Disability

Who counts?

Defining disability is tricky—and measuring it is even harder

The Economist | Dec 14th 2013 | From the print edition

LORETTA CLAIBORNE was born partially blind and could not walk or talk until she was four. Officials recommended that she be put into an institution—a common treatment for America’s “defectives” in the 1950s. Her mother refused. Today Ms Claiborne has 26 marathons and a black belt in karate to her name. She travels the world to speak for people like herself.

Disability—marked by an international day of action on December 3rd—can mean being blind, deaf or wheelchair-bound. But far more disabled people have such common chronic conditions as pain in the lower back (the greatest global cause of years lived with a disability). American labour law also counts high blood pressure and asthma as disabilities.

Measuring pain and misery is hard. Over 1 billion people—one in seven—have some kind of disability, according to the World Health Organisation. But that may be on the high side. America’s Census Bureau, which has been counting the disabled since 1830, found 57m in a survey of economic status in 2012. That was nearly one in five, of whom half said their disability was severe. A national housing survey counted a mere 22m, whereas a health survey tallied 62m. Ireland’s 2006 census found a disability rate of 9.3%. The 2011 round also asked about pain and breathing troubles; it reported a rate 40% higher.

Definitions change over time: the UN Convention on the Rights of Persons with Disabilities calls disability an “evolving concept”. In America “imbeciles” and “defectives” were segregated and sterilised until the 1960s. Some count dyslexia and autism as a disability. Others, including many with these conditions, fiercely contest what they see as a negative label.

The effect of a disability also depends on what means are available to cope with it. A survey in Zambia found that more than four out of five disabled people lacked the devices and aids they needed. What may be a nuisance in a rich country can be truly crippling in a poor one.

This makes it hard to decide the threshold at which disadvantage or woe merits recognition or special treatment. Sports administrators wrestle with this. Somebody who is legally blind in his home country, for instance, may not be sufficiently visually impaired to compete in the Paralympic game of goalball—which involves rolling a ball with a bell inside into the opposing team’s goal. Paralympic players wear eye masks, though that might cause some to ask why sighted people may not play too.

Technology has created a host of new solutions—and problems. Visitors to the Smithsonian National Air and Space Museum in Washington, DC, have been flocking to see the Bionic Man, a figure built from the most advanced artificial body parts. These replicate more than 50% of the human body. His arms and legs have the range of movement of real limbs. Hooked to a living body’s nerves, they can be controlled by the brain, just like healthy limbs. Such fixes are pricey. Bionic eyesight costs over $150,000. Robotic arms are $20,000-120,000 apiece. Yet if you think that is costly, imagine the forthcoming legal wrangles about whether such pieces of equipment negate disability, or even give unfair advantages to people who use them.