I went to a webinar launching the WHO Global Report on Health Equity for Persons with Disabilities. Haben Girma, a deafblind lawyer, moderated this gathering of professionals. The 312- page report’s findings were summarized in this setting. While I have not yet read the report in its entirety- I wanted to share my takeaways from the webinar. I am excited about the potential of the implications of this report and sincerely hope that health care systems around the world will start to incorporate these suggestions into planning and action steps.

1. 1.3 billion people worldwide live with a disability. That means 1 in 6 people globally have a disability.
2. People with disabilities experience health inequities, including poor health outcomes such as premature death (they die up to 20 years earlier), more depression, and limitations in day-to-day functioning. All of these inequities are associated with unjust factors, such as stigma, poverty, and exclusion from education.
3. The health system should alleviate these inequities, but in fact exacerbates them, for example, through inaccessible health facilities and medical ableism.
4. Making health care systems more inclusive isn’t just the right thing to do: it is economically smart. Every $1 spent on disability inclusive health care and prevention brings a return of $10 with an increase in healthy life years and human capital.
5. Health care facilities are 6 times more limiting to people with disabilities in terms of access. Transportation on the other hand, is 15 times more limiting to people with disabilities.
6. Three core principles of the report:
   • Include health equity for people with disabilities at the center of any health sector action: this aligns with the UN Sustainable Development Goal narrative of “leave no one behind” and putting the most marginalized at the center of any actions.
   • Ensure empowerment and meaningful participation of people with disabilities and their representative organizations when implementing any health sector action: “Nothing about us without us”
   • Monitor and evaluate the extent to which health sector actions lead to health equity for people with disabilities.
7. Health inequities due to unfair conditions include 4 broad areas:
   • Structural: eg. Stigma is a major structural barrier. Ableism, the belief that people with disabilities are inferior to non disabled people, is a major cause of this stigma.
   • Social determinants of health: these are the non-biological conditions to which we are born, live, grow, and work. E.g. poverty, lack of education and employment are factors that severely impact people with disabilities.
   • Risk factors for illnesses: tobacco use, alcohol consumption, obesity, amount of physical activity, etc. all contribute to poorer health outcomes. People with disabilities are less likely to be able to receive health promotion information because it is not accessible or inclusive.
   • Health systems: Components such as the health work force, financial mechanisms, health information systems, etc. E.g. negative attitudes (ableism) from health workers contribute to poor health care. There was an example given of a Senegalese pregnant woman with a disability who was refused access to health care centers because they felt her disability would make the delivery too complicated.
8. Framework for health sector strengthening through Primary Health Care approach: there are ten strategic entry points (see diagram on page 160 of the report) and 40 targeted actions within these entry points.
   • Rather than setting up separate disability specific systems, integrate disability inclusion within primary care. The end result would eventually be achieving SDG goal number three: Good Health and Well-Being and Universal
9. Changing the narrative is critical. Yes, it is going to cost money, but investing in health costs money and it is an investment that yields returns.
   • Disability is too expensive
   • Money only going in one direction instead of for multiple solutions
   • We don’t know how to do it
10. Solutions for health service providers to be inclusive of people with disabilities:
    • Accessibility:
      • The built environment- buildings are inaccessible
      • Service accessibility: accessible from the time people park their car/arrive at the destination to the conclusion of their service.
    • Attitudes:
      • Interpersonal communication- the stigma, attitudes, e.g. ableism, that hinder someone’s ability to get care
    • Medical Knowledge and practices:
      • Healthcare providers lack the knowledge of the kind of care to provide for people with disabilities. Most workers know how to deal with the “average” patient but people with disabilities often have more complex issues and not a lot is known or done about this.