Mobility Socio-Economics

Follow me for a moment to Bolivia. I want to introduce you to Alvaro, a 22-year-old born with lower-leg deformities. You'll note that his legs are dramatically undersized, frozen, bent at the knees. The platform he's rolling on down the dirt road – pieces of wood with dolly wheels attached, creating a crude skateboard-like device that he sits on and propels with his hands – is new to him. He spent the first 20 years of his life being carried or dragging himself along. Now, I want you to look at Alvaro, and explain to me why he doesn't have a wheelchair, why he merely has some tacked-together boards on dolly wheels for mobility?

Of course, we know why Alvaro doesn't have a wheelchair, as well as why virtually everyone else with a disability in Bolivia is without mobility: Socio-economics. See, Bolivia is the poorest country in South America, where 80% of its citizens don't have electricity, and 86% don't have running water. And, in Bolivia, the economic value placed on individuals with disabilities is virtually none – there is no money allocated to them, so they're without wheelchairs, period. From the Western world, we know that wheelchairs exist in abundance; however, because of the socio-economics in Bolivia, wheelchairs for their citizens with disabilities are simply unobtainable.

Interesting, not a day goes by that I don't get an angry or frustrated email from someone living in the United States, Canada, or Britain, complaining that power wheelchair technology is behind the times, that the mobility industry is curbing innovation – in fact, it's a rant I've heard for decades now.

However, what such frustrated consumers don't realize is that they're ideologically in the same predicament as those in the poorest of the poor countries like Bolivia: It isn't that advanced mobility technologies don't exist; rather, socio-economic factors prevent distribution of such technologies to those in need. While we don't want to literally compare not having any wheelchair to not having the very best wheelchair as an equivalent dilemma – as that would be offensive – we can compare the fact that socio-economics limit access to technology for those with disabilities, from Bolivia to the United States and beyond, albeit on varying levels.

In the U.S., we know that many loved the self-balancing iBot power wheelchair, but it was discontinued because there was not enough funding to support its sale in the market. We know that the technology to morph a power wheelchair wheel from round for use indoors, into a track for outdoors exists, but there is no funding available for consumers to afford it. And, we know that lithium-based batteries can double a power wheelchair's driving range, but there's no funding for them. Much like trying to sell ultralight manual wheelchairs in Bolivia is impossible because socio-economic factors prevent it, similarities hold true in richer countries like the United States, where a lack of funding – due to limited governmental and private insurance, and a staggering percentage of those with disabilities living in poverty – prevents the sale of very advanced technologies.

The fact is, manufacturers want to sell advanced technologies, as it opens the door for competitive advantages and increased profits – capitalism in full affect. Johnson & Johnson had the best of intentions when it rolled out the iBOT via its subsidiary, Independence Technologies, in 2003, offering inspired technology to consumers, while hopefully bolstering its profits, and driving other companies to innovate in order to compete – everyone was to win. Yet, Johnson & Johnson, consumers, and the mobility industry hit the socio-economic wall, where there simply wasn't enough funding in the public or private sectors to support the advanced technology. When Johnson & Johnson announced the discontinuation of the iBOT in the U.S. as of January 2009, their press release stated, “Despite significant, long-term investment by the company and acceptance of the iBOT Mobility System, demand has not proven sufficient to create a sustainable market. A challenging reimbursement environment for innovative assistive technologies has been a factor in limiting demand.” Johnson & Johnson wanted to sell power wheelchairs, and consumers wished to have them – but so few could fund them based on socio-economics in the U.S. that the innovative product was removed from the market.

Another widespread example is consumer frustration that lithium-based batteries aren't standard on power wheelchairs by now. With the buzz in many technologies sectors about lithium-based batteries these days, I receive a flow of feedback from disgruntled consumers thinking that mobility manufacturers are simply lazy, merely not putting such technology in power wheelchairs. However, nothing is further from the truth. Mobility manufacturers recognize that lithium-based batteries can double the driving range, quadruple the battery life span, and charge three-times as quick as conventional batteries. Further, with battery issues like sulfation being among the top service issue with power wheelchairs, lithium-based batteries would increase reliability and increase consumer satisfaction. So, why aren't lithium-based batteries in every power wheelchair?

Again, socio-economics – that's why. The most common rehab power wheelchair battery, a 22NF, is reimbursed by Medicare and Medicaids at a national state average of $125.00. To replicate that battery with lithium-based technology would be in the $1,000 range (the battery industry estimates that it will take around 10 years for the price of lithium-based batteries to drop to 1/3 of today's price, so economies of scale are likewise difficult in today's market even if done in volume). Therefore, the question becomes, if Medicare is funding batteries at $250.00 per pair, and equivalent lithium-based batteries are $2,000 per pair, who's paying for them at approximately 10 times the cost? Insurers won't fund them, and with SSI being the largest income source of those with severe disabilities, where in April of 2011, the average SSI check was $500.80, most consumers can't afford them out-of-pocket. Again, manufacturers would love to put lithium-based batteries in products, and consumers would love to have them, but the socio-economics dictate non-existent funding. (You'll read a few power wheelchair consumers note online that they're using lithium-based batteries, as if they're boasting that they know something that others don't; however, such boasting merely points to the fact that they somehow have more money than everyone else to buy expensive, off-the-shelf technology, where they're privileged not to be living on a scant $500.80 per month, where they're the 1% who are immune from the socio-economics of having a disability in the U.S. today.)

Socio-economics really define the haves and the have-nots – where many with disabilities are the have-nots when it comes to accessing technology, limited not by a lack of technology, but by an unjust lack of access to technology. No matter if you live in among the poorest countries like Bolivia, or among the wealthiest countries like the United States, socio-economics – that is, the monetary value assessed to the needs of those with disabilities – dictates the levels of mobility technology that's available, and it simply isn't what it could or should be. These limitations aren't created by behind-the-times manufacturers or complacent consumers, but by complex social ideology – from cultural views toward disability to governmental legislation – that truly dictates the technologies available, and, more disappointingly, which technologies aren't available. It's a weighty task, but sometimes improving technology means that we must first change the priorities of society – and that requires the ultimate in human innovation.