Multidimensional Measures and the Extra Costs of Disability: How Are They Related?

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• ntil now, multidimensional poverty measures have not been used to analyse the extra costs of disability and have not been evaluated to see if these measures are a good proxy of the standard of living and how the analysis can be implemented. In addition, it is important to define how the extra costs of disability increase the risk of deprivation and how being deprived in a specific indicator increases the risk of facing higher extra costs associated with disability and an increased risk of deprivation in other indicators. This is how the disability–deprivation/poverty cycle starts and persists.

• he method assumes that an income transfer can compensate for the reduction in a household’s standard of living and that the existence of a disability causes those reductions. It also assumes that households with members with disabilities have different conversion factors. Therefore, h

• ne of the most important assumptions of this model is that two individuals with the same income level experience different living standards if one has a disability and the other does not. This is assumed to be the case because the person with disabilities will spend more on the consumption of disability-related items and will therefore reduce the overall consumption of other items, an aspect that will affect his/her standard of living

• The SoL method only aims to capture the average direct costs of disability. It assumes that people with disabilities have different needs from those unaffected by disability and that therefore they prioritise those needs and reduce their consumption of nondisability-related items.

• This is followed by an analysis of how additional health care costs and accessibility costs might increase the probability of deprivation as measured by a range of indicators relating to health, education, employment, and living standards.

• Health: Higher transportation costs can increase the probability of accessing health care services when needed [26,33]. This will increase the risks of unsatisfied health care needs, the deprivation of access to health care, and the risks of living with chronic diseases and not having access to medicines or adequate treatments [

• Higher transportation costs can increase the probability of persons with disabilities being unemployed or outside the labour market. In addition, they might be associated with informal employment, given that persons with disabilities would have more flexibility and can work close to their homes [

• Health: Facing unaffordable assistive-device costs can increase the probability that a person does not have access to health care services and will therefore experience lower health care outcomes, with a higher probability of being exposed to chronic diseases and not receiving the correct treatment [

• Health: In the case of health care, people with disabilities have higher levels of need [26,37], which may be unsatisfied. For example, they will have lower access to medicines and preventative services, such as vaccination, prenatal care, and sexual health and reproductive care [26,38,39].

• Finally, using a multidimensional poverty measure as a proxy of standard of living would not make it clear how income compensation can reduce deprivation, especially in cases where the deprivation is created by social or environmental factors, which go beyond an individual’s own control. For example, even if households that include disability-affected members are compensated with a certain amount of income, that will not compensate them for the general lack of accessible transportation systems or the lack of schools or health providers in the community.

• The SoL method assumes that a person with a disability has a lower standard of living because she/he reduces her/his consumption of different goods because of the need to afford disability-related expenditures. Thus, we are assuming that there is a direct relationship between disability and consumption and that individuals with and without disabilities have the same preferences and will decide to consume similar items. However, when this assumption is analysed in terms of the concept of multidimensional poverty, an important role is played by aspects related to the opportunities available in the society, how services are provided, and the preferences of individuals and families. For example, it is difficult to assume that an individual will not have access to clean water because he/she needs to increase his/her disability-related consumption.

• Although there is a relationship between income and deprivation, being deprived in nonmonetary aspects is mediated by other factors, which might reduce or increase the potential effect of lack of income.

• The first one depends on the person’s circumstances, for example, disability. The second factor is social conversion aspects related to the society where the person lives; one example is class or caste. The third and final group consists of environmental conversion factors that capture the physical environment where the person lives, such as geographical location

• Under the capability approach, people with disabilities face a double handicap: one relating to the lack of income that they and their families receive (income handicap) and a conversion handicap relating to the difficulties confronting people with disabilities who must convert their available income into essential goods and services.

• Therefore, people with disabilities can have the same level of income as people unaffected by disability or a level of income that produces a similar standard of living, but without the existence of social and environmental transformations, it will not be possible to obtain the same levels of satisfaction.

• Therefore, it will be unfair to say that the same income compensation can compensate for deprivations in health (for example, access to health care) or in education (for example, years of schooling).

• Define the measure at the individual level. Thus, use the individual as the unit of identification and analysis. This will directly identify individual deprivations and achievements and allow us to assume that higher levels of deprivations or lower levels of achievements are directly related to disability or the extra costs of disability.

• Include indicators that reflect achievements for the whole society, disregarding individual characteristics, such as race, ethnicity, or disability, for example, the level of education that a person is expected to achieve in a specific country.

• Clearly define the trade-offs among indicators. For example, suppose that the measure includes five dimensions and 20 indicators equally weighted. In that case, it is important to define which indicators have a higher or lower relative importance and how those levels might affect the results of the measure.

• It is recommended to estimate regressions by income quintiles; thus, the sample can be stratified, and an income coefficient is computed for each quintile. It is expected that in the highest quintile, the income compensation will be lower. However, because the level of individual well-being is the result not only of consuming specific assets or goods but also of the person’s access to opportunities, people with disabilities will face barriers in all income quintiles, and so they will still face lower levels of well-being.