The present report is submitted in response to General Assembly resolution 61/106, by which the Assembly adopted the Convention on the Rights of Persons with Disabilities and the Optional Protocol thereto. As requested by the Assembly, a brief overview of the status of the Convention as at 3 August 2007 is presented. The report also contains a brief description of technical arrangements on staff and facilities made necessary for the effective performance of the functions of the Conference of States Parties and the Committee under the Convention and the Optional Protocol, and a description on the progressive implementation of standards and guidelines for the accessibility of facilities and services of the United Nations system. Recent efforts of the United Nations and agencies to disseminate information on the Convention and the Optional Protocol are also described.

わかりやすい障害者の権利条約 : 知的障害のある人の権利のために = Convention on the rights of persons with disabilities

Disability is a dynamic concept than varies in each individual, depending on the situation and the resources available. The World Health Organization (1) has tried to classify the consequences of illness at three levels: (1) impairment, defined as any loss or abnormality of psychological, physiological, or anatomical structure or function; (2) disability, defined as any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being, and (3) handicap, defined as a disadvantage for a given individual resulting from an impairment or a disability that limits or prevents the fulfillment of a role that is normal (depending on age, sex, social and cultural factors) for that individual.

/pdf/convention-on-the-rights-of-persons-with-disabilities-3vs2wxcyh2.pdf

Convention on the Rights of Persons with Disabilities

Rehabilitation seeks to optimize functioning of people with impairments and includes a range of specific health services-diagnosis, treatment, surgery, assistive devices, and therapy. Evidence on access to rehabilitation services for people with disabilities in low- and middle-income countries (LMICs) is limited. A systematic review was conducted to examine this in depth. In February 2017, six databases were searched for studies measuring access to rehabilitation among people with disabilities in LMICs. Eligible measures of access to rehabilitation included: use of assistive devices, use of specialist health services, and adherence to treatment. Two reviewers independently screened titles, abstracts, and full texts. Data was extracted by one reviewer and checked by a second. Of 13,048 screened studies, 77 were eligible for inclusion. These covered a broad geographic area. 17% of studies measured access to hearing-specific services; 22% vision-specific; 31% physical impairment-specific; and 44% measured access to mental impairment-specific services. A further 35% measured access to services for any disability. A diverse range of measures of disability and access were used across studies making comparability difficult. However, there was some evidence that access to rehabilitation is low among people with disabilities. No clear patterns were seen in access by equity measures such as age, locality, socioeconomic status, or country income group due to the limited number of studies measuring these indicators, and the range of measures used. Access to rehabilitation services was highly variable and poorly measured within the studies in the review, but generally shown to be low. Far better metrics are needed, including through clinical assessment, before we have a true appreciation of the population level need for and coverage of these services.

A Systematic Review of Access to Rehabilitation for People with Disabilities in Low- and Middle-Income Countries

Maintaining health and quality of life and decreasing the number of years lived with disabilities in old age are among the main challenges of aging societies worldwide. This paper aims to present current worldwide health-related gender inequalities throughout life, and especially in late life, as well as gender gaps in social and personal resources which affect health, functioning and well-being. This paper also addresses the question of whether gender gaps at younger ages tend to narrow in late life, due to the many biological and social changes that occur in old age. Based on international data regarding these gender gaps and the trends of change in personal resources and health-related lifestyles in the more and less developed nations, conclusions regarding future changes in gender gaps are presented, along with practical implications for future improvements in women's health and well-being.

/pdf/health-and-well-being-in-late-life-gender-differences-20kd3h8uk8.pdf

Health and Well-Being in Late Life: Gender Differences Worldwide

Collapse - How societies choose to fail or succeed

Neoliberal reforms lead to deep changes in healthcare systems around the world, on account of their emphasis on free market rather than the right to health. People with disabilities can be particularly disadvantaged by such reforms, due to their increased healthcare needs and lower socioeconomic status. In this article, we analyse the impacts of neoliberal reforms on access to healthcare for disabled people. This article is based on a critical analytical review of the literature and on two case studies, Chile and Greece. Chile was among the first countries to introduce neoliberal reforms in the health sector, which led to health inequalities and stratification of healthcare services. Greece is one of the most recent examples of countries that have carried out extensive changes in healthcare, which have resulted in a deterioration of the quality of healthcare services. Through a review of the policies performed in these two countries, we propose that the pathways that affect access to healthcare for disabled people include: a) Policies directly or indirectly targeting healthcare, affecting the entire population, including disabled people; and b) Policies affecting socioeconomic determinants, directly or indirectly targeting disabled people, and indirectly impacting access to healthcare. The power differentials produced through neoliberal policies that focus on economic rather than human rights indicators, can lead to a category of disempowered people, whose health needs are subordinated to the markets. The effects of this range from catastrophic out-of-pocket payments to compromised access to healthcare. Neoliberal reforms can be seen as a form of structural violence, disproportionately affecting the most vulnerable parts of the population – such as people with disabilities – and curtailing access to basic rights, such as healthcare.

/pdf/the-effects-of-neoliberal-policies-on-access-to-healthcare-5f23i1ccc3.pdf

The effects of neoliberal policies on access to healthcare for people with disabilities.

Objectives: The aim of this study was to investigate differences in access to health care between people with and without disabilities in the UK. The hypotheses were that: a) people with disabilities would be more likely to have unmet health care needs; and b) there would be gender differences, with women more likely to report unmet needs. Setting and Participants: We performed secondary analysis, using logistic regressions, of de-identified cross-sectional data from the European Health Interview Survey, Wave 2. The sample included 12,840 community-dwelling people over the age of 16 from across the UK, 5,236 of whom had a disability. The survey method involved face-to-face and telephone interviews. Outcome measures: Unmet need for health care due to long waiting lists, or distance or transportation problems; not being able to afford medical examination, treatment, mental health care, or prescribed medicines. All measures were self-reported. Results: Adjusting for age, sex, and other factors, people with a severe disability had higher odds of facing unmet needs. The largest gap was in ‘unmet need for mental health care due to cost’, where people with a severe disability were 4.5 times (CI 95%: 2.2-9.2) more likely to face a problem, as well as in ‘unmet need due to cost of prescribed medicine’, where people with a mild disability had 3.6 (CI 95%: 2.2-5.9) higher odds of facing a difficulty. Women with a disability were 7.2 times (CI 95%: 2.7-19.4) more likely to have unmet needs due to cost of care or medication, compared to men with no disability. Conclusions: People with disabilities reported worse access to health care, with transportation, cost, and long waiting lists being the main barriers. These findings are worrying as they illustrate that a section of the population, who may have higher health care needs, faces increased barriers in accessing services.

https://bmjopen.bmj.com/content/bmjopen/7/8/e016614.full.pdf

Access to healthcare for men and women with disabilities in the UK: secondary analysis of cross-sectional data

Neoliberal reforms in health systems and the construction of long-lasting inequalities in health care: A case study from Chile

Disabled people are particularly exposed to the risks of COVID-19, as well as to the measures taken to address it, and their impact. The aim of the study was to examine the disability-inclusiveness of government responses to COVID-19 in four South American Countries: Argentina, Brazil, Chile, and Peru. We conducted documentary research, using framework analysis to analyse reports, legislation, decrees, and other official documents that communicated measures taken in response to the pandemic, published from February 1st until May 22nd, 2020. We included documents reporting measures that affected disabled people either directly (measures specifically designed for disabled people) or indirectly (measures for the general population). We developed an analytical framework based on recommendations for disability-inclusive response to COVID-19 published by the Economic Commission for Latin America and the Carribean, the World Health Organisation, and other international organisations. We analysed 72 documents. The findings highlight that while some positive measures were taken, the needs of disabled people were not fully considered. Several countries published recommendations for a disability-inclusive response to COVID-19, without ensuring their translation to practice. All countries took at least some steps to ensure access to financial support, health, and education for disabled people, but at the same time they also implemented policies that had a detrimental impact on disabled people. The populations that are most exposed to the impacts of COVID-19, including disabled people living in institutional care, were protected in several cases only by recommendations rather by legislation. This study illustrates how the official government responses taken by four countries in the region – while positive, in several aspects – do not fully address the needs of disabled people, thus further disadvantaging them. In order to ensure response to COVID − 19 is disability inclusive, it is necessary to translate recommendations to practice, consider disabled people both in mainstream policy and in disability-specific measures, and focus on the long-term reconstruction phase.

/pdf/disability-inclusiveness-of-government-responses-to-covid-19-3nruse8ole.pdf

Disability inclusiveness of government responses to COVID-19 in South America: a framework analysis study.

We analysed cross-sectional data collected as part of the National Socioeconomic Characterisation Survey (2013) in Chile, in order to explore if there are differences in access to healthcare between adult Chileans with and without disability. The study included 7,459 Chilean adults with disability and 68,695 people without disability. Logistic regressions were performed in order to determine the adjusted odds ratios for the associated variables. We found that despite universal health coverage, Chileans with disabilities are more likely to report worse access to healthcare, even when controlling for socioeconomic and demographic variables, including age, gender, and income. Specifically, they are more likely to face greater difficulty arriving at a health facility, obtaining a doctor’s appointment, being attended to in a health facility, paying for treatment due to cost, and obtaining necessary medicine. Both people with and without disability are more likely to face difficulties in accessing health services if they are affiliated with the public health provider, an indication of the economic factors at play in accessing healthcare. This study shows that universal health coverage does not always lead to accessibility of health services and underlines the disadvantaged position of disabled people in Chile in accessing health services. While efforts have been made recently to improve equity in healthcare access, disability in Chile poses an additional burden on people’s access to healthcare, emphasising the necessity for policy to address this perpetual cycle of disadvantage for disabled people.

https://www.tandfonline.com/doi/pdf/10.1080/09581596.2016.1275524

Elena S. Rotarou

Papers

The effects of neoliberal policies on access to healthcare for people with disabilities.

Access to healthcare for men and women with disabilities in the UK: secondary analysis of cross-sectional data

Neoliberal reforms in health systems and the construction of long-lasting inequalities in health care: A case study from Chile

Disability inclusiveness of government responses to COVID-19 in South America: a framework analysis study.

Inequalities in access to health care for people with disabilities in Chile: the limits of universal health coverage