Disability and Poverty in Developing Countries

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DISABILITY AND POVERTY IN DEVELOPING COUNTRIES:

A SNAPSHOT FROM THE WORLD HEALTH SURVEY

SOPHIE MITRA, ALEKSANDRA POSARAC, AND BRANDON VICK

APRIL 2011

Key w!"#: Disability, Poverty, World Health Survey, Economic Outcomes, Multidimensional

Poverty Measure, Burkina Faso, hana, !enya, Mala"i, Mauritius, #ambia, #imbab"e,

Ban$ladesh, %ao Peo&le's Democratic (e&ublic, Pakistan, the Phili&&ines, Bra)il, Dominican

(e&ublic, Me*ico, Para$uay

$EL %&'##()(%'*(+#: +-, (-.

/his study is &art o0 the e00ort o0 the World Bank Social Protection and %abor 1nit, Human

Develo&ment 2et"ork 3HD2SP4 to investi$ate socio5economic conditions and &overty amon$

&ersons "ith disabilities in develo&in$ countries6 /he &re&aration o0 the study "as su&&orted

by Finland and 2or"ay throu$h the World Bank /rust Fund 0or Socially and Environmentally

Sustainable Develo&ment 3/FESSD46 /he 0indin$s, inter&retations and conclusions e*&ressed

in this &a&er are that o0 the authors and do not necessarily re0lect the vie"s o0 the E*ecutive

Directors o0 the World Bank or the $overnments they re&resent6 /he World Bank does not

$uarantee the accuracy o0 data included in this "ork6

ACKNOWLEDGEMENTS

/he authors are &articularly thank0ul 0or comments and advice received 0rom the WorldBank sta00 Michael %okshin, 7em Mete, (asmus Heltber$, !innon Scott, and DanielMont6 !aren Pe00ley 0rom the World Bank Disability 8 Develo&ment /eam has &re&aredthe E*ecutive Summary, edited the te*t and checked re0erences6 Dun$ /hi 2$oc /ran hasmeticulously &roo0read and 0ormatted the study6 So&hie Mitra thanks /yler Boston 0or e*cellent research assistance on literature revie"s related to this &a&er6

ABBREVIATIONS AND ACRONYMS

7DF 5 7umulative Distribution Function

DS 5 Descri&tive Statistics

+7F 5 +nternational 7lassi0ication o0 Functionin$, Disability and Health

DP 5 ross Domestic Product

%ao PD( 5 %ao Peo&le's Democratic (e&ublic

%SMS 5 %ivin$ Standard Measurement Survey

MD 5 Millennium Develo&ment oal

29 5 2ot 9vailable

OE7D 5 Or$anisation 0or Economic 7o5o&eration and Develo&ment

P7E 5 Per 7a&ita 7onsum&tion E*&enditure

PPP 5 Purchasin$ Po"er Parity

(9 5 (e$ression 9nalysis

12+7EF 5 1nited 2ations 7hildren's Fund

1S 5 1nited States

WHO 5 World Health Or$ani)ation

WHS 5 World Health Survey

TABLE OF CONTENTS

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1 I+*!"-%*(+1

2 De)(+(*(+# '+" B'%!-+"3

-66 De0initions6666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666-6-6 Health 7onditions and Poverty666666666666666666666666666666666666666666666666666666666666666666666666666;-66 %ikely Path"ays bet"een Disability and Poverty6666666666666666666666666666666666666666666666<-6=6 Disability and Poverty: 9 (evie" o0 (ecent Em&irical Evidence66666666666666666666-

3 D'*' '+" Me'#-!e#14

66 /he World Health Survey6666666666666666666666666666666666666666666666666666666666666666666666666666666666>6-6 7ountries in the Survey6666666666666666666666666666666666666666666666666666666666666666666666666666666666666?66 Disability Measures 1sin$ the World Health Survey Data6666666666666666666666666666666@

6=6 9dvanta$es and 7aveats o0 1sin$ the WHS Data to Measure Disability666666666-6;6 Economic Dimensions o0 Well5bein$ at the +ndividual %evel6666666666666666666666666-;6<6 Economic Dimensions o0 Well5bein$ at the Household %evel6666666666666666666666666-<6>6 Multidimensional Poverty Measures66666666666666666666666666666666666666666666666666666666666666666-?6?6 Data 9nalysis66666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666-

5 Re#-&*#33

=66 Disability Prevalence66666666666666666666666666666666666666666666666666666666666666666666666666666666666666666=6-6 +ndividual5%evel Economic Well5bein$666666666666666666666666666666666666666666666666666666666666=-=66 Household5%evel Economic Well5bein$66666666666666666666666666666666666666666666666666666666666===6=6 Multidimensional Poverty Measure666666666666666666666666666666666666666666666666666666666666666666;

6 C+%&-#(+#71

Re)e!e+%e#76

A88e+"( A: D(#'9(&(*y Le(#&'*(.e '+" P&(%y B'%!-+" (+ *e C-+*!(e#

-+"e! S*-"y42

A88e+"( B: D'*' A+'&y#(# Re#-&*#45

9&&endi* B: Disability Prevalence 3E*&anded Measure4 amon$ Workin$59$e+ndividuals in Develo&in$ 7ountries666666666666666666666666666666666666666666666666666666>;

9&&endi* B-a: Disability Prevalence 3Base Measure4 amon$ Workin$59$e +ndividuals,

by 9sset +nde* Auintile66666666666666666666666666666666666666666666666666666666666666666666666666><9&&endi* B-b: Disability Prevalence 3Base Measure4 amon$ Workin$59$e +ndividuals,

by 2on5medical P7E Auintile6666666666666666666666666666666666666666666666666666666666666666>>

9&&endi* B-c: Disability 3E*&anded Measure4 Prevalence amon$ Workin$59$e+ndividuals, by Auintile66666666666666666666666666666666666666666666666666666666666666666666666666>?

9&&endi* B: Disability 3E*&anded Measure4 Prevalence, by Poverty Status6666666666666>@

9&&endi* B=: +ndividual5%evel Economic Well5bein$ across Disability Status3E*&anded Measure4 amon$ Workin$59$e +ndividuals6666666666666666666666666?.

9&&endi* B;: Household5%evel Economic Well5bein$ Measures amon$ Households"ith"ithout a Workin$59$e Person "ith Disability 3E*&andedMeasure46666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666?

9&&endi* B<: Poverty Headcount, a&, and a&5SCuared amon$ Households"ith"ithout a Workin$59$e Person "ith Disability 3E*&andedMeasure4 Based on 2on5medical P7E666666666666666666666666666666666666666666666666666?

9&&endi* B>: Multidimensional Poverty 9nalysis "ith kd.6666666666666666666666666666666?;

9&&endi* B?: Multidimensional Poverty 9nalysis, "ith More (estrictive "ithinDimension 7uto00s666666666666666666666666666666666666666666666666666666666666666666666666666666666?<

9&&endi* B@: Multidimensional Poverty 9nalysis 3Bour$ui$non and 7hakravartyMethod kd-;46666666666666666666666666666666666666666666666666666666666666666666666666666666666?>

A88e+"( C: C-+*!y P!)(&e#;;

9&&endi* 76: Pro0iles 0or 7ountries in 90rica6666666666666666666666666666666666666666666666666666666666666@.

9&&endi* 766 Disability Pro0ile: Burkina Faso666666666666666666666666666666666666666666666666666666666666@.9&&endi* 766- Disability Pro0ile: hana666666666666666666666666666666666666666666666666666666666666666666666..9&&endi* 766 Disability Pro0ile: !enya666666666666666666666666666666666666666666666666666666666666666666666.9&&endi* 766= Disability Pro0ile: Mala"i6666666666666666666666666666666666666666666666666666666666666666666-.9&&endi* 766; Disability Pro0ile: Mauritius6666666666666666666666666666666666666666666666666666666666666666.9&&endi* 766< Disability Pro0ile: #ambia6666666666666666666666666666666666666666666666666666666666666666666=.9&&endi* 766> Disability Pro0ile: #imbab"e66666666666666666666666666666666666666666666666666666666666666;.

9&&endi* 76-: Pro0iles 0or 7ountries in 9sia66666666666666666666666666666666666666666666666666666666666666;?

9&&endi* 76-6 Disability Pro0ile: Ban$ladesh666666666666666666666666666666666666666666666666666666666666;?9&&endi* 76-6- Disability Pro0ile: %ao PD(6666666666666666666666666666666666666666666666666666666666666666<?9&&endi* 76-6 Disability Pro0ile: Pakistan666666666666666666666666666666666666666666666666666666666666666666>?9&&endi* 76-6= Disability Pro0ile: Phili&&ines6666666666666666666666666666666666666666666666666666666666666??

9&&endi* 76: Pro0iles 0or 7ountries in %atin 9merica and the 7aribbean6666666666666666@?

9&&endi* 766 Disability Pro0ile: Bra)il666666666666666666666666666666666666666666666666666666666666666666666@?9&&endi* 766- Disability Pro0ile: Dominican (e&ublic6666666666666666666666666666666666666666666666-.?9&&endi* 766 Disability Pro0ile: Me*ico6666666666666666666666666666666666666666666666666666666666666666666-?9&&endi* 766= Disability Pro0ile: Para$uay6666666666666666666666666666666666666666666666666666666666666666--?

A88e+"( D: S-//'!y C/8'!(#+ ) E%+/(% O-*%/e# '%!## D(#'9(&(*yS*'*-#23;

7hart %ikely Path"ays 0rom Disability to Poverty66666666666666666666666666666666666666666666@

7hart - %ikely Path"ays 0rom Poverty to Disability666666666666666666666666666666666666666666

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Fi$ure =6 Disability Prevalence 3Base Measure4 amon$ Workin$59$e+ndividuals, by 9sset +nde* Auintiles666666666666666666666666666666666666666666666666666<

Fi$ure =6- Disability Prevalence 3Base Measure4 amon$ Workin$59$e +ndividuals,

by 2on5health P7E Auintiles666666666666666666666666666666666666666666666666666666666666666>Fi$ure =6 Primary School 7om&letion (ates, by Disability Status6666666666666666666666=-

Fi$ure =6= (elative Em&loyment (ates o0 Persons "ith Disabilities66666666666666666666=

Fi$ure =6; (atios o0 Mean 9sset +nde* Score: Households "ith Disabilities toOther Households666666666666666666666666666666666666666666666666666666666666666666666666666666666=;

Fi$ure =6< Percenta$e o0 Households in the Bottom 9sset +nde* Auintile, byDisability Status666666666666666666666666666666666666666666666666666666666666666666666666666666666666=;

Fi$ure =6> (atios o0 Mean 2on5health P7E: Households "ith Disabilities toHouseholds "ithout Disabilities66666666666666666666666666666666666666666666666666666666666=<

Fi$ure =6? Percenta$e o0 Households in the Bottom P7E Auintile, by DisabilityStatus66666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666=>

Fi$ure =6@ (atio o0 Health to /otal E*&enditures, by Household Disability Status3Base Measure46666666666666666666666666666666666666666666666666666666666666666666666666666666666666;-

Fi$ure =6. Multidimensional Poverty Headcount (atio across Disability Status3Base Measure46666666666666666666666666666666666666666666666666666666666666666666666666666666666666;

Fi$ure =6 Multidimensional Poverty 9dusted Headcount (atio across DisabilityStatus 3Base Measure466666666666666666666666666666666666666666666666666666666666666666666666666;;

T'9&e#

/able 6 7ountries under Study: !ey Socioeconomic +ndicators66666666666666666666666@

/able 6- Washin$ton rou&'s (ecommended Short %ist o0 Disability Auestionsand Matchin$ WHS Auestions6666666666666666666666666666666666666666666666666666666666666-

/able 6 Washin$ton rou&'s (ecommended %on$ %ist o0 Disability Auestionsand Matchin$ WHS Auestions6666666666666666666666666666666666666666666666666666666666666--

/able 6= Dimensions o0 Economic Well5bein$ and (elated +ndicators66666666666666-;

/able 6; Dimensions and Wei$hts in the Multidimensional Poverty Measure666./able =6 Disability Prevalence 3Base Measure4 amon$ Workin$59$e +ndividuals

in ; Develo&in$ 7ountries666666666666666666666666666666666666666666666666666666666666666666=666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666

/able =6- Disability Prevalence 3Base Measure4 amon$ Workin$59$e +ndividuals, by 9sset +nde* and 2on5health P7E Auintiles6666666666666666666666666666666666666?

/able =6 Disability Prevalence 3Base Measure4 amon$ Workin$59$e +ndividuals, by Poverty Status6666666666666666666666666666666666666666666666666666666666666666666666666666666666=.

/able =6= +ndividual5%evel Economic Well5bein$ across Disability Status 3BaseMeasure4 amon$ Workin$59$e +ndividuals666666666666666666666666666666666666666666=

/able =6; Household5%evel Economic Well5bein$ Measures amon$ Households"ith"ithout a Workin$59$e Person "ith Disability 3Base Measure46 =?

/able =6< Household5%evel Economic Well5bein$ Measures amon$ Households"ith"ithout a Workin$59$e Person "ith Disability 3Base Measure46 =@

/able =6> Poverty Headcount, a&, and Poverty Severity amon$ Households"ith"ithout a Workin$59$e Person "ith Disability, Based on 2on5health P7E 3Base Measure4666666666666666666666666666666666666666666666666666666666666666666;.

/able =6? Multidimensional Poverty 9nalysis 0or Persons "ith and "ithoutDisabilities66666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666;

/able =6@ De&rivation 7ounts across Disability Status 3Base Measure466666666666666;=

/able =6.a 9dusted Headcount and 7ontribution o0 Each Dimension to Poverty:Breakdo"n by Dimension 0or Persons "ith Disabilities 3BaseMeasure466666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666;<

/able =6.b 9dusted Headcount and 7ontribution o0 Each Dimension to Poverty:Breakdo"n by Dimension 0or Persons "ithout Disabilities 3BaseMeasure466666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666;>666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666

/able =6 Multidimensional Poverty 9nalysis 0or Persons "ith and "ithoutDisabilities 3E*&anded Measure46666666666666666666666666666666666666666666666666666666666

/able =6- Multidimensional Poverty 9nalysis 3Bour$ui$non and 7hakravartyMethod k;.4666666666666666666666666666666666666666666666666666666666666666666666666666666666666;@

/able ;6 Summary o0 Economic +ndicator 7om&arisons across DisabilityStatus66666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666<-

EXECUTIVE SUMMARY

Disability and &overty are dynamic and intricately linked &henomena6 +n develo&edcountries, a lar$e body o0 em&irical research sho"s that &ersons "ith disabilitiese*&erience inter alia com&aratively lo"er educational attainment, lo"er em&loyment andhi$her unem&loyment rates, "orse livin$ conditions, and hi$her &overty rates6 +ndevelo&in$ countries, the still limited body o0 em&irical research &oints to"ardindividuals "ith disability bein$ o0ten economically "orse o00 in terms o0 em&loymentand educational attainment, "hile at the household level, the evidence is mi*ed6 Derivin$any conclusions on the association bet"een disability and &overty in develo&in$countries 0rom this literature is &roblematic, $iven the lack o0 com&arability o0 thedisability measures, economic indicators, and methods in these studies6

/his study aims to contribute to the em&irical research on social and economic conditions

o0 &eo&le "ith disabilities in develo&in$ countries6 1sin$ com&arable data and methodsacross countries, this study &resents a sna&shot o0 economic and &overty situation o0 "orkin$5a$e &ersons "ith disabilities and their households in ; develo&in$ countries6/he study uses data 0rom the World Health Survey 3WHS4 conducted by the WorldHealth Or$ani)ation 3WHO4 in -..-5-..= in . develo&ed and =. develo&in$ countriesacross the "orld6 /he countries 0or this study are: Burkina Faso, hana, !enya, Mala"i,Mauritius, #ambia, and #imbab"e in 90ricaG Ban$ladesh, %ao Peo&le's Democratic(e&ublic 3%ao PD(4, Pakistan, and the Phili&&ines in 9siaG and Bra)il, Dominican(e&ublic, Me*ico, and Para$uay in %atin 9merica and the 7aribbean6 /he selection o0 the countries "as driven by the data Cuality6

+t is essential to note that the WHS is a cross5sectional survey and that hence this studycan only describe the economic "ell5bein$ o0 &ersons "ith disabilities6 2o conclusionsabout the causality bet"een disability and &overty should be dra"n based on thedescri&tive statistics this study &resents6 Furthermore, the results o0 the study cannot be$enerali)ed 0or develo&in$ countries as a "hole, $iven that the ; countries included inthe study may not be re&resentative o0 all develo&in$ countries6

/his research is relevant 0or several reasons6 First, it contributes to a currently small body o0 em&irical evidence on the economic status o0 &ersons "ith disabilities indevelo&in$ countries6 Second, by &rovidin$ a baseline data on the economic "ell5bein$and the &overty status o0 "orkin$5a$e &ersons "ith disabilities and their households in-.. in the countries under study, it can in0orm national disability &olicies6 Finally, this

study can also in0orm 0uture data and research e00orts on disability in develo&in$countries6

Definitions, data, and measures of well-being

Disability: Di00erent models have been develo&ed to de0ine disability6 +n this study,disability is understood 0ollo"in$ the +nternational 7lassi0ication o0 Functionin$,Disability and Health 3+7F4 develo&ed by the WHO in -..6 /he +7F model inte$ratesthe medical model 3disability as a medical issue4 and social model 3disability as a social

construct4 o0 disability into a bio5&sychosocial model o0 disability by reco$ni)in$ that &eo&le are disabled both by the interaction bet"een their health condition and theenvironment6 Disability is an umbrella term 0or im&airments, activity limitations, and &artici&ation restrictions6 +t denotes the ne$ative as&ects o0 the interaction bet"een anindividual 3"ith a health condition4 and that individual's conte*tual 0actors

3environmental and &ersonal 0actors4I 3WHO -.., &6 -46 Environmental and &ersonal0actors may &resent barriers 0or &ersons "ith health conditions to 0unction and &artici&atein economic and social li0e6 9n im&lication o0 the +7F model o0 disability is that byremovin$ barriers, &ersons "ith health conditions can be enabled to 0unction and &artici&ate6

Poverty: %ike disability, &overty is a com&le* &henomenon6 /his study 0ollo"s acommon a&&roach and looks at both monetary 3incomeconsum&tion e*&enditure4 andnon5monetary as&ects o0 livin$ standard and &overty 30or e*am&le, education, health,livin$ conditions4, at the individual level 30or e*am&le, educational attainment,em&loyment4, and at the household level 30or e*am&le, e*&enditures, assets46

Pathways between disability and poverty: /he onset o0 disability may lead to lo"er livin$standard and &overty throu$h adverse im&act on education, em&loyment, earnin$s, andincreased e*&enditures related to disability6 7onversely, &overty may increase the risk o0 disability throu$h several &ath"ays, many o0 "hich are related to &oor health and itsdeterminants6 Poverty, as a conte*tual 0actor, may also increase the likelihood that ahealth condition may result in disability6 +n addition, sti$ma associated "ith a healthcondition may lead to activity limitations and &artici&ation restrictions $iven a &articular social and cultural conte*t and it mi$ht be "orsened by the sti$ma associated "ith &overty6 Finally, environmental 0actors due to limited resources in the community,leadin$ 0or instance to an inaccessible &hysical environment, make it di00icult 0or anindividual "ith a disability to have activities and &artici&ate in the community6

Disability measures using the WHS data: /here is no a$reed international standard tomeasure disability6 Disability measures may vary de&endin$ on the de0inition o0 disability, in0ormation collected by a &articular survey instrument, as "ell as researchobectives6 /his study ado&ts the +7F de0inition o0 disability 0ocusin$ on 0unctionin$ and &artici&ation and uses sel05re&orted data 0rom the WHS on di00iculties in 0unctionin$ ineveryday li0e to construct disability measures6 For the &ur&ose o0 this study, t"omeasures o0 disability are used6 /he base measure o0 disability is de0ined ase*&eriencin$ severe or e*treme di00iculty in at least one o0 the 0ollo"in$:seein$reco$ni)in$ &eo&le across the road 3"hile "earin$ $lasseslenses4G movin$aroundG concentratin$ or rememberin$ thin$sG and sel0 care6 /he expanded measureincludes the above 0our Cuestions o0 the base measure and 0our additional ones as0ollo"s: di00iculty in seein$reco$ni)in$ obect at armJs len$th 3"hile "earin$$lasseslenses4G di00iculty "ith &ersonal relationshi&s&artici&ation in the communityGdi00iculty in learnin$ a ne" taskG and di00iculty in dealin$ "ith con0lictstension "ithothers6

Economic dimensions of well-being : Several dimensions o0 "ell5bein$ at both individualand household levels are analy)ed to dra" country level &ro0iles o0 economic "ell5bein$and &overty across disability status6 9t the individual level, t"o dimensions are included:

education and em&loyment6 /he education dimension is measured by the years o0 com&leted schoolin$ and "hether a &erson has com&leted &rimary school6 /heem&loyment dimension is measured throu$h the em&loyment status6 9t the householdlevel, t"o "el0are a$$re$ates are analy)ed: 4 asset o"nershi& and livin$ conditionsG and-4 non5health &er ca&ita consum&tion e*&enditures 3P7E46 +n addition to the individual5

and household5level measures o0 economic status and &overty described above, severalmultidimensional &overty measures com&lement the use o0 the non5health P7E as"el0are a$$re$ate 0or &overty estimates6

Results

/he main te*t &resents the analysis usin$ the base measure o0 disability and overallresults6 +n0ormation usin$ the e*&anded measure o0 disability and individual country &ro0iles is &resented in the a&&endices6

verall disability prevalence: 7ountry s&eci0ic estimates o0 disability &revalence varytremendously: 0rom a lo" o0 &ercent in %ao PD( to a hi$h o0 < &ercent in Ban$ladesh

0or the base disability measure6 Disability &revalence is 0ound to be hi$her amon$"omen than men in every country6 /he lar$est di00erence in disability &revalence isobserved in Ban$ladesh, "here the &revalence stands at - &ercent amon$ "omen,com&ared to . &ercent amon$ men6 +n out o0 the ; countries under study, disability &revalence is hi$her in rural than in urban areas usin$ the base measure6 Similar results"ere 0ound "hen usin$ the e*&anded disability measure 0or each o0 these &revalence0i$ures6

Disability prevalence by economic status: Disability &revalence estimates by economicstatus vary by the measure used6 For the asset inde*, &revalence in the bottom Cuintileran$es 0rom a lo" o0 ; &ercent in Me*ico to a hi$h o0 - &ercent in Ban$ladesh and ishi$her in the bottom Cuintile in countries, but the di00erence is statistically si$ni0icant

in 0ive countries6 (esults are overall similar "hen the e*&anded disability measure isused6 When &overty status is measured usin$ non5health P7E as "el0are a$$re$ate andthe PPP 1SK6-; a day international &overty line, disability &revalence is si$ni0icantlyhi$her amon$ the &oor than the non5&oor in 0our countries6 When &overty is measuredthrou$h a multidimensional measure, disability &revalence amon$ &ersons "hoe*&erience multi&le de&rivations is si$ni0icantly hi$her in out o0 the = countriesincluded in this analysis6

!ndividual-level economic well-being : +n a maority o0 the countries under study, &ersons"ith disabilities, on avera$e, as a $rou& are 0ound to have statistically si$ni0icantly lo"er educational attainment and lo"er em&loyment rates than &ersons "ithout disabilities6

Education: 1sin$ a base disability measure, &ersons "ith disabilities are 0ound to have amean number o0 years o0 education that is statistically si$ni0icantly 0e"er com&ared to &ersons "ithout disabilities in - countries6 %ike"ise, the &ercenta$e o0 individuals "hohave com&leted &rimary education is si$ni0icantly lo"er amon$ &ersons "ith disabilitiesin all but one country6 Lery similar results are 0ound usin$ the e*&anded disabilitymeasure6

Em&loyment: +n a maority o0 the countries, the di00erence in em&loyment rates is to thedetriment o0 disabled &eo&le6 Persons "ith disabilities have lo"er em&loyment rates in- countries and this di00erence is statistically si$ni0icant in nine countries6 Lery similar results are 0ound usin$ the e*&anded disability measure6

Household-level economic well-being : 9t the household level, the economic situation o0 households "ith disabilities varies by dimension6 +n a maority o0 countries 3. out o0 ;4, households "ith disabilities have a si$ni0icantly lo"er mean asset inde*6 9lso, ahi$her &ercenta$e o0 households "ith disabilities belon$ to the bottom asset Cuintile andthis di00erence is statistically si$ni0icant in si* out o0 ; countries6 Households "ithdisabilities, on avera$e, also re&ort s&endin$ a hi$her &ro&ortion o0 their e*&enditure onhealth care: the mean ratio o0 health to total household e*&enditures is si$ni0icantlyhi$her 0or households "ith disabilities in . out o0 = countries irres&ective o0 "hether the base or the e*&anded disability measure is used6

Disability is si$ni0icantly associated "ith multidimensional &overty in to = o0 the =develo&in$ countries under study6 +n other "ords, &ersons "ith disabilities are more

likely to e*&erience multi&le de&rivations than &ersons "ithout disabilities in mostcountries6 /his result holds "hen di00erent multidimensional &overty measures and &overty thresholds 3"ithin and across dimensions4 are used6

Descri&tive statistics do not su$$est that households "ith disabilities are "orse o00 as &er mean non5health P7E: only 0ive countries had a share o0 households in the bottomCuintile o0 the non5health P7E si$ni0icantly hi$her amon$ households "ith disabilities6+n terms o0 &overty measures based on the non5health P7E com&ared to international &overty lines, the di00erence in the &overty status bet"een households "ith and "ithoutdisabilities "as statistically si$ni0icant only in very 0e" countries6 /his result should,ho"ever, be treated "ith caution $iven that it mi$ht be in0luenced by the limitations o0 the WHS "ith res&ect to its sam&lin$ desi$n "hen it comes to identi0yin$ the disabilitystatus o0 a household and its small set o0 Cuestions on e*&enditures6

Possible policy implications

9lthou$h this study does not discuss &olicies, the 0indin$s broadly &oint to three &ossible &olicy im&lications6

First, the results that in all the countries under study, &ersons "ith disabilities aresi$ni0icantly "orse o00 in several dimensions o0 economic "ell5bein$, and in mostcountries e*&erience multi&le de&rivations, call 0or 0urther research and action on &overtyamon$ &ersons "ith disabilities6

Second, &olicies and &ro$rams to im&rove socioeconomic status o0 &eo&le "ithdisabilities and their 0amilies need to be ada&ted to country s&eci0ic conte*ts6 /his studydoes not 0ind a sin$le economic indicator 0or "hich &ersons "ith disabilities aresystematically "orse o00 in all countries, su$$estin$ that the &rocesses "hereby disabilityand &overty are related are com&le* and vary 0rom country to country6 9 more in5de&th

One country, #imbab"e, could not be included in the analysis o0 P7E andmultidimensional &overty due to a lack o0 P7E data6

analysis "ould be needed at the country level to develo& s&eci0ic and conte*tuali)ed &olicy recommendations6

/hird, results 0rom the analyses "ithin dimensions o0 economic "ell5bein$ su$$est that &olicies that &romote access to education, health care and em&loyment may be &articularly im&ortant 0or the "ell5bein$ o0 &ersons and households "ith disabilities6

"urther research and data collection

/he results o0 this study tem&t 0or more research on disability and social and economicoutcomes in develo&in$ countries6

First, research is needed on the causal &ath"ays bet"een disability and &overty tounderstand ho" in a develo&in$ country conte*t, disability may lead to &overty and viceversa6 +t is necessary to brin$ causal &ath"ays into li$ht in order to make s&eci0ic &olicyrecommendations, at the country level, on ho" to reduce &overty amon$ &ersons "ithdisabilities, and ho" to curb the incidence o0 disability amon$ the &oor6

Second, com&rehensive &overty &ro0iles o0 &ersons and households "ith disabilities areneeded 0or disability &olicies to be e00icient and e00ective6

/hird, research is needed to evaluate interventions such as income su&&ort and &ro$ramsto economically em&o"er &ersons "ith disabilities in develo&in$ countries6 Someinterventions, such as community5based rehabilitation, have lon$ been in the 0ield, butlittle is kno"n on "hat "orks6

9ll three areas o0 research su$$ested above need more and better data on disabled &eo&leand their households6 %on$itudinal data is necessary to assess the causal &ath"ays bet"een disability and &overty6 +n develo&in$ countries, the lon$itudinal householdsurveys are rare and those that include disability Cuestions are all but lackin$6 7ross5

sectional data need to im&rove on the disability Cuestions and sam&le desi$n that "ouldalso allo" researchers to dra" reliable estimates on &ersons and households "ithdisabilities6 %ast but not least, better data collection is needed to investi$ate the accessand a00ordability o0 health care 0or &ersons "ith disabilities in develo&in$ countries6 /hisstudy 0ound a hi$her medical to total household e*&enditure ratio 0or households "ithdisabilities in most countries, but did not have data on access to health care services at theindividual level6

1.INTRODUCTION

/his study &resents a sna&shot o0 economic and &overty situation o0 "orkin$5a$e &ersons"ith disabilities and their households in ; develo&in$ countries6 /hese countries areBurkina Faso, hana, !enya, Mala"i, Mauritius, #ambia, and #imbab"e in 90ricaGBan$ladesh, %ao Peo&le's Democratic (e&ublic 3%ao PD(4, Pakistan, and the Phili&&inesin 9siaG and Bra)il, Dominican (e&ublic, Me*ico, and Para$uay in %atin 9merica and the7aribbean6 /he study also &resents estimates o0 disability &revalence amon$ "orkin$5a$e &o&ulation in those countries6

Disability and &overty are com&le*, dynamic and intricately linked &henomena6 /heonset o0 disability may increase the risk o0 &overty and &overty may increase the risk o0 disability6 While these relations are commonly assumed and have been noted in literature3Sen -..@4, there has been little systematic em&irical evidence on them6 +t is the t"o5

"ay causation bet"een disability and &overty, di00iculties in de0inin$ and measurin$disability and the lack o0 $ood statistical in0ormation that have cons&ired a$ainst thee00orts to em&irically disentan$le the &overty disability ne*us6 Furthermore, the availableem&irical evidence di00ers $reatly bet"een develo&ed and develo&in$ countries6 +ndevelo&ed countries, multi&le data sources are available and descri&tive statistics onvarious as&ects o0 social and economic "ell5bein$ o0 &ersons "ith disabilities iscommonly com&iled and &ublished6 Some countries, notably the 1nited States andmembers o0 the Euro&ean 1nion, also have lon$itudinal &anel surveys "hich arenecessary 0or em&irical analysis o0 the linka$es bet"een disability and &overtyG 0or e*am&le, 0or ans"erin$ the Cuestions on ho" the onset o0 disability a00ects thesocioeconomic situation o0 an individual and herhis 0amily and ho" &overty a00ects the

onset o0 disability6 +n contrast, in develo&in$ countries descri&tive statistics are rare,0ra$mented and s&oradic and lon$itudinal surveys are alto$ether lackin$6

/his study attem&ts to shed some li$ht on the &revalence o0 disability and thesocioeconomic status o0 "orkin$5a$e disabled &eo&le in ; develo&in$ countries6 /hestudy uses data 0rom the World Health Survey 3WHS4 conducted by the World HealthOr$ani)ation 3WHO4 in -..-5-..= in >. develo&ed and develo&in$ countries across the"orld6 +t is essential to note that, $iven that the WHS is a one o00, cross sectional survey,this study can only &rovide a sna&shot o0 socioeconomic indicators, in other "ords it canonly describe the economic "ell5bein$ o0 &ersons "ith disabilities alon$ severaldimensions6 2o conclusions about the causality bet"een disability and &overty should bedra"n based on the descri&tive statistics this study &resents6

/his research is relevant 0or several reasons6 First, it contributes to a 5 currently small 5 body o0 em&irical evidence on the economic status o0 &ersons "ith disabilities indevelo&in$ countries6 Second, by &rovidin$ a baseline data on the economic "ell5bein$and the &overty status o0 "orkin$5a$e &ersons "ith disabilities and their households in-.. in the countries under study, it can in0orm national disability &olicies6 Finally, this

study can also in0orm 0uture data and research e00orts on disability in develo&in$countries6

/his study is structured as 0ollo"s6 Section - &rovides de0initions and some back$roundon disability and &overty6 Section describes the data and methods6 Section = &resents

disability &revalence estimates in the ; develo&in$ countries under study and results onthe economic "ell5bein$ o0 "orkin$5a$e &o&ulation at the individual and householdlevels6 Section ; $ives results o0 an analysis o0 multidimensional &overty acrossdisability status6 Section < concludes6

2. DEFINITIONS AND BACKGROUND

/his section &resents de0initions and some back$round in0ormation on disability and &overty, describes some o0 the linka$es bet"een them and revie"s recent literature on thesocioeconomic status o0 &ersons "ith disability6

21 De)(+(*(+#

Disability

Di00erent models have been develo&ed to de0ine disability6- +n this study, disability isunderstood 0ollo"in$ the +nternational 7lassi0ication o0 Functionin$, Disability andHealth 3+7F or +nternational 7lassi0ication herea0ter4 develo&ed by WHO in -..69ccordin$ to the +7F, disability is an umbrella term 0or im&airments, activity limitationsand &artici&ation restrictions6 +t denotes the ne$ative as&ects o0 the interaction bet"een

an individual 3"ith a health condition4 and that individual's conte*tual 0actors3environmental and &ersonal 0actors4I 3WHO -.., &6 -46 /hus, this model starts "itha health condition 30or e*am&le, diseases, health disorders, inuries, and other healthrelated conditions4 "hich in interaction "ith conte*tual 0actors may result inim&airments, activity limitations, and &artici&ation restrictions6 /he +7F de0ines thatimpairments are &roblems in body 0unction or structure such as a si$ni0icant deviation or lossG activity is the e*ecution o0 a task or action by an individualG activity limitations aredi00iculties an individual may have in e*ecutin$ activitiesG participation is involvement ina li0e situationG participation restrictions are &roblems an individual may e*&erience ininvolvement in li0e situationsG environmental factors make u& the &hysical, social andattitudinal environment in "hich &eo&le live and conduct their livesG and personal factors

are the &articular back$round o0 an individual's li0e and livin$, includin$ $ender, race,and a$e 3WHO -.., &6 -46

Functionin$ and disability are t"o umbrella terms, one mirrorin$ the other6 Functionin$covers body 0unctions and structures, activities and &artici&ation, "hile disabilityincludes im&airments, activity limitations and &artici&ation restrictions6 +t is sometimesdi00icult to di00erentiate activities and &artici&ation6 For e*am&le, sel0 care can beconsidered as either 3WHO -.., &6 -;46 Hence, the +7F $ives domains that can be used0or both activities and &artici&ation6 /hey include learnin$ and a&&lyin$ kno"led$e,mobility, sel0 care, education, remunerative em&loyment, and economic sel05su00iciency6

/he +7F model re&resents an inte$ration o0 the medical and social models into a bio5 &sycho5social modelI 3WHO -.., &6 -.46 +n the medical model, disability is de0ined ascaused by a disease, an inury or other health conditions and it is considered intrinsic tothe individual6 1nder this model, addressin$ disability reCuires medical treatment andrehabilitation and an individual "ith any im&airment is considered disabled, re$ardless o0 "hether the &erson e*&eriences limitations in his or her li0e activities due to theim&airment6 +n the social model, disability is understood as a social constructG disability

- Detailed &resentations o0 these models are available in 9ltman 3-..4 and Mitra 3-..<46

is not a characteristic o0 the individual, instead it is created by the social environment andaddressin$ it reCuires social chan$e6 /he +7F model inte$rates the medical and socialmodel by reco$ni)in$ that &eo&le are disabled both by health conditions and by theenvironment6

+n a cross5country study such as this one, it is im&ortant to bear in mind thatenvironments could vary tremendously 0rom one country to the ne*t, and even "ithincountries 0rom one area to the ne*t6 /hus, t"o individuals "ith the same health conditionin t"o di00erent countries or in t"o di00erent re$ions "ithin the same country may havedi00erent disability status $iven di00erences in the environment6 9n individual in onecountryre$ion mi$ht have a severe &roblem movin$ aroundI because the terrain isdi00icult and there are no ram&s and curb cutsG the trans&ortation system is inadeCuateandor inaccessible, because 3as a "oman4 she can't travel unaccom&anied or becauseassistive devices are not available6 /he other individual may not 0ace any o0 theseenvironmental barriers and thus may only e*&erience a mild di00iculty movin$ aroundI6

#easuring disability

Because disability is not a readily identi0iable attribute such as $ender or a$e, but acom&le*, dynamic interaction bet"een a &erson's health condition and &hysical andsocial environment, it has &roven very di00icult to measure6 /hree disability measureshave been commonly used in a&&lied disability research: measures o0 im&airment,0unctional limitation measures and activity limitation measures6 !mpairment measures o0 disability 0ocus on the &resence o0 im&airment intrinsic to the individual6 For e*am&le,individuals may be Cueried about im&airments that mi$ht include blindness, dea0ness,mental retardation, stammerin$ and stutterin$, com&lete or &artial &aralysis6 /hemeasures that "ere 0ocused only on im&airment "ere commonly used in the &ast6 /hemeasures o0 functional limitations 0ocus on limitations e*&erienced "ith &articular bodily0unctions such as seein$, "alkin$, hearin$, s&eakin$, climbin$ stairs, li0tin$ and carryin$,irres&ective o0 "hether the individual has an im&airment or not6 $ctivity limitations

measures 0ocus on limitations in activities o0 daily livin$ such as bathin$ or dressin$69ctivity limitations may also include &artici&ation limitation in ma%or li0e activities suchas $oin$ outside the home, "ork or house"ork 0or "orkin$5a$e &ersons, and school or &lay 0or children6 /he measures o0 im&airments and 0unctional limitations relate todisability as &er the medical model6 /hey also ca&ture &roblems in body 0unctions andstructures under the +7F6 /he measures o0 activity limitations may be considered toca&ture disability as &er the social model and the activity limitations and &artici&ationrestrictions under the +7F6

/he measures o0 disability have chan$ed over time 0ollo"in$ chan$es in the conce&tual

a&&roach to it6 Over time, as a de0inition o0 disability has evolved 0rom an e*clusivelymedical &henomenon measured by im&airments to"ard a conce&t that encom&asses theinteraction bet"een an individual's health condition and herhis environment, the e00ortsto develo& measures o0 disability have accordin$ly 0ocused on measures that ca&tureactivity limitations and &artici&ation restrictions6 /his study attem&ts to use disabilitymeasures, "hich, to the e*tent &ossible $iven the data at hand, 0ollo" the +7F de0initiono0 disability6

Poverty

%ike disability, &overty is a dynamic &henomenon that is di00icult to measure6 9 vast body o0 literature on &overty, includin$ on its de0inition and measurement has been

&ublished over the last several decades 3World Bank @@. and -..G (avallion @@-G%i&ton and (avallion @@;G de anvry and !anbur -..<46 /his study 0ollo"s a commona&&roach and looks at both monetary 3incomeconsum&tion e*&enditure4 and non5monetary as&ects o0 livin$ standard and &overty 30or e*am&le, education, livin$conditions4, at the household level 30or e*am&le, e*&enditures, assets4, and at theindividual level 30or e*am&le, educational attainment, em&loyment46 +t also attem&ts tolook at &overty throu$h a multidimensional lens 0ollo"in$ methods &ro&osed byBour$ui$non and 7hakravarty 3-..4, and 9lkire and Foster 3-..@46

22He'&* C+"(*(+# '+" P.e!*y

+n most de0initions o0 disability, includin$ the +7F, havin$ a health condition is a

&rereCuisite 0or havin$ a disability6 One can then assume that a si$ni0icant &art o0 theassociation bet"een disability and &overty is mediated throu$h health6

+t is "ell established in the literature that &overty and ill health are interconnected6 +n astudy o0 ;< develo&in$ countries, "atkin et al6 3-..>4 0ind that the health o0 the &oor isnotably "orse than that o0 the better o00I "here health is measured by under50ivemortality, malnutrition, and 0ertility 3&6 >46 /his &attern o0 "orse health is 0ound in allcountries 0or malnutrition and 0ertility and in all but t"o countries 0or the under50ivemortality6 /he study also 0inds that the &oor use health services less and have lessadeCuate health related behaviorsI 3&6 >46 Poverty may lead to health conditions throu$hvarious &ath"ays and much evidence is available on this link in the literature on the

social determinants o0 health 3WHO -..@46 Path"ays include malnutrition 3Susser et al6-..?4, housin$ and environmental e*&osures 3(auh et al6 -..?4, and a lack o0 access tohealth services 3Peters et al6 -..?46 Some diseases such as malaria, measles, lo"er res&iratory in0ections, and diarrheal diseases are so stron$ly associated "ith &overty thatthey have been labeled diseases o0 &overtyI 3!aler -..?46 Poverty and health conditionsare also linked throu$h the $eneral level o0 a"areness and education o0 the &oor6 Parentala"areness, access to in0ormation, and maternal education have all been 0ound to have a$reat &reventive e00ect by &romotin$ the ability to ado&t health &romotin$ behaviors37utler et al6 -..<46

+n reverse, health conditions may increase the risk o0 &overty throu$h lost earnin$s andhealth e*&enditures6 9 com&rehensive revie" o0 em&irical literature 0ound that evidencesu$$ests that &oor health reduces the ca&acity to "ork and has substantive e00ects on"a$es, labor 0orce &artici&ation and ob choice 37urrie and Madrian @@@46 +n +ndonesia,0or instance, ertler and ruber 3-..-4 sho" that a chan$e in illness sym&toms lead to

7onsum&tion e*&enditure as a "el0are a$$re$ate is considered to have severaladvanta$es over income 3Deaton 1997); it fuctuates less and it is moreaccurately captured by household surveys compared to income data.It is also a better proxy o a household’s standard o livin.

reduced hours o0 "ork, reduced earnin$s, and increased health care s&endin$6 +ncreasedout5o05&ocket s&endin$ on health care may have an im&overishin$ im&act 3van Doorslaer et al6 -..<46

Finally, it should be noted that the links bet"een &overty and health are di00icult to study because &overty may a00ect health 3and disability4 self-reports6 /he &oor maysystematically under5re&ort health &roblems due to a lack o0 a"areness o0 "hatconstitutes a true healthy state 3Baneree et al6 3-..=4G Strauss and /homas 3-..?446

/o conclude, i0 health conditions and &overty are associated, and havin$ a healthcondition is a necessary 3but non5su00icient4 condition to have a disability, one mi$ht alsoe*&ect that disability and &overty are associated6

23 L(e&y P'*w'y# 9e*wee+ D(#'9(&(*y '+" P.e!*y

%ikely &ath"ays bet"een disability and &overty have seldom been de&icted in detail, = letalone established em&irically6 Some o0 those &ath"ays are described belo" andsummari)ed in 7harts and -6

"rom the onset of disability to adverse socioeconomic outcomes and poverty

/he onset o0 disability may lead to lo"er livin$ standard and &overty throu$h adverseim&act on education, em&loyment, earnin$s, and increased e*&enditures related todisability6

E"-%'*(+ Disability may &revent school attendance o0 children and youth "ithdisabilities and restrict human ca&ital accumulation and may thus lead to limitedem&loyment o&&ortunities and reduced &roductivity 3earnin$s4 in adulthood 0or &ersons"ith a disability onset at birth or durin$ childhood 3Filmer -..?46 Standard labor economics theory &redicts that investments in education "ill be more limited 0or children

"ith disabilities due to lo"er e*&ected returns 0rom education in terms o0 em&loymentoutcomes6 /he relevance and intensity o0 this link "ill vary de&endin$ on many 0actors,includin$ the socioeconomic status o0 a 0amily be0ore the onset o0 childhood disability,the timin$ o0 disability onset 30or e*am&le, at birth, early childhood4, the ty&e andseverity o0 disability, the interaction bet"een individual's disability and the schoolenvironment in the community, as "ell as the cultural and education &olicy back$round6

E/8&y/e+* Disability may &revent "ork, or constrain the kind and amount o0 "ork a &erson can do 3Evans @?@G ertler and ruber -..-G 7ontreras et al6 -..<G Meyer andMok -..?46 +n other "ords, to use 9martya Sen's 3@@-G -..@4 term earnings handicap,disability may restrict the ability to earn an income6 +n economic theory, the labor leisure

choice model su$$ests that the em&loyment rate is e*&ected to be lo"er 0or &ersons "ithdisabilities due to hi$her reservation "a$es 3sometimes as a result o0 the availability o0 bene0its4 and lo"er market "a$es as a result o0 lo"er &roductivity andor discrimination6 ;

+n &ractice, the e*tent o0 this ne$ative e00ect o0 disability on em&loyment "ill vary

= E*ce&tions include Neo and Moore 3-..4 and Neo 3-..;46; 9n e*&osition o0 the labor leisure choice model in relation to the em&loyment and"a$es o0 &ersons "ith disabilities is available in Bound and Burkhauser 3@@@4 and Mitraand Sambamoorthi 3-..?46

de&endin$ on a variety o0 0actors, startin$ "ith the individual's ty&e o0 disability, thetimin$ o0 disability onset 3at birth, durin$ childhood or adulthood4, its duration3tem&orary or &ermanent4 and ho" it relates to hisher occu&ation6 9s noted in Bald"inand ohnson 3@@=4, a blind &erson mi$ht 0ind it di00icult to o&erate a crane but mi$ht0ace no &roductivity im&ediment as a &hone o&erator6 +n an a$rarian economy, as is o0ten

the case in develo&in$ countries, most obs are in the &rimary sector 3a$riculture,0orestry4 and may involve heavy manual labor, "hich &ersons "ith "alkin$ or carryin$limitations may not be able to do6 /he e00ect o0 disability on em&loyment "ill alsode&end on the "ork &lace, its accessibility, available accommodations, and "hether thereis discrimination that mi$ht &revent access to em&loyment andor mi$ht lead to lo"er "a$es 3Bald"in and ohnson -..<G Bound and Burkhauser @@@46 9dditionally, therelevance and intensity o0 this &ath"ay de&end on the cultural conte*t in so 0ar asne$ative attitudes to"ard the em&loyment &otential o0 &ersons "ith disabilities in societyat lar$e or "ithin the household mi$ht limit access to "ork 3Mitra and Sambamoorthi-..?46 /he &olicy conte*t is also relevantG 0or instance, are vocational rehabilitation &ro$rams, disability insurance or social assistance &ro$rams available Such &ro$rams,

de&endin$ on ho" they are desi$ned and &ut into &ractice, could 0acilitate, limit or nota00ect access to em&loyment 0or &ersons "ith disabilities6

E/8&y/e+* ) (+)!/'& %'!e (.e!# Disability may lead to limited em&loyment and0or$one earnin$s o0 other 0amily members to care 0or a disabled 0amily member6 /herelevance o0 this &ath"ay is endo$enous to intra5household decision makin$ and suchdecision "ill de&end on "hether a disabled 0amily member is a child or an adult, theavailability and accessibility o0 care services outside the 0amily, the o&&ortunity cost o0 care, the e*istin$ labor market status o0 the 0amily members, the household decision onho" to share the care bet"een 0amily members and "hether 0amily members co5reside"ith the disabled &erson, and on customs and traditions6 For instance, i0 a 0amilymember is not em&loyed and assumes a care5&rovider role there "ill be no 0ore$one

earnin$s 3Heitmueller -..;G 7ontreras et al6 -..<46

I+%/e '+" e8e+"(*-!e# /hrou$h the earnin$s handica& 3by a00ectin$ an individual'sability to earn4, disability may lead to the lo"er income 0or the individual and thehousehold and may result in "orsenin$ o0 the livin$ standard and eventually &overty, i0 the household cannot com&ensate 0or the lost income and has to adust its e*&endituresaccordin$ly6 On the other hand, disability may also lead to additional e*&enditures 0or the individual and the household "ith disabilities, in &articular in relation to s&eci0icservices 3health care, trans&ortation, assistive devices, &ersonal assistance, and houseada&tation46 /he increase in s&endin$ "ill vary de&endin$ on the availability and0inancial accessibility o0 such services6 +0 such services are not available or are not

a00ordable, no e*tra cost mi$ht be incurred6 Sen 3@@-G -..@4 has coined the term o0 conversion handica& to re0er to this mechanism "hereby disability can lead to &overty6/he conversion handica& re0ers to the e*tra needs and costs o0 livin$ "ith a disability69ssessments o0 such costs can be used to evaluate i0 the minimum standard o0 livin$enca&sulated in the &overty threshold is su00icient to meet the needs o0 &ersons "ithdisabilities 3!uklys -..=G #aidi and Burchardt -..;G Braith"aite and Mont -..@G Montand Liet 7uon$ 0orthcomin$46 9s a result, althou$h incomee*&enditures o0 households"ith disabilities may be similar to other households, their standard o0 livin$ could be

lo"er due to additional e*&enditures, and hence &overty could be more &revalent< 3#aidiand Burchardt -..;G Braith"aite and Mont -..@G 7ullinan et al6 -..46 Becausedisability can both limit and increase household e*&enditures, the net e00ect is not a priori obvious6 9s a conseCuence o0 the earnin$s and the conversion handica&s, adisability may lead to a lo"er standard o0 livin$ and &overty, i0 a household cannot

com&ensate 0or the lost income and cover additional e*&enditures6 +n &ractice, thema$nitude o0 these e00ects "ould de&end on many 0actors, includin$ the household'ssocioeconomic status &rior to the onset o0 disability 3enkins and (i$$ -..4, ty&e,severity and duration o0 disability, "hether a disabled &erson is a &rinci&al income earner,as "ell as a &olicy conte*t6 9re there &rivate or &ublic disability insurance &ro$rams9re there social assistance &ro$rams 0or &ersons "ith disabilities +n 0act, i0 there is aran$e o0 disability bene0its, "hich "ould not only 0ully 3or to a lar$e e*tent4 re&lace theearnin$s, but also &rovide 0or covera$e o0 certain disability related e*&enditures, such asthe cost o0 s&eci0ic rehabilitation, 0ree assistive devices, care and attendance allo"ance,etc6, disability mi$ht not lead to si$ni0icant reductions in livin$ standard and &overty6

I+*!'<-#e&" "(#*!(9-*(+ ) !e#-!%e# Wel0are indicators such as income,

e*&enditures, and assets are usually collected at the household level6 +t is &ossible thatindividuals "ith disabilities "ithin the household may still su00er 0rom &overty andde&rivation, althou$h their household may not classi0y as &oor6 /his "ill de&end on thedistribution o0 resources "ithin the household6

/o conclude, the onset o0 disability may lead to a lo"er standard o0 livin$ and eventually &overty thou$h several interconnected &ath"ays6 Economic theory su$$ests that adults"ith childhoodyouth disabilities could be e*&ected to have lo"er educational attainment6+t also su$$ests that disabled "orkin$5a$e &o&ulation could be e*&ected to e*&eriencelo"er em&loyment rates6 /he earnin$s and the conversion handica&s su$$est that &ersons"ith disabilities and their households could be e*&ected to be "orse o00 as com&ared to

&ersons "ith no disabilities and their households6 Ho"ever, this may not necessarily bethe case due to a number o0 0actors includin$ the socioeconomic status &rior to disability,and the &ossibility 0or disability to be 0ully insuredcom&ensated 0or throu$h variousinsurance and &ublic assistance interventions6 /hus, the relevance and the intensity o0 the &ath"ays 0rom disability to &overty described above a&&ear to be conte*t s&eci0ic6De&endin$ on the individual, his household, community and country conte*t, some or allo0 the above links may be takin$ &lace, but "ith di00erent intensity and im&act6/here0ore, it is reasonable to e*&ect that the dynamic links above "ill in &ractice vary0rom country to country6

< One should be very cautious in com&arin$ recalculated &overty rates 0or householdslivin$ "ith disability 3a0ter havin$ accounted 0or e*tra cost o0 disability4 "ith the &overtyrates 0or the rest o0 the &o&ulation6 One "ould need to do the same 0or all other $rou&s"hich may have incurred some e*tra5cost 0or various reasons, 0or instance, because o0sickness, or a ne"5born baby, etc6, in order 0or those com&arisons to be methodolo$icallycorrect6

C'!* 1: L(e&y P'*w'y# )!/ D(#'9(&(*y * P.e!*y

E%+/(% (+"(%'*! E/8&y/e+*

=-!# w!e",

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#%& '**'(+/e+*>

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Disability onset maylead to a loss o0 ob,reduced "ork hours,or lo"er &roductivity

obs and thus lo"erincome 0or thehousehold6

Disability onset maylead to a schooldro&out or disability at

birth may &reventschool attendance in a$iven country conte*t6

Disability onset maylead to loss o0 earnin$sand reducede*&enditureconsum&tion0or the household, "hileat the same time causin$additional householde*&enditures6

Disability onlead to e*trae*&enditureshave an im&im&act6

W'* %-&" 9e

e8e%*e" *'* *e

"'*' w(&& #w?

DS: %o"erem&loyment amon$

&ersons "ithdisabilities6

DS: %o"er educationattainment amon$

&ersons disabled sincechildhoodyouth6

DS: %o"er income andhi$her disability relatede*&enditures inhouseholds "ith &ersons"ith disabilities6

DS: Elevateds&endin$ onservices in h"ith &ersonsdisabilities6

(9: 2e$ativecorrelation bet"eendisability andem&loyment6

(9: ne$ativecorrelation bet"eendisability sincechildhoodyouth andeducationalattainment6

(9: 2e$ative correlation bet"een households &erca&ita earnin$s andincomeG it is unclear ho"disability and overallhousehold &er ca&itaconsum&tion e*&enditure3P7E4 may becorrelatedG and &ositivecorrelation bet"een

disability and certainty&es o0 e*&enditures6

(9: Positivecorrelation bdisability ans&endin$ onservices

&ote: DS stands 0or descri&tive statisticsG (9 stands 0or re$ression analysis6

"rom poverty to disability

Poverty may increase the risk o0 disability throu$h several &ath"ays, many o0 "hich arerelated to &oor health and its determinants6

Poverty may lead to the onset o0 a health condition "hich may result in disability

includin$ throu$h malnutrition 3Maulik et al6 -..>G %ancet -..?4, diseases "hoseincidence and &revalence are stron$ly associated "ith &overty, lack o0 inadeCuate &ublichealth interventions 30or e*am&le, immuni)ation4, &oor livin$ conditions 30or e*am&le,lack o0 sa0e "ater and sanitation4, environmental e*&osures 30or e*am&le, unsa0e "ork environments4, and inuries 3intentional and unintentionalG 0or instance, vulnerable buildin$s in the conte*t o0 natural disasters46 On the other hand, one should note that"ealth may also lead to disability6 For instance, /homas 3-..;4 re0ers to studies in7ambodia "here the "ealthy are more at risk o0 road tra00ic inuries due to hi$her motorbike o"nershi&6

Poverty, as a conte*tual 0actor, may also increase the likelihood that a health condition

may result in im&airment, activity limitation, or &artici&ation restriction6 /his could bethe case i0 there is a lack o0 health care and rehabilitation services or a lack o0 resourcesto access those that are availableG acCuire &rosthetic, orthotic and mobility devicesG $et &ersonal assistance at the community level, etc6 +n &oor communities "here suchservices are not &rovided or are o0 lo" Cuality, health conditions may be more likely tolead to disability6 Even i0 such services are available, they may not be a00ordable 3Horner et al6 -..46 900ordability is in0luenced by the resources o0 the household 3income,assets4, the intra5household distribution o0 resources, by the economic environment3&rices o0 services4 and the health and disability &olicy conte*t 3health insurance,co&ayments46 Poor households across the "orld are 0ound to e*&erience less access tohealth services 3"atkin et al6 -..>4, unless s&eci0ic &olicies and &ro$rams are in &laceto 0acilitate access6 +n addition, sti$ma associated "ith a health condition may lead toactivity limitations and &artici&ation restrictions $iven a &articular social and culturalconte*t and it mi$ht be "orsened by the sti$ma associated "ith &overty6 Environmental0actors due to limited resources in the community, leadin$ 0or instance to an inaccessible &hysical environment, may also make it di00icult 0or an individual "ith a health conditionto have activities and &artici&ate in the community6

C'!* 2: L(e&y P'*w'y# )!/ P.e!*y * D(#'9(&(*y

E%+/(% (+"(%'*! E/8&y/e+* =-!#

w!e", e'!+(+#,

e/8&y/e+* #*'*-#>

E"-%'*(+ =#%&

e+!&&/e+*, #%&

'**'(+/e+*>

H-#e&"

e8e+"(*-!e#

He'&* e8e

F!/ 8.e!*y *

"(#'9(&(*y

%ack o0 and lo"

&roductivity obs andthe resultin$ lack o0resources may lead tothe lack o0 or limitedaccess to health andrehabilitation leadin$to onset o0 disability6

Malnutrition leads to

lo"er co$nitivedevelo&ment andschool attainmentG

&oor households mayunder5invest in theeducation o0 disabledchildrenG schools may

be unavailable,inaccessible andoruna00ordable6

%o" Cuality obs may &ose hi$her healthha)ard6

+nability to ensure

adeCuate diet, secure$ood housin$ and

better livin$conditions, and &ay0or health services andrehabilitation andother services mayincrease the likelihoodo0 a health conditionand a health conditionresultin$ in onset o0disability6

%ack o0 sa0e

sanitation an"ork environmay lead to adisablin$ heacondition6

W'* %-&" 9e

e8e%*e" *'* *e

"'*' w(&& #w?

DS: Hi$her disability &revalence amon$holders o0 lo" Cuality

DS: Hi$her disability &revalence amon$ lesseducated adult

&o&ulation6

DS: Hi$her &revalenceo0 disability amon$lo"erincomee*&enditureconsum&tion $rou&s6

DS: 2ot clea

(9: Positivecorrelation bet"eenlo" Cuality obs anddisability &revalence6

(9: 2e$ativecorrelation bet"eeneducational attainmentin adults anddisability6

(9: Positivecorrelation bet"eenhousehold lo" &erca&itaincomee*&enditureconsum&tion anddisability6

(9: 2ot clea

&ote: DS stands 0or descri&tive statisticsG (9 stands 0or re$ression analysis6

25 D(#'9(&(*y '+" P.e!*y: A Re.(ew ) Re%e+* E/8(!(%'& E.("e+%e

lobally, systematic evidence on socioeconomic status o0 &ersons "ith disabilities andthe relation bet"een disability and &overty in its various dimensions 3incomee*&enditureand non5income4 is limited, albeit the situation $reatly di00ers bet"een develo&ed anddevelo&in$ countries6 /y&ically, the em&irical evidence on &ersons "ith disabilities isderived 0rom &o&ulation censuses, and &o&ulation and household surveys6 9dministrativestatistics is much less commonly available, even in develo&ed countries6 /he maority o0 surveys are cross5sectional6 +n develo&in$ countries, surveys are o0ten conducted asstand5alone researches6 %on$itudinal surveys "hich are reCuired in order to observechan$es in socioeconomic status &rior to, immediately a0ter, and 0or a lon$er time0ollo"in$ the onset o0 disability are only available in a hand0ul o0 develo&ed countries6Ho"ever, even in those countries, the data sources are ar$ued to be in need o0 im&rovement 30or the 1nited States, see Houtenville et al6 -..@46

When available, data has many limitations6 Follo"in$ Houtenville et al6 3-..@4, thoseinclude: 3i4 o&erational de0inition o0 disability "hich may e*clude some &arts o0 the

&o&ulation "ith disabilitiesG 3ii4 chan$es in the de0inition o0 disability "ithin the samesurvey "hich may ham&er com&arability over timeG 3iii4 data collection methods maye*clude &eo&le "ith disabilities 30or instance, by de0inition, household surveys e*cludeinstitutionali)ed disabled &eo&le4G 3iv4 sam&le si)es are o0ten too small to ca&ture &ersons"ith disabilities even at the national level, nor allo" data to be disa$$re$ated$eo$ra&hically, by administrative levels, or by ty&es o0 disabilityG and 3v4 data on social, &hysical and in0ormation barriers is rarely collected6 9nother issue is the Cuality o0 the0ield "ork, because intervie"ers may not be adeCuately trained to survey &ersons "ithdisabilities6 9s a result, it is o0ten not &ossible to neither estimate disability &revalencenor $et a robust descri&tion o0 social and economic status o0 &eo&le "ith disabilities,"hich is essential 0or desi$n o0 the evidence5based disability &olicies and monitorin$ o0

their im&lementation6Because o0 the linka$es bet"een &overty and disability described earlier, in a cross5sectional data, various indicators o0 socioeconomic status "ould be e*&ected to &ointto"ard &ersons "ith disabilities and their households bein$ "orse o00 relative to &ersons"ithout disabilities and their households6 Some o0 these e*&ected outcomes 0romdescri&tive statistics and re$ression analysis are &resented above in charts and -6 For instance, one "ould e*&ect to observe a hi$her risk o0 income &overty amon$ households"ith a disability than amon$ households "ithout disabilities, or to observe hi$her disability &revalence rates amon$ the income &oor than amon$ the non5&oor6 /heabsolute and relative value o0 those indicators "ould be e*&ected to vary acrosscountries, $iven that disability e*&erience is hi$hly conte*t s&eci0ic, as e*&lained earlier6+n a re$ression analysis o0 lon$itudinal data one "ould e*&ect to observe the onset o0 disability resultin$ in adverse socioeconomic outcomes6 %ookin$ at the other side o0 thecausality, one "ould e*&ect adverse socioeconomic circumstances, such as &rolon$edacute malnutrition durin$ a 0amine, to lead later on to disability onset6

E/8(!(%'& e.("e+%e )!/ "e.e&8e" %-+*!(e# Most o0 the available descri&tivestatistics on the social and economic status o0 &ersons "ith disabilities &ertains todevelo&ed countries6 /he evidence su$$ests that &ersons "ith disabilities have lo"er

educational attainment and e*&erience lo"er em&loyment rates, have lo"er "a$es "henem&loyed, and are more likely to be &oor than &ersons "ithout disabilities6 9 -..@ study by the Or$anisation 0or Economic 7o5o&eration and Develo&ment 3OE7D4 coverin$ -hi$h income and u&&er middle income countries &resents a sna&shot o0 the labor marketoutcomes and &overty situation o0 "orkin$5a$e &ersons "ith disabilities6 /he study

sho"s hi$her &overty rates 3de0ined as &ercenta$es o0 &eo&le "ith disabilities inhouseholds "ith less than <. &ercent o0 the median adusted dis&osable income4 amon$"orkin$5a$e disabled &eo&le than amon$ "orkin$5a$e &eo&le "ith no disabilities in all but three countries 3S"eden, 2or"ay and Slovak (e&ublic, "here the reverse is the case46/he relative &overty risk 3&overty rate o0 "orkin$5a$e disabled relative to that o0 "orkin$5a$e non5disabled &eo&le4, ho"ever, varies $reatly6 +t is the hi$hest over t"otimes hi$her in the 1nited States, 9ustralia, +reland, and !oreaG and the lo"est, 0or e*am&le, only sli$htly hi$her than in the case o0 non5disabled &eo&le in the 2etherlands,+celand, and Me*ico6 /he study also sho"ed that "orkin$5a$e &eo&le "ith disabilitiesare less likely to be em&loyedG "hen em&loyed, more likely to "ork &art5timeG t"ice aslikely to be unem&loyedG and have relatively lo" income, unless hi$hly educated and

have a ob6/he OE7D 3-..@4 study &rovides summary statistics, and thus does not &rovide evidencein relation to the causal &ath"ays bet"een disability and &overty6 +t does not tell "hether disabled &eo&le "ere unem&loyed or &oor be0ore the onset o0 disability, or becameunem&loyed or &oor a0ter the onset o0 disability6 enkins and (i$$ 3-..4 analy)ed ei$ht"aves o0 the British Household Panel Survey 3@@5@@?4 and 0ound that "orkin$5a$eadults "ho became disabled "ere ty&ically more disadvanta$ed &rior to disability onset30or instance, not havin$ any educational Cuali0ication or not bein$ in &aid "ork46 /heyalso 0ound that em&loyment rates 0all "ith disability onset, and continue to 0all the lon$er a disability s&ell lasts6 9s 0or avera$e household income, it 0alls shar&ly "ith onset, butrecovers subseCuently althou$h not to &re5disability levels6> (esearch on the association

bet"een disability and lo"er economic status is also available 0or other develo&edcountries, includin$ 9ustralia 3Buddlemeyer and Lerick -..?G Saunders -..>4, +reland3annon and 2olan -..=4, +taly 3Parodi and Sciulli -..?4, and the 1nited States 3Meyer and Mok -..?G Mitra et al6 -..@G She and %ivermore -..>, -..@46

De.e&8(+ %-+*!(e# +n develo&in$ countries,? the Cuantitative literature, "hile stillsmall, has recently $ro"n6 Similar to the 0indin$s 0or develo&ed countries, this literature,as &resented belo", su$$ests lo"er social and economic status o0 &ersons "ithdisabilities, but inconclusively6 /he to&ics covered in the studies revie"ed 0or this &a&er include em&loyment, education, educational attainment amon$ adults, access to healthcare, household economic "ell5bein$, and livin$ conditions6

(e$ardin$ em&loyment, a lar$e maority o0 studies sho" that &ersons "ith disabilities areless likely to be em&loyed 37ontreras et al6 -..< 37hile and 1ru$uay4G Eide et al6 -..b

> For other 1! related research, see 0or instance !uklys -..= and #aidi and Burchardt-..;6? /he literature under revie" covers develo&in$ countries, e*ce&t 0or Mete 3-..?4, "hichis 0ocused on transition countries, and 12+7EF 3-..@4 and otlieb et al6 3-..@4 "hichcover both develo&in$ and transition countries6

32amibia4G Eide and %oeb -..< 3#ambia4G Eide and !amaleri -..@ 3Mo)ambiCue4GHoo$even -..; 31$anda4G Mete -..? 3Eastern Euro&e4G Mitra -..? 3South 90rica4GMitra and Sambamoorthi -..? 3+ndia4G World Bank -..@ 3+ndia4G %oeb and Eide 3-..=43Mala"i4G /rani and %oeb -.. 390$hanistan and #ambia4G #ambrano -..< 3Peru446Ho"ever, in #imbab"e, Eide et al6 3-..a4 0ind no statistically si$ni0icant di00erence

bet"een the em&loyment rates o0 &ersons "ith and "ithout disabilities69s 0or education, most o0 the evidence su$$ests that children "ith disabilities tend tohave lo"er school attendance rates6 9n analysis o0 = household surveys in develo&in$ countries in 90rica, %atin 9merica, and Southeast 9sia 3Filmer -..?4 0oundthat in all countries studied, children "ith disabilities <5> years o0 a$e "ere less likely tostart school or to be enrolled at the time o0 the survey6 Similar results "ere 0ound in %oeband Eide -..= 3Mala"i4, %oeb et al6 -..? 3South 90rica4, Mete -..? 3Eastern Euro&e4,(ische"ski et al6 -..? 3("anda4, /rani and Lan%eit -.. 390$hanistan and 7ambodia4,Eide et al6 -..a 3#imbab"e4, Eide et al6 -..b 32amibia4, Eide and %oeb -..<3#ambia4, Eide and !amaleri -..@ 3Mo)ambiCue4, and World Bank -..@ 3+ndia4612+7EF 3-..@4 0inds in a study o0 -. develo&in$ and transition countries an im&ortant

correlationI bet"een attendin$ early learnin$ activities and screenin$ ne$ative 0or increased risk o0 disability6 (esults are more mi*ed in otlieb et al6 3-..@4 "here, usin$the same data as in 12+7EF 3-..@4, screenin$ ne$ative 0or increased risk o0 disabilityand school attendance are si$ni0icantly correlated in ei$ht out o0 ? develo&in$ countries6+t should be noted that 12+7EF 3-..@4 and otlieb et al6 3-..@4 investi$ate theassociation bet"een school attendance and bein$ at risk o0 disability, "hich is di00erent0rom havin$ a disability6

%ookin$ at the educational attainment amon$ adults, there is consistent evidence thatadults "ith disabilities have lo"er educational attainment 37ontreras et al6 -..< 37hileand 1ru$uay4G Hoo$even -..; 31$anda4G %oeb and Eide -..= 3Mala"i4, %oeb et al6

-..? 3South 90rica4G Mete -..? 3Eastern Euro&e4G (ische"ski et al6 -..? 3("anda4G/rani and %oeb -.. 390$hanistan and #ambia4G World Bank -..@ 3+ndia4, #ambrano-..< 3Peru446 /o the authors' best kno"led$e, the only study "here this "as not 0ound to be the case is /rani et al6 3-..4 0or urban Sierra %eone6

(e$ardin$ access to health care, the literature on dis&arities across disability status indevelo&in$ countries is very limited6 World Bank 3-..@4 and /rani et al6 3-..4 sho"that individuals "ith disabilities have a reduced access to health care in +ndia and urbanSierra %eone res&ectively6 /rani et al6 3-..4 also sho"s that on avera$e, &ersons "ithsevere or very severe disabilities s&ent 6 times more on health care than non5disabledres&ondentsI 3&6 <46

(ecent research has also e*&lored dis&arities in household economic "ell5bein$ acrossdisability status6 /he main measures that have been assessed are asset o"nershi&,household e*&enditures, income, and livin$ conditions6@ For asset o"nershi&, a lot o0 studies sho" that households "ith disabilities have 0e"er assets com&ared to other

@ Other indicators o0 household "ell5bein$ have been used in various studies6 For instance, World Bank3-..@4 sho"s that in +ndia, households "ith disability "ere a lot "orse o00 in terms o0 the ability to havethree meals a day6 +n rural Ethio&ia, Fa0cham&s and !ebede 3-..?4 0ind that disability is associated "ithlo"er sel05re&orted "ealth and lo"er overall "ell5bein$6

households 3%oeb and Eide -..= 3Mala"i4G Eide et al6 -..b 32amibia4G Eide and %oeb-..< 3#ambia4G Eide and !amaleri -..@ 3Mo)ambiCue4G Palmer et al6 -.. 3Lietnam4GWorld Bank -..@ 3+ndia446 /"o studies 0ind no si$ni0icant di00erence 3Eide et al6 -..a3#imbab"e4G /rani and %oeb -.. 390$hanistan and #ambia446 (esults are more mi*ed0or income and household e*&enditures6 %oeb and Eide -..= 3Mala"i4 and Eide et al6

-..b 32amibia4 0ind that households "ith disabilities have lo"er incomes but threeother studies 3Eide et al6 -..a 3#imbab"e4G Eide and %oeb -..< 3#ambia4G and /rani etal6 -.. 3Sierra %eone44 do not6. +n a study o0 t"o %atin 9merican countries, results o0 &overty incidence based on &er ca&ita income are mi*ed6 +n both 7hile and 1ru$uay,7ontreras et al6 -..< 0ind hi$her &overty rates amon$ households "ith disabilitiescom&ared to households "ith no disabilities6 /he &overty rate o0 the subset o0 households "ith a head "ith a disability is similar to that o0 households "ith nondisabledheads in 7hile and is lo"er in 1ru$uay6 Furthermore, the re$ression analysis o0 the &robability o0 bein$ &oor sho"s that in 1ru$uay, disability has no si$ni0icant e00ect on the &robability o0 bein$ income &oor e*ce&t in households headed by severely disabled &erson6 +n the case o0 7hile, disability is 0ound to have a statistically si$ni0icant e00ect

and that increases the &robability o0 bein$ income &oor by 5= &ercent 37ontreras et al6-..<46 (e$ardin$ household e*&enditures, %oeb and Eide -..= 3Mala"i4, Eide and %oeb-..< 3#ambia4, and Hoo$even -..; 31$anda4 0ind that households "ith disabilities havelo"er e*&enditures than households "ithout, but Eide et al6 -..a 3#imbab"e4 and(ische"ski et al6 -..? 3("anda4 do not 0ind any si$ni0icant di00erence6

Finally, households "ith disabilities are 0ound to have "orse livin$ conditions in Eide etal6 -..b 32amibia4, Eide and !amaleri -..@ 3Mo)ambiCue4, and %oeb and Eide -..=3Mala"i4, but not in Eide et al6 -..a 3#imbab"e4 nor Eide and %oeb -..< 3#ambia46

/he studies on household5level economic "ell5bein$ re0erenced above are all countrylevel studies6 9 cross5country study o0 develo&in$ countries 3Filmer -..?4 0inds that

in a maority o0 countries, disability in adulthood is associated "ith a hi$her &robabilityo0 bein$ in &overty,- althou$h this association disa&&ears in a lot o0 countries "hencontrols 0or schoolin$ are included6 /his study, ho"ever, su00ers 0rom a limitation in thatthe household surveys it uses are based on di00erent measures o0 disability, and arethere0ore not strictly com&arable6

Overall, in develo&in$ countries, the evidence 0rom Cuantitative studies thus 0ar &ointsto"ard individuals "ith disability bein$ o0ten economically "orse o00 in terms o0 em&loyment and educational attainment, "hile at the household level, the evidence ismi*ed6 Ho"ever, derivin$ any conclusions on the association bet"een disability and &overty 0rom this literature is &roblematic6 First, studies use di00erent methods: somestudies only &resent means and 0reCuency counts across disability status 30or e*am&le,

. +n South 90rica, %oeb et al6 3-..?4 0ind that households "ith disabilities in the Eastern 7a&e Provincehave more &ossessions and a hi$her income than households "ithout disabilities6

7ontreras et al6 3-..<4 note that: /he de0inition o0 the household head is endo$enous to the household6Hence, the condition o0 disability o0 a member o0 the household may &revent himher to be household head6/hen, these results su$$est that 0or a &erson "ith disability to be the household head, hisher disability islikely not to be an im&ediment to be the main contributor o0 resources to the householdI 3&6 ;?46

- Filmer 3-..?4 measures &overty by belon$in$ to the lo"est t"o Cuintiles in terms o0household e*&enditures or asset o"nershi&6

12+7EF -..@G %oeb and Eide -..=G /rani and Lan%eit -..4, "hile other studies resortto multivariate analysis usin$ a variety o0 em&irical strate$ies "hich can be di00icult tocom&are 30or e*am&le, Filmer -..?G Mitra and Sambamoorthi -..?G /rani and %oeb-..46 Second, and more im&ortantly, the household survey data used in these studies arenot com&arable across countries, o0ten because o0 their di00erent measures o0 disability6

Some studies measure disability throu$h 0unctional limitations 30or e*am&le, /rani et al6-..4, "hile others use broad activity limitations 30or e*am&le, Mitra -..?4 or "ork limitations 30or e*am&le, %oeb et al6 -..?46 /he association bet"een disability and &overty is not inde&endent o0 the disability measure under use and the disabled &o&ulation included in analysis 3overall &o&ulation "ith disabilities, all adults, and"orkin$5a$e adults46 For instance, "hen disability is measured throu$h a "ork limitationCuestion, one e*&ects the earnin$s handica& to be more &ronounced than "hen disabilityis measured throu$h 0unctional limitations6 Em&loyment or incomee*&endituresindicators are e*&ected to be "orse 0or &ersons "ith disabilities identi0ied throu$h "ork limitations than 0or &ersons "ith disabilities identi0ied throu$h 0unctional limitations69nother e*am&le comes out o0 a study in +ndia: the World Bank 3-..@4 0inds a stron$

association bet"een household consum&tion &overty and disability "hen &ersons "ithdisabilities are identi0ied by the community, but only a "eak correlation "hen disabilityis measured throu$h activities o0 daily livin$6

9s a result, des&ite a $ro"in$ body o0 research in develo&in$ countries, there remainslittle certainty that &ersons "ith disabilities and their 0amilies are more likely to 0aceadverse socioeconomic outcomes than those "ithout disabilities6 /his &a&er attem&ts toshed a ne" li$ht to this literature by documentin$ the socio5economic outcomes o0 &ersons "ith disabilities in ; develo&in$ countries usin$ com&arable data and methodsacross countries6 /his study adds to the descriptive body o0 research6 iven the cross5sectional nature o0 the data, it is im&ortant to kee& in mind that this &a&er is no more thandescri&tive and cannot be used in any "ay to demonstrate any o0 the causal &ath"ays that

may link disability and &overty6

+t should be noted that 0ive o0 the studies above have been conducted by the sameor$ani)ation 3S+2/EF4 and use the same disability measures in the 0ive countries: Eide etal6 -..a 3#imbab"e4 and -..b 32amibia4, Eide and %oeb 3-..<4 3#ambia4, Eide and!amaleri -..@ 3Mo)ambiCue4, and %oeb and Eide -..= 3Mala"i46 /he 0ormer t"ostudies are, ho"ever, not strictly com&arable to the latter three in terms o0 sam&le desi$n6+0 one 0ocuses on the 0ormer three studies, "hich are com&arable, results varyG 0orinstance, households "ith disabilities are 0ound to have "orse livin$ conditions in Eideand !amaleri -..@ 3Mo)ambiCue4 and %oeb and Eide -..= 3Mala"i4, but not in Eide and%oeb -..< 3#ambia46

3. DATA AND MEASURES

31 Te W!&" He'&* S-!.ey

/his study uses a uniCue data set, the WHS6 = /o the best o0 the kno"led$e o0 theauthors, the WHS is the 0irst source o0 disability data that is com&arable across asi$ni0icant number o0 countries and that also includes several indicators o0 economic"ell5bein$6 /he WHS "as im&lemented in >. develo&ed and develo&in$ countries in-..-5-..= and data became &ublicly available in -..>6 /he &rimary obective o0 theWHS "as to collect com&arable health data across countries 3QstRn et al6 -..46 +t useda common survey instrument in nationally re&resentative &o&ulations "ith di00erentmodules to assess the health o0 individuals in various domains, health systemres&onsiveness, and household e*&enditures on health care and livin$ conditions6

+n all the countries included in this study, the WHS 0ollo"ed a strati0ied sam&le desi$n"ith "ei$hts6; For each household, one household in0ormant res&onded to a householdCuestionnaire includin$ Cuestions on household e*&enditures, livin$ conditions, assets,and household demo$ra&hics 3si)e and number o0 children46 +n addition, "ithin eachhousehold, an individual res&ondent o0 ? years o0 a$e or older "as selected randomlyusin$ !ish tables 3!ish @<;46 /hat &erson then res&onded to an individual5levelCuestionnaire, includin$ Cuestions about hisher o"n demo$ra&hic characteristics,disability and health, em&loyment, and education6 Because only one individualres&ondent "as chosen &er household, the individual sam&le si)e is the same as thehousehold sam&le si)e6

/here are several di00erences in the WHS survey Cuestionnaires used in hi$h incomecountries com&ared to those used in lo" and middle income countries6 +n &articular, theindividual5level Cuestionnaire came in t"o versions: a lon$ version 0or lo" and middleincome countries, and a short version 0or hi$h income countries6 /he lon$ version hasmore health and disability related Cuestions than the short version6 +n addition, somesections o0 the household5level Cuestionnaires "ere ada&ted to the lo", middle, and hi$hincome country conte*t: o0 relevance to this study, some items in the list o0 &ermanentincome indicators 3assets and selected livin$ conditions4 are di00erent 0or the t"o $rou&so0 countries6 For e*am&le, havin$ electricity and o"nin$ a clock are included in theCuestionnaire 0or lo" and middle income countries, but not in the Cuestionnaire 0or hi$hincome countries6 /his study, althou$h it is 0ocused on lo" and middle income countries,is some"hat a00ected by these di00erences in Cuestionnaires bet"een hi$h income

countries and lo" and middle income countries6 For instance, 0or three u&&er middleincome countries covered in this study 3Bra)il, Mauritius, and Me*ico4 the household

= Documentation on the WHS is available at: htt&:"""6"ho6inthealthin0osurveyeninde*6html /heWHS Cuestionnaires are available at: htt&:"""6"ho6inthealthin0osurveyinstrumentseninde*6html

; Out o0 the >. countries "here the WHS "as 0ielded, <. countries used a com&le*sam&le desi$n and . countries used random sam&lin$6

Cuestionnaire o0 hi$h income countries "as used6 /his a00ects only one o0 the surveyitems studied belo" in the analysis o0 household economic "ellbein$6<

/his study 0ocuses on "orkin$5a$e individual res&ondents a$ed ? to <;6> +t covers ;develo&in$ countries,? includin$ seven countries in 90rica 3Burkina Faso, hana, !enya,Mala"i, Mauritius, #ambia, and #imbab"e4, 0our countries in 9sia 3Ban$ladesh, %aoPD(, Pakistan, and the Phili&&ines4, and 0our countries in %atin 9merica and the7aribbean 3Bra)il, Dominican (e&ublic, Me*ico, and Para$uay46 +t is essential to notethat these develo&in$ countries may not be re&resentative o0 all develo&in$ countries6/hey "ere chosen 0rom the WHS sub5sam&le o0 =. develo&in$ countries based on the0ollo"in$ considerations6 First, three countries 5 7omoros, 7on$o, and 7ote d'+voire 5"ere e*cluded due to civil unrest at the time o0 the survey and related authors' concernsover the Cuality o0 the data6 Second, in three countries 5 /urkey, Mali, and Morocco 5 keyeconomic indicators "ere not collected and hence they could not be covered by the study6+n si* countries 5 7hina, Malaysia, Myanmar, 1nited 9rab Emirates, 1ru$uay, andSene$al 5 the sam&le o0 "orkin$5a$e &ersons "ith disabilities "as small6 iven theconcern that the descri&tive &ro0ile o0 &ersons "ith disabilities mi$ht su00er 0rom limited

statistical &o"er, these countries "ere not included6 For the rest o0 the countries, missin$data "as analy)ed6 Missin$ data rates varied across countries 0rom . &ercent to -; &ercent 0or selected disability and economic indicator Cuestions6 9n analysis o0 missin$data "as conducted to assess to "hat e*tent data on economic indicators "as missin$randomly across disability status6@ 9s a result o0 this analysis, more countries "eree*cluded: 7had, Ecuador, Ethio&ia, uatemala, +ndia, Mauritania, 2amibia, 2e&al, South90rica, Sri %anka, S"a)iland, /unisia, and Lietnam6

32 C-+*!(e# (+ *e S*-"y

< For Bra)il, Mauritius, and Me*ico, to com&ute the asset inde*, in0ormation on havin$

electricity "as not available6 +nstead, o"nin$ a L7(DLD "as included6> 9lthou$h data is available on the elderly, disability in old a$e is beyond the sco&e o0 this study $iventhat some o0 the economic indicators are only relevant 0or the "orkin$5a$e &o&ulation6 2eedless to say, thedisability in old a$e may increase the risk o0 &overty &ossibly throu$h e*tra costs, the increased need 0or alon$5term care and 0ore$one earnin$s 0or caretakers6 +t needs to be the subect o0 0urther research6

? For all the countries included in this study, data "as collected in -..6@ For each country, non5random bias in missin$ data "as checked in t"o "ays6 First,lo$istic re$ressions "ere run o0 the &robability o0 havin$ missin$ data on an economicindicator6 /hree de&endent variables "ere used in turn: havin$ missin$ data on assets,household e*&enditures, and em&loyment6 For each o0 the three re$ressions, inde&endentvariables included a dummy variable 0or disability status, a$e, a$e sCuared, marital status,and educationG and a dummy variable 0or rural residence6 Second, a lo$istic re$ression o0 missin$ data on disability a$ainst economic "ell5bein$ 3e*&enditures or assets4 andhousehold5level controls 3household si)e, dummies 0or rural residence, household head's$ender and marital status4 "as run6 /"o de&endent variables "ere used in turn: havin$missin$ data on the base disability measure and the e*&anded disability measure 3seesection on disability measures usin$ WHS data46 7onsiderin$ results 0or the coe00icientso0 relevant variables in these re$ressions, as "ell as missin$ data rates on economicindicators and disability measures, it "as assessed that non5random missin$ data "as aconcern 0or countries that "ere, there0ore, e*cluded 0rom this study6

/he countries included in this study vary $reatly in their level o0 develo&ment: ei$ht o0 them are lo" income countries 3Ban$ladesh, Burkina Faso, hana, !enya, %ao PD(,Mala"i, #ambia, and #imbab"e4G three are lo"er middle income countries 3Pakistan,Para$uay, and the Phili&&ines4 and 0our are u&&er middle income countries 3Bra)il, theDominican (e&ublic, Mauritius, and Me*ico46-. 9ccordin$ly, the key socioeconomic

indicators across these countries vary as "ell 3/able 646

T'9&e 31: C-+*!(e# -+"e! S*-"y: Key S%(e%+/(% I+"(%'*!#

C-+*!y

GDP 8e!

%'8(*'

=2003>

e8e%*'+%y

'* 9(!*

=2003>

U+"e! 6

/!*'&(*y !'*e

=8e! 1000>

=2006>

P8-&'*(+

PPP @126 8e! "'y

=2003>

e8e+"(*-!e

8e! %'8(*'

=2003>

P-9&(% e'&*

e8e+"(*-!e '#

8e!%e+*'e )

**'& e'&*

e8e+"(*-!e

=2003>Ye'! Pe!%e+*'e

S-9<S''!'+ A)!(%'

Burkina Faso @@@6< ;6= >;6; -.. ;<6; ;6@ =<

hana ;6; ;<6@ ?6? -..< -@6@ <@6- ?

!enya -<>6 ;6@ @-6@ -..; @6> ;6> ==

Mala"i <-6- ;.6= 6< -..= >6@ ;6; >=

Mauritius @<=<6= >6@ ;6- 5 5 <;6. ;=

#ambia .<6. =6? ;;6 -.. <=6< <;6 @ <-

#imbab"e -.-6? =6 .6> 5 5 5

Ban$ladesh @?.6< <6 <<6- -..; =@6< ->6= >

%ao PD( =@>6= <-6< <@6> -..- =6@ <>6; ->

Pakistan @?-6@ <=6@ @;6< -..- ;6@ ;.6@ -

Phili&&ines ->--6. >.6; ;6. -.. -6@ ?>6@ =.

L'*(+ A/e!(%' '+" *e C'!(99e'+

Bra)il >@@=6 >6. -;6? -.. .6= ;<?6? =Dominican(e&ublic ;>>6; >6> ;6. -.. <6- -6=

Me*ico @<<6@ >=6= -.6 -..- 6> <-?6> ==

Para$uay >>@6; >.6?; -;6> -..- >6- -?.6>> -

&ote:%i0e e*&ectancy 0or Mauritius is 0or -..-6 DP &er ca&ita, share o0 &o&ulation livin$ under 1SK6-;a day, and health e*&enditure &er ca&ita are &resented in constant &urchasin$ &o"er &arity 3PPP41S dollars usin$ -..; PPP e*chan$e rates6

Source: World Bank 3-..;5.4, World Develo&ment +ndicators database6

/he countries included in this study are not only hetero$eneous "ith re$ards tosocioeconomic environment, but they also di00er in their le$islative and &olicy back$rounds "ith res&ect to disability as sho"n in 9&&endi* 96

33 D(#'9(&(*y Me'#-!e# U#(+ *e WHS D'*'

-. Please see htt&:data6"orldbank6or$aboutcountry5classi0icationscountry5and5lendin$5$rou&s 0or a descri&tion o0World Bank country classi0ications6

+denti0yin$ &ersons "ith disabilities is not an easy task6 /here is no a$reed internationalstandard to measure disabilityG and disability measures vary de&endin$ on the de0initiono0 disability, in0ormation collected by a &articular survey instrument, as "ell as on theresearch obectives 3Mont -..>46 9s noted earlier, this study uses disability measuresthat re0lect the +7F de0inition o0 disability6 +t uses the Cuestions 0rom the Health State

Descri&tion module o0 the WHS6 /his module has a number o0 Cuestions on 0unctionaland activity limitations and &artici&ation restrictions "hich are consistent "ith the +7Fconce&tion o0 disability and cate$ori)ation o0 these com&onents, as "ell as Cuestions onoverall health, di00iculties related to &ain and discom0ort, and slee& and a00ect that can beused to measure disability6 +n constructin$ the measures, the study 0ollo"s therecommendations o0 the 1nited 2ations Washin$ton rou& on Disability Statistics 3theWashin$ton rou& herea0ter46- /he Washin$ton rou& has develo&ed, tested 3Miller etal6 -..4 and made recommendations 0or a short and a lon$ list o0 Cuestions on disabilityto be included in censuses and household surveys6 /his study uses t"o disabilitymeasures: a base measure and an extended measure o0 disability, based on t"o sets o0 Cuestions 0rom the WHS that match, as much as &ossible, the short and lon$ lists o0

Cuestions o0 the Washin$ton rou& as &resented in /ables 6- and 66/he base measure o0 disability used in the study is built by selectin$ WHS Cuestions that best match the Washin$ton rou&'s short list o0 Cuestions6 +t includes 0our Cuestionsrelated to: di00iculty in seein$reco$ni)in$ &eo&le across the road 3"hile "earin$$lasseslenses4G di00iculty in movin$ aroundG di00iculty in concentratin$ or rememberin$thin$sG and di00iculty "ith sel0 care6 +n the WHS, 0or each di00iculty, individuals couldres&ond on a scale o0 to ; as 0ollo"s: 5 no di00iculty, - 5 mild di00iculty, 5 moderatedi00iculty, = 5 severe di00iculty, and ; 5 e*treme di00icultyunable to do6 For the &ur&ose o0 this study, i0 a &erson re&orts a severe or e*tremeunable to do di00iculty in any o0 theabove 0our Cuestions, he or she is identi0ied as havin$ a disability6 /hus, the analysis0ocuses on economic status o0 &erson "ho in the WHS re&orted e*&eriencin$ severe or

e*treme di00iculties in certain domains o0 0unctionin$, leavin$ aside mild or moderatedi00iculties6-- MildI and ModerateI res&onse cate$ories have not 0ared "ell in co$nitive

- +n une -.., the 1nited 2ations +nternational Seminar on the Measurement o0Disability recommended that &rinci&les and standard 0orms 0or indicators o0 disability bedevelo&ed 31nited 2ations -..@46 /here "as a broad consensus on the need 0or &o&ulation5based measures o0 disability 0or country use and 0or internationalcom&arisons6 /he Washin$ton rou& on Disability Statistics "as 0ormed to address thisneed6 /he main &ur&ose o0 the Washin$ton rou& is to &romote and coordinateinternational coo&eration in the area o0 disability measures6 S&eci0ically, the Washin$tonrou& aims to $uide the develo&ment o0 a short set o0 disability Cuestions 0or use incensuses and national surveys in order to in0orm &olicy on eCuali)ation o0 o&&ortunities69 second &riority is to recommend one or more e*tended sets o0 Cuestions to measuredisability to be used as &art o0 &o&ulation surveys or as su&&lements to s&ecial surveys6+n0ormation on the Washin$ton rou& is available athtt&:unstats6un6or$unsdmethodscity$rou&"ashin$ton6htm6-- Sam&le si)e 0or individuals "ith e*tremeunable to do di00iculty "as too small tose&arate the analysis 0or those "ith severe di00iculty, on the one hand, and those "ithe*tremeunable to do di00iculty, on the other6

testin$ 3Miller -..4 and are there0ore not used in this study6 /his base measure o0 disability re&resents a combined measure o0 im&airments throu$h 0unctional limitations3seein$ and concentratin$4 and o0 activity limitations&artici&ation restriction 3movin$around,- sel0 care46

- +t should be noted that the movin$ aroundI Cuestion is &roblematic and may beunderstood di00erently across res&ondents6 +t does not s&eci0y "hether it re0ers to u&&eror lo"er body mobility, or both6 What i0 someone cannot "alk at all but has &lenty o0mobility above the "aist Ho" res&ondents ans"er this Cuestion "ould be very di00erentde&endin$ on "hat they think movin$ around means6

T'9&e 32: W'#(+*+ G!-8# Re%//e+"e" S!* L(#* ) D(#'9(&(*y -e#*(+#

'+" M'*%(+ WHS -e#*(+#

S!* &(#* ) "(#'9(&(*y -e#*(+# !e%//e+"e" 9y

*e W'#(+*+ G!-8

M'*%(+ WHS -e#*(+# -#e" (+ *(# #*-"y# 9'#e

"(#'9(&(*y /e'#-!e

I+*!"-%*(+ I+*!"-%*(+

'he next (uestions as) about difficulties you may havedoing certain activities because of a health problem*

&ow ! would li)e to review different functions of yourbody* When answering these (uestions+ ! would li)e

you to thin) about the last , days+ ta)ing both good

and bad days into account* When ! as) about

difficulty+ ! would li)e you to consider how muchdifficulty you have had+ on an average+ in the past ,

days+ while doing the activity in the way that you

usually do it* .y difficulty ! mean re(uiring increased

effort+ discomfort or pain+ slowness or changes in theway you do the activity* Please answer this (uestion

ta)ing into account any assistance you have available*

/0ead and show scale to respondent1*

6 Do you have di00iculty seein$, even i0 "earin$$lasses

A-.>.6 Do you "ear $lasses or contact lenses3+0 (es&ondent says NES to this Cuestion, &re0ace thene*t t"o Cuestions by Please ans"er the 0ollo"in$Cuestions takin$ into account your $lasses or contactlenses646 Nes -6 2o

A-.>6 +n the last . days, ho" much di00iculty didyou have in seein$ and reco$ni)in$ a &erson you kno"across the road 3i6e6 0rom a distance o0 about -.meters4

He'!(+

-6 Do you have di00iculty hearin$, even i0 usin$ a

hearin$ aid

M9(&(*y

6 Do you have di00iculty "alkin$ or climbin$ ste&s A-..6 Overall in the last . days, ho" muchdi00iculty did you have "ith movin$ around

Re/e/9e!(+

=6 Do you have di00iculty rememberin$ orconcentratin$

A-.;.6 Overall in the last . days, ho" muchdi00iculty did you have "ith concentratin$ orrememberin$ thin$s

Se&) %'!e

;6 Do you have di00iculty 3"ith sel0 care such as4"ashin$ all over or dressin$

A-.-.6 Overall in the last . days, ho" muchdi00iculty did you have "ith sel0 care, such as "ashin$or dressin$ yoursel0

A+#we! ey )! '&& *e '9.e -e#*(+#: A+#we! ey )! '&& *e '9.e -e#*(+#:a6 2o 5 no di00iculty 6 2one

b6 Nes 5 some di00iculty -6 Mild

c6 Nes 5 a lot o0 di00iculty 6 Moderate

d6 7annot do at all =6 Severe

;6 E*treme7annot do at all

&ote: 9ll the WHS di00iculty Cuestions re0er to 0unctionin$ di00iculties "hile usin$ assistive devices or &ersonal hel& that isusually in &lace 3WHO -..-46

T'9&e 33: W'#(+*+ G!-8# Re%//e+"e" L+ L(#* ) D(#'9(&(*y -e#*(+#

'+" M'*%(+ WHS -e#*(+#

L+ &(#* ) "(#'9(&(*y -e#*(+# !e%//e+"e" 9y

*e W'#(+*+ G!-8

M'*%(+ WHS -e#*(+# -#e" (+ *(# S*-"y#

e8'+"e" "(#'9(&(*y /e'#-!e

6 Do you have di00iculty seein$ and reco$ni)in$ a &erson you kno" 0rom > meters 3-. 0eet4 a"ay-6 Do you have di00iculty seein$ and reco$ni)in$ anobect at arm's len$th

A-.>.6 Do you "ear $lasses or contact lenses3+0 (es&ondent says NES to this Cuestion, &re0ace thene*t t"o Cuestions by Please ans"er the 0ollo"in$Cuestions takin$ into account your $lasses or contactlenses646 Nes -6 2oA-.>6 +n the last . days, ho" much di00iculty didyou have in seein$ and reco$ni)in$ a &erson you kno"across the road 3i6e6 0rom a distance o0 about -.meters4A-.>-6 +n the last . days, ho" much di00iculty didyou have in seein$ and reco$ni)in$ an obect at arm's

len$th or in readin$He'!(+

6 Do you have di00iculty hearin$ someone talkin$ onthe other side o0 the room in a normal voice-6 Do you have di00iculty hearin$ "hat is said in aconversation "ith one other &erson in a Cuiet room

M9(&(*y

6 Do you have di00iculty movin$ around inside yourhome-6 Do you di00iculty $oin$ outside o0 your home6 Do you have di00iculty "alkin$ a lon$ distance suchas a kilometer 3or eCuivalent4

A-..6 Overall in the last . days, ho" muchdi00iculty did you have "ith movin$ around

Re/e/9e!(+

6 Do you have di00iculty concentratin$ on doin$somethin$ 0or . minutes-6 Do you have di00iculty rememberin$ to doim&ortant thin$s

A-.;.6 Overall in the last . days, ho" muchdi00iculty did you have "ith concentratin$ orrememberin$ thin$s

Se&) %'!e

6 Do you have di00iculty "ashin$ your "hole body-6 Do you have di00iculty $ettin$ dressed6 Do you have di00iculty 0eedin$ yoursel0=6 Do you have di00iculty stayin$ by yoursel0 0or a 0e"days

A-.-.6 Overall in the last . days, ho" muchdi00iculty did you have "ith sel0 care, such as "ashin$or dressin$ yoursel0

C//-+(%'*(+

6 Do you have di00iculty $enerally understandin$"hat &eo&le say-6 Do you have di00iculty startin$ and maintainin$ aconversation6 Do others $enerally have di00iculty understandin$you

37ontinued4

T'9&e 33: W'#(+*+ G!-8# Re%//e+"e" L+ L(#* ) D(#'9(&(*y -e#*(+#

'+" M'*%(+ WHS -e#*(+# =C+*(+-e">

L+ &(#* ) "(#'9(&(*y -e#*(+# !e%//e+"e"

9y *e W'#(+*+ G!-8

M'*%(+ WHS -e#*(+# -#e" (+ *(# S*-"y#

e8'+"e" "(#'9(&(*y /e'#-!e

9dditional e*tended Cuestions are available in t"o other domains6 /hese include:

Le'!+(+

6 Do you have di00iculty learnin$ a ne" task, 0ore*am&le learnin$ ho" to $et to a ne" &lace-6 Do you have di00iculty analy)in$ and 0indin$solutions to &roblems in day to day li0e

A-.;6 +n the last . days, ho" much di00iculty didyou have in learnin$ a ne" task 30or e*am&le,learnin$ ho" to $et to a ne" &lace, learnin$ a ne"$ame, learnin$ a ne" reci&e, etc64

I+*e!8e!#+'& (+*e!'%*(+#

6 Do you have di00iculty dealin$ "ith &eo&le youdo not kno"-6 Do you have di00iculty maintainin$ a0riendshi&6 Do you have di00iculty $ettin$ alon$ "ith

&eo&le "ho are close to you

=6 Do you have di00iculty makin$ ne" 0riends

A-.<.6 Overall in the last . days, ho" muchdi00iculty did you have "ith &ersonal relationshi& or

&artici&ation in the communityA-.<6 +n the last . days, ho" much di00iculty didyou have in dealin$ "ith con0licts and tensions "ithothers

&ote: For the Washin$ton rou& and WHS Cuestions above, the same introduction and ans"er keys "ere used asnoted in /able 66 9ll the WHS di00iculty Cuestions re0er to 0unctionin$ di00iculties "hile usin$ assistivedevices or &ersonal hel& that is usually in &lace 3WHO -..-46

enerally, due to the absence o0 an a$reed standard, it is &re0erable to use more than onedisability measure in em&irical disability research6 9 second measure o0 disability, theexpanded measure, is there0ore used6 /he e*&anded measure includes the above 0our Cuestions o0 the base measure and 0our additional ones as 0ollo"s: di00iculty inseein$reco$ni)in$ obects at armJs len$th 3"hile "earin$ $lasseslenses4G di00iculty "ith &ersonal relationshi&s&artici&ation in the communityG di00iculty in learnin$ a ne" taskG

and di00iculty in dealin$ "ith con0lictstension "ith others6 One should note that "ith thee*ce&tion o0 the vision Cuestion, these additional Cuestions are likely to mean di00erentthin$s across countries6 /he WHS Cuestions on inter&ersonal relations are alsoCualitatively di00erent 0rom those recommended by the Washin$ton rou&6

%ike 0or the base measure, in the e*&anded measure, a &erson "ith a severe or e*tremeunable to do di00iculty in at least one o0 these ei$ht 0unctionin$ domains isconsidered to have a disability6 /he e*&anded measure is thus broad and ca&tures three0unctional limitations 3seein$ across the road, seein$ at arm's len$th, and concentratin$4and 0ive activity limitations&artici&ation restrictions 3movin$ around, sel0 care, learnin$, &ersonal relationshi&s&artici&ation in the community, and dealin$ "ith con0lictstension

"ith others4635A".'+*'e# '+" C'.e'*# ) U#(+ *e WHS D'*' * Me'#-!e D(#'9(&(*y

Di00erences in disability &revalence usin$ the WHS may re0lect di00erences inindividuals' underlyin$ heath conditions, conte*tual 0actors, as "ell as access to assistivedevices and &ersonal assistance6 9s e*&lained in the instructions to survey sta00 3WHO-..-4, all the WHS di00iculty Cuestions re0er to di00iculties "hile usin$ assistive devicesor "ith the e*istin$ &ersonal hel&6 +n addition, di00iculty Cuestions re0er to &eo&le's

e*&erience in the actual conte*t in "hich they live, "hich "ill vary 0rom one communityto the ne*t and o0 course 0rom country to country6

7om&ared to earlier research on disability &revalence and economic status o0 disabled &eo&le in develo&in$ countries 3Filmer -..?4, the maor advanta$e o0 the WHS is thatdisability related Cuestions "ere identically 0ormulated and seCuenced across countries6+t could, ho"ever, still be ar$ued that the WHS collects sel05re&orts to estimate disability,and that the com&arison o0 sel05re&orted Cuestions may su00er 0rom cultural biases acrosscountries, es&ecially 0or the broad Cuestions used in the e*&anded disability measure thatcould be subect to di00erent inter&retations 3&ersonal relationshi&s&artici&ation in thecommunity, or dealin$ "ith con0lictstension "ith others46 /he WHS survey instrument"as translated into several lan$ua$es usin$ co$nitive intervie"s and cultural a&&licabilitytests and &sychometric tests 0or reliability6 +n $eneral, the use o0 sel05re&orted measures0or disability has been considered to be valuable in attem&ts to better understande*&eriences o0 morbidity in $eneral, and disability in &articular 3Murray and 7hen @@-46Moreover, only sel05re&orted data is availableG there is no disability data that "ould be based on an obective assessment6 Finally, the use o0 sel05re&orts to estimate disability

&revalence and socioeconomic status o0 &ersons "ith disabilities has been critici)ed onthe basis that sel05re&orted measures could be biased and endo$enous to some economicoutcomes such as em&loyment6 Ho"ever, there is evidence 3Benite)5Silva et al6 -...4sho"in$ that disability sel05re&orted indicators are reasonable &redictors o0 a &erson'sobective health status, in &articular i0 disability measures are not "ork limitations6

/he WHS &resents limitations "hen it comes to measurin$ disability &revalence6 /heWHS5based disability measures may underestimate disability &revalence, because it doesnot cover t"o limitations included in the Washin$ton rou&'s recommended lists o0 Cuestions: limitation in hearin$ and limitation in communicatin$6 +0 available, the 0ormer limitation "ould be included in the base and e*&anded disability measures, and the latter

limitation "ould be included in the e*&anded disability measure so as to 0ollo" theWashin$ton rou&'s recommendations6 Finally, it should be noted that, like many other surveys, WHS does not include the institutionali)ed &o&ulation6 /he results o0 this studyare underestimates or overestimates o0 the e*tent o0 &overty amon$ &ersons "ithdisabilities i0 &ersons "ith disabilities in institutions are dis&ro&ortionately morelessde&rived that those covered in this study6 +t should ho"ever be noted that in develo&in$countries, rates o0 institutionali)ation tend to be lo"6

On the other hand, there are t"o reasons to e*&ect that WHS5based disability measuresmay overestimate disability &revalence6 /he introduction to the section containin$Cuestions on di00iculties in 0unctionin$ does not e*&lain that re&orted limitations or restrictions need to be related to a health &roblemI, as the introduction to the Cuestionso0 the Washin$ton rou& does6 For instance, a &erson "ho e*&erienced noise "ithconstruction and tra00ic in hisher nei$hborhood mi$ht re&ort a di00iculty concentratin$"hile this is only due to an environmental &roblem, not a health conditionim&airment &roblem6 /his mi$ht lead to an over5identi0ication o0 &ersons "ith disabilities in theWHS6 +n addition, one has to bear in mind that res&ondents "ere asked to re&ortdi00iculties durin$ the last . days &rior to the intervie", "hich mi$ht $ive rise to anu&"ard bias in estimatin$ disability &revalence6 +ndeed, acute and short5term healthconditions not resultin$ in im&airment mi$ht have been re&orted6 For instance, an

individual bedridden because o0 0lu or someone "ho recently broke a le$, mi$ht havere&orted a severe di00iculty in movin$ around, and "ould thus be counted as havin$ adisability, "hile they are in 0act e*&eriencin$ a tem&orary 0unctional limitation associated"ith a short5term health condition6

36 E%+/(% D(/e+#(+# ) We&&<9e(+ '* *e I+"(.("-'& Le.e&

/his study investi$ates economic "ell5bein$ amon$ &ersons "ith disabilities andcom&ares it "ith economic "ell5bein$ o0 &ersons "ithout disabilities6 Measurin$economic "ell5bein$ and identi0yin$ the &oor is no less di00icult than identi0yin$ &ersons"ith disabilities and measurin$ disability &revalence6 Several dimensions o0 "ell5bein$at both individual and household levels are analy)ed to dra" country level &ro0iles o0 economic "ell5bein$ and &overty across disability status6 /able 6= &resents a summaryo0 di00erent dimensions o0 economic "ell5bein$ and related indicators used in the study6

T'9&e 35: D(/e+#(+# ) E%+/(% We&&<9e(+ '+" Re&'*e" I+"(%'*!#

D(/e+#(+# ) e%+/(% we&&<9e(+ I+"(%'*!# !ndividual economic well-being

5 Education 6 Nears o0 schoolin$-6 7om&leted &rimary education

5 Em&loyment 3"orkin$ 0or &ay4 Em&loyed Household economic well-being

5 9ssets%ivin$ conditions 6 9sset inde*-6 Belon$s to the bottom Cuintile o0 the asset inde*distribution

5 Household e*&enditures 6 Monthly non5health P7E-6 Belon$s to the P7E bottom Cuintile6 Daily P7E under 1SK6-; a day=6 Daily P7E under 1SK- a day

5 E*&enditures on health services (atio o0 monthly health household e*&enditures tomonthly total household e*&enditures

9t the individual level, t"o dimensions o0 economic "ell5bein$ are included: educationand em&loyment6 While health is a dimension o0 "ell5bein$ "hich has increasin$lyreceived attention 3Baneree, et al6 -..=4, it is not included in this study, because disabled &eo&le are assumed to e*&erience "orse health relative to the rest o0 the &o&ulation6 9snoted earlier, accordin$ to the +7F, havin$ a health condition is a necessary condition 0or disability 3WHO -.., &6 -46 /he obective o0 this study is then to determine i0 this$rou& is "orse o00 alon$ other dimensions o0 "ell5bein$6 /he education dimension ismeasured by the years o0 com&leted schoolin$ and "hether a &erson has com&leted

&rimary school6 /he em&loyment is measured throu$h the em&loyment status, "hereem&loyment means "orkin$ 0or &ay6 +deally, one "ould need to have more data at theindividual level to study the economic "ell5bein$ o0 &ersons "ith disabilities6 Ho"ever,no other dimension at the individual level can be measured usin$ the WHS6-=

-= Several variables o0 economic "ell5bein$ such as siblin$ survivorshi& and sa0ety inthe community are available in the WHS, but data is lar$ely missin$ 0or some o0 thecountries included in this study6

37E%+/(% D(/e+#(+# ) We&&<9e(+ '* *e H-#e&" Le.e&

Be0ore describin$ the economic dimensions o0 "ell5bein$ that can be measured at thehousehold level, a cautionary note is needed6 9t the household level, because o0 thesam&le desi$n, the WHS &resents im&ortant limitations to measurin$ "ell5bein$ o0 households "ith disabilities6 Because not all household members "ere asked about their health and disability, there are some 0alse ne$atives in the identi0ication o0 the disabilitystatus o0 households6 Some households "ith disabilities are not identi0ied as such because the individuals "ith disabilities in these households "ere not the individualres&ondents6 +n addition, the WHS does not cover the health and disability o0 thechildren in the household6 9s a result, the com&arison $rou&, households "ithoutdisabilities 3re0erred to as other householdsI therea0ter4 mi$ht in 0act include adults or children "ith disabilities6 +0 there are dis&arities in household economic "ell5bein$ to thedisadvanta$e o0 households "ith disabilities, results usin$ the WHS may underestimatethe true e*tent o0 dis&arities and the descri&tion o0 dis&arities may be biased do"n"ard6-;

+t is not &ossible to estimate the e*tent o0 this bias6 +n li$ht o0 this limitation, results o0 this study on dis&arities bet"een households "ith an adult "ith a disability and other

households should be treated "ith caution6

+n this study, several as&ects o0 a household's economic "ell5bein$ are e*&lored6 /he0irst one is the asset o"nershi& and livin$ conditions measured by an inde* calculatedusin$ a method develo&ed by Filmer and Pritchett 3-..46 /he asset variables includeo"nershi& o0 a bike, a car, a re0ri$erator, a 0i*ed5line tele&hone, a cell &hone, a televisionset, and a com&uter6 %ivin$ condition variables include buildin$ Cuality 3hi$h5Cuality0loor and "all materials4, "ater source 30rom &i&es, 0rom &rotected "ells, and 0romun&rotected sources4, ty&e o0 toilet 30lush, latrine, othernone4, and use o0 a $as or electriccookin$ stove6 Each variable is "ei$hted usin$ the corres&ondin$ ei$envector 0or the

-; %et us assume "e kno" actual disability &revalence 0or a country o0 ,... individuals69t the individual level, disability &revalence stands at . &ercent6 9t the household level,the ... individuals live in .. households and <. households have one or moreindividuals "ith disabilities, thus household level disability &revalence is <... -.69 survey is conducted usin$ a desi$n similar to WHS6 We assume that the survey "assuccess0ully im&lemented "ith !ish tables to select one individual out o0 every sam&ledhousehold6 Follo"in$ 0rom this assum&tion, at the individual level, the estimated &revalence is eCual to the actual &revalence o0 . &ercent6 9t the household level, due tothe survey desi$n, "e $et the same &revalence as at the individual level because everyhousehold is re&resented by one individual that is labeled disabled or non5disabled6 9tthe household level, "e there0ore also estimate .5&ercent &revalence: "e have . &ercent o0 households "ith disabilities, "hom "e com&are to the remainin$ @. &ercent6+n 0act, this @. &ercent actually consists o0 some households that do not have a disability3?. &ercent4 and some households that have disabilities but are e*cluded 0rom thedisabled $rou& by error 3remainin$ . &ercent to make the 0ull -. &ercent o0 households"ith disabilities46 Our t"o constructed $rou&s o0 households "ith"ithout disabilities aremore similar to each other than the actual t"o $rou&s o0 households "ith"ithout adisability6 Estimated di00erences bet"een the constructed $rou&s o0 households "ill be biased to"ard )ero6 We "ill see this in our results, as the household5level indicators dotend to be more similar across disability status than the individual5level ones6

0irst &rinci&al com&onent, 0ound by a &rinci&al com&onent analysis6 /he inde* scores arenormali)ed to ran$e 0rom )ero to .. by subtractin$ the minimum score o0 the sam&le0rom the score o0 each observation, dividin$ by the ran$e o0 scores 0or the sam&le, andmulti&lyin$ by ..6 +t should be noted that one cannot make cross5country com&arisonso0 the asset inde*, only com&arison across disability status "ithin countries6 9n

additional indicator is used to sho" "hether the household belon$s to the bottom Cuintileo0 the asset inde* distribution, as it has been done in &revious studies 30or e*am&le,Filmer -..?46

/he second dimension o0 economic "ell5bein$ at the household level is householde*&enditures6 /he main indicator to measure this dimension is non5health P7E6 (ecentevidence su$$ests that includin$ e*&enditures on health in overall householde*&enditures leads to an underestimate o0 the e*tent o0 &overty in develo&in$ countries3van Doorslaer et al6 -..<46 Furthermore, $iven that additional health e*&enditures mi$ht be associated "ith disability status, it is all the more im&ortant to subtract healthe*&enditures 0rom re&orted total household e*&enditures be0ore com&arin$ householde*&enditure levels to &overty lines6 /he P7E indicator is 0urther used in terms o0 a

household belon$in$ to the bottom P7E Cuintile6 +n addition, the P7E is used tocalculate &overty rates at international &overty lines o0 PPP 1SK6-; a day 3e*treme &overty4 and PPP 1SK- a day 3&overty4 at the latest 3-..;4 &urchasin$ PPP e*chan$erates6 Here, three standard &overty indicators are estimated: &overty headcount 3H4, &overty $a& 3P4, and &overty severity 3P-4 3Foster, et al6 @?=G (avallion @@-46-< /hus,as sho"n in /able 6= above, 0our indicators based on P7E are used in this study tomeasure the household5level e*&enditure dimension o0 economic "ell5bein$: P7E, belon$in$ to the bottom P7E Cuintile, daily P7E is belo" 1SK6-;, and daily P7E is belo" 1SK-6

Several issues should be noted "ith re$ards to usin$ household 3non5health4 e*&enditures

as a dimension o0 economic "ell5bein$ in the conte*t o0 this study6 First, as &ointedearlier, i0 &overty is measured throu$h P7E a$ainst a &overty line, the com&arison o0 households "ith a disability to other households may be biased due to the conversionhandica&: households "ith disabilities may have additional 3non5health4-> needs andhence e*&enditures 30or e*am&le, trans&ortation, &ersonal assistance4 due to the disability6Evidence on the additional costs o0 livin$ "ith a disability is available only in very 0e"develo&in$ countries 3Braith"aite and Mont -..@ 3Lietnam and Bosnia andHer)e$ovina446 /o estimate the e*tra cost o0 disability, one "ould need more detaileddata on household e*&enditures than is the case "ith the WHS6 Second, there is a

-< /he poverty headcount 3 H 4, or &overty rate, is sim&ly the number o0 0amiliesidenti0ied as &oor divided by the total number in the &o&ulation o0 interest6 /he poverty

gap 3 P24 eCuals the summed amount that household income 0alls under the &overty line3as a &ro&ortion o0 the &overty line4 divided by the total number in the &o&ulation6 +norder to better analy)e levels o0 ineCuality across &oor households the poverty severity 3 P34 is calculated6 +t eCuals the sCuare o0 the amount that household income 0alls underthe &overty line 3as a &ro&ortion o0 the &overty line4 divided by the total number in the &o&ulation6-> 9s e*&lained earlier, health e*&enditures have been subtracted 0rom total householde*&enditures to calculate P7E6

&ossibility that the intra5household distribution o0 e*&enditures is uneCual acrossdisability status6 For these t"o reasons, P7E may not be an accurate indicator o0 economic dis&arities bet"een &ersons "ith and "ithout disabilities6 +n contrast, assets or livin$ conditions, at least the ones included in this study as described earlier, can be, to alar$e e*tent, considered as household common $oods, so the issue o0 intra5household

distribution is less likely to arise6 /hird, the WHS mi$ht have underestimated householde*&enditure across the board by only collectin$ summary data on householde*&enditures6 E*&enditures over the last month "ere collected as a total and also 0or si*e*&enditure cate$ories 30ood, housin$, education, healthcare, insurance &remiums, andother $oods and services46 /his is a very succinct set o0 e*&enditure Cuestions com&aredto those in household surveys such as the %ivin$ Standard Measurement Survey 3%SMS4that aim at measurin$ livin$ standard throu$h household e*&enditures6 For instance, theWHS did not include a diary o0 household e*&enditureconsum&tion or in0ormation onthe consum&tion in kind, "hich in develo&in$ countries re&resents a si$ni0icant 0ractiono0 consum&tion6 For these reasons, results 0rom the study o0 household e*&endituresacross disability status usin$ the WHS should be treated "ith a lot o0 caution6

Finally, the last dimension o0 economic "ell5bein$ e*amined in this study concerns thee*&enditure o0 health services6 Due to their underlyin$ health condition, &ersons "ithdisabilities and their households may consume more health services6 /his dimension ismeasured by one indicator: the ratio o0 monthly health e*&enditures to monthly totalhousehold e*&enditures6 /he WHS collected data on total household s&endin$ on healthcare and there0ore this ratio su00ers 0rom several limitations as an indicator o0 healths&endin$ because o0 disability6

On the one hand, the s&endin$ on health care re&orted in WHS may be overstated, because the Cuestions about di00iculties did not di00erentiate bet"een acute short5termhealth conditions and lon$er5lastin$ health conditions and health care needs related to

disability6 On the other hand, re&orted s&endin$ mi$ht be lo" not because the needs "erelo", but because o0 lo" ca&acity to &ay 0or the care andor lack o0 services i0 there areno services, no s&endin$ "ould be incurred, irres&ective o0 the need andor ca&acity to &ay6 9lso, to the e*tent that the WHS may underestimate true total householde*&enditure, as discussed above, this ratio may be overstated6 Furthermore, this indicator does not tell anythin$ about intra5household distribution o0 s&endin$ on health services,"hich may be to the detriment o0 a &erson "ith disability in the household6 /here0ore,one should kee& in mind these limitations "hen inter&retin$ the results6

34 M-&*("(/e+#(+'& P.e!*y Me'#-!e#

+n addition to the individual and household5level measures o0 economic status and

&overty described above, this study also estimates multidimensional &overty measures,usin$ the methods recently develo&ed by 9lkire and Foster 3-..@4 and Bour$ui$non and7hakravarty 3-..46 /he latter method is used as &art o0 robustness checks6

/he 9lkire and Foster method is a dual cuto00 method that is used to estimate amultidimensional &overty measure across d dimensions o0 economic "ell5bein$6Dimensions are "ei$hted: w % is the "ei$ht o0 dimension %6 Each individual i has a"ei$hted count o0 dimensions "here that &erson is de&rived 3ci4 across all measured

dimensions: T ci T d G "here∑=

i% %i cwc: "ith i%c a binary variable eCual to one i0

individual i is de&rived in dimension %, and )ero other"ise6 Dimensions can rely onordinal andor cardinal data6

%et (i be a binary variable eCual to one i0 the &erson is identi0ied as &oor, and to )eroother"ise6 9 &erson is identified as poor i0 the &erson's count o0 de&rivations is $reater than some s&eci0ied cuto00 3) 4:

i0 ci U )+ then (i i0 ci V )+ then (i .

/he headcount ratio 0or a $iven &o&ulation is then the number o0 &oor &ersons 3(4Σ(i4divided by the total &o&ulation 3n1:

/o ca&ture the breadth o0 de&rivation e*&erienced by the &oor, in other "ords, the

e*&erience o0 de&rivation in several dimensions, the avera$e number o0 de&rivations thata &oor &erson 0aces is com&uted6 /he total number o0 de&rivations e*&erienced by &oor &eo&le c3)1 is calculated as 0ollo"s:

c3)14 Σ3(ici4 0or i n6

/he average deprivation share is the total number o0 de&rivations o0 the &oor 3c3)14divided by the ma*imum number o0 de&rivations that the &oor could 0ace 3(d 4:

$ 4 c3)15 3(d1

9lkire and Foster's 3-..@4 multidimensional &overty measure # + or ad%usted headcount

ratio, combines in0ormation on the &revalence o0 &overty and the breadth o0 &overty,

combinin$ the headcount ratio and avera$e de&rivation share: # 4 H$ 4 c3)15 3nd1

/he number o0 &oor &ersons 3(4 0alls out o0 the ri$ht side o0 the eCuation, leavin$ theratio o0 total de&rivations e*&erienced by the &oor to the total &ossible de&rivations thatthe entire &o&ulation could e*&erience6 # can eCuivalently be e*&ressed as the "ei$htedavera$e o0 headcount ratios 0or dimensions % 3 H %4:

+t is im&ortant to note that this method has a number o0 limitations, includin$ the

0ollo"in$6 First, the three measures above 3 H , $ and # 4 are a 0unction o0 the "ei$hts w %

allocated arbitrarily to dimensions6 /hus, any &overty calculation usin$ this 0rame"ork issensitive to the assum&tions used in settin$ "ei$hts6 Second, this method is also sensitiveto the selection o0 dimensions and there is no $uidance on ho" to select them6Furthermore, this method also reCuires that cuto00s are set6 9 cuto00 needs to be set 0or each dimension6 Decidin$ on a s&eci0ic cuto00 &oint is an arbitrary choice, albeit likely to be an in0ormed one6 9nother challen$e "ith this method is to identi0y the cuto00 acrossdimensions ) or )5d 5 the share o0 dimensions "hereby one needs to e*&erience

de&rivation6 9s noted in 9lkire and Foster 3-..@4, settin$ ) establishes the minimumeli$ibility criteria 0or &overty in terms o0 breadth o0 de&rivation and re0lects a ud$mentre$ardin$ the ma*imally acce&table multi&licity o0 de&rivationsI 3&6 ->46 /his ud$mentis based on e*&ert o&inion and seems &articularly di00icult to make in a cross5countrystudy such as this one6 /his study uses kd=., in other "ords, an individual needs to

be de&rived in =. &ercent o0 the dimensions in order to be considered &oor6+n this study, several multidimensional &overty measures are &resented as a complement to the use o0 the P7E as "el0are a$$re$ate 0or &overty estimates, as "ell as to severalindicators o0 economic "ell5bein$ o0 &ersons and households "ith disabilities6 For the &ur&ose o0 this study, multidimensional &overty measures &rovide use0ul additionalin0ormation on the economic "ell5bein$ o0 &ersons "ith disabilities com&ared to those"ithout disabilities6 Since multidimensional &overty measures reCuire assum&tions 0or the selection o0 dimensions, "ei$hts and thresholds, it "ill be essential to assess thesensitivity o0 the results "ith res&ect to some o0 these choices6

Based on the in0ormation available in the WHS, . indicators "ere selected 0or the

calculation o0 the multidimensional &overty measures: t"o indicators 0or individualeconomic "ell5bein$ 3education and em&loyment4, t"o 0or household e*&enditure 3non5health P7E and ratio o0 health to total e*&enditures4, and si* indicators 0or assets andlivin$ condition 39lkire and Santos -..46 /hese si* indicators include an indicator "hich covers the o"nershi& o0 some consumer $oods: car, television, tele&hone,re0ri$erator, bicycle, dish"asher, "ashin$ machine, and com&uterG three standardMillennium Develo&ment oal 3MD4 indicators 3access to clean drinkin$ "ater,sanitation, and the use o0 clean cookin$ 0uel4G and t"o non5MD indicators: electricityand 0loorin$ material6

Each dimension's indicators and "ei$hts are &resented in /able 6;6 9s e*&lained earlier,

the estimates o0 the household5level indicators should be treated "ith caution due to theWHS data issues e*&lained earlier6

T'9&e 36: D(/e+#(+# '+" We(*# (+ *e M-&*("(/e+#(+'& P.e!*y Me'#-!e

D(/e+#(+# ) e%+/(% we&&<9e(+ I+"(%'*!# '+" "e8!(.'*(+ *!e#&" =we(*#>

!ndividual economic well-being 34

5 Education Did not com&lete &rimary education 3<4

5 Em&loyment +s not em&loyed 3<4

Household economic well-being

5 9ssetslivin$ conditions 34

Household does not have a car or any t"o o0 the otherassets 3/L, &hone, re0ri$erator, bicycle, dish "asher,"ashin$ machine, com&uter4 3?4

Household does not have electricity 3?4

HouseholdJs "ater source is not a &rotected &i&e or "ell or

is at least . minutes a"ay 3?4

Household does not have a covered latrine or 0lush toilet or the toilet 0acilities are shared 3?4

HouseholdJs 0loor is dirt, sand, or dun$ 3?4

HouseholdJs cookin$ 0uel is "ood, charcoal, or dun$ 3?4

5 Household e*&enditure 34Daily P7E under 1SK- a day 3<4

5 E*&enditure on health services (atio o0 monthly health e*&enditure to monthly totale*&enditure is more than . &ercent 3<4

/he individual economic indicators are "ei$hted at one third 3education and em&loymentat one si*th each46 /he household e*&enditure indicators are "ei$hted at one third 3P7Eand the ratio o0 health to total e*&enditures at one si*th each46 9nd, the assets and livin$conditions are "ei$hted at one third, "ith each o0 the si* items "ei$hted at ?6 /hecuto00s 0or the dimensions are as 0ollo"s: i0 a &erson 34 has less than &rimary educationG3-4 is not em&loyedG 34 lives in a household "here . &ercent or more o0 householde*&enditures are health e*&endituresG-? 3=4 P7E is belo" the international &overty line

3PPP 1SK- a day4G 3;4 no one has a cartruck or any t"o o0 the other assets 3/L, radio, &hone, re0ri$erator, bicycle, dish "asher, "ashin$ machine, and motorcycle4G 3<4 there isno electricityG 3>4 "ater source is not a &rotected &i&e or "ell or is at least . minutesa"ayG 3?4 there is not a covered latrine or 0lush toilet or the toilet 0acilities are sharedG 3@4the 0loor is dirt, sand, or dun$G and 3.4 cookin$ 0uel is "ood, charcoal, or dun$6

9 number o0 robustness checks "ere conducted, but only some o0 them are re&orted belo"6 First, more restrictive thresholds "ere used 0or t"o o0 the dimensions: 0or P7E,the 1SK6-; a day &overty line "as used instead o0 1SK- a day6 For the ratio o0 health tototal e*&enditures, a &erson "as considered to be de&rived i0 the ratio "as above ; &ercent instead o0 . &ercent in the base case6 Second, the values 0or the share o0 dimensions "here an individual needs to be de&rived to be considered &oor 3)5d 4 "as

chan$ed to . &ercent6 9 third robustness check "as &er0ormed by dro&&in$ the indicator 0or P7E 0rom the calculations and redistributin$ "ei$hts eCually across the remainin$nine dimensions6 +t "as decided to dro& the P7E indicator due to WHS data limitationsas e*&lained earlier6

+n a 0inal robustness check, the method develo&ed by Bour$ui$non and 7hakravarty3-..4 "as used to calculate another set o0 multidimensional &overty measures6 Similar to the &revious method, this method uses a dual5cuto00, "ith the authors considerin$ anindividual &oor, i0 she 0alls under the &overty line in any dimension6 +n order to &resentthis measure in a conte*t similar to the 9lkire and Foster method described above, thisstudy deviates 0rom the ori$inal Bour$ui$non and 7hakravarty im&lementation and uses

a multidimensional &overty line o0 kd;. 3that is, an individual is &oor i0 heshe 0allsunder t"o out o0 0our dimensional &overty lines46-@

-? /here is no consensus in the literature on the catastro&hic threshold and cut5o00 0or health e*&enditures6Lalues ran$in$ 0rom ; &ercent to -. &ercent o0 the total household income have been re&orted in theliterature 3Wys)e"ianski @?<G Berki @?<G (anson -..-G Water et al6 -..=46

-@ 1sin$ kdV=. leads to very hi$h &overty headcounts 0or &ersons "ith and "ithoutdisabilities, "hich dilutes the value o0 &er0ormin$ this analysis6 Ho"ever, calculationsare made usin$ kd-; are &resented in the 9&&endi* B@6

/he Bour$ui$non and 7hakravarty method reCuires the use o0 continuous variables,"hich allo"s the com&utation o0 dimensional &overty $a& and &overty severity6 9multidimensional $a& and &overty severity is com&uted by takin$ the "ei$hted avera$eo0 the res&ective dimensional $a&s and &overty severity6 Four economic indicators areused in this measure: years o0 schoolin$, P7E, health to total e*&enditure ratio, and the

asset inde*6 Dimensional &overty thresholds are as 0ollo"s: 34 individual has less than0ive years o0 educationG 3-4 P7E is belo" the international &overty line 3PPP 1SK- aday4G 34 . &ercent or more o0 household e*&enditures are health e*&endituresG . and 3=4the household asset inde* score is lo"er than . out o0 ..6

3; D'*' A+'&y#(#

Data analysis is limited to descri&tive statistics6 For each o0 the economic "ell5bein$indicators described above, this study &resents estimates 0or &ersons and householdsre&ortin$ disabilities and 0or those "ithout disabilities6 /he di00erences in indicators "ithand "ithout disabilities are tested 0or statistical si$ni0icance6

+t should be noted that the authors decided not to conduct a multivariable re$ressionanalysis because o0 the endo$eneity o0 disability and economic de&rivation6 9s e*&lainedearlier, disability and economic de&rivation are linked throu$h a t"o5"ay causation69nalysis o0 lon$itudinal data is necessary to disentan$le "hether the onset o0 disabilityhas led to de&rivation or &ersons "ith disabilities "ere already de&rived be0ore becomin$disabled6 Other"ise, a &otentially misleadin$ &icture o0 the dynamic relationshi& bet"een disability and disadvanta$e mi$ht emer$e6 For instance, usin$ this e*istin$ dataset, i0, in the re$ression o0 em&loyment a coe00icient o0 the disability variable is 0ound to be statistically si$ni0icant, one "ould not be able to conclude that &ersons "ithdisabilities are less likely to 0ind em&loyment com&ared to &ersons "ithout disabilities6 +tmay be that &ersons "ith disabilities are less likely to be em&loyed due to their disability, but it could also re0lect the 0act that &ersons "ho are not em&loyed are more likely tore&ort a disability6 /he &icture is even more blurred in the case o0 education, becausemost o0 disabilities occur durin$ adulthood, a0ter the education has been com&leted6

/here0ore, in a study o0 "orkin$5a$e &o&ulation, i0 in the re$ression o0 education acoe00icient o0 the disability variable is 0ound to be statistically si$ni0icant, one "ould not be able to conclude that &ersons "ith disabilities are less likely to be educated6 Further research usin$ lon$itudinal data is necessary to address this endo$eneity issue and

. /hresholds must be an u&&er bound, rather than a lo"er bound in this measure6 /hiscalculation is &er0ormed "ith a threshold o0 3health5to5total e*&enditure ratio4 0allin$ belo" @. &ercent6 9s an illustration o0 this issue one may use Filmer's analysis 3-..?46 Based on = household surveys

0rom develo&in$ countries, he estimates disability &revalence at 5- &ercent o0 the &o&ulation6 /here$ression analysis su$$ests that adults "ith disabilities ty&ically live in &oorer than avera$e households:disability is associated "ith about a . &ercenta$e &oint increase in the &robability o0 0allin$ in the t"o

&oorest Cuintiles6 Ho"ever, much o0 this association disa&&ears "hen controls 0or education are introducedand Filmer concludes that much o0 the association a&&ears to re0lect lo"er educational attainment amon$adults "ith disabilitiesI 3&6 =46 /here0ore, one cannot be sure "hether adults "ith disabilities are morelikely to be in the bottom t"o Cuintiles because o0 disability or because o0 lo" educational attainment6

2either can one s&eculate that &eo&le "ith disabilities have lo"er educational attainment because o0 theirdisabilities, as most o0 disabilities occur durin$ adulthood, once the education cycle has been com&leted 3ondisability dynamics, see Burchardt -...46

identi0y the causal &ath"ays that link disability and economic disadvanta$e and &overty6iven the data at hand, this is beyond the sco&e o0 this study6

4.RESULTS

/his section &resents the results o0 the data analysis6 (esults usin$ the base disabilitymeasure are in the body o0 the study, "hile those usin$ the e*&anded disability measureare in 9&&endi* B6 /he overvie" tables are intended to 0acilitate cross5countrycom&arisons 0or &articular indicators6 (esults are also &resented se&arately 0or eachcountry in country &ro0iles in 9&&endi* 76 7ountry &ro0iles com&lement the overvie"tables "ith more in0ormation 0or each country6 For instance, they &resent in0ormation onthe demo$ra&hic characteristics and ty&es o0 em&loyment 0or "orkin$ &ersons "ith and"ithout disabilities, and on the livin$ conditions o0 households "ith disabilities com&aredto other households6

+t is essential to note that the results &resented in this study, "hether in the overvie"tables or in the country &ro0iles, only &rovide a$$re$ate level estimates o0 selected

indicators o0 socioeconomic status o0 &ersons "ith disabilities6 /his set o0 results in itsel0 is insu00icient to 0ormulate hy&otheses 0or 0urther research or &olicies at the country level6/he 0ormulation o0 hy&otheses "ill reCuire additional country s&eci0ic kno"led$e6 /hedevelo&ment o0 &olicies "ill reCuire an in5de&th understandin$ o0 the determinants o0 thes&eci0ic indicators o0 economic "ell5bein$ and &overty and evidence on &ro$rams and &olicies6 For instance, in a country "here &ersons "ith disabilities e*&erience a lo"er em&loyment rate com&ared to &ersons "ithout disabilities, &rior to develo&in$ a &olicy or &ro$ram to increase em&loyment amon$ disabled &eo&le, one needs to 0ind out "hy theem&loyment rate is lo"6 +t could be because o0 many 0actors includin$: 3i4 the "ays ho"the underlyin$ health conditions reduce the &roductivity o0 disabled &eo&le 0or the ty&eso0 obs that are available in the labor marketG 3ii4 the lack o0 access to assistive devices or

&ersonal assistanceG 3iii4 conte*tual 0actors, 0or instance, a &hysically inaccessible "ork environment or ne$ative attitudes "ith res&ect to the ability to "ork o0 &ersons "ithdisabilitiesG andor 3iv4 the rules related to disability bene0its "hich may create incentives0or disabled &eo&le to dro& out o0 the labor market6 Once the main causes 0or lo"em&loyment rates 0or &ersons "ith disabilities in a &articular country are better understood, it becomes &ossible to introduce adeCuate, and &re0erably evidence5based, &ro$rams and &olicies to &romote em&loyment amon$ &ersons "ith disabilities6

51 D(#'9(&(*y P!e.'&e+%e

verall disability prevalence

1sin$ this study's base measure o0 disability as e*&lained above, the estimates o0 disability &revalence estimates amon$ "orkin$ a$e individuals are &resented in /able =66/he estimates vary tremendously: 0rom a lo" o0 &ercent in %ao PD( to a hi$h o0 < &ercent in Ban$ladesh6- /his 0i$ure re0ers to &eo&le "ho identi0y themselves as havin$ asevere or e*treme di00iculty in 0unctionin$ in at least one o0 the 0ollo"in$: inseein$reco$ni)in$ &eo&le across the road 3"hile "earin$ $lasseslenses4G movin$aroundG concentratin$ or rememberin$ thin$sG and "ith sel0 care6 /here could be a

- Disability &revalence estimates are not a$e standardi)ed6

variety o0 reasons "hy &revalence has such a "ide ran$e across countries6 +t could re0lectdi00erences in the &revalence o0 underlyin$ health conditions, as "ell as di00erences inconte*tual 0actors6 +t is also &ossible that cultural di00erences across countries mi$ht haveled to di00erent inter&retations by survey sta00 or res&ondents o0 the WHS Cuestions on0unctional and activity limitations6 Findin$ the determinants o0 disability &revalence in

the di00erent countries and e*&lainin$ cross5country di00erences is beyond the sco&e o0 this study6

T'9&e 51: D(#'9(&(*y P!e.'&e+%e =B'#e Me'#-!e> '/+ W!(+<Ae I+"(.("-'&# (+

16 De.e&8(+ C-+*!(e#

C-+*!y D(#'9(&(*y 8!e.'&e+%e

A&& M'&e# Fe/'&e# R-!'& U!9'+

S-9<S''!'+ A)!(%' Burkina Faso >6@; 3.6..@4 <6>? 3.6..@4 @6.. 3.6.4 ?6- 3.6.4 >6< 3.6..4

hana ?6= 3.6..<4 <6> 3.6..?4.6;

; 3.6..4 ?6- 3.6..>4 ?6<; 3.6..4

!enya ;6. 3.6..<4 6>- 3.6..?4 <6?. 3.6..@4 <6@ 3.6..>4 6.; 3.6.4

Mala"i -6@> 3.6.4 -6= 3.6.-46=

@ 3.6.4 =6.; 3.6.4 >6=? 3.6.?4

Mauritius 6= 3.6..?4 @6.; 3.6..46?

; 3.6..4 -6 3.6.4 .6< 3.6.4#ambia ;6>? 3.6..>4 6@? 3.6..>4 >6=@ 3.6..?4 <6;? 3.6..?4 =6. 3.6..?4

#imbab"e .6@? 3.6..>4 ?6@? 3.6..@4-6?

> 3.6..@4 -6@- 3.6..4 >6;- 3.6..4A#('

Ban$ladesh <6- 3.6..>4 @6@ 3.6..?4--6@

. 3.6.-4 >6- 3.6..@4 -6@- 3.6..4%ao PD( 6.? 3.6..4 -6> 3.6..=4 6=; 3.6..;4 6@ 3.6..=4 -6> 3.6..;4Pakistan ;6@@ 3.6..=4 6.- 3.6..=4 @6. 3.6..>4 =6; 3.6..<4 @6.- 3.6..@4

Phili&&ines ?6=@ 3.6..;4 >6<@ 3.6..<4 @6-@ 3.6..<4 @6>< 3.6..@4 >6>. 3.6..>4L'*(+ A/e!(%' '+" *e C'!(99e'+

Bra)il 6=; 3.6..?4 6 3.6..4<6=

. 3.6.4 <6 3.6.-.4 -6>< 3.6..?4Dominican(e&ublic ?6>- 3.6..<4 <6= 3.6..?4 6- 3.6..4 >6?- 3.6..@4 @6- 3.6..@4Me*ico ;6. 3.6..-4 =6. 3.6..-4 <6;. 3.6..4 ;6.> 3.6..=4 ;6> 3.6..-4Para$uay <6?> 3.6..=4 6@> 3.6..;4 @6>; 3.6..>4 >6= 3.6..<4 <6<< 3.6..<4

&ote:9ll estimates are "ei$hted6 Standard errors are in &arentheses and adusted 0or survey clusterin$ and strati0ication6Workin$5a$e individuals are a$ed ? to <;6 For e*&lanations on the base disability measure, see te*t6 9 number o0 observations 0or each country are sho"n in /able =6= belo"6

Source: 9uthorJs analysis based on WHS data as described in the te*t6

+n each o0 the ; countries, disability &revalence is 0ound to be hi$her amon$ "omenthan men6 For most countries, the $ender $a&, i6e6 the di00erence in disability &revalence

While this could be the case, it should be noted that in each country the WHS surveysta00 had to take the same trainin$ and 0ollo" the same instructions "hile administerin$the survey, and the Cuestionnaire "as subect to co$nitive testin$ in each country &rior toim&lementation6

bet"een 0emales and males is bet"een three and 0ive &ercenta$e &oints6 /he $ender $a&is the lar$est in Ban$ladesh: disability &revalence stands at - &ercent amon$ "omen,com&ared to . &ercent amon$ men, "hich $ives a $ender $a& o0 &ercenta$e &oints6/his result o0 a hi$her &revalence 0or "omen than men "as not 0ound in earlier casestudies in develo&in$ countries 30or e*am&le, Eide and !amaleri -..<G %oeb and Eide

-..=46 +t is, ho"ever, consistent "ith 0indin$s in develo&ed countries, althou$h the$ender $a& there "as 0ound to be small 3OE7D -..46 /o better understand this $ender $a& in disability &revalence in develo&in$ countries and its determinants, more researchis needed6

+n out o0 the ; countries under study, disability &revalence is hi$her in rural areasthan in urban centers6 9 hi$her &revalence in rural areas has been 0ound in earlier studiesin develo&in$ countries 30or e*am&le, World Bank -..@ 0or +ndia4, but 0urther research isneeded to understand i0 this is a systematic 0indin$6

9&&endi* B sho"s disability &revalence estimates "hen the e*&anded disabilitymeasure is used6 9s e*&lained earlier, the e*&anded measure includes severe or e*treme

di00iculty in at least one o0 the 0ollo"in$ ei$ht domains: seein$reco$ni)in$ &eo&le acrossthe road 3"hile "earin$ $lasseslenses4G movin$ aroundG concentratin$ or rememberin$thin$sG sel0 careG seein$reco$ni)in$ obect at armJs len$th 3"hile "earin$ $lasseslenses4G &ersonal relationshi&s&artici&ation in the communityG learnin$ a ne" taskG and dealin$"ith con0lictstension "ith others6 Disability &revalence "ith the e*&anded measureran$es 0rom a lo" o0 > &ercent in Me*ico to a hi$h o0 - &ercent in Bra)il6 %ike "ith the base disability measure, disability &revalence is hi$her 0or "omen than men in eachcountry, and amon$ rural &o&ulation com&ared to urban residents in most countries6

Disability prevalence by economic status

Disability &revalence is estimated by economic status 0irst by com&arin$ &revalence

across asset inde* or non5health P7E Cuintiles6 1sin$ base measures, the disability &revalence 0or each Cuintile 0rom the &oorest 30irst4 to the "ealthiest 30i0th4 is &resented inFi$ures =6 and =6-, and in 9&&endices B-a and B-b6 +n $eneral, Fi$ures =6 and =6-su$$est that disability &revalence tends to be hi$her in the &oorest Cuintiles than in the"ealthiest Cuintiles 0or both the asset inde* and non5health P7E6

Disability &revalence is then estimated in the lo"est 3or bottom4 Cuintile and com&ared tothe &revalence in the rest o0 the &o&ulation in /able =6-6= For the asset index, &revalencein the bottom Cuintile ran$es 0rom a lo" o0 ; &ercent in Me*ico to a hi$h o0 - &ercent inBan$ladesh and is hi$her in the bottom Cuintile in all but 0our countries 3hana, #ambia,Pakistan, and Me*ico46 /he di00erence in &revalence bet"een the bottom Cuintile and therest o0 the &o&ulation Cuintiles is statistically di00erent 0rom )ero in 0ive countries: !enya,Mauritius, Ban$ladesh, the Phili&&ines, and Bra)il6; +n !enya, disability &revalence is

= +n /able =6- and 9&&endi* B-, individuals are $rou&ed by household5levelcharacteristics such as assets and non5health P7E and then disability &revalence iscalculated "ithin each $rou&6 7alculations 0or &revalence in /ables =6 and =6- and9&&endi* B- utili)e WHS individual survey "ei$hts rather than household "ei$hts6; Si$ni0icantlyI and statistically si$ni0icantI are used interchan$eably in this study6+n the te*t, statistical si$ni0icance re0ers to si$ni0icance at the one5&ercent and 0ive5

almost double in the bottom Cuintile com&ared to the other Cuintiles 3@ &ercent versus = &ercent46 For non5health P7E, disability &revalence in the bottom P7E Cuintile ran$es0rom ; &ercent in %ao PD( to @ &ercent in Ban$ladesh and is hi$her in all countriese*ce&t Burkina Faso and the Dominican (e&ublic6 Ho"ever, the di00erence in &revalence bet"een the bottom Cuintile and the rest o0 the &o&ulation is small and not statistically

si$ni0icant in all countries e*ce&t in Ban$ladesh, the Phili&&ines, and Bra)il6 (esults areoverall similar "hen the e*&anded disability measure is used 39&&endi* B-c46

F(-!e 51: D(#'9(&(*y P!e.'&e+%e =B'#e Me'#-!e> '/+ W!(+<Ae I+"(.("-'&#,

9y A##e* I+"e -(+*(&e#

1st !uintile "nd !uintile #rd !uintile $th !uintile %th !uintile

ur*ina +aso ,hana -enya ala/i auritius 0ambia

0imbab/e

anladesh ao 2D3 2a*istan 2hilippines

&ercent levels6

ra4il Dominican 3epublic exico 2arauay

F(-!e 52: D(#'9(&(*y P!e.'&e+%e =B'#e Me'#-!e> '/+ W!(+<Ae I+"(.("-'&#,

9y N+<e'&* PCE -(+*(&e#

ur*ina +aso ,hana -enya ala/i auritius 0ambia

0imbab/e

anladesh ao 2D3 2a*istan 2hilippines

ra4il Dominican 3epublic exico 2arauay

T'9&e 52: D(#'9(&(*y P!e.'&e+%e =B'#e Me'#-!e> '/+ W!(+<Ae I+"(.("-'&#,

9y A##e* I+"e '+" N+<e'&* PCE -(+*(&e#

C-+*!y

A##e* (+"e PCE

B**/ -(+*(&e

U88e! )-!

-(+*(&e#

8<.'&-e +

.# -88e!)-! -(+*(&e#

B**/ -(+*(&e U88e! )-!

-(+*(&e#

8<.'&-e

.# -88e!)-! -(+*(&e#

S-9<S''!'+ A)!(%' BurkinaFaso .6. 3.6.-.4 >6=@ 3.6..@4 3.6@4 <6?? 3.6.4 ?6- 3.6..4 3.6?4hana <6>; 3.6..4 ?6<; 3.6..?4 3.6;4 @6? 3.6.=4 ?6? 3.6..>4 3.6;=4!enya @6. 3.6.4 =6- 3.6..>4 3.6..4 <6> 3.6..4 =6@@ 3.6..>4 3.6-=4Mala"i ;6.? 3.6.>4 -6-> 3.6..4 3.6.>4 =6=@ 3.6.@4 -6<. 3.6..4 3.6>4Mauritius <6- 3.6.?4 .6;? 3.6..@4 3.6..4 6=- 3.6.<4 .6?; 3.6..?4 3.64#ambia =6?< 3.6.-4 <6.- 3.6..?4 3.6=4 >6@ 3.6.=4 ;6< 3.6..>4 3.6-4#imbab"e -6>< 3.6.?4 .6;> 3.6..?4 3.6-?4 -6<> 3.6.?4 .6;; 3.6..?4 3.6.4A#(' Ban$ladesh -.6@= 3.6.>4 ;6- 3.6..>4 3.6..4 @6.> 3.6.<4 ;6; 3.6..>4 3.6.4%ao PD( 6@< 3.6..4 -6?< 3.6..4 3.6.4 =6<@ 3.6.4 -6<; 3.6..4 3.6.>4Pakistan ;6= 3.6.;4 <6-; 3.6..<4 3.6<=4 <6?> 3.6..4 ;6>; 3.6..=4 3.6-4Phili&&ines 6== 3.6.4 >6@; 3.6..;4 3.6..4 -6 3.6.-4 >6;< 3.6..;4 3.6..4L'*(+ A/e!(%' '+" *e C'!(99e'+ Bra)il ?6?> 3.6.-.4 -6= 3.6..?4 3.6..4 ?6-. 3.6.?4 -6. 3.6..?4 3.6..4Dominican(e&ublic .6>= 3.6.<4 ?6-< 3.6..>4 3.6<4 ?6; 3.6.-4 ?6?? 3.6..>4 3.6<-4Me*ico =6>@ 3.6..=4 ;6=- 3.6..-4 3.6-4 ;6<< 3.6..=4 ;6- 3.6..-4 3.6=4Para$uay >6> 3.6..@4 <6<> 3.6..;4 3.6.4 >6. 3.6..?4 <6? 3.6..;4 3.6?;4

&ote:P7E is in local currency6 For e*&lanations o0 the base disability measure, see te*t6 Standard errors are in &arenthesis and are adusted 0or survey clusterin$ and strati0ication6

Source: 9uthorsJ analysis based on WHS data as described in the te*t6

Disability &revalence is also estimated by &overty status, "hen &overty is measured usin$the P7E and international &overty lines, and "hen usin$ a multidimensional &overtymeasure6 When &overty status is measured usin$ the PPP 1SK6-; a day international &overty line, disability &revalence is si$ni0icantly hi$her amon$ the &oor than the non5 &oor in 0our countries: Mala"i, #ambia, the Phili&&ines, and Bra)il6 When &overty statusis measured usin$ the PPP 1SK- a day international &overty line, disability &revalence ishi$her in all countries e*ce&t Pakistan and the Dominican (e&ublic6 Ho"ever, thedi00erence is si$ni0icantly di00erent 0rom )ero in only three countries: #ambia, %ao PD(,

and Bra)il6 When &overty is measured throu$h a multidimensional measure, disability &revalence amon$ the &oor, i6e6 &ersons "ho e*&erience multi&le de&rivations issi$ni0icantly hi$her in out o0 = countries included in this analysis 3/able =646 Here,disability &revalence rate amon$ the &oor ran$es 0rom a lo" o0 6; &ercent in %ao PD( toa hi$h o0 -@6; &ercent in Mauritius6 +n several countries 3!enya, Ban$ladesh, andBra)il4, disability &revalence amon$ the multi5dimensionally &oor is close to t"o timeshi$her than amon$ the non5&oor6 /he dis&arity in disability &revalence is the most &ronounced in Mauritius, "here &revalence amon$ the multi5dimensionally &oor is three

times hi$her than amon$ the non5&oor6 Overall, it can be said that there are si$ni0icantdis&arities in disability &revalence in most countries by &overty status, "hen &overty ismeasured multi5dimensionally6

9&&endi* B &resents results o0 disability &revalence by &overty status usin$ thee*&anded disability measure6 (esults are overall similar6 One can also notice that,com&ared to the base disability measure, 0or each &overty measure under use, oneadditional country is 0ound to have a si$ni0icant di00erence in disability &revalence across &overty status6

T'9&e 53: D(#'9(&(*y P!e.'&e+%e =B'#e Me'#-!e> '/+ W!(+<Ae I+"(.("-'&#, 9y P.e!*y S*'*-#

P.e!*y /e'#-!e U+"e! US@126 ' "'y U+"e! US@2 ' "'y M-&*("(/e+#(+'& 8.e!*y

A/+ *e

8<.'&-e

.# ++<

A/+ *e

8<.'&-e

.# ++<

A/+ *e

8<.'&-e

.# ++<

S-9<S''!'+ A)!(%'

Burkina Faso ?6. 3.6..4 >6=< 3.6..4 .6;> ?6 3.6..4 <6;> 3.6.=4 .6= ?6-. 3.6.4 =6;. 3.6.4 .6.hana ?6;> 3.6..?4 ?6-- 3.6..?4 .6>; ?6>< 3.6..>4 >6- 3.6..?4 .6@ @6> 3.6.4 <6@= 3.6.4 .6.>!enya <6-. 3.6..?4 =6<- 3.6..@4 .6-. ;6; 3.6..>4 =6@? 3.6.-4 .6<@ <6> 3.6.4 6> 3.6.4 .6.-Mala"i 6= 3.6.-4 >6.= 3.6.;4 .6.. 6 3.6.-4 ?6?? 3.6.-<4 .6= 6;= 3.6.4 @6-@ 3.6.-4 .6.=Mauritius =6>? 3.6.;-4 6@ 3.6..?4 .6;- 6>< 3.6.-=4 6-= 3.6..?4 .6 -@6;= 3.6.4 .6. 3.6.4 .6..#ambia <6.> 3.6..>4 6@> 3.6..4 .6.= ;6@> 3.6..>4 -6?@ 3.6.=4 .6. <6@ 3.6.4 =6. 3.6.4 .6.A#('

Ban$ladesh <6== 3.6..4 ;6@. 3.6..@4 .6<= <6< 3.6..@4 =6@ 3.6.-4 .6 ?6=@ 3.6.4 ?6=> 3.6.4 .6..%ao PD( 6? 3.6..=4 -6?; 3.6..;4 .6<- 6 3.6..=4 6<< 3.6..;4 .6. 6; 3.6..4 -6 3.6..4 .6.@Pakistan ;6;? 3.6..<4 <6? 3.6..>4 .6=; ;6=> 3.6..=4 >6>> 3.6.4 .6.? <6= 3.6..4 ;6.< 3.6.4 .6Phili&&ines @6<= 3.6..?4 >6;> 3.6..<4 .6.- ?6?= 3.6..<4 >6<= 3.6..>4 .6; 6<> 3.6.4 <6@@ 3.6.4 .6..L'*(+ A/e!(%' '+" *e C'!(99e'+

Bra)il ?6; 3.6.@4 -6- 3.6..?4 .6.. >6@; 3.6.4 .6>. 3.6..?4 .6.. -6>; 3.6.-4 6-. 3.6.4 .6..Dominican (e&ublic ?6; 3.6.4 ?6?> 3.6..>4 .6<= >6@ 3.6..4 @6-= 3.6..@4 .6? 6?> 3.6.4 >6=@ 3.6.4 .6..Me*ico ;6>@ 3.6..=4 ;6? 3.6..-4 .6-- ;6== 3.6..4 ;6-- 3.6..-4 .6;; ?6. 3.6.4 =6? 3.6..4 .6..Para$uay <6@< 3.6..@4 <6?; 3.6..;4 .6@ >6.? 3.6..>4 <6>; 3.6..<4 .6<@ @6.< 3.6.4 ;6@ 3.6.4 .6..

&ote: Households &overty status "ith res&ect to the 1SK6-; or 1SK- a day &overty line is 0ound usin$ household P7E adustin$ 0or -..; PPP6 9llestimates are "ei$hted6 Poverty estimates 0or #imbab"e are omitted due to a lack o0 PPP 0i$ures 0or the years o0 analysis6 Standard errors are bet"een &arentheses and are adusted 0or survey clusterin$ and strati0ication6 For e*&lanations o0 the base disability measure, see te*t6

T'9&e 55: I+"(.("-'&<Le.e& E%+/(% We&&<9e(+ '%!## D(#'9(&(*y S*'*-# =B'#e Me'#-!e> '/+ W!(+<Ae I+"(.("-'&#

C-+*!y N-/9e! )

O9#e!.'*(+#

Me'+ ye'!# ) e"-%'*(+ w %/8&e*e" 8!(/'!y #%&

e/8&ye"

"(#'9(&(*y

8<.'&-e W(*

"(#'9(&(*y

8<.'&-e W(*

"(#'9(&(*y

8<.'&-e

S-9<S''!'+ A)!(%'

Burkina Faso . ,>@- 6 3.6.>-4 6< 3.6.-@4 3.6=;>4 ?6. 3.6.--4 6. 3.6..@4 3.6-;=4 =6. 3.6.=<4 ;@6. 3.6.?4 3.6...4hana -<= -,?= -6= 3.6.@4 -6< 3.6.=.4 3.6.-.4 ;=6. 3.6.>4 <;6. 3.6.>4 3.6..4 >?6. 3.6.;4 ><6. 3.6.4 3.6;;?4

!enya -? ,;< 6-= 3.6-;=4 6=? 3.6.;?4 3.6<4 ;@6. 3.6.;?4 >=6. 3.6.>4 3.6..?4 ;>6. 3.6.=@4 <6. 3.6.=4 3.6-.4

Mala"i =<- ,@@ 6@> 3.6.;?4 -6> 3.6.?4 3.6...4 ?6. 3.6.4 -?6. 3.6.;4 3.6..4 ;6. 3.6..4 ;-6. 3.6.-4 3.6;-?4

Mauritius ?@ -,?>< -6>? 3.6.<?4 6=> 3.6.=-4 3.6...4 <>6. 3.6..4 ?>6. 3.6..@4 3.6...4 =-6. 3.6.-4 <<6. 3.6.4 3.6...4

#ambia >@ -,>@; -6< 3.6.?@4 -6<; 3.6.<4 3.6..4 =6. 3.6.=>4 ;>6. 3.6.-=4 3.6..4 <.6. 3.6.;-4 <.6. 3.6.--4 3.6@<4

#imbab"e @. -,<;< -6?- 3.6.>?4 6= 3.6.=-4 3.6...4 <;6. 3.6.4 ?-6. 3.6.4 3.6...4 =6. 3.6.=4 -6. 3.6.?4 3.6;.4

Ban$ladesh @-> ,@<? 6@> 3.6.;@4 -6=? 3.6.=4 3.6...4 .6. 3.6.--4 =?6. 3.6.=4 3.6...4 ;6. 3.6.--4 ;=6. 3.6.4 3.6...4

%ao PD( -> ,;.? -6; 3.6=<4 -6>? 3.6.=<4 3.6..4 =6. 3.6.;;4 ;;6. 3.6.;4 3.6.->4 >>6. 3.6.=@4 ?-6. 3.6..@4 3.6<4

Pakistan -. =,@< 6@. 3.6..4 -6? 3.6.=>4 3.6...4 ->6. 3.6.-4 =-6. 3.6.-4 3.6...4 -@6. 3.6.-4 ;-6. 3.6.4 3.6...4

Phili&&ines ?;- ?,.- 6= 3.6.<4 6> 3.6.-@4 3.6...4 ><6. 3.6.-4 ?<6. 3.6..>4 3.6...4 =@6. 3.6.-=4 ;;6. 3.6..@4 3.6.?4

L'*(+ A/e!(%' '+" *e C'!(99e'+

Bra)il =. -,==- -6? 3.6.>@4 6>. 3.6.=>4 3.6...4 ;>6. 3.6.-@4 ?6. 3.6.4 3.6...4 =?6. 3.6.-@4 <6. 3.6.4 3.6...4

Dominican

(e&ublic

;= ,@? -6>- 3.6.4 -6>@ 3.6.=@4 3.6;->4 =-6. 3.6.?4 ;.6. 3.6.?4 3.6.=4 ;=6. 3.6.;4 <6. 3.6.4 3.6.=4

Me*ico ,? -,..- =6. 3.6.-4 =6-. 3.6..4 3.6...4 <6. 3.6.?4 ><6. 3.6..<4 3.6...4 @6. 3.6.;4 ;<6. 3.6..=4 3.6...4

Para$uay ;@ =,-.- -6?= 3.6.?-4 6-@ 3.6.-4 3.6...4 ;<6. 3.6.4 >-6. 3.6..@4 3.6...4 =@6. 3.6..4 <;6. 3.6..@4 3.6...4

&ote 9ll estimates are "ei$hted6 Standard errors are re&orted in &arentheses and are adusted 0or survey clusterin$ and strati0ication6 P5value is re&orted in thedi00erence bet"een &ersons "ith and "ithout disabilities6

52 I+"(.("-'&<Le.e& E%+/(% We&&<9e(+

Descri&tive statistics on the individual5level economic "ell5bein$ amon$ "orkin$5a$e &ersons "ith disabilities as &er base disability measure are &resented in /able =6= above6/he results usin$ e*&anded measure o0 disability are &resented in 9&&endi* B=6 Fi$ures=6 and =6= &resent the rates o0 &rimary school com&letion and the rates o0 em&loymentamon$ "orkin$5a$e &ersons "ith and "ithout disabilities in the ; countries6

Disability and schooling

Persons "ith disabilities have a mean number o0 years o0 education that is in statisticalterms si$ni0icantly smaller com&ared to &ersons "ithout disabilities 3/able =6=4 in allcountries e*ce&t Burkina Faso, !enya and the Dominican (e&ublic6 %ike"ise, the &ercenta$e o0 individuals "ho have com&leted &rimary education is si$ni0icantly lo"er amon$ &ersons "ith disabilities in all countries e*ce&t Burkina Faso 3Fi$ure =6 and/able =6=46 /he same results are 0ound usin$ the e*&anded disability measure 39&&endi*B=4, e*ce&t 0or !enya "here the di00erence in years o0 schoolin$ across disability status

then becomes si$ni0icantly di00erent 0rom )ero6 /his result is consistent "ith the 0indin$in the literature that &ersons "ith disabilities have lo"er educational attainment asrevie"ed earlier6

F(-!e 53: P!(/'!y S%& C/8&e*(+ R'*e#, 9y D(#'9(&(*y S*'*-#

0.500.60

Disability No Disability

+t is interestin$ to note that the dis&arities in educational attainment bet"een &ersons "ithand "ithout disabilities $reatly vary across countries6 /he lar$est di00erence in &rimaryschool com&letion rates across disability status is 0ound in Bra)il 3- &ercenta$e &oints40ollo"ed by Mauritius 3- &ercenta$e &oints4, "hile the smallest di00erence is 0ound inBurkina Faso 3three &ercenta$e &oints46 When dis&arities in &rimary school com&letion

are measured by the ratio o0 the com&letion rates o0 &ersons "ith and "ithout disabilities,dis&arities are most &ronounced in Mala"i, Ban$ladesh, and Pakistan, "here the &rimaryschool com&letion rates o0 &ersons "ith disabilities are <= &ercent, < &ercent, and <; &ercent o0 the &rimary school com&letion rates o0 &ersons "ithout disabilitiesres&ectively6 For other countries, this ratio is hi$her and ran$es 0rom > &ercent in Bra)ilto ?? &ercent in the Phili&&ines6

Disability and employment

Fi$ure =6= &resents the ratio bet"een the em&loyment rate o0 &ersons "ith disabilities andthe em&loyment rate o0 &ersons "ithout disabilities6 /his ratio is commonly used in thedisability and em&loyment literature 30or e*am&le, OE7D -.. and OE7D -..@4 to

indicate the level o0 labor market inte$ration o0 disabled &eo&le6 9 ratio at, above, or close to, one su$$ests that "orkin$5a$e &ersons "ith disabilities access em&loyment tothe same de$ree as &ersons "ithout disabilities6

F(-!e 55: Re&'*(.e E/8&y/e+* R'*e# ) Pe!#+# w(* D(#'9(&(*(e#

&ote: /he ratio is the em&loyment rate o0 &ersons "ith disabilities divided by the em&loyment rate o0 &ersons "ithout disabilities6

9s sho"n in /able =6= and Fi$ure =6= above, &ersons "ith disabilities have lo"er em&loyment rates in all countries e*ce&t in hana, #ambia, and #imbab"e6< /hedi00erence is statistically si$ni0icant in nine out o0 ; countries as 0ollo"s: Burkina Faso,Mauritius, Ban$ladesh, Pakistan, the Phili&&ines, Bra)il, Dominican (e&ublic, Me*ico,and Para$uay6

Overall, the estimates su$$est that in most o0 the countries included in the study, &ersons"ith disabilities as a $rou& have si$ni0icantly lo"er educational attainment than &ersons"ithout disabilities6 7om&aratively, they have 0e"er years o0 education and lo"er &rimary school com&letion rates6 Similarly, they have lo"er em&loyment rates than &ersons "ithout disabilities6 +n maority 3<. &ercent4 o0 the countries the di00erence inem&loyment rates to the detriment o0 disabled &eo&le "as statistically si$ni0icant6 53H-#e&"<Le.e& E%+/(% We&&<9e(+

Descri&tive statistics on household5level economic indicators across disability status are &resented 0or the base disability measure in /ables =6; and =6< belo"6 /he results usin$

the e*&anded disability measure are in 9&&endices B;a and B;b6 $sset ownership and living conditions

9s sho"n in /able =6;, households "ith disabilities have a si$ni0icantly lo"er mean assetinde* in . out o0 ; countries6 Fi$ure =6; &resents the asset inde* ratioG that is, the ratio bet"een the mean asset inde* score o0 households "ith disabilities and the mean assetinde* o0 households "ithout disabilities6 9 ratio at, above, or close to, one su$$ests thathouseholds "ith disabilities e*&erience similar asset accumulation as households "ithoutdisabilities6 Out o0 ; countries, the asset inde* ratio is belo" .6?. in 0ive countries3Burkina Faso, !enya, Mala"i, #imbab"e, and Ban$ladesh46 On the other hand,Pakistan sho"s hi$her levels o0 asset o"nershi& 0or households "ith disabilities, "hile

the Dominican (e&ublic and Me*ico sho" similar levels across household disabilitystatus6 Households "ith disabilities are statistically si$ni0icantly over5re&resented in the bottom Cuintile o0 asset inde* scores in < out o0 ; countries6 For instance, < &ercent o0 households "ith disabilities in !enya and -? &ercent in Bra)il are in the bottom Cuintileo0 asset inde* scores6 Fi$ure =6< com&ares the &ercenta$e o0 households 0allin$ in the bottom asset inde* Cuintile across disability status6

< /he result 0or #imbab"e is similar to that 0ound in Eide et al6 3-..a46 +n contrast, 0or #ambia, Eideand %oeb 3-..<4 and /rani and %oeb 3-..4 0ound lo"er em&loyment rates 0or &ersons "ith disabilities6/o the authors' kno"led$e, no additional evidence is available in hana6

F(-!e 56: R'*(# ) Me'+ A##e* I+"e S%!e: H-#e&"# w(* D(#'9(&(*(e#

* O*e! H-#e&"#

&ote: /he ratio is the mean asset inde* score o0 &ersons "ith disabilities divided by the

mean asset inde* score o0 &ersons "ithout disabilities6

F(-!e 57: Pe!%e+*'e ) H-#e&"# (+ *e B**/ A##e* I+"e -(+*(&e,

9y D(#'9(&(*y S*'*-#

Per capita non-health expenditure

Me'+ ++<e'&* PCE /hree countries 5 Mauritius, Bra)il, and Me*ico 5 have a meannon5health P7E that is statistically lo"er in households "ith disabilities 3/able =6;46 +n0ive countries 5 Ban$ladesh, %ao PD(, the Phili&&ines, Bra)il, and Mala"i 5 the share o0 households in the bottom P7E Cuintile is hi$her amon$ households "ith disabilities 3the

mean P7E 0or all households at the -.th &ercentile is used as a cuto00 &oint46 Fi$ure =6> &resents the P7E ratioG that is, the ratio bet"een the mean P7E o0 households "ithdisabilities and the mean P7E o0 households "ithout disabilities6 (esults vary "idelyacross countries, "ith 0our o0 ; countries sho"in$ ratios "ell above one, su$$estin$hi$her mean P7E 0or households "ith disabilities, and 0our countries at or belo" .6?,su$$estin$ lo"er mean P7E 0or households "ith disabilities6

F(-!e 54: R'*(# ) Me'+ N+<e'&* PCE: H-#e&"# w(* D(#'9(&(*(e#

* H-#e&"# w(*-* D(#'9(&(*(e#

Burkina Faso Kenya Mauritius Banla!es" #akistan Bra$il Me%i&o

&ote: /he ratio is the mean non5health P7E o0 &ersons "ith disabilities divided by the mean

non5health P7E o0 &ersons "ithout disabilities6

Fi$ure =6? com&ares the &ercenta$e o0 households 0allin$ in the bottom P7E Cuintile

across disability status6 Households "ith disabilities are statistically si$ni0icantly over5re&resented in the bottom Cuintile o0 P7E in 0ive out o0 ; countries 3Mala"i, %ao PD(,Ban$ladesh, the Phili&&ines, and Bra)il46 For instance, &ercent o0 households "ithdisabilities in %ao PD( and -? &ercent in Bra)il are in the bottom Cuintile o0 P7E6

F(-!e 5;: Pe!%e+*'e ) H-#e&"# (+ *e B**/ PCE -(+*(&e, 9y

D(#'9(&(*y S*'*-#

T'9&e 56: H-#e&"<Le.e& E%+/(% We&&<9e(+ Me'#-!e# '/+ H-#e&"# w(*w(*-* ' W!(+<Ae Pe!#+ w(*

D(#'9(&(*(e# =B'#e Me'#-!e>

C-+*!y H-#e&"#

"(#'9(&(*(e#

H-#e&"#

w(* "(#'9(&(*(e#

-#e&"#

8<.'&-e H-#e&"#

w(* "(#'9(&(*(e#

-#e&"#

8<.'&-e

N-/9e! )

9#e!.'*(+#

Me'+ '##e* (+"e Me'+ ++<e'&* PCE

S-9<S''!'+ A)!(%' Burkina Faso . ,>@- ?6.- 3.6?.4 .6=- 3.6;-4 3.6..-4 .6@ 3-6<4 6? 36.;4 3.6?;4hana -<= -,?= -6;; 36;;4 -;6=@ 3.6>?<4 3.6=4 <-6< 3>6?;.4 <6<@ 3<6=>-4 3.6?>@4!enya -? ,;< >6-> 3-6>@4 -6<= 36??;4 3.6.@4 <;6; 3@6?@4 @;6; 3?6;-?4 3.6<=4Mala"i =<- ,@@ ;6< 3.6<@-4 >6-> 3.6;@;4 3.6...4 =6<; 36<4 =6@. 3.6@@=4 3.6@=4Mauritius ?@ -,?>< >;6- 3.6@>4 >@6;= 3.6<;-4 3.6...4 ->6<; 3;6=-=4 =;6?. 3;6@;-4 3.6..<4#ambia >@ -,>@; 6?- 3-6-;@4 <6 3-64 3.6--4 ?6? 36?->4 -6-< 3-6==4 3.6.@<4#imbab"e @. -,<;? --6; 36?;.4 .6? 36<>?4 3.6...4 na na na na naA#(' Ban$ladesh @-> ,@<? 6>; 3.6?.=4 ;6;= 3.6>.4 3.6...4 ;6? 3=6>>4 =>6<. 36?.@4 3.6==>4%ao PD( -> ,;.? -6> 36>;4 -<6-< 3.6@>4 3.6.4 -@6?< 3=6>?4 >6@- 36@?.4 3.6.>?4Pakistan -. =,@< =.6< 3-6=?>4 <6.; 36?4 3.6..4 ;6-; 3<6>@>4 =;6?. 3-6>@-4 3.6.4Phili&&ines ?;- ?,.- =>6- 36=>4 ;-6. 3.6<>.4 3.6...4 =@6?@ 3-6<;4 ;6> 36>.4 3.6-@4L'*(+ A/e!(%' '+" *e C'!(99e'+

Bra)il =. -,==- ?.6<= 36->4 ?;6 3.6;?4 3.6...4 @<6;. 3<6=.;4 <<6- 36<;4 3.6...4Dominican (e&ublic ;= ,@? <6.= 36@<4 <=6> 36.?<4 3.6;;4 ->6? 3-6=@4 ?6. 3;6>=?4 3.6=;<4

Me*ico ,? -,..- ?6< 3.6<.;4 ?6.- 3.6=?-4 3.6-@4 -=>6;; 3-?6@..4 @.6< 3<6>-4 3.6.=>4Para$uay ;@ =,-.- =?6- 36>@4 ;6> 3.6;;4 3.6..4 .?6>< 3>6><4 -6@ 36<@>4 3.6>4

&ote: 9ll estimates are "ei$hted6 Standard errors are re&orted in &arentheses and are adusted 0or survey clusterin$ and strati0ication6 P5value is re&orted in thedi00erence bet"een household "ith and "ithout disabilities6 Household &overty status "ith res&ect to the 1SK6-; or 1SK- a day &overty line is 0oundusin$ household non5health P7E adustin$ 0or PPP 0or -..;6 P7E estimates 0or #imbab"e are omitted due to the lack o0 accurate PPP 0i$ures 0or the year o0 analysis6

T'9&e 57: H-#e&"<Le.e& E%+/(% We&&<9e(+ Me'#-!e# '/+ H-#e&"# w(*w(*-* ' W!(+<Ae Pe!#+ w(*

D(#'9(&(*y =B'#e Me'#-!e>

C-+*!y H-#e&"#

w(* "(#'9(&(*(e#

-#e&"#

8<.'&-e H-#e&"#

w(* "(#'9(&(*(e#

-#e&"#

8<.'&-e H-#e&"#

w(* "(#'9(&(*(e#

-#e&"#

8<.'&-e

R'*( ) e'&* * **'& e8e+"(*-!e# (+ 9**/ -(+*(&e '##e* (+"e (+ 9**/ -(+*(&e PCE

S-9<S''!'+ A)!(%' Burkina Faso .6. 3.6.4 .6.@ 3.6..;4 3.6>?4 .6-? 3.6.=-4 .6@ 3.6.@4 3.6.=;4 .6> 3.6..4 .6-. 3.6.<4 3.6-<=

hana .6 3.6.-4 .6.? 3.6..=4 3.6.<4 .6< 3.6.-4 .6-. 3.6.;4 3.6.@4 .6-. 3.6.-<4 .6-. 3.6.-4 3.6?=-!enya .6- 3.6.@4 .6.< 3.6..<4 3.6.4 .6< 3.6.;4 .6@ 3.6.>4 3.6..4 .6-< 3.6.@4 .6-. 3.6.=4 3.6.@>Mala"i .6.; 3.6..?4 .6.= 3.6..=4 3.6=?4 .6- 3.6.--4 .6-. 3.6.4 3.64 .6- 3.6.-.4 .6-. 3.6.=4 3.6.=>Mauritius .6. 3.6..>4 .6.> 3.6..4 3.6...4 .6-? 3.6.-@4 .6@ 3.6.4 3.6..4 .6- 3.6.->4 .6-. 3.6.=4 3.6;>#ambia .6.- 3.6..;4 .6.- 3.6..-4 3.6@><4 .6? 3.6.>4 .6-. 3.6.-@4 3.6;?<4 .6-< 3.6.=@4 .6-. 3.6.->4 3.6<-#imbab"e .6.= 3.6..@4 .6. 3.6..=4 3.6?-4 .6- 3.6.->4 .6-. 3.6.<4 3.6<==4 .6-- 3.6.4 .6-. 3.6.4 3.6=.<A#(' Ban$ladesh .6< 3.6..<4 .6 3.6..4 3.6...4 .6-; 3.6.--4 .6@ 3.6.=4 3.6..4 .6- 3.6.?4 .6@ 3.6.4 3.6.=%ao PD( .6; 3.6.-=4 .6 3.6..=4 3.6.@>4 .6-? 3.6.;-4 .6-. 3.6.>4 3.6.?<4 .6 3.6.;;4 .6-. 3.6.-4 3.6.-Pakistan .6; 3.6.4 .6- 3.6..4 3.6.4 .6> 3.6.<-4 .6-. 3.6.;4 3.6;@@4 .6-> 3.6.=@4 .6-. 3.6.>4 3.6=Phili&&ines .6 3.6..?4 .6.? 3.6..4 3.6...4 .6-; 3.6.-4 .6@ 3.6.4 3.6..;4 .6-? 3.6.--4 .6@ 3.6..@4 3.6...L'*(+ A/e!(%' '+" *e C'!(99e'+

Bra)il .6< 3.6.-4 .6- 3.6..;4 3.6..;4 .6-? 3.6.-@4 .6@ 3.6.;4 3.6...4 .6-? 3.6.-;4 .6@ 3.6.4 3.6...Dominican(e&ublic .6> 3.6.?4 .6. 3.6..=4 3.6...4 .6-< 3.6.=.4 .6@ 3.6.?4 3.6.<;4 .6- 3.6.-?4 .6-. 3.6.4 3.6<?-Me*ico .6.? 3.6..>4 .6.= 3.6..4 3.6...4 .6? 3.6.4 .6-. 3.6..4 3.6.=-4 .6-. 3.6.=4 .6-. 3.6..>4 3.6>;;

Para$uay .6- 3.6..4 .6.@ 3.6..4 3.6..<4 .6- 3.6.-=4 .6-. 3.6..@4 3.6??4 .6- 3.6.-4 .6-. 3.6..>4 3.6;>;

&ote: 9ll estimates are "ei$hted6 Standard errors are re&orted in &arentheses and are adusted 0or survey clusterin$ and strati0ication6 P5value is re&orted in thedi00erence bet"een household "ith and "ithout disabilities6 Household &overty status "ith res&ect to the 1SK6-; or 1SK- a day &overty line is 0ound usin$household non5health P7E adustin$ 0or PPP 0or -..;6 P7E estimates 0or #imbab"e are omitted due to the lack o0 accurate PPP 0i$ures 0or the year o0 analysis6

T'9&e 54: P.e!*y He'"%-+*, G'8, '+" P.e!*y Se.e!(*y '/+ H-#e&"# w(*w(*-* ' W!(+<Ae Pe!#+ w(*

D(#'9(&(*y, B'#e" + N+<e'&* PCE =B'#e Me'#-!e>

C-+*!y H-#e&"#

w(* "(#'9(&(*(e#

-#e&"#

8<.'&-e H-#e&"#

w(* "(#'9(&(*(e#

-#e&"#

8<.'&-e H-#e&"#

w(* "(#'9(&(*(e#

-#e&"#

8<.'&-e

P.e!*y e'"%-+* 3US@126 ' "'y> P.e!*y '8 3US@126 ' "'y> P.e!*y #e.e!(*y 3US@126 ' "'y>

S-9<S''!'+ A)!(%' Burkina Faso .6>; 3.6.-<4 .6>; 3.6.<4 3*6631 .6> 3.6.-4 .6@ 3.6.=4 3*721 .6- 3.6.-4 .6-; 3.6.-4 3*,871

hana .6=> 3.6.4 .6=@ 3.6.=4 3*7271 .6- 3.6.@4 .6- 3.6..@4 3*6,91 .6- 3.6.=4 .6- 3.6..<4 3*81!enya .6;. 3.6.<;4 .6? 3.6.-.4 3*7;1 .6- 3.6.4 .6? 3.6.4 3*6;1 .6= 3.6.--4 .6 3.6..?4 3*2;81

Mala"i .6@< 3.6.4 .6@- 3.6..@4 3*1 .6>. 3.6.>4 .6<? 3.6.-4 3*21 .6;< 3.6.?4 .6;= 3.6.-4 3*261

Mauritius .6.- 3.6..<4 .6. 3.6..-4 3*3,71 .6.. 3.6..-4 .6.. 3.6..4 3*;,91 .6.. 3.6..4 .6.. 3.6...4 3*9921

#ambia .6?< 3.6.-<4 .6?= 3.6.-=4 3*,8;1 .6;? 3.6.4 .6;- 3.6.4 3*771 .6== 3.6.4 .6> 3.6.4 3*721

A#(' Ban$ladesh .6;> 3.6.--4 .6;? 3.6.=4 3*9221 .6-. 3.6..4 .6? 3.6..>4 3*81 .6.@ 3.6..<4 .6.? 3.6..=4 3*,81

%ao PD( .6> 3.6.==4 .6<@ 3.6.<4 3*;91 .6== 3.6.=4 .6? 3.6.4 3*2691 .6= 3.6.=<4 .6-> 3.6.4 3*21

Pakistan .6=< 3.6.<=4 .6;- 3.6.;4 3*,,61 .6? 3.6.->4 .6> 3.6..4 3*9281 .6.@ 3.6.;4 .6.? 3.6..=4 3*,9;1

Phili&&ines .6=@ 3.6.-;4 .6= 3.6.4 3*2;1 .6-- 3.6.;4 .6> 3.6..<4 3*1 .6 3.6.4 .6.@ 3.6..=4 3*1

L'*(+ A/e!(%' '+" *e C'!(99e'+

Bra)il .6-= 3.6.-;4 .6< 3.6.4 3*21 .6. 3.6.4 .6.? 3.6..<4 3*781 .6.< 3.6..4 .6.; 3.6..=4 3*3621

Dominican(e&ublic .6-. 3.6.->4 .6? 3.6..@4 3*331 .6- 3.6.@4 .6.? 3.6..;4 3*781 .6.@ 3.6.>4 .6.; 3.6..=4 3*3;1

Me*ico .6@ 3.6.=4 .6? 3.6..>4 3*7271 .6.@ 3.6..?4 .6.? 3.6..=4 3*3,91 .6.< 3.6..>4 .6.; 3.6..4 3*9,1

Para$uay .6? 3.6.--4 .6> 3.6..>4 3*731 .6.? 3.6.4 .6.< 3.6..=4 3*3781 .6.; 3.6..4 .6.= 3.6..4 3*2671 &ote: Standard errors are re&orted in &arentheses and are adusted 0or survey clusterin$ and strati0ication6 Household &overty status "ith res&ect to the 1SK6-; a

day &overty line is 0ound usin$ household P7E adustin$ 0or PPP 0or -..;6 Poverty estimates 0or #imbab"e are omitted due to the lack o0 accurate PPP0i$ures 0or the years o0 analysis6

Source: 9uthorJs analysis based on WHS data as described in the te*t6

T'9&e 5;: M-&*("(/e+#(+'& P.e!*y A+'&y#(# )! Pe!#+# w(* '+" w(*-* D(#'9(&(*(e#

Pe!#+# w(* "(#'9(&(*(e# Pe!#+# w(*-* "(#'9(&(*(e#

Obs H P5value 9 P5value M. P5value Obs H 9 M.

S-9<S''!'+ A)!(%'

Burkina Faso . .6@< 3.6.4 .6. .6>> 3.6.-4 .6.. .6>= 3.6.-4 .6.. ,>@- .6@ 3.6.4 .6> 3.6.4 .6<< 3.6.4

hana -<= .6<> 3.6.=4 .6.< .6<. 3.6.4 .6. .6=. 3.6.-4 .6.- -,?= .6<. 3.6.-4 .6;> 3.6..4 .6= 3.6.4

!enya -? .6<> 3.6.>4 .6. .6<< 3.6.-4 .6. .6== 3.6.;4 .6. ,;< .6;- 3.6.-4 .6< 3.6.4 .6- 3.6.-4

Mala"i =<- .6@. 3.6.-4 .6. .6<? 3.6.4 .6. .6<- 3.6.4 .6.. ,@@ .6?< 3.6.-4 .6<< 3.6..4 .6;> 3.6.4

Mauritius ?@ .6; 3.6.-4 .6.. .6; 3.6.4 .6; .6.? 3.6.4 .6.. -,?>< .6.; 3.6.4 .6;- 3.6.4 .6.- 3.6..4

#ambia >@ .6? 3.6.=4 .6.= .6<- 3.6.4 .6- .6; 3.6.-4 .6. -,>@; .6> 3.6.=4 .6< 3.6.4 .6== 3.6.-4

Ban$ladesh @-> .6?? 3.6.4 .6.. .6>- 3.6.4 .6.. .6< 3.6.4 .6.. ,@<? .6>; 3.6.4 .6<< 3.6..4 .6;. 3.6.4

%ao PD( -> .6>- 3.6.;4 .6.> .6< 3.6.-4 .6=. .6=; 3.6.=4 .6.< ,;.? .6< 3.6.-4 .6< 3.6..4 .6? 3.6.4

Pakistan -. .6>= 3.6.4 .6- .6<> 3.6.-4 .6;- .6=@ 3.6.4 .6 =,@< .6<@ 3.6.4 .6<< 3.6..4 .6=; 3.6.4

Phili&&ines ?;- .6== 3.6.-4 .6.. .6;? 3.6.4 .6.. .6-< 3.6.4 .6.. ?,.- .6 3.6.4 .6;; 3.6..4 .6> 3.6.4

L'*(+ A/e!(%' '+" *e C'!(99e'+

Bra)il =. .6- 3.6.4 .6.. .6;> 3.6.4 .6.. .6? 3.6.-4 .6.. -,==- .6< 3.6.4 .6;= 3.6.4 .6.@ 3.6.4

Dominican (e&ublic ;= .6? 3.6.=4 .6.. .6;? 3.6.4 .6= .6-- 3.6.-4 .6.. ,@? .6-> 3.6.4 .6;> 3.6..4 .6; 3.6.4

Me*ico ,?

.6-- 3.6.4 .6.. .6;= 3.6.4 .6>? .6- 3.6.4 .6.. -,..- .6= 3.6.4 .6;= 3.6..4 .6.> 3.6..4

Para$uay ;@ .6=. 3.6.4 .6.. .6<= 3.6.4 .6.. .6-; 3.6.-4 .6.. =,-.- .6-@ 3.6.4 .6;@ 3.6..4 .6> 3.6.4

&otes: Standard errors are in &arentheses and are adusted 0or survey clusterin$ and strati0ication6 P5value 0or 9dusted Wald /est 0or di00erence in values acrossdisability status6 Poverty 7uto00: kd =.6 9 &erson is considered &oor i0 heshe is de&rived in at least a sum o0 0our out o0 . dimensions6

<H= is the multidimensional headcount "hich measures the share o0 &eo&le "ho are multi5dimensionally &oorG $= avera$e de&rivation share: the &ercenta$eo0 dimensions that the &oor are de&rived inG and <# = is the adusted headcount: the ratio o0 the number o0 de&rivations e*&erienced by the &oor to the totalnumber o0 &ossible de&rivations that the entire &o&ulation could e*&erience6

Source: 9uthorsJ calculations based on WHS data6

P.e!*y /e'#-!e# 9'#e" + ++<e'&* PCE Poverty headcounts, $a&s, and severityare &resented in /able =6< and Fi$ures =6> and =6? above and Fi$ures =6@, =6. and =6 belo", usin$ the non5health P7E as "el0are a$$re$ate and international &overty lines o0 e*treme &overty 31SK6-;46

9s &resented in /able =6> above, in most countries, the headcounts under the e*treme &overty line 31SK6-;4 are close both 0or households "ith disabilities and other households6 /he di00erence across disability status is statistically si$ni0icant in three outo0 ; countries: Mala"i, the Phili&&ines, and Bra)il6 +n - o0 ; countries, households"ith disabilities have hi$her &overty $a&s 3P4 than other householdsG ho"ever, thisdi00erence is statistically si$ni0icant only in the Phili&&ines6 Similarly, &overty severity3P-4 is hi$her 0or households "ith disabilities across most countries, "ith Ban$ladesh, thePhili&&ines, and the Dominican (e&ublic sho"in$ statistically si$ni0icant di00erences6

0atio of health to total expenditures

/he mean ratio o0 health to total household e*&enditures is si$ni0icantly hi$her 0or

households "ith disabilities in . out o0 ; countries irres&ective o0 "hether the base3/able =6>, Fi$ure =6@4 or the e*&anded disability measure 39&&endi* B<4 is used6

F(-!e 5: R'*( ) He'&* * T*'& E8e+"(*-!e#, 9y H-#e&" D(#'9(&(*y

S*'*-# =B'#e Me'#-!e>

/o summari)e, at the household level, the economic situation o0 households "ithdisabilities varies by dimension6 +n a maority o0 countries 3. out o0 ;4, households"ith disabilities have a si$ni0icantly lo"er mean asset inde*6 9lso, a hi$her &ercenta$eo0 households "ith disabilities belon$ed to the bottom asset Cuintile and this di00erence"as statistically si$ni0icant in si* out o0 ; countries6 Households "ith disabilities, on

avera$e, also re&ort s&endin$ a hi$her &ro&ortion o0 their e*&enditure on health care6 /hemean ratio o0 health to total household e*&enditures "as si$ni0icantly hi$her 0or households "ith disabilities in . out o0 ; countries irres&ective o0 "hether the base or the e*&anded disability measure is used6 +n contrast, descri&tive statistics do not su$$estthat households "ith disabilities "ere "orse o00 as &er mean non5health P7E6 Only three

countries had statistically si$ni0icant lo"er mean non5health P7E and only 0ive had theshare o0 households in the bottom P7E Cuintile si$ni0icantly hi$her amon$ households"ith disabilities6 +n terms o0 &overty measures based on the P7E as a "el0are a$$re$ate,the di00erence in the &overty status bet"een households "ith and "ithout disabilities "asstatistically si$ni0icant only in very 0e" countries6

55 M-&*("(/e+#(+'& P.e!*y Me'#-!e

0esults

+n this section, "e look at &overty throu$h a multidimensional lens, usin$ the dimensionsthat have been looked at so 0ar one a0ter the other: education, em&loyment, assetslivin$

conditions, household, and health services e*&enditures6 9ll countries analy)ed so 0ar areincluded e*ce&t #imbab"e 0or "hich reliable P7E PPP data is not available6 (esultsobtained usin$ the method &ro&osed by 9lkire and Foster 3-..@4 are &resented in /able=6? above6 9 hi$her headcount is 0ound amon$ &ersons "ith disabilities 0or everycountry, as sho"n in Fi$ure =6.6 /he di00erence across disability status is 0ound to bestatistically si$ni0icant in all countries e*ce&t hana, %ao PD(, and Pakistan6 /hedi00erence in the multidimensional headcount ratio across disability status is the lar$est in!enya 3; &ercenta$e &oints4 and the lo"est in Burkina Faso 3three &ercenta$e &oints46

F(-!e 510: M-&*("(/e+#(+'& P.e!*y He'"%-+* R'*( '%!## D(#'9(&(*y

S*'*-# =B'#e Me'#-!e>

/he avera$e de&rivation shareG that is, the total number o0 de&rivations o0 the &oor divided by the ma*imum number o0 de&rivations that the &oor could 0ace + is si$ni0icantlyhi$her amon$ &ersons "ith disabilities in nine out o0 ; countries6 +n other "ords, in amaority o0 the countries under study, the &oor "ith disabilities 0ace more de&rivationsthan the &oor "ithout disabilities6 /his is con0irmed by the distribution o0 de&rivation

counts across disability status 3/able =6@46

T'9&e 5: De8!(.'*(+ C-+*# '%!## D(#'9(&(*y S*'*-# =B'#e Me'#-!e>

N-/9e! )

"e8!(.'*(+#

Pe!#+# w(*-*

"(#'9(&(*(e# Pe!%e+*'e

Pe!#+# w(*

"(#'9(&(*(e# Pe!%e+*'e

. ,@;; = ;.- >

-,>>@ ; -

- @,@;; - ,-= >

-,>@> ; ,;> ;

= @,>> ?-

; ;,;@- > <@ ?< .,-?= - , ;

> <,-<@ > ??< -

? =,<;< ; <@< @

@ ,... -<@ =

. -.< . ;<

/otal ?;,-. .. >,;-- ..

/able =6? and Fi$ure =6 &resent the adusted headcount ratio # , "hich is the ratio o0 total de&rivations e*&erienced by the &oor to the total &ossible de&rivations that the entire &o&ulation could e*&erience6 /he adusted headcount ratio is 0ound to be hi$her amon$ &ersons "ith disabilities than &ersons "ithout disabilities in all countries6 /he di00erenceacross disability status is statistically di00erent 0rom )ero in all countries but %ao PD( andPakistan6 /he di00erence in the adusted headcount ratio across disability status is thelar$est in Mauritius: the adusted headcount is 0our times hi$her amon$ &ersons "ithdisabilities com&ared to &ersons "ithout disabilities6

F(-!e 511: M-&*("(/e+#(+'& P.e!*y A"-#*e" He'"%-+* R'*( '%!##

D(#'9(&(*y S*'*-# =B'#e Me'#-!e>

/able =6.a and /able =6.b &resent the &overty headcount in each dimension H % 3that is,the share o0 the &oor "ho are de&rived in dimension % to the total sam&le4 0or &ersons"ith and "ithout disabilities6 9lso sho"n is the &ercent contribution o0 each dimensionto the 0inal adusted headcount 3 # 4 score6 +n $eneral, in almost all countries, de&rivation

in terms o0 P7E is the leadin$ contributor to &overty, 0ollo"ed by de&rivation ineducation, 0ollo"ed by de&rivation in em&loyment6 /here are three dimensions that inmost countries contribute more to multidimensional &overty 0or &ersons "ith disabilitiescom&ared to &ersons "ithout: education, the ratio o0 health to total e*&enditures, andem&loyment6 +n other "ords, amon$ the multi5dimensionally &oor, &ersons "ithdisabilities are, on avera$e, more de&rived in terms o0 education, the ratio o0 health tototal e*&enditures, and em&loyment than &ersons "ithout disabilities6

/he results are very similar "hen the e*&anded measure o0 disability is used instead o0 the base measure6 9s sho"n in /able =6, the adusted headcount ratio is thensi$ni0icantly hi$her 0or &ersons "ith disabilities in all countries6

T'9&e 510': A"-#*e" He'"%-+* '+" C+*!(9-*(+ ) E'% D(/e+#(+ * P.e!*y: B!e'"w+ 9y D(/e+#(+ )! Pe!#+# w(*

D(#'9(&(*(e# =B'#e Me'#-!e>

C-+*!y De8!(.'*(+ e8e!(e+%e" 9y 8e!#+# w(* "(#'9(&(*(e#

E/8&y/e+* E"-%'*(+ PCE He'&* !'*( E&e%*!(%(*y W'*e! T(&e* F&! C(+ A##e*# M0

S-9<S''!'+ A)!(%' Burkina Faso .6<= .6@- .6@. .6 .6@- .6=@ .6@- .6>< .6@< .6?> 045

Dominican (e&6 = - -. > > = > < > > ..hana .6@ .6= .6< .6-@ .6= .6-= .6<. .6-. .6< .6; 050

? ? -< - < ? @ > ..!enya .6- .6=. .6;= .6. .6<; .6; .6= .6;- .6<= .6<= 055

- ; - ? = ; > ? ? ..Mala"i .6=> .6? .6@. .6 .6?< .6; .6= .6>> .6@. .6?< 072

-- -= = ? = > ? ? ..Mauritius .6= .6 .6.; .6 .6.@ .6.. .6. .6.. .6. .6. 00;

-@ -> -- < . - . - ..#ambia .6> .6;< .6? .6.= .6>? .6== .6 .6<; .6>? .6>? 061

- ? -> @ ; = > @ @ ..A#(' Ban$ladesh .6< .6<? .6>@ .6;- .6< .6.< .6;> .6? .6> .6>@ 073

< ? - = ; ; > < > ..%ao PD( .6? .6;. .6> .6; .6; .6=< .6;> .6.< .6>- .6;; 056

> ? -< < < > @ > ..Pakistan .6;= .6<= .6<= .6== .6< .6.< .6 .6=> .6; .6;; 05

? -- -- ; - ; < < ..Phili&&ines .6-@ .6-. .6== .6-- .6? .6. .6> .6.< .6 .6- 027

@ -@ = = - = > > ..L'*(+ A/e!(%' '+" *e C'!(99e'+

Bra)il .6- .6-> .6-? .6- .6.- .6.< .6.@ .6.= .6. .6. 01; - -; -< @ . - . ..Dominican (e&ublic .6-> .6; .6-? .6-< .6.> .6 .6. .6. .6 .6- 022

-. -< - @ - - ..Me*ico .6? .6? .6-. .6.@ .6. .6. .6. .6.; .6.? .6. 012

-; -; -? - - - = . ..Para$uay .6-? .6- .6-@ .6@ .6.? .6-- .6 .6< .6= .6-. 026

? - @ - ; > = > ; ..

&ote: Headcount re&resents the &ercent o0 individuals "ho are both multi5dimensionally &oor and de&rived in that s&eci0ic dimension6 <H= si$ni0iesmultidimensional headcount, i6e6 the share o0 &eo&le "ho are multi5dimensionally &oorG $= avera$e de&rivation share: the &ercenta$e o0 dimensionsthat the &oor are de&rived inG and <# = adusted headcount: the ratio o0 de&rivation e*&erienced by the &oor to total &ossible de&rivations in the entire &o&ulation6

T'9&e 5109: A"-#*e" He'"%-+* '+" C+*!(9-*(+ ) E'% D(/e+#(+ * P.e!*y: B!e'"w+ 9y D(/e+#(+ )! Pe!#+#

w(*-* D(#'9(&(*(e# =B'#e Me'#-!e>

C-+*!y De8!(.'*(+ e8e!(e+%e" 9y 8e!#+# w(*-* "(#'9(&(*(e#

E/8&y/e+* E"-%'*(+ PCE He'&* !'*( E&e%*!(%(*y W'*e! T(&e* F&! C(+ A##e*# M0

S-9<S''!'+ A)!(%' Burkina Faso .6@ .6?> .6?> .6-> .6?> .6=< .6?= .6> .6@- .6?; 077

Dominican (e&6 . -- -- > > = > < ? > ..hana .6? .6. .6;< .6- .6? .6- .6;< .6? .6;> .6=@ 035

@ ; -> . < = @ @ ? ..!enya .6-? .6- .6=> .6; .6=? .6-? .6. .6< .6== .6=> 032

; - -; ? ? ; ; < ? ? ..Mala"i .6=< .6>- .6?< .6- .6?- .6-= .6= .6>. .6?; .6?= 064

- -; ? - > ? ? ..Mauritius .6.= .6. .6.- .6.= .6. .6.. .6. .6.. .6.. .6. 002

-? -. > -< < . . - ..#ambia .6 .6= .6>- .6.= .6<? .6= .6? .6;< .6> .6<? 055

- < -> @ ; ; > @ ? ..A#(' Ban$ladesh .6@ .6;. .6>. .6? .6;- .6. .6=; .6<@ .6<- .6<? 060

> -= < . ; ? > ? ..%ao PD( .6 .6=- .6< .6 .6=; .6> .6=@ .6.; .6<- .6=@ 03;

< ? -> > ; > @ > ..Pakistan .6? .6;= .6< .6? .6? .6 .6@ .6; .6< .6;- 056

= -. - = - ; < ? < ..Phili&&ines .6- .6 .6. .6- .6- .6.< .6= .6.; .6-- .6- 014

-. . - = - = - > > ..L'*(+ A/e!(%' '+" *e C'!(99e'+

Bra)il .6- .6. .6; .6. .6.. .6.- .6.; .6.- .6.; .6.. 00 - @ -? -. . - . ..Dominican (e&ublic .6< .6-= .6- .6; .6.< .6.? .6.? .6.= .6.@ .6. 016

? -< -; < - = ..Me*ico .6. .6. .6 .6.= .6. .6.- .6. .6.; .6.> .6.. 004

-= -= -@ @ - - = ; . ..Para$uay .6; .6@ .6-= .6 .6.< .6> .6- .6 .6-< .6; 014

= @ - - - ; > = ? ; ..

&ote: Headcount re&resents the &ercent o0 individuals "ho are both multi5dimensionally &oor and de&rived in that s&eci0ic dimension6 <H= si$ni0iesmultidimensional headcount, i6e6 the share o0 &eo&le "ho are multi5dimensionally &oorG $= avera$e de&rivation share: the &ercenta$e o0 dimensions thatthe &oor are de&rived inG and <# = adusted headcount: the ratio o0 de&rivation e*&erienced by the &oor to total &ossible de&rivations in the entire &o&ulation6

T'9&e 511: M-&*("(/e+#(+'& P.e!*y A+'&y#(# )! Pe!#+# w(* '+" w(*-* D(#'9(&(*(e# =E8'+"e" Me'#-!e>

C-+*!y

Pe!#+# w(* "(#'9(&(*(e# Pe!#+# w(*-* "(#'9(&(*(e#

Obs H P5value 9 P5value M. P5value Obs H 9 M.

S-9<S''!'+ A)!(%'

Burkina Faso =<? .6@< 3.6.4 .6.. .6>; 3.6.4 .6.. .6>- 3.6.4 .6.. ,<. .6@ 3.6.4 .6> 3.6.4 .6<< 3.6.4

hana >< .6<; 3.6.4 .6> .6<. 3.6.4 .6.. .6@ 3.6.-4 .6. -,-=? .6<. 3.6.-4 .6;> 3.6..4 .6= 3.6.4

!enya =; .6<@ 3.6.;4 .6.. .6<; 3.6.4 .6. .6=; 3.6.4 .6.. ,?> .6; 3.6.-4 .6< 3.6.4 .6 3.6.-4

Mala"i <.; .6?? 3.6.-4 .6-< .6<? 3.6.4 .6. .6<. 3.6.4 .6. ,<?@ .6?< 3.6.-4 .6<< 3.6..4 .6;> 3.6.4

Mauritius =?. .6= 3.6.-4 .6.. .6; 3.6.4 .6=< .6.> 3.6.4 .6.. -,><; .6.; 3.6.4 .6;- 3.6.4 .6.- 3.6..4

#ambia ->@ .6?. 3.6.4 .6.- .6< 3.6.4 .6.? .6;. 3.6.-4 .6.. -,<<@ .6> 3.6.=4 .6< 3.6.4 .6== 3.6.-4

Ban$ladesh @>< .6?< 3.6.-4 .6.. .6>. 3.6.4 .6.. .6< 3.6.4 .6.. ,-@ .6>= 3.6.4 .6<; 3.6..4 .6=? 3.6.4

%ao PD( =;? .6>- 3.6.4 .6.. .6< 3.6.4 .6.. .6=< 3.6.-4 .6.. ,<- .6<- 3.6.-4 .6< 3.6..4 .6> 3.6.4

Pakistan =. .6>; 3.6.4 .6.- .6<> 3.6.-4 .6;? .6;. 3.6.4 .6. =,?< .6<? 3.6.4 .6<< 3.6..4 .6=; 3.6.4

Phili&&ines ,?- .6= 3.6.-4 .6.. .6;> 3.6.4 .6.. .6-; 3.6.4 .6.. >,@;; .6 3.6.4 .6;; 3.6..4 .6> 3.6.4

L'*(+ A/e!(%' '+" *e C'!(99e'+

Bra)il <=. .6-@ 3.6.-4 .6.. .6;< 3.6.4 .6.. .6< 3.6.4 .6.. -,@= .6; 3.6.4 .6;= 3.6.4 .6.? 3.6.4

Dominican (e&ublic =@> .6= 3.6.4 .6.= .6;@ 3.6.4 .6< .6-. 3.6.-4 .6.- ,.@ .6-> 3.6.-4 .6;> 3.6..4 .6; 3.6.4

Me*ico -,;?; .6-- 3.6.4 .6.. .6;= 3.6.4 .6=@ .6- 3.6.4 .6.. ,-;. .6 3.6.4 .6;= 3.6..4 .6.> 3.6..4

Para$uay ;?; .6=. 3.6.-4 .6.. .6<- 3.6.4 .6.. .6-; 3.6.-4 .6.. ,@>; .6-@ 3.6.4 .6;@ 3.6..4 .6> 3.6.4

&ote: Standard errors in &arenthesis and are adusted 0or survey clusterin$ and strati0ication6 P5value 0or 9dusted Wald /est 0or di00erence in values across

disability status6 Poverty 7uto00: kd =.6 9 &erson is considered &oor i0 heshe is de&rived in at least a sum o0 0our out o0 . dimensions6

<H= si$ni0ies multidimensional headcountG $= avera$e de&rivation share: the &ercenta$e o0 dimensions that the &oor are de&rived inG and <# =

adusted headcount: the ratio o0 de&rivation e*&erienced by the &oor to total &ossible de&rivations in the entire &o&ulation6

T'9&e 512: M-&*("(/e+#(+'& P.e!*y A+'&y#(# =B-!-(++ '+" C'!'.'!*y Me*" 60>

C-+*!y Pe!#+# w(* "(#'9(&(*(e# Pe!#+# w(*-* "(#'9(&(*(e#

Obs Headcount P5value Poverty $a& P5value Povertyseverity

P5value Obs Headcount Poverty $a& Povertyseverity

S-9<S''!'+ A)!(%'

Burkina Faso -;. .6@; 3.6.4 *2 .6;< 3.6.-4 *9 .6; 3.6.-4 *23 -,@?< .6@- 3.6.4 .6; 3.6.4 .6 3.6.4

hana -< .6> 3.6.=4 * .6- 3.6.-4 *, .6= 3.6.4 *8, -,.@ .6;? 3.6.-4 .6. 3.6.4 .6= 3.6.4

!enya -<> .6>> 3.6.;4 * .6-@ 3.6.=4 * .6= 3.6.-4 * ,- .6<. 3.6.-4 .6@ 3.6.4 .6.> 3.6.4

Mala"i =. .6?? 3.6.4 *2; .6=@ 3.6.4 * .6-> 3.6.4 * ,<- .6?= 3.6.-4 .6=; 3.6.4 .6- 3.6.4Mauritius <> .6@ 3.6.4 *36 .6.; 3.6.4 * .6.- 3.6..4 * -,<<< .6; 3.6.-4 .6.- 3.6..4 .6. 3.6..4

#ambia >= .6>= 3.6.=4 *27 .6=- 3.6.4 *; .6-. 3.6.4 * -,<>< .6<< 3.6.;4 .6@ 3.6.4 .6? 3.6.4

Ban$ladesh <. .6?= 3.6.-4 * .6@ 3.6.4 * .6-. 3.6.4 * -,@-@ .6>= 3.6.4 .6- 3.6.4 .6= 3.6.4

%ao PD( -> .6>; 3.6.;4 *2 .6=- 3.6.-4 * .6- 3.6.-4 * ,;. .6<> 3.6.-4 .6= 3.6.4 .6; 3.6.4

Pakistan -? .6? 3.6.4 * .6< 3.6.-4 *;6 .6< 3.6.4 *6 =,-;< .6<@ 3.6.4 .6= 3.6.4 .6; 3.6..4

Phili&&ines ?=. .6=- 3.6.-4 * .6-. 3.6.4 * .6.> 3.6..4 * ?,?- .6 3.6.4 .6; 3.6.4 .6.; 3.6..4

L'*(+ A/e!(%' '+" *e C'!(99e'+

Bra)il ?? .6<. 3.6.4 * .6-= 3.6.4 * .6.@ 3.6.4 * -,>> .6=? 3.6.-4 .6 3.6.4 .6.= 3.6..4

Dominican (e&ublic = .6== 3.6.;4 *96 .6> 3.6.-4 *2 .6.< 3.6.4 *2 ,..> .6= 3.6.-4 .6- 3.6.4 .6.= 3.6..4

Me*ico ,?- .6=- 3.6.-4 * .6- 3.6.4 * .6.= 3.6..4 * ,@@? .6 3.6.4 .6.> 3.6..4 .6.- 3.6..4

Para$uay ;? .6=@ 3.6.=4 * .6< 3.6.-4 * .6.< 3.6.4 * =,@; .6? 3.6.4 .6.@ 3.6..4 .6. 3.6..4

&ote: Standard errors in &arenthesis are adusted 0or survey clusterin$ and strati0ication6 P5value 0or 9dusted Wald /est 0or di00erence in values across

disability status6 Poverty 7uto00: 9 &erson is considered &oor i0 heshe is de&rived in at least t"o dimensions6Source: 9uthorsJ calculations based on WHS data6

0obustness chec)s

/o check the robustness o0 the multidimensional &overty measure estimates, several checks "ereconducted6 (esults are identical "hen the cuto00 across dimensions is set at . &ercent instead o0 =. &ercent 39&&endi* B>46 2e*t, more restrictive thresholds "ithin dimensions are used6>

9$ain, similar results hold 39&&endi* B?46 9 third robustness check "as &er0ormed by dro&&in$the indicator 0or P7E 0rom the calculations and redistributin$ "ei$hts eCually across theremainin$ nine dimensions6 Since this had little e00ect on the overall multidimensional scores,the results o0 this check are not &resented6

+n a 0inal check to this analysis, /able =6- above sho"s the results o0 the Bour$ui$non and7hakravarty 3-..4 method a&&lied to &ersons "ith and "ithout disabilities6 9n individual isconsidered &oor i0 he or she 0alls under t"o o0 0our dimensional thresholds 3kd;.46 +n nineout o0 ; countries, &ersons "ith disabilities have a si$ni0icantly hi$her multidimensional &overty headcount com&ared to &ersons "ithout disabilities6 /he di00erence in &overtyheadcounts bet"een &ersons "ith disabilities and &ersons "ithout ran$es 0rom one &ercenta$e &oint in Burkina Faso to -. &ercenta$e &oints in Bra)il6 (e$ardin$ the multidimensional $a&, all

countries sho" statistically si$ni0icant and hi$her $a&s 0or &ersons "ith disabilities6 /hemultidimensional &overty severity is si$ni0icantly hi$her in all countries but hana6

%ike 0or 9lkire and Foster, the Bour$ui$non and 7hakravarty method's results are sensitive tothe share o0 dimensions 0or "hich one needs to e*&erience de&rivation to be identi0ied as &oor67alculations 0or 9&&endi* B@ use a less restrictive cuto00 3kd-;46 Even "ith this lo"threshold, the results hold: &overty headcounts are hi$her 0or &ersons "ith disabilities in nine outo0 ; countriesG the multidimensional &overty $a& is hi$her in all countries, and themultidimensional &overty severity in = out o0 ; countries6

/o conclude, the results 0rom the multidimensional &overty analysis &resented above su$$est thatin a maority o0 the countries under study, &ersons "ith disabilities, on avera$e, e*&erience

multi&le de&rivations at hi$her rates and in hi$her de&th than &ersons "ithout disabilities6 /heresults 0or the multidimensional headcount usin$ the Bour$ui$non and 7hakravarty method0ocusin$ on continuous dimensions o0 &overty are some"hat more mi*ed than in the case o0 the9lkire and Foster method usin$ both continuous and dichotomous dimensions o0 &overty6 /hemultidimensional &overty headcount is si$ni0icantly hi$her 0or &ersons "ith disabilities in nineout o0 = usin$ Bour$ui$non and 7hakravarty "ith kd-; or kd;., and in - countriesusin$ the 9lkire and Foster method 3"ith kd. or =.46 /here is less variation in the results0or the multidimensional &overty measures that adust 0or the ran$e and severity o0 de&rivationssuch as 9lkire and Foster's adusted headcount 3 # 4 and Bour$ui$non and 7hakravarty's $a& and &overty severity6 1sin$ these measures and de&endin$ on the cross5dimensional cuto00 3)5d 4, &ersons "ith disabilities are si$ni0icantly more &rone to multidimensional &overty in to = o0

the = countries under study6

> For P7E, the 1SK6-; a day &overty line is used instead o0 1SK- a day6 For the ratio o0 healthto total e*&enditures, a &erson is considered to be de&rived i0 the ratio is above ; &ercent insteado0 . &ercent in the base case6

5.CONCLUSIONS

1sin$ WHS data, this study investi$ates the economic status o0 &ersons "ith disabilitiesin ; develo&in$ countries, &resentin$ a sna&shot &icture o0 several indicators o0 economic "ell5bein$ at the individual and household levels6

/his study has several limitations "hich re0lect the limitations o0 the data set6 First,results cannot be $enerali)ed 0or lo" and middle income countries as a "hole, $iven thatthe ; countries included in the study may not be re&resentative o0 all develo&in$countries6 Second, it is not &ossible to e*actly identi0y households "ith and "ithoutdisabilities $iven the WHS sam&le desi$n: not all household members res&onded todisability Cuestions6 Because o0 this WHS 0eature, disability &revalence at the householdlevel may be underestimated and economic dis&arities across household disability statusmay not be accurately measured and may be biased to"ard )ero6 /hird, the recall &eriod

3. days4 may lead to an overestimate o0 disability &revalence, as "ell as a00ect other indicators6 For instance, it could have elevated the s&endin$ on health care, because o0 s&endin$ associated "ith the tem&orary health conditions6 Fourth, usin$ a relativelymodest set o0 e*&enditure5related set o0 Cuestions may lead to an overestimate o0 thehousehold e*&enditure &overty across the board6 9$ain, one cannot &redict ho" thismi$ht a00ect the com&arison bet"een households "ith and "ithout disabilities6

Furthermore, the authors o0 this study decided not to conduct a multivariable re$ressionanalysis, because o0 the endo$eneity o0 disability and economic de&rivation6 9se*&lained earlier, disability and economic de&rivation are linked throu$h a t"o5"aycausation6 +n sna&shot data, one "ould not be able to disentan$le "hether the onset o0 disability has led to de&rivation or &ersons "ith disabilities "ere already de&rived be0ore becomin$ disabled, thus &otentially creatin$ a misleadin$ &icture o0 the relationshi& bet"een disability and disadvanta$e6

!ee&in$ in mind data limitations, the 0ollo"in$ &icture on the economic status o0 &ersons"ith disabilities and their households in ; develo&in$ countries emer$es6

First, lookin$ across all 0ive dimensions o0 economic "ell5bein$ e*&lored in this study3education, em&loyment, assetslivin$ conditions, household e*&enditures, and householde*&enditures on health care4, one 0inds in all the countries that &ersons "ith disabilities asa $rou& are si$ni0icantly "orse o00 in t"o or more dimensions in = out o0 ; countries3/able ;646?

Second, disability is si$ni0icantly associated "ith multidimensional &overty in to = o0 the = develo&in$ countries under study6@ +n other "ords, &ersons "ith disabilities aremore likely to e*&erience multi&le de&rivations than &ersons "ithout disabilities6 /his

? +n one country 3#ambia4, &ersons "ith disabilities are "orse o00 in only one dimension3education46@ One o0 the ; countries under study 3#imbab"e4 "as not included in the analysisusin$ PPP P7E data, and in the multidimensional &overty analysis6

result holds "hen di00erent multi5dimensional &overty measures and &overty thresholds3"ithin and across dimensions4 are used6

T'9&e 61: S-//'!y ) E%+/(% I+"(%'*! C/8'!(#+# '%!## D(#'9(&(*y S*'*-#

C-+*!y I+"(.("-'& e"-%'*(+ I+"(.("-'&e/8&y/e+*

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Burkina Faso 5 5 X X X 5 5 5hana X X 5 5 5 5 5 X!enya 5 X 5 X X 5 5 XMala"i X X 5 X 5 5 X 5Mauritius X X X X X X 5 X#ambia X X 5 5 5 5 5 5

#imbab"e X X 5 X 5 29 29 29A#(' Ban$ladesh X X X X X 5 X X%ao PD( X X 5 X 5 5 X 5Pakistan X X X X 5 5 5 XPhili&&ines X X X X X 5 X XL'*(+ A/e!(%' '+" *e C'!(99e'+

Bra)il X X X X X X X XDominican (e&ublic 5 X X 5 5 5 5 XMe*ico X X X 5 5 X 5 XPara$uay X X X X 5 5 5 X

T*'& - = @ < ; .

&ote: X +ndicates that &ersonshouseholds "ith disabilities e*&erience a statistically si$ni0icant 3at least at ; &ercent4 "orse economic "ell5bein$ outcome in the &articular cate$ory6 29 stands 0or not available6

/hird, at the individual level, in most o0 the countries included in the study, &ersons "ithdisabilities have lo"er educational attainment and e*&erience lo"er em&loyment ratesthan &ersons "ithout disabilities6 +n education, they have 0e"er years o0 education andlo"er &rimary school com&letion rates6 Similarly, they have lo"er em&loyment ratesthan &ersons "ithout disabilities6 +n a maority 3<. &ercent4 o0 the countries thedi00erence in em&loyment rates to the detriment o0 disabled &eo&le "as statisticallysi$ni0icant6

Fourth, at the household level, in most o0 the countries 3 out o0 ;4, households "ithdisabilities have a si$ni0icantly lo"er mean asset inde*6 9lso, a hi$her &ercenta$e o0 households "ith disabilities belon$ to the bottom asset CuintileG this di00erence "asstatistically si$ni0icant in si* out o0 = countries6 Households "ith disabilities, onavera$e, also re&ort s&endin$ a hi$her &ro&ortion o0 their e*&enditure on health care: themean ratio o0 health to total household e*&enditures "as si$ni0icantly hi$her 0or households "ith disabilities in t"o thirds o0 the countries6

Fi0th, descri&tive statistics su$$est that in most countries households "ith disabilities arenot "orse o00 "hen their "ell5bein$ is measured by mean non5health P7E6 Similar results "ere obtained 0or the &overty headcount, $a&, and severity based on the P7E as"el0are a$$re$ate6 /his result should be treated "ith caution $iven that it mi$ht bein0luenced by the limitations o0 the WHS sam&lin$ desi$n "hen it comes to identi0y the

disability status o0 a household and its small set o0 Cuestions on e*&enditures6 Possible policy implications

9lthou$h this study does not discuss &olicies, the 0indin$s broadly &oint to three &ossible &olicy im&lications6

First, the results that in all the countries under study, &ersons "ith disabilities aresi$ni0icantly "orse o00 in three to 0our dimensions o0 economic "ell5bein$, and in mostcountries e*&erience multi&le de&rivations, is a call 0or 0urther research and action on &overty amon$ &ersons "ith disabilities6

Second, &olicies and &ro$rams to im&rove socioeconomic status o0 &eo&le "ith

disabilities and their 0amilies need to be ada&ted to country s&eci0ic conte*ts6 /his studydoes not 0ind a sin$le economic indicator 0or "hich &ersons "ith disabilities aresystematically "orse o00 in all countries, su$$estin$ that the &rocesses "hereby disabilityand &overty are related are com&le* and vary 0rom country to country6 9 more in5de&thanalysis "ould be needed at the country level to develo& s&eci0ic and conte*tuali)ed &olicy recommendations6

/hird, results 0rom the analyses "ithin dimensions o0 economic "ell5bein$ su$$est that &olicies that &romote access to education, health care and em&loyment may be &articularly im&ortant 0or the "ell5bein$ o0 &ersons and households "ith disabilities6

"urther research and data collection

/his study e*amines the economic status o0 &ersons "ith disabilities and their householdsin ; develo&in$ countries usin$ the -..-5-..= WHS data6 /he results tem&t 0or moreresearch on disability and social and economic outcomes in develo&in$ countries6

First and 0oremost, research is needed on the causal &ath"ays bet"een disability and &overty to understand ho" in a develo&in$ country conte*t, disability may lead to &overty and vice versa6 +t is necessary to brin$ causal &ath"ays into li$ht in order tomake specific &olicy recommendations, at the country level, on ho" to reduce &overtyamon$ &ersons "ith disabilities, and ho" to curb the incidence o0 disability amon$ the &oor6 For instance, i0 unem&loyment is relatively hi$h amon$ &ersons "ith disabilities,

"hat are the causes +t becomes necessary to investi$ate the causes o0 unem&loyment ineach labor market6 Possible causes are numerous6 For e*am&le, on the demand side, itcould be the result o0 &reudice or discrimination by the em&loyer6 On the su&&ly side, itcould come 0rom lo" sel05e*&ectations that lead to a decision not to oin the labor 0orceor 0rom lo" skills level that may decrease chances o0 $ettin$ a ob6

Second, com&rehensive &overty &ro0iles o0 &ersons and households "ith disabilities areneeded at the country level investi$atin$ in detail the e*tent and the causes o0 economicde&rivation6

%ast, research is needed to evaluate interventions such as income su&&ort and &ro$rams toeconomically em&o"er &ersons "ith disabilities in develo&in$ countries6 Someinterventions, such as community5based rehabilitation, have lon$ been in the 0ield, butlittle is kno"n on "hat "orks6

9ll three areas o0 research su$$ested above need more and better data on disabled &eo&leand their households6 /he disability data measurement 0ield has made advances since theWHS "as 0ielded in -..-5-..=6 /he Washin$ton rou& has made recommendations ondisability Cuestions that a number o0 countries have ado&ted 0or their &o&ulation census6/he Washin$ton rou& has continued technical "ork on a number o0 household surveyCuestions related to disability 3Miller et al6 -..46 9lthou$h the WHS &rovides uniCuedata in the area o0 disability and economic "ell5bein$, "e recommend that a modi0iedversion o0 the WHS be 0ielded that 3i4 builds u&on technical advances made by theWashin$ton rou& in disability measurementG 3ii4 enables valid estimates o0 bothindividual and household level disability &revalence 0or an analysis o0 household leveleconomic outcomesG 3ii4 has a lon$itudinal desi$n so as to enable an analysis o0 thecausal links bet"een disability and economic "ell bein$6

%on$itudinal data is necessary to assess the causal &ath"ays bet"een disability and &overty6 +n develo&in$ countries, the lon$itudinal household surveys are rare and thosethat include disability Cuestions are all but lackin$6 7ross5sectional data need to im&roveon the disability Cuestions and sam&le desi$n that "ould also allo" researchers to dra"reliable estimates on &ersons and households "ith disability6 %ast, but not least, better data collection is needed to investi$ate the access and a00ordability o0 health care 0or &ersons "ith disabilities in develo&in$ countries6 /his study 0ound a hi$her health tototal household e*&enditure ratio 0or households "ith disabilities in most countries, butdid not have data on access to health services at the individual level6=.

=. /he WHS includes a Cuestion on access to healthcare services at the individual level, but data "as o0ten missin$ in lots o0 the countries under study6

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Disability and Poverty in Developing Countries

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