Disability World
A bimonthly web-zine of international disability news and views, Issue no. 7 March-April 2001

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High Level Baloney for Third World Disabled People

By M. Miles (M99miles@hotmail.com)

Modern governments run largely on baloney, tempered occasionally by the thought that a maverick tribunal might one day judge a particular piece of baloney to constitute a legally actionable promise.

In the case of high level baloney on "Disability, Poverty and Development" (the title of a recent British DFID policy paper, available at http://www.dfid.gov.uk/public/what/pdf/disability.pdf), the chances are slim that any supposed beneficiary, such as a group of disabled people living in serious poverty in a developing country, would ever gain access to the document, would be able to read it, could identify anything concrete in it or might call anyone to account five or ten years later.

Plank or Boat?
DFID (Department for International Development) is the branch of British government responsible for "promoting development and the reduction of poverty". A central plank of its Third World development policy is the worthy if improbable target "to halve the proportion of people living in extreme poverty by 2015", with associated targets of increasing provision of elementary education and health care. To hoist itself aboard the DFID rescue boat, disability must be packaged within 'poverty'; so the document opens with a familiar half-truth, "Disability is both a cause and consequence of poverty" (p. 1). Next, the authors have a quick dip in the numbers tank: "According to the United Nations, one person in 20 has a disability." (p.1)

The "United Nations" authority here turns out to be some figures from Einar Helander's Prejudice and Dignity, 1992, UNDP, pp. 20-33, in which "developing countries" are represented by surveys in China (National Sampling Surveys of the Handicapped,1987), and Mali (Population census, 1976). Those figures are of course up to a quarter of a century old, the census methods even older, the definitions of "the Handicapped" are antiquated and, perhaps wisely, they are omitted from the presentation.

In the same book, Helander claims responsibility for an earlier global guesstimate of disability prevalence, the easily remembered and much cited "One in Ten", publishedby the WHO in 1976. Proceeding with greater caution in 1992, Helander suggests a prevalence of 77 per thousand for "moderate and severe disability in more developed regions", and 45 per thousand for those levels of disability in "less developed regions" (Prejudice and Dignity, p. 24). Such data may be comprehensible in terms of vertical versus pyramidal population age structures - but the DFID document ignores this regional comparison. The suggestion that there may be substantially more disability in wealthier countries than in poorer countries would clearly be off-message in a report that requires disability to be secured within 'poverty'. ("No, Madam. Your question, whether the data or the suggestion have any evidence base, is not admissible in the baloney world.")

The DFID document emerged from a leisurely period of consultation with some British development NGOs and disability NGOs, and was processed by civil servants unbiased by practical experience of working with disabled people in developing countries. Vigorous polemics between the various consulted groups arose from the tendency of development NGOs to advocate practices and policies with at least some marginal capacity for national implementation in real-life countries where they have had aid experience; and the tendency of disability NGOs to advocate the sort of policies for which they have fought with modest success in Britain and which they believe ought to be implemented worldwide regardless of historical, cultural and socio-economic differences between the world's nations.

The resultant DFID document is strong on the conventional jargon of the past decade of disability campaigning in a dozen of the wealthier countries of Europe and North America, proceeding through 15 pages with the sort of half-referenced snippets, evidence-free assertions, slogans and kind thoughts indicated by the opening page. The view that 'if it's right for disabled people in wealthy countries, nothing less can be offered to those in the Third World', suggests a generous, if paternalistic, streak; yet such a view seems likely to promote merely the reproduction of euro-american baloney in Third World capitals (a process known as "aid ventriloquism"), accompanied by a cosmetic layer of services for the urban middle classes. Norman Acton in the early 1980s cautioned against the 'social magnetism effect' in disability development aid, whereby the well-meaning, euro-american middle classes find their natural counterparts in the well-heeled and English-speaking classes in developing countries. There is little evidence that his caution has been heeded.

Nostalgia Nook
The old favourites of the late 1980s and early 1990s are once again offered to the Third World in the DFID document - their authors happy no doubt to get away from the stirrings of doubt and dissent back home. Here are the 'social model', 'community based rehabilitation' (CBR), 'inclusion', and disability as a 'rights issue', none of them apparently understood by the DFID writers but reproduced anyway from a variety of unpublished conference offerings, unrefereed discussion papers, and standard baloney from the UN, listed in footnotes. DFID apparently remains unpersuaded that 'disability' can be explained entirely on the basis of a disabling environment and discriminatory society; but under pressure from social modellers a compromise definition is offered on the lines of 'impairment with adverse social consequences'.

Recent History Repositioned
It is fascinating to see a little recent history being repositioned, as CBR is introduced as having "grown out of the debate between the so-called medical and social models of disability" (p. 9). Until now the WHO version of CBR, the only version to make even the slightest public noise in the 1970s, could fairly easily be documented as borrowing its title from the US penal system, and growing out of the global movement towards Primary Health Care in the 1960s and early 1970s. At that period the British construction of the 'social model of disability' - the only one to have reached the DFID writers - had hardly crystallised let alone been subject to any sort of public debate. (In fact, a social theory of mental deficiency began to be developed by Lewis Dexter, an able-minded American, as early as the 1940s; but that did not impinge on the consciousness of British social modellers in the 1970s).

However, any such 'factist' objection to DFID's document really misses the point. The policy document is a piece of carefully crafted baloney. No part of it should be scrutinised as though it were a contribution to factual or documentable knowledge. It is about the access of Third World disabled people to British taxpayers' money. If they want access, they had better learn that CBR grew out of the medical-social model debate, and any other meaningless 'mis-facts' that are presented to them. That sort of thing is easy to memorise when there's a chance of winning a ticket to enter the development aid lottery.

Rights, Wrongs and Romantics
One of the curious features of disability development discourse in the 1990s was the simultaneous promotion of seriously conflicting policies, e.g. CBR and "rights-based" approaches. In the rural areas of some economically weaker countries, bonds of custom, religion and village gerontocracy still tie together the traditional community, where some 'community spirit' can still be found (though not so easily when water, food or space become scarce). There are still communities of mutual obligation, based on networks of relationships and socialised roles into which everyone is born. There are almost no individual rights in such communities, but everyone can make some demands on some other people, and everyone must meet the demands of some others. The community has rights over all its members. The rhetoric of CBR appeals to euro-american romanticism about this 'traditional community spirit' (however attenuated in practice) which should support and include disabled people. On the other hand, the agenda of the international Disability Movement, dominated by an urban, conference-hopping elite, promotes "Disability as a Rights Issue", and this is reflected in the DFID document (p. 5). This slogan derives from individualising, urban, post-industrial societies, where 'community spirit' has been relegated to theme parks, sentimental films, and gatherings of oldsters bewailing its loss.

The two appeals - to `Community Spirit' and to `Rights', are almost at opposite poles. Development agencies somehow manage to tie them together, perhaps because the whole purpose of a slogan is to save people from having to do any thinking about real situations. One could of course argue that both slogans have some appeal to transitional societies, as they stand semi-paralysed at the crossroads between the claustrophobic traditional community and the agoraphobic prospect of the modern, urban, lonely crowd.

The Disability Movement will approve DFID's emphasis on consulting disabled people, though this too could use some clearer thinking. Should euro-american aid policies intending to benefit the poorest disabled people of Tanzania, Nepal or Vietnam, for example, be influenced by British, Swedish or Canadian disabled people who have never spent a day in Tanzania or Nepal or Vietnam, let alone lived in the rural areas of those countries?

Disillusion with Wonderplans
Rights, Inclusion, Social Model, CBR - where are they now? In the latest Inclusion International Newsletter (No. 25, Aug.-Sept. 2000), the highly experienced Swedish ombudsman for people with intellectual disabilities, Victor Wahlstrom, expresses his dismay at the lack of impact of the Standard Rules and similar high-level baloney: "the UN are world champions at agreeing upon human rights documents but are ineffective in their implementation." Meanwhile Mel Ainscow, the indefatigable promoter of UNESCO's teacher education package for Inclusion, "Special Needs in the Classroom ", has made the belated discovery that "schooling is so closely tied into local conditions and cultures that the importation of practices from elsewhere is fraught with difficulties." (M. Ainscow (1999) Understanding the Development of Inclusive Schools, London: Falmer, pp. 1-2.)

The founding editor of the British journal, Disability and Society, Len Barton, recently ran a call for papers on "Beyond the Social Model" and "Is there a return to the medical model?"

The leading proponent of CBR, Einar Helander, recently reviewed 25 years of effort, against a background of increasing 'incredulity towards metanarratives' and steadily increasing numbers of disabled people in developing countries. His conclusion is that, "For most people with disabilities the situation can at present be expected to become worse each year. Most of them are to be found among the poorest of the poor, and will remain there until something substantial is done. We have on our hands a growing moral, social, health and economic problem of vast proportions. When will it go away?"(Asia Pacific Disability Rehabilitation Journal 11 (1) p. 9.)

One may well ask where are the wonderplans of the 1980s and 1990s. Never fear - they'll be back! Baloney has the autogenerative power to grow new wings like a pig, and fly again...

So, is there any alternative?
("Stand by for another lovely, cool, refreshing wonderplan built at least 3000 miles from where the shoe pinches.") The recent US conference "Disability Studies: A Global Perspective" might well have been expected to generate further servings of cream-topped baloney about developing countries. Sharply to the contrary, however, was the response of conference discussion panelist Gene Rodgers to the question, "What is the most appropriate role for the US disability movement in the international arena?"

Rodgers believes the most appropriate role would be "that of observer and student". For an American describing himself as "a C-5 paraplegic, paralyzed from the shoulders down", this could be read as merely a pious wish; but Rodgers has taken some trouble to make himself an observer and student, getting porters to hump him around mountainous areas of Nepal in a wicker basket in order to see the living conditions of rural people. Unlike some development tourists, Rodgers' experience did not result in a conviction that he had any easy solutions for the problems facing disabled Nepalis. In fact, he thinks that the US could learn from the resourcefulness and creativity of people in economically weaker countries.

Has the era of instant, fact-free, western wonderplans and global disability policies peaked? In the health and education fields it is increasingly required that planning should have some realistic, culturally-appropriate, country-specific evidence base. Could the disability field be heading in this direction?

Twenty years ago, the myth was propagated that "services" in the Third World reached less than two per cent of disabled people, and that for 98 per cent "nothing was being done". This ignored the documented fact that considerable numbers of disabled children and adults have always made some use of the ordinary health, education and welfare services available in their locality; and the usually undocumented fact that the majority have also benefitted from the daily, unpaid care and service of millions of mothers, wives, grandmothers, daughters, aunts, and even some male relatives or neighbours. These unspectacular 'resources in the community', plus their own energy, determination and self-help, have been the major factors in the everyday lives of the great majority of disabled people -- yet they are usually absent from official baloney, which prefers to focus on poverty and deprivation, with occasional 'miracle stories' of super-crips who made good.

A recent ESCAP study, again on 'disability and poverty' (available at http://www.unescap.org/decade/hydpovdisrpt.htm) has some alternative perspectives. It was formulated by participants in rural development, a little nearer to Asian grassroots realities:
"The majority of persons with disabilities live in the rural areas. Most of them are poor. Yet in most countries of the ESCAP region, they are excluded from mainstream poverty alleviation programmes. Their exclusion is rooted in attitudinal and physical barriers. There is a critical need to question why, in practice, rural disabled persons merely have token access to mainstream poverty alleviation programmes. . . . There is an acute poverty of disability data." (p. 5)
Such questions open large cans of worms, and touch the complexities and diversities of the Asian nations in which the majority of the world's disabled people live. The positions and roles of disabled people in South and East Asia have been documented over some 3000 years, during which there has been a surprising diversity of positive participation and achievement by some, against a strong background of adverse attitudes and practices that have limited the lives of many.

It would be easy to summarise this vast cultural heritage in baloney terms. Indeed, the ESCAP report does include some patronising talk of awareness-raising among disabled people and their families, in terms of "liberating them from superstitions" (p. 8), the sort of programme that European colonial powers eventually gave up on after a century of crashing around in the jungle and trampling on little-understood beliefs. Nevertheless, the positive goal of the proposed awareness-raising is to build the confidence and self-esteem of groups of disabled people, in solidarity with other self-help groups among the rural poor.

Proposed by Indians, Chinese, Cambodians, Bangladeshis and others meeting in an Institute of Rural Development at Hyderabad, with commitments for their own follow-up action, it has a rather more authentic ring than the smooth baloney from air-con desks in London and New York.

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