Global disability: an emerging issue
Authors: Nora Ellen Groce
Journal: The Lancet Global Health (2018)

Over the 5 years since the launch of The Lancet Global Health, there has been a growing and long overdue shift in how people with disabilities are included in the global health landscape—the result of a combination of social, technological, and political factors. However, a critical juncture has been reached; aspirational words and well-intended policies must be quickly translated into action or this unique opportunity might be missed. According to WHO, 1 billion people—15% of the world's population—lives with a physical, sensory (eg, deafness, blindness), intellectual, or mental health impairment significant enough to affect their daily lives.1WHOWorld BankWorld report on disability. World Health Organization and World Bank, Geneva2011Google Scholar Often without equal access to health care and rehabilitation, education, and employment, and marginalised or excluded from the socioeconomic, religious, and political lives of their communities, people with disabilities have also routinely been overlooked by global health and international development efforts. The long-standing assumption that rates of disability would decrease with improved medical care and public health initiatives has proved only partly correct. Certainly, major inroads into areas such as infectious disease and malnutrition have resulted in significant decreases in the number of people disabled by these factors worldwide. But these numbers are balanced by improvements in clinical care and public health that now ensure that millions who would previously have died—eg, infants with serious birth anomalies, people injured through accident, injury, or violence, and those with diseases with potentially disabling sequelae, such as diabetes or HIV/AIDS—now survive, but survive with disability for years and often decades. Additionally, the global ageing population is growing and is at increased risk of acquiring disabling conditions over time. A critical engine driving the change in attitude and inclusion has been the global Disability Rights Movement led by people with disabilities themselves. Beginning in the 1970s, the movement has increasingly driven the pace of change, leading to the landmark UN Convention on the Rights of Persons with Disabilities (CRPD), passed in 2006.2UN General AssemblyResolution adopted by the General Assembly on 13 December 2006. 61/106. Convention on the Rights of Persons with Disabilities.http://www.un.org/en/development/desa/population/migration/generalassembly/docs/globalcompact/A_RES_61_106.pdfDate: Jan 24, 2007Date accessed: June 25, 2012Google Scholar Momentum for the CRPD's policy and programming changes has continued to increase, and it has now been ratified by more than 170 countries. The CRPD has ensured a concomitant shift in global initiatives, most notably the 2015 Sustainable Development Goals (SDGs). Although people with disabilities went unmentioned in the Millennium Development Goals,3UN Department of Economic and Social AffairsDisability and the Millennium Development Goals: a review of the MDG process and strategies for inclusion of disability issues in Millennium Development Goal efforts. United Nations, New York2011Google Scholar the SDGs include disability throughout, in keeping with the CRPD, both implicitly in the call to "leave no one behind" and explicitly by including people with disabilities in a series of specific targets and indicators. Adding to the combined effect of the CRPD and the SDGs, new methods (most notably the UN Washington Group on Disability Statistics Short and Extended Set of Questions)4Washington Group on Disability StatisticsShort set of disability questions.http://www.washingtongroup-disability.com/washington-group-question-sets/short-set-of-disability-questions/Date accessed: May 30, 2018Google Scholar, 5Washington Group on Disability StatisticsExtended set of questions on functioning.http://www.washingtongroup-disability.com/washington-group-question-sets/extended-set-of-disability-questions/Date accessed: May 30, 2018Google Scholar for the first time provide an easily implementable, low-cost, internationally comparable way of collecting disaggregated data as part of larger census and surveys. Growing use of these methods by the UN, governments, and civil society has generated increasing insight into the number, type, and distribution of people with disabilities and has provided a solid way to compare how people with disabilities fare in society compared with their non-disabled peers. A concomitant shift in rapidly improving technology, with emphasis on universal design, is bettering the lives of millions with disabilities. Computers and smartphone applications that provide a range of information and services, three-dimensional printers that can rapidly and inexpensively reproduce artificial limbs or wheelchair parts, and new initiatives that now bring low-cost glasses and hearing aids to millions increasingly provide people with disabilities access to a growing number of affordable options to more easily navigate and participate in their communities and societies. However, much remains to be done. Because of restricted access to education and employment, people with disabilities and households with disabled members remain disproportionately poor. Research shows that in many countries, a disability and development gap is growing: unless people with disabilities are routinely included in development efforts, their socioeconomic status often remains static while the status of their non-disabled peers surges ahead.6Groce N Kett M The disability and development gap. Leonard Cheshire Disability and Inclusive Development Centre working paper series no. 21. Leonard Cheshire Disability and Inclusive Development Centre, London2013Google Scholar Emerging bodies of research also clearly show that unless systematically planned for and included in policies and programmes, people with disabilities are at increased risk of being adversely affected in times of humanitarian disaster and emergency or climate change.7Kett M Cole E Research report. Disability and climate resilience research project. April, 2018. Leonard Cheshire Research Centre, London2018Google Scholar This increasing recognition of the role of people with disabilities is reflected in commitments to include them by UN agencies, governments, funding agencies, international non-governmental organisations, and civil society. A reflection of this growing commitment is the major upcoming Disability Summit organised by the UK's Department for International Development in London (July, 2018).8International Disability AllianceUK Global Disability Summit.https://www.internationaldisabilityalliance.org/summitDate: 2018Date accessed: May 30, 2018Google Scholar Increasingly, the question is no longer if but how people with disabilities are included in global health efforts. Nevertheless, many initiatives are still at the level of well-intentioned statements and broadly defined policy objectives. These efforts must be translated into effective implementation and followed-up carefully by solid monitoring and assessment mechanisms if true global inclusion of persons with disabilities is to succeed. Leading journals, such as The Lancet Global Health, can make an important contribution to this effort by supporting and disseminating cutting edge research and evidence-based advocacy that ensures that previously marginalised populations, such as people with disabilities, become part of all mainstream global health efforts. I declare no competing interests. 5 years laterA lot can happen in 5 years. In many parts of the world, so much can happen that a child's reaching that milestone age is a cause for celebration. In 5 years, a medical student can receive her basic training and start treating patients. 5-year action plans are common components of global health programmes, this timeframe being considered adequate to optimise the use of available funds and implement strategies. 5 years is also the amount of time granted a newly-elected WHO Director-General to reform the institution, set priorities, and orient the global health agenda to make a difference. Full-Text PDF Open Access