2 October 2015

Public Health in the post-2015 Development Agenda Series: Ensuring Disability and Development are part of the SDGs

This is the first article of the UNAI series “Public Health in the post-2015 development agenda”. Schools and departments of public health at UNAI member institutions were asked to submit articles highlighting research and work relating to the proposed SDGs and to showcase the importance of public health in the post-2015 development agenda. Please note that the articles are for discussion, and do not necessarily reflect the views of the United Nations.

Disability, in all its forms, has a global prevalence of 15% according to the World Health Organization (WHO), with the prevalence in developing countries believed to be vastly underestimated. Finding ways to develop interventions and alleviate disability by increasing services for this population is critical since individuals with disabilities face higher levels of poverty, and in a cyclical effect, the impoverished often face higher levels of disability.  

Unfortunately, developing a universal definition of disability is a difficult task due to the complex interaction between one’s health and one’s environment which determine the level of impairment. As a result, the interdisciplinary nature of public health is well suited to dealing with the needs of persons with disabilities and finding ways of targeting the issues that they face, especially in developing countries.  

There is a dearth of evidence generating mechanisms because until the end of the last century disability was viewed through the prism of charity or social welfare. Concerted efforts began only in the new millennium with the adoption of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) with particular emphasis on a rights-based approach which includes the rights to health care, education and social participation. The International Classification of Functioning (ICF), a WHO developed framework for measuring health and disability at both the individual and population levels, was also a step in the right direction. ICF is used for functional status assessment, goal setting and treatment planning and monitoring in the clinical setting. It is also used at an international level to measure health outcomes and guide disability management.  

The Millennium Development Goals (MDGs) represent a concerted effort to address global poverty. Yet there was a striking gap in the MDGs: the estimated 1 billion people worldwide who live with one or more physical, sensory (blindness/deafness), intellectual or mental health impairments were not mentioned in any of the 8 Goals or the attendant 21 targets or 60 indicators, nor in the Millennium Declaration. After the start of the MDGs, a growing consensus of disability advocates, experts and researchers found that the most pressing issue facing persons with disabilities around the world is not their specific disability, but rather their lack of equitable access to resources such as education, employment, health care and social and legal support systems. This results in persons with disabilities having disproportionately high rates of poverty.  

Advocacy efforts, based on the UNCRPD aim to correct this discrepancy going forward; disability is referenced in various parts of the Zero draft of the outcome document for the UN summit to adopt the Post-2015 Development Agenda, specifically in areas related to education, growth and employment, inequality, accessibility of human settlements, as well as data collection and monitoring of the SDGs. 

The University of Hyderabad’s School of Medical Sciences has seized this opportunity to look at disability from a planning and management viewpoint, using an evidence-based approach for planning and implementing services along with advocacy and outreach efforts including information, education and communication strategies.

The activities that have been proposed or undertaken include: 

  • Developing and offering a dedicated course module on Public Health Disability through its flagship MPH Program;  
  • Examining the current epidemiology and demographics of disability; assessing how these measures are collected; participating in epidemiological studies with collaborating and partner institutions;  
  • Working with the local and provincial health, social justice & empowerment and human resource development departments to identify opportunities and challenges to developing interventions and managing issues facing persons with disabilities based on the evidence gathering initiatives; 
  • Developing and understanding how the public health approach can be used to help understand the needs and experiences of persons with disabilities;  
  • Providing the capacity at appropriate levels to plan and manage a disability project and/or program using the skills and competencies of public health; 
  • And working in partnership to advocate and campaign for the rights of persons with disability with particular emphasis on access to health care.  

To ensure equitable access to education, employment and health care for all, including those with disabilities, it will be beneficial to apply a holistic approach that encompasses the many facets of public health including epidemiological studies to measure the demographics of disabilities, human rights, policy-making and region specific program development 

Dr. Shamanna, Associate Professor at the School of Medical Sciences at the University of Hyderabad, completed his medical education at Karnataka Medical College, and his Doctor of Medicine in Community Medicine at the All India Institute of Medical Sciences. He holds his Master of Science from University College London and also holds a double Diplomate of the National Board in Maternal & Child Health as well as Social & Preventive Medicine. He has published extensively, and his interests are health & welfare economics, disability inclusive development, education and teaching methods and alternative opinions and politics in health care. This public health discussion series was created and curated by UN Academic Impact Intern Zinnia Batliwalla.