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The World Health Organisation (WHO) has released its first ever world report on disability, available free as a PDF file. It’s big document–299 pages excluding the glossary and index–so some of you may prefer their shorter report sheet (PDF file).

World report on disability cover - small

I have to admit I was a little surprised to learn that it’s the first report. Naïvely I’d have thought that an international report on disability would be something that occurred in an established periodic fashion.

As an idealistic newly minted Ph.D. graduate I pitched the idea of collating the resources offering assistance to the deaf on the Indian subcontinent as a kind of working holiday. I’d plans to travel there and looking for people to visit I thought I’d be able to drop in on deaf group in India. Looking up resources listing deaf groups and organisations around the world, I found that the Indian subcontinent wasn’t represented at the time, which gave me the seed of the idea. It never came to pass. Youthful idealism is like that. But looking at the scope of this document things have clearly moved on to better awareness of the situation of the disabled outside of Western countries.

This report attempts to present a global picture of disabilities and offer some general recommendations for a national and international level, and look at each of the elements that could be addressed. Professor Stephen Hawking providing the opening introduction. Interestingly, along with the contributors, the documents lists and extensive list of peer-reviewers.All disabilities are covered in the report, but I’m only going to cover to items related to deafness. My own remarks are limited by not having read the full document; I am presenting these excerpts as teasers to encourage those who might be interested to read further. I’ve left aside deafblind issues and references to hearing aids and cochlear implants.

The report covers a wide range of issues such as practical issues such as health care workers interaction with their clients:

An investigation into Deaf women’s access to health care in the United States found that health-care workers often turn their heads down when talking, preventing deaf women from lip-reading

the appropriate style of intervention needed for different disabilties

Groups that are difficult to reach through broad-based programmes — people with intellectual impairment, mental health conditions, or Deaf people, for example

the need for support services, such as sign language interpreters for those who rely on sign language

A survey on the human rights situation of Deaf people found that 62 of the 93 countries that responded have sign language interpreting services, 43 have some kind of sign language interpreters training, and 30 countries had 20 or fewer qualified sign language interpreters, including Iraq, Madagascar, Mexico, Sudan, Thailand, and the United Republic of Tanzania

Throughout the report makes reference to extensive research findings. I like the use of boxed items detailing specific cases, so that some individual items can be presented in more detail.

Access to subtitled broadcasts gets attention,

In a survey conducted by the World Federation of the Deaf, only 21 of 93 countries were found to provide captioning of current affairs programmes and the proportion of 185 Chapter 6 Enabling Environments programmes with sign language was very low. In Europe only one tenth of national-language broadcasts of commercial broadcasters were provided with subtitles, only five countries provided programmes with audio description, and only one country had a commercial broadcaster that provided audio description [...]

and

Accessibility of information — leaflets, broadcasts, web sites — is vital if people are to debate issues and exercise informed choice. For example, sign language and closed captioning on party political broadcasts would remove barriers to deaf people and those with hearing loss.

I have previously written about YouTube (then nascent) efforts to enable automated subtitles of videos; you’d like to think that further development automated captioning may eventually make providing a solution to this relatively straight-forward.

Use of texting services is also mentioned. My own impression is that use of fax and various text-over-telephone services has now largely be superceded by text messages in many countries (these services have the added limitation of being fixed wire, limited to one location).

(A different, but related, use of technology is to use internet-based video conversations to allow users to communicate in sign language. An interesting example of this in New Zealand was the early demonstrations by telecommunications companies of broadcasting video over the internet were set up in shopping malls in the major centres, linked to centres elsewhere in the country. In short notice local sign language users were using the demonstration facilities to communicate directly with friends in other centres. I can imagine iPads being put to this use, something I must look into when I have time.)

Some of the brief remarks on the situation in poorer countries, as expected, make for sobering reading,

Enrolment rates also differ according to impairment type, with children with physical impairment generally faring better than those with intellectual or sensory impairments. For example in Burkina Faso in 2006 only 10% of deaf 7- to 12-year olds were in school, whereas 40% of children with physical impairment attended, only slightly lower than the attendance rate of non-disabled children (17). In Rwanda only 300 of an estimated 10 000 deaf children in the country were enrolled in primary and secondary schools, with another 9 in a private secondary school (18).

Are we to infer that 90% of deaf children in Burkina Faso have basically no formal education at all?

In discussing approaches to educating children with disabilities, they effectively use the WFD as the voice of authority,

Some disability advocates have made the case that it should be a matter of individual choice whether mainstream or segregated settings meet the needs of the child (39, 40). Deaf students and those with intellectual impairments argue that mainstreaming is not always a positive experience (41, 42). Supporters of special schools — such as schools for the blind, deaf, or deafblind — particularly in low-income countries, often point to the fact that these institutions provide high-quality and specialized learning environments. The World Federation of the Deaf argues that often the best environment for academic and social development for a Deaf child is a school where both students and teachers use sign language for all communication. The thinking is that simple placement in a regular school, without meaningful interaction with classmates and professionals, would exclude the Deaf learner from education and society.

My own views are very much with looking for a ‘fit’ for each child. I am, of course, coloured by my own experience having been brought up through mainstreamed schooling. (You will note the capital D in ‘Deaf’ in the last sentence; more on this below.) Later an argument is raised that some children may prefer the ‘special school’ to avoid bullying. I have a lot of empathy for that–the social isolation bullying brings is not fun at all–but I worry this conflates issues and simply avoids the underlying problem of addressing the bully’s behaviour and it’s causes. They lack space in the report to elaborate and explore themes like this; the report needs to be read with that in mind, and, I think, treated as ‘seed ideas’ rather than statements per se.

The mixed use of capital-D Deaf in the report, to my reading, may be an editing weakeness – if so, I hope it is one they avoid in future.

Strictly speaking ‘Deaf people’–with the capital D–refers to the so-called ’culturally’ deaf – those that choose to form a deaf community based around their sign language (different countries have different sign languages). By contrast, there are those that are equally deaf but choose to prefer to spend them time mostly with the hearing community and dominantly rely on lip-reading (and technology). The latter not a denial of their hearing loss, but the personal preference of the person. If you think this can be political, you’d be right – I don’t care for the politics myself. Whatever people are happy in is fine with me, provided they don’t make disparaging remarks about other’s choices!

To give you an example, this is from a quote in the report:

’Until I was 19 years old, I had no opportunities to learn sign language, nor had Deaf friends. After I entered a university, I learned sign language(s) and played an active role as a board member of Deaf clubs. Since I completed graduate school, I worked as a bio-scientist in a national institute. I mainly communicate with my colleagues by hand-writing, while I use public sign language-interpreting service for some lectures and meetings. My Deaf partner and I have two Deaf children…my personal history gives me the distinct opinion that the sign language and Deaf culture are absolutely imperative for Deaf chil- dren to rise to the challenge.’

As you can see, the Deaf relates to Deaf culture. Otherwise you’d write ’I have two deaf children…’ and so on.

There are two components to this: one being consistency, the other being the lack of an explanation (as far as I have seen thus far) of the meaning of the capital-D ‘Deaf’ to readers who may not be familiar with it. I’m uncomfortable picking on this as the document notes a large list of peer-reviewers and consultants, so this will have been examined and quite closely. It may be that they have elected to use the language of each contributor. In the case of the quote above it’s fair – it’s a person’s ’words’ (probably originally signs translated to words).

I found myself thinking at points that it have helped for each item to identify which specific subset of the disability it referred to. Each disability (any of them) has considerable variation in affects, needs and wants and the recommendations or points need to be related to that.


Other disability-related articles on Code for life:

Automatic video captions for YouTube

Temperature-induced deafness

Rubella not a benign disease if experienced during early pregnancy

Enabling deaf people to text emergency calls to 111

Minorities, disabilities and scientists