Abstract
In 2015, as I embarked on my doctoral journey in global public health with four other women colleagues, we were determined to advance research that promotes inclusive and equitable access to health services for diverse population groups, particularly those experiencing vulnerability and marginalisation. To address critical global health challenges, we proposed, at that time, an approach that combines inter-sectionality and interdisciplinarity, while giving systematic attention to equity, the social determinants of health, and effective community participation in global health research and initiatives (1). In 2019, with another group of 10 Francophone junior and senior interdisciplinary public and global health re-searchers, we further recommended specific strategies for the future of global health. Two of these included the adoption of the intersectional approach to highlight hidden inequities and the promotion of the social responsibility of public health institutions and professionals (2). Recently, in my new role as an assistant professor of global health, I have been asked to reflect on my position on global health, including health promotion, and propose key dimensions that should be prioritised. Given my past experiences, the ongoing impact of the COVID-19 pandemic and the increasingly severe climate change events and environmental upheavals affecting nations and citizens of all continents, I find myself constantly pondering whether we continue to overlook – consciously and unconsciously – certain population groups, especially the 1.3 billion of the global population living with disabilities and how they are impacted by these intersecting crises (3). In this editorial, I will address three key dimensions of inclusive climate response through the lens of disability: (i) ableism as reinforced by a societal power structure that discriminates against people with disabilities, (ii) intersectional equity considerations and (iii) transformative health outcomes driven by leadership and accountability in governance.
First, people with disabilities, representing 16% of the global population, are considered as one of the largest minority groups in the world. However, they still face multiple and severe discriminations and encounter physical, attitudinal, communication and structural barriers that prevent them from exercising their basic human and disability rights (3). In many societies, people with disabilities are often perceived as being of lesser worth than non-disabled people. They are stigmatised and socially excluded due to their impairments. It is argued that ableism, a powerful societal structure and structural determinant of health, systematically privileges the able-bodied while discriminating against and further marginalising people with disabilities (4). Ableism has profound implications for the inclusion or exclusion of people with disabilities in various policies and programmes on health, education, employment and the environment (3,4). The 2020 Lancet Countdown on Health and Climate Change reports that climate change has already considerably impacted the health of global populations. It has drastically shifted our emphasis on determinants of health, while also deepening social inequities, especially for population groups experiencing intersectional vulnerabilities such as people with disabilities (5). Hence, promoting the implementation of anti-ableist climate-related policies and responses is a crucial step toward fully including people with disabilities, by involving them, addressing their specific needs and contexts and removing the numerous structural barriers they face, one by one.
Second, it is forecasted that climate and environmental changes will unevenly affect vulnerable population groups such as women, children, elderly people, people with disabilities and Indigenous communities (6). Stein and Stein (7) further contend that climate change is disproportionately threatening ‘the right to health of people with disabilities due to higher ambient temperatures, elevated air pollutants, and increasing exposure to extreme weather events that include heatwaves, floods, hurricanes, and wildfires’. During climate disasters, people with disabilities may be less able to escape from dangers and left behind during emergency evacuations (3). A recent systematic analysis of the adoption by State Parties of the Paris Agreement reports that none of the State Parties refer to people with disabilities in their climate mitigation policies, while only 45 State Parties included people with disabilities in their climate adaptation policies (8). Climate policies that do not fully recognise the rights of people with disabilities may further exacerbate inequitable socioeconomic and health outcomes among people with disabilities of multiple social identities. Considering the intersectional vulnerabilities and inequities experienced by marginalised population groups based on sex, gender, age, disability, ethnicity, residence, education, wealth and other social identities assumes a renewed importance for inclusive and comprehensive climate response implementation (9). Intersectionality enables policy- and decision-makers to better understand and analyse the multiple jeopardy vulnerable and marginalised population groups face, and highlight less visible inequities and injustices, while taking into account the context within which people live and work, diverse sources of knowledge, power dynamics and their own positionality (10). Intersectionality also requires data collection and analysis as well as monitoring and evaluation activities to be disaggregated by different social identities and contextual factors to inform evidence-based decision- and policy-making (9). Failing to do so will only perpetuate the invisibility and effacement of certain population groups such as people with disabilities.
Third, more than a decade ago, Lord et al. (11) argued that the invisibility of people with disabilities in global health governance constitutes one of the most pressing concerns global health actors should explicitly address. To date, 186 Member States have ratified the Convention on the Rights of Persons with Disabilities, which stipulates specific obligations for governments to advance the rights of their respective populations with disabilities (12). Furthermore, despite the limited climate policies that mention disability, a significant disparity still exists between the intended and actual implementation of universally accessible and disability-inclusive climate-related initiatives; this gap may further worsen social inequities and injustices (13). In order to consolidate and put into action anti-ableist, intersectional and equitable climate policies and programmes, leadership and accountability in climate governance is required (13). Good governance suggests that leaders, including policy- and decision-makers, understand the impacts of the policies and decisions they propose, while being held accountable for their actions or inactions (14). According to the 2022 Global Report on Health Equity for Persons with Disabilities, pathways forward toward equitable and inclusive health and climate equity involve clear political commitment, leadership and governance. This entails giving priority to disability inclusion in strategic plans, which serves not only to significantly contribute to the Sustainable Development Goals 3 (health), 10 (reduced inequalities) and 13 (climate action), but also beyond 2030. This involves providing strategic direction and leadership, implementing disability budgeting and financing, conducting disability-oriented monitoring and evaluation, engaging in health policy and systems research, and fostering intersectoral collaboration with sectors such as environmental and climate action, as well as emergency preparedness and response (3).
Climate change is undeniably a stark reality. Recent events such as disastrous wildfires in Hawaii and several Canadian provinces, El Nino’s impacts in the Americas, severe droughts in the Horn of Africa, extreme temperatures affecting European countries, flash floods in Asia and melting snow caps at both the North and South Poles underscore this fact. Any further delay or evasion from addressing climate change for all is no longer acceptable. We also cannot leave 1.3 billion people with disabilities behind. We have the duty to act, hold governance actors accountable and actively advocate for global solidarity, equity and social justice.