## Economic benefits

Assistive technology has a powerful impact on the lifetime earning potential of individual users and their families. The total economic gains from meeting the unmet need for the four ATs across LMICs amount to over USD 10 trillion in real terms over the next 55 years— equivalent to over 1% of total LMIC gross domestic product (GDP) over that period. 9

Table 1: Breakdown of economic benefits from AT access

| HEARING AIDS | PROSTHESES | EYEGLASSES | WHEELCHAIRS
| CHILDREN | ADULTS | CHILDREN | ADULTS | CHILDREN | ADULTS | CHILDREN | ADULTS
Cohort size | 4 million | 50 million | 5 million | 30 million | 20 million | 830 million | 10 million | 50 million
Avg. lifetime gains per user | ~USD 59,500 | ~USD 2,800 | ~USD 246,300 | ~USD 8,400 | ~USD 76,800 | ~USD 4,200 | ~USD 106,200 | ~USD 8,100
Total lifetime user gains | ~USD 200 billion | ~USD 100 billion | ~USD 1,200 billion | ~USD 300 billion | ~USD 1,700 billion | ~USD 3,600 billion | ~USD 1,000 billion | ~USD 400 billion
Total lifetime user gains across products | ~USD 8,500 billion
Total family supporter gains | ~USD 70 billion | ~USD 110 billion | ~USD 180 billion | ~USD 150 billion | ~USD 160 billion | ~USD 740 billion | ~USD 330 billion | ~USD 140 billion
Sum of family supporter gains across products10 | ~USD 1,900 billion
Total economic gains9 | ~USD 10 trillion

User

Expanding use of the four products among children today in LMICs leads to improved educational outcomes, contributing to over USD 4 trillion in increased lifetime earnings. Improving access to AT for today’s adult users leads to a further USD 4 trillion in increased earnings through greater employment and productivity. This means that investments made over the coming decade will yield significant benefits over the subsequent decades, constituting a major investment in the well-being of our children and grandchildren.

I. Education

Better education has lifelong impact on users’ employment and earnings. Each year of additional schooling a child receives increases future earnings by an estimated 10%.11 Today, without access to AT, children who need it commonly do not receive the education they require to be successful in the workforce. Providing AT to children in LMICs who need it to attend school—and, once there, to learn to their full potential—would result in average estimated additional lifetime earnings of over USD 100,000 per child today. 12 This is equivalent to an annual average of USD 1,900 per person, or just over 25% of average per-capita income across LMICs.

AT enables children to overcome numerous obstacles to attend school. Children with disabilities, in particular, are between 10 and 60% less likely to attend school than their peers without a disability. 13 The enhanced mobility provided by wheelchairs and prostheses, for example, can help children with disabilities overcome many of the transportation barriers that previously prevented them from attending school. 14

AT also helps children perform better while in class. Challenges within the classroom for children requiring AT are often multi- fold — including inaccessible learning materials, unaccommodating teachers, and attitudinal, physical, and communication barriers— often keeping them from learning to their full potential. 15 Devices such as hearing aids and eyeglasses allow for better engagement with teachers and fuller participation in classroom activities, thus overcoming some of these barriers. 16

Finally, young users of AT are more likely to finish school than those without access to it. Although data are not available across all AT users, we do know that children with disabilities, many of whom require AT, are approximately one-third less likely to have completed primary school than those without disabilities. 17 With greater academic access, engagement, and chance for academic success, children who need AT are less likely to experience bullying and discouragement and are more likely to complete their schooling.

Barriers to employment

Attitudinal barriers | Institutional barriers | Communication barriers | Physical barriers
--- | --- | --- | ---
Individuals with disabilities, and those that require AT, are often incorrectly viewed as lacking capacity or being unable to work, and therefore may be discriminated against when applying for jobs. 11 | Discriminatory government and/or organisational policies may either prohibit employment or indirectly discriminate, for example by not including provisions for reasonable accommodation 11 to support employment (including use of AT). Barriers to access to quality education earlier in life also present barriers to employment later in life. 13 | Inaccessible information about employment opportunities and inaccessible information and communication processes during recruitment and during employment can adversely affect both the recruitment process and job performance and satisfaction. | Inaccessible transport and workplaces, which may be exacerbated by a lack of AT, can also prevent people with disabilities /those who require AT from obtaining employment.

SPOTLIGHT:

Impact of AT access on child learning

Shakira is a 13-year-old girl from Malawi who developed hearing loss following meningitis at the age of five. Her parents realised she was having difficulty hearing when she stopped regularly speaking. She could lip read and speak a bit, but only her parents could fully understand her.

Shakira’s mother, Famely, observed that Shakira was growing increasingly isolated due to her hearing loss. She was struggling to fit in with her peers and her confidence and self- esteem were diminishing. Following information provided at school, Famely brought her to a local hearing screening outreach in January 2017.

Shakira was assessed and diagnosed with bilateral hearing loss. She was measured and fitted with hearing aids in February 2017, and both her mother and she were overwhelmed by the marked change in her hearing. Only after the hearing aid fitting did she realise that some people were actually shouting when speaking with her—she now asks them to speak more softly.

Since receiving hearing aids, Shakira’s interaction and communication with her friends has vastly improved. Now her friends come around to the house to spend time with her and she goes over to her friends’ houses. Just as importantly, Shakira’s teacher says that she is completely different in class: she is much better able to communicate with the teacher and her fellow students.

II. Employment

Lack of AT limits the employment prospects of many of those who need it and represents a profound barrier particularly for those with disabilities. The last available data across 51 countries from the World Report on Disabilities showed that on average only about half of men with disabilities were employed, compared with two-thirds of men without disabilities. 18 And while specific data in LMICs are limited, WHO highlights that people with disabilities who work are more likely to do so in the informal sector or to hold part-time jobs. 11, 19

Adults with access to AT are better able to overcome barriers to learning about available jobs and traveling to and from workplaces. Communication aids such as eyeglasses and hearing aids help eliminate barriers to discovering and understanding information about job opportunities. Mobility technologies such as wheelchairs and prostheses in combination with advances in accessibility help people address or eliminate barriers to getting to the job or interview site.

SPOTLIGHT:

Impact of AT access on a user’s employment opportunities

In 1991, Mohammad lost both his legs to a landmine in Myanmar. At the time, he was able to receive a pair of prosthetic legs. In August 2017, he had to flee Myanmar with his family, and was forced to abandon his prosthetic legs and crutches. He is now 50 years old and living in Cox’s Bazar, Bangladesh. Back in Myanmar, Mohammad was a tailor and the only breadwinner for his family. To continue earning a living and supporting his family in their new home, he improvised by attaching plastic bottles to his amputated legs in order to be able to pedal the sewing machine.

After accessing a new pair of fitted prostheses from a local health centre, Mohammad can now walk independently again. He has managed to comfortably resume his fulltime job as a tailor and is earning enough to support his wife and three children.

III. Productivity

AT can boost productivity, allowing users to earn more on the job. When people who need AT gain access to it, they are better able to perform daily tasks, communicate with colleagues, and engage with equipment, processes, and systems within the workplace. Inaccessible locations, communication barriers (such as poor lighting or group conversation for someone who lip reads), and structural challenges (e.g. limited promotion opportunities) hinder workers from being as productive as their peers. AT helps overcome only some of these barriers directly, yet our economic model estimates that the four focus products improve a user’s productivity on average by 16%. Research, though scarce, supports this. For example, correcting presbyopia with eyeglasses increased productivity of tea-pickers by 22%, and up to 32% for those aged over 50 years old. 20

IV. Working timespan

Access to AT extends the working life of AT users. With AT, users are physically able to work for a longer span of years as better health outcomes enable them to better cope with the challenges of ageing. Particularly in places with weaker social safety nets, this can protect older workers and ensure they maintain a source of income for as long as possible.

In each of these ways, AT can help users increase and prolong their incomes, generating over USD 8 trillion in additional earnings for the AT users themselves.

Family

Meeting the unmet need for AT can enable family supporters to increase their time spent at work, resulting in nearly USD 2 trillion of additional income for families over the users’ lifetimes.

Some people in need of AT require regular in-person support to complete tasks in their daily lives. This may include support with mobility, toileting and self-care, accessing water, preparing and consuming food, moving around their homes and communities, and more. Having access to AT helps many users independently complete these tasks. In high-income countries supplementary assistance is often provided by state-funded support services, such as personal assistant schemes, sign

language interpreter services, and (compensated) support from family members. The limited availability of such services in LMICs forces some people to rely more heavily on unpaid support from close relatives for their daily needs.

Increased AT uptake enables family supporters to pursue new opportunities for paid work. AT facilitates greater independence and autonomy for users, reducing their reliance on family members for support. This allows support providers—disproportionately women and girls—to use time previously spent supporting the needs of people lacking AT to regain opportunities for education and paid work. Those previously not employed at all may take on new work responsibilities, while those working part-time may be able to further increase their time spent at work.

Society

The individual and familial economic benefits create a powerful multiplier effect that can contribute to lifting AT users out of poverty while rippling out to impact entire countries.

The cumulative value of the economic benefits accrued by today’s AT users would be worth 1% of total LMIC GDP over the next 55 years. And with the spreading of this increased income and spending flowing through the economy, the multiplier effect suggests that the total benefit to local economies could be many times larger. Greater income for AT users translates into greater income for others in their communities and increased tax revenue. As household incomes increase due to higher levels of employment and greater productivity, AT users and their families have more resources to spend in their communities, pay taxes, and otherwise contribute to a virtuous cycle that drives accelerated national-level economic growth.

Earning more income also helps AT users and their families become more resilient to economic shocks, reducing their risk of experiencing poverty and relying on social safety nets. Although the research is limited, available data on workers with disabilities in LMICs have shown them to have lower average incomes than workers

without disabilities. 11, 21 At the same time, people with disabilities and other AT users often must cover high healthcare and other costs (e.g. taxi fare where public transportation is inaccessible). An estimated one in three people with disabilities faces ‘catastrophic health expenditures22, compared with one in five people without disabilities. 11 Depressed wages and additional cost burdens are clear contributors to elevated poverty rates among those in need of AT. 11, 23 To varying degrees, these findings can be extrapolated to other AT user groups.

Expanding the availability of AT can also create new work opportunities, such as jobs in assessment, fitting, and training on the use of assistive devices, as well as service and maintenance of devices through follow-up processes. These are jobs that often employ AT users themselves, creating opportunities for more inclusive employment.

SPOTLIGHT:

AT and gender

Women and girls routinely face systemic and cultural challenges, resulting in negative consequences for their economic wellbeing

In much of the world, girls are prevented from achieving the same level of educational outcomes as their male counterparts. Women account for an estimated two-thirds (520 million) of illiterate adults around the world today—the vast majority of whom live in LMICs. 24 There are an estimated 5.5 million more out-of-school girls than boys, and out- of-school girls are more likely than boys never to have enrolled in school in the first place. 25

Already at a gender-based disadvantage in the classroom, girls in need of AT face even greater challenges, resulting in even poorer educational outcomes. For example, survey data found that girls with disability—a large AT user group—are an additional 20% less likely to complete primary school than girls without disability.18 UNICEF has also found that girls with disabilities are particularly at risk of experiencing discrimination and abuse. 31 In the classroom, this manifests as bullying, which may result in poorer mental health or self- esteem and contribute to elevated drop-out rates.

Adult women face cultural and institutional barriers that present significant barriers to employment and work productivity. Women are traditionally burdened by outsized responsibilities for unpaid care and domestic work. This ‘time poverty’ limits their ability to pursue paid work outside the home. On average, women do three times more unpaid work than men and spend seven more years performing unpaid work over the course of their lifetimes. 26, 27, 28 Even when women are empowered to work for pay, numerous barriers limit their productivity and earning potential. For example, in most of Sub-Saharan Africa, women are not awarded with the same land rights as men and often must access land through male relatives. Furthermore, women often face challenges accessing key inputs, such as fertiliser and mechanical equipment, because they are unable to get the credit / financial support they need to purchase these items. 29 This results in a 20–30% productivity gap between men and women working in agriculture in Sub-Saharan Africa. 30

Adult women are further disempowered by a lack of AT. Women in need of AT are even more likely than other women to be left out of the workforce. The same survey data found that just under 20% of women with disability are employed compared with about 30% of women without disability. 25 In addition, women who live in households in which someone else needs AT are disproportionately likely to take on any required support responsibilities. In other words, a lack of access to AT restricts women’s potential even when they are not the prospective users.

Ensuring access to AT will play a key role in improving outcomes for women and girls and accelerating progress towards achieving the gender-related SDGs.

A major pillar of the 2030 Agenda for Sustainable Development is to ‘leave no one behind’—and to ensure that efforts reach the furthest behind first. Women are among the most broadly marginalised groups in the world, and those in need of AT are at even further disadvantage. Increasing access to AT offers a powerful opportunity to overcome poverty. By increasing mobility and the ability to engage with others, AT improves the opportunities for women with disabilities to achieve better economic outcomes. Not only does this help the global community realise the SDGs for quality education and decent work, but it is also critical to achieving SDGs 5 (gender equality) and 10 (reduced inequalities)— targeting empowerment for women and girls and reducing inequalities within and among countries.

Figure 4: Health benefits of AT provision