Building inclusive support systems for persons with disabilities – World Bank Group

Report on Disability-Inclusive Social Protection and Long-Term Care

Introduction: Addressing Systemic Challenges in Line with the Sustainable Development Goals

The provision of long-term care for persons with disabilities and aging populations presents a significant global challenge, directly impacting the achievement of multiple Sustainable Development Goals (SDGs). The reliance on informal family care, predominantly provided by women, perpetuates gender inequality (SDG 5) and economic vulnerability. This report analyzes the intersection of disability, aging, and social protection, highlighting the necessity of inclusive policies to advance SDG 1 (No Poverty), SDG 3 (Good Health and Well-being), and SDG 10 (Reduced Inequalities).

Socio-Economic Disparities and Demographic Pressures

Barriers to Achieving SDG 8 and SDG 10

Persons with disabilities face a heightened risk of poverty and social exclusion, undermining progress towards SDG 1 and SDG 10. Systemic failures create significant obstacles to realizing fundamental rights and opportunities.

• Economic Exclusion: Barriers to education (SDG 4) and employment result in lower earnings, while higher costs for healthcare and adapted living exacerbate financial strain. This directly contravenes the objective of decent work for all (SDG 8).
• Gender Inequality: The disproportionate burden of unpaid caregiving on women reinforces gender disparities, impacting household income and limiting women’s economic participation, a key target of SDG 5.
• Demographic Shifts: The rapid aging of populations, particularly in Europe and Central Asia, intensifies pressure on care services. This demographic trend challenges the sustainability of healthcare and social support systems, impacting SDG 3.

Framework for Inclusive Social Protection

Aligning National Policies with SDG 16 and Human Rights

Effective social protection is a critical mechanism for reducing the exclusion of persons with disabilities. However, traditional models often favor segregated services over community-based support, failing to align with the principles of the UN Convention on the Rights of Persons with Disabilities (CRPD) and the ethos of SDG 16 (Peace, Justice and Strong Institutions).

Pathways to Inclusive Systems

• Community-Based Services: A shift from institutionalization to community-based living is essential for ensuring persons with disabilities have choices equal to others, supporting SDG 11 (Sustainable Cities and Communities).
• Rights-Based Approach: As stated by UNICEF, disability-inclusive social protection is a human rights obligation. Reforms must place the individual at the center of the process to effectively reduce inequalities (SDG 10).
• Economic Co-Benefits: Investing in inclusive systems is not merely a social expenditure but a driver of economic growth (SDG 8). It creates decent jobs within the care economy and reduces gender disparities in the workforce (SDG 5).

International Cooperation and Best Practices

Fostering Partnerships for the Goals (SDG 17)

A core course on Disability-Inclusive Social Protection Systems and Long-Term Care, organized by the World Bank and UNICEF, exemplifies SDG 17 (Partnerships for the Goals). The event convened specialists from 13 countries to share knowledge and promote reforms. Discussions underscored that targeted public investment in individual support yields broad societal benefits, contributing to economic resilience and social cohesion.

Innovations in Policy and Practice

Several countries have implemented successful reforms that offer scalable models for achieving the SDGs:

1. Romania & Uzbekistan: Simplified and digitized disability assessment processes improve the efficiency and accessibility of public institutions, a key target of SDG 16.
2. Georgia: A comprehensive support package designed to cover the extra costs associated with disability directly addresses poverty and inequality (SDG 1, SDG 10).
3. Sweden: A legal right to personal assistance empowers individuals to lead independent lives, fostering inclusive communities (SDG 11).
4. Spain: The use of mobile technology to provide job-specific training enhances autonomy and access to mainstream employment (SDG 8).
5. Belgium: Individualized subsidies for jobseekers with disabilities promote integration into the mainstream workforce, advancing the goal of decent work for all (SDG 8).

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 1: No Poverty
   • The article directly links disability to a higher risk of poverty, stating, “Persons with disabilities are at far greater risk of poverty and marginalization.” It also highlights how social protection systems can mitigate this risk.
2. SDG 3: Good Health and Well-being
   • The article discusses the challenges of aging populations and the increasing need for long-term care for older people with disabilities. It also mentions that people with disabilities face “higher costs for essentials like healthcare.”
3. SDG 4: Quality Education
   • The text points out that people with disabilities often earn less due to “barriers to education, training and jobs.” It also critiques models like “special classrooms in mainstream schools” as falling short of true inclusion, implying a need for fully inclusive education systems.
4. SDG 5: Gender Equality
   • The article explicitly states that women provide the majority of unpaid family care for persons with disabilities, which “hits household income, and since women provide most of this support, gender inequalities are reinforced.”
5. SDG 8: Decent Work and Economic Growth
   • The article addresses employment barriers for people with disabilities and provides examples of initiatives aimed at improving their work prospects, such as a phone app for job-specific training in Spain and a subsidy system in Belgium. It also notes that investing in disability-inclusive systems “creates decent jobs in the care economy.”
6. SDG 10: Reduced Inequalities
   • This is a central theme. The article focuses on the social and economic exclusion of persons with disabilities, advocating for “disability-inclusive social protection” and reforms to make systems “truly inclusive for people with disabilities and older adults, addressing inequalities.”
7. SDG 11: Sustainable Cities and Communities
   • The article touches upon the need for accessible living environments, mentioning that people with disabilities face “higher costs for… adapted housing” and advocating for the right “to live in the community, with choices equal to others,” moving away from segregated institutions.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 1.3: Implement nationally appropriate social protection systems and measures for all, including floors, and by 2030 achieve substantial coverage of the poor and the vulnerable.
   • The entire article is centered on the role of “social protection policies” and “disability-inclusive social protection systems” in addressing the challenges faced by persons with disabilities, who are identified as a vulnerable group at high risk of poverty.
2. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
   • The discussion on “higher costs for essentials like healthcare” and the increasing pressure on “formal care services” for aging populations with disabilities directly relates to the need for universal access to health and long-term care without financial hardship.
3. Target 4.5: By 2030, eliminate gender disparities in education and ensure equal access to all levels of education and vocational training for the vulnerable, including persons with disabilities, indigenous peoples and children in vulnerable situations.
   • The article identifies “barriers to education, training” as a key reason for lower earnings among people with disabilities and discusses the shortcomings of segregated educational settings, aligning with the goal of ensuring equal access and true inclusion in education.
4. Target 5.4: Recognize and value unpaid care and domestic work through the provision of public services, infrastructure and social protection policies and the promotion of shared responsibility within the household and the family as nationally appropriate.
   • The article’s statement that “women provide most of this support [unpaid family caregiving], gender inequalities are reinforced” directly addresses the core issue of this target. The call for better social protection and formal care services is a proposed solution.
5. Target 8.5: By 2030, achieve full and productive employment and decent work for all women and men, including for young people and persons with disabilities, and equal pay for work of equal value.
   • The text discusses “barriers to… jobs” and highlights successful reforms in Spain and Belgium that use technology and subsidies to open up “better work prospects in mainstream employment” for people with disabilities.
6. Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.
   • This target is the overarching goal of the article, which advocates for making systems “truly inclusive for people with disabilities and older adults” and ensuring they have a “say in how they live, learn, work, or lead their lives.”
7. Target 11.1: By 2030, ensure access for all to adequate, safe and affordable housing and basic services and upgrade slums.
   • The mention of “higher costs for… adapted housing” and the push for community living over institutionalization connects to the need for accessible and affordable housing for persons with disabilities.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Proportion of persons with disabilities at risk of poverty and social exclusion.
   • The article explicitly states, “In the European Union, people with disabilities are 50% more likely than the general population to be at risk of poverty and social exclusion.” This statistic serves as a direct indicator for measuring inequality and the impact of social protection.
2. Proportion of persons with disabilities covered by social protection systems.
   • The article mentions that “social protection reduces that risk [of poverty] threefold,” implying that the coverage and effectiveness of these systems are key metrics for progress.
3. Proportion of children with disabilities in institutional care versus inclusive community/educational settings.
   • The statistic that “children with disabilities are 6 to 30 times more likely to be placed in residential institutions” provides a clear, measurable indicator of the lack of inclusive community support and educational systems.
4. Proportion of time spent on unpaid care work, by sex.
   • While not providing a number, the article implies this indicator by stating that “women provide most of this support [unpaid family caregiving].” Measuring the disparity in time spent on care is essential to track progress on gender equality.
5. Employment rate of persons with disabilities.
   • The examples from Spain and Belgium, which aim to improve “work prospects in mainstream employment,” suggest that a key measure of success would be an increase in the employment rate for people with disabilities.
6. Proportion of the population aged 65 and over.
   • The article provides demographic data: “today 15% of the population is over 65, but… nearly one in four will be seniors by 2070.” This is an indicator of the growing need for long-term care and disability support systems.

4. Summary Table of SDGs, Targets, and Indicators

Source: worldbank.org