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SDGs, Inclusive Health and the path to Universal Health Coverage

HASHEMI, Goli
KUPER, Hannah
WICKENDEN, Mary
2017

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The Sustainable Development Goals (SDGs) are a set of goals designed to improve the social, economic and well-being of all, while maintaining global and environmental sustainability. Health is one of the 17 goals, and focuses not only on addressing morbidity and mortality, but also on improving access to healthcare services for all through Universal Health Coverage (UHC). While disability is not specifically mentioned in this goal, a focus on people with disabilities is important given the inclusive nature of the SDGs and the fact that people with disabilities make up the largest minority group in the world. This paper aims to critically consider what the health goal could mean for people with disabilities and advocates for inclusive health. It discusses the complex relationship between disability and health, and why people with disabilities are more vulnerable to poor health are discussed, and then considers factors that impact access to quality healthcare for people with disabilities and how these impact on the achievement of the targets in SDG Health Goal and the main principles of UHC. The paper argues that developing an inclusive approach to healthcare will not only improve achieving good health for all, but is also important since experiencing poor health may reduce quality of life and participation (e.g. in education, employment or community activities). Poor quality of life and participation can exacerbate disability, poverty and exclusion in addition to increasing suffering, morbidity and early mortality. The paper concludes that an inclusive UHC will not only fulfil the fundamental rights of people with disabilities to health and rehabilitation, as emphasized within the UN Convention on the Rights of Persons with Disabilities, but also contribute to the achievement of the SDGs.

 

Disability & the Global South (DGS), 2017, Vol. 4 No. 1

The medical inadmissibility of intellectual disability: A postcolonial reading of Canadian immigration systems

SPAGNUOLO, Natalie
2016

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This article builds upon existing critiques of Canada’s immigration system by focusing on the medical inadmissibility of young people labelled with intellectual disabilities. In considering how the Canadian state regulates applications for permanent residency, it explores discourses and practices of citizenship which invoke mutually-constituting identity markers such as disability and race. A close reading of case studies involving family applicants, demonstrates how immigration policies and legal systems frame the needs of young people labelled with intellectual or ‘profound’ disabilities as a burden to Canadian society. Individuals who were initially denied admission to Canada due to their diagnostic label, experience disability-related discrimination in different ways depending on the role of their perceived racial, gender, and class identities, among others. The individuals considered in this study navigate intersectional identities and ableist legal systems in their efforts to resist discrimination and win a review of their residency applications. This analysis will show that applicants are forced to work through the logic of medical assessment processes to favourably position their children within impairment hierarchies which rank intellectual disability as ‘too disabled’ to be admissible.

 

Disability & the Global South (DGS), 2016, Vol. 3 No. 2

The Re-covering Self: a critique of the recovery-based approach in India’s mental health care

BAYETTI, Clement
JADHAV, Sushrut
JAIN, Sumeet
2016

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This paper critiques recent initiatives for deploying the Recovery Model in the Indian sub-continent. It traces the history and growth of the model, and questions its applicability for mental health care in the Indian sub-continent. The authors argue that mental health professionals in this region are at the crossroads of a familiar past: either to uncritically import and apply a Euro-American 'recovery' model or reconfigure its fundamental premise such that it is embraced by the majority Indian population. The paper proposes a fundamental re-thinking of existing culturally incongruent 'Recovery Models' before application in India’s public mental health and clinic settings. More crucially, policy makers, clinicians and researchers need to reconsider the local validity of what constitutes 'recovery' for the very people who place their trust in State mental health services. This critical reappraisal, together with essential culturally-sensitive research, is germane to prevent yet again the deployment of culture-blind programmes and practices. Addressing these uncontested issues has profound implications for public mental health in the Global South.

 

Disability & the Global South (DGS), 2016, Vol. 3 No. 1

Beneath the rhetoric: Policy to reduce the mental health treatment gap in Africa

COOPER, Sara
2015

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In this paper I problematize knowledge on reducing the ‘gap’ in treatment produced by 14 national mental health policies in Africa. To contextualize this analysis, I begin with a historic-political account of the emergence of the notion of primary health care and its entanglement within decolonization forces of the 1960s. I unpack how and why this concept was subsequently atrophied, being stripped of its more revolutionary sentiments from the 1980s. Against this backdrop, I show how, although the 14 national mental health policies are saturated with the rhetoric of primary health care and associated concepts of community participation and ownership, in practice they tend to marginalize local meaning-systems and endorse a top-down framework heavily informed by colonial medicine. The policies thus end up reproducing many of the very Eurocentric assumptions that the original primary health care notion sought to transcend. More specifically, the paradigms of evidence-based research/practice and individualised human rights become the gatekeepers of knowledge. These two paradigms, which are deeply embedded within contemporary global mental health discourse, are legislating what are legitimate forms of knowing, and by extension, valid forms of care. I argue that a greater appreciation of the primary health care concept, in its earliest formulation, offers a potentially fruitful terrain of engagement for developing more contextually-embedded and epistemologically appropriate mental health policies in Africa. This in turn might help reduce the current ‘gap’ in mental health care treatment so many countries on the continent face.

 

Disability and the Global South (DGS), 2015, Vol. 2 No. 3

Mental Health Care, Diagnosis, and the Medicalization of Social Problems in Ukraine

YANKOVSKYY, Shelly
2014

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This paper focuses on cultural issues associated with reforms of the mental health system in Ukraine. Specifically, the paper will explore the adoption of the International Classification of Diseases (ICD-10), with its heavy focus on biomedical definitions of health and illness, and the applicability of applying this model cross-culturally. Using first hand ethnographic data with psychiatrists, social workers and advocates, as well as patients or ‘bolnoi’ (bolnoi translates literally as ‘an ill person’) of psychiatric services, I argue that ‘mental illness’ is not always, or solely, biological, but also culturally shaped, and therefore a ‘one-size-fits-all’ approach to mental health becomes problematic. I follow this argument with a discussion of how social problems more generally come to be redefined in Ukraine as medical in nature, where issues such as gender relations, alcoholism, poverty and environmental disasters are subject to medicalization. Here ‘symptoms of oppression’ or ‘distress’ are diagnosed within a psychiatric framework and become ‘symptoms of illness’, to be treated within the biomedical arena. This redefinition places the responsibility for larger societal issues on the individual and ignores the social and environmental underpinnings of suffering - a dynamic that was also operative in the Soviet system. I argue that the growing popularity of the medicalization of behavior coupled with its relationship with the pharmaceutical industry is thus a moral issue, and one with harmful results.

 

Disability and the Global South, 2014, Vol. 1 No. 2

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