NATASHA ALTIN, MSc(OT)
Today’s public health situation is quite different from what it was in the 20th century. Today, in many parts of the world we see populations living longer, surviving communicable and non-communicable diseases and injuries due to better healthcare and related factors (WHO, 2014). As the result, population demographics have seen increases in ageing population, number of people who have disability and in the burden of chronic disease (McMaster Health Forum, 2017). This brings a new set of challenges and opportunities to the public health field, as governments look for ways to support and meet the needs of the changing populations to remain independent, healthy and productive, thereby promoting the population’s well-being, decreasing the impact of disease and disability on the person, their caregivers and society as a whole (WHO, 2017a).
Assistive technology (e.g. wheelchairs, hearing aids) has been proposed by the World Health Organization as a strategy to equalize opportunities for both the ageing population and individuals with disabilities by maximizing functional ability, enabling civic participation, living productive and independent lives (WHO, 2014). However, today, only 5-15% of the world’s population (including high income settings) who require assistive technology (AT), have access to it. Access to AT has been identified by the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) as a human rights obligation and a necessary facilitator in the achievement of all 17 Sustainable Development Goals, widely adopted in 2015 (Tebbutt, Broadmann, Borg, MacLachlan, Khasnabis, & Horvath, 2016). Countries that have ratified the UNCRPD (177 ratified the Convention so far) (UN, no date) must ensure the availability of high-quality, affordable assistive products as a human right as it represents an essential step towards equal opportunities (WHO, 2014; Khasnabis, Mirza & MacLachlan, 2015; Borg et al., 2012). The implementation of UNCRPD as it pertains to AT continues to be challenging for many countries, resulting in the World Health Organization launching the Global Cooperation on Assistive Technology (GATE) initiative to provide direct action to realization of UNCRPD principles and improve the AT situation worldwide (Khasnabis, Mizra & MacLachlan, 2015; WHO, 2014).
Canada, which ratified the UNCRPD in 2010 (Councils of Canadians with Disabilities, 2010), has an obligation to make AT accessible and available to all (Government of Canada, 2014), meaning access to AT, AT services, and information has to be affordable and physically available to all Canadians (WHO, 2017b). However, with a closer look at the current AT system, it becomes apparent that it does not adequately support Canada’s obligation to UNCRPD due to highly variable, complex, restricted and underfunded AT programs across Canada.
Currently, Canada does not have federal legislation that enables universal access to AT, leaving AT not clearly covered by mandates in health or social services (Schreiber, Wang, Durocher, & Wilson, 2017). Where AT is referenced in Canadian legislation, definitions of AT, AT services and what is mandated in relation to AT are vague, leading to a lack of consistency and accountability in the provision of AT (Schreiber et al., 2017; Durocher, Wang, Bickenbach, Schreiber, & Wilson, 2017). As a result, there are extensive differences in how AT is funded and provided across the country, as well as in the eligibility criteria for accessing publicly funded programs, and the costs that consumers have to cover themselves to obtain or use AT and related services (Durocher et al., 2017). Current federal provisions apply to only a specific subset of Canadians (e.g. veterans) and are unavailable to the rest of the population with similar needs, who have to rely on highly variable provincial and territorial AT programs, thus leading to inequities in access (Durocher et al., 2017).
Economic accessibility (affordability) is a key barrier to AT access in Canada. Most government-funded programs do not cover the entire cost of the required AT and services, forcing the AT user to pay a portion of the cost (Gordon, Kerzner, Sheldon, & Hansen, 2007). Without appropriate levels of funding, some AT users may be forced to go without AT or choose less appropriate, but more affordable options, potentially decreasing functionality and safety. Additionally, government-funded programs rarely cover repairs and maintenance of the AT, putting those who are unable to pay for the costs at risk of using ineffective and unsafe AT (Schreiber et al., 2017). Additionally, government-funded programs operate within a limited selection of appropriate ATs and AT suppliers. These practices restrict AT users’ choices and can result in users making compromises that do not adequately meet their needs. In terms of information accessibility, current AT programs lack integration, resulting in confusion and difficulty navigating, limiting the ability of the AT users to actively participate in the decision making process about their own care and technologies they require (Schreiber et al., 2017; McMaster Health Forum, 2017).
As a country that has signed and ratified the UNCRPD, Canada has a direct obligation to provide AT to all Canadians who require it (Councils of Canadians with Disabilities, 2010; Government of Canada, 2014; WHO, 2017b). However, the above analysis of current access to AT demonstrates that it does not adequately fulfill Canada’s obligation to UNCRPD due to highly variable, complex, restricted and underfunded AT programs across Canada. Innovations in AT enhance opportunities for many individuals to participate in society and the need for AT will continue to increase due to rises in ageing populations, number of people who have disabilities, and the growing burden of chronic disease (McMaster Health Forum, 2017). Despite the increased number of mainstream AT and AT innovations available, current Canadian policies have not responded to AT progress and growing user demand. The expense, lack of federal legislation and policies, and a lack of concrete and comprehensive definitions of AT, creates barriers to access and further amplifies inequalities. As a result, there is an urgent need to develop legislation that directly addresses current and future equitable access to AT in Canada.
|Assistive technology is an “umbrella term covering the systems and services related to the delivery of assistive products and services” (WHO, 2016).
Assistive products are defined by World Health Organization as products that are used to “maintain or improve an individual’s functioning and independence, thereby promoting their well-being” (WHO, 2016).
Borg, J., Larson, S., Ostergren, P., Rahman, A. A., Bari, N., & Khan, A. N. (2012). Asssitive technology use and human rights enjoyment: A cross sectional study in Bangladesh. BMC International Health and Human Rights, 12(18), 1-11
Council of Canadians with Disabilities. (2010). Canada ratifies United Nations Convention on the Rights of Persons with Disabilities. Retrieved from http://www.ccdonline.ca/en/international/un/canada/crpd-pressrelease-11March2010
Durocher, E., Wang, R., Bickenbach, J., Schreiber, D., & Wilson, M. (2017). ‘Just access?Questions of equity in access and funding for assistive technology. Ethics and Behaviour, doi: 10.1080/10508422.2017.1396461
Gordon, P., Kerzner, L., Sheldon, T., & Hansen, E. (2007). Assistive Devices in Canada: Ensuring Inclusion and Independence. ARCH Disability Law Centre, Toronto, Ontario.
Government of Canada. (2014). Convention on the Right of Persons with Disabilities.First report of Canada.
Khasnabis, C., Mizra, Z., & MacLachlan, M. (2015). Opening the GATE to inclusion for people with disabilities. The Lancet, 386, 2229-2230.
McMaster Health Forum. (2017). Panel summary: Enhancing equitable access to assistive technologies in Canada. Retrieved from https://macsphere.mcmaster.ca/bitstream/11375/21912/1/asst-tech-cps.pdf
Schreiber, D., Wang, R., Durocher, E., & Wilson, M. (2017). Access to Assistive Technology in Canada: A jurisdictional scan of programs.
Tebbutt, E., Broadmann, R., Borg, J., MacLachlan, M., Khasnabis, C., & Horvath, R. (2016). Globalization and Health, 12(79), 1-6.
United Nations (No date). Division for social policy and development disability: Convention on the rights of persons with disabilities. Retrieved from https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html
World Health Organization. (2014). Concept note: Opening the GATE for assistive health technology: Shifting the paradigm. Retrieved from http://www.who.int/phi/implementation/assistive_technology/concept_note.pdf.
World Health Organization. (2016). Assistive technology: Fact sheet. Retrieved from http://www.who.int/mediacentre/factsheets/assistive-technology/en/.
World Health Organization. (2017a). Global research, innovation and education in assistive technology: GREAT Summit 2017 report. Geneva, Switzerland: Natasha Layton
World Health Organization. (2017b). Health and human rights. Retrieved from http://www.who.int/mediacentre/factsheets/fs323/en/