Healthy Lives and Wellbeing for Persons with Disabilities
The World Health Organization (“WHO”) has reported that approximately 16% of the global population, over 1.3 billion people worldwide, had some form of disability, and that an additional 190 million people (3.8% of people over 15 years of age) experience serious difficulties in functioning normally daily. While the number of persons with disabilities is large, their experiences are diverse and not all people with disabilities are equally disadvantaged. For example, disability does not necessarily imply limited well-being and poverty; however, growing evidence confirms that disability and poverty are highly correlated, and that disability is both a cause and consequence of poverty and disability and poverty reinforce each other in ways that contribute to increased vulnerability and exclusion. In fact, WHO has pronounced disability as a “development issue, because of its bidirectional link to poverty: disability may increase the risk of poverty, and poverty may increase the risk of disability” and noted that “[a] growing body of empirical evidence from across the world indicates that people with disabilities and their families are more likely to experience economic and social disadvantage than those without disability”.
While the Convention on the Rights of Persons with Disabilities was adopted in 2006 and went into force in 2008, making it the first binding international instrument addressing the needs of persons with disabilities worldwide, disabled persons of all ages, and particularly older persons with disabilities, continue to face several barriers to inclusion. In response, advocates for persons with disabilities have called for recognition of disability inclusion as essential to realization of the Sustainable Development Goals (“SDGs”) of the 2030 Agenda for Sustainable Development adopted by world leaders in September 2015 and, in fact, there are eleven explicit references to people with disabilities in five of the 17 SDGs relating to education (SDG 4), decent work and economic growth (SDG 8), reducing inequality (SDG 10), sustainable cities and communities (SDG 11), and partnerships and goals (SDG 17), and the inclusion of persons with disabilities as vulnerable people by the SDGs extends the scope of references to persons with disabilities to targets related to poverty (1.3, 1.4 and 1.5), food (2.1), water and sanitation (6.2) and disaster situations (11.5). However, while progress has been made, much remains to be done for persons with disabilities to enjoy full inclusion and participation in the life of their communities including steps that need to be taken to eradicate their disproportionate levels of poverty; improve their access to education, health services and employment; and elevate and expand their representation in decision-making and political participation.
SDG 3, ensuring healthy lives and promoting wellbeing for all persons (including persons with disabilities), turns on achievement of an aggressive and expansive set of targets relating to reduction of the global maternal mortality ratio (Target 3.1); ending epidemics of a wide range of diseases (i.e., AIDS, tuberculosis, malaria and neglected tropical diseases) and combatting hepatitis, water-bone diseases and other communicable diseases (Target 3.3); strengthening the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol (Target 3.5); ensuring universal access to sexual and reproductive health-care services, including for family planning, information and education (Target 3.7); and achieving universal health coverage including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all (Target 3.8).
The 2018 Disability and Development Report noted that “[p]ersons with disabilities generally have more healthcare needs than others—both standard needs and needs linked to impairments—and are therefore more vulnerable to the impact of low quality or inaccessible health-care services than others”. In fact, the evidence collected from countries across the world is clear that compared to persons without disabilities, persons with disabilities are more likely to have poor health, and the report found that “[t]he number of persons with disabilities who report poor health tends to be higher in countries with lower gross domestic product per capita, suggesting that increased availability of financial resources may provide the accessible health, basic and community services needed to achieve better health”.[1] All in all, persons with disabilities remained challenged by lack of access to health care and rehabilitation services, lack of financial resources, lack of access to and accessibility of medical facilities and transport and inadequate training of health personnel to accommodate persons with disabilities remain major challenges.
DESA recommended consideration of the following actions to achieve the highest attainable standard of health for persons with disabilities: strengthen national legislation and policies on health care in line with the CRPD; identify and eliminate obstacles and barriers to accessibility in health-care facilities; improve health care coverage and affordability for persons with disabilities as part of universal approaches to health care; train health-care personnel on disability inclusion and improve service delivery for persons with disabilities; empower persons with disabilities to take control over their own health-care decisions, on the basis of informed consent; prohibit discriminatory practices in health insurance and promote health insurance coverage for assistive products and rehabilitation services; and improve research and data to monitor, evaluate and strengthen health systems to include and deliver for persons with disabilities.[2] In addition, the 2018 Disability and Development Report called for actions to be taken to provide persons with disabilities with access to sexual and reproductive health care services and reproductive rights (SDGs 3.7 and 5.6)[3], reduce premature mortality from noncommunicable diseases and promote mental health and wellbeing among persons with disabilities (SDG 3.4) and achieve universal health coverage (SDG 3.8) so that persons with disabilities do not go without healthcare services due to cost.[4]
In the 2024 Disability and Development Report DESA reported that persons with disabilities were 15 times more likely to perceive their health as bad or very bad than persons without disabilities, and persons with disabilities were 7 times more likely than others to not have access to health care when they needed it.[5] Public health interventions to promote health and well-being (e.g., nutrition information campaigns and regular health testing and monitoring) frequently failed to reach persons with disabilities and persons with disabilities faced various challenges to getting the care they needed including cost, lack of affordable transport to health care facilities and poor access for wheelchair users at health care facilities. Incredibly, only one-third of countries had incorporated disability inclusion in their national health strategies by 2022. In addition, while reporting on progress toward reducing maternal mortality and accessing sexual and reproductive health services and reproductive rights for all persons with disabilities (targets 3.1, 3.7 and 5.6), DESA noted that persons with disabilities were regularly excluded from the provision of sexual and reproductive health services and in various countries more than 50% of both women and men with disabilities did not have comprehensive knowledge of HIV/AIDS, more than 50% of women with disabilities did not have their need for family planning satisfied with modern methods, did not have the births of their babies attended by skilled health personnel, did not receive a timely postnatal check, did not have autonomy in making decisions about their reproductive health (with others making decisions for them) and were not empowered to exercise their reproductive rights.
This article is an excerpt from my recently updated chapter on Disability and Development.
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Notes
[2] Id. at 4-5.
[3] Id. at 5 (noting that “misperceptions about persons with disabilities and the assumption that persons with disabilities are not sexually active has contributed to little attention being paid to ensuring that persons with disabilities have access to sexual and reproductive health care services” and limited evidence in a few developing countries indicates that large numbers of married women with disabilities have unmet needs relating to family planning).