Abstract
Globally, disability represents a major challenge for health systems and contributes
to the rising demand for rehabilitation care. An extensive body of evidence testifies
to the barriers that people with disabilities confront in accessing rehabilitation
services and to the enormous impact this has on their lives. The international legal
dimension of rehabilitation is underexplored, although access to rehabilitation is
a human right enshrined in numerous legal documents, specifically the Convention on
the Rights of Persons with Disabilities. However, to date, no study has analyzed the
implications of the Convention for Rehabilitation Policy and Organization. This article
clarifies states' obligations with respect to health-related rehabilitation for persons
with disabilities under the Convention. These obligations relate to the provision
of rehabilitation but extend across several key human right commitment areas such
as equality and nondiscrimination; progressive realization; international cooperation;
participation in policymaking processes; the accessibility, availability, acceptability,
and quality of rehabilitation services; privacy and confidentiality; and informed
decision making and accountability. To support effective implementation of the Convention,
governments need to focus their efforts on all these areas and devise appropriate
measures to monitor compliance with human rights principles and standards in rehabilitation
policy, service delivery, and organization. This article lays the foundations for
a rights-based approach to rehabilitation and offers a framework that may assist in
the evaluation of national rehabilitation strategies and the identification of gaps
in the implementation of the Convention.
Keywords
List of abbreviations:
CRPD (Convention on the Rights of Persons with Disabilities)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- World report on disability 2011.World Health Organization, Geneva2011
- Counting disability: global and national estimation.Disabil Rehabil. 2013; 35: 1065-1069
- Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.Lancet. 2012; 380: 2197-2223
- Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010.Lancet. 2012; 380: 2163-2196
- Projections of global mortality and burden of disease from 2002 to 2030.PLoS Med. 2006; 3: e442
- Resolution adopted by the 58th World Health Assembly on Disability, including prevention, management and rehabilitation: report by the Secretariat (WHA58.23).World Health Organization, Geneva2005
- Resolution adopted by the 66th World Health Assembly on Disability (A66/12).World Health Organization, Geneva2013
- The precarious balance between ‘supply’and ‘demand’for health care: the increasing global demand for rehabilitation service for individuals living with chronic obstructive pulmonary disease.Int J Chron Obstruct Pulmon Dis. 2008; 3: 393
- Analysis of factors affecting demand for rehabilitation services in Ontario, Canada: a health-policy perspective.Disabil Rehabil. 2008; 30: 1837-1847
- Community based rehabilitation: a strategy for peace-building.BMC Int Health Hum Rights. 2002; 2: 6
- Community-based rehabilitation and health professional practice: developmental opportunities and challenges in the global North and South.Disabil Rehabil. 2011; 33: 165-173
- The International Classification of Functioning, Disability and Health (ICF): a unifying model for the conceptual description of the rehabilitation strategy.J Rehabil Med. 2007; 39: 279-285
- Multidisciplinary rehabilitation versus medical care: a meta-analysis.Soc Sci Med. 1995; 40: 1699-1706
- Effectiveness of multidisciplinary rehabilitation services in postacute care: state-of-the-science: a review.Arch Phys Med Rehabil. 2007; 88: 1526-1534
- Evidence for the effectiveness of multi-disciplinary rehabilitation following acquired brain injury: a synthesis of two systematic approaches.J Rehabil Med. 2008; 40: 691-701
- Economic evaluation of adult rehabilitation: a systematic review and meta-analysis of randomized controlled trials in a variety of settings.Arch Phys Med Rehabil. 2014; 95: 94-116.e4
- A bibliography of cost-effectiveness practices in physical medicine and rehabilitation: AAPM&R white paper.Arch Phys Med Rehabil. 2001; 82: 711-719
- The effect of rehabilitation on positive interpretations of illness.Psychol Health. 2002; 17: 753-760
- A positive turning point in life–how persons with late effects of polio experience the influence of an interdisciplinary rehabilitation programme.J Rehabil Med. 2010; 42: 559-565
- General Comment 5: persons with disabilities. E/1995/22(SUPP).United Nations, New York1995
- Convention on the Rights of Persons with Disabilities.United Nations, New York2006 (Available at: http://www.un.org/disabilities/documents/convention/convoptprot-e.pdf. Accessed July 13, 2014.)
- The World Report on Disability and recent developments in South Korea.Am J Phys Med Rehabil. 2014; 93: S58-62
- Implementing the World Report on Disability in West Africa: challenges and opportunities for Ghana.Am J Phys Med Rehabil. 2014; 93: S50-S57
- Health care access and support for disabled women in Canada: falling short of the UN Convention on the Rights of Persons with Disabilities: a qualitative study.Women’s Health Issues. 2012; 22: e111-e118
- Public health goals for persons with disabilities: looking ahead to 2020.Disabil Health J. 2009; 2: 111-115
- Disability and human rights: the World Report on Disability as a unique opportunity to review and enrich European health policy.Eur J Phys Rehabil Med. 2012; 48: 179-188
- Research priorities for health of people with disabilities: an expert opinion exercise.Lancet. 2009; 374: 1857-1862
- Disability and health: a research agenda.Soc Incl. 2013; 1: 37-45
- Health and human rights in scientific literature: a systematic review over a decade.Health Hum Rights. 2011; 13: E102-E129
- The impact of rehabilitative services in the lives of adults and children with disabilities, in low-income and middle-income countries: an assessment of the quality of the evidence.Disabil Rehabil. 2013; 35: 703-712
- Dignity, rights and capabilities in clinical rehabilitation.Disabil Rehabil. 2010; 32: 2138-2146
- Human rights and rehabilitation outcomes.Disabil Rehabil. 2010; 32: 965-971
- Core concepts of human rights and inclusion of vulnerable groups in the disability and rehabilitation policies of Malawi, Namibia, Sudan, and South Africa.J Disabil Pol Stud. 2012; 23: 67-81
- A Good Lives Model of clinical and community rehabilitation.Disabil Rehabil. 2007; 29: 1604-1615
- A patient-centered care ethics analysis model for rehabilitation.Am J Phys Med Rehabil. 2013; 92: 818-827
- Vienna Convention on the Law of the Treaties. United Nations Treaty Series.United Nations, Vienna1969: 331
- Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. Report No. E/CN.4/2004/49.United Nations, New York2004
- Resolution adopted by the Human Rights Council on the protection of human rights in the context of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). A/HRC/RES/12/27.United Nations, New York2009
- Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. Report No. E/CN.4/2005/51.United Nations, New York2005
- Assistive technology in low-income countries.in: MacLachlan M. Swartz L. Disability and international development: towards inclusive global health. 1st ed. Springer, New York2009: 144-160
- Socioeconomic inequality in disability among adults: a multicountry study using the World Health Survey.Am J Public Health. 2013; 103: 1278-1286
- Access to services for persons with disabilities in challenging environments.Handicap International, Lyon2010 (Available at:) (Accessed July 13, 2014)
- Indignity, exclusion, pain and hunger: the impact of musculoskeletal impairments in the lives of children in Malawi.Disabil Rehabil. 2012; 34: 1736-1746
- The political origins of health inequity: prospects for change.Lancet. 2014; 383: 630-667
- Still a health issue.Disabil Health J. 2012; 5: 129-131
- Exploring disability.1st ed. Polity Press, Malden1999
- The health of disabled people and the social determinants of health.Public Health. 2011; 125: 145-147
International Disability Caucus. Information sheet for the sixth session of the Ad Hoc Committee on Article 21 on Health [IDC Information Sheet, Article 21, 6th Session]. 2005. Available at: http://www.un.org/esa/socdev/enable/rights/ahcstata26sscomments.htm#childright. Accessed July 13, 2014.
- Theories of disability in health practice and research.BMJ. 1998; 317: 1446-1449
- Client participation in medical rehabilitation for adults with severe disabilities.Scandinavian Journal of Disability Research [Internet]. 2013; (Available at: http://dx.doi.org/10.1080/15017419.2013.859176. Accessed September 4, 2014): 1-18
- Rethinking care from the perspective of the disabled people: conference report and recommendations.WHO Disability and Rehabilitation Team, World Health Organization, Geneva2001 (Available at:) (Accessed July 13, 2014)
- Why is rehabilitation not yet fully person-centred and should it be more person-centred?.Disabil Rehabil. 2007; 29: 1616-1624
- Rehabilitation: disability ethics versus Peter Singer.Arch Phys Med Rehabil. 2003; 84: 1246-1248
- Towards a conceptual description of rehabilitation as a health strategy.J Rehabil Med. 2011; 43: 765-769
World Health Organization. Proposal for the seventh session of the Ad Hoc Committee on Article 25 on health [WHO Proposal Article 25, 7th Session]. 2006. Available at: http://www.un.org/esa/socdev/enable/rights/ahc7contunagencies.htm. Accessed July 13, 2014.
- Communication No. 3/2011: views adopted by the Commitee at its Seventh session (16-27 April 2012). CRPD/C/7/D/3/2011.United Nations, Geneva2012
Constitutional Court of the Republic of Belarus. Decision No. D-358/2009. 2011. Available at: http://www.globalhealthrights.org/health-topics/health-systems-and-financing/decision-no-d-3582009/. Accessed July 13, 2014.
Allain J. Treaty interpretation and the United Nations Convention on the Rights of Persons with Disabilities. Belfast: Disability Action’s Centre on Human Rights for People with Disabilities; 2009.
- The Maastricht Guidelines on Violations of Economic, Social and Cultural Rights. E/C.12/2000/13.United Nations, New York2000
- Dichotomies, trichotomies or waves of duties?.Hum Rights Law Rev. 2005; 5: 81-103
- The disabilities convention: towards a holistic concept of rights.Int J Hum Rights. 2008; 12: 261-278
- Mental disabilities and the human right to the highest attainable standard of health.Hum Rights Q. 2006; 28: 332-356
- General Comment 20: non discrimination in economic social and cultural rights. E/C.12/GC/20.United Nations, New York2009
- The role of reasonable accommodation in securing substantive equality for persons with disabilities: the UN Convention on the Rights of Persons with Disabilities.in: Rioux M.H. Basser M. Lee A. Jones M. Critical perspectives on human rights and disability law. 1st ed. Martinus Nijhoff Publishers, Leiden2011: 273-307
Thomas P. Jimmo v. Sebelius—Settlement agreement has major implications on Medicare beneficiaries with disabilities and chronic conditions. 2012. Available at: http://www.aapmr.org/advocacy/legal-initiatives/Documents/CCD-Memo-on-Settlement-D0445616.pdf. Accessed May 6, 2014.
- Stigma: ignorance, prejudice or discrimination?.Br J Psychiatry. 2007; 190: 192-193
- Stigma as a fundamental cause of population health inequalities.Am J Public Health. 2013; 103: 813-821
- General Comment 3: the nature of state parties obligations. E/1991/23(SUPP).United Nations, New York1991
- Report of the United Nations High Commissioner for Human Rights. Report No. E/2007/82.United Nations, New York2007
- Suffering and powerlessness: the significance of promoting participation in rights-based approaches to health.Health Hum Rights. 2009; 11: 5
- People at the Centre of Health Care: harmonizing mind and body, people and systems (A WPRO publication).World Health Organization, Geneva2007 (Available at:) (Accessed May 6, 2014)
- General Comment 14: the right to the highest attainable standard of health. E/C.12/2000/4.United Nations, New York2000
- Disabled people and professionals differ in their perceptions of rehabilitation needs.J Public Health Med. 2000; 22: 393-399
- User involvement in service delivery predicts outcomes of assistive technology use: a cross-sectional study in Bangladesh.BMC Health Serv Res. 2012; 12: 330
- Concluding observations on the initial report of Austria adopted by the Committee at its tenth session (2-13 September 2013). CRPD/C/AUT/CO/1.United Nations, Geneva2013
- Concluding observations on the initial report of Australia adopted by the Committee at its tenth session (2-13 September 2013). CRPD/C/AUS/CO/1.United Nations, Geneva2013
- Human Rights Council resolution on the rights of persons with disabilities: participation in political and public life. A/HRC/19/L.9/Rev.1.United Nations, New York2012
- Participation and the right to the highest attainable standard of health.University of Essex Human Rights Centre, Colchester2008
- The right to health in international law.1st ed. Oxford Univ Pr, Oxford2012
- General Comment No. 2: Article 9: accessibility. CRPD/C/GC/2.United Nations, Geneva2014
- Patient-centred access to health care: conceptualising access at the interface of health systems and populations.Int J Equity Health. 2013; 12: 18
- Health care expenditures of living with a disability: total expenditures, out-of-pocket expenses, and burden, 1996 to 2004.Arch Phys Med Rehabil. 2009; 90: 1532-1540
- Sources of payment for assistive technology: findings from a national survey of persons with disabilities.Assist Technol. 2006; 18: 77-86
- Disparities in usage of assistive technology among people with disabilities.Assist Technol. 2008; 20: 194-203
- Assistive technology in developing countries: national and international responsibilities to implement the Convention on the Rights of Persons with Disabilities.Lancet. 2009; 374: 1863-1865
- Assistive technology in developing countries: a review from the perspective of the Convention on the Rights of Persons with Disabilities.Prosthet Orthot Int. 2011; 35: 20-29
- Joint position paper on the provision of mobility devices in less-resourced settings: a step towards implementation of the Convention on the Rights of Persons with Disabilities (CRPD) related to personal mobility.World Health Organization, Geneva2011
- Delivering services in multicultural societies.World Bank, Washington (DC)2010
- Immigrants, disability and rehabilitation.in: Stone J. Culture and disability: providing culturally competent services. 1st ed. SAGE Publications, Thousand Oaks2005: 1-13
- Gender-specific issues in cardiac rehabilitation: do women with ischaemic heart disease need specially tailored programmes?.Eur J Cardiovasc Prev Rehabil. 2007; 14: 163-171
- Gender differences in stroke incidence and poststroke disability in the Framingham Heart Study.Stroke. 2009; 40: 1032-1037
- Defining and measuring quality of care: a perspective from US researchers.Int J Qual Health Care. 2000; 12: 281-295
- Rethinking quality in the context of persons with disability.Int J Qual Health Care. 2003; 15: 287-299
- Processes in rehabilitation.in: Dean S.G. Siegert R.J. Taylor W.J. Interprofessional rehabilitation: a person-centred approach. 1st ed. Willey-Blackwell, Chichester2012: 79-107
- A glossary of terms for community health care and services for older persons.World Health Organization, Kobe2004 (Available at:) (Accessed May 8, 2014)
- On autonomy and participation in rehabilitation.Disabil Rehabil. 2002; 24 (discussion 5-1004.): 970-974
- Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. Report No. A/64/272.United Nations, New York2009
- General Comment No. 1: Article 12: equal recognition before the law. CRPD/C/GC/1.United Nations, Geneva2014
- Applying the principles of informed consent to patient care: legal and ethical considerations for physical therapy.Phys Ther. 1984; 64: 934-937
- Informed consent in physical medicine and rehabilitation: the physician/patient relationship—the doctor as a fiduciary.Phys Med Rehabil Clin N Am. 2002; 13: 213-224
- Who will be accountable? Human rights and the post-2105 development agenda.United Nations, Geneva2013 (Available at:)
- Beyond compassion: the central role of accountability in applying a human rights framework to health.Health Hum Rights. 2008; 10: 1
- Governance for health in the 21st century.WHO Regional Office for Europe, Copenhagen2012
- The right to health—note by the Secretary General. A/62/263.United Nations, New York2008
- Concluding observations on the initial report of China adopted by the Committee at its eighth session (17-28 September 2012). CRPD/C/CHN/CO/1.United Nations, Geneva2012
- Core concepts of human rights and inclusion of vulnerable groups in the United Nations Convention on the Rights of Persons with Disabilities.ALTER Eur J Disabil Res. 2012; 6: 159-177
- Will we take suffering seriously? Reflections on what applying a human rights framework to health means and why we should care.Health Hum Rights. 2008; 10: 45
Article info
Publication history
Published online: August 14, 2014
Footnotes
Presented in part to the European Health Law Conference, April 28–30, 2014, Riga, Latvia.
Supported by the Disability Rights Expanding Accessible Markets project (grant no. ITN-2010-265027) under the European Union 7th Framework Programme—Marie Curie Actions.
Disclosures: none.
Identification
Copyright
© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
