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Disability must be seen as a development issue, says report by Claire Provost

The first global report on disability reveals how the exclusion of 1 billion people – invisible in official statistics and absent from aid budgets – is holding back development progress

The UN millennium development goals (MDGs) may not be met by 2015 unless urgent action is taken to address the needs of people with disabilities, according to the first world report on disability.

More than 1 billion people live with a disability, says the world report on disability, published by the World Health Organisation (WHO) and the World Bank on Thursday. It covers all forms of disability, from blindness to mental health issues.

It updates global disability estimates for the first time in 40 years and finds that 20% of the world's poorest people have disabilities and nearly 80% of people with disabilities live in low-income countries.

"Addressing the health, education, employment and other development needs of people living with disabilities is fundamental to achieving the millennium development goals," said the World Bank president, Robert Zoellick.

Children with disabilities are less likely to attend and complete school, says the report, putting at risk international targets for universal primary education. Disabled women are more likely to be victims of discrimination and sexual violence, pushing back progress on global goals for gender equality. People with disabilities are at greater risk of HIV and Aids than "classic risk groups" such as drug users. And children with disabilities have higher mortality rates – because of medical conditions and because of challenges accessing public services.

The higher living costs faced by people with disabilities also mean that they have a 50% greater risk of incurring "catastrophic health costs" – those so high that they push them under the poverty line.

But despite being pivotal in global efforts to reach the MDGs by 2015, people with disabilities are largely invisible in development statistics and absent from aid budgets. Disability is not mentioned once in any of the eight MDGs, or the 21 targets, or the 60 indicators for achieving the goals. A key challenge is how complex and diverse disabilities are, argues the report. While policies are usually written with thresholds and targets in mind, "disability is a matter of more or less, not yes or no", says the report.

However, aid donors cannot afford to plan and fund development programmes that neglect the needs of people living with disabilities, says Tom Shakespeare, one of the report's authors.

"Aid donors should not be funding projects that are not inclusive to people with disabilities," says Shakespeare, a technical officer at the WHO. "They should not, for example, be building schools that are not accessible." Donors must include people with disabilities in all mainstream development projects and make specific investments to enable people with disabilities to participate in broader society, he says. "You are simply not going to meet the MDGs unless you include them."

One of the report's key messages is that disability is less about health conditions and more about social and economic barriers to inclusion. This is a bold stance for the WHO to take, says Shakespeare, and one that points the way to cost-effective strategies to overcome the disadvantages associated with disability.

"Making a building accessible, for example, adds just 1% to the total cost of construction," he says. Training teachers to consider the special needs of children with disabilities is another low-cost but highly effective strategy to help tackle discrimination and keep children in school, he adds.

But while disability has been largely absent from the international agenda, many developing countries have already been making significant – though partial – progress on including people with disabilities in development projects.

"Lots of countries have done good things," says Shakespeare. Uganda, for example, has enshrined disability rights in its constitution, and people with disabilities participate at every level of the political process. Vietnam and Laos get top marks for a project to make schools inclusive. And Yemen gets Shakespeare's applause for its support services. "Even somewhere in crisis has a good story to tell. But no country has got it completely right."

Disability must be seen as a development issue, says the report, but like obesity and ageing, it is an issue that transcends the traditional north-south distinctions. "Disability is part of the human condition," says the WHO director general, Margaret Chan. "Almost every one of us will be permanently or temporarily disabled at some point in life." But even in high-income countries, up to 40% of people with disabilities do not have access to the services they need.

A stronger focus on disability will only become more important as the world's population ages and chronic diseases – such as diabetes and cardiovascular disease – spread, the report says.