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Article of the Week
Disabled people in Kerala
Below Dr.G.K.Mini analyzes the Literacy and employment status of the disabled people in Kerala at different socio-economic levels.
Disability is a multidimensional concept, relating to the body functions and structures of people, the activities they do, the life areas in which they participate, and the factors in their environment that affect these experiences (WHO 2001a). In any society, disability is a normative, cultural, and legal construct more than a physical factor. Disability is a general feature of humanity with disparity in its causes and characteristics in different societies.
Disability rates vary noticeably between different countries in the world, mainly due to their differentials in conceptual measurements. The disability rate of Brazil was 14.5% in 2000 and the American Community survey in 2003 reported a disability rate of 11.5%, which is lower than the US census figure of 19.3% in 2000. With the available results, comparatively lower rates were observed in the census figures of Chile (2.2%) and Colombia (1.8%). (Bercovich A, 2005)
The history of data collection concerning disability in India is from 1872 onwards and continued up to the census of 1931. Collection of information related to disability discontinued after 1931 due to the limitations in authencity and quality of data collection.
After half a century gap, in 1981, the data collection has again been started. But the question on disability was not included in the 1991 census. Again in 2001 census, information on disability for five types of disabilities (seeing, speech, hearing, movement and mental) was collected.
View Table: Information on Disability
Among the five types of disabilities considered, the prevalence is highest among the visually disabled class followed by movement disability, mental disability, hearing disability and speech disability in that order. Among the total disabled population in Kerala, 38.87% are visually disabled, 7.79%have speech disability, 9.26% have hearing disability, 27.61% have movement disability and 16.46% are mentally disabled.
Visual disability is the highest in Idukki district and lowest in Kannur district. Speech disability is the highest in Pathanamthitta district followed by Alappuzha and the lowest rate is observed in Malappuram. The highest prevalence of hearing disability was observed in Kottayam district followed by Kozhikode, Kollam district and so on and the lowest rate is observed in Trissur district.
Movement disability prevalence is highest in the districts of Kollam and lowest in the districts of Malappuram. Mental disability is the highest in Kottayam district and lowest in Kasargode district.
| Type of disability | Males | Females | Total |
|---|---|---|---|
| Visual | 1.08(36.51) | 1.02(41.56) | 1.05(38.87) |
| Speech | 0.24(8.11) | 0.18(7.42) | 0.21(7.79) |
| Hearing | 0.24(7.95) | 0.26(10.75) | 0.25(9.26) |
| Movement | 0.92(31.06) | 0.58(23.69 | 0.75(27.61) |
| Mental | 0.48(16.36) | 0.41(16.57) | 0.44(16.46) |
| Total | 2.96 | 2.46 | 2.7 |
Figures in brackets are the proportion of each disability among the total disabled population.
Literacy
The literacy rate of the general population in Kerala is 90.9%. Among the disabled population the literacy rate goes down to 67.0% with comparatively low percentage for females. The male-female gap in literacy rate of the general population is 6.5, which widens to 15.8 among the disabled population. Literacy rate is the highest among the movement and mentally disabled population whereas the lowest rate is seen among people with speech disability.
| Type of disability | Males | Females | Total |
|---|---|---|---|
| Visual | 82.2 | 63.1 | 72.7 |
| Speech | 55.4 | 44.7 | 50.6 |
| Hearing | 73.7 | 55.4 | 63.8 |
| Movement | 80.8 | 65.4 | 76.6 |
| Mental | 80.8 | 65.4 | 76.6 |
| Total | 74.4 | 58.6 | 67.0 |
The highest literacy is seen in Kottayam district (75.8%) followed by Pathanamthitta, Ernakulam, Idukki and so on. The lowest literacy rate is seen in Kasargod district.
The male-female gap in literacy rate is 15.8 in Kerala. The widest gap is observed in the district of Kozhikode followed by Kasargod, Palakkad, Wayanadu etc. The lowest male-female gap in the literacy rate is observed in the Thiruvananthapuram district.
View Table: Literacy rate of disabled people in the districts of Kerala
Working Status
Work participation rate1 among the general population in Kerala is 50.2% for males and 15.9% for females with male-female gap of about 34.3%. While the rate among disabled population is 37.8% among males and 11.4% among females with a comparatively lower gap of 26.4%.
Work participation rate is the highest among visually disabled and lowest among mentally disabled people. Male-female gap in work participation rate is the widest among visually disabled population. More than half of the disabled males are workers which is in corroboration to the state's general work participation rate among males in general population.
| Type of disability | Males | Females | Total |
|---|---|---|---|
| Visual | 53.5 | 15.1 | 34.3 |
| Speech | 32.4 | 9.3 | 22.1 |
| Hearing | 36.5 | 11.0 | 22.7 |
| Movement | 34.0 | 10.9 | 24.7 |
| Mental | 13.5 | 4.2 | 9.2 |
| Total | 37.8 | 11.4 | 25.5 |
Highest work participation rate is seen in Iddukki, where the disability rate is also the highest. In the general population also the highest work participation rate is observed in the same district. Among male disabled population the highest work participation rate is observed in Wayanadu district and among females the highest rate is seen in Idukki district.
The wide gender gap observed in work participation rate of males and females in Idukki is a point of curiosity. The work participation rate of males is 17.4% in Idukki where the highest rate of 58.1% is observed among general population. Work participation rate among females is 63.5% among disabled population while the rate is 28.1% in general population in Idukki.
Wayanadu with lowest disability rate but showed the second highest work participation rate. The districts like Ernakulam, Palakkad and Alappuzha are also showed high work participation rate. The lowest work participation rate is observed in Malappuram district.
The work participation rate among the disabled population is higher than the general work participation rate in districts like Ernakulam, Trissur, Thiruvananthapuram, Kottayam and Pathanamthitta. The districts like Thiruvanthapuram, Kollam and Pathanamthitta, proportion of male work participation among the disabled population is higher than that in general population.
The total work participation rate among disabled population is the highest in Idukki district which is mainly contributed by females. It is to be noted that in Idukki district, female work participation is the lowest among the general population.
View Table: Work participation rate among disabled population in Kerala
Type of work involved
Apart from the work participation rate, the type of work the disabled population are involved is a point of interest since the working population among the disabled population means that they are able to work. The type of work involved is clear from Table 7 for each type of disability.
Irrespective of the type of disability the highest percentage of people are involved in other type of work than cultivators, agricultural laborers and household industries. Secondly preferred type of work is agricultural labor and the least preferred is household industrial work in all types of disabilities.
Work participation by type of work involved in each districts of Kerala is presented in Table. Disable population encaged in Cultivation are the highest in Idukki district and in agriculture the highest rate is observed in Palakkadu district. Work participation of the disabled population in household industries is the highest in Kasargode and Koazhikode. Other sector work participation rate is the highest in Ernakulam district.
View Table: Proportion of each type of work among the working disabled population by type of disability
View Table: Work participation rate by type of work in different districtsSpatial Variation
Spatial variation in disability rate by type of disability is shown in the below table. Prevalence of disability is slightly higher in rural Kerala than in urban Kerala irrespective of the type of disability. The male-female gap is almost same in both rural and urban areas.
The difference in rural-urban prevalence of disability is the highest in the district of Idukki. The district wise proportion of disabled people in rural and urban areas in Kerala is shown in the below table.
Limitation
In the present study, the major limitation of explaining the disability among the state's population is the non-availability of an important demographic composition of age-wise picture. Most of the earlier studies reported that older people are less productive in the labor force since the prevalence of disability may be comparatively high among them.
And thus older workers who find difficulty to work after the commencement of disability is also added in the total work participation of disabled population. But due to this inclusion the work participation rate is actually lower than the actual work participation of the disabled population in the productive age group. So results should be interpreted with this limitation while making related policies.
Another limitation of the study is that the analysis is limited to the availability of five types of disabilities. Also multiple burden of disability can not be extracted from the data since during data collection the criteria is that if a person suffered from one or more of the disabilities, only one of these was recorded based on the most preferred type by the respondent themselves.
The data is taken based on the self-reported information from the respondent, which is a further limitation of the study.
Discussion
The objective of the present study is to analyze the prevalence of disabled population in Kerala in different socio-economic levels for different types of disability. Overall disability rate of Kerala (2.7%) is higher than the national average (2.1%). One of the possible explanations for this is the increased propensity to report diseases and illness.
Such trend was also observed in morbidity related studies (NSSO, 1998) in Kerala. Chamie in 1995 found that in addition to socio-economic factors, morbidity can help to predict the prevalence and demographic pattern of disability in a country or community. The comparatively low mortality from some major diseases seen in the state can also be the reason for the high level of disability rate.
Demographic changes are also affecting the number of people with disability, particularly in societies facing the problem of ageing. Population ageing could result in an increase in the overall prevalence rate and the number of people with disability in the population.
Comparative analysis of disability prevalence over the period 1981-1998 in Canberra suggested that the ageing population has had a strong impact on the prevalence of severe or profound core activity restriction (AIHW 2000b).
High proportion of aged population may be one of the reasons for the high prevalence of disability observed in Kerala, which have the highest proportion of aged population among the Indian states. The increasing proportion of ageing observed in the state will expect to rise the disability prevalence in Kerala.
Kerala has reported the highest morbidity rates as well as the lowest mortality rates. These rates indirectly play role in the disability prevalence of the state. The compound relationship between morbidity and mortality with disability is under debate with currently many arguments.
The main arguments are related to the increased longevity accompanied by a longer period of disability in the later years of life, causing disability prevalence to increase (e.g. Verbrugge 1984, 1989) and the later onset of diseases means a compression of morbidity and disability into a shorter period at the end of the life span, resulting in lower disability prevalence in the population (e.g. Fries 1980, 1989).
But contradictory confirmations were available in the international literature related to morbidity and disability.
Results of NSSO report 2003 showed the highest literacy among disabled population is in Delhi followed by Kerala among the Indian states. As observed among general population in Kerala, clearly, wide gender gap is seen in literacy rate of males and females among disabled population of the state.
The highest literacy rate is seen among people with mental disability and movement disability. This high rate seen among mentally disabled population is a point of interest since integrating mentally disabled population with high literacy and work participation is an enormous task than with other type of disabilities.
In persistence with the highest populous district, Malappuram, also have the highest number of disabled population among the districts in Kerala. As seen among general population in Kerala the highest work participation is observed in the district of Idukki. A result of interest in work participation is the high female work participation and the wide gender gap in the work participation rate in Idukki district.
There is very little variation in the type of work involved among the disabled population in different types of disability groups. Apart from the highest preferred type of other sector, the highly preferred type of work is agricultural labor and least preferred is household industries.
It is concluded that people with disability have lower levels of literacy and work participation compared to general population. Male dominance in literacy as well as work participation is clearly seen among disabled population in Kerala.
Since the census figures are not available for each age group we cannot precede to the age wise composition of disability in Kerala which can predict the disability free life expectancy and future burden related to disability mainly because of the high ageing observed in the state.
The study proposes the need for more detailed studies on people with disabilities in the region. The comparatively lower literacy and work participation of disabled population compared to general population in the state is to be considered by the government and intervention programmes should be formed to better the condition.
Those who are unable to work at all would not benefit the advantages of employment opportunities. So policies related to employment of disabled population must concentrate people with disabilities who can work at all.
The findings of the study will hope to be useful to policy makers for identifying the weaker socio-economic sections of the disabled population in Kerala which hoped to improve the disability based plans
References:
- AIHW (Australian Institute of Health and Welfare) 2000b. Disability and ageing: Australian population patterns and implications. AIHW cat. no. DIS 19. Canberra: AIHW (Disability Series).
- Australian Institute of Health and Welfare (AIHW) 2003. Disability prevalence and trends. Disability Series. AIHW Cat. No. DIS 34. Canberra: AIHW.
- Bercivich A, 2005, People with disability in Brazil: a look at 2000 Census results, Paper presented at the IUSSP conference 2005.
- David C. Stapleton Richard V. Burkhauser (Editors), 2003. The Decline in Employment of People with Disabilities: A Policy Puzzle, W.E. Upjohn Institute for Employment Research Kalamazoo, Michigan.
- Fries J 1980. Ageing, natural death, and the compression of morbidity. New England Journal of Medicine 303(3):130-5.
- Fries J 1989. The compression of morbidity: near or far? Milbank Quarterly 67(2):208-3.
- IIPS, National Family Health Survey-II (1998-1999), Bombay: International institute of population studies, 2000.
- National Sample Survey Organisation. Disabled persons in India, New Delhi: Department of Statistics, Government of India; 2003(report no. 485).
- National Sample Survey Organisation. Morbidity and Treatment of Ailments. New Delhi: Department of Statistics, Government of India; 1998 (report no. 441).
- Registrar General of India: Census of India 2001, Data on Disability, Vol.-III.
- Registrar General of India: Census of India 2001, Data on Disability, Vol.-II.
- Verbrugge L 1989. Recent, present, and future health of American adults. Annual Review of Public Health 10:333-61.
- Verbrugge LM 1984. Longer life but worsening health? Trends in health and mortality of middle-aged and older persons. Milbank Quarterly 62:475-519.
- Verbrugge LM, Jette AM (1994) The disablement process. Soc Sci Med 38: 1-14
- WHO (World Health Organization) 2001a. International classification of functioning, disability and health. Geneva: WHO.
Source: Disabled people in Kerala, Dr.G.K.Mini, Research Associate, Achutha Menon Centre For Health Science Studies, Sree Chitra Thirunal Institute for Medical Sciences And Technology, Thiruvannathapuram
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