therefore, barriers to Disability Inclusion can be addressed and broken using functional legislation, reasonable accommodations, and awareness raising for attitude change.

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