Indian Journal of Public Health

COMMENTARY
Year
: 2020  |  Volume : 64  |  Issue : 1  |  Page : 79--82

Addressing the health needs of people with disabilities in India


Suraj Singh Senjam1, Amarjeet Singh2,  
1 Additional Professor, Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
2 Professor, Department of Community Medicine, School of Public Health, PGIMER, Chandigarh, India

Correspondence Address:

Abstract

In India, the number of people with disabilities is continuously growing over the past few decades. The figure is expected to increase due to population aging, with a resultant increase in chronic health conditions. The health of people with disabilities is a relatively neglected and ignored area. Further, the disabled face poor access to healthcare and frequently encounter discrimination or stigmatization. These situations make them more vulnerable to many comorbidities in their health, making severe compromises in their quality of life. Therefore, people with disabilities need special healthcare than people without disabilities. There is a need for sensitization of all health-care providers to ensure quality, affordable, and accessible health-care services for people with disabilities. To address the health-care needs of people with disabilities to the maximum, Ministry of Health, Government of India should incorporate appropriate guidelines in various national health programs and work together with a relevant ministry.



How to cite this article:
Senjam SS, Singh A. Addressing the health needs of people with disabilities in India.Indian J Public Health 2020;64:79-82


How to cite this URL:
Senjam SS, Singh A. Addressing the health needs of people with disabilities in India. Indian J Public Health [serial online] 2020 [cited 2021 Sep 21 ];64:79-82
Available from: https://www.ijph.in/text.asp?2020/64/1/79/280769


Full Text



 Introduction



International Classification of Impairments, Disabilities, and Handicaps-I (ICIDH-I) defines disability as any restriction or lack of ability resulting from impairment to perform any activity within the range considered as normal for a human being.[1] In 2001, ICIDH-II, now renamed as international classification of functioning (ICF), disability and health (ICF) revises the sequence of disease events, and thereby, redefines disability.[2] The term impairment, disability, and handicap were replaced by the new constructs as “impairment,” “activities limitation,” and “participation restrictions,” and reconstructs disability is an umbrella term, which includes all three components. Globally, the WHO estimates that more than 1 billion people suffer any form of disability, and further expected to increase to 2 billion by 2030.[3] Worldwide, disability is disproportionately distributed across countries or regions. Nearly two-thirds of disabled live in low- and middle-income countries, majority of them living with underprivileged, isolation, and poverty compared to affluent countries.[4]

 Magnitude of Disabilities



In India, the proportion of elderly population (≥60 years) is about 8.6%, further expected to increase to 12.2% by 2026.[5],[6] The data on disability in elderly population have been documented in many surveys such as census, National Sample Survey Organization, and WHO report.[7] The estimated prevalence rate of disability varies according to measure used in disability, study methodologies, definitions, type of disabilities, etc.[8] The world report on disability showed that the prevalence in India was 24.9% in people aged ≥18 years, and increase to 43.4% among ≥60 years in low- and middle-income countries, including India.[3] The rate will continue to rise as the aging population, and increase in chronic debilitating conditions.[9] The largest disability-adjusted life years lost is also reported from South Asia representing one-quarter of the global figure.[10]

The census India reported the disability rate was 2.2% across all ages, slightly higher in males (56%).[5] Around 21% of disabled people are attributed to aged ≥60 years. Further analysis of the data showed that the prevalence in aged ≥60 years was 5.1%, being highest in aged ≥80 years (8.4%).[8] The locomotor and visual disabilities were the most common (25% each), followed by hearing disabilities (19%), speech disability (4%), mental disability (2%), and multiple disabilities (12%).[11] Females had a higher rate than males (5.3% vs. 5.0%) and rural versus urban (5.6% vs. 4.2%). Telangana study reported the prevalence was 38.8% in aged ≥50 years with hearing and vision impairment as 17.4% and 15%, respectively.[12],[13] Another rural study in South India reported that the prevalence of disability was 5.6% in aged ≥60 years.[14]

Using activity limitation as a measure of disability in North India, the prevalence was range from 23.4% to 55.2%.[15] A study in Delhi, around 72% of participants, who were elderly population had at least one disability type.[16] A similar study in the Southern part showed 20.6% as prevalence in elderly. Study on participation restriction of the disability in rural Bengaluru reported that the prevalence was 57% aged ≥65 years.[17]

 Disabilities and Health



Disability is public health as well as a human right concern. Elderly people with disabilities usually are vulnerable to poor health. In addition to the primary health condition leading to impairment of disability, disabled may experience greater vulnerability to secondary health conditions (related to primary) and comorbid (unrelated to primary). For example, a cerebral palsy (primary) individual may develop pressure ulcers, urinary tract infections (secondary), or development of diabetes or hypertension in people with schizophrenia.[18],[19]

People with disabilities need higher and special healthcare compared to the general population. Some disabled may have multiple health conditions or may involve multiple body functions. The Telangana disability study showed that the experience in serious health conditions was 2.4 times higher in people with disabilities than those without in aged ≥50 years.[14] This study also showed that chronic health conditions (hypertension, diabetes, and arthritis) were more likely to present in disabled.[13] The South India disability evidence study reported that people with disabilities need significantly higher number of visits to a hospital than without (18.4% vs. 8.8%).[20] The same study showed that disabled had nearly five times higher risk of suffering from diabetes, and six times higher risk of having depression compared to people without disabilities. A study in rural Haryana, the prevalence of diabetes and respiratory disease was more common with disability.[21] Similar study in Chandigarh showed a higher risk of respiratory diseases, osteoarthritis, hypertension, eye problems, anemia, and neurological problems.[22] The Delhi study reported that the quality of life of elderly population was severely affected by disability compared to elders without disability.[16]

In general, people with disabilities are also frequently neglected and ignored. They have also a higher risk of early death.[9],[23] They are often denied their right to be included in the general pool, to be educated or employed, and to be participated.[19] These social issues adversely affect the health of disabled people further. Often, individuals with disabilities remain invisible and sidelined in society; thus, they are unable to exercise the full range of their rights.

 Disability and Health Care Utilization



People with disabilities in India face many difficulties to access either general or specialized healthcare or rehabilitation services. Around 15% of them living in urban and 3% in rural areas avail any form of rehabilitation services with total coverage of 5.7%.[24] A study in Delhi reported that only 50% of participants with disabilities was sought some form of medical treatment. Further, the study highlights that the treatment seeking was neglected and ignored, leading severe degree of disabilities.[25] However, Telangana study reported a good coverage of medical rehabilitation services (76%), vocational (88%), but relatively low for assistive devices (44%).[13]

In fact, not only higher in health-seeking behavior in people with disabilities but also face significant barriers in accessing healthcare needs compared to people without. The South Indian study reported that few most significant barriers in disabled compared to without were lack of awareness of services (13.3% vs. 2%), cost of transportation (13.3% vs. 2.2%), inaccessible physical building (12.7% vs. 2.3%), and poor fitting of hospital equipment (13.2% vs. 2.1%). People with disabilities also face discrimination or stigma from hospital staff as well as in society.[19],[23] Poverty is also one of the very important reasons why people with disabilities cannot avail the needed healthcare in India. The WHO reported that about 53% of disabled were unable to afford health-care costs as compared to those without (32%).[23] This report shows that the lack of appropriate disability-oriented services is a significant barrier to health-care access, for example, in Uttar Pradesh and Tamil Nadu, it is the second most important barrier next to the cost of services. Inadequate skills, low knowledge of providers, and their skewed distributions were also important barriers in the country.

 Addressing the Issues



Recently, the WHO provides a lot of push to improve the life of people with disabilities after publishing the first global report in 2011. There has been also a paradigm shift in dealing with disabilities, that is, from medical or charity-based approaches (medical model) to one, based on protection of human rights and dignity, and at the same time, ensuring the same equality as everyone (social model).[26] This model considers the impairment simply as a part of individual's health; but disability is recognized as being created by social and community that have been without taking needs of disabled people into account.

The goal of the WHO global action plan for disabilities is to achieve optimal health, functioning, well-being, and human rights for all disabled.[19] The UN Convention on the Rights of Persons with Disabilities (UNCRPD) states that “persons with disabilities (PWD) have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability.”[27] India is a signatory to both and strives to have better health and improve the quality of life for disabled. The two main ministries concerned in India dealing with disabilities are Ministry of Social Justice and Empowerment, and to some extent by the ministry of health and family welfare. The first one is responsible for the implementation and delivery of various national health programs in India. The MoSJ ensures the welfare of marginalized population, minorities as well as disabled.[28] Under the MoSJ, there are policy, schemes, and programs related to health and rehabilitation for disabled, for example, national policy for disabled, assistance to disabled persons scheme, etc., There are many statutory bodies, national institutes under MoSJ, for example, national trust with autism, cerebral palsy, and multiple disabilities, etc. To make it compliant with the UNCRPD, the PWD act of 1995 was amended, and a revised in 2016 was passed in the houses of parliament. The act lays stress on nondiscrimination, effective participation and inclusiveness, respect for difference, equal rights (social model) etc.[29]

Despite so many welfare programs, there is still a major gap in health-care access between people with and without disabilities. The main concern is, these two ministries are working in vertical manner without much of collaboration from top to bottom. MoH is seldom involved in the area of rehabilitation services although majority of disabled frequently visit health facilities for their health needs. The health sector is the first contact point of all disabled. Therefore, MoH should emphasize on the inclusion of disability services in its health policy. All medical facilities and professionals across the country are needed to be sensitized, educated about the health needs of disabled. The issues ranging from inaccessible hospital building and equipment, negative attitudes, negligence, and lack of training to communicate with people having hearing and speech problems in the hospital need to be tackled under health-care delivery system.

All the national health programs, which have a potential to benefit disabled, should also aim to have a special emphasis on healthcare as well as inclusiveness in their respective program guidelines. The two ministries should support each other in building up inclusive rehabilitative services in the states, district hospitals. With the increasing cost of healthcare, health insurance should become compulsory for all people with disabilities. The integration of this subject in the curriculum of the medical teaching program will help in improving services for disabled. The MoSJ should expand the existing support to the other NGOs to capture the maximum number of disabled across the country in collaboration with MoH. Generation of quality database on disability related should be done, which will help in the planning of inclusive disabilities care services.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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