An Exchange of Ideas on the World Report on Disability
n June 9, 2011, the World Report on Disability (WRD) was released at the United Nations in New York.1 The report followed the call of the World Health Assembly for a comprehensive report on the situation of people with disability around the world and has nine chapters that refer to the understanding of disability, recent epidemiologic data, general health care, rehabilitation, assistance and support, enabling environments, education, employment, and several recommendations (Fig. 1). Each of the chapters strikingly demonstrates that disability is not simply a health condition or an individual characteristic but an interaction between health-related impairments and societal and environmental barriers.2 These barriers include stigma and discrimination, lack of adequate health care and rehabilitation services, inaccessible transport and buildings, as well as deficient access to information and communication technologies. The crucial question is whether one is able and willing to remove these barriers to improve the life situation of persons with disabilities. In his foreword to the report, the renowned theoretical physicist Professor Stephen Hawking calls the necessary efforts ‘‘a moral duty,’’ and with much optimism, he declared his hope that ‘‘this century will mark a turning point for inclusion of people with disabilities in the lives of their societies’’ (p. IX).1 Indeed, the report’s publication indicates that some lessons might already be learned. The WRD is the first major health report of the World Health Organization to be available in Braille, and there is also a version for people with mental retardation consisting largely of pictures and captions. Optimism is certainly needed to face the challenges. The report demonstrates that almost one-fifth of the esti-
0894-9115/14/9301(Suppl)-S1/0 American Journal of Physical Medicine & Rehabilitation Copyright * 2013 by Lippincott Williams & Wilkins DOI: 10.1097/PHM.0000000000000015
mated global population lives with disabilities, and most countries do not have sufficient legislations, services, and financial and human resources to adequately respond to the needs of people with disabilities. However, the WRD is not only another document that claims a better understanding of disability and reveals attitudinal barriers and service deficits. The authors and contributors want to point forward toward concrete actions to overcome barriers that hinder participation of people with disabilities. Consequently, the WRD ‘‘focuses on measures to improve accessibility and equality of opportunity; promoting participation and inclusion; and increasing respect for the autonomy and dignity of persons with disabilities’’ (p. XXII).1 Rehabilitation is thereby seen as a major strategy and has a central role in the report’s structure (Fig. 1). Immediately after the launch of the WRD, the International Society for Physical and Rehabilitation Medicine (ISPRM) agreed to develop an action plan to disseminate, analyze, and implement the WRD in rehabilitation and particularly in physical and rehabilitation medicine (see the final article of this issue). Moreover, the ISPRM president’s cabinet and members of the World Health Organization Liaison Committee decided to work on a special issue on the WRD, and the Editorial Board of the American Journal of Physical Medicine & Rehabilitation kindly offered the opportunity to use this high-quality journal for publication for the resulting articles. In total, 30 authors contributed to this special issue. The authors start with a summary of the report’s main contents with a special focus on the rehabilitation chapter. Afterward, von Groote and coauthors discuss how to meet the challenge of getting publications such as the WRD into practice. The inner chapters of this issue present comments and perspectives from eight different nations including the United States of America, Mexico, Argentina, Sweden, Saudi Arabia, Ghana, Korea, and Indonesia. These nations were selected to provide examples from the three ISPRM world areas and to cover most of the subareas (Table 1). The editors of this supplement are aware of the arbitrariness of this choice. However, the editors and authors are confident Editorial
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FIGURE 1 Model of the structure of chapters of the WRD.
that their selection is a sound representation of the diversity that characterizes the ISPRM community. Moreover, the different cultural and national environments enable them to identify common themes and challenges of their work. Finally, the last article draws some conclusions from the perspective of the ISPRM president’s cabinet and
identifies five major challenges that will impact forthcoming ISPRM activities. The authors recognize that this issue will not present the one and only ultimate strategy for how rehabilitation and rehabilitation medicine should be developed to fit the recommendations of the WRD. However, they are
TABLE 1 ISPRM world areas and subareas ISPRM World Areas The Americas Europe, Eastern Mediterranean, and Africa Asia and Oceania
ISPRM Subareas North America Middle America South America Europe Eastern Mediterranean Africa Central and East Asia South and South East Asia Oceania
Am. J. Phys. Med. Rehabil. & Vol. , No. (Suppl), January 2014 Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
convinced that the articles support the exchange within the vivid ISPRM community and provide substantial input for the efforts to support the independence and the inclusion of people with disability. Last but not least, the authors want to thank the journal’s Editorial Board for publishing this special issue and especially Walter Frontera for his valuable comments and strong support.
Lucerne, Switzerland Swiss Paraplegic Research Nottwil, Switzerland
Boya Nugraha, MSc Department of Rehabilitation Medicine Hannover Medical School Hannover, Germany
Matthias Bethge, PhD Christoph Gutenbrunner, MD Department of Rehabilitation Medicine Hannover Medical School Hannover, Germany
Department of Rehabilitation Medicine Hannover Medical School Hannover, Germany
Gerold Stucki, MD, MS
REFERENCES 1. World Health Organization: World Report on Disability. Geneva, Switzerland, World Health Organization, 2011
Department of Health Sciences and Health Policy University of Lucerne
2. Imamura M, Gutenbrunner C, Li J, et al: 2012VAn ISPRM landmark year. J Rehabil Med 2013;45:417Y22
Editorial Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.