On 30 January 2013, disability rights scholar Anna Lawson delivered the Annual Lecture of the McGill Research Group on Health and Law. Lawson is Deputy Director of the Interdisciplinary Centre for Disability Studies at the University of Leeds (UK).
The lecture highlighted how making progress in disability rights depends on both the achievement of the rights to health and equality. In other words, we need both equality in health (i.e. equality in accessing care, refusing unwanted treatment) and health in equality (i.e. preventing disability status from being a determinative factor in where people live and work). Lawson also stressed the importance of implementing the Convention on the Rights of Persons with Disabilities (CRPD) as well as an integrated approach to disability issues that reaches across disciplines.
Below is an overview of the lecture.
- 15% of the world’s population is disabled
- 1/5 of the world’s poorest are disabled
- There is a bilateral link between poverty and disability: if you are poor, you are more likely to become disabled; if you are disabled, you are more likely to be poor.
- 35% of all children not in school are disabled
- only 2% of disabled children are enrolled in school
- disabled people experience disproportionately high levels of unemployment
Equality in Health
Disabled people experience significant inequality across the globe. Realizing equality in health means achieving equality in the following areas:
EQUALITY IN REFUSING UNWANTED TREATMENT
Most people have the right to refuse treatment with informed consent. Disabled people, in particular girls and women, have been victim to the imposition of treatment such as mental health therapies and sterilisation. The CRPD says imposition of treatment without informed consent is torture and that there are ways for states to support disabled people in exercising their legal capacity in such situations.
EQUALITY IN ACCESSING GENERAL HEALTH CARE
Where health care is available, disabled people should have access like everyone else. However, there are institutional obstacles that currently prevent disabled people from accessing care in the same way as others. These obstacles include lack of accessible transport, inaccessible buildings and medical equipment, lack of sign language interpreters, and lack of awareness and understanding of disability issues by care workers.
EQUALITY IN ACCESSING DISABILITY-SPECIFIC TREATMENT
Disabled people may require specialized services related to their particular disabilities. These services place added demands on governments in caring for their citizens.
EQUALITY IN ACCESSING UNDERLYING DETERMINANTS OF HEALTH
There should be non-discriminatory access to an adequate standard of living, food, clothing, water, public housing, social protection and poverty reduction programs and disability-related expenses. Stigma can often cause disabled people to be refused these basic services. Therefore, states must challenge the stigmatization of disabled people in order to create access to water and sanitation.
Health in Equality
Health plays an important role in trying to realize equality.
DISABILITY STATUS RESTRICTS EQUALITY
Diagnoses of disability affect where people live, where they are educated, where they work, and the type of welfare benefits they receive (for instance, if one chooses to receive disability benefits instead of working full time).
HEALTH LIMITS THE ABILITY OF DISABLED PEOPLE TO BRING DISCRIMINATION CLAIMS
Disabled people must show they meet a certain definition of disability before bringing a claim for discrimination. This is especially difficult for people with fluctuating health conditions or progressive conditions that fall outside the accepted definition.
The Promise of the CRPD
The CRPD was celebrated upon its adoption by the disability movement as the beginning of a new era for disability rights. There are innovative provisions within the convention. For example, Art. 4(3) states that disabled people should be actively involved and consulted by governments in policies affecting them. However, the CRPD does not provide guidance on how actively involve disabled people in these decisions. It is hopeful that these details will come through individual and group complaints to the UN Committee on the Rights of Persons with Disabilities, which has already heard its first case (see HM v Sweden).
Going forward, we need to ensure that health does not inhibit equality. Implementing the CRPD will contribute to this goal, but there also need to be inclusive development practices that integrate disability into development frameworks like the Millennium Development Goals.
Take away message: until equality is tackled, disability will be a big problem. We must reach beyond our professional and disciplinary boundaries to begin addressing inequalities around us.