What Does Disability Inclusion have to do with Universal Health Coverage?

Kate Wilson

Technical Advisor

This post originally appeared on the Management Sciences for Health Global Health Impact Blog.

Members of government and civil society from Myanmar, Cambodia, Laos, Vietnam, and Philippines work together on priority challenges related to ensuring persons with disabilities in their countries can access the rehabilitation services they need. (Photo: MSH)

Members of government and civil society from Myanmar, Cambodia, Laos, Vietnam, and Philippines work together on priority challenges related to ensuring persons with disabilities in their countries can access the rehabilitation services they need.
(Photo: MSH)

A recent increase in political commitment and global cooperation has led many countries to adopt Universal Health Coverage (UHC) strategies—such as establishing packages of essential health services and implementing health financing reforms—in an effort to ensure their citizens have access to basic health care services. Health is increasingly being embraced as the driver of human welfare and sustained economic and social development, but I wonder: If persons with disabilities are not deliberately included in the design of UHC strategies and reforms, will they be left behind? What do we, as a development community, stand to gain if we prioritize disability inclusion?

UHC is for Everyone

Persons with disabilities are the world’s largest minority group. One in seven people around the world—15 percent of the world’s population, accounting for more than one billion individuals—live with some form of disability. Yet, they are rarely at the table when health policies and programs are being designed, governed, or evaluated. The majority of these persons live in the developing world. Disability disproportionately affects the key populations who already face development inequities, such as women, the elderly, people living in poverty, indigenous populations, ethnic minorities, and LGBT persons.

It might sound obvious, but it is worth stating that persons with disabilities have many of the same health needs as the general population. Persons with disabilities have sex, suffer injuries, have children, contract infectious diseases, develop chronic conditions, and so on—in addition to often needing specialized services particular to their type of disability. However, according to the World report on disability, persons with disabilities are more likely to be denied care and have poorer health outcomes than persons without disabilities, even though households in low- and middle-income countries with disabled members spend a third more of their income on health care compared with other households.

WHO Infographic on the status of health for persons with disabilities. (Photo: WHO)

WHO Infographic on the status of health for persons with disabilities. (Photo: WHO)

Some of the barriers posed by health systems are physical, such as inaccessible buildings and transport; some are institutional, such as inadequate policies, legislation, and information; others are attitudinal, such as health providers often discussing health issues with caregivers rather than the person with disability herself (even if her impairment has nothing to do with intellectual functioning) and not asking for consent before medical procedures.

Health promotion and disease prevention activities seldom target persons with disabilities. Women with disabilities receive fewer cancer screenings and are less likely to be offered family planning than women without disabilities, according to the aforementioned report. Many health facilities lack sign language interpreters, and so hearing impaired patients struggle to seek, receive, and communicate health information. And those are just a few examples.

Remember, the heart of UHC is this: that everyone receives the health care they need without suffering financial hardship—and yet persons with disabilities have greater unmet needs for health care than the general population and are 50 percent more likely to suffer from catastrophic health expenditures.

Room for Improvement

We can and must do better. Many of the barriers faced by persons with disabilities in health systems are avoidable with targeted action and attention. We have an opportunity to apply an inclusion lens to all current and emerging UHC efforts and overcome these inequities. But it will not happen without deliberate action to ensure persons with disabilities participate in health decision-making.

When disability inclusive development is a priority, everyone benefits. The World Bank, The London School of Hygiene & Tropical Medicine, and others have found that excluding persons with disabilities from society hurts the entire economy. Inclusion allows communities to tap into the full potential of their members and deliberate universal design results in public spaces, technology, products, and services that are not only accessible and responsive to persons with disabilities but can also be enjoyed by all people to the greatest extent possible.

Together, we can make inclusive societies happen—where health care for all really means everyone.

A group of wheelchair providers receives training at the Myanmar National Rehabilitation Hospital on basic wheelchair services in accordance with WHO guidelines. (Photo: Maggie Lamiell/MSH)

A group of wheelchair providers receives training at the Myanmar National Rehabilitation Hospital on basic wheelchair services in accordance with WHO guidelines. (Photo: Maggie Lamiell/MSH)

Take Action Today for Inclusive Health

Here are some actions you can take right now to move inclusive health forward:

Provides a list of organizations that represent persons with disabilities. You can also ask around in your program implementation area for other local groups.

Provides a list of questions to help a project team systematically consider the inclusion of persons with disabilities in each stage of the project cycle.

Provides practical information and tools for assessing and improving quality and human rights standards in health facilities.

Six questions that can be added to existing surveys and registration processes to disaggregate project data by disability status. Will only had 1 minute and 15 seconds per person to data collection process.

Click on the link above and then select the “Disability IAT”.

Note: People are often surprised by their results of IAT tests (that is what makes these biases implicit—after all, they were previously hidden from our view and our understanding of ourselves). Learning about them can be uncomfortable, but exploring these can be a step to helping us understand that this is why we really must be deliberate if we want to behave in ways that counter our implicit biases (we can't assume it will come naturally, even with our sincerely good intentions).