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CBM position paper on the post-2015 Millennium Development Goals (MDGs) global framework

1. CBM’s position on a post-2015 framework: Content and process

1.1 A revision of the current understanding and definition of poverty, progress and development beyond material living standards alone (income, consumption and wealth)[1].
1.2 A framework that addresses causal explanations of poverty and promotes agency rights and equality for people with disabilities[2].
1.3 Disability-inclusive development that adopts a human rights-based approach adhering to the principles of empowerment, participation, equality and non-discrimination, with a focus on the poorest, most excluded groups, such as people with disabilities[3].
1.4 Disaggregation of data[4] and the collection of new datasets on disability can be used as an evidence base for global comparisons as well as monitoring against any new nationally set targets and indicators.
1.5 National governance and ownership in any new structures or institutional arrangements. The involvement and participation of people with disabilities through deliberative processes that take into account the context and starting point of each country’s circumstances; the strengthening of accountability processes and mechanisms that are accessible to people with disabilities.
1.6 Any new global partnerships on poverty reduction have a more equitable relationship[5] and mainstream disability[6] in their international cooperation efforts[7].
1.7 A revision of overseas development assistance (in terms of financing channels and mechanisms, accountability contracts for donors and ‘beyond aid’ approaches) to include disability markers identifying the percentage spend for disability-inclusive development.

2. The context: Poverty, disability and development

2.1 Disability is both a cause and consequence of poverty, yet international policy-makers and stakeholders have not recognised or prioritised this issue within international development efforts such as the MDGs.
2.2 Fifteen per cent of the world’s population are people with disabilities – over one billion people[8], of whom 80 per cent live in developing countries[9].
2.3 The current MDGs have given rise to distortions of national progress by focusing on percentages and non-universal cover rather than targeting and changing the situation of the poorest people, including those with disabilities[10].
2.4 Across the world, people with disabilities have poorer health, lower educational achievements, less economic participation and higher rates of poverty and inequality than people without disabilities[11].
2.5 The MDGs are framed by conventional ideas of development that have not recognised the importance of inequality in poverty reduction.
2.6 The shifting global distribution of poverty means that 72 per cent of the world’s poorest people (800 million) now live in middle-income countries (MICs), and most of those in stable MICs[12], which are not the main recipients of overseas development assistance.

CBM reducing poverty-related diseases

CBM works with its partners to tackle a group of poverty-related diseases, including the neglected tropical diseases[13] (NTDs). Globally NTDs affect 1.4 billion of the poorest people and another 2 billion people are at risk. Because of their adverse affects on child development, maternal morbidity and worker productivity, the NTDs have a major impact on poverty[14].

3. Emerging Issues on the post-2015 MDG agenda

Since the Millennium Declaration, the global context in relation to poverty and development has changed significantly. Three key areas which are currently emerging in global post-2015 MDG debates are summarised below: increasing inequality, climate change and urbanisation. These issues are also framed by the global economic and debt crisis.

4. Inequality and global justice

4.1 Inequality affects all countries, rich or poor, and arguably mediates poverty and wellbeing to a greater extent than growth does[15].
4.2 Intra-country inequalities have widened[16], of which people with disabilities are disproportionately represented[17]. Social protection mechanisms can provide safeguards for the most marginalised people.
4.3 Most of the world’s poor have shifted from low-income countries to middle-income countries[18]. The global burden of malnutrition, disease and mortality are middle-income concentrated[19].
4.4 Key explanations for escaping from poverty are largely a) equity related, for example, changes in employment, land ownership and education; b) related to social exclusion and discrimination; and c) linked to location in remote or otherwise disadvantaged areas[20].
4.5 High inequality can inhibit growth, discourage institutional development towards accountable government and undermine civic and social life leading to conflict[21] and undermine human rights.

CBM, inequality and global justice

  • All of CBM’s work is underpinned by disability-inclusive development. Estimates of the number of people with severe disabilities, a key group for CBM’s work, vary between 110 million and 190 million[22].
  • CBM advocates for inclusive development to improve the quality of lives for people with disabilities. It recognises the importance of other existing inequalities such as gender, age (children[23] and older people), race, ethnicity, or HIV status etc.[24] and their impact on the lives of people with disabilities that can lead to multiple discrimination.

5. Climate change

5.1 The impacts of climate change (extreme weather, sea level changes and agriculture productivity changes, leading to food insecurity) will affect the world’s poorest people[25].
5.2 Higher food prices due to climate change combined with urbanisation trends will lead to more households being net food consumers, this too will affect (urban) poor people more[26].
5.3 Most of the world’s poor (800 million) live in ten countries, six of which are listed in the top 20 countries[27] most at risk of extreme weather in 2015: China, India, the Philippines, Vietnam (middle-income countries) and Bangladesh and Ethiopia (low income-countries).
5.4 Any new agreement must address climate change, sustainable consumption, climate resilient development and the protection of people with disabilities in situations of risk and humanitarian emergencies[28].

Climate change and CBM

  • In 2010, CBM’s partners provided services to over half a million people in situations of risk and humanitarian emergency.
  • CBM works in all of the six countries where both the poorest people and those most at risk of extreme weather live.
  • CBM has worked in partnership to ensure people with disabilities are included in food security emergency response programmes in the horn of Africa where over 4.5 million people are in need of assistance from the worst droughts experienced in the last 60 years.

6. Linking climate change and urbanisation

As the effects of climate change force people to move in search of food and water, migration or dislocation may increase. Significant numbers of people relocate, especially from rural to urban areas, for example people moving from the Sahel zone of West Africa to coastal areas, due to regular crop failures in their home regions[29]. There are an estimated 3.5 million refugees and internally displaced people with disabilities worldwide[30].

7. Urbanisation

7.1 High rates of overall population growth, together with significant rural–urban migration, have contributed to rapid urbanisation and related unplanned expansion of low-income settlements on the outskirts of many large cities[31].
7.2 In sub-Saharan Africa two-thirds of urban dwellers live in low-income settlements[32].
7.3 Worldwide, approximately 900 million people live in low-income settlements, of which approximately 135 million could be people with disabilities[33].
7.4 Those living in urban low-income settlements lack improved water, sanitation, and durable housing, all three are harder to access for people with disabilities.
7.5 Environmental conditions such as indoor air pollution from cooking fires and atmospheric pollution in urban areas lead to chronic respiratory diseases and a heightened risk of tuberculosis, which is a significant cause of disability[34].
7.6 With greater reliance on the monetised economy, urban populations depend on integration into informal employment markets to earn cash income to meet their ongoing consumption needs.
7.7 The rate of economic inactivity is 2.5 times higher amongst people with disabilities[35].

Urbanisation, CBM and the rural question

CBM advocates for disability-inclusive development in both urban and rural areas. Urbanisation is a critical issue for the post-2015 MDG agenda, however, most poor people (70%) still live in rural areas[36]. CBM remains committed to working for the rights of people with disabilities in both rural and urban areas.

For more information please contact Diane Mulligan, the Coordinator of International Advocacy and Alliances for CBM - .

References and additional information

1 For example, non-economic aspects of people’s lives that reflect multiple dimensions of poverty such as access to education, health, social connections, wellbeing, levels of insecurity, housing, environmental conditions etc.
2 Article 28 of the Universal Declaration of Human Rights clearly links human rights with poverty reduction and development. The UN Convention on the Rights of Persons with Disabilities (CRPD) has comprehensive inclusive articles: the right to education (article 24), the right to health (article 25), the right to work and employment (article 27), the right to adequate standards of living and social protection (article 28).
3 Comprehensive accessibility for people with disabilities would need to be integral to a human rights-based approach, namely: physical, communication, policy and attitudinal barriers are all identified and addressed. Additionally, a human rights based approach would serve to highlight areas neglected by the MDGs, such as equal access to justice (article 13 of the CRPD), the rule of law (article 12 of the CRPD) and democratic governance (article 29 of the CRPD: the right to participation in political and public life; as well as notions of entitlements and accountability into the development process.
4 Article 31 of the CRPD states that countries that have ratified the Convention will collect statistics and data about people with disabilities and disseminate it in accessible formats.
5 Any new global partnerships are more balanced in terms of their relationships and accountability between donor countries and developing countries.
6 The CRPD is the only international human rights instrument to have an article on international cooperation; the CRPD provides a comprehensive normative framework for mainstreaming disability in the development agenda. Countries that have ratified the CRPD will ensure that international cooperation, including international development programmes, are inclusive of, and accessible to people with disabilities.
7 Including aid, debt, trade, tax, corporate regulation and accountability, fiscal policy and foreign policy support to national, regional and global human rights mechanisms, diplomatic support, and military assistance.
8 World Health Organization and World Bank (2011) World Report on Disability. Geneva: WHO Press.
9 Disability and Poverty: a Survey of World Bank Poverty Assessments and Implications’. Jeanine Braithwaite and Daniel Mont, SP discussion paper No. 0805, World Bank, February 2008.
10 For example, children with disabilities are much less likely to attend school than children without disabilities. World Health Organization and World Bank (2011) World Report on Disability. Geneva: WHO Press, p. 225.
11 World Health Organization and World Bank (2011) World Report on Disability. Geneva: WHO Press.
12 Sumner, A. & Tiwari, M. (2011) Global Poverty Reduction to 2015 and Beyond. Journal of Global Policy.
13 Parasitic and bacterial infections, namely: three soil transmitted helminthiasis (ascariasis, hookworm infections,and trichuriasis), lymphatic filariasis, onchocerciasis, dracunculiasis (guinea-worm disease), schistosomiasis, Chagas’ disease, human African trypanosomiasis, leishmaniasis, Buruli ulcer, leprosy, and trachoma.
14 In addition, the disease burden of NTDs is more than double that caused by tuberculosis. Hotez, PJ. Kamath, A. Neglected Tropical Diseases in Sub-Saharan Africa: Review of Their Prevalence, Distribution, and Disease Burden. PLoS Negl Trop Dis 3(8).
15 Vandemoortele, J. (2011) The MDG Story Intention Denied: Development and Change. Development and Change, Vol. 42, (1), pp. 1-21. The Hague.
16 Palma, J.G. (2011) Homogeneous Middles vs. Heterogeneous Tails, and the End of the ‘Inverted-U’: It's All About the Share of the Rich. Development and Change, Vol. 42, (1), pp. 87-153. The Hague.
17 20.7% of people in the poorest quintile of both lower and higher income countries have disabilities; 18% of all people in lower income countries have disabilities; and 20% of all people in the poorest three quintiles of lower income countries have disabilities: World Health Organization and World Bank (2011) World Report on Disability. Geneva: WHO Press p. 28.
18 Sumner, A. and Tiwari, M. (2011) ‘Global Poverty Reduction to 2015 and Beyond’, Journal of Global Policy.
19 See Kanbur, R. and Sumner, A. (2011) Poor Countries or Poor People? Development Assistance and the New Geography of Global Poverty. Charles H. Dyson School of Applied Economics and Management Working Paper, Ithaca, NY: Cornell University; and also Glassman, A., Duran, D. & Sumner, A. (2011) Global Health and the New Bottom Billion. Center for Global Development (CGD) Working Paper, Washington, DC: CGD.
20 Dercon, S. & Shapiro, J. (2007) Moving On, Staying Behind, Getting Lost: Lessons on Poverty Mobility from Longitudinal Data. Economic and Social Research Council Global Poverty Working Group, Paper 75.
21 Birdsall, N. (2006) ‘Income Distribution: Effects on Growth and Development’ - Working Paper 118; Center for Global Development, Washington.
22 World Health Organization and World Bank (2011) World Report on Disability. Geneva: WHO Press, p. 29.
23 There are 93 - 150 million children with disabilities under 15 years of age worldwide (World Health Organization and World Bank (2011) World Report on Disability. Geneva: WHO Press, p 262).
24 While equally at risk of HIV/AIDS, for a variety of reasons people with disabilities do not have equal access to HIV information, education and prevention services. UNAIDS (2009) Disability and HIV Policy Brief.
25 Eighty per cent of the 300 million people who live within 5 meters of sea level are in developing countries. The Intergovernmental Panel on Climate Change Debate on Sea-Level Rise: Critical Stakes for Poor Countries: February 2, 2007. http://blogs.cgdev.org/globaldevelopment/2007/02/the-ipcc-debate-on-sea-level-r.php (accessed 13 February 2012).
26 Skoufias, E., Rabassa, M. & Olivieri, O. (2011) The Poverty Impacts of Climate Change: A Review of the Evidence, Policy Research Working Paper 5622, The World Bank.
27 Middle-income countries (China, India, the Philippines, Sri Lanka, Vietnam, Honduras, Thailand, Zambia) and low-income countries (Kenya, Somalia, Mozambique, Bangladesh, Djibouti, Ethiopia, Bolivia, Cuba, Madagascar, Colombia, Zimbabwe). UNHABITAT 2010.
28 See Article 11 of the UN Convention on the Rights of Persons with Disabilities.
29 Brauch, H. G. (2002) Climate Change and Conflict Prevention. German Federal Ministry for the Environment, Nature Conservation and Nuclear Safety (BMU).
30 Women’s Commission for Refugee Women and Children (2008) Disabilities among Refugees and Conflict-Affected Populations: Resource Kit for Fieldworkers. NY: Women’s Commission for Refugee Women and Children.
31 Although the number of people living in low-income settlements in urban areas is declining in incidence, it is rising in absolute numbers. The proportion is highest in sub-Saharan Africa where two-thirds of urban dwellers are living in low-income settlements; the number of people living in low-income settlements in this region has nearly doubled over the period 1990-2010: UNHABITAT 2010.
32 Sumner, A. (2012) A post-2015 global framework: key issues, criteria and options. Institute of Development Studies at the University of Sussex (unpublished: commissioned research by CBM).
33 http://www.unmillenniumproject.org/documents/Slumdwellers-complete.pdf quotes 900 million people, of which up to fifteen per cent (see World Health Organization and World Bank (2011) World Report on Disability. Geneva: WHO Press.) could be people with disabilities.
34 European Commission (2007) Environmental Integration Handbook for EC Development Cooperation.
35 World Health Organization and World Bank (2011) World Report on Disability. Geneva: WHO Press.
36 http://www.ifad.org/rpr2011 (accessed 13 February 2012).


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