Disability, Economic Globalization and Privatization_ a Case Study of India _ Hiranandani _...

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16/9/2014 Disability, Economic Globalization and Privatization: A Case Study of India | Hiranandani | Disability Studies Quarterly

http://dsq-sds.org/article/view/1272/1302#top 1/19

Disability, Economic Globalization and Privatization: A Case Study

of India

Vanmala Hiranandani

Associate Professor-cum-Deputy Director

Center for the Study of Social Exclusion and Inclusive

Policies

SNDT Women's University

Mumbai, India

E-mail: [email protected]

Deepa Sonpal

Program Coordinator

UNNATI Organization for Development Education

Gujarat, India

E-mail: [email protected]

Keywords:

disability; privatization; India-economic reforms; international development

Abstract

People with disabilities are one of the most disenfranchised groups in India.

Standardized measurements of disability in India and internationally have overlooked

the linkages between the economy and disability. In recent decades, neo-liberal

economic reforms imposed in developing countries, under pressure from international

financial institutions, have downsized state role, privatized social goods, and

encouraged export-led strategies and market-based economics. India's economic

reforms, initiated in 1991, have led to rapid economic growth that is, however,increasingly mal-distributed.

This paper investigates the implications of economic restructuring in the arenas of

social programs, education, employment, accessibility, health, agriculture and food

security, and water and land acquisition from a disability perspective. Our analysis

shows that while increased employment opportunities and accessibility have

benefitted middle-class and highly-skilled disabled persons, the majority of people

with disabilities have been left out of India's economic affluence. We contend thatIndia's globalized economy and reduced state role necessitate renewed

understanding of human rights, including disability rights.


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Introduction

Recent estimates suggest 85-90% of the global population of persons with disabilities

resides in so-called developing countries. The United Nations estimated that more than 1.3

billion people live in abject poverty in the global South, 600 million of which are disabled

(Yeo, 2005). Thus, the majority of people with disabilities in the South are not only poor, but

they are among the poorest of the poor. In India, there are no clear estimates of the numberof persons with disabilities. Concerns persist that, given the stigma surrounding disability,

many individuals with severe impairments, mainly women and rural disabled, are excluded

from census and surveys (Jeffery & Singal, 2008).

Moreover, large-scale government studies as well as most small-scale research in India has

overlooked the impact of economic globalization in the form of changing roles of the state

and the market on the lives of people with disabilities. The hype about India's recent

economic growth obscures the lived realities of spiraling inequality, the declining welfarestate, and the growing misery of the poor. As the state withdraws from the service sector,

access to basic necessities such as education, health, employment, and food and water

security has become increasingly difficult for vulnerable populations (Bhaduri, 2008). Little

critical analysis of economic globalization and privatization exists from a disability rights

perspective.

Using India as a case study, this paper assesses privatization and the state's abdication of

responsibility for essential services and their implications for disability, specifically thepropagation of chronic illnesses and impairments. Some of the ramifications of globalization

and the privatization for human rights, including disability rights, are discussed, which

underscores the need to re-visit the notion of human rights given the growing power of non-

state actors in the globalized era.

Measuring Disability in India: Definition Dilemmas

Estimating the prevalence of disability in India has been hampered by complex andmultitudinous factors. Deep-seated social stigma results in the exclusion and invisibility of

individuals with disabilities. The lack of adequate definitions of disability further compounds

the task of accurately assessing the prevalence of disability. There are two government

sources of nationwide disability statistics in India: the Census and surveys of the National

Sample Survey Organization (NSSO). The 58th round of the National Sample Survey (NSS)

reported there were 18.5 million persons with disabilities in 2002 (NSSO, 2003) compared

with 21.9 million reported by the Census of 2001 (Registrar General of India, 2001). The

Census of 2001 did not adopt any particular definition of disability, rather it included afunctional limitation question that asks respondents about their type of functional limitation

(e.g., in seeing, hearing, movement). In contrast, the NSS considers a person as disabled if

s/he has restrictions or lacks the ability to perform an activity in the manner or within the


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range considered normal for a human being. The NSS thus defines disability as an activity

limitation.

Since the independence of India in 1947, a charity and medical model of disability has

informed policymaking under the aegis of the welfare state. To date, these models are

deeply embedded in the Indian society. Notwithstanding contemporary studies that have

addressed poverty and social stigma, until recently, socio-political responses were focusedmainly on medical intervention in the form of treatment and rehabilitation to cure the

'disease' or the 'problem' (Addlakha & Mandal, 2009). It was the ground-breaking Persons

with Disabilities - Equal Opportunities, Protection of Rights and Full Participation (PWD) Act

of 1995 that recognized the multi-faceted nature of disability and provided for education,

employment, creation of a barrier-free environment, social security, etc. The Act articulated

seven major kinds of impairments: blindness, low vision, leprosy-cured, hearing

impairments, locomotor impairments, mental retardation and mental illness. Although the Act

is guided by the philosophy of empowerment by addressing social attitudes, it is still

premised on thresholds of physical and cognitive impairments defined largely in medical

terms. Thus, even though the discourse in India's disability rights movement has advanced

towards a social model, the policy environment remains "a hybrid between the medical and

social models of disability" (World Bank, 2007, p. 124).

Lately, the conceptualization of disability has drawn from the International Classification of

Functioning, Disability and Health (ICF) (WHO, 2001). This framework, termed as the

biopsychosocial model of disability (World Bank, 2007), begins with a health condition that

gives rise to an impairment leading to activity limitations, consequently affecting the ability to

participate due to environmental, personal and institutional barriers. However, as Barile

(2003) mentions, ICF standards and their earlier versions (ICIDH-1, ICIDH-2) ignore the

historical and contemporary inequities between developing and developed countries and

disparities within each country. Standardized definitions and measurements have overlooked

the interactions between socio-cultural and economic factors in different regions that result in

varying levels of impairment and opportunities for disabled persons. Barile aptly notes that in

its attempt to attain a synthesis between different viewpoints of health from a medical,

individual and social perspective, the ICF neglects the crucial link between economics and

disability.

Economy and Disability

The linkages between disability and poverty have been increasingly recognized in

international development literature (Yeo, 2005). Poor people are much more likely to live in

unhealthy conditions without access to clean water or adequate nutrition. In times of illness,

poor people are less likely to be able to afford treatment, often leading to chronic conditions

or lifelong impairments. Conversely, impairment can lead to poverty and social exclusion by


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fostering financial dependency on handouts, the state and the extended family. Thus,

disabled people are more likely to be poor than their non-disabled counterparts, and people

living in poverty are more likely to become disabled than the non-poor. The relationship

between poverty and disability has been referred to as a vicious circle (Elwan, 1999; Yeo,

2005).

However, just as disability is not simply a matter of bodily variations but is caused by socialexclusion, poverty too is not merely a matter of inadequate incomes. According to the

Poverty Assessment Study Report (1995) (cited in Dube and Charowa, 2005, p. 9), poverty

is a symptom of structural inequities, social exclusion, powerlessness, and economic,

political and socio-cultural deprivation. Poverty results from having limited or no access to

basic services and is exacerbated by inadequate access to land, credit, technology and

resources for sustainable livelihoods. Thus, poverty is an inevitable consequence of the way

socio-economic systems are organized. However, hitherto most anti-poverty work has

viewed poverty as a lack of individual or household incomes. As Sen (2007) emphasizes, a

limited conception of poverty as lowness of personal income overlooks socio-political and

economic processes that perpetuate poverty. Any efforts to eliminate poverty would,

therefore, be unsuccessful if structural processes and socio-economic inequities are

unaddressed. Sen cites the example of Europe where poverty was reduced by state

provision of public health care, educational facilities, shared legal protections and other such

common resources.

Yet, in the last two decades, under pressure from international financial institutions (IFIs)

such as the World Bank and IMF, many countries in the global South have introduced

economic reforms characterized by opening domestic markets to global competition,

increasing transnational capital flows, and weakening the role of governments. These

economic policies aimed at accelerated global economic integration ('globalization') (Razavi,

2008) believe in the ideology of neo-liberalism that maintains state intervention is an

obstacle to economic growth because it creates inefficiency and market distortions.

Therefore, government expenditures should be reduced, allowing provision of services

through the private sector that is more efficient due to profit incentives (Gershman & Irwin,

2000). These principles have lead to privatization of health and social services, education,

transport and, increasingly, water and food provision in many parts of the world. Neo-

liberalism that underpins the current era of globalization has major implications for disabled

persons; however, disability definitions and discourse have paid insufficient attention to this

phenomenon. Given the virtual absence of literature on the impact of economic globalization

for persons with disabilities in India, the next section explores this topic in greater detail.

Economic Globalization, Privatization and Disability: A View from India

A mounting burden of debt and balance of payments crisis led India to adopt economic


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reforms on the lines of IMF-World Bank structural adjustment programs. These reforms,

known as the New Economic Policy (NEP), were introduced in July 1991. The NEP included

standard measures including the devaluation of the rupee (India's currency); privatization of

government-owned entities; reduction in public expenditure; cutbacks to food, agricultural

and fertilizer subsidies; increase in imports and foreign investment in capital-intensive and

high-tech industries; liberalization of trade regulations; and structural changes in the

economy aimed at export-led growth (Upadhyay, 2000).

The NEP has resulted in far-reaching effects on the economy and society. While reforms

have led to record economic growth, they have also led to unprecedented economic

inequalities, environmental degradation, rise in food prices, and unrest in several states that

has further hurt historically disadvantaged groups (Bidwai, 1995, 2000; Kumar, 2008).

Bidwai (2000) observes as reform policies pry open India's markets to attract multinational

telecommunications, information technology and automobile corporations, there is little

dispute that economic globalization has benefited India's 40 million middle-class and elite;

however, these policies have been ruthless to its 500- million-plus miserably poor.

Amidst these diverse forces impacting the lives of ordinary people in the country, the

situation of people with disabilities is particularly concerning given that their exclusion from

government census and surveys translates into denial of their citizenship rights and

entitlements to existing state programs for the poor and disabled. In this section, we assess

reform-induced changes in the arenas of social programs, education, employment,

accessibility, health, water, agriculture and food security, and land acquisition from a

disability perspective.

Social Programs:

The central government's allocation of funding to the states, which constitutes a major

resource to implement social programs in India, declined drastically in the post-reform

period. For instance, funding for poverty alleviation programs operated jointly by the

Center and states on 80:20 basis was drastically cut due to economic reforms(Teltumbde, 1996). Nevertheless, the range of social protection schemes that cover

people with disabilities, such as below poverty line (BPL) ration cards for government-

subsidized food grains and kerosene, social security pensions, scholarships, and

reservations in government jobs, provide some hope for the destitute, although they are

stingy and inadequate. Yet, as Mander's (2008) study reveals, access to these

programs remains riddled with bureaucratic challenges, corruption and delays with the

cumulative effect of denying benefits to those who need them most. Few disabled adults

actually receive disability pensions. Neither they nor their caregivers have adequateinformation about their entitlements or how to apply. In order to avail of disability

benefits, people with disabilities are required to undergo medical tests. Reports suggest

given the large number of applicants, thousands of young and elderly disabled face


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grueling ordeals lining up at hospitals from morning to evening for registration, tests and

the issuance of disability certificates (The Hindu, 2008). Moreover, in many states there

is a lack of focus on social protection for people with disabilities, as the low rates of

social pension coverage indicate (World Bank, 2007).

Budget cuts in the post-reform period have not only compounded already existing

bureaucratic challenges, they have also reduced government spending on disabilityprograms. Between 1998 and 2003, the Ministry of Social Justice and Empowerment

(MSJE), the nodal agency for promoting the welfare of disabled and other marginalized

groups, accounted for only between 5 to 7% of total government spending, signifying

the low priority placed by the government on core programs for people with disabilities

(World Bank, 2007). Although funding for inclusive education under the education

ministry has increased substantially in recent years, MSJE does not have consolidated

figures for spending on disability across ministries. As such, a comprehensive picture

about government spending on people with disabilities is lacking (World Bank, 2007).

Budget cuts for social programs of the MSJE, however, have adversely affected non-

governmental disability organizations that depended on government funding. NGOs

have been encouraged by the government to seek philanthropic contributions from

private wealthy donors and international aid organizations and by collecting fees from

few elite clients who can afford to pay for services rather than receiving their funding

from the central government (Erevelles, 2001).

Social protection in the form of social insurance interventions are not a reality for the

vast majority. Most disability insurance in India is provided publicly in the form of a

mandated benefit based on the retirement income scheme. However, disability

insurance schemes cover only workers in the formal sectors. Public social protection

system for people with disabilities outside of the formal sector is sketchy in most states

and offers low coverage and limited financial protection. Disability insurance that covers

employees in the private formal sector provides similar benefits; however, the private

insurance market in India is still at an early stage of development without much

experience in annuity products. In any case, public and private sector schemes together

cover only one in 10 workers in the country. Thus coverage is low and concentrated in

the top half of the income distribution, excluding most Indians with disabilities (World

Bank, 2007).

The latest National Policy for Persons with Disability 2006 signals a further withdrawal of

the state from its responsibility towards disability and a tendency to push that

responsibility on civil society and communities. Although the policy includes extending

rehabilitation services to rural areas, increasing employment opportunities, improving

access to public services etc, the section on 'Responsibility for Implementation' states:

The community should take a leading role in generating resources within


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themselves or through mobilization from private sector organizations to

maintain the infrastructure and also to meet running costs. This step will not

only reduce the burden on state resources but will also create a greater

sense of responsibility among the community and private entrepreneurs

(quoted in Bhas, 2006, para 22).

The attempt to absolve the state of its obligation towards disenfranchised persons byplacing the onus of generating resources on the private sector and the community

draws from a global neo-liberal trend that, as studies elsewhere have shown, has led to

disconcerting consequences for the poor and disabled (ex. see Hiranandani, 2002;

Johnson & Woll, 2003; Maskovsky, 2000; Waitzkin & Iriart, 2000).

Education:

The Persons with Disabilities Act of 1995 emphasized free education for disabled

children up to eighteen years of age, the development of teacher training programs

specializing in disabilities to provide trained manpower for special schools and

integrated schools for children with disabilities, equal access for disabled people to all

levels of education including higher and vocational education, and reservation of a

minimum of 3% in admissions to all levels of public educational institutions (Government

of India, 1996). Yet, after more than a decade of the PWD Act, few persons with

disabilities have access to education or training. Illiteracy is high across all categories of

disability, at 52% compared to 35% for the general population. Ninety percent of India'sdisabled children five times the general rate do not attend school, totaling around

40 million (Chatterjee, 2003 cited in Gabel & Chander, 2008). Disabled children rarely

progress beyond primary school, and only 9% have completed higher secondary

education (World Bank, 2007).

The Sarva Siksha Abhiyan(SSA), a program formulated under the Education for All

National Plan of Action, has a special section on inclusive education; however,

enrollment and retention rates remain poor. Similarly, only 2 to 3% of persons withdisabilities receive vocational training in low-profile stereotyped non-engineering areas

likely to deliver low income (Mishra &Gupta, 2006). While the poor utilization of these

interventions can be attributed to multiplicity of factors, including low awareness and

ritualistic implementation of programs with discrimination, privatization has not

advanced the cause of education for children and youth with disabilities. Spending on

inclusive education, although promoted under the SSA, is only 1% nationally (World

Bank, 2007).

In addition, the quality of public schools has suffered immensely due to reduced

government expenditure on education. In 2005, the government's Common Minimum

Program promised a gradual increase in the education budget to at least six percent of


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GDP. However, the education budget continues to remain at 3% of GDP (D'Costa,

2008; Das, 2009). Several states (eg. Karnataka) have education budgets that are

2.25% lower than the national average. Private investors have established educational

institutions ranging from kindergartens to universities offering more expensive education

for the middle class and elites, motivated mainly by profit (Bagal, 2005). These changes

have hardly benefited disabled students, as is evidenced by a survey of 89 schools by

the National Centre for Promotion of Employment for Disabled People (NCPEDP),

which found in 2004, more than a decade after liberalization and economic reforms, only

0.1% of disabled students were in mainstream educational institutions at the university

level and 0.51% at the primary and secondary level, a negligible figure compared to the

3% reservation enacted by the PWD Act (NCPEDP, 2004). The NCPEDP survey further

shows that 20% of the schools acknowledged they do not admit disabled students and

18% were not even aware of the PWD Act. Only 20 out of 55 schools that admit

disabled children employ special educators. Moreover, pedagogical methods continue

to be outmoded and rote-based, and the disempowering approach of the formal

education system considers the needs of children with disabilities to be largely a non-

issue (D'Costa, 2008).

Although the PWD Act encouraged equal access in higher education, NCPEDP's 2005

survey showed, out of the 119 universities that responded, 20% did not follow the 3%

reservation rule. Only 15% of the universities reported providing appropriate desks and

chairs for students with physical impairments. Only 16 universities provided assistive

software to students with visual impairments and only 10 universities provided books in

Braille and sign language interpreters (cited in Gabel & Chander, 2008).

The recent Right to Education (RTE) Act of 2009 promises free and compulsory

education to all children between 6 and 14 years and requires public and private

schools to reserve 25% seats for children from disadvantaged sections. However, the

Act excludes children below six years from their fundamental right to pre-primary

education - a shortcoming that was brought to the attention of the human resources

minister by disability rights groups (EPW, 2009). Moreover, the Act does not specifically

require disabled-friendly infrastructure in schools; rather, it uses the vague and

undefined phrase of 'barrier-free access.' The minister assured that the Act would be

amended later to include enabling provisions for disabled students and children under

age 6, but pleaded that it be passed in its current form to avoid losing time. In its current

form, the RTE Act covers only those impairments included under the PWD Act, with

promises for amendments to incorporate impairments covered by the National Trust for

the Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple

Disabilities Act, 1999. However, as EPW (2009) aptly notes, the fact that this law, hailed

as 'historic' and 'revolutionary,' needed to be amended within a month of its passing and

did not give sufficient attention to children from one of the most marginalized sections of


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India, is indeed intriguing. Moreover, the RTE Act augments the pace of

commercialization in India's education sector by banishing the very idea of public-

funded common school system and promoting public-private partnerships, which will

ensure that India's poor continue to be relegated to sub-standard schools and excluded

further from an increasingly elite-centered formal education system.

Employment:

Privatization has led to mixed outcomes for people with disabilities in the employment

sphere. On one hand, technological advances have reduced their job opportunities. ILO

(2003) cites the example of jobs earlier available to visually-impaired people such as

telephone operator, stenographer and typist that have declined due to changes in

communication technology and introduction of computers. On the other hand,

privatization has opened newer avenues for employment of people with disabilities in

highly-skilled and service jobs, making them more mobile and competitive in the jobmarket (B. Punani, Executive Director, Blind People's Association, personal

communication, March 22, 2009). However, this is limited to those with access to higher

education and adequate training. Most training programs do not match the demand of

the service sector leaving most persons with disabilities unequipped to avail of highly-

paid jobs in this transitional phase of the Indian economy (ILO, 2003). Furthermore, the

vast population of the rural disabled is deprived of access to technology and jobs that

involve its application (Sridhar, 2003).

Overall, employment of people with disabilities fell from 42.7% in 1991 to 37.6% in 2002

despite strong economic growth (World Bank, 2007). Since most organized sector jobs

available to persons with disabilities were earlier available in government and public

sectors, globalization has constricted job opportunities due to disinvestments by the

government in the public sector (ILO, 2003). The PWD Act of 1995 provided for 3%

reservation in all government and public sector employment. Although the Act provides

incentives to private sector employers for promoting disabled persons' employment, the

3% reservation rule is not mandatory for private employers (Friedner, 2009; Mishra &

Gupta, 2006). More than fifteen years after the reforms, disabled people have about

60% percent lower employment rates than the general population, a gap that has been

increasing over the past fifteen years (World Bank, 2007). The World Bank report

mentions in the late 1990s, employment of people with disabilities in large private firms

was only 0.3% of the companies' workforce. In 1999, the National Centre for Promotion

of Employment for Disabled People (NCPEDP) conducted a research study of the top

100 companies in India to examine employment practices in the corporate sector. Of the

796,363 total employees in 70 of the companies that responded, only 3,160 were

disabled persons comprising 0.4% of the workforce. The percentage of employees with

disabilities in public sector companies was 0.54, while in private companies only 0.28


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percent employees were disabled (Abidi, 1999). The percentage of employees with

disabilities in multinational corporations is only 0.05% (World Bank, 2007).

People with disabilities are often employed in the private sector under the rubric of

corporate social responsibility and such initiatives are highlighted by corporations in

their PR campaigns. Friedner's (2009) study cites the example of one data entry and

processing company in Bangalore that employs only disabled people since, according tothe company's chief operating officer, turnover of 'normal' people is persistent. Despite

consistently paying less than minimum wages to its disabled workers, this corporate

was awarded a leading disability and employment accolade in India and it prominently

displays its employment of people with disabilities on its website utilizing this initiative as

a unique selling point.

Accessibility:

Although the PWD Act promotes accessibility in public buildings, evidence shows

accessibility continues to be largely an unrealized goal in India (World Bank, 2007). No

budgetary provisions are in place to provide accessibility features in transport, road and

the built environment (Raturi, 2008). As such, ramps or lifts that accommodate

wheelchairs, signs in Braille, audio commands at traffic signals, accessible toilets etc

are rare. Due to resource constraints, courts often restrict the availability of state

assistance to a few categories of people with disabilities (Addlakha & Mandal, 2009).

Besides, as the PWD Act does not enforce accessibility in the private sector, mostmultinational and domestic businesses have ignored accessibility requirements in their

buildings.

Rural-urban disparities persist in the accessibility of transportation services. In rural

areas, people with stigmatized conditions, such as leprosy-cured, are not allowed to use

public transport even if they can afford it (Mander, 2008). Although, most buses and

trains continue to be inaccessible for people in wheelchairs (PACS, 2005), in urban

areas, privatization has had a positive impact in a way. For instance, Samarthyam, anorganization that advocates accessible environment and universal access for all, was

able to convince the New Delhi Municipal Council (NMDC) to make 197 new bus

shelters barrier-free and accessible. The contract for construction was given to the

multinational, J. C. Decaux, which is well-versed with accessibility requirements as

these are mandatory in Western countries. NDMC agreed to incorporate accessibility

features in these new bus shelters only if the bidders agreed to do so at no extra cost.

Advocacy with J. C. Decaux successfully led to the addition of universal design features

in the new bus shelters (A. Agarwal, Executive Director, Samarthyam National Centrefor Accessible Environment, personal communication, March 30, 2009). Likewise, the

Ministry of Railways has undertaken an initiative to upgrade accessibility in all 'A'

category stations in larger cities followed by category 'B' and 'C' stations in a phased


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manner (World Bank, 2007). However, as the World Bank Report indicates, provisions

of the PWD Act concentrate mainly on end-point access issues: consultations with

people with disabilities could go a long way to prioritize investments to promote access

and monitor access outcomes. Moreover, grievance redress procedures are weak and

penalties for non-compliance are non-existent. Orders from the Commissioner of

Persons with Disabilities are often not implemented unless the litigation reaches the

High Courts (Raturi, 2008). Addlakha & Mandal (2009) note that although the PWD Act

is rooted in a rights discourse, its application in concrete cases shows various

government agencies and departments are either unaware and/or refuse to implement

clauses of the disability act passed by the very same government. Checks and balances

as well as mechanisms to empower people with disabilities to undertake long and

complicated litigation processes are urgently needed to ensure that the law does not

"remain a paper tiger" (Addlakha & Mandal, 2009, p. 68).

Health And Health Care:

In the first decade of the reforms, state spending on health care as percentage of Gross

Domestic Product (GDP) fell from 1.3% in 1990 to 0.9% in 1999 (Gupta, 2005). During

1990-1999, with the introduction of user fees in public health care, the proportion of

people unable to access any health services has doubled, primarily among

disadvantaged castes, religious minorities and low-income people with disabilities.

Currently, only 2% of the national budget is spent on health care, compared to 13% on

defense (The Globe and Mail, 2009). Public health spending accounts for less than 20%

of the total health spending, while out of pocket expenses amount to 98% of the total

private health expenditure, signifying unequal access (Duggal, 2009). Duggal further

notes, ironically, the central government's attempt to increase spending on public health

by boosting allocations to its National Rural Health Mission has been unsuccessful

because states have responded by reducing their expenditures. Instead of

decentralizing health expenditures, the central government has taken greater control of

available health sector resources that have not been adequately utilized even for priority

programs such as immunization and rural child health, which in turn has affected health

outcomes.

Moreover, the National Health Policy of 2002 legitimizes the ongoing privatization of

health care. While domestic and foreign private insurance companies, health care

management organizations, and medical technology and pharmaceutical companies

have proliferated often with government support already poorly-funded public

health care that has traditionally cared for the poor has collapsed (Sengupta & Nundy,

2005).

Additionally, privatization and deregulation have resulted in rising drug prices. The

number of drugs under price control decreased from 347 in 1979 to only 35 in 2004,


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which is about 22% of the total market (Gupta, 2005). In 2005, under pressure from the

World Trade Organization's (WTO) Trade-Related Intellectual Property Rights (TRIPs)

agreement, the Indian government changed its Model Patent Act of 1970, thereby

raising the cost and reducing the availability of essential drugs. The increased cost of

medical care is the second most common cause of rural indebtedness in India (People's

Health Movement - India, 2007). Given that almost 40% of India's population lives in

poverty, the health of the poor and disabled population is threatened.

Under the liberalization regime, India has become one of the world's leading exporters

of pharmaceuticals, with the U.S. its largest customer (Gupta, 2005). As European

countries and the U.S. protect their environment by importing drugs, populations in India

such as villagers in Patancheru in Medak district in Andhra Pradesh are forced to

consume a slew of toxic residues dumped in the local streams by numerous drug

factories (Mason, 2009). With the government's drive to industrialize 'backward' areas,

Medak district has seen a sharp rise in morbidity rates, from 10% in 1991 to 25% in

2004. Orthopedic and skin problems have escalated. Increased levels of heavy metals

have been detected in blood, urine, hair and nail samples of local people, due to

consumption of industrially contaminated water and vegetables grown in contaminated

soils (Greenpeace India, 2004). Although it is evident that ill-health is on the rise in

Medak, country-wide environment and health impact assessments to investigate the

relationships between rapid industrial growth, unchecked pollution, and chronic health

conditions and impairments have been lacking.

There is limited research on the use of health services by people with disabilities in India

(World Bank, 2007). The 58th National Sample Survey Organization's (NSSO)

conducted in 2002 shows that most states which lag in the provision of health care

services to the general population also fall behind in the use of those services by people

with disabilities. The exception is Delhi, which has adequate health services overall, but

where less than 50% of people with disabilities sought any treatment. Overall, around

16% of people with disabilities reported negative attitudes of providers as a reason for

not seeking treatment. While it can be contended that privatization has increased

access to assistive devices and rehabilitation technology for at least some sections

within the disabled population, data from 2002 NSSO shows less than 16% of people

with disabilities had actually acquired aids and appliances (NSSO, 2003).

Overall privatization has not improved the health of the majority. Indeed, death, ill-health

and impairment of the poor have become collateral damage in the cause of economic

growth and profit maximization (Baviskar, 2008). Baviskar reports that hundreds of

migrant adivasis1from Madhya Pradesh have died from acute silicosis (caused by

inhaling silica) while working in quartz crushing factories in Gujarat.

Furthermore, Western countries, particularly the US, Canada, Britain, Australia and


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Germany, are increasingly disposing their recycled and hazardous waste by shipping

them to the 'Third World', where they pose substantial threats to human health and

environment (Pucket et al, 2002; Stebbins, 1992). To liberalize the economy, the Indian

government abolished regulatory licensing in most industry groups. Consequently, India

has quickly become a major dumping ground for the West's hazardous waste.

Greenpeace reports that India imported 5 million kilograms of metal waste, 346,000

kilograms of used lead-acid batteries and 2.85 million kilograms of metal scrap from

Australia in the first half of 1994 (cited in Bidwai, 1995). Although World Bank's (2007)

report states "[t]he medical causes of impairments are rapidly changing in India - from

communicable disease to non-communicable disease and accidents" (p. xii), the report

is silent on health conditions and impairments induced by the processes of economic

globalization, liberalization and privatization.

Food Security, Globalized Agriculture And The Rural Sector:

Although 80% of India's disabled persons live in rural areas, most government and NGO

programs and rehabilitation centers are located in urban areas (D'Costa, 2008; Klasing,

2007). World Bank's (2007) study shows that the rural disabled have lower access to

health care, not only due to the poorly functioning current system of disability

identification and certification, but also because of poor awareness about disability

issues among providers, as well as community and provider attitudes that act as

constraints in the provision of health care for people with disabilities. Government

schemes for the disabled, whether in education or employment, rarely reach rural

people. Ninety percent of India's children with disabilities reside in rural areas where

even non-disabled children find access to education difficult. The lack of services, such

as accessible transportation, and the distance between home and school in rural areas

further push children with disabilities to the margins (D'Costa, 2008; World Bank, 2007).

People with disabilities in rural areas are largely excluded from mainstream poverty

alleviation programs due to attitudinal and physical barriers. The PWD Act requires

governments to reserve not less than 3% in all poverty alleviation programs for people

with disabilities. However, different poverty alleviation programs have interpreted the 3%

reservation rule differently. As World Bank (2007) noted, the Sampoorna Grameen

Rojgar Yojana(SGRY) (The Complete Rural Employment Scheme) mentioned parents

of children with disabilities (CWD) rather than adult workers with disabilities, assuming

that disabled people are unable to work. Yet, there is no specific quota mentioned for

parents of CWD, unlike other groups such as women and other minority groups. The

Indira Avaz Yojana (subsidized housing program named after the late prime minister

Mrs. Indira Gandhi) mentions people with disabilities as a priority category among other

groups; however, no specific quantitative targets are mentioned. In contrast,

the Swaranjayanti Gram Swarozgar Yojana(SGSY) (The Centennial Rural Self-


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Employment Scheme) provides specific guidelines and requires that 3% of beneficiaries

annually must be people with disabilities. However, the World Bank (2007) observes

that data reported by various poverty alleviation programs do not clarify the share of

beneficiaries who are persons with disabilities. Wherever clear data is available, people

with disabilities are well below the 3% reservation rule in all schemes. For instance, the

share of disabled beneficiaries in SGSY was below 1% between 1999 and 2004. In

SGRY, a much bigger program in total spending than SGSY, data are reported for

works completed for the benefit of disabled people rather than the number of days of

employment generated for people with disabilities. However, the Comptroller and

Auditor General Report (2004) shows the share of disabled beneficiaries in SGRY was

below 1.7% during the reporting period 1998-2003 (cited in World Bank, 2007). More

recent data from various states compiled by the World Bank report demonstrates even

lower percentages. For instance, in the state of Orissa, people with disabilities

accounted for only 0.3% of total employment days generated under SGRY during 2001-

2005.

The new National Rural Employment Guarantee Act (NREGA) of 2005 in principle

provides every person who is willing to work with a statutory right to 100 days of

guaranteed wage labor at minimum wages. However, Dalal (forthcoming) reports

disabled people constituted only 0.1% (167,934 persons) of the 16 million total NREGA

beneficiaries in January 2007. Furthermore, NREGA recently deleted provisions for

reservations for disabled people (World Bank, 2007).

Roughly 700 million (70%) of India's 1 billion people depend on the agricultural sector

for their livelihoods (Coleman, 2003). International rules that encompass agricultural

trade liberalization and the use of genetically engineered seeds have transformed

agricultural practices and rural livelihoods everywhere. Recent free trade and seed

patenting policies, such as the Agreement on Agriculture (AoA) and the Trade-Related

Aspects of Intellectual Property Rights (TRIPs) instituted by the World Trade

Organization (WTO), have required developing countries, such as India, to open their

agricultural sector to global agribusinesses and to replace traditional farm-saved seeds

with genetically engineered seeds (which are non-renewable and thus require re-

purchasing for each growing season). The bulk of empirical evidence suggests that

trade liberalization has led to unprecedented crisis in the agrarian sector as small-scale

farmers are unable to compete in international markets (see Hiranandani, 2008).

Declining rural credit, rising farm input prices and decreasing prices for agricultural

produce have forced small-scale and subsistence farmers, including disabled farmers,

off the land. India, home to 557 million subsistence farmers, has experienced an

epidemic of farmer suicides since 1997 (Sainath, 2007). FAO (2004) notes that disabled

farmers with inadequate access to means of production such as land, water, inputs and

improved seeds, appropriate technologies and farm credit are particularly hard-hit.


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Given the decline of the rural economy, nearly 40% of rural households have no land of

their own and it is estimated that the rural unemployment is as high as 30% (Dalal,

forthcoming).

For India's 380 million officially-recognized poor, neo-liberalism has meant spending

more money to buy less food, reducing calorie intake and facing starvation in many

cases (Patnaik, 2004). Cereal consumption declined by 12% in rural India after adecade of reforms initiated in 1991 (Shiva, 2001). Economic reforms have slashed

government spending for the public distribution system (PDS) that provides basic

necessities such as food grains and pulses to the poor at subsidized rates. Prices of

food items offered by the PDS have increased manifold. Unsurprisingly, the National

Family Health Survey (NFHS-3) of 2005-06 reported that almost half of the children

under age five are too short for their age, 20% are too thin for their height and 43% are

under weight due to chronic malnutrition (IIPS & Macro International, 2007). While

malnutrition has been recognized as a major cause of preventable impairments in India

(World Bank, 2007), the association between agricultural trade liberalization, rising

hunger and malnutrition-induced impairments in the post-reform period have been

ignored.

Water:

There is increased pressure by international financial institutions (IFIs) such as the

World Bank and the Asian Development Bank to export natural resources critical to thelives of local communities. IFIs claim that these exports are essential in order to

generate revenues to repay outstanding external debt and to finance future

development programs (Asia Pacific Civil Society Forum, 2003). The World Bank-driven

policies espouse a shift from social goods to a commercial orientation. While the gift of

free water to the thirsty has been a core part of India's culture, privatization policies

have commodified water. Water fees have doubled, thereby diverting water from the

poor to the rich and from rural to urban areas. In Delhi alone, tariff increases have

generated Rupees (Rs.) 30 billion, generating super profits of Rs. 26.66 billion to

corporations (Shiva, 2005). While water parks abound for rich tourists, privatization of

water has created undue hardships for the poor and disabled. Even homes for people

with disabilities and orphanages have not been spared of spiraling tariff increases.

Besides, local agriculture has borne the brunt of water privatization. In Plachimada in

Kerala, Coca-Cola extracted 1.5 million liters of deep well-water, bottling and selling

them for profit. Depleting ground water levels have affected thousands of communities

creating water shortages and destroying agricultural livelihoods. The poor, includingdisabled people, have to travel farther to fetch water. The remaining ground water has

become contaminated with high chloride and bacteria levels, leading to scabies, eye

problems and gastro-intestinal diseases. The company also sells the plants' industrial


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waste to farmers as fertilizers, despite high levels of hazardous waste and cadmium

(Global Exchange, 2005). Yet, comprehensive assessments of water privatization for

disease, impairment and environmental degradation have been lacking.

Land Acquisition For Special Economic Zones:

To pursue the export-led growth strategy under the liberalization regime, India adoptedthe idea of Special Economic Zones (SEZs) to provide government-financed

infrastructure to developers (Skeers, 2006). A Special Economic Zone (SEZ) is a

geographical region with favorable economic laws more liberal than a country's typical

regulations. The goal of SEZs is to promote rapid industrialization and economic growth

by using tax and business incentives to attract foreign investment and technology. The

Special Economic Zone (SEZ) Act 2005, passed with little parliamentary or public

debate, facilitated the forceful acquisition of land with meager compensation thereby

provoking determined protests by thousands of displaced farmers (Skeers, 2006). Primeagricultural land has been acquired in several areas with serious implications for food

security and aggravating regional disparities. Following the brutal manner of state-

sponsored land acquisition efforts in Nandigram in West Bengal that left 11 people dead

and hundreds injured, a National Policy on Rehabilitation and Resettlement was

adopted in 2007 (Kazi, 2007). This policy provides for land-for-land compensation and

life-time monthly pensions to vulnerable persons, such as the disabled, destitute,

orphans, widows, unmarried girls, abandoned women, and elderly persons without

alternative livelihoods.

However, anecdotal evidence suggests that promises of resettlement and rehabilitation

have not materialized. For instance, many acres of coastal land in Vishakhapatnam in

Andhra Pradesh have been acquired for the SEZ program and the Indian Navy, thereby

displacing thousands of people. Persons with disabilities in particular have been

adversely affected. Not only have they received less compensation than the non-

disabled, their houses are re-located further away in remote areas creating accessibility

problems (M. Chandrasekar, Advocacy Coordinator, Community-Based Rehabilitation

Forum, personal communication, March 22, 2009). People with disabilities have been

left out of vocational training programs set up by the state government in SEZs.

Although NGOs in these areas have been appeased by promises of employing trained

persons with disabilities in textile industries of the SEZ, there are no job reservations for

them in these private sector industries (Mishra & Gupta, 2006; World Bank, 2007).

Recently, Gitanjali Gems, a Mumbai based diamond and jewellery maker established

the 'Saksham' training centre in the Rajiv Gems Special Economic Zone in Hyderabad

in the state of Andhra Pradesh. The training centre aims to empower people with

disabilities and is expected to generate 1000 jobs for them within the next three years

(Business Standard, 2010). While such initiatives are welcome, it remains to be seen


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whether the precedent set by Gitanjali Gems will be followed by other private companies

in India's SEZs.

Moreover, as Murayama & Yokota's (2009) review of labor and gender issues in SEZs

in Bangladesh, India and South Korea observes, workers in Indian SEZs are in a

disadvantaged position not only against capital but also in comparison to their

Bangladeshi and South Korean counterparts. Although wages and working conditions inIndian SEZs vary, Mazumdar's (2001) study showed 80% of workers in Noida SEZ in

North India receive less than the minimum wage (cited in Murayama & Yokota, 2009).

Young women who form the bulk of SEZ workforce receive wages well below the

minimum wage (PRIA, 1999) and working conditions are similar to those prevailing in

the urban informal economy (Neetha & Varma, 2004). Widespread malpractices are

common, including unrecorded workers on company payrolls, lack of health insurance

or workers' provident funds, and denial of leave stipulated by law. While studies have

documented working conditions and employment practices for women workers in SEZs,

systematic data on employment trends and working conditions of people with disabilities

in SEZs is lacking.

Human Rights, Privatization and Disability

Disability rights have been increasingly addressed in the international development

discourse since the 1980s. The International Year of Disabled Persons in 1981, followed by

the United Nations Decade for Disabled Persons declared by the United Nations in 1983, put

disability into a global context (Yeo, 2005). However, the basic assumption that underpins all

United Nations human rights agreements, including disability rights, is governments'

responsibility to attain these rights. The underlying premise of globalization, however, is the

abdication of government responsibility for essential services (Naim-Ahmed, 2007). This

paradox complicates progress towards human rights declarations in an era of unfettered

global market economy since international human rights obligations apply to government

organizations and not to the private sector. Privatization has reduced the power of

governments to ensure access to services that are essential to the enjoyment of human

rights (Amnesty International, 2005).

Disability is an arena that is particularly susceptible to the shifting boundaries between the

public and private domains. The consequences of dismantling the welfare state are severe,

especially for poor and disabled people in developing countries who depend on state

provision of basic needs such as education, health care etc. With disability still treated as a

'special interest' issue in India that is, not of interest to the general population - the risks of

privatization are high. Fortunately, India has a large, varied and active movement of NGOs

working on disability issues, though many still have a welfare-led approach and are mainly

urban-based (Thomas, 2004). However, in the era of privatization and liberalization, large


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companies, seeking to create reputations of 'corporate social responsibility,' have initiated in-

house NGOs, especially as the state dismantles its public provision of basic services

(People's Health Movement - India, 2007). The implication of this civil society transformation

for disabled people is yet ambiguous. It is clear, nonetheless, that one of the most salient

elements in the globalization process, the explosion of information and communication

technology such as the Internet, has enabled people with disabilities from different regions

and countries to communicate and access information quickly and across great distances.

Albeit of benefit to urban-based populations, this has fostered increased dialogue between

disabled persons across the globe and facilitated the formation of extensive support and

advocacy networks.

However, people with disabilities in India still remain a weak political constituency without full

citizenship rights. Although political party workers conduct house-to-house surveys to

register voters, homelessness especially among the urban destitute and disabled combined

with social stigma and family shame perpetuates the invisibility and isolation of many

persons with disabilities and their consequent absence from lists of voters (Jeffery & Singal,

2008; UNNATI & Handicap International, 2004; World Bank, 2007). Even when disabled

people are registered, inaccessible pooling booths, inadequate transport facilities and lack of

information in accessible formats hinder their ability to vote. Thus, persons with disabilities

are politically disenfranchised. This is despite the fact that in addition to ratifying international

human rights instruments, India has one of the strongest rights-based constitutions in the

world that holds the government primarily responsible for the well-being of historically

disadvantaged populations (Thomas, 2004).

The failure of the rights-based legislation to promote full inclusion and increase disabled

people's employment rates exposes the contradictions of promoting equal opportunity within

the paradigm of economic growth in an unequal society (Russell, 2002). Economic reforms

have led to increasing mal-distribution of growth. While currently India has the world's fourth

highest number of billionaires (36 billionaires) with total wealth equaling one-fourth of the

country's GDP, poverty reduction has been the slowest in the neo-liberal years; in fact,

poverty and destitution has been aggravated by reform-induced dispossession and

displacement (Bidwai, 2007).

Neo-liberal globalization, with its emphasis on privatization of services, threatens universal

access to basic services. Privatization has re-defined education and agriculture as 'industry'

and has commodified basic necessities such as health care, education, food and water

(Shiva, 2005). Free trade agreements have jeopardized the health and human rights of the

majority and undermined social policies aimed at promoting employment and full inclusion

for people with disabilities (PSAC, 2005). Privatization and the globalized economy thus

compel the re-envisioning of the concept of human rights to ensure that state andnon-state

actors, such as corporations, are held accountable to human rights agreements. Hitherto,


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civil rights and disability rights, conceptualized in an individualist framework, do not address

structural barriers and health abuses caused by business practices, the economic system

and class power relationships (see Russell, 2002). Human rights for persons with disabilities

across all sections of the society cannot be achieved until the very system that lavishes

wealth on a few and impoverishes the masses is brought under scrutiny.

Concluding Remarks

People with disabilities have been excluded from most evaluations of economic reforms in

India. Our analysis shows that while increasing employment opportunities and accessibility

has benefitted a few persons with disabilities, the majority, particularly the poor and rural

disabled, have been left out of India's economic boom. It is questionable whether unbridled

market reforms are sustainable given their human and environmental costs. Furthermore,

the implications of the current economic downturn for India's urban and rural disabled

populations are yet unknown.

Due to constraints of space, this analysis has included class differences and urban-rural

disparities within the disabled population, where data permit. However, given India's

enormous diversity, intersectionality based on gender, caste, religion, age and marital/family

status differences among people with disabilities merit further investigation to provide a more

comprehensive picture of reform-induced changes.

The importance of including people with disabilities in the development agenda has beenincreasingly recognized. The former president of World Bank, James Wolfensohn stated "

if we are to achieve the Millennium Development Goals (MDGs) of halving poverty by 2015,

dealing with education for all, halving the rates of birth and child mortality, it is simply

impossible to conceive of doing that without the inclusion of the disabled community" (quoted

in Yeo, 2005, p. 13). Yet, the Bank's well-intentioned efforts towards full inclusion do not

address the health, impairment and disability effects of global economic processes. Neo-

liberalism, with its tenets of market economy and reduced state role, necessitates renewed

understanding of human rights, including those of disabled persons. It is difficult to imagine

how the MDGs will be achieved unless poverty and disability, and indeed impairment itself,

are recognized as manifestation of the ways in which society and economy are organized.

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