Global Disability Context and Wheelchair Mobility

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Introduction

Over a billion people in the world today are estimated to live with some form of disability, which corresponds to about 15% of the world's population. These people generally have poorer health, lower education achievements, fewer economic opportunities and higher rates of poverty. This is largely due to the barriers they face in their everyday lives, rather than their disability. Between 110 million (2.2%) and 190 million (3.8%) people 15 years and older have significant difficulties in functioning. Furthermore, the rates of disability are increasing in part due to ageing populations and an increase in chronic health conditions. Disability is extremely diverse. While some health conditions associated with disability result in poor health and extensive health care needs, others do not. However all people with disabilities have the same general health care needs as everyone else, and therefore need access to mainstream health care services.

The World Report on Disability published in 2011 by the World Health Organization and the World Bank, amassed a wide range of evidence that, across the globe, people with disabilities have poorer access to health care and poorer health outcomes than nondisabled people. The disparities are especially great in low-income contexts, within which most people in the world find themselves. The disparities relate to almost every aspect of health and health care.

It is estimated that there are 65 million people globally who would benefit from wheelchairs but that 20 million of these people did not have access to them. The prevalence of wheelchair use is rising, in part due to the aging of the population. Of the wheelchairs in use in highly developed parts of the world, about 70% are manual wheelchairs, with the remainder divided about equally between powered wheelchairs and scooters.

Rights to a Wheelchair

On 13 December 2006 the United Nations Convention on the Rights of Person with Disabilities (UNCRPD) and its Optional Protocol (A/RES/61/106) was adopted at the United Nations Headquarters in New York, opening for signature on 30 March 2007 and finally entering into force on 3 May 2008, becoming international law. While there are basic human rights that apply to everybody, the UNCRPD focuses on ensuring that everybody recognises that these rights also apply to people with disabilities. Intended as a human rights instrument with an explicit, social development dimension, the UNCRPD "adopts a broad categorization of persons with disabilities and reaffirms that all persons with all types of disabilities must enjoy all human rights and fundamental freedoms, clarifying how all categories of rights apply to persons with disabilities and identifies areas where adaptations have to be made for persons with disabilities to effectively exercise their rights and areas where their rights have been violated, and where protection of rights must be reinforced".

Article 20 provides for the right to personal mobility, which is means the means and ability to move in a manner, at a time of one’s own choice. It affirms that "States Parties shall take effective measures to ensure personal mobility with the greatest possible independence for persons with disabilities", which is a commitment to provide mobility aids, such as wheelchairs, that make personal mobility possible. This key international declarations create rights to wheelchairs because it is universally recognized that an appropriate wheelchair is a precondition to enjoying equal opportunities and rights, and for securing inclusion and participation.

UNCRPD Article 20 - Personal Mobility

States Parties shall take effective measures to ensure personal mobility with the greatest possible independence for persons with disabilities, including by: Facilitating the personal mobility of persons with disabilities in the manner and at the time of their choice, and at affordable cost; Facilitating access by persons with disabilities to quality mobility aids, devices, assistive technologies and forms of live assistance and intermediaries, including by making them available at affordable cost; Providing training in mobility skills to persons with disabilities and to specialist staff working with persons with disabilities; Encouraging entities that produce mobility aids, devices and assistive technologies to take into account all aspects of mobility for persons with disabilities.

Wheelchairs and wheelchair services are critical to ensure people with mobility impairments have personal mobility. Wheelchair Service Personnel can help to implement Article 20 of the UNCRPD by:

• Provision of an appropriate wheelchair for wheelchair users who access their service;
• Development of adequate training for wheelchair users to learn how to use their wheelchair effectively including transfers, propulsion, and maintenance enabling them to be as independent as possible for the individual;
• Educate family members to support wheelchair users to be as independent as they can be.

Independent mobility makes it possible for people to study, work, participate in cultural life and access health care. Without wheelchairs, people may be confined to their homes and unable to live a full and inclusive life. It is a vicious circle: lacking personal mobility aids, people with disabilities cannot leave the poverty trap. They are more likely to develop secondary complications and become more disabled, and poorer still. If they are children they will be unable to access the educational opportunities available to them, and without an education they will be unable to find employment when they grow up and will be driven even more deeply into poverty.

Personal mobility is an essential requirement to participating in many areas of social life, and wheelchairs are for many the best means of guaranteeing personal mobility. With an appropriate wheelchair, people with mobility impairments can more easily access and enjoy many of the other human rights outlined in the UNCRPD including;

• Living independently and being included in the community (Article 19) ;
• Right to education (Article 24);
• Right to the enjoyment of the highest attainable standard of health (Article 25);
• Right to work and employment (Article 27);
• Right to participate in political and public life (Article 29);
• Right to participate in cultural life, recreation, leisure and sport (Article 30).

To find out more detail about the United Nations Convention on the Rights of Person with Disabilities (UNCRPD) click here or to access the United Nations Convention on the Rights of Persons with Disability in it's entirety, click here.

Summary

Disability is not only a public health issue, but also a human rights and development issue. WHO’s efforts to support Member States to address disability are guided by the overarching principles and approaches reflected in the WHO Global Disability Action Plan 2014-2021, the World Report on Disability, and the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). While many countries have started taking action to improve the lives of people with disabilities, much remains to be done. The evidence in the World Report on Disability suggests that many of the barriers people with disabilities face are avoidable and that disadvantages associated with disability can be overcome. The report calls on governments to review and revise existing legislation and policies for consistency with the United NationaConvention on the Rights of Persons with Disabilities (CRPD) and to develop national disability strategies and action plans.

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