Author: Autumn Coalwell
January 11, 2024
Executive Summary
Jamaica has made great strides in the reduction of poverty and the provision of social services in recent decades, and new projects and policies are ongoing that will improve transportation and expand the provision of public services. However, persons with disabilities continue to suffer from discrimination and face transportation and mobility challenges due to poor infrastructure, two major impediments which lead to decreased access to education and employment. According to the World Bank (World Bank, 2016), less than 1% of individuals in Jamaica who identify as having a disability are employed. The government of Jamaica estimates that approximately 15% of Jamaicans may be living with a disability (World Bank, 2016), but the data that is being collected regarding disability in the country is either insufficient or not readily available online. In 2014, Jamaica passed the Disabilities Act, which promised to promote equal rights, dignity, and autonomy for persons with disabilities, ensure full inclusion in society, and prevent discrimination. Despite this, persons with disabilities still face exclusion from many facets of society, including education and employment. In this paper, I will provide an introduction to Jamaica, an overview of healthcare, disability, and transportation in the country, an analysis of efforts that are being made to advance accessibility, and a briefing on suggested improvements to help support disability rights and accessibility within the country.
Introduction
In 2018, the United Nations (UN) released the Disability and Development Report which outlined the current state of disability globally and provided guidance for including persons with disabilities in the quality-of-life improvements of the Sustainable Development Goals (SDGs). Disability around the world has major impacts on quality of life because roads, neighborhoods, cities, shops, and even medical facilities are not built to be accessible. In many countries, disability status is correlated with challenges accessing clean water and sanitation. In countries with poor public transportation, this issue is further compacted due to increased challenges to mobility for persons with disabilities. A study by the Global Alliance on Accessible Technologies & Environments (GAATES) found that the biggest challenges for persons with disabilities living in low- and middle-income countries included inaccessible public transportation and attitudes of public transportation operators and staff (GAATES, n.d.). These challenges can certainly be witnessed in Jamaica and are likely impacting the ability of disabled individuals to access education, healthcare, and employment.
Jamaica is a low-income country located in the Caribbean and has approximately 2.8 million citizens. The median age of the population of Jamaica is 31.8 years and the life expectancy is 72.4 years (Worldometer, 2023). Most widely known for its white sand beaches and island resorts, Jamaica has a vibrant culture centered around music, dance, art, and cuisine. Jamaica was a British colony until 1962 when it gained independence, and during the colonial period its citizens faced exploitation through slavery. The government of Jamaica is a constitutional monarchy with a parliamentary system (the “monarch” is a largely ceremonial role played by the British monarchy). The country’s cabinet, made up of the Prime Minister and other appointed ministers, is primarily responsible for policy making. Jamaica also has a bicameral legislature which includes a house and a senate. The 21 members of the senate are appointed by the governor-general, while the 63 members of the house are directly elected by the people (Britannica, 2019). The country’s economy is heavily reliant on tourism, which accounts for $60 billion dollars in gross domestic product (GDP) and 2.8 million jobs. Because of this heavy reliance on tourism, the country was greatly impacted by the COVID-19 pandemic. Jamaica’s poverty rate before the pandemic was approximately 17%, and in 2020 it increased to 23%. During the pandemic, the country’s GDP also decreased by almost 10% (Saeisha, 2022).
The nation’s budget has a large expenditure for education. Primary school is free in Jamaica, and it is estimated that 9/10 women and 4/5 men are literate (Britannica, 2019). However, this statistic does not carry over to persons with disabilities, who have faced significant impediments to accessing education. Jamaica is both a signatory and has ratified the United Nations Convention on the Rights of Persons with Disabilities. In 2014, Jamaica passed the Disabilities Act of 2014, which defines a person with a disability as “a person who has a long-term physical, mental, intellectual or sensory impairment which may hinder his full and effective participation in society, on an equal basis with other persons” (JCPD, 2014). The Disabilities Act finally went into effect in 2022 after being passed by the Jamaican parliament. The Disabilities Act was developed to ensure the rights of persons with disabilities; these rights include the provision of a disability certificate, the right to education and training, the right to employment, the right to adequate healthcare and accessible facilities, and the right to housing. The Disabilities Act also included the establishment of the Jamaican Council for Persons with Disabilities (JCPD, n.d.) to advance equity for persons with disabilities. Since its establishment, the JCPD has offered disability sensitivity training upon request, and they have reported an increasing number of businesses reaching out to secure this essential training. The JCPD has also developed an accessibility checklist (based on the accessibility clause of the Americans with Disabilities Act) to help businesses comply with accessibility requirements. In addition to these efforts, new infrastructure projects initiated by the Jamaican Department of Education will be required to meet criteria for accessibility (LoopNews, 2023). While these are monumental and positive steps, more needs to be done to promote accessibility and mobility for persons with disabilities. While it is essential for schools to be accessible, it is equally important for persons with disabilities to have accessible transportation so that they can reach schools in the first place. While many businesses are choosing to enroll their staff in sensitivity training, persons with disabilities still face discrimination in both the public and private sectors. Disability sensitivity training will need to be implemented on a larger scale to ensure that persons with disabilities throughout the country can access public services without discrimination.
In Jamaica, only 20% of individuals have access to health insurance, with the rest relying on poorly funded public hospitals that have a ratio of around one doctor per 1,000 people (World Bank, 2016). A study found that the average wait time for persons with disabilities at public hospitals was four hours, compared to only 1.5 hours at private hospitals (Morris, 2018). Non-communicable diseases make up almost 80% of deaths in the country, including diabetes, heart disease, and cancer (The Borgen Project, 2023). In high-income countries, deaths from non-communicable diseases tend to primarily occur in older individuals (60 years old and above). In contrast, in low- and middle-income countries, the percentage of deaths from non-communicable diseases is becoming more concentrated in younger populations. The increase in non-communicable diseases is in part the result of rapid, unplanned urbanization, sedentary lifestyles, a transition to diets higher in sugar, fat, and salt, and increased alcohol and tobacco use. Persons with disabilities may be at an increased risk of developing non-communicable diseases due to their physical impairments and decreased access to healthcare and education (Morris, 2018). Morris also discovered that many persons with disabilities had limited awareness of their healthcare options and that healthcare practitioners may not be adequately trained on how to best serve and relate to persons with disabilities.
Hospitals can be difficult for patients to reach, especially if they are disabled. As of 2022, approximately 43% of the population of Jamaica lived in rural areas (World Bank, 2022) and surveys by Morris (2018) found that 57% of persons with disabilities live in rural areas of the country. Rural roads are often unpaved and unmaintained, and frequently blocked, flooded, or washed out, creating serious transportation challenges. A 2005 study (Persaud et al., 2019) found that only 12% of the country’s roads could be considered “good” quality. The increase in road traffic in recent years has resulted in major congestion getting in and out of urban areas. Jamaica has completed several major infrastructure improvement projects that have significantly expanded transportation options across the island. Jamaica has both public and private bus transit, consisting primarily of minibuses. Public transportation is limited and unreliable, while private bus services can often be inaccessible, overcrowded, and even dangerous. Private minibus drivers get paid solely on the number of passengers they are able to transport per day and are therefore incentivized to overcrowd buses and drive at unsafe speeds to reach their destinations. Accidents on these modes of travel are common, and some even result in fatalities (Brugulat-Panés et al., 2023).
There are ongoing efforts between the Jamaican government and the Pan-American Health Organization to improve access to healthcare by modernizing the country's hospitals and building more hospitals across the island to improve access. This initiative is known as Vision for Health 2030, and although it began in 2009, progress has been slow. The country's National Development Plan includes $800 million in infrastructure upgrades to help support better access to healthcare facilities, clean water, and electricity, and it remains to be seen if these funds will successfully lead to improvements (Ministry of Health, 2022).
Examining The Data
Disability Categories in Jamaica
The most common forms of disability reported in Jamaica were physical disabilities (31.1%), multiple disabilities (24.4%), sight disabilities (15.5%), and mental disabilities (15.2%). This is a major concern due to the lack of accessible infrastructure in the country, as well as the poor state of roads and public transportation, which may have significant impacts on those with physical disabilities.
Disability and Educational Access
As of 2011, the Statistical Institute of Jamaica reported that 53% of persons with disabilities did not have access to education, versus 3% of the general population (Statistical Institute of Jamaica, 2011). This is a huge disparity that demonstrates the inequities that remain in the provision of education for the population. A lack of education leads to lower levels of employment, higher rates of poverty, and less access to healthcare, which can compound other health impacts.
Limits to Data Availability
Although the government of Jamaica is actively working to provide equitable circumstances and reduce discrimination for persons with disabilities, there is a lack of data surrounding the topic of disability in the country. There were many data points that are challenging to locate online, and, indeed, it’s possible they’re not currently being collected.
These data points include:
The % of disabled population living below the poverty line vs the general population.
The % of disabled population that is unemployed vs the general population.
Mortality rates for those with disability vs those without disability.
The % of those with disabilities who have access to healthcare and health facilities.
The % of the disabled population that is suffering from food insecurity vs the general population.
Collection of these data points through the national census would allow for a more thorough assessment of the state of disability in Jamaica and inform more successful approaches in the fight for equity.
Policy Recommendations
In my review of the literature, I found many compelling policy suggestions that could help to remove the barriers that prevent persons with disabilities from accessing public services such as healthcare, education, and employment. I will identify a few suggestions below that I believe are underrepresented in the literature and could have a major impact on the quality of life for persons with disabilities in Jamaica.
Public Transit
In 2011, 53% of persons with disabilities in Jamaica did not have access to education (Statistical Institute of Jamaica, 2011). One major cause of this was the lack of accessible transportation. Although para-transit options exist in the country, they can be unreliable, overcrowded, dangerous, and even lack important accessibility features for persons with disabilities (Brugulat-Panés et al., 2023). If accessible transportation is provided, access to education, healthcare, and public services for the disabled population will increase exponentially. The disabled population will have better access to healthcare as well as expanded career options due to increased mobility and education levels. The JCPD should work to organize a safe and accessible public transit system for persons with disabilities. In many low-income countries, successful attempts have been made to establish special transport services (STS) which provide public transportation options for persons with disabilities and special needs. STS are not always exclusive to those with special needs, and they typically consist of accessible bus lines that run within cities and between cities, towns, and rural areas to provide connections. Civil society organizations and non-governmental organizations should be included in the conversation on special transport services, as they may be able to provide funding, staffing, or guidance on the development and implementation of these services. Implementing STS for persons with disabilities is an important step to allowing disabled individuals to access schools, hospitals, and public services. Since existing minibus systems exist within the country, reforms should be pursued to provide a minimum wage for bus drivers so that they are less incentivized to overcrowd buses and drive recklessly. Since many of the minibuses operating in Jamaica are privately owned (often by individuals), the establishment of a minimum wage and regulatory safety oversight could be achieved by requiring bus operators to form companies or conglomerates that would act as an umbrella, reduce competitiveness, and be held accountable for the safety of their services. These companies or conglomerates would instead compete with one another to achieve the best government ratings on the basis of safety, accessibility, and cost. These ratings could be published in local and national newspapers for the public to see, incentivizing companies and conglomerates to improve their services and keep costs low for the greater population. As the majority of persons with disabilities in Jamaica are unemployed, it is important that the services are both accessible and affordable for the target populations. While discussing the provision of STS, it is important to consider that STS will become more feasible if the Jamaican government succeeds in its attempts to modernize other aspects of transportation infrastructure, such as roads and bridges, as without this infrastructure it will continue to be difficult to reach rural communities.
Expansion of Disability Awareness Training
Secondly, Jamaica should develop and implement disability awareness training for policymakers and public servants (including healthcare workers and transit staff). Establishing disability awareness training for policymakers and public servants is essential to ensuring the provision of inclusive services. Policymakers who don’t understand disability cannot develop inclusive policies. Public servants who don’t understand disability may not have the tools to best support disabled members of the population, and any stereotypes and negative perceptions that these individuals hold can create barriers to the use of public services. JCPD should work with community-based, civil service, and other non-governmental organizations to implement these programs, as they may be able to provide funding or support. For example, churches in Jamaica have already shown the ability and willingness to support health promotion programs within their communities (Tomlinson, 2018).
Revise the National Census
Finally, the Jamaican government should revise the national census to include key data points that will help collect more comprehensive data on the state of disability nationally. These data points should be made readily available in online databases:
The % of disabled population living below the poverty line vs the general population,
The % of disabled population that is unemployed vs the general population,
Mortality rates for those with disability vs those without disability,
The % of those with disabilities who have access to healthcare and health facilities, and
The % of the disabled population that is suffering from food insecurity vs the general population.
Revising the national census is an affordable way to gather additional information about disability in the country, especially as disability awareness helps promote a stronger understanding of what is and is not a disability. The collection of these additional data points will allow for more effective assessment of the progress of the global disability strategy and better targeting for support programs.
Conclusion
Jamaica has made great strides in the realm of disability rights in recent years, and it can maximize positive outcomes by improving transport services, providing disability awareness training for policymakers and public servants, and revising the national census to collect more data on the state of disability in the country. Through the continued work of the JCPD, the implementation of Vision for Health 2030, and several ongoing infrastructure improvement projects, Jamaica may be able to achieve a much more inclusive and equitable future for its citizens.
Glossary
Bicameral legislature: a system of government in which the legislature comprises two houses (Britannica, 2019).
Civil society organization: Civil society comprises organizations that are not associated with government—including schools and universities, advocacy groups, professional associations, churches, and cultural institutions (Ingram, 2020).
Conglomerate: in business, a corporation formed by the acquisition by one firm of several others, each of which is engaged in an activity that generally differs from that of the original (Britannica Money, n.d).
Constitutional monarchy: a system of government in which a monarch shares power with a constitutionally organized government (Britannica, 2019).
Gross domestic product (GDP): the total monetary or market value of all the finished goods and services produced within a country’s borders in a specific time period (Fernando, 2023).
Non-communicable disease (NCD): Non-communicable diseases (NCDs), also known as chronic diseases, are non-transmissible diseases of often long duration. Examples of NCDs include mental health conditions, stroke, heart disease, cancer, diabetes, and chronic lung disease (UNICEF, 2021).
Paratransit: a demand-responsive mode of transportation for disabled and aging people who, because of their disabilities and advanced age, cannot use fixed route public transit services to get from point A to point B. The service is usually provided by public transportation companies to complement their fixed-route bus and rail services, but other paratransit operators include nonprofit organizations, community groups, and for-profit private agencies (Ecolane, n.d.).
Parliamentary system: a democratic form of government in which the party (or a coalition of parties) with the greatest representation in the parliament (legislature) forms the government, its leader becoming prime minister or chancellor (Britannica, 2023).
Special Transport Service (STS): a transportation service designed and operated to serve primarily individuals, including a transportation service provided by an entity licensed or certified by the department (Law Insider, n.d)
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