1. In May 2013, the Sixty-sixth World Health Assembly in resolution WHA66.9 on disability endorsed the recommendations of the World report on disability.3 The Health Assembly requested the Director-General to prepare, in consultation with Member States4 and organizations of the United Nations system, a comprehensive WHO action plan based on the evidence in the World report on disability, and in line with the Convention on the Rights of Persons with Disabilities (adopted by the United Nations General Assembly in resolution 61/106) and the outcome document of the high-level meeting of the United Nations General Assembly on the realization of the Millennium Development Goals and other internationally agreed development goals for persons with disabilities: the way forward, a disability-inclusive development agenda towards 2015 and beyond.
2. Disability is universal. Everybody is likely to experience disability directly or to have a family member who experiences difficulties in functioning at some point in his or her life, particularly when they grow older. Following the International Classification of Functioning, Disability and Health and its derivative version for children and youth, this action plan uses “disability” as an umbrella term for impairments, activity limitations and participation restrictions, denoting the negative aspects of the interaction between an individual (with a health condition) and that individual’s contextual (environmental and personal) factors. Disability is neither simply a biological nor a social phenomenon.
3. WHO recognizes disability as a global public health issue, a human rights issue and a development priority. Disability is a global public health issue because people with disability, throughout the life course, face widespread barriers in accessing health and related services, such as rehabilitation, and have worse health outcomes than people without disability. Some health conditions may also be a risk factor for other health problems, which are often poorly managed, such as a higher incidence of obesity in people with Down syndrome and higher prevalence of diabetes or bowel cancer in people with schizophrenia. Disability is also a human rights issue because adults, adolescents and children with disability experience stigmatization, discrimination and inequalities; they are subject to multiple violations of their rights including their dignity, for instance through acts of violence, abuse, prejudice and disrespect because of their disability, and they are denied autonomy. Disability is a development priority because of its higher prevalence in lower-income countries and because disability and poverty reinforce and perpetuate one another. Poverty increases the likelihood of impairments through malnutrition, poor health care, and dangerous living, working and traveling conditions. Disability may lead to a lower standard of living and poverty through lack of access to education and employment, and through increased expenditure related to disability.
4. The action plan will be relevant to and should benefit all people with disability from birth to old age. Persons with disability include people who are traditionally understood as disabled, such as children born with cerebral palsy, wheelchair users, persons who are blind or deaf or people with intellectual impairments or mental health conditions, and also the wider group of persons who experience difficulties in functioning due to a wide range of conditions such as noncommunicable diseases, infectious diseases, neurological disorders, injuries, and conditions that result from the ageing process. Article 1 of the Convention on the Rights of Persons with Disabilities indicates that 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.
5. Much of WHO’s mission is dedicated to the prevention of health conditions that may result in death, morbidity or disability. This action plan, however, is directed at improving the health, functioning and well-being of people with disabilities. It therefore considers prevention only in so far as persons with disabilities require the same access to preventive services and programmes as others. Prevention includes a wide range of measures aimed at reducing risks or threats to health: promotion of healthy lifestyles, such as guidance on good nutrition, the importance of regular physical exercise and avoiding tobacco use; protection of people from developing a health condition in the first place, such as immunization against infectious diseases or safe birthing practices; detection of a secondary or co-morbid health condition at an early stage, such as screening for diabetes or depression; and reduction of the impact of an established health condition, by means such as pain management, rehabilitation programmes, patient support groups or removal of barriers to access. Improving access to preventive services and programmes for persons with disabilities is important for achieving better health outcomes and is covered by Objectives 1 and 2 of this plan.Overview of the global situation
6. There are more than 1000 million people with disability globally, that is about 15% of the world’s population or one in seven people. Of this number, between 110 million and 190 million adults experience significant difficulties in functioning. It is estimated that some 93 million children – or one in 20 of those under 15 years of age–live with a moderate or severe disability. The number of people who experience disability will continue to increase as populations age, with the global increase in chronic health conditions. National patterns of disability are influenced by trends in health conditions and environmental and other factors, such as road traffic crashes, falls, violence, humanitarian emergencies including natural disasters and conflict, unhealthy diet and substance abuse.
7. Disability disproportionately affects women, older people, and poor people. Children from poorer households, indigenous populations and those in ethnic minority groups are also at significantly higher risk of experiencing disability. Women and girls with disability are likely to experience “double discrimination”, which includes gender-based violence, abuse and marginalization. As a result, women with disabilities often face additional disadvantages when compared with men with disability and women without disability. Indigenous persons, internally displaced or stateless persons, refugees, migrants and prisoners with disability also face particular challenges in accessing services. The prevalence of disability is greater in lower-income countries than higher-income countries. In its outcome document of the high-level meeting on disability and development in 2013, the United Nations General Assembly noted that an estimated 80% of people with disability live in developing countries and stressed the need to ensure that persons with disabilities are included in all aspects of development, including the post-2015 development agenda.
8. People with disability face widespread barriers in accessing services, such as those for health care (including medical care, therapy and assistive technologies), education, employment, and social services, including housing and transport. The origin of these barriers lies in, for example, inadequate legislation, policies and strategies; the lack of service provision; problems with the delivery of services; a lack of awareness and understanding about disability; negative attitudes and discrimination; lack of accessibility; inadequate funding; and lack of participation in decisions that directly affect their lives. Specific barriers also exist in relation to persons with disabilities being able to express their opinions and seek, receive and impart information and ideas on an equal basis with others and through their chosen means of communication.
9. These barriers contribute to the disadvantages experienced by people with disabilities. Particularly in developing countries, people with disability experience poorer health than people without disabilities, as well as higher rates of poverty, lower rates of educational achievement and employment, reduced independence and restricted participation. Many of the barriers they face are avoidable and the disadvantage associated with disability can be overcome. The World report on disability synthesizes the best available evidence on how to overcome the barriers that persons with disability face in accessing health, rehabilitation, support and assistance services, their environments (such as buildings and transport), education and employment.
Vision, goal, objectives, guiding principles and approaches
10. The vision of the action plan is a world in which all persons with disabilities and their families live in dignity, with equal rights and opportunities, and are able to achieve their full potential.
11. The overall goal is to contribute to achieving optimal health, functioning, well-being and human rights for all persons with disabilities.
12. The action plan has the following three objectives:
(1) to remove barriers and improve access to health services and programmes;
(2) to strengthen and extend rehabilitation, habilitation, assistive technology, assistance and support services, and community-based rehabilitation; and
(3) to strengthen collection of relevant and internationally comparable data on disability and support research on disability and related services.
13. This action plan supports the implementation of measures that are designed to meet the rights of persons with disabilities, as enshrined in the Convention on the Rights of Persons with Disabilities, in particular Articles 9 (Accessibility), 11 (Situations of risk and humanitarian emergencies), 12 (Equal recognition before the law), 19 (Living independently and being included in the community), 20 (Personal mobility), 25 (Health), 26 (Habilitation and rehabilitation), 28 (Adequate standard of living and social protection), 31 (Statistics and data collection), 32 (International cooperation) and 33 (National implementation and monitoring). It also supports Articles 4 (General obligations), 5 (Equality and non-discrimination), 6 (Women with disabilities), 7 (Children with disabilities) and 21 (Freedom of expression and opinion, and access to information). It proposes actions to support the commitments made in the outcome document adopted by the United Nations General Assembly at its high-level meeting on disability and development (New York, 23 September 2013) to ensure access for persons with disabilities to health care services, including rehabilitation, habilitation and assistive devices, and to improve disability data collection, analysis and monitoring and promote knowledge, social awareness and understanding of disability.
14. The action plan supports the Organization’s continuing work towards mainstreaming disability in its programmes, in line with recent United Nations General Assembly resolutions.1 It is aligned with the Twelfth General Programme of Work, 2014–2019, in particular reflecting the new political, economic, social and environmental realities and evolving health agenda. It complements and supports the implementation of other plans and strategies of the Organization, such as those on healthy ageing, reproductive, maternal and child health, emergencies and disasters, mental health, avoidable blindness and visual impairment, and noncommunicable diseases.
15. The design of the action plan is guided by the following principles, most of which are reflected in the Convention on the Rights of Persons with Disabilities:
– respect for the inherent dignity, individual autonomy, including the freedom to make one’s own choices, and independence of persons;
– non-discrimination;
– full and effective participation and inclusion in society;
– respect for difference and acceptance of persons with disabilities as part of human diversity and humanity;
– equality of opportunity;
– accessibility;
– equality between men and women;
– respect for the evolving capacities of children with disability and respect of the right of children with disability to preserve their identities;
– respect for the continued dignity and value of persons with disabilities as they grow older.
16. People with disability have unique insights about their disability and situation but have been excluded from the decision-making process about issues that directly affect their lives. In line with Article 4 of the Convention on the Rights of Persons with Disabilities, persons with disabilities through their representative organizations should be fully consulted and actively involved in all stages of formulating and implementing policies, laws, and services that relate to them.
17. The design and implementation of the action plan are based on and guided by the following approaches:
– a human rights-based approach, including empowerment of persons with disabilities
– a life-course approach, including the continuum of care
– universal health coverage
– a culturally-appropriate person-centred approach
– multisectoral/community-based rehabilitation2
– universal design (see paragraph 29 below).
Monitoring progress towards the achievement of the objectives of the action plan
18. The indicators of success set for each objective can be used to help to monitor and measure progress towards attainment of the plan’s goal. Baseline data and targets will be decided upon once the plan is approved. Given that the targets will be voluntary and global, each Member State is not expected to reach all the specific targets but can contribute to varying degrees towards their achievement. As indicated in the actions for Objective 3, the Secretariat will provide guidance, training and technical support to Member States, upon request, for improving disability data analysis and use in an efficient and cost-effective manner. Monitoring and reporting to the governing bodies on progress in implementing this action plan are recommended at the midway point (2017) and during its final year (2021).
Objective 1: To remove barriers and improve access to health services and
programmes
19. Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. WHO’s Constitution enshrines the enjoyment of the highest attainable standard of health as a fundamental right of every human being. The right to health includes access to timely, acceptable and affordable health care of appropriate quality. Promoting the right to health also requires Member States to generate conditions in which: (i) each person can enjoy the highest attainable standard of health; and (ii) health services are provided on the basis of free and informed consent.
20. Disability is extremely diverse. Even though some health conditions associated with disability result in extensive health care needs and others do not, all people with disability have the same general health care needs as everybody else and therefore require access to mainstream health care services. People with disability may experience greater vulnerability to preventable secondary conditions, comorbidities and age-related conditions, and may require specialist health care services. Sometimes they are subjected to treatment or other protective measures without consent. Some studies have also indicated that certain groups of people with disabilities exhibit higher rates of risky behaviour such as smoking, poor diet and physical inactivity. They are also at greater risk of experiencing violence than those without disability, and have a higher risk of injury from road traffic crashes, burns or falls. For example, children with disability are three to four times more likely to experience violence. Children with mental health conditions or intellectual impairments appear to be among the most vulnerable, with a 4.6 times higher risk of experiencing sexual violence than their non-disabled peers.
21. As well as causing disability, emergencies can also increase the vulnerability of persons with disabilities, whose basic and specific needs are frequently ignored or overlooked in emergency risk management. Those needs are often not identified and addressed before, during and after an emergency. Persons with disabilities are rarely consulted or represented in the design of emergency risk management policies and programmes.
22. Good health enables participation in a wide range of activities, including education and employment. However, evidence shows that people with disability, throughout the life course, have unequal access to health care services, have greater unmet health care needs and experience poorer levels of health compared with the general population. Health systems frequently fail to respond adequately to both the general and specific health care needs of people with disabilities. People with disabilities encounter a range of attitudinal, physical and systemic barriers when they attempt to access health care. Analysis of the World Health Survey shows that, compared with people without disability, men and women with disabilities are twice as likely to find that health care facilities and providers’ skills are inadequate, three times more likely to be denied health care and four times more likely to be treated badly in the health care system. Of all persons with disabilities, half cannot afford required health care; people with disabilities are also 50% more likely than those without disability to suffer catastrophic health expenditures.1
23. Barriers to accessing health services include: physical barriers related to the architectural design of health facilities, medical equipment or transport; health providers’ lack of adequate knowledge and skills; misconceptions about the health of persons with disabilities, leading to assumptions that persons with disabilities do not require access to health promotion and disease prevention services and programmes; lack of respect or negative attitudes and behaviour towards persons with disabilities; informational barriers and communication difficulties; and inadequate information for persons with disabilities about their right to access health care services. Although both men and women face barriers to health care, men are less likely than women to consider that they or their children are sick enough to require health care services and to know where to access those services. Men also report more difficulties in accessing health care financing.
24. Article 25 of the Convention on the Rights of Persons with Disabilities reinforces the rights of persons with disabilities to enjoy the highest standard of health without discrimination on the basis of disability. Article 9 (Accessibility) outlines the measures to be taken to ensure that persons with disabilities have access, on an equal basis with others, to the physical environment, transport, information and communications (including information and communications technologies and systems), and other facilities and services open or provided to the public by both State and non-State actors and in both urban and rural areas. These measures include the identification and elimination of obstacles and barriers to accessibility in relation to buildings, roads, transportation and other indoor and outdoor facilities (including medical facilities), and information, communications and other services (including electronic and emergency services). Because of the diversity of health service users, a universal design approach is important in ensuring that products, environments, programmes and services are designed to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design.
25. Health disparities will be reduced by making existing health care systems more inclusive at all levels and making public health programmes (including those for a healthy lifestyle, promoting improved diets and encouraging physical activity) accessible to persons with disabilities throughout the life course. Given that multiple factors limit access to health care for people with disability, actions are needed in all components of health care systems, including improving governance and increasing levels of awareness, knowledge and data in health and related ministries so that they may better consider disability and increase access to services. Maintaining nationally-defined social protection floors2 containing basic social security guarantees that ensure universal access to essential health care and income security at least at a nationally defined minimum level is recommended. National health care policies need to acknowledge formally that some groups of people with disability experience health inequalities; that acknowledgement will be an essential step towards reducing health disparities, and towards making a commitment to collaboration and a coordinated approach
among health care providers. Community-based rehabilitation is an important means of ensuring and improving coordination of and access to health services, particularly in rural and remote areas.
26. Successful removal of barriers and improvement in access to health services require input from persons with disabilities, who are most familiar with and affected by such barriers. Ensuring that health-related information is issued in an appropriately accessible format, and that modes of communication meet the requirements of persons with disabilities (such as sign language) is important. Some persons with disabilities may also require support to assert their right to health and equal access to health services.
Read more about the plan of action through this link:
https://www.who.int/publications/i/item/who-global-disability-action-plan-2014-2021
No comments:
Post a Comment