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Assistive Technology Inequality – Erik Kondo

A photo collage of different types of adaptive mobility equipment in a garage.

Assistive technology has improved the lives of people all over the world. It has enabled people with disabilities to participate in many areas of life previously unavailable to them. Assistive technology is in many ways a great equalizer of opportunities. In a perfect world, everyone would have access to all the AT that they need and desire. As you can see from the above collage photo of devices in my garage, I have acquired quite a bit of AT devices over the years and there is more that is not shown.

But we don't live in a perfect world. We live in a world of “the Haves” and “the Have Nots". A world of income inequality that directly transfers to Assistive Technology Inequality (ATI). For example, it is common to hear in the media about a high technology innovation that is going to change the lives of millions of wheelchair users across the globe. Typically, this “life changing” innovation involves some type of mobility device or attachment costing many thousands of dollars. What seems to be forgotten is that the majority of wheelchair uses in the developing world have been left to use poorly functioning wheelchairs. These low quality wheelchairs are mass produced at very low cost. Yet they are the primarily means of mobility for literally millions of people.

A teenage boy in Nigeria in a broken hospital wheelchair

These wheelchair users are not looking for a high tech innovation to change their lives. A device already exists in the form of a modern well-functioning wheelchair - manual or powered. If they can't afford or don't have access to existing basic assistive technology, how will they benefit from newly created expensive and specialized high technology? We know the answer. They will not.

Unfortunately, most people and institutions that promote AT for people with disabilities are primarily thinking in terms of devices that are "SMART" or are manufactured with ever increasing complexity. Minimal thought is given to real world considerations such as affordability, cost of operation, and ease of maintenance and repair.

Not only should AT allow some people to do more, but it should also allow more people to benefit. In other words, the range of people who have access is AT should expand along with improving absolute levels of performance. The current trend in AT seems to be one of limiting AT to only those fortunate enough to be able to afford it, or get a grant to pay for it, or fundraise to pay for it.

The temptation is for device designers to want to be the ones to create something completely new. Something revolutionary. Something that nobody has thought of before regardless of affordability. But if they really want to help out a large number of people, then it is also important for designers to examine existing devices and figure out how to make them more affordable for widespread use. Design them so that more people are able to obtain them. While determining how to make an existing design cheaper may not be as sexy as creating an never seen before innovation, it matters.

How is it that in poor countries, where people with disabilities are we barely able to get around on broken down and antiquated wheelchairs, the majority of the population still has access to cheap, but functional smart phones?

It is a question of priorities. Society has decided that it makes economic sense to mass produce a wide variety of smart phones at along a continuum of prices from very cheap to extremely expensive of ever increasing functionality. The capabilities of today’s low end smartphone is well beyond the expensive ones of just a few years ago.

Bicycles in developing countries are inexpensive, readily available, and functional. They may not be made of carbon fiber frames or have electronic shifting. But they still work just fine. They get the job of efficient mobility done. The bicycle is a great example of AT that has successfully spread across the world.

Conversely, the design of the standard wheelchair used in less resourced countries has not changed in decades. In many places, the style of wheelchair used in 2022, is literally indistinguishable from the ones of 1970’s.

While these wheelchairs may be cheap according to wealthy country standards, their cost is still more than a locally obtained bicycle. Despite their low quality and poor functionality, their relative cost is expensive. These wheelchairs are all that is available to the local population. Rich countries have put minimal effort into using the creativity, brain power, and resources of their AT centered institutions to design modern affordable wheelchairs for developing countries which could be locally manufactured, repaired, and maintained.

The result is a tremendous AT gap between the rich and the poor. Where people like me have access to as much modern AT as I am willing to pay for, and others are stuck using primitive AT, if they are able to obtain any at all.

An actionable solution to this problem is a concerted effort to extend the perception and scope of AT development to include lowering cost and increasing worldwide device availability as an essential part of the process of innovation.

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