[SCMP Column] Against All Odds

May 13, 2017

Hanoi’s National Convention Centre, sepulchral host to the second APEC Senior Officials’ cluster in Vietnam’s APEC chairmanship year, feels an improbable place for a discussion on the high price we pay for treating our disabled people like pariahs.

Much more appropriate the squalid teeming streets of Hanoi’s old quarter, where people with a multitude of daunting disabilities hawk their wares, hawk their services, on locals and tourists alike, determined to make a living against all the odds. Such a contrast with the manicured lawns, lakes and villas around the grand, sepulchral Convention Centre.

The discussion on disability – driven by the United States – provided a valuable next step in APEC’s three year examination of the social and economic price we pay across the region for paying inadequate attention to “inclusion”. In the past, valuable work has been done – again mainly driven by American colleagues – on the economic cost of discrimination against women, on the business cost of poor health among employees, and the distinctive problems being faced by the region’s youth. Work has also been done of the cost of mental ill-health.

This exploration of the opportunity-costs of failing to capture the surprising and sometimes counter-intuitive contributions that can be made by people with disability is clearly linked to these other discriminations, and is a valuable complement to these past projects.

The Symposium was launched with some explosive numbers: according to a 2011 study by the World Health Organisation and the World Bank, around 15 per cent of the world’s population lives with some form of disability. That is over a billion people. The price we pay for failing to ensure people with disability can contribute in the workforce amounts to something between US$1.37 trillion and US$1.94 trillion. As for the Asia-pacific region, we have around 650m people living in hardship or poverty because of their exclusion from the workforce because of disability of one form or another. Around 85 million of these are in China.

But these shocking big numbers had hardly sunk into the discussion before some awkward questions began to surface about their reliability – not that they may be too large, but that they may not be large enough. First, the WHO-World Bank study that everyone seems to rely upon is already six years old, and very little systematic empirical work has been completed since then. Second, it quickly became clear from the symposium presentations that many economies worldwide do not gather the relevant data – certainly not on an apple-to-apple basis. So even the 2011 study’s empirical underpinnings look fragile.

Perhaps most critically, there was a frustrating absence of comparable data on what counts as a disability, and what kinds of disability make the largest difference. Since different forms of disability would need different policy responses, surely it must be quite basic that we should have an idea on what proportion are wheelchair-bound, or are blind, or deaf, or autistic or suffer some other form of mentally disabling condition? And where do things like chronic migraines or depression fit in?

I presume that economy by economy, relevant officials have such data and use it as a basis for local policymaking. Our Hong Kong government, for example, says 8.1 per cent of our population – some 578,000 – suffer some form of disability, with over half of these suffering “restricted body movement”. They also say almost three quarters of these are over 60 years old, and “economically inactive” because they have passed retirement age. But for coherent action across our APEC region we need numbers that are regionally more comparable than that.

Most of the discussion appeared to focus on what I would call the “life-time disabled”, but as the day progressed it became clear that this is just the tip of the iceberg if we are talking about the cost to our economies of failing to deal with disability appropriately. Beyond the “life-time disabled”, what about the “temporarily disabled” who might have fallen down stairs or broken a leg in a car accident, or developed a serious thyroid condition during pregnancy? These have to number in the millions, creating very significant disruption in the workplace.

Then what about what I would call about the “late-onset disabled”, victims of lifetime cigarette abuse, or serious obesity, or chronic debilitating lower back pain, or simply the wear and tear of a long, hard life? This has to constitute a further huge number, including in Hong Kong’s government data, but it seems to be ignored in many economies because so many of these “late-onset” sufferers are at or beyond what most economies define as retirement age?

Even more significant, I sensed that the numbers being thrown around took very little empirical account of the price we pay in our economies for losing the workplace contribution of people who are forced to be carers of the disabled. Most of these are unpaid family members, and are uncaptured by most labour ministries or census and statistics departments. In Hong Kong, for example, about 40 per cent of our disabled have full time carers, and 80 per cent of these carers are spouses, sons and daughters or their spouses, or parents. Does this suggest that the economy-wide cost of excluding disabled might be double the US$1.94 trillion discussed at the Symposium if the loss to the workforce of unpaid carers is taken into account? If Hong Kong is anything to go by, it would seem so.

This implies we are seriously underestimating aggregate costs linked with disability. Does that US$1.94 trillion simply measure that lost potential economic contribution of the world’s 1 billion disabled? Does it include the cost of providing formal care and support? Does it include the unmeasured cost of unpaid family carers? Does it include the cost of those carers being kept out of the workforce?
Mercifully, the Hanoi discussion was the start of a journey, providing lots of food for thought, and a myriad anecdotal insights into the inspirational things that can be done to embrace disabled people into the workforce. But gosh, so much work still to be done – not least here in Hong Kong. And without better numbers, I suspect we will end up asking more questions than working on solutions.
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