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1、Global report on health equity for persons with disabilitiesGlobal report on health equity for persons with disabilitiesGlobal report on health equity for persons with disabilities ISBN 978-92-4-006360-0(electronic version)ISBN 978-92-4-006361-7(print version)World Health Organization 2022Some right

2、s reserved.This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence(CC BY-NC-SA 3.0 IGO;https:/creativecommons.org/licenses/by-nc-sa/3.0/igo).Under the terms of this licence,you may copy,redistribute and adapt the work for non-commercial purposes,provide

3、d the work is appropriately cited,as indicated below.In any use of this work,there should be no suggestion that WHO endorses any specific organization,products or services.The use of the WHO logo is not permitted.If you adapt the work,then you must license your work under the same or equivalent Crea

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6、ealth equity for persons with disabilities.Geneva:World Health Organization;2022.Licence:CC BY-NC-SA 3.0 IGO.Cataloguing-in-Publication(CIP)data.CIP data are available at http:/apps.who.int/iris.Sales,rights and licensing.To purchase WHO publications,see http:/apps.who.int/bookorders.To submit reque

7、sts for commercial use and queries on rights and licensing,see https:/www.who.int/copyright.Third-party materials.If you wish to reuse material from this work that is attributed to a third party,such as tables,figures or images,it is your responsibility to determine whether permission is needed for

8、that reuse and to obtain permission from the copyright holder.The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user.General disclaimers.The designations employed and the presentation of the material in this publication do not imply t

9、he expression of any opinion whatsoever on the part of WHO concerning the legal status of any country,territory,city or area or of its authorities,or concerning the delimitation of its frontiers or boundaries.Dotted and dashed lines on maps represent approximate border lines for which there may not

10、yet be full agreement.The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned.Errors and omissions excepted,the names of proprietary products are distinguishe

11、d by initial capital letters.All reasonable precautions have been taken by WHO to verify the information contained in this publication.However,the published material is being distributed without warranty of any kind,either expressed or implied.The responsibility for the interpretation and use of the

12、 material lies with the reader.In no event shall WHO be liable for damages arising from its use.Design concept and layout:Inis CommunicationFOREWORD vACKNOWLEDGEMENTS viiACRONYMS AND ABBREVIATIONS xINTRODUCTION 1CHAPTER 1.HEALTH EQUITY FOR PERSONS WITH DISABILITIES MATTERS 13Overview 151.1 Persons w

13、ith disabilities and their experience of health inequity 161.2 Health equity for persons with disabilities is a state obligation 191.3 A large proportion of the population has disability 221.4 Addressing health equity for persons with disabilities will advance the achievement of global health priori

14、ties 281.5 Addressinghealthinequitiesforpersonswithdisabilitiesbenefitseveryone 371.6 Health equity and meaningful participation in society 411.7 Health equity for persons with disabilities:an essential investment 43CHAPTER 2.HEALTH INEQUITIES EXPERIENCED BY PERSONS WITH DISABILITIES,AND THEIR CONTR

15、IBUTING FACTORS 59Overview 612.1 Health inequities faced by persons with disabilities 622.2 Contributing factors to health inequities for persons with disabilities 65CHAPTER 3.ADVANCING HEALTH EQUITY FOR PERSONS WITH DISABILITIES IN THE HEALTH SECTOR 153Overview 1551.Political commitment,leadership,

16、and governance 163Contents2.Healthfinancing 1823.Engagement of communities and other stakeholders,including private sector providers 1884.Models of care 2005.Health and care workforce 2146.Physical infrastructure 2227.Digital technologies for health 2288.Systems for improving quality of care 2339.Mo

17、nitoring and evaluation 23910.Health policy and systems research 246CHAPTER 4.RECOMMENDED PRINCIPLES FOR IMPLEMENTATION 263Recommended Principle 1:Include health equity for persons with disabilities at the centre of any health sector action 264Recommended Principle 2:Ensure empowerment and meaningfu

18、l participation of persons with disabilities and their representative organizations when implementing any health sector action 266Recommended Principle 3:Monitor and evaluate the extent to which health sector actions are leading to health equity for persons with disabilities 267ANNEX 1.METHODOLOGY O

19、F SCOPING REVIEWS OF LITERATURE 270ANNEX 2.CONSULTATION PROCESS 281ANNEX 3.PREVALENCE OF DISABILITY METHODOLOGY 285ANNEX 4.METHODOLOGY OF ECONOMIC ANALYSES 289ANNEX 5.STANDARDIZING DATA COLLECTION ON DISABILITY 296vForewordForewordAn estimated 1.3 billion people globally experience significant disab

20、ility.This figure has grown over the last decade and will continue to rise due to demographic and epidemiological changes,underscoring the urgency for action.Over a decade ago,WHO and the World Bank published the first World Report on Disability.Substantial progress has since been made in many count

21、ries,yet many people with disabilities are still being left behind.Due to persistent health inequities,they die earlier,they have poorer health and functioning,and they are more affected by health emergencies than the general population.Doing nothing to address these health inequities for persons wi

22、th disabilities means denying the realization of the universal right to the highest attainable standard of health.Each country has an obligation,under international human rights law and many domestic legal frameworks,to address these inequities.The COVID-19 pandemic has unveiled and exacerbated the

23、health inequities faced by many people around the world.Many persons with disabilities and their families have been disproportionately affected by social movement restrictions,physical distancing requirements and prioritization of certain health services all of which have affected their access to es

24、sential services which are critical to maintaining health and functioning.As the world continues to recover from the COVID-19 pandemic and prepare for future health emergencies,we have an opportunity to make health systems more inclusive for persons with disabilities through the primary health care

25、approach.Doing so must be part of every countrys journey towards universal health coverage and the other health-related targets in the Sustainable Development Goals.The Global Report on Health Equity for Persons with Disabilities presents the evidence base for more systematic,comprehensive,and susta

26、inable change in the health sector.It outlines key policy and programmatic actions and recommendations for Member States to strengthen and expand services for persons with disabilities.viGlobal report on health equity for persons with disabilitiesWe hope that governments,health partners and civil so

27、ciety,including organizations of persons with disabilities,will work together to implement the recommendations in this report,so that persons with disabilities can realize the highest attainable standard of health.Dr Tedros Adhanom GhebreyesusDirector-General,World Health OrganizationviiAcknowledgem

28、entsAcknowledgementsThe World Health Organization(WHO)would like to thank the numerous contributors for their support and guidance.Without their dedication,time,and expertise this report would not have been possible.The Global report on health equity for persons with disabilities was written by Kalo

29、yan Kamenov,Darryl Barrett,Emma Pearce,and Alarcos Cieza with technical support from Mangai Balasegaram,Allison Choe,Mlanie Graux,Juliet Milgate,Maria Francesca Moro,Deepa Palaniappan,Amy Russell,and Emre Umucu,under the overall guidance of Bente Mikkelsen,Director,Department of Noncommunicable Dise

30、ases,and Ren Minghui,Assistant Director-General.The development and finalization were made possible through the support of Yasaman Etemadi and Robin Chasserot.The report benefitted from contributions from the following WHO staff:Mohammed Bappirambharath,Shannon Barkley,Melanie Bertram,Rayana Ahmad B

31、ou Haka,Marzia Calvi,Alex Camacho,Bochen Cao,Matteo Cesari,Shelly Chadha,Somnath Chatterji,Giorgio Cometto,Nathalie Drew,Antony Duttine,Abdelrahman Elwishahy,Michelle Funk,Susana Lidia Gomez Reyez,Wouter de Groote,Hayatee Hasan,Shirin Heidari,Ernesto Jaramillo,Safo Kalandarov,Jagdish Kaur,Chapal Kha

32、snabis,Pauline Kleinitz,Theadora Koller,Aku Kwamie,Daniel Low-Beer,Nathalie Maggay,Jody-Anne Mills,Andrew Mirelman,Satish Mishra,Ryoko Miyazaki-Krause,Win Moh Moh Thit,Cathal Morgan,Derrick Muneene,Pudentienne Musabyimana,Taina Nakari,Joyce Nato,Marjolaine Nicod,Alana Officer,Miriam Orcutt,Christina

33、 Pallitto,Edith Patouillard,Juan Pablo Pea Rosas,Sunil Pokhrel,Martine Annette Prss,Kumanan Rasanathan,Alexandra Rauch,Anna Laura Ross,Jose Antonio Ruiz Postigo,Binta Sako,Hala Sakr,Kylie Shae,Bolormaa Sukhbaatar,Juan Tello,Tashi Tobgay,Nuria Toro Polanco,Masahiro Zakoji.ContributorsTECHNICAL CONTRI

34、BUTORSRenu Addlakha(Centre for Womens Development Studies,India),Anthony Danso-Appiah(University of Ghana Centre for Evidence Synthesis and Policy),Alessandra Aresu(Humanity&Inclusion),Jerome Bickenbach(University of viiiGlobal report on health equity for persons with disabilitiesLucerne,Switzerland

35、),Alexandre Bloxs(World Federation of the Deaf),Marieke Boersma(Light for the World),Jarrod Clyne(International Disability Alliance),Sarah Collinson(Sightsavers),Julian Eaton(CBM Global Disability Inclusion and London School of Hygiene and Tropical Medicine,United Kingdom of Great Britain and Northe

36、rn Ireland),Danny Haddad(CBM Global Disability Inclusion),Dominic Haslam(Sightsavers),Xiangyang Hu(China Disabled Persons Federation),Lisa Iezzoni(Harvard Medical School,USA),Anne Kavanagh(University of Melbourne,Australia),Gloria Krahn(Disability consultant for government and university groups),Han

37、nah Kuper(London School of Hygiene and Tropical Medicine,United Kingdom),Vivian Lin(University of Hong Kong),Caitlin Littleton(HelpAge International),Amanda McRae(Women Enabled International),Manel Mhiri(Inclusion International),Sophie Mitra(Fordham University,USA),Sagit Mor(University of Haifa,Isra

38、el),Susan L.Parish(Virginia Commonwealth University College of Health Professions,USA),Andrea Pregel(Sightsavers),Susannah Rodgers(Foreign,Commonwealth&Development Office,United Kingdom),Dikaios Sakellariou(Cardiff University,United Kingdom),Michael Schwinger(CBM International),Ashley Shew(Science,T

39、echnology,and Society,Virginia Tech,USA),Shahin Soltani(Kermanshah University of Medical Sciences,Iran),Leslie Swartz(Stellenbosch University,South Africa),Bonnielin Swenor(Johns Hopkins Disability Health Research Center,USA),Alberto Vsquez Encalada(Center for Inclusive Policy),Martine Abel Williams

40、on(World Blind Union),Sandra Willis(World Enabled and Columbia University,USA).DATA ANALYSIS AND MODELLINGTheo Vos,Sarah Wulf Hanson,Yifan Wu,from Institute for Health Metrics and EvaluationECONOMIC ANALYSIS AND MODELLINGRobert Smith,Christine Leopold,David Tordrup,from Triangulate Health LTDCOMMUNI

41、CATION STRATEGY AND TOOLKITSarah Bourn,Corinne Clark,Natasha Kennedy,Kate McCoy,from SightsaversPERSONAL STORIESChris Agbega(advocate and peer trainer for the Ghana Noncommunicable Diseases Alliance),Philippe Aubert(person with cerebral palsy and author of the book Rage),Myint Aung(person with epile

42、psy in Myanmar),Ahmed Hankir(psychiatrist and presenter of the Wounded Healer),Coumba Ndiaye(disability activist and councillor in a Dakar municipality in Senegal),Nguyen Phuong Ha(deputy chairwoman,Cerebral Palsy Family Association,Viet Nam),Raja ixAcknowledgementsSabra(person with a psychosocial d

43、isability and lecturer in Lebanon),Frank Trigueros(president of European Deafblind and FASOCIDE,the Federation of Associations of Deafblind people in Spain)CASE STUDIESAgustin Bergeret(Ministry of Public Health,Uruguay),Pratima Gajraj(Ministry of Health,Fiji),Khalid Abdul Hadi(Ministry of Public Hea

44、lth,Qatar),Juan Lacuague(Ministry of Public Health,Uruguay),Rosemary McKay(Department of Foreign Affairs and Trade,Australia),Thomas Morrin(Department of Health,Ireland),Aoife OFlaherty(Department of Health,Ireland),Synnve Ravnestad Eikefet(Ministry of Health and Care Services,Norway),Maria Cristina

45、 Raymundo(Department of Health,Philippines),Nassib Tawa(Centre for Research in Spinal Health&Rehabilitation Medicine,J.K.U.A.T.Kenya),Tatiana Vasconcelos Da Cruz(UNV Specialist for the Inclusion of Disability at the UN,Uruguay)UNITED NATIONS ORGANIZATIONSFood and Agriculture Organization of the Unit

46、ed Nations(FAO),International Telecommunication Union(ITU),International Trade Centre,United Nations Childrens Fund(UNICEF),UN Resident Coordinators Office(UNRCO),United Nations Educational,Scientific and Cultural Organization(UNESCO),United Nations Entity for Gender Equality and the Empowerment of

47、Women(UNWOMEN),United Nations High Commissioner for Human Rights(UNOHCHR),United Nations High Commissioner for Refugees(UNHCR),United Nations Human Settlements Programme(UN-Habitat),United Nations Office for the Coordination of Humanitarian Affairs(UN OCHA),United Nations Partnership on the Rights o

48、f Persons with Disabilities(UNPRPD),United Nations Population Fund(UNFPA),UN Office of the Secretary Generals Envoy on Youth,World Bank.OTHER CONTRIBUTORSWHO gratefully acknowledge the contributions made by more than 150 Member States from all WHO Regions,organizations of persons with disabilities,d

49、isability and health service providers,international disability and development organizations,academic institutions,private health sector entities as well as individuals who participated in the regional and global consultations or provided online feedback to the draft global report.WHO also wishes t

50、o acknowledge the following entities for their generous financial support in the development,publication and dissemination of the report:Sightsavers and USAID.xGlobal report on health equity for persons with disabilitiesAcronyms and abbreviationsCRPD Convention on the Rights of Persons with Disabili

51、ties DAT digital and assistive technologyFDD11 Functioning and Disability Disaggregation Tool(WHO)GDP gross domestic productGLAD Global Action on Disability HIS health information systemsHPSR health policy and systems researchHRQoL health-related quality of lifeICD International Classification of Di

52、seasesICF International Classification of Functioning,Disability and Health ILO International Labour OrganizationITU International Telecommunication Union LGBTQIA lesbian,gay,bisexual,trans,queer or questioning,intersex,asexual MDS Model Disability Survey(WHO)NCD noncommunicable diseaseNGO nongovern

53、mental organizationPAHO Pan American Health Organization(WHO)PHC primary health careRQ research questionSDG Sustainable Development GoalxiAcronyms and abbreviationsSRH sexual and reproductive healthUHC universal health coverageUN United NationsUNDIS United Nations Disability Inclusion Strategy UNFPA

54、 United Nations Population Fund UNPRPD United Nations Partnership on the Rights of Persons with DisabilitiesWASH water,sanitation and hygieneWCAG Web Content Accessibility Guidelines WHA World Health AssemblyWHO World Health OrganizationxiiGlobal report on health equity for persons with disabilities

55、 WHO/NOOR/Sebastian Liste1IntroductionIntroduction2Global report on health equity for persons with disabilitiesOverview Disability is part of being human and integral to the human experience.It results from the interaction between health conditions and/or impairments that a person experiences,such a

56、s dementia,blindness or spinal cord injury,and a range of contextual factors related to different environmental and personal factors such as societal attitudes,access to infrastructure,discriminatory policies,age,or gender.As of 2021,approximately 1.3 billion people about 16%of the global population

57、 experience disability.Persons with disabilities are part of human diversity,and although often referred to as a single population,they are a very diverse group of people.Persons with disabilities have an equal right as any person to the highest attainable standard of health.Substantial progress has

58、 been made in many countries;however,the world is still far from realizing the right to the highest attainable standard of health for persons with disabilities.This is due to the persistent health inequities that persons with disabilities experience.The overarching aim of this report is to make heal

59、th equity for persons with disabilities a global health priority.The specific objectives of the report are to:bring health equity for persons with disability to the attention of decision-makers in the health sector;document evidence on health inequities and country experiences on approaches in advan

60、cing health equity in the context of disability;and make recommendations that stimulate country-level action.3IntroductionDisability and persons with disabilitiesDisability is part of being human and integral to the human experience.It results from the interaction between health conditions and/or im

61、pairments that a person experiences,such as dementia,blindness or spinal cord injury,and a range of contextual factors related to different environmental and personal factors including societal attitudes,access to infrastructure,discriminatory policies,age,and gender.This understanding of disability

62、 is grounded in the WHO International Classification of Functioning,Disability and Health(ICF),published in 2001(1).The ICF,adopted by WHO Member States,was the first document to set a new understanding of disability,based on the biopsychosocial model,and defining disability not only by the underlyi

63、ng health condition or impairment of a person,but also by the fundamental effect of their environment.Disability is not the same as a health condition.For example,depression,cerebral palsy or having a retinopathy are not disabilities:they are health conditions which contribute to disability if the s

64、urrounding environment negatively impacts the persons life.A person with disability can be a child with blindness who cannot attend school because of a lack of vision-assistive products and educational materials that are not adapted to their needs.A person with disability can be a man in his forties

65、 with a diagnosis of schizophrenia,who does not have a job because of the stigmatization associated with mental health.A person with a disability can be a retired woman with dementia who does not have the means to afford health care or long-term care and lives isolated from society.Regardless of the

66、 health condition or impairment,persons with disabilities can enjoy healthy lives by realizing their aspirations,satisfying their needs and changing their environments(2).As of 2021,approximately 1.3 billion people about 16%of the global population have disability.This number has increased substanti

67、ally during the past decade due to different demographic and epidemiological changes such as population rising and the increase in the number of people with noncommunicable diseases,who are living longer and ageing with limitations in functioning.Persons with disabilities are part of human diversity

68、;although often referred to as a single population,they are a very diverse group of people.The United Nations Convention on the Rights of Persons with Disabilities(CRPD)describes persons with disabilities as“those who have long-term physical,mental,intellectual or sensory impairments which in intera

69、ction 4Global report on health equity for persons with disabilitieswith various barriers may hinder their full and effective participation in society on an equal basis with others”(3).Persons with disabilities can be of any age,gender identity,race,or religion.Several factors contribute to this dive

70、rsity including the substantial variety of underlying health conditions and impairments that determine the different health-care needs of the individual.For example,children with underlying conditions such as congenital heart disease or muscular dystrophy may require health interventions such as ear

71、ly identification and rehabilitation to optimize their development and functioning(4).Adolescents with mental health conditions and psychosocial disabilities may benefit from health services in non-specialized care settings.Persons with chronic health conditions associated with high levels of disabi

72、lity,such as spinal cord injury,stroke,or rheumatoid arthritis often have long-term care needs delivered by specialized health professionals(5).Older persons are likely to experience more health conditions and impairments which can result in elevated health-care use and the need for personal support

73、 services(6).The environment is an additional factor influencing the diversity of persons with disabilities.As described above,different environmental barriers such as inaccessible education,transportation,employment and health care,may hinder persons with disabilities from participating fully and e

74、ffectively in society on an equal basis with others.Two people with the same type of impairment and health condition can have very different experiences of disability.For example,a person with a spinal cord injury living in a low-income setting without accessible transportation,health information an

75、d communication,or employment,will experience disability differently from a person with the same condition,who benefits from a good job,wide social network,family support and the health care they need.The intersection of disability with factors such as sex,age,gender identity,sexual orientation,reli

76、gion,race,ethnicity,and economic situation also affects the experiences and participation of persons with disabilities.While disability often correlates with disadvantage,not all persons with disabilities are disadvantaged equally.For example,women,children and older people with disabilities experie

77、nce a combined disadvantage associated with sex,age,and disability(7),which is evidenced in discrimination,limited access to health care or increased forms of violence(811).Conversely,higher income and status often helps with overcoming activity limitations and participation restrictions(12).Further

78、more,persons with disabilities living in rural or remote areas have substantially reduced access to services and support compared to people living in metropolitan areas and thus can experience greater disadvantage(13).5IntroductionPersons with disabilities and the right to the highest attainable sta

79、ndard of healthThe constitution of the World Health Organization sets out a range of principles and obligations,including that“the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race,religion,political belief,econom

80、ic or social condition”(14).Persons with disabilities have an equal right to the highest attainable standard of health as anyone else.This right is inherent,universal,and inalienable,and is enshrined in international law through human rights treaties,and in domestic legal frameworks including nation

81、al constitutions.The CRPD is the core human rights treaty1 that fostered a new era reframing disability with respect to human rights and establishing the norm of participation of persons with disabilities in society on an equal basis with others.The CRPD has 185 ratifications or accessions,and 164 s

82、ignatories,2 recognizing the broad global support for addressing the human rights of persons with disabilities everywhere.It provides an international framework that,among other things,promotes and protects the right of persons with disabilities to enjoy their highest attainable standard of health b

83、y making decisions about their own bodies and their own health care and without being discriminated against on the basis of their disability.In addition to international law,various global development and health frameworks have recognized and promoted the right to health for persons with disabilitie

84、s.Disability-specific international policy and guiding frameworks have evolved over time,starting with the World Programme of Action Concerning Disabled Persons in 1982(15)which included a particular focus on rehabilitation and health services.This was followed in 1993 with the Standard Rules on the

85、 Equalization of Opportunities for Persons with Disabilities,adopted by the United Nation General Assembly,and provided policy guidance for governments around the world on actions to improve the experiences of persons with disabilities(16).The WHO Global Disability Action Plan 20142021 was a signifi

86、cant step in achieving health and well-being and human rights for persons with disabilities(17).In 2021,at the Seventy-fourth World Health Assembly,WHO Member States adopted resolution WHA74.8:“The highest attainable standard of health for persons with disabilities”(18)which reiterated the need for

87、countries to ensure that persons with disabilities exercise their 1 https:/www.ohchr.org/en/professionalinterest/pages/coreinstruments.aspx.2 https:/www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html.6Global report on health equity for persons with di

88、sabilitiesfull right to health.The resolution aligns with broader international frameworks on health,such as the United Nations Political Declaration on Universal Health Coverage(19)which commits Member States to ensuring that all people can access the essential health services they need without fin

89、ancial hardship,thereby aligning with Sustainable Development Goal(SDG)target 3.8.At the national level,various legal frameworks,health laws or disability laws support the realization of the right to health for persons with disabilities,with some constitutions specifically guaranteeing this.For exam

90、ple,the constitution of Montenegro states that“a person with disability shall have the right to health protection from public revenues,providing for free health care”(20).In addition to national laws,some countries have national policies which set out an objective on health and well-being for person

91、s with disabilities(21).One example is Australias Disability Strategy 20212031 which has the outcome that“people with disability attain the highest possible health and wellbeing outcomes throughout their lives”(22).Arguably,as expressed by the CRPD Committee in its concluding observations to State r

92、eports,more needs to be done in all countries to harmonize existing laws related to disability(23,24).Substantial progress has been made in many countries;nonetheless,the world is still far from realizing the right to the highest attainable standard of health for persons with disabilities.This repor

93、t shows that persons with disabilities continue to experience a wide range of health inequities.Contributing factors to these inequities remain unchanged during the past decade,and many persons with disabilities continue to die prematurely,have poorer health,and experience more functioning limitatio

94、ns as a result.The COVID-19 pandemic revealed the disadvantaged position of persons with disabilities within and beyond the health sector3,and the need for urgent action.Why this report now?The call for this report comes at an important time.Several factors and developments during the past decade ha

95、ve contributed to the need for such a report today.3 The terms“health sector”and“health system”have the same meaning and are often used interchangeably.WHO defines“health system”as the“aggregate of all public and private organizations,institutions,and resources mandated to improve,maintain or restor

96、e health.This includes both personal and population services as well as activities to influence the policies and actions of other sectors to address the political,social,environmental,and economic determinants of health”.However,the term“health system”is very often referred to exclusively as a compo

97、site of“building blocks”or components which work together to deliver health services;its other key roles,such as coordinating multisectoral action,are not considered.Therefore,for clarity,this report will use“health sector”as an overarching term,and“health system”when referring to the six building b

98、locks.7IntroductionMore than 10 years have passed since the launch of the first ever World report on disability4 produced jointly by WHO and the World Bank.In the previous report,health was one of many topics,together with others such as education and employment.This current report provides a more c

99、omprehensive analysis of challenges in the health sector,as well as the actions needed for ensuring the highest attainable standard of health for persons with disabilities.In 2014,to implement the recommendations of the World report on disability,WHO Member States endorsed the WHO Global Disability

100、Action Plan 20142021.The plan called on countries to remove barriers and improve access to health services and programmes;to strengthen and extend rehabilitation,assistive products and support services;and to enhance research on disability and related services,and the collection of relevant and inte

101、rnationally comparable data on disability.In 2021,the action plan expired but the need for global guidance to scale up the health sector response for persons with disabilities remained.In 2015,all United Nations Member States adopted the 2030 Agenda for Sustainable Development which sets out 17 goal

102、s to transform the world.The agenda pledges to leave no one behind,including persons with disabilities,and recognizes disability as a cross-cutting issue to be considered in the implementation of all the goals.In 2019,heads of state and government representatives adopted the political declaration:“U

103、niversal health coverage:moving together to build a healthier world”,which includes a specific reference made to persons with disabilities,in terms of increasing“access to health services for all persons with disabilities”.The call was also to remove“physical,attitudinal,social,structural,and financ

104、ial barriers,provide quality standard of care and scale up efforts for their empowerment and inclusion,noting that persons with disabilities,representing 15%of the global population,continue to experience unmet health needs”(19).In 2019,the UN Secretary-General launched the United Nations Disability

105、 Inclusion Strategy(UNDIS)to implement the inclusion of disability through mainstreaming disability in both the programmatic areas and business operations of the United Nations.The strategy enables the UN system to support the implementation of the CRPD and other international human rights instrumen

106、ts,as well as the achievement of the SDGs,the Agenda for Humanity(25)and the Sendai Framework for Disaster Risk Reduction(26).Aligning with the UNDIS,this report also provides insights in how to mainstream disability across WHO and UN programmatic areas.4 World report on disability.World Health Orga

107、nization.20118Global report on health equity for persons with disabilitiesThe landmark resolution,adopted in 2021 by the World Health Assembly,on“The highest attainable standard of health for persons with disabilities”,aims to advance the agenda of disability inclusion in the health sector in countr

108、ies,and focuses on three central areas:i)access to effective health services;ii)protection during health emergencies;and iii)access to cross-sectorial public health interventions.A specific request made to the WHO Director-General was to develop a global report on the highest attainable standard of

109、health for persons with disabilities before the end of 2022.This report represents the response to that request.Objectives of the report This Global report on health equity for persons with disabilities identifies and analyses the contributing factors to systemic health inequities for persons with d

110、isabilities and outlines key policy and programmatic actions along with recommendations to reduce these health inequities.The report calls on WHO Member States to take action to advance health equity for persons with disabilities.It also invites civil society,including organizations of persons with

111、disabilities and other health partners,to collaborate and advocate for the implementation of the recommendations included in the report,so that persons with disabilities can achieve the highest attainable standard of health.The overarching aim of the report is to make health equity for persons with

112、disabilities a global health priority.The specific objectives are to:bring health equity for persons with disability to the attention of decision-makers in the health sector;document evidence on health inequities and country experiences on approaches to advance health equity from a disability lens;a

113、nd make evidence-based recommendations that stimulate country-level action.Development processThe Global report on health equity for persons with disabilities was prepared through an evidence-based and consultative process.After determining the structure of the report,WHO performed a series of revie

114、ws of the academic literature to inform and shape the content.In addition,a broader review 9Introductionof grey literature,human rights reports and civil society documents was carried out to ensure that the report was based on,and reflected,real-life experiences that are not always captured in peer-

115、reviewed literature.Protocols for these reviews have not been published,but details of the methodology followed can be found in Annex 1.Through a series of regional and global consultations,WHO also engaged with Member States,civil society,including persons with disabilities and their representative

116、 organizations,academia,health service providers,and other developmental partners.Throughout the process,consultations were held between WHO and a technical expert group,a civil society group,sister UN entities and WHO units.More details on the consultation process can be found in Annex 2.Estimation

117、s of the prevalence of disability were made in collaboration with the Institute for Health Metrics and Evaluation.Economic analyses were also undertaken to demonstrate the importance of fostering a disability-inclusive health sector.Governmental and nongovernmental partners across the world contribu

118、ted examples,case stories and photographs.10Global report on health equity for persons with disabilitiesReferences1.International Classification of Functioning,Disability and Health:ICF.Geneva:World Health Organization;2001(https:/apps.who.int/iris/handle/10665/42407,accessed November 2022).2.United

119、 Nations.Report of the Special Rapporteur on the rights of persons with disabilities.Office of the High Commissioner for Human Rights.2018.3.United Nations Department of Economic and Social Affairs Disability(DESA).Convention on the Rights of Persons with Disabilities(CRPD).(https:/www.un.org/develo

120、pment/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html,accessed November 2022).4.Kuper H,Heydt P.The missing billion:access to health services for 1 billion people with disabilities.London:London School of Hygiene and Tropical Medicine;2019(https:/www.lshtm.ac.uk/TheMissi

121、ngBillion,accessed November 2022).5.Fehlings MG,Tetreault LA,Wilson JR,Kwon BK,Burns AS,Martin AR et al.A clinical practice guideline for the management of acute spinal cord injury:introduction,rationale,and scope.Global Spine J.2017;7:84S94S.doi:10.1177/2192568217703387.6.World report on ageing and

122、 health.Geneva:World Health Organization;2015(https:/apps.who.int/iris/handle/10665/186463,accessed November 2022)7.United Nations Department of Economic and Social Affairs.Disability and development report,2018.Realization of the sustainable development goals by,for and with persons with disabiliti

123、es.New York:United Nations;2018(https:/social.un.org/publications/UN-Flagship-Report-Disability-Final.pdf,accessed November 2022).8.Plummer SB,Findley PA.Women with disabilities experience with physical and sexual abuse:review of the literature and implications for the field.Trauma Violence Abuse.20

124、12;13:1529.doi:10.1177/1524838011426014.9.Fang Z,Cerna-Turoff I,Zhang C,Lu M,Lachman JM,Barlow J.Global estimates of violence against children with disabilities:an updated systematic review and meta-analysis.Lancet Child Adolesc Health.2022;6:313323.10.Seppl P,Vornanen R,Toikko T.Multimorbidity and

125、polyvictimization in children an analysis on the association of childrens disabilities and long-term illnesses with mental violence and physical violence.Child Abuse Neglect.2021;122:105350.11.Global report on ageism.Geneva:World Health Organization;2021.12.Grammenos S.Illness,disability and social

126、inclusion.Dublin:European Foundation for the Improvement of Living and Working Conditions;2003(https:/sid-inico.usal.es/idocs/F8/FDO6543/social_inclusion.pdf,accessed November 2022).13.Dassah E,Aldersey H,McColl MA,Davison C.Factors affecting access to primary health care services for persons with d

127、isabilities in rural areas:a“best-fit”framework synthesis.Global Health Res Policy.2018;3:113.14.Constitution of the World Health Organization.World Health Organization.Geneva 1946(https:/treaties.un.org/doc/Treaties/1948/04/19480407%2010-51%20PM/Ch_IX_01p.pdf,accessed November 2022).11Introduction1

128、5.UN General Assembly Resolution 37/52 of 3 December 1982.World programme of action concerning disabled persons.1982(https:/unstats.un.org/unsd/demographic/sconcerns/disability/A-RES-37-52.htm,accessed November 2022).16.UN Department of Economic and Social Affairs.Standard rules on the equalization

129、of opportunities for persons with disabilities:resolution/adopted by the General Assembly.UN General Assembly 48th Session 199394;1993.17.WHO global disability action plan 20142021:better health for all people with disability.World Health Organization:Geneva;2015.18.Seventy-Fourth World Health Assem

130、bly;WHA 74.8.The highest attainable standard of health for persons with disabilities.2021(https:/apps.who.int/gb/ebwha/pdf_files/WHA74/A74_R8-en.pdf,accessed November 2022).19.UN General Assembly 74th Session A/RES/74/2.The political declaration of the high level meeting on universal health coverage

131、.Universal health coverage:moving together to build a healthier world.2019(https:/undocs.org/en/A/RES/74/2,accessed November 2022).20.Raub A,latz I,Sprague A,Stein MA,Heymann J.Constitutional rights of persons with disabilities:an analysis of 193 national constitutions.Harvard Human Rights J.2016;29

132、:20340(https:/heinonline.org/HOL/Page?handle=hein.journals/hhrj29&id=207,accessed November 2022).21.United Nations Department of Economic and Social Affairs.Disability strategies and action plans by country/area.2021(https:/www.un.org/development/desa/disabilities/strategies.html,accessed November 2

133、022).22.Commonwealth of Australia.Australias Disability Strategy 20212031.Department of Social Services;2021(https:/www.disabilitygateway.gov.au/sites/default/files/documents/2021-11/1786-australias-disability.pdf,accessed November 2022).23.United Nations.Committee on the Rights of Persons with Disa

134、bilities 24th Session CRPD/C/EST/CO/1.Concluding observations on the initial report of Estonia.2021.24.United Nations.Committee on the Rights of Persons with Disabilities:25th session CRPD/C/FRA/CO/1.Concluding observations on the initial report of France.2021.25.World Humanitarian Summit.Agenda for

135、 Humanity.2016(https:/agendaforhumanity.org/,accessed November 2022).26.United Nations Office for Disaster Risk Reduction.Sendai framework for disaster risk reduction 20152030.AskSource;2015(https:/ November 2022).12Global report on health equity for persons with disabilities WHO/Alasdair Bell131.He

136、alth equity for persons with disabilities matters1.Health equity for persons with disabilities matters14Global report on health equity for persons with disabilitiesSpeaking out on stigma to fight it When Dr Ahmed Hankir first experienced psychological distress as a medical student in the United King

137、dom of Great Britain and Northern Ireland,he delayed seeking help due to the shame and stigmatization associated with having a mental health condition.Compounding his situation was the stigmatization of being a man of colour,a Muslim and a migrant a“triple whammy”which contributed towards an“identit

138、y crisis”and the strain of surviving through low-paid jobs and a war in the country of his roots.He felt the stigmatization of mental health most acutely within his own profession.He was“ridiculed”by fellow medical students and ostracized by his closest companions.When he sought help from the person

139、 in charge of student support,he was“psychologically tortured”.“Stigma is rampant in the medical profession.Unless we address it,it will continue,”he said.“It takes strength to accept that you might be a source of stigma.Theres ignorance and arrogance from providers.What we need is humility.Ive met

140、inspirational,humble doctors.”As a psychiatrist,he draws from his past.“My lived experience is my superpower.It makes me more insightful,and I can mobilize empathy.”Today,Hankir is renowned for his“Wounded Healer”presentation,which aims to debunk myths about mental illness through blending performin

141、g arts and psychiatry.He has won many awards for this,including the World Health Organization Director-General Award for Global Health in 2022.“Speaking out on stigma challenges it.I try to engage and educate the audience,”he explained.More than 100 000 people across 20 countries have heard him spea

142、k.He continues to face negativity from some psychiatrists;some are“suspicious”of his success.“They think I cant function.I was miserable for many years.But now I am not just surviving,Im thriving,”he laughed.Personal storyPhoto:Dr Ahmed Hankir151.Health equity for persons with disabilities mattersOv

143、erview As of 2021,an estimated 1.3 billion people or 16%of global population experience significant disability.This number is growing driven by increased number of people with noncommunicable diseases,who are also living longer and ageing with limitations in functioning.Many of the differences in he

144、alth outcomes between persons with disabilities and those without cannot be explained by the underlying health condition or impairment and are associated with avoidable unjust or unfair factors.These factors are called“health inequities”.It is an obligation of the state,through their health sector i

145、n coordination with other sectors,to address existing health inequities so that persons with disabilities can enjoy their inherent right to the highest attainable standard of health.The obligation is an international law of human rights.Addressing health inequities for persons with disabilities will

146、 advance the achievement of global health priorities.Health equity is inherent to the pursuance of UHC.Countries can make faster progress in improving the health and well-being of their population through cross-sectoral public health interventions that are inclusive and provided in an equitable mann

147、er.Advancing health equity for persons with disabilities is a central component of all efforts to protect populations in health emergencies.Addressing health inequities for persons with disabilities benefits everyone.Older people,persons with noncommunicable diseases,migrants and refugees,or frequen

148、tly unreached populations,such as those from lower socioeconomic backgrounds can benefit from disability inclusive approaches that target persistent barriers to inclusion in the health sector.Advancing health equity for persons with disabilities contributes to their wider participation in society.In

149、vesting in health equity for persons with disabilities means investing in Health for All,which whilst would likely require additional investments for ensuring equitable access to people with disability still brings high economic and societal dividends.For example,there could be nearly US$10 return p

150、er US$1 spent on implementing disability inclusive prevention and care for noncommunicable diseases.Other population-wide interventions such as family planning and vaccination also remain highly cost-effective when provided in disability inclusive manner,despite the additional cost required.16Global

151、 report on health equity for persons with disabilities1.1 Persons with disabilities and their experience of health inequityA wide range of differences in health outcomes exist between persons with disabilities and those without disabilities.These differences can be seen in three key health indicator

152、s:mortality,morbidity,and functioning.5 For example,persons with intellectual disabilities die at a younger age than the general population in persons with Down syndrome,20 years younger,on average(1).Compared to those without disabilities,persons with disabilities also have higher rates of limitati

153、ons in functioning,and chronic health conditions such as diabetes,asthma,arthritis,cardiac disease,dental disease,osteoporosis or stroke(2,3).Some of the differences in health outcomes are referred to as inequalities because they can be explained to some extent by the underlying health condition or

154、impairment.For example,compared to the general population,persons with traumatic brain injury have a two-fold increased risk for mortality;the more severe the injury,the higher the probability of early death(4).Evidence shows that persons with Down syndrome are more likely to develop earlier onset d

155、ementia than the general population and that dementia is the leading cause of death in this group of people.A study carried out in a community setting in England showed that,among 211 adults aged over 36 years with Down syndrome,70%of deaths are caused by dementia,and mortality rates are five times

156、higher in adults with Down syndrome who have dementia compared to those without dementia.In comparison,in the general population,mortality rates are slightly less than two-fold higher in those with dementia than those without(5).Compared to younger adults with disabilities,older adults with disabili

157、ties have more functioning limitations and comorbid conditions which to some extent can be associated with the ageing process(6).5“Mortality”is another term for death and is used to indicate the number of deaths due to an illness or a health condition among a certain group of people during a certain

158、 time period.“Morbidity”refers to having a disease or a symptom of disease.“Functioning”is a multidimensional concept,relating to the body functions and structures of a person(functioning at the level of the body);the activities of a person(functioning at the level of the individual);the participati

159、on or involvement of a person in areas of life(functioning of a person as a member of society);and environmental factors which affect the level of functioning as they can be facilitators or barriers.Of all the forms of inequality,injustice in health care is the most shocking and inhumane.”Dr Martin

160、Luther King,Jr 171.Health equity for persons with disabilities mattersA significant proportion of the differences in health outcomes between persons with and without disabilities are associated with unjust or unfair factors that are avoidable and cannot be explained by the underlying health conditio

161、n or impairment.These differences are referred to as health inequities and are the focus of this report(Box1).The existence and persistence of health inequities raise moral concerns and,from a human rights perspective,should be viewed as objectionable since they impede persons with disabilities to e

162、xercise their inherent right to the highest attainable standard of health.In terms of international law and domestic legal instruments they may also represent unlawful acts.Distinguishing between health inequities and health inequalities can sometimes be difficult due to the lack of data and systema

163、tic research on these topics.Examples of health inequities demonstrate that their existence is pervasive and unacceptable(as explored in Chapter 2);with health inequalities,even when the differences can be explained by the underlying health condition or impairment,this does not mean that they are ac

164、ceptable or that nothing can be done.As an example,the advances in health care and improvements in the overall health of individuals with Down syndrome led to a dramatic increase in the life expectancy of those with this condition.The life expectancy for persons with Down syndrome was only 10 years

165、several decades ago,congenital heart defects being responsible for most deaths within the first year of life.Now for children with the condition who were born in 2010,the median life expectancy is estimated to be 65 years(7).This longer life span,however,brings a considerable increase in the risk of

166、 dementia;therefore,research needs to be conducted and health interventions provided to close the gap in terms of delaying the onset of dementia in persons with Down syndrome.Health inequitiesHealth inequities are differences in health outcomes that are avoidable and unjust.In general,health equity

167、is the absence of unfair,avoidable,or remediable differences among groups of people,whether those groups are defined socially,economically,demographically,or geographically,or by other dimensions of inequality(e.g.age,sex,gender,ethnicity,disability,or sexual orientation).With health equity,every in

168、dividual has a fair opportunity to realize their full health potential without being disadvantaged in achieving it.Box 118Global report on health equity for persons with disabilitiesA variety of health inequities lead to persons with disabilities dying prematurely.For example,people with vision impa

169、irment have a higher risk of dying prematurely compared to those who have mild or no vision impairment(8);moreover,socioeconomic deprivation and poor access to health care are well documented risk factors for vision impairment and mortality,among other outcomes(9).A six-fold discrepancy in deaths am

170、enable to quality health care can be seen between persons with intellectual disabilities and the general population(10).Contributing factors to premature mortality include problems in advanced care planning,inappropriate living accommodation,or adjusting care as needs change(11).The higher rates in

171、mortality escalated more markedly during the COVID-19 pandemic,during which persons with intellectual disabilities were eight times more likely to die from the disease than those without an intellectual disability(12).They were also less likely to receive critical care support suggesting that qualit

172、y of health care may be a contributing factor in the higher case fatality(13).A mortality gap of 20 years for men,and 15 years for women,was experienced by persons with psychosocial disabilities in high-income countries,due to a combination of lifestyle risk factors,social determinants,and poorer he

173、alth care(14,15).In terms of inequities leading to poorer health,persons with disabilities have higher rates of acquiring new health conditions or increased morbidity,which are often driven by reduced access to health care,including rehabilitation services(16,17).Such conditions can include tubercul

174、osis,diabetes,stroke,sexually transmitted infections or cardiovascular problems(16,1822).Having multiple impairments increases the risk of a high prevalence of vision impairment among persons with disabilities(23).Furthermore,persons with disabilities have an increased risk of poor oral health and d

175、eveloping mental health conditions such as depression or anxiety(16,19,21,2427).Differences in everyday functioning can also be attributed to unfair conditions such as barriers to economic life,transport,leisure activities,social contact,accessibility,and participation in employment(28).The WHO Mode

176、l Disability Survey reveals the impact of the surrounding environment on the levels of functioning of persons with disabilities.In Cambodia,for example,factors such as inaccessible transportation,the hindering aspects of places where persons with disabilities can take part in community activities,th

177、e lack of social support and of assistive products are detrimental to functioning(29).In Cameroon,inaccessible physical environments,especially inside a persons home(e.g.the toilet or the dwelling itself),as well as negative attitudes and barriers to accessing health care,can increase limitations in

178、 functioning to a far greater extent than for those without disabilities(30).191.Health equity for persons with disabilities mattersAdvancing health equity for persons with disabilities can be achieved through addressing the contributing factors to health inequities which disadvantage persons with d

179、isabilities.These factors include:i)any structural conditions related to the social,economic,or political context,including stigmatization and discrimination against persons with disabilities;ii)the social determinants of health,such as poverty,education,employment,sex,or age;iii)a range of risk fac

180、tors related to ill health that have an adverse impact on persons with disabilities,such as poor diet,physical inactivity(31),the use of tobacco products(32),alcohol consumption,drug use(24),and sexually transmitted infections(22);and iv)the broad set of barriers in the health system prominently the

181、 lack of access to quality and affordable health care services,including for sexual and reproductive health.The health inequities and contributing factors that lead to increased mortality,morbidity,and limitations in functioning are detailed in Chapter 2.1.2 Health equity for persons with disabiliti

182、es is a state obligationIt is a state obligation,through the health sector and in coordination with other sectors,to address existing health inequities so that persons with disabilities can enjoy their inherent right to the highest attainable standard of health.Obligations to address health inequiti

183、es are created through international human rights treaties which are binding on the governments of States Parties.Governmental and nongovernmental actors in the health sector may also be bound under domestic policies and legislation.Addressing health inequities implies assuming obligations and dutie

184、s to respect,protect and fulfil the right to health for every individual.The obligation“to respect”means that countries must refrain from interfering with,or curtailing,the enjoyment of this right.The obligation“to protect”requires countries to defend individuals and groups against human rights viol

185、ations.6 The obligation“to fulfil”means that the health sector must take positive action to facilitate the enjoyment of the basic human right for health through adopting a human rights-based approach to health and addressing existing health inequities.The practical implications of adopting this appr

186、oach are elaborated in Chapter 3.Countries have an obligation under international human rights law to ensure that their legal and policy frameworks do not discriminate on the basis of 6 https:/www.un.org/en/about-us/udhr/foundation-of-international-human-rights-law.20Global report on health equity f

187、or persons with disabilitiesdisability.Since 2007,this obligation has been reaffirmed by the CRPD(see Box 2).The articles of the CRPD address non-discrimination as a cross-cutting issue.While Article 2 defines discrimination based on disability very broadly,Article 3 includes non-discrimination and

188、equality of opportunity as general principles.Article 4 requires States that are party to the CRPD to repeal any legislation,regulations,customs and practices that constitute discrimination against persons with disabilities,including coercive and involuntary hospitalization and treatment of persons

189、with disabilities,without their choice and informed consent.Article 5 calls on States to adopt strong anti-discrimination legal frameworks prohibiting any form of discrimination on the basis of disability.This will guarantee equal and effective legal protection against discrimination on all grounds

190、to all persons with disabilities(33).Article 25 of the Convention on the Rights of Persons with Disability(CRPD)Article 25 of the CRPD lays down that States Parties must recognize that persons with disabilities have the right to the enjoyment of the highest attainable standard of health without disc

191、rimination on the basis of disability.States Parties must provide persons with disabilities with the same range,quality,standard of free or affordable health care and programmes as provided to other persons,including sexual and reproductive health services,population-based health programmes and othe

192、r health services.It also prohibits discrimination against persons with disabilities in the provision of health insurance,and life insurance where such insurance is permitted by national law.Box 2Furthermore,it is the obligation of each State to act upon the multiple and intersecting forms of discri

193、mination faced by persons with disabilities.The CRPD recognizes the significance of such forms of discrimination,particularly in relation to women,girls and boys with disabilities,since these groups are at a higher risk of discrimination and exclusion.In domestic policies and programmes,States that

194、are party to the CPRD or other relevant human rights treaties,are bound to address the different health inequities experienced by the most marginalized among persons with disabilities,such as women,children,young people,older persons,indigenous peoples,persons with psychosocial disabilities,sexual m

195、inorities groups,or persons with intellectual disabilities.In reality,however,while some countries have non-discrimination 211.Health equity for persons with disabilities mattersincluded in their legislation and constitutions,disability is often not mentioned as a basis for discrimination,or when in

196、cluded,is only considered in specific areas,such as education or employment(34).The health sector has several available mechanisms to confront inequity,including directly reducing exposure to risk factors and vulnerability to ill health;improving equitable and non-discriminatory access to health ser

197、vices and health information;or promoting cross-sectoral action to address the wider social and environmental determinants of health and improve health status.Examples of the latter include water and sanitation policies for better hygiene,food supplements in collaboration with the food and agricultu

198、ral sector,educational initiatives,or transport policies to address geographical barriers to access health services.Furthermore,the health sector can play a fundamental role in mediating the consequences of illness in the lives of persons with disabilities.For example,financial risk protection withi

199、n countries plans for universal health coverage(UHC)can support persons with disabilities from impoverishment or catastrophic health expenditures.The World Health Assembly resolution,WHA74.8(35),reiterates the need for governments to commit to ensuring health equity for persons with disabilities.The

200、 resolution aligns with broader international frameworks on health.These WHO/NOOR/Sebastian Liste22Global report on health equity for persons with disabilitiesinclude the 2030 Agenda for Sustainable Development,under which Member States have an obligation under Sustainable Development Goal 3(SDG3)to

201、 ensure healthy lives and promote well-being for all at all ages;and the United Nations Political Declaration on Universal Health Coverage(36)which commits countries to ensuring that all people can access the essential health services they need without financial hardship(SDG 3.8).1.3 A large proport

202、ion of the population has disability Prevalence estimatesTo estimate the most recent prevalence of disability,WHO applied a similar approach to the 2011 World report on disability.This was done for consistency.The 2011 report relied on a combination of methods,using data from both the WHO World Heal

203、th Survey of 20022004 and the 2004 Global Burden of Disease(GBD)study.In the absence of updated comparable WHO World Health Survey data,WHO used exclusively the 2021 data from the GBD for the current report.Various factors,however,impede the direct comparisons between the prevalence estimates of the

204、 previous report and this report.This is because the Institute for Health Metrics and Evaluation(IHME),the organization behind the GBD data,has updated various details in the methodology over the years(for more details see Annex 3).In addition,IHME updates annually all data in the GBD study based on

205、 new epidemiological evidence from all around the world.This not only ensures more accurate prevalence estimates for health conditions,but also the possibility of considering data on new conditions or impairments for which information has lacked in the past.The prevalence estimates are updated retro

206、spectively for all previous years up to 1990.This means,for example,that when the estimates of 2021 are published,the estimates for each health condition and impairment for every year since 1990 are also updated and published.Using the new estimates published every year,it is accordingly possible to

207、 observe trends over time with more valid and robust data.Box 3231.Health equity for persons with disabilities mattersTo explore time trends,thus,we did not compare the estimates presented in the 2011 WHO and World Bank World Report on Disability,but the estimates of the GBD study produced by IHME i

208、n 2021 for the years 2010 and 2021.The underlying health conditions and impairments included in the estimates are those that typically last longer than 6 months and are associated with significant(moderate or severe)levels of disability.All data is disaggregated by age and sex.There is no double cou

209、nting of people who have more than one underlying health condition or impairment since an adjustment for comorbidity was made that considers the increased probability of having certain pairs of conditions.Full details on the methodology can be found in Annex 3.The estimates presented here are based

210、on underlying health conditions and impairments associated with significant(moderate and severe)levels of disability,without considering the impact of the surrounding environment.This was also the case of the estimates presented in the World Report on Disability 2011.This is justifiable since there

211、is little data on disability that measures the effect of different environmental factors.Even if the WHO Model Disability Survey,which considers the impact of the environment,has been conducted in 15 countries and there are other few studies that do the same using disability-specific tools,the data

212、is not sufficient to obtain global or regional estimates.We acknowledge the limitations of this approach.As in most settings the environment presents more barriers than facilitators,if the impact of the environment is considered in estimating the prevalence of disability,the number of persons with d

213、isabilities is likely to be much higher due to the environmental impact.1.3.1 2021 prevalence estimates of disabilityAs of 2021,an estimated 1.3 billion people 16%of the global population have significant disability.Of these people,around 142 million have severe levels of disability.Nearly 80%of the

214、 1.3 billion persons with disabilities live in low-income and middle-income countries of the world,as opposed to 20%in high-income countries.However,the prevalence of disability is highest in high-income countries(21.2%)and lowest in low-income countries(12.8%)(Figure 1).This 24Global report on heal

215、th equity for persons with disabilitiesdifference can be explained by two factors.On the one hand,certain very prevalent health conditions such as musculoskeletal conditions or neurological conditions are more prevalent in high-income than in low-income countries.On the other hand,underdiagnosis and

216、 underreporting in low-income settings may lead to an underestimation of the number of persons with disabilities in many countries.Figure 1.Prevalence of disability by World Bank country income group,20210%5%10%15%20%25%Percentage prevalence of disability21.2%16.2%14.8%12.8%High-incomeUpper middle-i

217、ncomeLower middle-incomeLow-incomeSource:Global burden of disease data,2021The prevalence of disability varies across WHO regions with the European Region having the highest(20%),followed by the Region of the Americas(19.4%);the African Region has the lowest prevalence of disability with 12.8%(Figur

218、e 2).These results are in line with the findings per income group,with a substantial proportion of the countries in the European Region being in the high-income category,whereas in the African Region there are more low-and middle-income countries.251.Health equity for persons with disabilities matte

219、rsFigure 2.Prevalence of disability,by WHO region,2021Percentage prevalence of disabilityAfricaAmericasEurope Western Pacific12.8%19.4%20%South-East Asia15.6%15.3%0%5%10%15%20%25%Eastern Mediterranean 14.7%Source:Global burden of disease data,2021The global prevalence of disability increases with ag

220、e,rising from 5.8%in children and adolescents aged 0-14 years,to 34.4%among older adults aged 60 years(Figure 3).This indicates that 1 in 3 older adults is a person with a disability.In terms of differences by sex,women have higher prevalence of disability compared to men.Estimates show that 14.2%of

221、 the male population have disability compared to 18%of the female population.Figure 3.Prevalence of disability,by age and sex,2021Percentage prevalence of disability5.8%14.3%32%5.8%18.4%36.6%5.8%16.4%34.4%0%5%10%15%20%25%30%35%40%0-14 15-5960+MenWomenBoth sexesSource:Global burden of disease data,20

222、2126Global report on health equity for persons with disabilities1.3.2 Time trendsThe most recent GBD data for 2010 show that a decade ago,approximately 1 billion people had significant disability.This means that within only 10 years,there has been an increase globally of more than 270 million people

223、 who now have disability(see Box 3 for more information on data used to compare time trends).This increase is due to demographic and epidemiological changes in the population.On the one hand,population numbers are rising,with almost 1 billion more people living today than in 2010.In addition,populat

224、ions are ageing,with a 40%increase,during the past decade,in people aged 60 years(37).On the other hand,the number of people with noncommunicable diseases,who are living longer and ageing with limitations in functioning is increasing.Comparisons between 2021 and 2010 using the latest GBD estimates r

225、eveal a significant increase in the number of people with musculoskeletal,mental health and neurological conditions,as well as sense organ conditions such as hearing and vision loss.In addition,more people are living and ageing with chronic health conditions.GBD 2021 data used for this study show th

226、at the number of people aged 60 years with noncommunicable disease is significantly higher compared to 2010.More information on the changes between 2021 and 2010 are provided in Annex 3.Alongside the increase due to demographic and epidemiological changes,health emergencies,including infectious dise

227、ase outbreaks,natural disasters and conflicts,can result in many new impairments and an increase in disability in the affected population.For example,traumatic injuries may contribute to a higher prevalence of disability in conflict-affected communities(38,39).According to a recent meta-analysis,of

228、people living in conflict settings,1 in 5(22%)have a mental health condition,such as depression,anxiety,post-traumatic stress disorder,bipolar disorder,or schizophrenia(40).Furthermore,many people are experiencing post COVID-19 conditions.Initial studies demonstrate that 1 in 5 people will have a ne

229、w disability when assessed six months after COVID-19 hospitalization(41).However,the evidence on how COVID-19 impacts disability prevalence in populations is still evolving.1.3.3 How do the prevalence estimates relate to other studies?A direct comparison between estimates is not possible due to the

230、diverse nature of data collection tools to produce them.For example,some studies use a single item in their censuses or national surveys to identify those 271.Health equity for persons with disabilities matterswith disability,for example,“Do you have a disability?”(42,43).Others use instruments asse

231、ssing functioning limitations that refer to a set of difficulties that people experience in undertaking specific activities such as walking,seeing,or hearing(44,45).While direct comparisons cannot be made,it is possible to provide some overview of how the trends presented in this report relate to da

232、ta from other organizations and initiatives.The United Nations Statistics Division maintains an international repository of disability statistics,which contains disability data from official statistics compiled from national population and housing censuses,household surveys,or administrative data.Da

233、ta from the past decade show prevalence estimates varying from 1.5%in Guinea,based on the 2014 Population and Housing Census,to 32.5%in Sweden,derived from the Living Conditions Surveys 2014/2015(46).While country estimates vary from one country to another,the overall trends in disability prevalence

234、 are consistent to those described in this report.For example,the prevalence is higher among women compared to men in almost all countries,as well as in high-income countries compared to lower-income settings.In a recent publication,UNICEF reported that approximately 1 in every 10 children aged betw

235、een 0 and 17 has disability globally(47).This estimate was derived from a harmonization of data from the Multiple Indicator Cluster Surveys,Demographic and Health Surveys(DHS),the European Health Interview Survey(EHIS)and the European Survey on Income and Living Conditions(EUSILC).A trend that is co

236、nsistent with the data presented in this report is the similar prevalence estimates between boys and girls.UNICEF found that in most countries and areas,no statistically significant differences were found in the proportion of boys and girls with disabilities.The WHO Model Disability Survey,which ass

237、esses difficulties in functioning which may arise due to a persons health or their living environment,was implemented in 15 countries over the past 7 years.The survey allows for obtaining the distribution of disability in the population,reporting estimates for no,mild,moderate or severe disability.T

238、he trends that were found in the countries that have implemented the MDS,are similar to those presented in this report.For example,prevalence is higher in women compared to men,and increases with age,reaching the highest values in individuals aged 60 years(48).The recent Disability Data Initiative r

239、eported estimates of disability prevalence for 41 countries published from 2008 to 2019(49).Data showed that the median prevalence of adults aged 15 who have functioning difficulties was 28Global report on health equity for persons with disabilities12.6%.The authors acknowledge that the studies rely

240、 on instruments focusing on difficulties in selected functioning domains,that do not capture all persons with disabilities,particularly persons with psychosocial disabilities.As with the WHO estimates,the Disability Data Initiative reports higher estimates of functioning difficulties in older rather

241、 than younger age groups,and among women more than men.1.4 Addressing health equity for persons with disabilities will advance the achievement of global health prioritiesThe estimates provided in this report reinforce the scale,the public health relevance,and the political importance of disability.T

242、he number of persons with disabilities has increased substantially over the last decade,and the continuous demographic and epidemiological changes suggest that it will continue to grow.This brings urgency to the need to advance health equity for persons with disabilities,as countries cannot meet the

243、ir global health priorities if 1.3 billion people are left behind.Based on the discussions taking place in international fora around health among heads of states,ministries of health and the general health policy community,including researchers,there is an agreement that to progress towards SDG3,cou

244、ntries need to concentrate on three key health priorities:i)achieving universal health coverage;ii)promoting healthier populations;and iii)addressing health emergencies.For several years,these three health agendas have been a topic of discussion at high-level governmental meetings and events.At the

245、annual G20 Health Ministerial meetings,7 ministers have repeatedly discussed universal health coverage,addressing the diversity of determinants of health to improve population health,and health emergencies,especially in the context of the COVID-19 pandemic.Similarly,central topics for the 2022 World

246、 Health Summit include investment for health and well-being,climate change and 7 https:/g20.org/about-the-g20/I firmly believe that inclusion is a prerequisite for sustainable development.”Honourable Mr Jonas Gahr Stre,Prime Minister,Norway 291.Health equity for persons with disabilities mattersplan

247、etary health,pandemic preparedness,and the resilience and equity of health systems.8In addition to international fora,several important high-level declarations and resolutions made during the past decades highlight the importance of the three global health priorities.For universal health coverage,th

248、e Declaration of Alma-Ata on Primary Health Care from 1978,and the 2018 Declaration of Astana are central and guiding documents(50).For improving the health of the population through addressing determinants of health,important documents include the Ottawa Charter for Health Promotion(1986)(51);the R

249、io Political Declaration on Social Determinants of Health(2011)(52);the Helsinki Statement on Health in All Policies(2013)(53);and the Shanghai Declaration on promoting health in the 2030 Agenda for Sustainable Development(2016)(54).The importance of addressing health emergencies was emphasized in t

250、he International Health Regulations(2005)and the Sendai Framework for Disaster Risk Reduction(55).The COVID-19 pandemic has emphasized more strongly the need to focus on these three priorities in a consistent manner.Besides the consequences in terms of illness and mortality,the pandemic has also adv

251、ersely impacted on countries health systems and on society as a whole.The Sustainable Development Goals Report 2021 documents how progress towards health goals has been derailed in the context of COVID-19,with 90%of countries reporting ongoing disruptions to essential health services and an exacerba

252、tion of health inequalities(56).The three global health priorities are interconnected and need to be tackled in a mutually reinforcing manner.Addressing health equity for persons with disabilities offers an important and unifying approach across all three priorities.Health equity can be advanced thr

253、ough building a fair health sector which provides opportunities for health for ALL members of society,regardless of their age,income level,gender,ethnic background,or any other social or economic reasons.This includes fair provision of health services without financial hardship(pursuing UHC);fair ac

254、cess to health promotion and prevention strategies to improve the health of the population;and fair response to health emergencies that protects everyone,including persons with disabilities.Advancing health equity across the three health priorities is a means of achieving SDG3 and progressing other

255、related SDGs.The following sections explore the relation between health equity for persons with disabilities and the global health priorities.8 https:/www.conference.worldhealthsummit.org30Global report on health equity for persons with disabilities WHO/Blink Media-Daiana Valencia1.4.1 Achieving Uni

256、versal health coverageHealth equity is inherent to the pursuance of UHC.The 2008 World Health Report defined UHC reforms as“reforms that ensure that health systems contribute to health equity,social justice and the end of exclusion,primarily by moving towards universal access and social health prote

257、ction”(57).By ensuring that financial barriers and service delivery models do not restrict access to the health services that any person needs,UHC provides an opportunity for health inequities to be addressed(Box 4).311.Health equity for persons with disabilities mattersUniversal health coverageUniv

258、ersal health coverage(UHC)means that all people have access to the health services they need,when and where they need them,without financial hardship9.UHC must be understood in a comprehensive way,as it takes into consideration not only the delivery of quality services,but also the strengthening of

259、the entire health system and intersectoral action.In terms of services,UHC includes the full spectrum of essential,quality health services,from health promotion to prevention,treatment,rehabilitation,and palliative care across the life course.These services respond to the needs of people and include

260、 those that are specialized and used most frequently by persons with disabilities.Quality is fundamental to all services(58).The delivery of services depends on several factors.Financing functions of the health systems are a central component and include revenue collection,pooling of resources,and p

261、urchasing of services,all of which are critical to the realization of UHC.More details on financing in the context of UHC are provided in Chapter 3.The means to achieve UHC is health system strengthening.More specifically,UHC progress is dependent on the wider health system strengthening approach of

262、 primary health care(PHC).For example,the delivery of services requires physical accessibility and adequate and competent health professionals with an optimal mix of skills at facility and community levels,who are equitably distributed and supported.Services,broadly,also include the provision of rel

263、evant health information,as well as universal access to drugs,products,and other goods.The realization of UHC requires intersectoral action(59)and needs to be understood as going beyond the health sector since some actions needed to improve access to health services lie in other sectors.For example,

264、while affordability of health services is the primary responsibility of the health sector,certain barriers that lie outside the health sector can have an impact on the individuals ability to receive services.For example transportation costs,which depend on other sectors policies may impede people re

265、aching health facilities.Box 4To advance UHC,countries must progress in three dimensions making choices regarding equity:i)expand priority services,deciding which services to focus 9 https:/www.who.int/health-topics/universal-health-coverage#tab=tab_132Global report on health equity for persons with

266、 disabilitieson first;ii)include more people,deciding who to include first;and iii)address barriers to effective coverage,such as reducing out-of-pocket payments(see Figure 1(60).While choices are clear,the implementation of these choices requires good long-term planning and clear strategies that en

267、sure inclusive and equitable progressive realization of UHC(61).In terms of service expansion,packages of services can be prioritized,based on relevant criteria such as prioritizing the most disadvantaged,the most costeffective services,or those that provide the most financial risk protection or in

268、reality,a balance amongst these and other criteria.Packages can include services specific to the underlying impairments and health conditions of persons with disabilities such as vision rehabilitation or the provision of assistive technology or mainstream services such as regular screening and exami

269、nations,or services for sexual and reproductive health.Health services need to be expanded as much as possible at community levels since much of the global population still lacks access to essential services close to where they live(62).In terms of financing,equitable health budgeting and progressiv

270、ely reducing out-of-pocket payments can contribute to expanding coverage of high-priority services to everyone,including persons with disabilities,supported by pooled funds from compulsory sources(some form of taxation).Figure 4:Universal Health Coverage CubeServices:which services are covered?Direc

271、t costs:proportionof the costscovered Population:who is covered?CURRENTPOOLEDFUNDS Extend tonon-covered Reduced costsharing and fees Includeotherservices Most countries are already taking steps and strengthening efforts to advance universal access to health care.However,inclusive actions are often n

272、ot put into practice,which leaves out priority populations living in marginalized conditions,thus compromising the realization of UHC.It is important,therefore,that the disability considerations of all age groups are brought to the fore when UHC commitments are being framed at global,regional,and co

273、untry 331.Health equity for persons with disabilities matterslevel and in subsequent political and technical decisions regarding the content of packages of essential care.The progress of UHC is dependent on the wider health system strengthening approach of Primary Health Care(PHC).PHC as a health-sy

274、stem strengthening approach entails three interrelated and synergistic components:i)integrated health services,with an emphasis on primary care and essential public health functions;ii)multisectoral policies and actions to address the wider determinants and risk factors for health;and iii)engaging a

275、nd empowering individuals,families,and communities to increase social participation,and enhance self-care and self-reliance in health(63).These three pillars are fundamental to addressing the factors contributing to health inequities in general,but particularly for persons with disabilities.The PHC

276、approach is explained in more detail in Chapter 3.1.4.2 Promoting healthier populationsPromoting the health of the population is a global public health priority that requires multisectoral policies and actions to effectively address the wider determinants and risk factors for health.Health system st

277、rengthening through the PHC approach is important because it encourages multisectoral action in delivering public health interventions.These interventions can be population-wide,such as tobacco taxation,water and sanitation infrastructure,or personal-level services,such as the provision of health ad

278、vice.The most effective interventions for tackling determinants and risk factors for health are often led by,and require the engagement of,sectors other than the health sector.For example,reducing exposure to risks such as unhealthy diets,tobacco use,harmful consumption of alcohol or use of drugs,in

279、sufficient physical activity,violence and injuries,or unsafe roads,all require a multisectoral approach to influencing public policies across social development,transport,finance,education,entertainment and leisure,agriculture and other sectors.Frequently,public health actions require population-bas

280、ed policy,legislation or regulatory measures including fiscal measures,as well as government engagement with the private sector.Health equity is at the core of this public health priority;however,the design,planning and implementation of multisectoral public health interventions frequently overlooks

281、 persons with disabilities who therefore do not benefit on an equal basis with others.For example,public health information is often not provided in accessible formats such as Braille,Easy Read(64),sign language interpretation,and captioning;and information is frequently not tailored to the needs of

282、 persons with disabilities or their caregivers(65).The physical 34Global report on health equity for persons with disabilitiesenvironment is also a barrier for many persons with disabilities.A lack of ramps,ground cover that is appropriately surfaced,accessible bathrooms,changing spaces and fitness

283、facilities and equipment can all create barriers to inclusion(66).In addition,the actions of health-care workers themselves can be a barrier:by making assumptions about the appropriateness of referral or recommendations,workers can block access to public health interventions for persons with disabil

284、ities(67).A key reason for these barriers is that responsibilities for public health and disability inclusion are often not clarified within governments,with some struggling to define whose role it is to provide inclusive public health interventions.This is particularly the case when considering cro

285、ss-sectoral public health interventions,such as water sanitation and hygiene(6871).By assuming its stewardship role and ensuring that cross-sectoral public health interventions are inclusive and provided in an equitable manner,the health sector can faster achieve improvements in the health and well-

286、being of the population.The responsibility for public health policies and actions often spans departments or sits outside departments of health;with disability,this can result in a lack of cross-ministry and cross-sectoral coordination.Therefore,disability inclusion needs to be acknowledged and desi

287、gned as a necessary component of public health initiatives,so that accessibility is in-built from the start.Consultation with persons with disabilities is critical to achieving this.The health sector,as a steward for intersectoral action,coordinates processes,which ensures three things:first,that a

288、proper alignment across all stages of implementation of a public health intervention is established;second,that knowledge,expertise,reach,and resources can be leveraged from other sectors and partners,and thereby benefit from their combined and varied strengths;and third,that health equity is the dr

289、iving force for achieving progress in improving population health.Recommended disability-inclusive actions to advance health equity in cross-sectoral public health interventions is provided in Chapter 3.351.Health equity for persons with disabilities matters1.4.3 Addressing health emergenciesNo coun

290、try was fully prepared for a pandemic of the scope and scale of COVID-19(73).As a result,addressing health emergencies has become even more prominent as a global health priority and health equity more central to such emergencies.In relation to persons with disabilities,particularly women and girls,t

291、he evidence shows that during the pandemic they were,and continue to be,directly affected and disproportionately disadvantaged due to the increased risk of infection,morbidity,and mortality.There is evidence that COVID-19 infection rates are 45 times higher among persons with disabilities currently

292、living in residential or long-term care facilities compared with the general population(74),which is often due to the inability to provide basic services or ensure prevention measures are put in place.Persons with intellectual disabilities are 45 times more likely to be admitted to hospital,and up t

293、o 8 times more likely to die from COVID-19 than those without an intellectual disability(75).The disproportionate impact on persons with disabilities extends to a range of health emergencies.For example,children with disabilities are often more at risk of negative health outcomes in food security-re

294、lated emergencies,with evidence that they are 1.52.7 times more likely to be underweight for age,stunted,and have low body mass index for age when compared to neighbour or family controls(76).We are still invisible.But the pandemic has made us more invisible.”(72)Ana,a 57-year-old woman with disabil

295、ity in Panama during COVID-1936Global report on health equity for persons with disabilities WHO/Ala KheirPersons with disabilities are also affected indirectly in emergencies,due to the impact of public health emergency response measures.Looking more closely at the substantial evidence relating to i

296、nfectious disease outbreaks,such as COVID-19,persons with disabilities are at risk of new or worsening health conditions.Lockdowns,physical distancing requirements,school closures,disruptions to health services,and prioritization of health services have hampered access to regular health consultation

297、s,medication,psychosocial support,rehabilitation,including assistive technology provision,as well as personal assistant and home and school-based support services.All of these factors are critical to a persons independence and autonomy(77,78),and add pressure to families and informal care mechanisms

298、(79).Isolation due to physical distancing and movement restrictions has exacerbated the risk of violence against persons with disabilities,especially women,older persons,and transgender and non-binary persons with disabilities(8083).People who are deaf or hard-of-hearing also faced challenges with c

299、ommunication during the COVID-19 pandemic due to preventative measures such as use of face masks and physical distancing(84).Furthermore,persons with disabilities are now facing greater economic impacts(e.g.,due to job losses and reduced household income)compared to those without disabilities,adding

300、 to higher rates of poverty(8588).371.Health equity for persons with disabilities mattersAdvancing health equity for persons with disabilities is central to all efforts to protect populations in health emergencies.There is widespread recognition that strengthening health systems and addressing the s

301、ocial determinants of health are critical to effective,sustainable,and equitable health emergency responses.Health systems strengthening and emergency preparedness have been described as“two sides of the same coin”:functioning and effective health systems enable better preparedness and response to h

302、ealth emergencies(89).WHOs Health Emergency and Disaster Risk Management Framework highlights how essential health service coverage and public health interventions improve the overall health status of affected populations,contributing to the prevention of outbreaks,mitigating risks and building comm

303、unity resilience to such hazards(90).As social determinants of health and community engagement are still largely absent from wider health emergency frameworks,there are calls for a“unified Global Health Security Universal Health Coverage Agenda which should be built with intersectional equity at the

304、 centre”(91).Chapter 3 elaborates on targeted actions that can be integrated to the PHC approach to ensure disability inclusion in health emergencies(92).1.5 Addressing health inequities for persons with disabilities benefits everyoneIn order to achieve good health outcomes for persons with disabili

305、ties,it is essential to address the health inequities they experience.Taking action on health inequities benefits everyone simultaneously by contributing to universality,people-centeredness,and non-discrimination in health services and public health promotion,thereby allowing health services to beco

306、me more effective and responsive.Older people,persons with noncommunicable diseases,migrants and refugees,and frequently unreached populations,such as those from lower socioeconomic backgrounds,or people with limited literacy skills,often experience similar barriers.For example,inaccessible physical

307、 environments,stigmatization by health-care providers and community Achieving health and well-being for all must include addressing the barriers that prevent people with disabilities from accessing the health services they need.Removing these barriers benefits everyone,especially vulnerable populati

308、ons,older people,people with temporary limitations,or those living with chronic conditions.”Tedros Adhanom Ghebreyesus,WHO Director-General38Global report on health equity for persons with disabilitiesmembers,health information that is not in an understandable format,and financial barriers to access

309、ing health services can discriminate against various groups of health service users.All of these groups can benefit from approaches that target the persistent barriers to inclusion of persons with disabilities in the health sector.Older persons present a good example of a population that will benefi

310、t from disability-inclusive actions.Despite the predictability and accelerating pace of ageing populations,currently many older adults experience similar health inequities as persons with disabilities.This is also because a large percentage of the population of persons with disabilities are above 60

311、 years of age.Older people often experience barriers when accessing the basic resources necessary for living a life with meaning and dignity,including daily barriers that prevent them from experiencing good health and well-being and fully participating in society(93).These difficulties are exacerbat

312、ed for people in emergencies,where resources are more limited and the barriers higher(94).In addition,older adults are often subject to institutional or interpersonal ageism through the stereotypes,prejudice and discrimination directed towards them on the basis of their age.This very often intersect

313、s with the discrimination and stigmatization associated with the disability experienced by older people.For older people,ageism is associated with a shorter lifespan,poorer physical and mental health,cognitive decline,increased social isolation and loneliness,and increased risk of violence and abuse

314、(95).Globally,the number of people aged 60 years and above is expected to double by 2050;this unprecedented demographic change will require a radical response from society and the health sector.Four main actions identified through the Global strategy and action plan on ageing and health,10 and the r

315、elated United Nations Decade of Healthy Ageing 20212030,include combating ageism;providing person-centred integrated care andlong-term care;providing community-based services for people who need them;and creating age-friendly environments.Cross-cutting to these actions are four enablers:i)listening

316、to diverse voices and enabling meaningful engagement of older people;ii)nurturing leadership and building capacity to take appropriate action integrated across sectors;iii)connecting various stakeholders worldwide to share and learn from the experiences of others;and iv)strengthening data,research a

317、nd innovation to accelerate implementation(94).Efforts towards the inclusion of disability in the health sector will contribute to the advancement of all the above actions for two reasons.First,commonly experienced health inequities can be addressed through inclusive actions;and second,10 https:/www

318、.who.int/publications/i/item/9789241513500.391.Health equity for persons with disabilities matterssince a substantial proportion of older adults have disabilities,disability actions that address their needs can be set as good practices for the ageing population overall.Addressing health equity for p

319、ersons with disabilities can benefit people living with noncommunicable diseases(NCDs),communicable diseases or short-term injuries(96).NCDs are increasing in magnitude globally because of population ageing and an epidemiological shift towards chronic conditions.Disability is strongly linked with NC

320、Ds.Persons with disabilities are more vulnerable to NCDs,often because of exclusion from health-care services or other unjust factors,and,as shown in section 1.3,the health condition underlying a disability is frequently a NCD.In addition,people living with NCDs may develop secondary impairments,whi

321、ch can cause restrictions in activity and participation when supportive personal and environmental factors are not in place(96).Inclusive strategies and actions also benefit people with communicable diseases such as malaria,tuberculosis,or neglected tropical diseases,and those with short-term injuri

322、es due to accidents or other causes,or with reduced mobility from surgical procedures.People with these conditions can often experience limitations in their functioning when facilitating environmental factors are unavailable.Advancing disability inclusion can also benefit migrants,refugees,internall

323、y-displaced persons and asylum seekers in the context of conflicts or natural disasters.These populations very often experience similar barriers to those faced by persons with disabilities.Forced displacement often exacerbates the risk of violence,including sexual and domestic abuse,exploitation by

324、family members,discrimination,and exclusion from health services.In contexts of forced displacement,persons with disabilities are more likely to be left behind in all aspects of humanitarian assistance due to a range of environmental barriers hindering access to health care,information,and human rig

325、hts protection(97).Persons with disabilities are often under-identified at reception,which negatively impacts their access to protection and assistance.Therefore,setting a disability-inclusive agenda within the health sector,which includes We advocate for the meaningful involvement of people living

326、with NCDs so their lived experience is heard.I had to struggle to access healthcare and it took me nine years to get diagnosed.When I speak to health professionals and people in the government,then they understand theres a lot of work to be done.If I dont,who knows what will happen to the next perso

327、n like me.”Christopher Agbega,disability advocate for the Ghana NCD Alliance40Global report on health equity for persons with disabilitieshealth emergency management,has multiple effects which not only can benefit populations of migrants and refugees and reduce the health inequities they face,but al

328、so support advancements in gender equality.WHO/NOOR/Sebastian ListeEvidence shows that gender inequality contributes to poorer health outcomes for women and girls with disabilities;globally,they remain disadvantaged compared to men with disabilities in the social determinants of health,such as emplo

329、yment,education,and risk of violence(98).Furthermore,women and girls disproportionately assume caregiving roles for persons with disabilities(99102),which has been linked to loss of opportunities(103,104),mental health concerns(100,105107),and in some situations,an increased risk of violence for the

330、se groups(104,108).Addressing the contributing factors to health inequities for persons with disabilities will therefore facilitate advancements in gender equality not only among persons with disabilities,but also within their wider support network.The opposite is also true:a firm focus on ensuring

331、gender responsive and gender equitable approaches when meeting the needs of persons with disabilities,contributes to reducing the health inequities that they and their families experience.For example,confronting gender-based violence,abuse and marginalization is important to also improving health ou

332、tcomes for women and girls with disabilities(109).411.Health equity for persons with disabilities matters1.6 Health equity and meaningful participation in societyAdvancing health equity contributes to the wider participation of persons with disabilities in society.Having good health and well-being i

333、s important for people to build a good and meaningful life.Conversely,for persons with disabilities,a lack of access to health care on an equal basis as others hinders the realization of other fundamental rights,such as to education or employment.A study carried out in Nepal revealed that a major reason why children with disabilities do not go to school is because of poor health(110).If persons wi