Social Determinants of Disabilitybased Disadvantage: Fostering Capabilities in Solomon Islands Research team:
Dr Alexandra Gartrell, Professor Lenore Manderson, Dr Megan Jennaway Judy Fangalasuu, Simon Dolaiano and Savina Nonegbatu
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Implementing rights-based approaches
Socio-cultural attitudes to disability in Solomon Islands: Identifying culturally appropriate solutions to disadvantage
Disability, culture, social circumstances and rights
Tension between constitutional rights and traditional beliefs
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“All citizens are entitled to same rights, privileges and benefits” (Article 61).
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Greatest barriers:
“Traditional and religious belief systems, negative attitudes and a lack of understanding about impairments” (Stubbs et al 2005, Miller 2007).
Disability as a development and rights issue
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CRPD signed in 2008
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National Disability Policy 2005-2010
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Aims to develop appropriate legal and social protection
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Low government priority
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Lack of recurrent budget
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National Coordinating Council for Disability never been established.
Social and political invisibility of disability
Solomon Islands
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552, 267 people settled in more than 5000 villages, across 350 inhabited islands
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22.7% live below national poverty line (ADB 2010)
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85% live in rural areas and practice subsistence agriculture
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Rapid economic growth (9% in 2011)
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High population growth (2.3%)
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Low per capita income ($1782)
Cultural attitudes toward disability: “Something for the parents to worry about”.
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Sign of ancestor curse, kastom or black magic
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Violation of taboo
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Exclusion explained by inability to contribute to household economy, not by cultural beliefs
Methodology •
Ethnographic approach
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3 rural field sites
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Double/triple disadvantage of rural areas
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Field site selection
Fieldwork •
Pilot
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3 blocks of fieldwork
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October 2011 – June 2012
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Recruitment: CBR worker and Co-Researcher social networks
Participants • 50 people with disability • 13 in Takwa
• 16 in Malu’u • 21 in Isabel
• 28 women • 22 men
• 38 key informants
Age distribution •
24% of interviewees were between 21 and 30 years of age
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64% of interviewees were under the age of 40
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18% of interviewees were between 61 and 70 years of age
Impairments
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Mobility
21
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Multiple disorders
12
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Sensory
10
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Psychological
4
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Nervous system disorders 3
North Malaita: Takwa and Malu’u
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by swidden agriculture inland, fishing and gardening S Takwa residents more connected to
the water and fishing S Predominant economic activity in
Malu’u is gardening, suggesting a more recent migration from the mountainous inland (Hogbin 1939);
Isabel •
The island of Santa Isabel lies directly to the north of Malaita
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Forested, mountainous island with very little flat land.
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Traditional patterns of subsistence: fishing and some gardening along the coast and swidden cultivation inland.
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Strong population drift away from the centre and towards the coast
Starting with families
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Assumption of extended family systems in non-Western societies, particularly subsistence economies
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Embedded in government, donor, aid and development agency thinking and debate in regard to disability
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Communal, inter-dependent, coresident, cooperative
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Extended family as foundation of social cohesion in Pacific
Patrilineal and matrilineal systems of descent
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Patrilineal system: out marriage of daughters into wife-taking clans, along with the introduction of wives from wife-yielding clans
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Settlement patterns based on several co-resident patrilocal clans or extended family
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Affect on family-based forms of support available to people with disabilities
Bilateral basis of community affiliation
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Customary social practices subordinate to economic pragmatism
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Secondary inheritance rights (traced through mothers/fathers) strategically deployed to access coast land
Key findings 1: Limited support for people with disabilities and their households
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Majority of PWDs live with one or more family members
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Support of one or at most two of these.
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One case of PWD living alone.
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People with disabilities and their households have very little support from extended family members, irrespective of matrilineal or patrilineal context.
Key findings 1
S In principle relatives available to help with care for a
person with disability S No specific cultural mechanism to ensure this
actually occurs outside of the neighbourhood S Few extended family members provide support from
a distance in all three field sites S No specific family visits for purpose of respite or
other disability related support
Overtaxed carers
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The burden of care for a family member with a disability devolves to only one or two highly overtaxed household members and/or immediate family members living adjacent (‘the local family circle’),
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Carers are effectively taken out of household economic production.
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Siblings taken out of school
Emily and her family
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30 year old woman developed epilepsy after birth of second child
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6 children under 12 years
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Little family support despite living amongst husband’s kin
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No help from her natal family – isolated and excluded
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Husband sole support
Social determinants of household wellbeing
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Structures of social hierarchy determine social conditions in which people grow, live, work and age (Marmot 2007).
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Differences in wellbeing reflect inherent structural features of society (land ownership and descent systems, gendered power relations, rural-urban inequities)
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Social determinants approach used to understand compound and multiple disadvantages
Determinant 1: Social gradient
S Poor rural economic prospects for
salaried employment and cash income S Greater material hardship (food
insecurity, poor housing, lack of access to safe water and sanitation), violence S Health and education (4.3% and
5.2% of GDP) S Accumulate over life course S Structural determinants
Determinant 2: Secure economic foundation
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Security of land ownership, economic wellbeing, and the associated material and social assurance and confidence
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Angela: family live on Crown land surround by patrilineal estate
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Material and social resources to support her inclusion
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Cash income
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Status within the Church
Living as outsiders
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40% of cases
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Secondary and tertiary claims
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Carrie: patrilineal land to which she has secondary rights to occupy and garden
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Primary gardener, carer and income earner
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Active in community
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Presence of other determinants
Determinant 3: Inclusive early life S Weak land claims, poor
economic status – energy for care traded-off against livelihood activities S Labour poor households
children and people with disabilities vulnerable to neglect and shame S Christian and Justine:
secondary claim to land
Determinant 4 – Contribution to the household economy
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Absence of government and community support
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Self-worth, efficacy and wellbeing enhanced with contribution and living situations are better
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Education, vocational training key but poor access: poverty, attitudes, physical access
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Dependency and long term vulnerability
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Ofata and Eddie
Determinant 5: Stigma and social exclusion
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Even with contribution and as primary support for family, stigma persists
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Denial of socially expected status, denied decision-making and norms of reciprocity
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Joseph – denied use of resources – canoes and knifes
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James – contributions never reciporcated
Determinant 6 - Gender
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Gendered power relations in both patrilineal and matrilineal systems, undermine women’s security and wellbeing
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Dependency, vulnerability and no choices
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Women choosing not to marry
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Emily – triple burden
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Frances: patrlineal systems doubly disadvantage women
Determinant 7: Social support and accumulated disadvantage S
Social capital and presence of carers key to wellbeing of elderly with disabilities
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Care for the elderly is expected
Key finding 2: Presence of several social determinants most likely to foster inclusive environments S
Families with positive presence of several social determinants have greater material, social and emotional resources
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Meaningful lives typified with inclusion and dignity
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If absent, compound disadvantages which amplify across the life course
Key findings 3: Disability overly determines choice
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Opportunities are withheld or granted exceptionally
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A minority develop their capabilities and fulfil their aspirations.
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Life choices and possibilities are shaped by negative cultural attitudes and socio-economic determinants
Poverty of opportunity and achievement
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Equality of possibility depends upon individual and household engagement with local institutions to build capabilities and functioning in daily activities that they value.
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Demonstrated agency and initiate is likely to be supported by others within and beyond the immediate household and by government and church-based institutions.
Current sources of village-based support
S Extremely limited S Government and NGO reach to village level poor S CBR worker – an irregular visitor but in some cases key
to providing adapted devices S Mothers Union (Anglican) and Dorcas (STA) – irregular
visits by village women to PWD and the elderly (ranging from monthly to every couple of months, to annual visits) S food, soap, clothing and sometimes cash (a few
dollars)provided
Local social institutions
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Specific and targeted assistance, delivered under the guidance of people with disabilities is required
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Inclusive processes are critical
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Local social institutions such the Church and schools are key to the provision of such assistance
Opportunistic linkages •
CBR worker linking in with Agricultural Extension officers and other Ministry of Health village visits
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Particularly in areas where boat access is required
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Train staff in disability awareness
Building on existing social infrastructure
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Awareness raising and training by people with disabilities (PWDSI)
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Church
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School
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Health Centre
Micro-enterprise development run by and for people with disabilities •
Social determinant amenable to change
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Core group of PWD, all trained at Bethesta, travelling around villages in Isabel doing awareness raising
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Built training centre where PWD will consult with other PWD, design and build locally appropriate devices
