Poverty and disability.

In the previous editorial we discussed the importance of rehabilitation professionals having a goal of assisting individuals with disabilities to find employment at or above a living wage. In this editorial would like to broaden the discussion to consider the connection between poverty and disability. According to the 1999 National Survey of American Families of the approximately 29 million low income (<200% of the federal poverty level) adults 23% report a work limitation, 25% report fair/poor health, and 15% report poor mental health. When one considers those who are poor (<100% of the federal poverty level) the number of people with work limitations (31%), fair/poor health (33%) or poor mental health (23%) significantly increase (Wittenburg, & Favreault, 2003). In a recent article in the New York Times the number of individuals without healthcare and living poverty continues to grow (Leonhardt, 2004, August 27). According the Rehabilitation Services Administration data on competitive employment outcomes vocational rehabilitation clients earn approximately 57% of the average U.S. wage. Clearly there is a relationship between poverty and disability.

We think that it is important for rehabilitation professionals to have an understanding of how chronic poverty impacts the development and perpetuation of disability. The following is a basic model based on the work of Yeo (2001) that can be used to facilitate an understanding of how chronic poverty causes disability. This model is not intended to be comprehensive; instead, the purpose is to help rehabilitation professionals start to conceptualize how certain variables impact poverty and disability and to promote a more in-depth discussion regarding this relationship.

By living in chronic poverty individuals assume socially devalued roles. According to Wolfensberger (2000) social roles decisively shape the way in which people are treated. People who occupy socially devalued roles (i.e. people who are poor) are typically mistreated and denied opportunities. The result is that people who are poor have diminished self-efficacy and sense of coherence, limited access to quality education and employment, live in rundown housing and neighborhoods, have limited participation in the legal/political process and social service system, and limited access to quality healthcare (Elwan, 1999).

For example, individuals with lower sense of coherence are more likely to have difficulty finding employment and less likely to persist at finding employment (Strauser & Lustig, 2003). By attending low quality schools students develop attitudes and work habits that are counterproductive to obtaining and maintaining employment in the competitive labor market (Haberman, 1997). By occupying a marginalized role in the legal/political and social service system, they are less likely to receive quality services and legal representation. Limited access to healthcare leads to poor physical and mental health (Elwan, 1999). As a result of these experiences, individuals living in poverty tend to also experience a generalized level of chronic stress. All of these conditions place individuals at a higher risk of becoming disabled and can increase the severity of pre-existing disabilities. This model describes the connection between poverty and disability. It is important to note that disability also causes poverty.

Listed below are recommendations for rehabilitation professionals:

1) Rehabilitation professionals should conceptualize their clients holistically. The rehabilitation professional should also consider issues related healthcare, living conditions, transportation, empowerment, and access to quality services.

2) Rehabilitation professionals should assist individuals with disabilities in obtaining more valued roles.

3) Continued efforts should be focused on obtaining and maintaining high quality jobs that pay a living wage so that the cycle of poverty can be broken.

4) It is important for rehabilitation professional and researchers to examine the connection between poverty and disability.

References

Leonhardt, L (2004, August 27). More Americans were uninsured and poor in 2003, census finds. The New York Times, pp. A1, A18.

Strauser, D.R. & Lustig, D.C. (2003). The moderating effect of sense of coherence on work adjustment: Implications for career and employment interventions. Journal of Employment Counseling, 40, 129-140.

Wittenburg, D. & Favreault, M. (2003). Safety net or tangled web?: An overview of programs and services for adults with disabilities (Occasional Paper Number 68), Urban Institute.

Wofensberger, W. (2000). A brief overview of social role valorization. Mental Retardation, 38, 105-123.

Yeo, R. (2001). Chronic poverty and disability. Somerset, United Kingdom: Action on Disability and Development (Background Paper # 4).