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Evidence that people with disabilities, including those affected by leprosy, are disproportionately affected by poverty is well known, and evidence points to increased rates of poverty of households with members affected by leprosy. Data from Myanmar suggest that households with a leprosy-affected member have double the rates of household poverty than households with a member who is disabled from any other cause. Rather than pursuing exclusive programmes, the integration of rehabilitation for people affected by leprosy into general disability ‘is what ultimately offers the best future for people affected by leprosy.’ However, effective poverty reduction for people affected by leprosy needs to take place in the context of broader inclusion movements. Mainstreaming of leprosy rehabilitation should be approached on the basis of human rights principles and not only in consideration of economy or efficiency. However, with the emphasis in the broader disability movement on wider ‘Disability Inclusive Development’, the requirement is not simply to ensure that leprosy-affected people are included in the disability movement, but to ensure that they are further included in the wider development agenda as part of the disability mainstreaming. This ‘double mainstreaming’ ultimately seeks to ensure that leprosy-affected people are enabled to realise their rights under the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). This approach places the responsibility for inclusion of leprosyaffected people with all stakeholders, requiring providers of healthcare services, education, livelihoods, employers, legislators, transport services, development programmes and political movements to take necessary steps to ensure full inclusion of leprosy-affected people as equal right holders. Critically, this approach rejects the notion of creating or upholding special rights or entitlements.

‘Double mainstreaming’: including people affected by leprosy in poverty reduction programmes