残疾人社会保障和社会服务国际论坛

论文摘要

Jean Van Wetter（尚维德）—国际助残驻华代表

广州 - 2009年12月1-3日

虽然中国在过去30年里，生活环境得到了显著改善，但是生活贫困的人口依然数字庞大。在这种背景下，残疾人代表着最弱势的群体，贫困既是残疾的原因，又是残疾的后果。世界银行最近的一份报告1显示，由于收入对获得和实现健康而言，现在比过去更起作用，所以贫困者的健康支出负担增加了。其结果是，贫困的易受性十分普遍，特别是在中国农村，并且在一个给定的年份，那些容易遭受陷入贫困的风险的人口是贫困人口的两倍。

根据第二次全国残疾人抽样调查（2006），现在每个残疾人的平均年收入不到全国人均年收入的一半。残疾人占农村地区贫困人口的1/3。中国的残疾人口超过8300万，并且现在那些需要康复服务的人之中仅有1/3能够享受这种服务，那些需要辅助器具的人里面仅有1/5得到了辅助器具。类似的数字也适用于教育2和就业的获得情况。

因此，建立一种妥善的社会保障制度所面临的挑战是巨大的，而国际助残组织为能与中国残疾人联合会（CDPF）合作举办这个国际论坛感到十分自豪。通过在2008年6月批准联合国残疾人权利公约，中国政府对改善残疾人社会福利作出了了不起的承诺（比较（cf.）第28条）。

中国的关键问题是找到提供能让更多的人享受优质服务（康复、教育、职业培训等）的社会福利与同时避免对正在建立起来的长期残疾福利的依赖之间的恰当平衡。

根据国际社会保障协会（ISSA）的说法，多数发达的经济体确实已经看到，在过去20年里，接受长期残疾福利的人口数量出现了明显增长，而那些制度的财政可持续性是一个关键问题。许多经济合作与发展组织（OECD）成员国家现在花在残疾福利上的钱是花在失业福利上的钱的两倍。因此，现在国际社会保障协会（ISSA）推行了几项措施。以减少残疾的扩展和需要长期残疾福利的人数。那些措施包括以下几条：

-促进早期康复、再培训和预防；

-鼓励保留工作和恢复工作

-激励雇主参与员工康复。

为此，改善康复服务是一个巨大挑战。即使政府增加财政鼓励措施以改善康复服务的享受情况，合格的康复治疗师的巨大缺口也是一个问题。例如，根据人民大学所做的一项研究3，中国目前物理治疗师的人数是5,000。按其占人口的比例，这表示每260,000人才有一名物理治疗师，而发达国家的平均数是，每1,400 人有一名物理治疗师。

中国面临的另一个挑战是找到针对农村地区的灵活解决方案，那里生活着75％的残疾人口。在那些地区，除了官方的政府社会保障制度和服务之外，旨在增强残疾人权利的、由私人部门和民间团体发挥的基于社区的积极性也要进一步强化。这包括职业培训、小额贷款和基层民众生财创收策略。

1.世界银行 (2009)- 从贫困地区到贫困人口: 中国正在展开的扶贫议事日程——行动纲要:

2.约有40％的6至14岁的残疾儿童不能上学。

3.孙树菡，毛艾琳——我国残疾人康复需求与供给研究——中国人民大学劳动人事学院

International Forum on Social Security and Social Services for People with Disabilities

Guangzhou - 1st – 3rd December 2009

Speech of Jean Van Wetter – China Director of Handicap International

Abstract

Although the living environment has considerably improved over the last 30 years in China, the number of people living in poverty remains high. In this context, persons with disabilities represent one of the most vulnerable groups, poverty being both a cause and a consequence of disability. A recent World Bank report1 shows that because incomes matter more now than they used to for access and outcomes in health, the burden of health expenditures for the poor has increased. As a consequence, vulnerability to poverty is widespread, especially in rural China, and the number of those vulnerable to the risk of falling into poverty is about twice as high as the number of poor in a given year.
According to the Second China national sample survey on disability (2006), the average annual income per person with disabilities is currently less than half of the average national annual income per person. Persons with disabilities account for 1/3 of the poor in rural areas. There are more than 83 millions people with disabilities in China and only 1/3 of those needing rehabilitation services currently have access to them and only 1/5 of those needing assistive devices receive them. Similar figures apply for access to access education2 and employment.
The challenges in setting up an appropriate social security system are therefore enormous and Handicap International is very proud to collaborate with the China Disabled Persons Federation (CDPF) for this international forum. By ratifying the United Nations Convention on the Rights of Persons with Disabilities in June 2008, the Chinese Government has made a great commitment in improving social benefits for persons with disabilities (cf. article 28).
The key for China is to find the right balance between providing social benefits that allow more people to access quality services (rehabilitation, education, vocational training…) while avoiding dependency on the long-term disability benefits that are being set up.
According the International Social Security Association (ISSA), most of the advanced economies have indeed witnessed significant increase in the number of people receiving long-term disability benefits over the last 20 years and the financial sustainability of those systems is a key concern. Many OECD countries are now spending twice as much on disability benefits as on unemployment benefits. Several measures are therefore currently promoted by the ISSA to reduce the development of disability and the number of people needing long-term disability benefits. Those measures include the following:
-Promote early rehabilitation, retraining, and prevention;
-Encourage work retention and work resumption
-Activate employer participation in employee rehabilitation.
To this regard, improvement of rehabilitation services is a huge challenge. Even if the Government improves financial incentives to improve access to rehabilitation services, the huge shortage of qualified rehabilitation therapists is an issue. For example, according to a research by the Renmin University3 , the current number of physiotherapists in China is 5,000. As a percentage of the population, it represents only 1 physiotherapist per 260,000, while on average in developed countries, the number of physiotherapists is 1 per 1,400 persons.
Another challenge for China will be to find flexible solutions for rural areas where 75% of the disabled population live. In those areas, on top of the official Government social security systems and services, community-based initiatives taken by the private sector and the civil society to empower persons with disabilities need to be further promoted. Those include vocational training, micro-credit and grassroots income generating strategies.

1. World Bank (2009)- From poor areas to poor people : China’s evolving Poverty reduction agenda - Executive Summary :
http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/EASTASIAPACIFICEXT/CHINAEXTN/0,,contentMDK:22131856~pagePK:1411 37~piPK:141127~theSitePK:318950,00.html :
2.Almost 40% of children with disabilities aged 6 to 14 do not have access to school.
3.Sun shuhan and Mao ailin-Rehabilitation Demand and Supply for Disabled People in China -School of Labor and Human Resources - Renmin University of China

--(本文摘自《残疾人社会保障与服务国际论坛暨第三届中国残疾人事业发展论坛论文集》)