Creating inclusive communities

Editor's Notes

• #3: On a societal level, the disability rights movement has clearly articulated the social and political nature of disability, diluting the dominance of biomedical discourses and prompting legal recognition of a more holistic notion of health and wellbeing [15]. Societal responsibilities for health and inclusion are recognized in international legislation drawn from a human rights perspective. The complexity of translating disability rights into improved outcomes, even with political support and regulatory incentives, is acknowledged in other studies [52]. Findings in this paper illustrate the imperative for professionals working with humans and with the environments and contexts in which humans live to identify and address mismatches that result in disablement. Professionals should advocate for and enact systemic, as well as local environmental change, and be pro-active to ensure that benefits are shared across communities.
• #4: Communities have a direct impact on the health and wellbeing of individuals.
• #5: Disability correlates with disadvantage. Poor people, women and older people are more likely to experience disability. Not all people with disabilities are equally disadvantaged: people with intellectual impairments and people with mental health conditions often do much worse. The World report on disability highlights the disabling barriers which make life difficult for people with disabilities. The key message is that these barriers can be modified and prevented. (World Health Organisation & World Bank, 2011)
• #6: It has been noted by the Productivity Commission (2004) that disability discrimination in one area of community life can have a negative flow on effect in others. For example, “accessible public transport can yield most benefit only when destinations become accessible. Discrimination in education feeds into limited employment opportunities - and access to both requires accessible transport and buildings. Limited employment opportunities, in turn, affect income levels and opportunities for social participation.” Accordingly, reducing disability discrimination in one area of community life can have flow on benefits in others
• #8: how do people’s experiences of community environments inform our understanding of the relationship between environment and inclusion?” This entails focusing on the standpoint of the person with disability and addressing the multiple tangible and intangible aspects of environment which influence their outcomes, at all available opportunities. Competent and ethical professionals, working with people with disability and across disciplines, are in a strong position to enact change that enhances wellbeing and inclusion.
• #9: The ICF includes elements that traditional or clinical perspectives on health and disability did not: environmental factors personal factors ICF describes ‘disability’ as the result of a sub-optimal fit between the person and their environment Disability can therefore be defined as impairment of body structure or function combined with subjective experience of disablement brought about by environmental barriers. Should environmental barriers exist, the effects of impairment are magnified and the person experiences disablement
• #10: Respondents identified having between one and twelve impairments or long-term health conditions, and reported nearly 60 separate diagnoses, the majority relating to physical impairment (59%), followed by multiple (14%), sensory (14%), psychological (6%) and neurological (5%) impairments. Nine percent of the sample identified cognitive impairments such as acquired brain injury or as secondary effects of other conditions such as the late effects of polio. There were more female (59%) than male (41%) respondents, grouped in age from 18 to 24 (7%), 25 to 44 (26%), 45 to 64 (50%), and over 65 (16%). Respondents’ living situations differed, with the majority living in private dwellings (92%). Of these, 65% reported living with a spouse or partner, and 27% with family members. Two percent of respondents lived in a supported group home, and a further 2% lived in a larger congregate care residence. Seventy four percent were unemployed, with 21% engaged in volunteer work and 4% interested in working or volunteering but reporting they are currently unable to due to lack of suitable supports and accommodations.
• #11: Participants frequently reported concurrent experiences of inclusion and disablement, and environments with a mix of barriers and facilitators. Environmental factors which present a barrier for some, are a facilitator for others. Path of travel is a key concept, not just disconnected accessibility features.
• #12: Built and non-physical elements of places are capable or creating or eliminating the experience of disablement. multi-dimensional and subjective nature of the environment, its interactions with individuals, and significant relationship to inclusion and wellbeing Physical (footpaths, shop entrances, churches, portable ramps, trams, reception desks, seating) Virtual (computers, communication devices, online resources) Attitudinal (staff assistance, friends, landlords) Institutional (locked accessible toilets, kerb cuts, airline policies, attendant support, parking proximity, talking timetables) Socioeconomic (income support, concessions and allowances, flexibility in spending on supports).
• #13: Confidence, security, information and forms of social interaction and assistance are all relevant to the usability of physical space. Individual participants identified many possibilities for removing existing environmental barriers, and described potential outcomes should this occur. Any one individual has limited agency within societal structures. People with disability experience higher costs of disability, a thinner margin of health, and vulnerability to significant capability gaps in non-inclusive environments [40]. Systemic environmental changes necessitate collective responsibility for the creation of inclusive environments, rather than reliance on individual agency or governmental regulation. Professionals hold moral and ethical responsibilities in relation to inclusive environments and are encouraged to perceive and co-ordinate action on environmental barriers.
• #14: Occupational therapists for example has predominantly addressed local adaptation of the built environment related to an individual and their impairment. Beyond remediating issues of individual ‘fit’ between one individual and one environment, this transactive understanding of human functioning and health in context, along with human rights advocacy by people with disability, has informed society’s understanding of the nature of disability and highlighted discrimination and exclusion that occurs due to barriers in public buildings and services. This means, rather than being perceived as outside the scope of professionals’ practice, advocacy for systemic change is necessary to bridge the capability gaps identified by people with disability [47]. Restricting environmental interventions to local adaptations risks a failure to respect human rights, and misses the opportunity to facilitate widespread inclusion across communities. Research has shown that participation in intervention planning itself is health enhancing and that clients meet their goals more effectively and efficiently when they are actively involved in the planning process. Participants identified barriers that limit their participation and “cost” them their inclusion; a cost borne individually. Recent work outlines a “reversed” position of responsibility with respect to access and inclusive communities, that focuses on the cost of non-social [35] and non-inclusive environments [24,36]. Termed the “economics of inclusiveness”, costs are calculated over all community members (parents with prams, elders with shopping trolleys etc.) who may benefit from interventions such as kerb cuts and accessible transport [37,38]. Such a shift in approach and accounting would mean, for example, that architects conceive access not as a constraint upon design, but as a “major perceptual orientation to humanity” [39] (p. 112). Systemic change in community environs is usually enacted by local and regional government authorities or individual businesses. This is often in response to complaints under disability discrimination legislation, or as part of regulatory procedures in building and planning. Examples include visual and tactile surfacing of roads and paths; retro-fitting entrance ramps, or providing “disability awareness” training. From a human rights perspective, the state has a key role in supporting inclusion through its tools of public administration; usually laws and regulations. Pursuing regulation is one obvious route to change, however some authors question the use of regulation as the primary avenue of change, as it may position inclusion as a compliance problem. Non-regulatory policy instruments that can change cultural attitudes, as well as physical infrastructure, are required [51].