Mitra, Sophie (2017). 'Disability, Health and Human Development. Palgrave MacMillan: New York.' Paper presented at the annual conference of the HDCA, Cape Town 2017.


This book deals with disability, health and wellbeing in the poorest countries. To my knowledge, this is the first book framed within the capability approach that is centrally focused on disability. The book is scheduled for publication in August 2017.

Jean-François Trani (University of Washington, St Louis, USA) and Sridhar Venkatapuram (King’s College, London) have agreed to serve as discussants as part of this session.

This book first introduces the human development model of disability, health and wellbeing. It is a conceptual framework developed to describe and explain health deprivations, their causes and their consequences on wellbeing. The model is based on the capability approach of A.K. Sen and informed by the socioeconomic determinants of health. It defines disability as a deprivation in terms functionings or capabilities among persons with health deprivations (impairment and/or health condition). Impairments, health conditions and disability result from the interaction of individual characteristics (e.g. sex, age), structural factors (e.g. policies, social attitudes, physical environment) and resources (e.g. assets). It is universal in that any individual is vulnerable to impairment, health condition or disability.

The human development model is then applied using household survey data for Ethiopia, Malawi, Tanzania, and Uganda. Health deprivations are measured using the Washington Group on Disability Statistics short set of questions on functional difficulties (difficulty seeing, hearing, walking, concentrating, selfcare and communicating). It demonstrates that contrary to common perception, functional difficulties are not rare among adults in resource poor settings.  They are more common among women compared to men, among older individuals and the poor. A strong age and socioeconomic gradient in prevalence is found.

In all four countries, there is a consistent, significant and large correlation between functional difficulties and deprivations in employment, morbidity, assets/living conditions, multidimensional poverty and mortality within two years. Very few persons with functional difficulties use assistive devices or health care services. In Ethiopia and Uganda, increasing functional difficulty over time is correlated with a higher probability of leaving work, showing one channel whereby functional difficulties may lead to declining economic wellbeing. At the same time, not all persons with functional difficulties experience deprivations, even in very poor settings.

Overall, the human development model and its application to four countries in Africa suggest that in policy and research, disability needs to be considered through multi-sectoral approaches related to aging, health, gender and poverty. It also suggests that the current conventional wisdom that is largely focused on changing the environment and based on an oppressed minority group approach from the social model, is unlikely to be conducive to human development for all. This book concludes with a call for inclusion and prevention interventions as the sustainable solutions to the deprivations associated with impairments and health conditions.  

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