Disability is a global public health problem as people with disability, throughout the life course, face widespread barriers in accessing health and related services, such as rehabilitation, and has worse health outcomes than people without disability. Disability is any continuing condition that restricts everyday activities. The International Classification of Functioning, Disability and Health (ICF) defines disability as an umbrella term for impairments, activity limitations and participation restrictions. Impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; participation restriction is a problem experienced by an individual in involvement in life situations.
Disability is not just a health problem; it is the interaction between individuals with a health condition and personal and environmental factors (such as negative attitudes, inaccessible transportation and public buildings, and limited social supports). Overcoming the difficulties faced by people with disabilities requires interventions to remove environmental and social barriers.
Over 1 billion people, about 15% of the world's population have some form of disability. Of this number 110 million to 190 million people of 15 years and older have significant difficulties in functioning and 93 million people less than 15 years of age live with a moderate or severe disability.
In India according to the Census 2011, 2.2% of population had some form of disability. The prevalence of disability was found to be more in rural areas (2.24%) as compared to urban areas (2.17%) and more among males (2.4%) than among females (2%). The proportion of different types of disability among people with disability reported as: (i) seeing 18.8%, (ii) hearing 18.9% (iii) speech 7.5% (iv) movement 20.3% (v) mental retardation 7.6% (vi) mental illness 2.7%, (vii) multiple disabilities 7.9% (viii) Any other 18.4%.
In the coming years, prevalence of disability will continue to increase due to increase in ageing populations and with the global increase in chronic health conditions such as diabetes, cardiovascular disease, cancer and mental health disorders, injuries, car crashes, falls, violence.
All people with disabilities have the same general health care needs as everyone else; however they have greater unmet health care needs than people without disabilities. Evidence suggests that people with disabilities face barriers in accessing the health and rehabilitation services they need in many settings. According to World Health organization (WHO) estimates:
People with disabilities have generally poorer health, lower education levels, fewer economic opportunities and higher rates of poverty than people without disability. This is due to many obstacles they face in their everyday life and due to lack of services available to them.
Disability is now understood to be a human rights issue. People are disabled by society, not just by their bodies. These barriers can be overcome, if governments, nongovernmental organizations, professionals and people with disabilities and their families work together.
General symptoms for a disabled person according to type of disability-
i. Disability in seeing/ visual disability: A visually disabled person does not have any light perception (both eyes taken together) or has light perception but cannot count fingers of a hand (with spectacles/contact lenses if he/she uses spectacles/contact lenses) from a distance of 3 meters (or 10 feet) in good day light with both eyes open.
The visually disabled persons may be categorized into two broad groups:
Blindness: A person who does not have light perception and a person who has light perception but cannot count fingers at a distance of 1 meter even with spectacles are taken as blind.
Low vision: A person who has light perception but cannot count fingers up to a distance of 3 meters even with spectacles is taken as a person with Low Vision.
ii. Disability in speech/speech disability: A person is unable to speak like normal persons.
iii. Disability in hearing/hearing disability: A person may have problem in hearing day to day conversational speech when hearing aid is not used. A person may have the following degrees of hearing disability:
(A person who has problem only in one ear is not considered as having hearing disability).
iv. Disability in movement/ locomotor disability
(a) Loss or absence or inactivity of whole or part of hand or leg or both (due to amputation, paralysis, cerebral palsy, deformity or dysfunction of joints) which affects his/her “normal ability to move self or objects” and
(b) those with physical deformities in the body (other than limbs), such as, hunch back, deformed spine regardless of whether the same caused loss or lack of normal movement of body are considered as disable with locomotor disability. Thus, dwarfs and persons with stiff neck of permanent nature who generally do not have difficulty in the normal movement of body and limbs are also to be treated as disabled.
v. Mental disability A mentally disabled person has difficulty in understanding routine instructions or does not carry out his/ her activities like others of similar age or exhibited behaviours like talking to self, laughing/crying, staring, violence, fear and suspicion without reason. The mentally disabled are categorized into two groups viz. mentally retarded and mentally ill. If persons with mental disability manifests this behaviour since birth/ childhood but before 18 years of age and the person was late in talking, sitting, standing or walking, they are classified as ‘mentally retarded’. The remaining mentally disabled persons are classified as ‘mentally ill’
vi. Leprosy Cured Persons who have been cured of leprosy and are having extreme physical deformity as well as advanced age which prevents him from undertaking any gainful occupation.
Risk factors for the disabilities:
Communicable diseases (Infectious diseases) such as lymphatic filariasis, tuberculosis, HIV/AIDS, and other sexually transmitted diseases; neurological consequences of some diseases such as encephalitis, meningitis, and childhood cluster diseases (such as measles, mumps, and poliomyelitis) contribute to disability.
Non communicable diseases (NCDs)-
Injuries due to road traffic accidents, occupational injury, violence, conflicts, falls and landmines have long been recognized as contributors to disability.
Mental health problems- mental health retardation and mental illness are the causes of mental disability. In more than 50% cases mental retardation has been reported to be caused by serious illness or head injury in the childhood and birth defects. Mental retardation was observed mostly at birth or at very early ages of life while the problem of mental illness is more of an old age problem.
Those with lower education levels, lower incomes, and those who are unemployed were also more likely to suffer a disability.
There is higher risk of disability at older ages.
Diagnosis of particular disability may be done at health care centre with the help of a specialist. A concerned medical authority in Government hospital can issue a disability certificate*.
The disability certificate and/ or Identity card is the basic document that a person with any disability of more than 40 percent requires in order to avail any facilities, benefits or concessions under the available schemes.
Increasing evidence suggests that, as a group, people with disabilities experience poorer levels of health than the general population. By improving access to quality, affordable health care services, health outcomes for people with disabilities can be improved. Primary health-care services with the support of specialists can provide health services to people with disability. Health services should be focused for the following health conditions:
Primary health conditions: A primary health condition is the possible starting point for impairment can lead to a wide range of impairments, including mobility, sensory, mental, and communication impairments.
Secondary conditions: Secondary conditions occur in addition to (and are related to) a primary health condition, and are both predictable and therefore preventable; such as depression is a common secondary condition in people with disabilities, osteoporosis is common in people with a spinal cord injury or cerebral palsy.
Co-morbid conditions occur in addition to (and are unrelated to) a primary health condition associated with disability. One study indicated that adults with developmental disabilities had a similar or greater rate of chronic health conditions such as high blood pressure, cardiovascular disease, and diabetes (due to increased physical inactivity) than people without disabilities.
Age-related conditions: The ageing process for some groups of people with disabilities begins earlier than usual and they may experience age related health conditions (such as osteoporosis, loss of strength and balance) more frequently.
Risk behaviours: People with disabilities have higher rates of engaging in risky behaviours such as smoking, alcohol conumption, poor diet and physical inactivity as compare to general population.
Violence :People with disabilities are at greater risk of violence than those without disabilities.
Unintentional injury: People with disabilities are at higher risk of unintentional injury from road traffic crashes, burns, falls, and accidents related to assistive devices.
Assistive technologies and assistive devices such as crutches, prostheses, wheelchairs, and tricycles in mobility impairments; hearing aids and cochlear implants for hearing impairments; ocular devices, talking books, and software for screen magnification and reading for people with visual impairments may be advised according to the user and the user’s environment.
Rehabilitation: It is an important aspect of management for people with disability. It involves combined and coordinated use of medical, social, educational, and vocational measures for training or retraining the individual to the highest possible level of functional ability.
Community-based rehabilitation (CBR) was initiated by WHO to enhance the quality of life for people with disabilities and their families; meet their basic needs; and ensure their inclusion and participation. CBR is implemented through the combined efforts of people with disabilities, their families and communities, and relevant government and non-government health, education, vocational, social and other services.
Disability prevention includes all actions taken to reduce the occurrence of impairment (first level prevention) and its development into functional limitation (second level prevention), and to prevent the transition of functional limitation to disability (third level prevention)
Primary prevention is the actions to avoid or remove the cause of a health problem in an individual or a population before it arises. It includes health promotion measures designed to promote general health and well being and quality of life of the people; and specific protection by specific protective measures such as polio vaccination, intake of iodized salt. The concept is also now being applied to the prevention of chronic diseases (coronary heart disease, hypertension and cancer), based on elimination or modification of risk factors of the disease such as prevention of harmful lifestyle including eating pattern, lack of physical exercise, smoking.
Secondary prevention is the actions to detect a health problem at an early stage in an individual or a population, facilitating cure, or reducing or preventing spread, or reducing or preventing its long-term effects (for example, supporting women with intellectual disability to access breast cancer screening). In order to achieve it, proper diagnostic and treatment facilities should be uniformly available at all levels of health care.
Tertiary prevention includes actions to reduce the impact of an already established disease by restoring function and reducing disease related complications. When long term functional limitation has developed, measures instituted should aim at prevention of disability. Such measures should include medical and psycho-social care, with educational and vocational training. The environment may be changed to improve health conditions, prevent impairments, and improve outcomes for persons with disabilities such as accessible design of the built environment and transport, more opportunities for work and employment for persons with disabilities.
Ministry of Social Justice and Empowerment (MoSJE), Government of India has formulated several acts/legislations and rules/regulations* for providing support to people with diability (PwD). According to guidelines by MosJE, GOI, the minimum degree of disability should be 40% for an individual to be eligible for any concessions or benefits.
Rules and regulations:
National Institutes: The establishment of the seven National Institutes has contributed to the enhancement of specific research and interventions in the country. All these National Institutes have a broad mandate to undertake research to promote education, rehabilitation and empowerment of PwDs.
Accessible India Campaign (Sugamya Bharat Abhiyan) is a nation-wide flagship campaign for achieving universal accessibility that will enable persons with disabilities to gain access for equal opportunity and live independently and participate fully in all aspects of life in an inclusive society
Ministry of Health and Family Welfare, Government of India has also formulated several health programmes for prevention and control of certain diseases such as blindness, polio, leprosy, tuberculosis, mental health (which result in disability), immunization and strengthening of physical medicine rehabilitation centers in medical colleges, involvement of Accredited Social Health Activist (ASHA) in awareness generation.
“Better health for all people with disability”