Dentistry for a Rapidly Increasing Population with Disabilities in India

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INTRODUCTION

Individuals with disabilities are a major global public health concern. Great numbers of youngsters and middle aged persons with a wide range of disabilities increasingly are surviving with conditions, which in the past, would have resulted in markedly foreshortened lives. As a result, in this century, increasing numbers of individuals will reach their eighties, nineties and beyond--the decades of life with the highest proportion of individuals with disabilities, associated dependency and increasing costs for health and social services. For example, in India in 2000, there were approximately 340 million youngsters less than fifteen years of age and 47.5 million individuals 65 years and over. It is estimated that by 2020, the older population cohort will increase to 93.5 million individuals and reach more than 230 million by 2050. [1, 2]

The World Health Organization reports that non-contagious somatic illness, malnutrition, chronic alcoholism, drug abuse and congenital disease are the main causes of worldwide disability with each contributing 100 million cases. Other major causes of disability worldwide are injuries and wounds (78 million), contagious diseases (56 million) and functional psychiatric disorders (40 million). [3] Depending on 1) the definitions used to define "disabilities" and 2) whether it includes complete impairment, moderate or severe conditions, the prevalence of disabilities in various countries ranges from 1.5 to 21.3 percent of the total population. [2] Currently, an estimated 650 million people live with disabilities throughout the world. [4, 5] The needs of this population are, and will be, a major challenge to the national health system of many countries.

SPECIFICALLY, INDIA

The Registrar-General of India reported the results from the 2001 census study which indicated that 2.13 percent of total population (21.9 million individuals) had some form of disability. The highest percentage (48.5%) of those with disabilities was in the visual impairment category, followed by the movement disorders (27.9%) and intellectual disability (10.3%). [6]

By contrast, the World Bank reported that, "India has some 40 to 80 million people with disabilities ... At least one in twelve households has a member with disability." [7] They noted that, illiteracy, unemployment, and poverty among the disabled is high, and children with disabilities are 5 times more likely to be out of school than the average for children without disabilities. They added the further commentary, that "... low literacy, few jobs and widespread social stigma are making people with disabilities and special health care needs among the most excluded in India. In the years to come, the number of people with disabilities in India is expected to rise sharply as age related disabilities grow and traffic accidents increase." [7]

The Government of India put the estimated figure of the number of disabled at 1.9%--"... so low that it was easy to pretend that everything was hunky-dory and no special attention was required for the disability sector... Finally, we now have the officially accepted number of 70 million disabled people in the country--an estimated 7% of the population." [8] In addition,

Only 2 percent of the individuals with disabilities are educated and 1 percent employed. If the youngsters attend school, "...they rarely progress beyond primary levels. This leads to lower employment and incomes." [7,8]

70% of people with disabilities in India live in rural areas and 50% of them are extremely poor. At most, 1 percent of funds for welfare activities for persons with disabilities is used in rural development, housing and poverty alleviation. [9]

There are reports of inadequate numbers of teachers for the numbers of children with disabilities. [10]

ATTITUDES TOWARD PEOPLE WITH DISABILITIES

In 2009, India's prime minister commented that, "attitudes toward people with disabilities must shift and focus on human rights. …