In January 2011, the chief of police of São José dos Campos (100 km from São Paulo) parked his car in a spot reserved for people with impairments. A lawyer in a wheelchair, who happened to witness the action, publicly rebuked the police official for his action. In response, the policeman took out his gun, threatened the young man and punched him. The incident was widely publicized in the media and the chief of police was temporarily relieved of his duties. A few days later, the impaired lawyer received a phone call threatening his life, and investigators traced the call to a line at Police Department of São José dos Campos. This story might have remained unknown and untold, if the young man in the wheelchair did not happen to be educated about his rights. It illustrates that people with impairments continue being invisible and violated in Brazilian society, and while some of them rise to struggle against such social attitudes, the power structures in place oppress lives of millions of disabled Brazilians.

According to recent World Health Organization (WHO) reports,1 approximately 15 percent of the world's population, or 1 billion people, live with impairment(s) and the great majority of these individuals reside in developing countries,2 which typically offer little or no support to them. The reasons for the growing numbers are diverse, but WHO suggests the growth is due to population aging, trends in health conditions and environmental degradation, among other factors. Disabled individuals, who account for a significant share of the poor in those nations, were left out of the Millennium Development Goals formulated by the United Nations in 2001. As a result, there was a real possibility of this very large population and its complex issues being ignored entirely in global development efforts. One major implication of that oversight was broad recognition that many of the Millennium Development Goals could not, in fact, be fulfilled without addressing disability-related injustice in the developing world (Mercer & MacDonald, 2007).

To give an idea of the dimensions of the disability-related injustice in Brazil, I will refer here to the most recent national Census and several small-scale studies. The Census in 2010 revealed that there are more than 45 million Brazilians with various impairments, which corresponds to almost 24 percent of the population. As Maio and Gugel (2009) have noted, Brazil has no official national statistics on violence perpetrated against its disabled citizens. However, information available from prosecutors who defend the rights of the nation's disabled citizens suggest that intellectually impaired individuals are the most vulnerable to violence, whether children or seniors (Maio & Gugel, 2009, p. 2). Several scholars (Williams, 2003; Cavalcante, Marinho, Bastos, Deus, Maimone, Carvalho, Fiaux, and Valdene, 2009; Cavalcante & Minayo, 2009) have conducted small-scale studies in Brazil to obtain a better understanding of the dimensions, causes, prevention and effective responses to violence against disabled people. Williams (2003), for example, has presented four case studies illustrating how disability directly results from acts of domestic violence, and how violated and disabled individuals are victimized.

Cavalcante et al. (2009) have explored forms of violence most prevalent in an area of Rio de Janeiro, and found that disabled youth mostly suffered from negligence and psychological abuse followed by physical and sexual abuse. This study focused on three institutions in Rio de Janeiro, in public (federal and municipal) and nonprofit sectors that develop programs and projects in the areas of rehabilitation, social inclusion, and health and quality of life of people with impairments and other vulnerable populations. From those institutions, the scholars selected and analyzed 53 cases of violence against children and youth with impairments and found that those with intellectual impairments were the most violated by their families and communities in terms of their rights, physically and sexually (p.50). Cavalcante and Minayo (2009) analyzed the data collected by Cavalcante et al. (2009) and found that violence against disabled people is often linked to their lack of awareness of their rights and avenues of recourse.

Marinho (2009) has argued that violence against disabled individuals does not occur solely in poverty-stricken environments, although chronic poverty within the disabled community may be related to social exclusion, anger, violence and domestic maltreatment. Cumulatively, the findings of these studies suggest that violence against disabled Brazilians is a significant problem.

In this article, I briefly review the available literature on the subject of violence against disabled people in general and in Brazil in particular. In addition, I examine available governmental reports and nongovernmental organization websites to inform my discussion of violence prevention strategies enacted in Brazil. I also carried out fieldwork in Brazil in the summer of 2011, conducting 11 individual semi-structured interviews with people with various impairments to explore their experiences and their understanding of justice and equality in Brazilian society.

Before examining the character and extent of abuse of the disabled in Brazil, I wish here to clarify the use of terminology in this analysis. I acknowledge and respect the choices that disabled people make in choosing how best to describe their identity and experiences. The disability movement advocacy organizations in Brazil and majority of those I interviewed preferred 'persons with disability,' or 'pessoas com deficiência' in Portuguese, to put people first, before disability, "to humanize the denomination," as Lanna Jr. (2010) has described it (p.15). I chose to adopt 'disabled people' throughout this article to point to those with various impairments who are oppressed and discriminated against, or 'disabled', based on their society's dominant values and attitudes, and the oppressive structures that render them marginalized and powerless. In my use of the terms 'impairment' and 'disability' I am mindful of a conceptual link between them; impairment may or may not be tied to disability and social oppression, but there is no disability without impairment.

As Seth Berkley and his colleagues (2013) argue, "[a] healthy population is a pre-requisite for development" (p.1076). However, health should be viewed broader than immunizations, disease treatment and environmental factors. WHO defines health beyond physical and mental well-being, including social well-being (Beisser, 1990, p.179), which introduces new levels of complexity into researching health-related issues. In the post-2015 development agenda, social well-being should have an important place, including the quality of relationships, positive emotions and resilience, the realization of individuals' potential, or their overall satisfaction with life that are meaningful to the public. Physical violence and psychological and emotional abuse that are part of everyday life of disabled Brazilians have a great negative impact not only on disabled Brazilians, but on the society generally, as several studies find (see the subsection on the forms of violence for more detail).

The article is organized in three parts. First, I outline briefly the main issues in defining impairment, disability and violence, since these represent political choices that affect policy directions and shifts. Second, I analyze the forms of violence that affect disabled Brazilians and the relationships and institutions that create and sustain them. Third, I describe and evaluate some of the government's key current strategies aimed at addressing violence against disabled Brazilians. My ultimate purpose here is to suggest ways in which violence against disabled Brazilians can be addressed in public programs and policies as a sustainable development issue and thus help close the "gap" between disabled and nondisabled populations to create truly sustainable democratic societies that honor human dignity.

Issues in Defining Impairment, Disability and Violence

Before exploring the forms of violence experienced by disabled Brazilians, it is critical to understand what constitutes impairment and disability. Defining impairment and disability is important since it helps identify those who fit the definition, affecting directions for and shifts in social policy (Devlin & Pothier, 2006, p.4).

Impairment and disability have often been conceived in terms of the biological features of a person that deviate from society's culturally established normality—physical, intellectual or emotional attributes. The United Nations Convention on the Rights of Persons with Disabilities introduced the present conception of disability into the Brazilian legal system (Decree 6.949/2009). The Convention, adopted in Brazil with the status of a Constitutional amendment, defined "Persons with disabilities" as follows: "Persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others" (UN, 2006).

Discussing disability from a medical perspective and treating impairment as illness, some scholars have used the language of symptoms, syndromes and diagnostic typologies to describe and analyze impairment and disability phenomena. However, Shakespeare (2006) has argued impairment should be viewed not in terms intrinsic to a particular individual, such as the nature and relative severity of a specific condition, but in social terms, "related to values and attitudes of a wider society" (p.35). As one of my visually impaired interviewees put it, consistent with Shakespeare's view,

The problem is the establishment of a competitive society, which values perfection, aesthetics, people who theoretically have no difficulty. The more perfect you are, the better accepted and valued will you be. […] When a person demonstrates a "defect," for example, physical or sensory impairment, that person is placed on a lower level. We are trying to lift these people to the same level of people without disabilities. We were put so low that to reach the same level, it will take a long time.3

Critical scholars Devlin and Pothier (2006) also have contended that depending on what is valued, or perhaps overvalued, in a society, specific personal characteristics may be understood as defects (p.5). As Omote (2004) has explained, no biological feature or attribute is deviant just because it differs from the norm; in fact, any quality can be interpreted and treated as a case of deviation, depending on who possesses the particular feature and the context in which the judgment occurs (p.292). Thus, the notion of impairment remains controversial and how it is understood has broad implications for allied definitions of disability.

I agree with Shakespeare (2006) that although there is no disability without impairment, impairment, conceived by a society in terms of certain physical, intellectual and emotional attributes, is a necessary, but not always a sufficient cause of the difficulties that disabled people experience (p.34). Advocates of the social model of disability argue that disability wholly results from discriminatory social practices and institutions. However, some impairments may be so severe that they limit an individual's functioning, irrespective of how society is arranged (Hartley, 2011, p.121). It is more accurate to conceive of disability as the result of an interaction between an individual and structural factors or, put differently, it is the outcome of the relationship between factors intrinsic to the individual (nature and severity of an impairment, their own attitudes to it, their abilities and personality) and contextual factors (enabling or disabling environment, wider cultural, social and economic values and attitudes) (Shakespeare, 2006, pp.55-56). One of my interviewees referred to the majority of disabled Brazilians living in poverty and lacking access to basic needs in the following way: "In the Brazilian context, blindness is equivalent to death, or worse than death. I am of the opinion that blindness by itself doesn't mean anything; it all depends on the context. Real life depends on the education you have, on the technology you have, but most importantly, the attitude."4

I discuss conceptions of impairment and disability here because interviewees used both terms to convey their experiences of inferiority and emotional injury within their families and/or wider society. I am not trying to defend the impairment/disability distinction supported by social model advocates. Rather, I am using the concepts to illustrate the difficulty of sustaining a clear-cut dichotomy in conceptual terms. I believe that for analytical purposes it is important to point to several different sources of disability to illustrate the complexity of the attendant issues and the similar intricacy of the solutions that must be developed to address them.

The experiences of Brazilians with impairments are not formed in isolation by factors intrinsic to individuals alone, but also are influenced by contextual factors, including the prevailing social values and attitudes of family and loved ones and of the wider society. These may be either enabling or disabling. Conceptions of impairment and disability informed impaired interviewees' understandings of themselves and consequently, what constituted what they understood to be abuse against them.

There is no agreement among scholars concerning what actions constitute violence against disabled individuals. No scholar has suggested using the concept in a strictly legalistic way—meaning, acts of violence identified as criminal. Brazil's Criminal Code and several other specific laws and policies protect vulnerable populations, including women, children, the elderly and impaired individuals, from multiple forms of violence and abuse. The studies I was able to identify all support the view of violence as a complex issue requiring intricate solutions. Maio and Gugel (2009), for example, have argued that violence should be understood as a violation of fundamental human rights, such as access to education and health, accessibility, autonomy and quality of life. Cavalcante et al. (2009) saw violence as a function of multiple vulnerabilities, such as poverty, social inequality and exclusion, which, when compounded with impairment, result not only in producing but also in perpetuating cumulative disadvantages.

I was not able to find studies that explore subtle and more concealed forms of violence. Macfarlane (1994) has warned that subtle forms of violence affecting disabled people are ignored in many instances, but that they have long-term effects. In addition, Harvey (1999) has contended that the concealed violence she called "civilized oppression" may cause both tangible and intangible harms (p.2). Relationships lie at the heart of such understated forms of abuse, and such inappropriate relationships lead to exclusion and isolation of the victims, thus placing these vulnerable individuals into morally subordinate roles (Harvey, 1999, p.2). To combat exclusion and isolation of disabled citizens and to bring visibility to the history of the struggle for rights, the government of São Paulo has inaugurated Museum of Persons with Disabilities (Museu da Pessoa com Deficiência), referred to as the Inclusion Memorial.5 The museum is an important symbolic institution, and can serve as a public space to bring attention to violence against disabled people in Brazil either through its permanent exhibitions or through a special thematic one, helping address the continuing oppressive attitudes and norms of Brazilian society. The next section discusses forms of violence practiced against disabled Brazilians. I argue that subtle and concealed forms of oppression are the most prevalent forms of violence that disabled Brazilians experience today.

Forms of Violence against Disabled Brazilians

The existing literature suggests that the following forms of violence affect disabled people:

• Physical violence
• Sexual abuse
• Psychological and emotional abuse
• Neglect and acts of omission, and
• Financial exploitation (Ticoll, 1994, pp.7-12).

These forms of violence are part of everyday life of disabled Brazilians, as some of the existing statistics and small-scale studies show. Physical violence and psychological and emotional abuse have a grim impact on Brazilian society generally. Urban violence affects mental health and consequently, the quality of life for all of Brazilian society, according to a study conducted by the Integrated Laboratory for Research on Stress in Rio de Janeiro. The study evaluated the stress indicators and prevalence of post-traumatic stress disorder (PTSD) in people who lived through physical violence and sexual abuse, reporting that they would be more likely to develop Stress Disorder if exposed to violence in the future, because they have suffered changes in the physiology of the brain that had caused mental harm and vulnerability.6 Urban violence contributes strongly to the growing numbers of Brazilians with impairments every month. Of 8,000 new cases of impairments, 76% are attributable to traffic accidents and firearms.7 According to the Instituto Brasileiro dos Direitos da Pessoa com Deficiência—IBDD—between 2001 and 2011, the number of victims of traffic accidents leaving individuals permanently impaired, increased more than 20 times, from 11,000 to 239,000, but existing public policies do not devise appropriate prevention strategies to address the most frequent causes of these impairments.8

The degree of violence varies among impairment types. For example, a study by Cavalcante et al. (2009) conducted in Rio de Janeiro, showed that individuals with intellectual impairment suffer from more violence that their peers with other impairments physically, sexually and in terms of rights violation (p.50). Children and youth with physical impairments, meanwhile, are most often exposed to neglect and acts of omission, while deaf youth are preferred recruitment targets of drug traffickers (Cavalcante et al., 2009, p.51). To a large degree, many abuse risk factors are related to family environment, both in low and middle-income families, such as drug use and alcohol abuse by parents, mental illness or intellectual impairment of parent(s), physical impairment of parent(s), abandonment by family, and family history of abuse (Ibid). This study reported that factors related to poverty and social exclusion, such as homelessness, living in violent neighborhoods, and misery, play a lesser role in violence against a disabled family member (Ibid). Unfortunately, Brazil does not maintain adequate child maltreatment and domestic violence reporting systems, but Marinho (2009) has suggested that disabled children are at high risk of such violence.

While these studies have addressed important aspects of violence against disabled Brazilians, as a group their analyses did not involve examining the power relations at work or the relationships and institutions that perpetuate those power relations, which may result in economic deprivation or even physical harm that Brazilians with impairments face on a daily basis. Many of the discourses of impairment and disability are internalized and articulated by disabled individuals locating the problem with the person, considering such individuals either as victims of their impairment or having physical problems that must be cured. Although many physicians realize that some conditions cannot be "fixed," by nonetheless broadly adopting this approach society agrees to "treat" the person rather than address potentially relevant contextual factors contributing to their challenges. When some of those I interviewed identified themselves as having a "problem" or as being "unproductive," their rhetoric suggested they had internalized this perspective. When disabled people adopt this stance, they ironically and implicitly justify society's discriminatory attitudes toward them.

Davis (2005) has observed that American society invested in physical accessibility in recent decades "to enable some disabled persons to have greater access to public buildings and have made changes that enable some persons with disabilities to be physically present and reasonably safe in the workplace and the classroom," but they are still not effectively "happy, productive, and successful" (pp.197-98). She argues that "there are many more subtle and pervasive mechanisms of inaccessibility and exclusion that may both exacerbate disability and limit the participation of disabled persons in the life of the society." (p.198) Davis's observation suggests that when disability is reduced to a set of quickly identifiable factors, public policies are unlikely to account for the complex lived experiences of disabled people.

Charlton (1998) has perceptively noted that attitudes toward disability and impairment are "individually experienced but socially constituted" (p.51). That fact implies that the attitudes of people with impairments I interviewed are influenced by how they and their families see their impairment and disability as well as how others in society view those aspects of human diversity and social disadvantage. Charlton (1998) has further explained that society's negative beliefs and attitudes toward impairment and disability are eventually also internalized by individuals with impairments (p.70), which makes finding a starting-place from which to launch efforts to change those beliefs and attitudes more difficult than it otherwise might be.

Davis (2005) has argued that although perceptions may be more difficult to change than policies, the first listed are not "immutable" (p.191). Generally, individuals with impairments are thought of as badly off or unfortunate, maybe because of pain and numerous difficulties they face every day, maybe because of the negative image of the future their lived experiences imply, or maybe for other reasons. Many of my respondents commented on the importance of their family's influence on the formation of their own attitudes toward impairment, an argument to which I return below. Two sets of discourses emerged across my 11 interviews on the experiences of impaired individuals: as a loss and as intrinsic inferiority. Related to these narratives, interviewees offered several comments on the importance of family values in the formation of attitudes towards their impairments and disability.

The notion of inferiority emerged in several interviews, unrelated to specific impairments. It was especially clear when a young man with an intellectual impairment observed, "I am special; I have a problem."9 He believed he was entitled to receive a disability benefit from the state to cope with his "problem," to buy medicine and to survive, but his request was denied. A doctor examining him to determine his eligibility for a social security benefit informed him that he could walk, run, and jump, so he was able to work and was not entitled to public support. I have no way of knowing whether this young man thought of his intellectual impairment as "his problem" before or after the incident with the state physician he recounted in his interview, but this story illustrates how he internalized the professional (in this case, medical) discourse of attributing the perceived "problem" to the individual, who thereupon must find a "solution" to his or her perceived shortcoming or "condition." And when they cannot, they feel inferior for many reasons—for not finding employment, for not having income, for having multiple health issues, for facing discrimination in their family and neighborhood—just to mention a few concerns. Another discourse of inferiority could be identified in the narrative of a young deaf individual in his interview:

I see a deaf person in a hearing society as some sort of delay, and of course it depends on people themselves, but I see that deaf people lose a lot of information compared to those who are able to hear, they are far behind in this regard. The information that is communicated is quite impoverished, and the society begins to see the deaf as incompetent and ignorant. So education must be a way that the deaf can catch up. But right now, I see it unfair to be marked as incompetent.10

Another interviewee brought up the privileged standing enjoyed by nondisabled individuals in his view:

People without disabilities consider themselves different, or privileged. There is a feeling I have sometimes that people with disabilities are not considered effective. We are called damaged and several other harming expressions. I have a feeling that it was socially constructed. I think there is still no sense of equality. Of course it has exceptions, but if you ask people who live in São Paulo, certainly a huge majority does not consider people with disabilities like them, in the sense of rights and capabilities.11

On the whole, interviewees saw inferiority as closely related to disability and impairment. The experiences of individuals with impairments are different: some had internalized this sense of inferiority and expressed it in their interviews while others had sought to overcome it and did not evidence it when they spoke to me. As one physically impaired woman observed, "I thought I would never go out, flirt, have a relationship, or get married." 12 Nonetheless, she was engaged to marry and planned to have children, go to college and work.

In general, the interviewees' views of impairment and disability as a loss reflect the perception of the individual as an unproductive burden to society. This view slowly undermines the basic skills and capabilities of individuals who have adopted it. Furthermore, even when nondisabled working professionals favor inclusion of disabled employees in the workplace, their stance concerning doing so is inconsistent, as my interviewees commented. One of my respondents shared his experience observing managers justifying why they could not hire impaired individuals for their areas:

I heard managers saying, 'I am in favor of inclusion, we need to give opportunity to these people, they can be useful, but here in my area it's complicated. We need to be highly productive here in my area, but I am very much in favor of inclusion.' You see, the person has a discourse, but it's contradictory. This equality does not exist culturally yet, just politically and legally.13

Overall, there are fewer opportunities for people with impairments compared to non-impaired individuals, as one deaf interviewee noted: "For the deaf, there are fewer opportunities to take advantage of. Because of [better] communication, those who hear have a choice to learn or not, but we face a barrier if the information is not communicated. If this barrier is removed, the deaf will have a choice to learn or not, it will depend on us. But now we have this barrier." 14

Many interviewees perceived family support as a very important factor in their own attitudes to impairment and disability. This assistance is not so much material although, of course, robust material resources give better access to healthcare and technology, but more psychological and moral in character, as the examples and quotations that follow show. Some people with impairments enjoyed the strong support of their families and these encouraged them to seek personal and professional fulfillment in life. As one blind interviewee noted, they had been raised to understand their own potential:

The most important variable in my attitude to disability is my parents. They considered and treated me as somebody with a lot of potential, and never as somebody as a victim. I think that really shaped my life and my attitude towards blindness. And I think of that as an incredible help, because I've seen many people with more opportunities than I had, with access to good education, access to assistive technology, but they accomplished a fraction of what I did. Not because they were not intelligent, but I think because they didn't have the same attitude, the same understanding of themselves.15

Two deaf men I interviewed came from different home environments; one family was nurturing and supportive, resulting in his positive attitude toward his deafness. The other case involved a lack of acceptance and support. In the latter case, the family tried to limit his use of sign language and forced him to use oral language. Based on his experience, he now insists something must be done to ensure that impaired people experience acceptance from childhood onwards. In his view, social attitudes must shift if discrimination and fear are to be overcome.16

This overview of the meanings assigned to impairment and disability by those with such conditions who experience their effects on a daily basis show the dangers of people becoming objects of others' will, internalizing an oppressive society's views of their identity and capabilities, of their value of human beings. Families, professionals (of care, education, and medicine), and policymakers are part of society and carry societal values and prejudices in their actions, even when they do not intentionally desire to harm and discriminate. Many times, internalized norms of inferiority cause many disabled individuals to believe that even from their disadvantaged positions in society, they bear more responsibility for their inclusion in wider society, for social acceptance, than do their non-disabled peers. As Shakespeare (2006) has suggested, helping disabled individuals to enhance their self-esteem and self-confidence transforms their lives as much as access to appropriate facilities and medical care can (p.61). Viewing health in terms of not only physical, mental, but also social well-being introduces new levels of complexity into researching and addressing health-related issues. This view helps underscore the importance of fulfilling relationships, positive emotions and resilience, the realization of individuals' potential that are meaningful to the both disabled and nondisabled people.

Discussing Violence Prevention Strategies

It is difficult to conduct an informed discussion on violence prevention strategies in Brazil because there is no systematized data available on the topic. For example, the law commonly referred to as the Maria da Penha Law, aimed at designing and implementing mechanisms to prevent domestic and family violence against women, was enacted in 2006. Nonetheless, in more than six years, its implementation has thus far generated no data on violence against disabled women, according to a recent government report (Brazil, 2012, para.61).

Analyzing the intersection of disability and poverty, several recent studies have proposed comprehensive strategies of violence prevention. Maio and Gugel (2009) have underscored the importance of education about rights, since disabled people can only start combating abuse with knowing that they have been abused and violated. Cavalcante and Minayo (2009) have concluded that public policies should give more attention to families with disabled members, educating them about rights and strengthening their resilience to daily obstacles. Cavalcante et al. (2009) have concluded that the state must address the relative invisibility of children with impairments in their families and acknowledge that these families have specific needs, for example more flexible work hours for caregivers.

Brazil's new governmental plan Viver Sem Limite (To Live Without Limits) is aimed at disabled Brazilians. Its principal provisions were enacted into law in November 2011. The statute called for coordinated efforts by the Federal, State, and Municipal governments and civil society organizations to work towards the goals established in several key areas, such as guarantee of inclusive education, promotion of a better access to job markets, prevention of causes of impairments, and access to assistive technology, among others. However, violence practiced against the disabled population has not been directly addressed by the new policy. While it can be argued that promoting the access of disabled individuals to education, employment, health, culture and assistive technology may diminish the incidence of violence against them, I would suggest that establishing a set of appropriate goals for violence prevention grounded in the realities of Brazilians with impairments, and collecting data and tracking outcomes directly would likely prove a more effective approach. Policies need also to consider helping disabled individuals to enhance their self-esteem and self-confidence, which will greatly transform their lives, as Shakespeare (2006) has suggested earlier. The policies should also assure transparency and accountability mechanisms to enable government officials, civil society organizations, interested researchers and people with impairments and their families to participate in and monitor their implementation and revision.

In general, while current policies emphasize participation in social life and more opportunities for disabled people, Macfarlane (1994) was right to point out that they would not likely affect the ways in which subtle abuses are practiced daily. To protect disabled citizens successfully, effective violence prevention policies must be devised as part of broader sustainable development agenda. In post-2015, this agenda should have goals that put a much greater focus on equity within nations and establishing targets to close the existing gaps, prioritizing the most disadvantaged communities in every nation, as Boerma and colleagues (2013) have suggested. They also argue for the adoption of a health-in-all-policies approach, which will help understand the contributions of other sectors and setting health-related targets under other goals (Ibid). UN Secretary-General Ban Ki-moon has been leading a global conversation about the post-2015 world, in which health has been considered in the final short list, along with inequalities, population, education, economic growth and employment, conflict and fragility, governance, environmental sustainability, and food security and nutrition (Horton, 2012). However, the sustainable development and health communities need to be mindful that such goals and policies should be devised with a broader and more complex conceptualization of health and its close links to other issues of sustainable development.

Conclusions

Although Brazil lacks national statistics on the violence perpetrated against disabled people, a number of small-scale studies conclude that violence against disabled Brazilians is a significant problem that needs to be addressed by engaging many stakeholders. This article has argued that the most prevalent and urgent forms of violence in the nation are subtle and concealed forms of oppression. Social and family attitudes, my primary focus discussed here, serve to perpetuate specific types of violence discussed in the existing literature. Moreover, many of my respondents commented on the importance of their family's influence on the formation of their own attitudes toward impairment, resulting either in personal and professional fulfillment in life, or in negative attitudes and blame towards medical professionals, educators and family members, as the examples and quotations above showed.

Existing policies face a number of challenges in addressing violence suffered by the disabled Brazilians. First, without official national data on violence perpetrated against its disabled citizens, the nation will hardly be successful in devising effective violence prevention methods. Second, without transparency and accountability neither government officials nor other stakeholders in Brazilian society are able to participate in and monitor the conception and implementation of social policies on the prevention of violence against disabled population. Third, current policies would not likely affect the ways in which subtle abuses are inflicted on daily basis if they are not helping disabled individuals to enhance their self-esteem and self-confidence, which may be tied to their political participation. As Schneider and Ingram (1993) have reported, citizens access and cognitively internalize messages not only through observation of politics and media coverage, but also through their direct, personal experiences with public policy and presumably with members of the population in question. These experiences tell them whether they are viewed and treated by the government as objects or as subjects, whether they are atomized individuals who should deal directly with state bureaucracy to press their claims or whether they are participants in a cooperative process joining with others to address problems collectively for the common good (pp.340-41). Thus, as these scholars concluded, citizen orientations toward government determine their participation patterns.

To successfully deal with the issue of violence against disabled people, the post-2015 development agenda should conceive of health not only as absence of illness, but also as people's social well-being, including the quality of relationships, positive emotions and resilience, the realization of individuals' potential, or their overall satisfaction with life. Physical violence and psychological and emotional abuse that are part of everyday life of millions of disabled people have a significant negative impact on both disabled and nondisabled populations. Moreover, the adoption of a health-in-all-policies approach will help understand the contributions of other sectors and setting health-related targets under other goals, as argued by development professionals in the field. Such broader conception of health will help reframe health services, giving more attention to families with disabled members, acknowledging their specific needs (for example, more flexible work hours for caregivers), educating them about rights and strengthening their resilience.