The COVID-19 pandemic in Canada: Building Back Better for a disability-inclusive society

The COVID-19 pandemic in Canada: Building Back Better for a disability-inclusive society
August 20, 2020

Women in Global Health Canada

By Muriel Mac-Seing, Selma Kouidri, Meenu Sikand, Dr. Djenana Jalovcic, and Dr. Beverly Johnson.
 

Since March 2020, when the World Health Organization declared the COVID-19 outbreak a pandemic, 18,902,735 confirmed cases and 709,511 deaths have been recorded in 216 countries and territories around the world (1). In Canada, 118,561 confirmed cases and 8,966 deaths have been reported (2). This unprecedented humanitarian and health crisis has forced governments and health authorities worldwide to put in place drastic public health measures to curtail the propagation of SARS-CoV-2 and protect population health. These measures ranged from compulsory quarantine for returning travellers to home confinement, school closures, reengineering health care provision and facilities, and shutdown of economic activities to reduce contacts of transmission of the respiratory infection.

Although these measures were critical, it is important to consider their impact on the billion people with disabilities who constitute one of the world’s largest minorities (3). According to a recent global human rights survey on COVID-19 at the intersection of gender and disability, people with disabilities reported experiencing several challenges (4).  Women, girls, non-binary, trans and gender non-confirming people with disabilities who were interviewed identified increased barriers to meet their basic needs and access to services, negative impacts affecting their mental and physical health, and greater risk of violence. The following table summarises the main barriers experienced by people with disabilities during non-COVID-19 period (5) and which are exacerbated by the measures implemented due to the current COVID-19 pandemic (4, 6).

 

Table 1. Main barriers to health service access and use faced by people with disabilities

Barriers

Examples

Environmental

  • Difficulty in applying physical distancing because some people with disabilities are institutionalised
  • Reduction of adapted transport due to public health confinement measures
  • Lack of physical and virtual accessibility, e.g. inaccessible telehealth services
  • Lack of universal design of all health services

Attitudinal

  • Negative, discriminatory and ableist attitudes from community and health providers
  • Lack of awareness-raising of community and health providers on disability rights and disability-sensitive approaches

Communication

  • Lack of large fonts and prints of health information and public health announcements
  • Lack of sign language interpretation
  • Lack of disability-friendly masks (with a clear patch in the middle of the mask allowing for lip-reading)
  • Lack of accessible health information and communications technology

Structural (procedural, policy and planning)

  • Absence of equity, disability and inclusion lens at different levels of government planning in pandemic planning, including no disability-disaggregated data collection of who is infected and affected by COVID-19
  • Lack of governmental prioritisation of disability issues in prevention and control of infections, such as delay in financial and human resources support in COVID-19 relief plan
  • Lack of consideration of specific disability needs of younger and older adults with disabilities living in the institutions or in community setting relying on caregivers, for example when restricting family visits and restricting caregivers’ employment to one client only 
  • Harmful impact of government decisions on children, adults and seniors with disabilities influenced by ageism and ableism, as well as their caregivers (such as lack of personal protective equipment)
  • Ableist and discriminatory triage protocols that adversely and disproportionately impact people from marginalised communities including but not limited to people with disabilities, elderly people, Indigenous people, Black people and people from other racialized communities

 

In Canada, 6.2 million people aged 15 and over live with a disability, with women more likely to experience fluctuating limitations and men more likely to face continuous limitations (7). Representing 22% of the Canadian population, women, men and youth with disabilities have not received the same attention as other vulnerable groups, such as elderly people who live in long term facilities and who constitute the greatest number of reported deaths in Canada (8). The invisibility of people with disabilities, however, does not mean that they have not borne a part of the brunt of this crisis. To denounce this social health inequity, representatives of disabled people’s organisations in Canada have expressed themselves publicly (9, 10). They reported that “people with disabilities cannot be held on pause!” (9). According to them, physical distancing and social confinement further exacerbate their access to services such as personal attendants and home care as well as increase their risk to heightened experience of psychological, physical and sexual violence. Disability-sensitive COVID-19 responses, such as the use of inclusive and non-discriminatory triage protocols (11) and availability of accessible resources, are not optional, they are vital for people with disabilities.

Women In Global Health Canada (WGH) believes that Building Back Better must not only be gender-inclusive but also inclusive of the billion people of all genders with disabilities. COVID-19 response measures adopted so far have negatively impacted on women, who has been forced to take additional caregiving responsibilities for their children or adult members with disabilities during quarantine and closure of therapy and respite services.  We further argue that an intersectional analysis of the multiple jeopardy experienced by people with disabilities is necessary to better understand the underlying health inequities and systematic discrimination faced by people with disabilities and better address the COVID-19 pandemic preparedness and response interventions (12). Disability-responsive approaches and strategies to the COVID-19 response directly contribute to the Universal Health Coverage promise of  ‘leaving no one behind’ (13) by accounting for people with disabilities, irrespective of gender, age, geographic location, wealth, education, gender identity and other social categories.

In conclusion Building Back Better for an inclusive COVID-19 prevention and response and society must consider the following (14):

  • Remove environmental, attitudinal, communication, structural, policy and procedural barriers to access and use of health and social services.
  • Disaggregate data based on gender, age and ability.
  • Provide concrete reasonable accommodations in preparedness, prevention, control, and response strategies.
  • Empower people with disabilities to participate in the above strategies like anyone else.
  • Ensure continuation of the care and support people with disabilities need.
  • Address the mental and physical health of people with disabilities, and their household members and caregivers.
  • Ensure telehealth for people with disabilities.
  • Guarantee the rights of people and residents with disabilities during the current COVID-19 outbreak and the potential subsequent waves.
  • Ensure disability budgeting in preparedness, prevention, control, and response strategies.

These measures will ensure that people with disabilities are included in the discussion and planning execution of Building Back Better after the COVID-19 Pandemic.
 

 

About the Authors

Muriel Mac-Seing is a PhD Candidate in Public Health (Global Health Option) and a member of the WGH Canada Launch Committee.
Selma Kouidri is the co-founder and Director of l'Institut national pour l’équité, l’égalité et l’inclusion des personnes en situation de handicap (INÉÉI-PSH)
Meenu Sikand is the founder and CEO of Accessibility for All.
Dr. Djenana Jalovcic, EdD is a member of the WGH Canada Launch Committee.
Dr. Beverly Johnson MD CCFP serves as co-chair of the WGH Canada Launch Committee.
 

 



References

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