Introduction
There has been and continues to be a wide-ranging and fiercely contested debate about how disability should be understood. For those unfamiliar with this subject it might seem surprising that something apparently as obvious as the definition of disability should excite controversy. The objective of this briefing note is to outline why this has happened, why the apparently obvious is not so obvious, and why the arguments are of such importance for policies and practices concerned with disability and poverty in the developing world.
Understanding disability
Individual/medical model of disability
The traditional understanding of disability is that it is what ‘is wrong’ with disabled people – how their health is compromised. This view equates disability with impairment. So, ‘disabilities’ would include blindness, deafness, the various conditions that make it difficult or impossible to walk or to speak, mental illnesses and such conditions as Downs Syndrome and epilepsy. This is a medicals view of disability and is often called the medical model of disability.
In general, by conceptualizing disability as an individual health issue disabled people are socially imagined and may imagine themselves as, among other things, damaged, abnormal, as patients and/or as the dependent objects for a variety of medical or rehabilitative interventions. While those who view disability through a medical lens may concede that there are unfortunate social consequences that arise from having a disability, within this paradigm social exclusion is seen essentially as the result of limitations imposed by ‘disabilities’. As the problem is primarily a medical one the solution tends to be cure and/or rehabilitation, the latter, in some cases, requiring segregation into special institutions. This is carried out, usually by health service professionals of one sort or another, with the intention of caring for and protecting the disabled person, as in the case of institutionalization, or to restore ‘normal functioning’.
Social model of disability
“It is society that disables us, not our impairments.”
The critique of the traditional interpretation of disability, which eventually was transformed into the social model of disability, was developed from the 1970s within the disability movement in the
Unlike medical model assumptions of individual abnormality and the primacy of cure, the social model, while not rejecting medical intervention, implicitly acknowledges the normality of impairment. Furthermore, it is recognized that medical advances far from reducing the number of disabled people have led to an increase, as people not only live longer but are also better able to survive illness and injury. It might be said that the proportion of disabled people in a population is a good indicator of an economy’s prosperity.
Fierce academic and political debates continue both within the disability movement and from outside, about the nature of the social model, its relevance, as well as how and if it can be applied in any given situation. It is beyond the scope of this note even to outline these debates. Instead, after a brief account of some benefits of applying the social model in development, specific questions that have been raised about the social model in this context will be considered.
“In the broadest sense, the social model of disability is about nothing more complicated than a clear focus on the economic, environmental and cultural barriers encountered by people who are viewed by others as having some form of impairment – whether physical, sensory or intellectual.”
Nothing about us without us!
By seeing impairment as an ordinary part of life, and disability as the result of discrimination and exclusion, the social model has underpinned efforts to extract disability from the medicals, ‘special needs’ ghetto and push for the mainstreaming of disability concerns in all development policies and practices. Although this is yet to happen, there have been numerous positive statements of intent by both government and international agencies about the need to mainstream disability in development work.
The social model has also provided a powerful framework for bringing disabled people together in a common struggle for equality and rights. By doing this the social model has promoted the idea that disabled people should be actors in their own lives, rather than passive recipients of care. This equates almost exactly to current thinking on a rights-based approach to development, adopted by government development agencies throughout the world. For example, a key DFID paper about planning to meet the UN’s International Development Targets (latterly the Millennium Development Goals) states that: “The central message […] is that the International Development Targets can only be achieved with the engagement of poor people in the decisions and processes which affect their lives. Human rights are a central part of work to achieve the International Development Targets because they provide a means of empowering all people to make effective decisions about their own lives.”
By projecting disabled people into a leading role in defining and controlling their lives, the social model offers a powerful device for the liberation of those who remain the poorest of the poor in all countries, both developed and developing. The model is so powerful because it illuminates the fact that the roots of poverty and powerlessness do not to reside in biology but in society. The former is, for most disabled people, immutable; the latter, through purposeful collective action, can be transformed. A human rights approach offers both the platform for such societal transformation and a way for disabled people to transform their sense of who they are – from stigmatized objects of care to valued subjects of their own lives. For people who are Poor and oppressed this is a key starting point of any meaningful process of social and economic development.
“Disability is a human rights issue! I repeat: disability is a human rights issue. Those of us who happen to have a disability are fed up being treated by the society and our fellow citizens as if we did not exist or as if we were aliens from outer space. We are human beings with equal value, claiming equal rights…If asked, most people, including politicians and other decision makers, agree with us. The problem is that they do not realize the consequences of this principle and they are not ready to take action accordingly.”
Relevance of the social model in developing countries
Is the social model relevant for poor disabled people in developing countries? A number of questions have been raised about the efficacy of both the human rights approach to development and the use of the social model of disability in helping to frame that approach. Some of these questions, and comments on them, are briefly outlined below.
Ignoring impairment?
Perhaps the most common issue raised by critics of the social model is that it ignores the reality of what impairment means for disabled people. This, they say, is problematic in the North, but when applied to the South it is catastrophic. At one level this claim could be dismissed as it is most frequently made by non-disabled people, while the social model has been embraced by disabled people, in both the North and South, who clearly do know what impairment means on a daily basis.
Advocating the social model does not mean ignoring the causes of impairment or the health care needs of anyone, including disabled people. Proper health care is a basic human right and provision of clean water, disease prevention, ending conflicts, eradicating poverty, and getting rid of landmines, all of which would remove major causes of illness and injury, are important for all. Finally, it should be stressed that the social model critique of the medical model of disability is, at least in part, about rejecting the lexicalization of disabled people, not rejecting medical intervention.
Ignoring assistive technology?
An objection related to the above has been raised by David Werner, one of the founders of the Proximal Project in
The issue of disability rights, far from being a Northern project, has found some of its most vocal and innovative proponents in the South. Furthermore, as the practice at Proximal indicates, access to the proper technology, far from being antithetical to a rights-based approach to disability, can be immensely liberating if developed within a framework that prioritizes the real needs of disabled people as well as their genuine participation at all levels. In fact, access to a wheelchair or a hearing aid is a basic human right for someone who would otherwise be unable to take part in any social activity.
Ignoring cultural difference?
Another criticism is that the social model as been developed in the North where the cultural context, particularly the emphasis on individual rights, differs greatly from the more family-based and/or communal situation found in many developing countries. Similar culturally-relativist arguments have been made about the international human rights agenda in general. Such criticisms raise the question of whether any practice – slavery, female circumcision, infanticide and so on – can be defended on the grounds that it is part of local culture.
More significantly, by stressing the commonality of disability discrimination, the social model, rather then promoting an individualist agenda, has helped foster cross-impairment-based collective action on issues of concern to all disabled people, i.e. transport, access to education and employment. Finally, it is up to disabled people in the South, if they find the social model useful, to interpret it in ways appropriate to their own circumstances. Such cultural adaptation is precisely what has happened in many developing countries.
Ignoring difference?
It has been claimed that the social model of disability ignores the differences among disabled people with respect to their impairments, and that there is an impairment, class and gender hierarchy (wheelchair-using, middle-class men being dominant) within the disability movement.
Leaving aside the latter point, which is factually incorrect, the criticism about a lack of homogeneity is rather curious as no one has ever made such an argument or even implied that differences do not exist or are not significant. Individually, disabled people, even those with the same impairment, have a vast range of life experiences, as do any other oppressed group such as women or ethnic minorities. What brings them together in a movement is the shared experience of discrimination and exclusion. This is precisely the focus given by the social model and one reason that it has been so important for, and embraced so avidly by, disabled people.
Ignoring poverty?
Why, in conditions of extreme poverty in which most disabled people in the developing world live, should they care about the social model or a rights-based approach to disability? Surely ‘you cannot eat rights’. Just as surely, people without rights often can’t eat. As indicated above, this latter idea firmly underpins current thinking on the poverty reduction in the developing world, with its emphasis on a human rights approach. It must be stressed, however, that this approach can only yield results for disabled people if they are able to organize and lobby effectively as equal members of civil society. Otherwise the mantra of human rights will remain little more than a public relations exercise to cover the failure of globalization to meet the needs of the worlds’ poor.
“A rights perspective means incorporating the empowerment of poor people into our approach to tackling poverty. It means ensuring that poor people’s voices are heard when decisions which affect their lives are made. It means recognizing that equality matters. Addressing discrimination in legislation, policies and society contributes to an environment in which excluded people have more control over their lives. A rights approach also means making sure those citizens can hold governments to account for their human rights obligations.”
Conclusion
The social model of disability represents a protean challenge to traditional thinking about disability. If applied in the development context it has the potential to transform policies and practice as well as the lives of disabled people. However, neither it nor a human rights approach is magic wands. While many people may find the social model a helpful way to conceptualize disability and have even begun using disability rights language in reports and policy documents, this is not enough to make a real difference. A too-easy acceptance of the new disability paradigm may even be counterproductive: by being so easy it runs the risk of ignoring how negative assumptions and attitudes about disability (held by both disabled and non-disabled people) are so deeply ingrained and continually reinforced.
Furthermore, understanding the strength and social authority of these attitudes demands a genuine awareness of the unequal power relationships that define the reality of disability. This applies equally to gender and ethnicity. For example, you cannot challenge sexism and racism in a ‘white man’s world’ by using non-sexist, non-racist language while accepting the power relationships in that world. Until this problem is addressed and the insidious layers of institutionalized disables are exposed and stripped away it will be impossible to develop and implement effective policies to address the poverty and disadvantage so endemic among the hundreds of millions of disabled people in the developing world.
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