“At risk” and “vulnerable”! Reflections on inequities and the impact of COVID-19 on disabled people

Abstract

This professional perspective provides background knowledge and evidence to support reflection on disability outcomes internationally and in Aotearoa New Zealand. Over one billion people live with disability worldwide. Approximately 4.5% of the world's population live with significant difficulties in function, activity, and participation. In Aotearoa New Zealand, approximately 1.1 million (24%) people have a disability, making disability the largest minority group. Yet disabled people face extreme health inequities. These are exacerbated when response planning and service delivery during times of humanitarian emergency, such as COVID-19, fail to include and consider the impact decisions will have for disabled people. Disabled people are more "at risk" of contracting COVID-19, and some disabled people are "at risk" of poorer health outcomes from COVID-19. However, "vulnerability" arises from the continuation and exacerbation of discriminatory policies, including health professionals' conscious and unconscious biases, in times of crisis but also within conventional health service delivery. As part of the health system, it is perhaps timely for physiotherapists to reflect upon their knowledge of the health inequities disabled people experience, and to consider personal and collective bias. There are strategies physiotherapists might adopt to challenge interpersonal, internalised, and institutional bias. These steps will help affirm disability inclusiveness at all levels of the health system and support a human rights expectation that all New Zealanders should have equitable health outcomes.

Time to be counted: COVID-19 and intellectual and developmental disabilities—an RSC Policy Briefing

“…As discussed throughout this report (see the "Caregiver Support" section), these restrictions have had an impact on the mental health and emotional well-being of many adults and children with IDD as well as their families and staff who support them. Isolation and separation from loved ones due to visitation bans and restrictions on public outings have resulted in mental and emotional distress among both residents and family caregivers, or have exacerbated existing mental and physical health conditions (Hewitt et al 2020;Lunsky 2020;Perry et al 2020). Moreover, the potential trauma caused by these measures may go undetected and untreated, as some individuals with IDD may not be able to communicate their needs and feelings to caregivers (Seucharan 2020).…”

Examining the role of government in shaping disability inclusiveness around COVID-19: a framework analysis of Australian guidelines

“…More information can be found at: www.disability.royalcommission.gov.au. 3 For more information on the NDIS eligibility process, please see: Am I eligible | NDIS. 4 Information on DSP eligibility and payments can be found at: Disability Support Pension -Services Australia.…”

“…However, not all disabled people have access to NDIS [8] as it relies on age-and eligibility-based factors; further, people need to have sufficient 'evidence' of their disability and its impacts to be able to access the scheme. 3 Those who do not have access to the NDIS may be eligible for social welfare through the Disability Support Pension (DSP), although this also subject to stringent eligibility criteria. 4 The DSP provides a basic level of support for disabled people: subject to an income and assets 'means test', recipients can receive a fortnightly maximum of $868.30 for single people or $654.50 if they are in a relationship.…”

“…Disabled people are disproportionately affected by the COVID-19 pandemic; existing inequalities have exacerbated, and new ones have emerged [1,2]. Disabled people are seen as vulnerable to COVID-19 infection due to their bodily conditions, a perception which places responsibility for the prevention from infection onto the individual [3]. Research and advocacy have highlighted that, far from being an 'inherent' artefact of disability, this vulnerability is an artefact of interactions between structural factors and the individual.…”

“…Notably, they found that where government responses did not fully address disability inclusion, they compounded the disadvantage experienced by people living with disability. Uneven levels of inclusion of people with disability in pandemic-specific policies, detailed by Kavanagh et al [ 8 ], range from the failure to consider disabled people as an ‘at risk’ or ‘vulnerable’ population group in pandemic management plans [ 3 , 8 ] to the release of disability-specific advice (including operational plans) for people in response to community-based advocacy. In Australia, where over 4 million people, or 18 % of the population, live with disability, including 51 % of the population aged over 65 [ 15 ], both the Federal and the state governments designed and implemented policies to control the pandemic.…”