Disability Benefits: The Neglected Social Security Instrument

A few years ago, I was in Kiribati in the Pacific holding discussions with a group of persons with disabilities (PwDs) who had set up an independent camp in the capital, South Tarawa. They had become disillusioned with the indifference, lack of support and, in some cases, abuse – one blind woman had been repeatedly raped by her kin – they received from their relatives and believed that they would be better off supporting each other. The government had proposed a Disability Benefit in the previous election but nothing had happened.

I asked them whether they supported the introduction of a disability benefit and the answer was a resounding yes, tempered by disbelief that it would ever happen. What difference would it make, I asked. They replied that, instead of the exclusion and discrimination that was their daily lot, people would “fight like dogs to have us live with them.” But, more importantly, it would strengthen their ability to live independently: they were a hard working bunch and believed that a disability benefit would offer them an important step on the ladder into the labour market. However, as far as I’m aware, Kiribati still doesn’t have a disability benefit; no one appears to be listening to the people with disabilities of Kiribati.

Therefore, in recognition of the International Day of Persons with Disability, we are launching a Disability Benefit database to give some much needed publicity to this oft-neglected social security instrument. The database complements a similar and very useful old age pension database that can be found at HelpAge International’s Pension Watch website. Our hope is that the database will give some support to the persons with disabilities of Kiribati and across the world as they struggle to have their rights recognised.

Disability benefits are rarely given prominence in discussions on social security in developing countries. Yet, we managed to find a total of 48 schemes across 32 low and middle income countries (as well as the Republic of Korea and Singapore). The focus of the database is mainly on tax-financed schemes but we have also included a small number of social insurance schemes (and we hope to incorporate more as we update the database). So, while disability benefits are often invisible in social security policy discussions, it is likely that they are as common as conditional cash transfer schemes (although CCTs receive rather more publicity given their popularity among neoliberals). Indeed, if we were to expand our horizons and include high-income countries, we’d find that disability benefits are a core social security instrument in many countries: most OECD countries have disability benefits, with expenditures commonly ranging between 1% and 5% of GDP [1].

However, our database indicates very different levels of commitment to PwDs across low and middle-income countries. Some countries provide very significant support to PwDs across the lifecycle: so, for example, Mauritius, South Africa and Uzbekistan provide comprehensive benefits for children and adults, complemented by old age pensions for the elderly disabled (the age group at which disability prevalence is highest). Uzbekistan is the most generous, investing more than 2% of GDP in its disability benefits (with much more in its old age pension). However, in many other countries, support is little more than nominal and hardly scratches the surface: so, in Indonesia – a country with over 20 million PwDs – benefits are provided to less than 20,000 people.

Disability benefits should be a core component of any national social security system. There is strong international evidence that disability increases the risk of individuals and families falling into poverty. Many PwDs face additional costs if they are to access school or employment and disability benefits can provide them with essential support to increase their independence. Others face care costs – which can be significant – while family members often have to give up or reduce their employment to look after them. In the absence of a disability benefit not only do PwDs experience greater difficulties, so do their relatives, with significant impacts on the wellbeing of children. One consequence of the absence of a disability benefit – or an old age pension for the elderly with disabilities– is the greater social exclusion of PwDs, as experienced in Kiribati and in many other countries.

When a breadwinner experiences a disability, this can have a catastrophic impact on families. A study in Bangladesh by Foley and Chowdhury (2006) found that 87% of breadwinners who become disabled leave employment within one year, resulting in a significant fall in their incomes. [2] Furthermore, 90% of carers have to spend more time caring for their spouses, thereby reducing their own ability to gain an income: around 26% forgo at least 15 hours work a week and a further 28% give up over 26 hours. Compounding the loss of income, families also face significant additional health costs. At least PwDs in Bangladesh are better off than those in many other countries in that they can – if they are lucky – access a small disability benefit: however, it provides only US$4 per month, which in no measure compensates for the loss of income and additional costs faced by families.

The lack of interest among many development agencies and governments in disability benefits almost certainly reflects more generalised discrimination experienced by PwDs. The Convention on the Rights of Persons with Disability specifies the “right to social protection” but this right is rarely taken seriously. To give one example, as I’ve discussed elsewhere, the cuts in social security benefits in the United Kingdom – as part of the government’s austerity drive – have disproportionately affected PwDs, in particular the rather nasty and unfair “bedroom tax” that penalises those PwDs with an additional room in their house (they’re expected to move house, in a housing market in which smaller houses are unavailable; if they don’t, they lose 20% of their benefit). It’s not surprising that similar discriminatory attitudes – or, at best, indifference – are found within some development agencies.

So, on the International Day of Persons with Disability, let’s consider whether disability benefits should be given more prominence in the social policy of low and middle-income countries. As I mentioned earlier, a number of countries have demonstrated that the provision of support to PwDs across the life course is possible, comprising specific disability benefits for children and adults and an old age pension for the elderly. Let’s not kid ourselves: almost all countries are able to finance such a package of benefits; the key question is why they don’t.

At least, let’s recognise that this is not a peripheral issue: in most countries, PwDs comprise over 10% of the population and, if their needs are not addressed, broader based poverty reduction initiatives will be compromised. Disability benefits need to move to the centre of discussions on social security policy. Or, at least they should in countries truly committed to fairness and a strong social contract.

Finally, I’m writing this as the father of a daughter who has received a disability benefit from birth. It has made a significant difference to her life, enabling us to finance activities for her that – in the absence of the benefit – we would never have been able to. There are those who believe that my daughter should never have received this benefit, arguing that it should have been means-tested. They are wrong and they are prejudiced. Without it, her life would have been much less fulfilling. So, let’s not let the mean means-testers destroy the lives of people with disabilities across developing countries.