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Marginal Analysis and Disability Stigma in Low Resource Countries – Erik Kondo

One of the constants around the world is that, as a group, people with disabilities are the lowest social class and the poorest demographic. Governments, institutions, and the general public are really not interested in the welfare of this demographic in comparison to other groups. Fortunately, in wealthy counties, government funds and insurance coverage do offer some opportunities for profiting in the disability sector. On the other hand, in places where people with disabilities are left to fend for themselves, there is a common theme of neglect and disinterest in their welfare. The free market of the developing world shows this situation to be the case.

For example, people with disabilities (PWDs) in the developing world are desperately in need of assistive technology (AT) for all sorts of needs from mobility, to vision, to hearing, to access to education. One explanation for the lack of AT in low resource countries for PWDs is the combination of the relatively high prices and the low availability of AT products. The most obvious solution is to utilize the cost savings of mass production of AT devices to lower prices and increase availability. The thinking is that the widespread availability of affordable AT will ensure that PWDs get the products that they need.

But what if there is more to the problem? One of the most important pieces of AT of the 21st century could arguably be the mobile phone combined with internet access. For PWDs, this device provides tremendous potential to integrate PWDs into society and improve their lives with its powerful communication functionality. Many models of mobile phones are relatively inexpensive and widely available AT. Yet, studies have shown that PWDs in low resource countries have significantly less ownership of mobile phones than the general population.

This example illustrates that even when AT is mass produced, wide availability and relatively affordable, PWDs are still not getting sufficient access to it to meet their needs. But why is this the case?

Marginal Analysis shows us that roughly identical items are not valued equally in terms of the cost vs. benefit equation. When you are thirsty, your first glass of water is more valuable to you than your second. The third is worth even less. Imagine picking a team from identical players to perform a task. The first few people you pick are inherently more valuable than the last. If ten people is the optimum number of people on a team, then the 10th pick is worth much less to you than your 2nd pick. Pick number 11 is a detriment and has negative value to you. Even among identical items, the very act of sequential picking changes the perceived value of the items in real time.

Now imagine a school yard pick. This time, we are not choosing identical items. We are choosing school children. And who always gets picked last? The kid with a disability. Do we really need a scientific study to prove to us what we all know to be true?

The societal negative stigma against disability, deeply ingrained into society has deemed that PWDs have less value. Think of a gingerbread man that is either broken or missing a body part. Given the choice of other options, you will not buy it, or if you do, you will want a discount. The perception of society is that the output (benefit) created by PWDs is less than people without disabilities. Therefore, PWDs get picked last.

Not only do they get picked last for school yard teams, as a demographic, they get pick last for pretty much everything when the free market is involved. Employment, relationships, business opportunities, politics, social and recreational opportunities, the list goes on. The negative stigma against disability has ensured that PWDs always get picked last. And marginal analysis illustrates that those that get picked last are also typically assigned less worth. That’s a double whammy to overcome.

Ever wonder why PWDs are commonly described of as being “on the margins” of society? Stigmatized Marginal Analysis (SMA) of PWDs has put them there. Following SMA, successful businesses already have plenty of existing able-bodied customers, why bother with the minimal marginal benefit provided by selling a few more products to the disability community? An expanding business may need to hire new employees, but they will choose from the disability community last.

In terms of the AT in low resource countries, what little that is available, is typically poorly functioning. Take wheelchairs for example. Why are most wheelchairs of such low quality and usually in states of disrepair? If you assume that PWDs are unlikely to accomplish very much in life, then marginal analysis concludes that you provide the least amount of AT for the person. The implicit thinking is that more or better functioning AT would be wasted. Why provide someone with an ultralight wheelchair when a hospital wheelchair will do? If the PWD can’t do much anyway, what difference does it make? The extra expense is not worth it. Even if the expense is for a basic wheelchair repair, if the person can survive without the repair, does it really matter if it is not done?

Stigmatized Marginal Analysis dictates that society should provide (invest in) the least amount of assistive technology even when more and better AT exists (at slightly greater expense). SMA is based on the underlying assumption of the low output of PWDs. Society’s low expectations for PWDs output leads to providing them with insufficient and inappropriate AT (and lack of accessible transportation, educational opportunities, affordable healthcare, etc.), which leads to poor outcomes, which confirms the underlying assumption, as part an ongoing cycle of stagnation.

For a personal example of SMA, I am fine with giving a street panhandler a dollar but will not give them $5. It is not that I can’t afford to give more. But, I have low confidence that the extra $4 will be spent wisely. I am making a marginal analysis based on my biased assumptions (which could easily be incorrect).

Here is another way to look at it. Maybe the PWD’s family has decided that they have already applied enough resources towards the care of the person. Therefore, why spend more if the person will always remain dependent on them? The thinking could be that it is best to spend as little as possible. In this case, slightly more expensive, but higher quality AT will still not be purchased (invested in).

As long as the underlying societal expectation of low output from PWDs exist, it is my opinion, that PWDs in less resourced countries are unlikely to get the AT they desperately need. In wealthy countries, there also exists a lowered expectation of the output of PWDs. But there is an acknowledgement of the importance of their medical health needs. Therefore, much of AT purchases and investment comes in the form of providing medically necessary equipment that paid for by insurance companies.

In conjunction with increasing the availability and affordability of AT, to change the negative stigma, society will need to see examples of how this AT acts to increase the output of PWDs. Evidence of increased output from PWDs will eventually change the marginal analysis such that investment in more and better AT is seen as worthwhile. Effective assistive technology has the potential to be a powerful equalizer that could create a world in which PWDs don’t always get picked last.

1 Comment

Aug 07, 2023

at brave, our registered NPO in Cape Town South Africa, at brave we have spent the past 5 years advocating for a local and global mobility equipment exchange. In South Africa a wheelchair for someone with a serious spinal cord injury ranges upwards from R40 000 excluding a cushion! For our quadriplegics....R200 000 plus...When we talk monopoly here, we are looking at entrenched companies that have held the reins for decades, here they import most at huge price margins but even those manufactured are monopolized, did we mention the commissions paid to healthcare professionals to "seat you in a chair" before leaving hospital or rehab? The FACT that your body will dramatically change in the first year of recovery seem…

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