Hey Debriefers,

We're a year into the pandemic. While it changed all areas of life, I wanted to understand more about the health crisis at its core. So I spoke with Antony Duttine, a specialist on disability and health: in this conversation he guides us through the key issues and how they open the door to more work on inclusive health systems.

If you're new… Welcome! I'm Peter Torres Fremlin and I make Disability Debrief so we can keep up with and understand international work on disability. See previous issues or search the archive, and subscribe to get them going forward. I love when people get in touch - reply on email, or find me on twitter @desibility.

Overview

This interview really helped me understand how to relate what I know about disability inclusion in other sectors to what it means in health systems. Antony warns that we should remain suspicious of the medical model - even in medicine itself - and insists on the importance of communication and engagement.

We start off by getting into the different concepts in play, understanding what inclusive health systems would look like, and clarifying where rehabilitation does — and doesn't — fit in.

From there we get into COVID-19 and see both how that put a “magnifying glass” on the health sector. “Health equity” is a way into understanding how a lot of the response — from public health, or health care — excluded persons with disabilities.

We explore how the crisis has particularly brought to light the way disability is dealt with in health systems and the need above all to engage persons with disabilities themselves. Later in the interview we talk about vaccines and the factors to ensure access as well as prioritization for persons with disabilities.

I always like to understand how people relate with their work, so I asked about Antony's own career, and about how he transitioned from being a physio to working on disability in a rights-based way. His came to inclusive health from physiotherapy and via Community Based Rehabilitation. This journey highlights challenges as well as opportunities for further engagement in inclusive health.

Thanks to Antony for giving time and sharing openly on this interview. We've been in touch for a while, but this was the first time we could get into things properly. I'm so glad we did, and hope you get the clarity from this conversation that I did.

Antony Duttine is an Advisor on Disability and Rehabilitation at the Pan American Health Organization, the regional office of the World Health Organization. He tweets from @antduttine.

Heads up on some acronyms coming:

• CBR: Community Based Rehabilitation
• CDC: United States Centers for Disease Control and Prevention
• CRPD: Convention on the Rights of Persons with Disabilities
• HI: Humanity and Inclusion (previously Handicap International)
• IDA: International Disability Alliance
• SAGE: WHO Strategic Advisory Group of Experts on Immunization
• VSO: Voluntary Services Overseas
• WHO: World Health Organization

Conversation with Antony

We spoke on Zoom: here's our conversation edited for clarity.

Understanding Inclusive Health: “there's still a ways to go.”

Peter: Can you help us navigate concepts like “inclusive health”, “universal healthcare” and “rehabilitation?”

Antony: Universal healthcare is a good one to start with. It's not a new concept but it's a new trend that's come up over the last five to ten years within the global health space. It means that everybody should have access to the care they need without suffering major financial hardship.

Unfortunately, we know around the world that a lot of people don't have access to the care and healthcare that they need at the time that they need it. If they do, then people can suffer significant out-of-pocket expenses in accessing that healthcare. Universal healthcare is an approach to make sure that: the services are in place and that they cover across a country, and make sure that all groups are included in that; the services are appropriate and of sufficient quality; and also making sure that there's financial protection within that.

There's no one hard and fast way of delivering universal healthcare. It looks different in different places depending on the context, but that's the overarching theme of it. When you look at it like that, the core concepts are around equity, are around access, are around affordability. A lot of the things that we often see that certain population groups have as barriers in order to get healthcare.

Inclusive health — or disability-inclusive health — is how do we make healthcare equitable and accessible and inclusive for people with disabilities? I think the health sector hasn't moved forwards on that in the era of the CRPD, as much as other sectors have. For all of us working in the disability space, inclusive education is very clear to us what that means and the fact is that inclusive health — or disability-inclusive health —  hasn't necessarily become a clearly understood phenomenon. I think shows that there's still a ways to go.

We'll come back to it maybe later but health equity is a major and again a growing component of universal health coverage. The barriers that people with disabilities face and the historical inequalities and disparities in health and healthcare access really speak to this health equity agenda that's moving forwards in the global health space.

Inclusive health really is trying to make sure that Article 25 of the CRPD is achieved and what the health sector does in order to make sure that that's a reality.

Peter: What would an inclusive health system for disabled people look like?

Antony: It would be from the very basic pieces of ensuring physical accessibility to spaces. We hear and we learn stories of people being unable to access a health service because the space is inaccessible. I was at a meeting a couple of years ago, and a lady in a wheelchair was describing how she couldn't have a mammogram because the equipment did not adapt for her specific needs. You needed to stand in order to have a mammogram, which again meant that she couldn't have the same level of health screening that other women of her age had.

There's an immediate inequality there. It goes right through from health promotion and prevention. So, are we promoting all of the general health promotion issues? Smoking, mental health and wellbeing, front-of-package labelling for food and diet. Is that in formats that are accessible for the community, in different formats that can be accessed by all people and understood by all people and implemented by all people?

Through to services and I think a big piece is also the attitudes of healthcare providers as well in addressing disability. I think there is still a long-standing and probably a persistent medical understanding of disability from inside the health sector. This change in mindset and attitude to a more inclusive and rights-based approach where, in the health sector, the mandate is delivering healthcare. It is a "medical model" to put it that way, but not to have a medical understanding of disability: to apply a right-based model.

“Time and time again, the focus is on the impairment and not the health issue”

Peter: People might think sort of well, doctors should have a medical model. How would a rights based model apply?

Antony: It would be recognizing that people with disabilities have the same healthcare needs as everybody. So that when somebody with a disability goes to a health service that the focus isn't on their impairment — if, say, they're going in for a family planning need, or going in for completely unrelated health-related issues. Time and time again, I've heard from people with disabilities that the focus is on the impairment and not on the health issue that the person is coming in to discuss with the medical team. Or, and what I think also happens is that somebody refers them to somebody that they feel "works with people with disabilities".

Time and time again, somebody's saying, "Oh, no. It's a neurologist who deals with this issue.", even if you're coming in for an everyday stomach complaint. Or for example I heard during the Zika epidemic in Brazil that mothers who took their children in for regular inoculations, regular vaccines at their primary healthcare clinic, were referred to specialist hospitals hundreds of miles away to just get the regular vaccine. Because the primary healthcare team were a little bit unsure about whether they could provide the vaccine for a child with microcephaly.

Barriers are put up in front of families or people with disabilities that really could be avoided to mean that people with disabilities access the same sort of standard and equity and healthcare that everybody else does.

Peter: These examples are really helpful because they're the way we would see any other sector. We would look at accessibility. We would look at exclusion. We'd look at segregation. We'd look at can you get the services in a practical, affordable way? That our view of disability-inclusion can be applied to the health system.

“There's been a historic attachment that rehabilitation is the health service for people with disabilities”

Peter: The other term that is present when you think about persons with disabilities and health, is “rehabilitation”. How does that fit in?

Antony: Rehabilitation can be an important strategy for many people with disabilities. It's absolutely not a strategy that all people with disabilities require rehabilitation, absolutely not. So, I think there's been a historic attachment that rehabilitation is the health service for people with disabilities and as long as you have strong rehabilitation services, then people with disabilities have their health care needs met. I think it's important to dispute that and say, "Rehabilitation is an important strategy." It's Article 26 of the CRPD. We know that it's an important strategy that many people with disabilities need and many people without disabilities access rehabilitation as well.

A recent report came out and said 2.4 billion people have a potential health condition which may require rehabilitation, when you take into account short-term conditions and episodic disability and so on.

Peter: I might have had an accident and need physio and it's irrelevant whether I'm disabled or not.

Antony: Exactly. Thousands and thousands of people experience back pain every year, again have a few sessions of physiotherapy and then that back pain doesn't become chronic or long term. But, that's still an important aspect of the rehabilitation agenda. There's many people who don't self-identify as a person with disabilities who access rehabilitation.

More importantly, there's much more from the health system that people with disabilities require than just rehabilitation. I think that's the key part of inclusive health, is actually separating the two, that actually, they've got a relationship with one another but we need to, on the rehab side, set up a system that everybody can access at the time that they need it.

As part of universal health care as well, rehab should be a comprehensive part of a package of universal health coverage, again whether that's somebody who's had a road traffic crash, who's had a stroke, who's an older person with mobility difficulty, whether that's a child with a neurodevelopmental disability. Everybody should have the right to access rehabilitation at the time that they need it.

The health services for people with disability don't stop at rehabilitation and assistive technology, but go on to the whole package of healthcare that all populations have and require.

COVID-19: “it's been a magnifying glass on the health sector”

Peter: This context sets us up to get into the COVID crisis. At the beginning of the crisis and throughout and still to this day, the disability community was scared we wouldn't get healthcare, scared we would be excluded deliberately, let alone all these kind of accidental exclusions that you've talked about. What's your view on how this has turned out?

Antony: It's undeniable that people with disabilities have been disproportionately impacted by COVID-19. That's everywhere around the world. What we've seen is a lot of, what we call the “social determinants of health” coming to the fore as well. The congregate settings have been one of the most heavily impacted settings — residential facilities, nursing homes and so on — they are heavily populated proportionately by people with disabilities, so we can see how even before we get to the health services and the health response, the social determinants of health are factors that lead to a greater probability of health challenges already impact the community.

Early on WHO and the disability community, talked about the importance of health promotion and as we were learning more about hand washing or mask wearing or social distancing or whatever the piece it was, making sure that that is in formats that is accessible for the disability community as well and is realistic.

Then putting in measures to make sure that people with disabilities' needs are met. I'd say it's highlighted many of the inequalities in the health system that continue to exist. I think it's been a magnifying glass on the health sector, where there's still a huge long way to go in order to make sure that these health inequalities are addressed and the barriers are identified and broken down.

There's a lot of discussion about building back better. Somebody put the very strong point to me that, "Why are we talking about building back? We should be talking about building forwards. We don't want to go back to a health system that was inaccessible and exclusive, but we want to build forwards to health systems that are inclusive and understand people with disabilities' needs."

So, I think it's certainly shown and highlighted many of the challenges. We've also heard as well, the examples of prioritization of services, or decisions of treatment versus non-treatment. So a lot of ethical discussions as well, that has come up and discussions around discrimination as well.

“We shouldn't be seeing decisions made based on disability”

Peter: I think the image in everyone's mind from March is like, "Look, there's one ventilator, two people and they're not going to give it to me." Can you talk us through the discussions around discrimination.

Antony: I think certainly there has been cases where there has been a report of a discrimination against people with disabilities. Those need to be looked at, understood and addressed. And it needs to be stated and reinforced by those responsible for delivering health services at all levels that discrimination on the base of disability is not acceptable in any stage of the health system.

Any discrimination is unacceptable on the basis of disability. We shouldn't be seeing decisions made based on disability, just like we shouldn't on age or gender, or ethnicity, or any other sociodemographic factor. I think the [WHO] Director General has come out to talk about that, specific to disability and more generally, and unequivocally has said, "Yes, any form of discrimination is going against the principles of healthcare for all, and universal health coverage which means that people should have access to the care and health that they need."

Obviously, down an individual level it's about making sure that healthcare providers are able to discuss the treatment plan and the care plan and have discussions with each and every one of their patients on an individual basis. Everybody's health case is different. We need to make sure that healthcare providers are empowered to be able to discuss and engage appropriately with people disabilities, with their carers to have appropriate, informed and constructive discussion about healthcare. Whether that's COVID, whether that's family planning, whether that's other aspects as well. That's what we want from the system, that medical providers and people with disabilities have trust in one another to be able to fully engage in their health plans.

Peter: So it's not just a case of did someone get treatment, yes or no. It's complex decisions in relationships. You look what the factors were and how decisions were made?

Antony: Each case is different and there needs to be an informed decision-making process between an individual and their healthcare provider. However, certainly there needs to be a system that is not discriminatory in any way and if someone reports discrimination that this is investigated and, if necessary, changes are made to make sure that it does not happen, no matter how complex or straightforward medical decision-making is. And of course, it’s also crucial that the reporting systems themselves are accessible to people with disabilities so there is equal opportunity to access those systems and report inequities and discrimination.

I think that's a key piece of the equation. Communication is such an important part of healthcare. We need to make sure that that healthcare communication happens at all levels of the system.

“There's a perception that disability and health is dealt with as a single issue”

Peter: You were saying that COVID has highlighted inequalities in the health system. That's exactly what we say about other areas. Tell us some of the inequalities it's highlighted in regards to disability.

Antony: It's really highlighted the fact that disability inclusion, accessible spaces and places are not necessarily at the forefront of a lot of the health programming agenda. There's often a perception that disability and health is dealt with as a single issue by a programmatic team who work with people with disabilities, or it's in a different sector. It’s not necessarily this transversal approach that every department of every hospital, every health facility, every approach should be thinking about people with disability.

It's also highlighted that people with disabilities and organizations of people with disabilities and health services, are not as in collaboration and communication, as perhaps they should be. I think there's a lot of work to be done there. I know that historically, there's a lot of sensitivities around disability and health and understandably so. The legacy of the medical model still persists. One of the thematic themes of the Conference of State Parties in 2019 was on article 25 and health. A lot of these issues came up, a lot of the historical legacies. I think COVID has highlighted where those gaps have occurred.

Peter: Do you have examples that illustrate that?

Antony: The most apparent ones would be in terms of messaging. The COVID pandemic has been so important on making sure that inclusive and accessible health messaging comes out.

I think at times, we've seen good examples of that, where there has been sign language interpreters by key figures, where there's been information that has been made available in different formats, but often that has not been, which means that people with disabilities haven't got the same information at the same time, or the same quality of information at the same time, as non disabled people. That is just a very simple example of a health inequality.

Then when it comes to access to hospital care, there've been a lot of challenges and a lot discussed about access for caregivers, or carers, or secondary support workers of people with disabilities, where protocols have been put in place that are very strict. Yet we know that many people with disabilities, or some people with disabilities do have a support worker, or a caregiver, or a carer that usually would accompany them with things. There's been challenges in navigating that, that when you create a very hard and fast rule-based system, because public health demands that sort of system, then there needs to be then, some sort of thinking about, "Well how do we adapt the system to meet these needs.”

“It's just talking to the people who are experiencing the inequities”

Peter: So, that demonstrates they weren't in touch with the disability community, because otherwise they just would've gotten that point quicker.

Antony: I think when now, one of the few silver linings that's coming out, is that more people are now talking about including people with disabilities. I think it's unfortunately taken an event like this to begin to think of disability in the health system more from an inclusive perspective. I think now when people say to me, "What should we be doing to make an inclusive health system?". My very first rule, whenever I'm giving a presentation is, engage with the community because, people with disabilities are the experts in inclusion. They know better than anybody else what an inclusive health system looks like in their local context.

It's not for me sitting my office in Washington, to give you all the answers. Certainly, I can give you guidance of what I know from my work but, you if want to know what an inclusive health system looks like in your community, or your city, or your hospital, engage with the disabled people in that community or that hospital and ask them what an inclusive system is for them.

That's the key and it's not rocket science. It's not some sort of miracle approach or anything like that. It's just talking to the people who are experiencing the inequities and inequalities and learning from them and hearing from them, as to what do we do to make sure that these barriers are removed.

If we can start at that point then what should come next starts to become a little more straight forward. Of course, the same would go for other population groups that also experience marginalization and inequities. Indigenous populations, or older people, or others. I'm not an expert in those areas, but I would imagine that the rules are quite similar. So, making sure that you engage with those population groups to say, "What does an inclusive approach look like for different population groups?"

Fundamentally it starts with that and it's got to start with that. If the health sector more broadly were starting from that point more universally… I know of good examples where there is good engagement between the health sector and the disability community but, I think if that were more universal, then as the public health approaches were coming in, it's about discussing and saying, "Well, this is what we need to do in order to limit the spread of the outbreak, because that's what the science is telling us we need to do. How can this work in an inclusive way? What do we need to do in order to make sure we can meet these public health requirements, which are fundamental for saving lives and preventing the spread, but make sure also that this doesn't doubly, triply marginalize your population. The people with disabilities."

“Remaining suspicious of the medical model is important”

Peter: To get a different perspective on these links between disability and health, I thought it would be interesting to reflect on your own personal trajectory. You come from a physio and then a rehabilitation perspective but, as we see today, you're a very strong advocate of inclusive health.

Not everyone makes that journey, even if they do do work on disability issues and I, like other people in the disability community are sometimes suspicious that the medical model remains…

Antony: Thanks for that. I think it's a good point. Before I talk about myself, I think that remaining suspicious of medical model is important. Coming as a disability advocate from inside the health system, I think that is still a strong legacy that exists. I talk with colleagues and a lot of my job is internally advocating and internally educating about different models.

It's important that we don't suddenly just say the medical model, or the medical understanding “is no more." Of course, health is providing medical care. There's a medical aspect to it. We can't change that, but at the same time I think it's really important that we keep that skepticism.

From my own journey, I trained as a physiotherapist in the UK. I worked clinically and I wouldn't have identified myself as working on disability rights issues when I was working. I was working more in acute hospital care settings and providing clinical rehabilitation care for people with strokes, people after cancer or going through cancer treatment and stuff. Very much in the acute health care approach.

I then traveled internationally and went to Namibia with an organization called VSO and worked. There I was working in a lower resources context and CBR was being implemented. CBR is a really comprehensive approach. It cross-cuts not just health, but livelihoods and social and education and so on. For me that was a big learning aspect as well, of really seeing outside of the world of rehabilitation and into the broader world of social inclusion and how rehabilitation fits into that broader world and isn't the only thing.

“Rehab's just rehab. It's not making the health sector inclusive.”

When you're inside a thing, you can think, "Well, yeah. All people need is rehabilitation." Then you actually see how your piece of rehabilitation fits into people going to work and people going to school and people living their lives and of course, that's an important part of the rehabilitation agenda as well. When you're putting it together with a CBR project, then it really shows how things fit together.

That was a piece for me, where I really started to engage more on the disability rights agenda and then working with HI in Afghanistan and then in the headquarters. Obviously, HI has a strong component of rehabilitation work that obviously has social inclusion, has strong work on advocacy and disability rights. So, I was suddenly then working with people who'd worked in the disability rights agenda for a lot longer than I had and that was a real learning experience for me, to think, "Where does my piece of the picture come in to what everybody else knows?"

I remember working with Priscille Geiser, who's now at IDA, and really just trying to absorb from people like her who'd had a wealth of knowledge and information on that and trying to think, "Well this perhaps sort of challenges some of my medical way of thinking as a physiotherapist and how does that fit in?" The inclusive health piece sense evolved from that, where I was seeing what was happening in pieces like inclusive education and in inclusive livelihoods and thinking, "Well, the same isn't applied to the health sector. You know, it seems to be rehab or nothing." I got a sense that it was like, well rehab's just rehab. It's not making the health sector inclusive.

I realized that there wasn't that space on inclusive health. It was almost default handed to rehabilitation workers, because we happen to be health workers who work often with people with disabilities. So, then there's almost a default that, "Oh, you must be an expert in inclusive health then, because you know, you provide rehabilitation for people who are wheelchair users and therefore, you must know all about accessibility of hospitals."

This has been a bit of a challenge and fortunately or unfortunately, I'm a classic legacy of that. I'm a rehabilitation professional, who is suddenly doing work on inclusive health issues that perhaps, my background and training wouldn't have geared me towards that. What I have done is then worked hard to make sure that I have the skills and understanding of what inclusive health is and trained in public health and tried to understand from a public health point of view, what is broader in health. I think more rehabilitation professionals are now doing public health, or health approaches to understand the more system based approach.

Peter: It's interesting the way you put your growth in terms of a journey: when I spoke with Stefan, he also spoke about his own journey and inclusion  in terms of a journey, even though it was a very different starting point and end point.

“This is a space to grow into”

There is definitely a space and as we're seeing more of that opening of the space for not just rehabilitation professionals to transition into inclusive health, but actually for people who are doing disability studies. People with disabilities to also engage in public health and this space of inclusive health I think, is a space for the next five or ten years to really grow into, like probably, inclusive education did ten years ago and other spaces have done. I think this is really an area that I'd really like to encourage and see more people with disabilities training, working on health related issues and coming in, because I can really see... I look out for people who have that twin skillset.

There's not a ton of people at the moment that are working in that, like there is in maybe other areas of disability and inclusion. For me, I think that's one thing I'd like to call out to your community reading this newsletter, is sort of say, "This is I think a space now, COVID has identified that there's a massive need to be able to work in this intersection and I would really encourage the community to consider that and begin to look into what they can do in this space."

Peter: Thank you for that invitation.

“How do we make sure that the priority groups are getting access to the vaccines?”

Peter: In terms of going forward vaccines are one of the most important things on everyone's mind right now and will people with disabilities get access to vaccines?

Antony: A big question. The vaccines is the major thing that is rolling out at the moment. The SAGE guidelines are global guidance on prioritization for populations. They're broad guidelines that are categorizing the high priority groups, where there's not sufficient numbers of vaccines to cover a whole population at the minute so, who do you prioritize? SAGE guidelines are the broad WHO ones, but then each country comes up with their own specific one as well.

This is where the 1A, 1B, 1C, 2, 3, categorization comes from. The SAGE guidelines have done a job of identifying those at most risk. Those who are high priority groups, and so on. People with disabilities fall into many categories along those SAGE guidelines. Many people with disabilities may be eligible because of an underlying health condition, because they're frontline health workers, because they're teachers or working in settings where they're exposed to higher risk.

Other people with disabilities may not be at a high priority because their health conditions don't mean that they're at a higher risk of a more severe outcome. Obviously, congregate settings is one of the big ones as well and people over the age of 65 — many people over the age of 65 may be people with disabilities as well. Across the SAGE guidelines you can see that people with disabilities may fit in a number of different categories, depending on the circumstances that people face. I think absolutely the disability community are a priority group because there's such a high proportion that may be within one of those areas.

One of the key things where we're working on now is, it's all very well identifying that people with disabilities may be in category 1B, or 1C, but many people may be in these and then services aren't made accessible. I think the twin point of saying, "Well, who should be prioritized?". We also need to be saying, "Well, how do we make sure that the priority groups are getting access to the vaccines?". Again, first and foremost, "Are we engaging with the disability community in vaccine planning?". Secondly, "Are points of delivery inclusive? Are the information about whether somebody should or shouldn't take a vaccine and being given their information, is that accessible to all people?".

There's a lot of discussion about who should be prioritized. We need to also have that at the same time. How do we make sure that prioritized people get access to it as well. We're working on pieces around that to guide member states at the moment to say, "Well, what does inclusive vaccine programming look like? What are the 10 steps?". We've drafted a 10 steps document that hopefully, will be coming out very soon to say, "What are 10 good steps?". Targeting directly, the vaccine programmers can be used as materials by the community to show, but this is really 10 steps for people who are planning and delivering vaccine programmings to say, "What are the 10 things?".

It goes from engage the community, first and foremost. People with disabilities are experts in inclusion. Ask them how to make an inclusive response. Make sure information is accessible. Consider the diversity of the community. Make sure there is informed consent and processes for informed consent, which means engaging with the person with the disability and not just to a caregiver or to somebody who's attending with. So, 10 practical things. Data I think, is a big piece as well. Capture information. Are people with disabilities attending services? Ask yourself, "If not, why not?". We know 15% of a population has a disability, so if only 2% of a population is coming to a service, well what's the reason for that disparity?

On the vaccines, I'm hopeful as we see more roll out that I think people with disabilities are going to be included. We've seen cases as well, recently in the UK people with learning disabilities, in the US in CDC, people with Down syndrome are identified as a specific population groups. We're seeing certain population of people with disabilities specifically identified within those guidelines.

Peter: Thank you, those are pragmatic points for people to engage or look for, to understand the vaccine process in an equitable way.

“How to get involved and engaged? A hundred and one ways.”

Peter: What about in the bigger picture in this invitation you gave us, that we shouldn't ignore health so much anymore, but how to engage with inclusive health?

I would say it's not the disability community ignoring healthcare. I think it's as much the health community ignoring disability, as a rights issue. It's the two areas.

Two big things that are really moving in the WHO at the moment, is a new WHO policy on disability, which is both internal and external, in that it talks about our internal practices as an organization and making our own offices, employment approaches inclusive as well as our programmatic areas. I think that's going to be a  game changer for us at the WHO, which will hopefully filter. At the same time there's the WHO resolution on disability that's being proposed this year, that really is about achieving article 25 and really is about equitable... Ensuring the higher standards of health for everybody, for people with disabilities and lifting languages directly from the CRPD.

How to get involved and engaged? A hundred and one ways. Just like with many areas, if there's an interest I'd love to speak to people, hear from people who have an interest in that area. I think, the ins to working in public health are, if you have an interest in becoming a healthcare professional, there's some great areas. There's a wonderful twitter tag called Docs With Disabilities, that talks about people with disabilities who are working in the healthcare sector. There's an incredible legacy of people with disabilities as healthcare providers, as well.

I think we need to raise more visibility of people with disabilities who are working in that sector. Doctors and nurses, physiotherapists, radiographers and so on. Secondly,  encouraging people with disabilities to engage in public health programming. Look at public health schools. Thinking of that intersectionality between inclusive disability, inclusive development and public health. I'm working with Gallaudet University at the moment a little bit, which is the university here for deaf and hard of hearing people. They've got a public health program. We're looking at that intersectionality of health programing for deaf and hard of hearing people and how inclusive health services are.

So, I think there's opportunities there. Things are driven by demand, so if more people are coming in and saying, "Hey, we want to have courses on disabled people as a marginalized group within the health sector.", then I think universities will start to respond to that. It's really important that that sort of issue gets pushed, because I think it's become the norm at lot to talk about other cross-cutting issues, like gender and ethnicity in healthcare and how that gets addressed.

We can do the same on disability inclusion as well. There's clearly a lot of also, still sensitive issues in health and disability. I think it's important that we are coming together to discuss those issues, whether that's forced sterilization, whether that's treatment of people with psychosocial disabilities and forced treatments of people with psychosocial disabilities.

Clearly, there are areas that the health and disability sector need to work together on. There are some really straightforward issues that yes, health services should be accessible. Other issues much more need to be discussed out in the open and talked about, more out in the open from a rights based point of view. I think that's a really important piece to do, that the two sides aren't hiding their position, but actually coming towards and discussing how do we move forwards on mental health? How do we move forwards on discrimination against people with disabilities in the healthcare setting? Talking about sexuality and disability and sexual reproductive health planning. These are big issue that need to be out in the open and normalized within the health community and not seen as taboo issues, I think.

Peter: Thank you so much. You've guided us through the sector and given us lots of ways for the Building Forwards Better.

Antony: I thank you for the time and I hope this is useful for your readership. I'm always open for hearing from the community and thoughts. Feel free to share my information if people want to do and excited to see the article.

For more…

From the WHO:

• WHO Disability Policy
• The highest attainable standard of health for persons with disabilities, draft of WHO resolution passed at Executive Board meeting (link to pdf)
• SAGE Roadmap For Prioritizing Uses Of COVID-19 Vaccines In The Context Of Limited Supply

More on health and disability:

• The Missing Billion Report: Access to Health Services for 1 billion people with disabilities.
• Example of a “mainstream” health group taking forward disability inclusion: American Public Health Association.

On Twitter:

• Antony tweets from @antduttine.
• The hashtag Antony mentions: #docswithdisabilities

And on this newsletter, stay tuned for the next news-roundup as new resources are coming out on inclusive health. If you're into UN specialists on disability talking about what they do, see the interview with Stefan Tromel.

Acknowledgements

Many thanks to Antony for giving the time and attention to this interview. And thanks to Nick Corby who suggested Antony as a guest and helped me prepare questions and context.

And of course, thanks to you for reading, sharing and feedback.

Until next time,

Peter