Age International submission to the IDC inquiry FCDO and disability-inclusive development

September 2023

Contact:

Katie Jakeman

Parliamentary Officer, Age International

katie.jakeman@ageinternational.org.uk

07867 455303

Introduction

1.      Age International is a UK charity focusing on improving the lives of older people in low- and middle-income countries. Age International is a subsidiary of Age UK and a member of the HelpAge International (HAI) global network. Our mission is to help older people around the world to overcome poverty, claim their rights and challenge discrimination, so they can lead dignified, secure, active, and healthy lives.

2.      The world is ageing as people are living longer. By 2030, 1 in 6 people in the world will be aged 60 years or over. By 2050, the world’s population of people aged 60 years and older will double to 2.1 billion. The number of persons aged 80 years or older is expected to triple between 2020 and 2050 to reach 426 million.[1]

3.      It is now low- and middle-income countries that are experiencing the greatest change in population ageing. By 2050, 80% of older people will be living in low- and middle-income countries. Government policies must be prepared for this demographic shift. The likelihood of having a disability increases with age, with the majority of disabilities in low and middle-income countries caused by chronic diseases.

4.      More than 46 per cent of older persons – those aged 60 years and over—have disabilities and more than 250 million older people experience moderate to severe disability.[2] Common conditions in older age include hearing loss, cataracts, and refractive errors, back and neck pain and osteoarthritis, chronic obstructive pulmonary disease, diabetes, depression, and dementia.

5.      There is a need to address accessibility requirements in ageing populations, including the availability and use of assistive technology (AT). There is also the concern that functional limitations will be more severe for older people with disabilities, which can increase the levels of risk individuals experience over time.

6.      Global prevalence of disability is greater for women than men. Age-related chronic diseases and disability can pose particular challenges for older women in accessing and carrying out their work[3].

7.      The published Equality Impact Assessment revealed that UK ODA cuts will have a disproportionate impact on those with protected characteristics, including, women and girls, people with disabilities, and older people.[4]

The adequacy of FCDO’s new disability and inclusion rights strategy as a framework for approaching disability-inclusive development

8.      Age International welcomes the inclusion of older people in the FCDO 2022 disability and inclusion rights strategy (DIRS): “FCDO takes a life course approach, aiming to protect the rights of all people at all stages of their lives. We will continue to consider the diverse experiences, priorities, and requirements of older people, many of whom have disabilities, impacting their autonomy, dignity, and social participation. We recognise the critical role of older people and their representative organisations, including older women and widows of all ages who face additional discrimination and abuse”.

9.      The FCDO also commits to using its international influence to strengthen the rights of older people. “We will continue to include age as an important dimension across our work, engaging closely with UN bodies, and supporting UN resolutions on the human rights of older people and widows and encouraging our partners to do the same. We are supportive in principle for a multilateral instrument dedicated to the human rights of older people. We will invest in improving collection, analysis and use of age disaggregated data and will remain a key stakeholder in the Titchfield City Group on ageing to support this work”.

10.  It is disappointing that the DIRS did not mention non-communicable diseases (NCDs). NCDs are now the top global killers, making up 74% of all deaths globally and contributing to 80% of all years lived with disability, and 87% of deaths for those over 55.[5]

11.  Mental disorders are a leading contributor of disability. Dementia is considered one of the most disabling chronic diseases, with mid to late stages of dementia leading to loss of physical and cognitive function, autonomy, and independence. The number of people living with dementia around the world is over 55 million, which is expected to rise to 139 million-people by 2050.[6] The DIRS did not include any explicit reference to dementia.

Recommendations

1.      The UK Government must support the creation of a UN Convention on the Rights of Older Persons as part of its broader approach to ensuring that the rights of older people with disabilities are protected.

2.      It is crucial for the UK's disability-inclusive development to incorporate strengthening of long-term care and support, especially in light of global ageing populations, as this will ensure that individuals with disabilities can access the necessary services and assistance to lead fulfilling lives and maintain their independence as they grow older.

3.      The FCDO must have a greater focus on NCDs in its health priorities, including extending the UK Government’s commitment to tackling dementia and the need for specialist training for all healthcare staff to better understand the health needs and rights of older people.

4.      The UK should be more explicit in tying health and disability commitments together, as in the recent global health framework there wasn’t reference to how previous commitments from the DIRS will be integrated into its health work.

The adequacy of FCDO’s spending on disability-inclusive programmes and the impact of cuts to ODA programmes on people with disabilities

FCDO’s spending on disability-inclusive programmes

12.  AT2030 is a UK Aid funded programme which tests and delivers proven methods of 'what works' to improve access to affordable assistive technology through the Global Disability Innovation Hub[7]. HelpAge International (HAI) is a delivery partner. We welcome the announcement that the UK will invest a further £31 million into the AT2030 programme.

a.       This AT30 research paper looked at AT in two humanitarian contexts, Bangladesh, and Jordan.[8] Overall, it found that provision of AT is ad hoc, and largely related to the access, availability and focus of NGO-funded projects in camps or communities. When it was available, for many of those interviewed, AT had a positive impact on their lives.

b.       Findings also indicate a need for disaggregated data, or more needs-based data such as the rapid Assistive Technology Assessment – to develop and deliver effective, evidence-based health and rehabilitation services. As yet, there is still limited evidence on what works for effective AT, how to deliver it and how much it costs, and while programmes such as AT2030 are beginning to explore these, there is much more work needed in specific areas, including humanitarian contexts.

The impact of cuts to ODA programmes on people with disabilities

13.  The UK Aid funded Global Better Health Programme aimed to improve health in 8 partner countries, contributing to inclusive economic growth and reducing poverty.[9] Due to ODA reduction, the programme activity ended in Mexico and Myanmar in November 2021.

a.       HAI had been implementing the project in Myanmar. Myanmar was experiencing political instability and a collapsed health care system after the military coup. The withdrawal of FCDO funding in such a fragile context was an abandonment of people at a time when they needed the support the most.

b.       The primary purpose of the Global Better Health Programme was the reduction in avoidable disability and mortality (overall and premature) due to NCDs; increased access to healthcare, reduced gender, and income inequality; improved patient safety/quality of care; new vaccines, treatments; higher rate of GDP growth due to a healthier, and more productive workforce; and stronger health systems.

c.       According to 2019 survey, 12.8% of the population (estimated 5.9 million people) are living with disabilities in Myanmar.[10] People with disabilities in Myanmar face unequal access to health care, education, opportunities, and employment – discrimination that has only got worse amid the political crisis and the COVID-19 pandemic. Older people and people with disabilities are disproportionately affected when programmes are cut as they are often reliant on the support provided.

14.  AcT2 was a UK Aid funded five-year project in Tanzania aimed at strengthening civil society organisations.[11] The priorities were improving the civic space, social inclusion (disability, women, girls, and youth/elderly), anti-corruption and climate change.

a.       HAI was one of the implementing organisations with the objective of ensuring older people, including those with disabilities, and their dependents lead more dignified, healthy, and secure lives.

b.       As a result of the ODA reduction, a decision was taken to reduce the total value of the AcT2 programme from £42 million to £26.8 million, and to close the programme early by the end of March 2022. The programme was forced to terminate all its existing contracts with civil society partners.

c.       This sudden termination happened when HAI was responding to the COVID-19 pandemic in Tanzania in 2020, putting lives and livelihoods at risk. Rapid needs assessments conducted by HAI in Tanzania showed significantly increased insecurity for income and food, forcing older people to reduce the quality or quantity of food consumed. Older age groups where prevalence of disability was higher, were particularly impacted. Apart from the self-governing state of Zanzibar, Tanzania did not initiate a social protection response to the pandemic which disproportionately impacted older people and people with disabilities, many of whom were isolated.

Recommendations

1.      The UK must return to 0.7% ODA spend to ensure that assistance is able to reach those furthest behind.

2.      Reports should be made publicly available on the full impact of the ODA cuts on disability inclusive programming and mainstreamed programmes that support people with disabilities.

3.      The UK Government should continue to fund research and access to AT for older people and people with disabilities, particularly in humanitarian contexts.

4.      The FCDO should increase support for social protection programmes that deliver income security, health, employment, and education to people with disabilities of all ages.

5.      The FCDO should remove discriminatory age-caps. The UK Better Health programme was only looking at NCDs and 'premature mortality' for under 70s. This has impacts on the growing disability challenges in older populations and misses the opportunities for preventing and managing NCD-related disabilities in older populations.

FCDO’s work to encourage and facilitate the participation of people with disabilities, and relevant advocacy groups, in developing its strategy and approach

15.  The UK Government provides funding to Elhra, a humanitarian research and innovation charity. One of their focus areas is on the inclusion of older people and people with disabilities.

16.  HAI and our network partner in Malawi, MANEPO, were part of the steering committee for the Elhra report ‘Gap Analysis: the Inclusion of People with Disability and Older People in Humanitarian Response’,[12] funded by UK Aid. Data collection for the report included interviews, consultations with persons with disabilities and older people who had experienced humanitarian response (these only took place in Indonesia due to COVID-19), and online workshops.

a.       Participants in the online workshops noted that the progress of change towards increased inclusion is uneven. While progress was being made by disability and older age-focused organisations in improving inclusion in response, there was less progress by ‘mainstream’ organisations. An OPD (organisation of persons with disabilities) participant noted that while they are increasingly considering gender in their work, older age has received less attention. 

b.       It was also noted that the inclusion of people with disabilities and older people is sometimes left to later stages of a response. Falling back on what is known and what is familiar to organisations can result in the exclusion of people with disability and older people in the critical early stages of rapid responses.

c.       They also identified little evidence that directly addressed the links, or intersectionality, between disability and older age, as well as other identity characteristics, such as gender, religion, and ethnicity. Findings from interviews and the online workshops indicate that progress on the inclusion of older people lags behind the inclusion of people with disability in humanitarian response.

Recommendations

1. The FCDO should continue to provide funding to Elhra and other research organisations so that knowledge gaps can be filled on how to better mainstream age and disability inclusive programming into humanitarian response.

2. The UK must facilitate the attitudinal change, environmental adaptations, better provision of resources (including rehabilitation) and much wider awareness about the policies and legislation that support the rights of older people and persons with disabilities, including displaced persons.

3. The UK should continue to include older people and people with disabilities in the consultation process and encourage their partners to do so, as we need more knowledge and shared learning on the nexus between social protection and humanitarian response.

The role of the UK in disability inclusion within the global humanitarian and development community

17.  The UN Convention on the Rights of Persons with Disabilities (CRPD) sets out the legal obligations of States to promote and protect the rights of persons with disabilities in, society and development. It contains a number of articles which highlight the cross-sectionalities of ageing and disability. Article 9 (accessibility), Article 19 (living independently and being included in the community), Article 20 (personal mobility) and Article 25 (health) are just a few examples of how the Convention provides a concrete framework for action which may be of particular interest to the discussions on disability and ageing.

18.  The UK has been a champion in the disaggregation of data by age, disability, and gender. The UK’s Office for National Statistics (ONS) leads the United Nations Titchfield City Group on Ageing and Age-disaggregated data (TCGA).[13]

19.  The Sustainable Development Goals (SDGs) of the 2030 Agenda make explicit references to older people and people with disabilities with regards to ending poverty, good health and well-being, decent work and economic growth, and sustainable cities and communities, as sustainable development will not be achieved without the inclusion of older people with and without disabilities. The SDGs provide a critical platform for countries to address the cross-sectionalities of ageing and disability.

20.  By adopting the SDGs, the UK and other member states have committed to leave no one behind, which recognises that age and older people need to be taken into account. Despite some progress, significant disparities remain and the 2030 deadline for eradicating poverty will not be achieved if current trends continue. Universal access to quality education and universal health coverage is also unlikely to be achieved at the current rate of progress. Not only are people and countries being left behind, but they risk being pushed further behind by other factors such as conflict and climate change. These global challenges have a disproportionate impact on older people and people with disabilities.

Recommendations

1.      The FCDO must recommit to requiring disaggregated data by age and disability in all development and humanitarian funding proposals.

2.      The UK must use its influence on the Titchfield City Group to encourage partners and other countries to develop and use standardized tools and methods for producing data disaggregated by age and ageing-related data that is fully inclusive of older people in all their diversity.

3.      The UK must maintain its commitment to the SDGs at the upcoming summit and use its international influence to ensure progress is made by all countries to leave no one behind in the lead up to 2030.

Safeguarding issues within disability inclusion that should be prioritised in FCDO’s work tackling sexual exploitation and abuse in the aid sector

21.  The Humanitarian Inclusion Standards for Older People and People with Disabilities were published in 2018[14].The standards are designed to help address the gap in understanding the needs, capacities and rights of older people and people with disabilities and promote their inclusion in humanitarian action. It can be used by humanitarian actors as guidance for programming, and as a resource for training and advocacy, particularly for influencing organisational policies and practice to be more inclusive – including policies to prevent discrimination, sexual exploitation, and all forms of abuse against older people and people with disabilities.

22.  The UK’s strategy on safeguarding against sexual exploitation and abuse and sexual harassment (SEAH) published in 2020 sets out the actions the UK is taking across all government departments which engage in delivering ODA.[15] It acknowledged that people with disabilities are more vulnerable to SEAH, but missed the opportunity to acknowledge that older age is also a risk factor to abuse.

23.  Around one in six older people face abuse worldwide. Emerging evidence is indicating violence, abuse and neglect of older people has increased since the outbreak of COVID-19.[16]

Recommendations

1.      The UK Government should mainstream safeguarding of older people and people with disabilities across all its programmes and be more explicit about the specific abuses older people and people with disabilities face in its safeguarding policies.

2.      A UN Convention on the Rights of Older Persons would build upon the CRPD and provide an international legally binding instrument to better protect the rights of older people living with disabilities.

FCDO’s progress in implementing the Committee’s previous recommendations, and the commitments made at the Global Disability Summit

Committee’s previous recommendations

24.  The Committee’s previous report recommended that “The FCDO should ensure that it scales up its spending on disability specific projects over time, as well as provide support for effective and imaginative mainstreaming with specific funding.”[17]

a.       The ODA cuts have meant that rather than scaling up their spending on disability inclusive programming, this has been decreased as evidenced in the Equalities Impact Assessment.[18]

25.  In the Government’s response to recommendation 11 of the previous report they said “We recognise the close link between ageing populations and disability, and we will continue to take a ‘life cycle’ approach as set out in our strategy and ensure that our work reaches people of all ages. We expect to publish a health systems strengthening position paper at the end of this year outlining our approach to the provision of quality, accessible and inclusive services”.[19]

a.       In the subsequent health systems strengthening paper the FCDO committed to supporting countries to achieve health equity through disaggregating programme data by gender, age, location, and disability status.

Commitments made at the 2022 Global Disability Summit

26.  “The forthcoming FCDO 2022 Women and Girls Strategy and Implementation Plan will ensure that women and girls with disabilities are meaningfully embedded across key priorities and mutually reinforces the 2022 FCDO Disability Inclusion Strategy”.[20]

a.       The FCDO’s 2022 Women and Girls Strategy included no reference to older women or the DIRS.[21]

Recommendations

1. The UK Government should ensure its new White Paper fully integrates previous commitments to strengthening the rights of people with disabilities and must be explicit in recognising the need for addressing the needs and rights of older people.

2. The UK Government should use all relevant multilateral fora and meetings at the UN to demonstrate their commitment to taking a life course approach to development, and encourage other stakeholders to do the same.

3. Programmes and policies designed to eradicate gender inequality must consider the accumulation of inequalities across the life course and explicitly include older women with and without disabilities.