Disability as a Consequence of Poverty
Although a moderate amount of research exists on the role disability plays in causing or exacerbating poverty (still not nearly enough – the intersection of disability and poverty is rarely discussed in either field of research), little to no research has been carried out on how poverty can cause disability. This became apparent to me as I came to know a young girl named Neat.
At 3 years old, Neat has General Developmental Delay, which causes her to experience seizures and delayed mental and physical growth. She isn’t very responsive to external stimuli, is unable to communicate verbally, and struggles with crawling. General Developmental Delay, or GDD, is a common diagnosis in Cambodia, and can cover a wide range or combination of disabilities that the doctor may be unable to diagnose. After coming down with an illness, Neat was brought to the hospital, where they discovered that she had meningitis. Her blood tests were even more revealing. A lack of glucose was found in her blood, which had resulted in a significant loss of her sight and hearing. Her family finally understood why she wasn’t reacting to stimuli, reaching for toys, or turning her head at the sound of a voice.
If Neat had not been taken to the hospital for her illness, it would have likely taken a lot longer for symptoms of sight and hearing loss to be noticed by her family, at which point such symptoms could become permanent. Luckily, with a change in Neat’s diet and with supplementation, her condition has improved immensely, as she can now see and hear almost perfectly.
Finding substantial research on the prevalence of disability due to conditions of poverty is incredibly difficult. Even the leading experts in income-poverty research only rarely consider disability as a consequence of poverty. The Centre for Economic and Policy Research cites a set of nine papers by leading income-poverty researchers on “high-priority poverty-stricken strategies”, which does not include a single paper on the link between disability and poverty.[1] Yet, the “income-poverty rate for a person with disabilities is between two and three times the rate for persons without disabilities.”[2] Despite a clear link, this seems to be a forgotten connection in poverty research.
Living in poverty means a lack of access to healthcare, a lower standard of health and nutrition, exposure to unsafe working environments, limited access to employment and education opportunities, and as a result a lack of knowledge about disabilities. People living in poverty face a unique set of challenges whereby they experience a higher likelihood of illness or injury, and financial and social exclusion limits access to proper healthcare or treatment. As a result, the risk of disability is higher.
Children are often the most vulnerable to this cycle, as a lower standard of health and nutrition can have huge implications in terms of a child’s proper growth and development. Developmental disabilities such as cerebral palsy are often caused by toxins, stress, sickness, or malnutrition of the mother during pregnancy, factors which are often caused by poverty. Women living in poverty in rural areas of Cambodia are often too far away or don't have access to a hospital or clinic during pregnancy and birth. Their children may be birthed by midwives who are untrained, or in unsanitary spaces, which can lead to disability at the point of birth. In Cambodia, birthing complications causing brain damage are a large contributor to prevalence of mental and physical disabilities in children. Furthermore, with only one third of Cambodia’s countryside having access to clean water, children are at risk of stunted growth and impaired brain development due to illnesses from sanitation and water-related causes.[3] A limited understanding of proper sanitation and hygiene results in preventable diseases being spread in drinking water.
A lack of access to healthcare means that simple infections, illness, and injury can go untreated or are mistreated, sometimes resulting in permanent disability. Malnourishment due to poverty can not only affect the mothers during pregnancy, leading to disability in their child at birth, but as in the case of Neat, can also cause developmental delay and long-term intellectual disability during childhood. A lack of vitamin A in a child’s diet is the leading cause of childhood blindness, and iron and iodine deficiency can stunt a child’s intellectual development. Poor nutrition may also increase the chance of acquiring illnesses such as meningitis and rickets, which often lead to disability if left untreated. In fact, it is reported that by the age of two, half of all Cambodian children are stunted due to malnourishment. Thus, poverty can increase the risk that illness becomes permanent disability.
Education about disability care in poverty-stricken areas is limited, and thus families often practice behaviors that can further stunt or worsen the condition of their child with disability. Neat, who lives with and is cared for by her grandmother, has a particularly difficult case, as her inability to crawl or walk makes it hard for any time to be spent away from her. Her grandmother, trying to help Neat learn to walk, will stand her up on her legs, which tend to bend back in an unnatural way. Because Neat is not yet at the point where she can stand naturally, forcing her into this position can be damaging to her development and can teach her the wrong habits. Even with the best of intentions, a lack of knowledge about disability care can be dangerous on a child and can lead to injury or the worsening of their disability.
The correlation between poverty and unsafe or strenuous working conditions also leaves workers at risk of injury. In Cambodia, where much of the countryside is still contaminated with the remnants of explosives and landmines from the aftermath of war, poor subsistence farmers are the most vulnerable to accidents. Despite an awareness of the danger of minefields, farmers depend on this land for their very survival, and thus have no choice but to face the threat every day. In the year 2020, there were 17 deaths, 36 injuries, and 12 limb amputations due to landmines in the country, a disproportionate number of victims being farmers and the rural poor.[4] Unfortunately, access to proper medical treatment and rehabilitation is also restricted for those living in the countryside, resulting in an increase in the likelihood that injury becomes permanent disability.
Researchers have only scratched the surface in exploring the link between poverty and disability. Poverty reduction policies remain negligent in considering the manifestation of disability as an outcome of poverty, an outcome that in turn leads to a deeper entrenchment in poverty. This vicious cycle needs to be addressed in order for those living in poverty to be safeguarded from its most severe consequences. Developing policies that target disability prevention will require extensive research into the role poverty plays in producing disability. Poverty researchers should feel the urgency of this task, as the link between poverty and disability merits a much closer look.
Informed consent was given for sharing the names and stories documented in this article.
[1] https://www.cepr.net/documents/publications/poverty-disability-2009-09.pdf
[2] Ibid.
[3] https://www.unicef.org/cambodia/water-sanitation-and-hygiene#:~:text=Diarrhoea%2C%20which%20often%20results%20from,and%20hygiene%20(WASH)%20targets.
[4] https://www.khmertimeskh.com/50800915/landmine-uxo-casualties-in-cambodia-down-16-percent-last-year/