We know from El Gibbs’ excellent #CripCroakey posts on this site, that the health impacts of disability go far beyond the physical aspects of the disability itself.
The post below, drawn from Disability Discrimination Commissioner Alastair McEwin’s recent Southgate Institute for Health, Society and Equity Oration, extends this idea, and suggests ways in which current initiatives in Australia could be used to eliminate the harm caused by the way Australian society treats people with disabilities.
Dr Toni Delany writes:
The eighth Oration (#sgateoration) of the Southgate Institute for Health, Society and Equity was held at Flinders University last week.
The guest orator was Alastair McEwin, who commenced as Australia’s Disability Discrimination Commissioner in August 2016. McEwin focused his Oration on ‘Achieving the right to health for people with disability: eliminating discrimination in a changing world’.
The disability gradient in health
“There is a clear disability gradient in health,” stated McEwin as he argued that the most significant impediments for people with disabilities are not physical.
Instead they stem from the disabling effects of social, environmental and attitudinal barriers that prevent the full and equal participation of people with disabilities across all areas of life in Australia.
“Being discriminated against, disempowered, marginalised and unable to access opportunities and activities on an equal basis are far more significant determinants of health than any disability.”
McEwin offered stories and examples to illustrate the disabling effects of social and economic barriers, which often result in the exclusion of people with disabilities from decision making about personal expression, social participation and reproduction.
Systems that do not recognise or support the needs of people with disabilities also result in reduced opportunities for participating in education, meaningful employment and civic duties.
The deficit lens and other barriers to health
McEwin argued that this is because people with disabilities are most often viewed through a deficit lens, making system changes appear largely undesirable and too costly.
This denies the productive potential of people with disabilities, however, and stifles the benefits that may flow to communities, educational institutions and workplaces through system changes that facilitate inclusivity.
People with disabilities also experience barriers to accessing information about protecting and promoting personal wellbeing, and finding appropriate health care.
The resulting impediments lead to co-morbidities, reduced life expectancy and the imposition or acceptance of inappropriate and potentially unsafe health care.
Such injustices result in generally poorer health and wellbeing for people with disabilities, both caused and exacerbated by discrimination, which, ultimately, impedes access to civil, political, cultural, social and economic rights.
“Discrimination and circumstance compromise the full realisation of the right to health, and this is why achieving the right to accessible health is so important to the full citizenship of people with disabilities.”
Areas for action
McEwin’s oration is timely. 2016 marks ten years since the Australian Government signed the United Nation’s Convention on the Rights of Persons with Disabilities.
The Convention provides guidance about how government policy and action can shape environments that foster inclusivity and contribute to the promotion of wellbeing for people with disabilities.
The National Disability Insurance Scheme (NDIS) is also being implemented around the country. Both the Convention and the NDIS provide the foundations for major social reform.
Throughout his Oration McEwin identified several areas that should be acted upon to facilitate, and further progress, such reform through the creation of environments that contribute to the wellbeing of people with disabilities.
- Government policy must be underpinned by the recognition that people with disabilities have the right to enjoy the highest attainable standard of health without system level or personal discrimination on the basis of disability.
- The ongoing discrimination faced by Indigenous Australians, particularly those with a disability, in Australian health, justice and education systems must be recognised and prioritised for intervention.
- Government focus should shift from the dominant institutional model of housing for people with disabilities, and be replaced by efforts to offer affordable housing that will contribute to wellbeing. This involves the provision of housing that is close to relatives, transport and networks of formal and informal support.
- Research should direct attention to the social, economic and attitudinal barriers that restrict the opportunities available to people with disabilities. Within such work, disability should not be viewed as a physical problem but rather as a social issue that is amenable to improvement through changes in the way that Australian society is structured and the way that opportunities are distributed.
- The NDIS is intended to position people with disabilities at the forefront of decision making about their lives by providing support that is controlled by people with disabilities themselves. All academics, practitioners and advocates can play a role in ensuring that the ultimate intent of the NDIS is achieved and protected by committing to this personally, but also by advising current and future governments about its importance. One strategy for doing so is advocating for continued commitment to the National Disability Strategy (2010 – 2020), which outlines a suite of actions on the social determinants of health that are intended to shape environments in ways that contribute to the wellbeing of people with disabilities.
Realising health equity
Alastair McEwin concluded the Oration by reflecting on the importance of continuing the legacy of Dr Deane Southgate, whom the Southgate Institute for Health, Society and Equity is named after, and whom the Oration series honours
Dr Southgate was a South Australian GP and public health advocate with a desire to direct attention to, and address, the social factors that exacerbate vulnerability, oppress and marginalise. His practice reflected a deep understanding of the impacts of people’s circumstances, and the environments in which they live, on their health and opportunities.
His example is particularly relevant to work in the area of disability, where discrimination and injustices operate as significant impediments to the realisation of health equity for all.
Dr Toni Delany is a Research Fellow at the Southgate Institute for Health, Society and Equity, Flinders University. On twitter @ToniDelany
