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Dec 03
Get over your discomfort about disability and be an agent of change… it starts with you

​By: Thesandree Padayachee (Programme Manager for Health Systems Research at the Health Systems Trust and PhD candidate in Disability Studies at the University of Cape Town)​​

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The year 2020 will forever be etched in our memories as a year of challenge and extreme change. A year that compelled us to reassess the values and priorities that guide all aspects of our lives and reflect on the merits of how we operate as a society. How we value and respond to the needs of the most vulnerable and marginalised, such as persons with disabilities, can often serve as the barometer of our progress as a society. Disability inclusion, is a virtuous societal imperative with global support and reach that remains a poorly understood and under-prioritised issue across many development sectors, including health.

The global commitment to address marginalised and vulnerable populations such as persons with disabilities is clear and if the public health community has been slow to respond to the call, chances are they will have very little choice going forward. Article 25 of the United Nations Convention on the Rights of Persons with Disabilities is an important statement for public health professionals to reflect on. It recognises that persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability. Similarly our public health drive to achieve Universal Health Coverage (UHC) is the cornerstone of the global health agenda, and an important target of the Sustainable Development Goals. Public health practitioners, researchers and health service implementers are, therefore, key actors who play a pivotal role in driving this development agenda within the heath sector, ensuring that even at its point of greatest weakness and strain, our health system upholds the value of "leaving no one behind."​

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Persons with disabilities are at higher risk for poor health outcomes. There are those who will require specialist healthcare services as well as rehabilitation, however; persons with disabilities also have basic healthcare needs much like everyone else and have the same right as you and I do of accessing preventative, promotive and curative healthcare services that offer the best chance of leading a healthy and fulfilling life. During the course of 2020; the world witnessed first-hand how the COVID-19 pandemic exposed the dire effect that our health system weaknesses have on vulnerable populations. Locally, the well-documented, fragmented nature of our healthcare services in South Africa have only served to deepen inequities relating to the availability, affordability and access to health services for people with disabilities, and during times of crises this gap widens with disastrous consequences. The situation is further exacerbated by stigma and discrimination often experienced by persons with disabilities when accessing public health services.

The disappointment that stigma still exists around disability isn't surprising, but the awkwardness and discomfort that the topic brings to public health conversations is quite a different matter and one that needs to be well understood and addressed. Barring the exceptions, many public health professionals avoid engaging in disability-related issues despite the fact that a large part of public health is promoting healthcare equity, quality and accessibility. What is it about the term "disability" and all things disability-related that makes us feel so out of touch with our humanity? Perhaps it is our lack of understanding and the relative invisibility of persons with disabilities that fuels our fear? People who are not seen are not understood. Bringing disability out of the shadows and into the centre of all debates around public health policy and service delivery plans is one way to address this. But this depends on the key players having the willingness to make the shift and see disability inclusion as a core value of public health and a way of thinking and being. Keeping disability on our public health agenda by constantly and actively reflecting on how the system can be strengthened to address the needs of persons with disabilities is what we all must do. It is needed to not just to address the invisibility of disability but also to reignite our connectedness to what it means to be vulnerable and have unmet needs. It is through this understanding that we will be better equipped to problem solve our way towards the creation of inclusive health systems.

Beyond the individual shift that is required, the department of health and the many partner organisations, non-profit organisations and academic institutions must drive change at strategic and operational levels of the health system. These entities need to take a deep dive into their own priorities, policies and workplace culture to identify key levers of change and activate them with urgency. Employment Equity Committees, for instance, serve an important function in driving the change towards a more equitable and inclusive workplace, but also in ensuring that persons with disabilities are well represented in the workforce that is striving for change and inclusion.​

Today is the International Day for Persons with Disabilities with the theme: Building Back Better: toward a disability-inclusive, accessible and sustainable post COVID-19 World. My call to all HST staff, public health professionals and others is to overcome your fear of the unknown and embrace your important role in making healthy lives a reality for the most vulnerable in our society. The global call to the public health community is loud and crystal clear; we are the change that is needed.  

Please also read the Secretary-General's report on the implementation of the UN Disability Inclusion Strategy:​​

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It's aslo the final countdown to the official release of the South African Health Review (SAHR) 2020, a flagship publication produced by the Health Systems Trust (HST) and addressing key health issues that affect South Africans collectively in the public and private health sectors. One of the publication's focal areas in this edition is improving access to healthcare and the overall quality of life for persons with disabilities, and accordingly, this blog article reminds us not only to count our blessings one-by-one, but also sit up and take note that every individual can play their part in raising awareness. 

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