Date Published: July 17, 2019
Publisher: Public Library of Science
Author(s): Mark T. Carew, Tim Colbourn, Ellie Cole, Richard Ngafuan, Nora Groce, Maria Kett, Stefano Federici.
Evidence suggests that people with disabilities are the most marginalised and vulnerable group within any population. However, little is known about the extent of inequality between people with and without disabilities in contexts where the majority of persons experience extreme poverty and hardship. This includes in Liberia, where very little is understood about the lives of disabled people in general. This study uses a multidimensional wellbeing framework to understand perceived relative inequality associated with disability by assessing several facets of wellbeing across and within households containing disabled members (N = 485) or households with no disabled members (N = 538) in Liberian communities (Total individuals surveyed, N = 2020). Statistical comparisons (adjusted for age, sex, education and wealth differences and clustered at the household, village and county level) reveal that disabled Liberians are managing similarly to non-disabled Liberians in terms of income and education, but experience many perceived relative inequalities including in life satisfaction, transport access, political participation and social inclusion. Our results further suggest that disability may lead to perceived relative inequality at the household level in terms of trust held in neighbours. However, they also show that being the head of a household may protect against perceived relative inequality in certain dimensions (e.g. healthcare and transport access, political participation) irrespective of disability status. Results are discussed in terms of practical implications for development efforts in Liberia and for disabled people in other low- and middle-income settings.
This paper sets out to explore the issue of perceived relative inequality in Liberia using a multidimensional well-being framework, with particular attention to how people with disabilities compare to their non-disabled peers. In recent years, evidence has accumulated to show that people with disabilities are the most marginalised and vulnerable group within any population [1, 2] and may be the world’s largest minority . It is perhaps small wonder then that international development efforts in low- and middle-income countries–where 80% of the global population of disabled people are estimated to reside - have begun to explicitly target, as well as grown steadily more inclusive of, people with disabilities. This work is underpinned by several international human rights conventions and declarations that both protect the rights of persons with disabilities ; as well as set global goals that constitute a call to action for international actors regarding what is needed so that all persons, including those with disabilities, can enjoy prosperity and wellbeing (e.g., the Sustainable Development Goals [SDGs]). Ultimately, these goals reflect that much still needs to be done in the least developed settings to ensure entire populations experience equitable life chances, while disability-specific declarations highlight the need for additional efforts so that the most marginalised and excluded in these societies are not left behind . However, where all members of a community face hardships, little is known the experiences of persons with disabilities vis a vis their non-disabled counterparts. Understanding these experiences will help better target interventions and reduce extant inequalities and exclusion.
The present research makes an important contribution by shedding light on the areas of perceived relative inequality which are associated with disability within a context where most individuals experience extreme hardship. Specifically, we compared the multi-dimensional wellbeing of people with and without disabilities across and within households in Liberian communities, using statistical models that adjusted for demographic characteristics (age, sex, education & wealth) and clustered by household, village and county. We consider our findings for each of our primary groups of interest in turn (i.e. disabled respondents and disabled household heads).
In sum, our study provides a differentiated understanding of perceived relative inequality between disabled and non-disabled people in a context of extreme hardship and in a country where comparatively little is known about the lives of people with disabilities. We find that while disabled Liberians are managing similarly to non-disabled individuals in key areas of wellbeing, like income and education, there are many aspects of perceived relative inequality that need to be redressed (e.g., life satisfaction, social exclusion). Moreover, disabled Liberians who are not household heads are more at risk of relative inequality in some areas, notably exclusion from accessing transport and political participation. As such, actors concerned with disability-inclusive development in Liberia and other similar settings should pay attention not only to broad development issues, but also to specific dimensions where interventions need to be targeted, acknowledging that these may be beyond material (objective) indicators and reach into more psychological (subjective) aspects of wellbeing. Put differently, given the systemic marginalisation and exclusion experienced by persons with disabilities in Liberia, merely making programmes technically inclusive will not address the broader issues of self-esteem, trust, confidence and wellbeing. This work is also timely, as there are a number of initiatives currently in progress building on advocacy work already underway by disabled people and their representative organisations. These include the development of a National Disability Action Plan , which aims to support the delivery of the commitments made by the Government of Liberia. We hope our findings are helpful in guiding these future efforts.