WHO's engagement for a disability inclusive development
Moving forward the agenda on disability in the health sector: a call for partnerships
By Alarcos Cieza ,
Kaloyan Kamenov and
Emma Pearce
Disability is part of being human. Everybody is likely to experience difficulties in functioning at some point in their lives, particularly when growing older. How much disability a person experiences in daily life varies greatly and is dependent upon how their impairment or health condition interacts with barriers in society.
Disability is a global public health issue
because it affects an estimated 15% of the world’s population (World Health Organization & The World Bank. 2011) with
increasing prevalence due to a rise in noncommunicable diseases and with
populations’ aging. Disability is a human rights issue with people with
disability being subject to multiple violations of their rights, including acts
of violence, abuse, prejudice, and disrespect because of their disability,
which intersects with other forms of discrimination based on age and gender,
among other factors (OHCHR. 2018). People with disability also face barriers,
stigmatization, and discrimination when accessing health and health-related services
and strategies (Special Rapporteur. 2018). Disability is a development priority because of its higher
prevalence in lower-income countries and because disability and poverty
reinforce and perpetuate one another (World Health Organization & The World Bank. 2011). The World Health Organization (WHO)
is committed to leaving no one behind within the transformative agenda of the
Sustainable Development Goals (WHO. 2019), by supporting countries to include persons
with disabilities in all efforts to achieve Goal 3: Ensure healthy lives and
promote well-being for all at all ages.
WHO's work on disability in the last decade
In the last decade, WHO has advanced the
disability agenda in different ways. The World Report on Disability in 2011 (WHO & WB. 2011) provided the first ever global figure on the number of persons with
disabilities, which serves as a key advocacy figure until today. The report,
based on the best available evidence at that time, revealed that persons with
disabilities have generally poorer health, lower education achievements, fewer
economic opportunities and higher rates of poverty compared to persons without
disabilities. The report discussed how barriers to health care, education,
employment, and support services can be overcome, providing a concrete set of
recommendations for actions for governments and other stakeholders. The World Report
on Disability was a pioneering document that made a significant contribution to
the implementation of the Convention on the Rights of Persons with Disabilities,
positioned disability as a critical development issue and set the stage for the
global disability agenda for the following years.
"The World Report on Disability was a pioneering document that made a significant contribution to the implementation of the Convention on the Rights of Persons with Disabilities, positioned disability as a critical development issue and set the stage for the global disability agenda for the following years."
Based on the recommendations of the World
Report on Disability, a next step in the disability agenda was the endorsement
of a Global Disability Action Plan 2014-2021 (WHO. 2014).
The plan had three key
objectives:
to remove barriers and improve access to health services and
programmes;
to strengthen and extend rehabilitation, assistive devices and
support services, and community-based rehabilitation; and
to enhance
collection of relevant and internationally comparable data on disability. Much
progress was achieved since 2014.
For example, in 2017, WHO launched
“Rehabilitation 2030: A Call for Action” (WHO. 2017), to drive a coordinated action and joint commitments by all stakeholders towards raising the profile of rehabilitation as a health strategy for all. Many countries committed themselves to key actions, including improving rehabilitation management and investment, and building a high-quality rehabilitation workforce and services. In terms of data collection, WHO developed the Model Disability Survey (WHO. 2021), a population-based tool for collection of comprehensive and comparable data on disability. The survey has been conducted in a number of countries, amongst which Afghanistan, Chile, Costa Rica, Oman, the Philippines, Qatar, Sri Lanka, India and Tajikistan.
WHO has also invested efforts in moving forward
the agenda of disability in children and adolescents’ health. A recent article
published in the BMJ revealed that even though the numbers of children living
with disability has risen substantially in the past three decades, disability
has low priority in the general agenda of child and adolescent health (Cieza, A. et al. 2021). WHO
is working towards scaling up service delivery with a strong focus on primary
healthcare. This will help widen access and meet rising demand from the growing
number of children with disability, many of whom will require services close to
home. In addition, rehabilitation must be expanded to reach all children in
need – something that can be achieved only through integration of
rehabilitation services into the health system and specifically at primary care
level. Early access to rehabilitation is crucial to ensure optimal outcomes for
children with disabilities and mitigate any risks of ongoing complications that
may affect their health, as well as managing the long-term demand on health
systems.
"WHO is working towards scaling up service delivery with a strong focus on primary healthcare. This will help widen access and meet rising demand from the growing number of children with disability, many of whom will require services close to home."
Another critically important strategy that shapes
WHO’s agenda on disability is the UN Disability Inclusion Strategy (UNDIS),
which was launched by the UN Secretary-General in 2019 (United Nations. 2019). The purpose of
UNDIS is to bring disability inclusion to the forefront of all areas of the
UN’s work around the world, both inside and outside the organization. WHO
launched its first-ever Policy on Disability in 2020, which serves as the
framework for implementing the UNDIS across the Organization, formalizing
commitments and driving institutional change to make disability inclusion
central to WHO’s operational and programmatic work (WHO. 2020).
Since the beginning of the global COVID-19 crisis, WHO has provided a strategic response to the challenges that the pandemic has posed to persons with disabilities. The pandemic has disproportionately affected persons with disabilities, who have commonly experienced three increased risks: risk of contracting COVID-19, of developing severe symptoms or dying from the complications of the disease, and of having poorer health during and after the outbreak. To address these challenges, WHO published, almost immediately after the start of the pandemic, a document on key disability considerations in COVID-19 responses, including simple actions and protective measures that can be taken by key stakeholders, such as governments and persons with disabilities (WHO. 2020a). Another key document provided recommendations for actions for stakeholders to ensure equity in access to vaccination against COVID‑19 for persons with disabilities (WHO & UNICEF. 2021). WHO also provided support to countries in ensuring disability inclusive COVID-19 response and recovery, and is currently working on the development of a global standard for accessibility of telehealth services to reach those with disabilities.
A shift towards disability inclusion in the health sector
Regardless of the progress that has been
made in improving the situation of persons with disabilities in the last
decade, the COVID-19 pandemic has demonstrated that major gaps still exist and
there is a long way to go. Disability is not a priority in countries’ health
agendas, and this can be seen in every aspect. Persons with disabilities
continue to face significant barriers and inequalities in accessing everyday
health services. Public health emergencies disproportionately impact those with
disability because they have not been considered in national health emergency
preparedness and response plans. Few countries collect or disaggregate data by
disability, and public health initiatives rarely consider the needs of this
group. In summary, the rights of persons with disabilities are not being met
when it comes to equal access to health services.
"Public health emergencies disproportionately impact those with disability because they have not been considered in national health emergency preparedness and response plans. Few countries collect or disaggregate data by disability, and public health initiatives rarely consider the needs of this group."
All these challenges demonstrate that a major shift needs to be made towards mainstreaming and integrating disability in the health sector. A first step towards achieving this goal was taken with the adoption of a new resolution on the highest attainable standard of health for persons with disabilities at this year’s World Health Assembly (WHA. 2021). This resolution aims to advance countries’ disability inclusion agenda in the health sector by tackling the significant barriers faced by persons with disabilities through access to effective health services, protection during health emergencies, better access to public health interventions across different sectors, and collection and disaggregation of reliable data on disability. The new resolution sets a clear way forward for the global agenda on disability and health.
A call for partnerships
However, integration of disability in the health sector can only be achieved through a strong and successful partnership. Partners are a fundamental pre-requisite for WHO’s ability to effectively implement the agenda on disability in countries and to raise visibility on the topic. Therefore, WHO is looking for partners from the public and private sector, nongovernmental organizations, philanthropic foundations and academic institutions to accelerate the agenda of disability in the health sector. Partnerships can take different forms - as donors, collaborating centres, or official partners. In all instances, these partnerships will form an international collaborative network that works together with WHO to build a world where persons with disabilities achieve the highest attainable standard of health and well-being.
"Therefore, WHO is looking for partners from the public and private sector, nongovernmental organizations, philanthropic foundations and academic institutions to accelerate the agenda of disability in the health sector."
Cieza, A., Kamenov, K., Sanchez, M.G., Chatterji, S., Balasegaram, M.,
Lincetto, O., Servili, C., Bermejo, R. and Ross, D.A., 2021. Disability
in children and adolescents must be integrated into the global health
agenda. BMJ, 372. https://www.bmj.com/content/372/bmj.n9
Special Rapporteur on the rights of persons with disabilities. 2018.
Report on the rights of persons with disabilities to the highest
attainable standard of physical and mental health. OHCHR https://www.ohchr.org/EN/Issues/Disability/SRDisab...
World Health Organization. 2014. WHO global disability action plan
2014-2021: Better health for all people with disability. World Health
Organization. Geneva, Switzerland https://www.who.int/publications/i/item/who-global...
Dr Alarcos Cieza oversees the World Health Organization’s work on vision, hearing, disability and rehabilitation in her position of Unit Head, Sensory Functions, Disability and Rehabilitation. Prior to joining WHO in September 2014, she served as Chair and Professor of Medical Psychology at the Faculty of Social and Human Sciences at the University of Southampton in the United Kingdom. After obtaining her MSc in psychology in Madrid, Spain, she conducted a Master in Public Health and obtained a PhD in Medical Psychology from the Ludwig-Maximillians University in Munich, Germany. She led the research unit for over ten years at the Department of Physical Medicine and Rehabilitation and then at the Pettenkofer School of Public Health at the Ludwig-Maximilians-University, Munich, Germany. Email
KaloyanKamenov is originally from Bulgaria. He is a technical officer in the WHO HQ disability programme. He has a background in psychology and epidemiology. He has been working at WHO since 2016, initially in the area of rehabilitation, then overseeing the Make Listening Safe initiative of the organization, and in the last one year supporting the programme of disability. Before joining WHO Kaloyan was working as a researcher in the field of mental health. Email
Emma Pearce works as a Gender & Inclusion Consultant providing technical support and advice to a range of organizations, including the World Health Organization. In her former role as Associate Director at the Women’s Refugee Commission, Emma led the organization’s global research and advocacy on gender and disability inclusion across the humanitarian sector.
International agreements and Switzerland's responsibility
