Rehabilitation Psychology 2014, Vol. 59, No. 2, 117–124

© 2014 American Psychological Association 0090-5550/14/$12.00 http://dx.doi.org/10.1037/a0036715

COMMENTARY

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The World Report on Disability and Its Implications for Rehabilitation Psychology Malcolm MacLachlan

Hasheem Mannan

Trinity College Dublin and Stellenbosch University

Melbourne University and Trinity College Dublin

Objective: This study reviewed the World Report on Disability (World Health Organization & World Bank, 2011) and explored its implications for rehabilitation psychology. Method: Key findings and recommendations were identified within the World Report and issues that are salient to the profession, practice and research within rehabilitation psychology were highlighted. Results: The World Report has a particular emphasis on disability in low-income countries, where the majority of people with disabilities live. Despite the origins and development of rehabilitation psychology within high-income countries, the profession has much to contribute to addressing many of the challenges identified in the World Report. Specific targeted contributions might include addressing the human resources for health crisis in rehabilitation; developing prosocial and community-based interventions and programs; helping to identify and overcome difficulties to accessing health care; refining the measurement and classification of disability; and strengthening research, policy and advocacy for and with people with disabilities. Implications: The World Report on Disability presents exciting and challenging opportunities that exist for rehabilitation psychology practitioners and researchers, and for the profession itself. Keywords: World Report on Disability, rehabilitation psychology, human resources, access, policy

The World Report on Disability (World Health Organization [WHO] & World Bank, 2011) is a stock-taking and agenda-setting document intended to influence the experience, processes and outcomes of disability and rehabilitation worldwide. In this paper, we first describe the policy context that has led to the development of the World Report on Disability and summarize its main findings and recommendations. We then consider what the World Report on Disability means for rehabilitation psychology and highlight some areas where rehabilitation psychology may have a particularly valuable contribution to make. The World Report on Disability presents an opportunity for rehabilitation psychology to now enhance its profile and its reach, in ways that contribute to addressing the recommendations within the Report.

The World Report on Disability The International Policy Context of the World Report on Disability The World Report on Disability (WHO & World Bank, 2011) is the most recent in a number of important international initiatives that have brought increasing focus to and reflection on disability and rehabilitation. Dating back a decade, the International Classification of Functioning, Disability, and Health, reinterpreted the deficit and deficiency ‘medical’ model, presenting disability as an interaction between some form of impairment and opportunities for social inclusion and meaningful participation in society (WHO, 2001a). The World Report on Disability is set to promote a similarly fundamental shift in thinking about disability. Two other landmark initiatives mark critical milestones to its development. The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD; United Nations, 2006)—which has now passed into international law—sought to address discrimination, change perceptions and combat stereotypes and prejudices regarding disability. It focuses particular attention on the rights of women and children with disabilities, as they have been particularly marginalized. Article 25 of the Convention on Health states that “persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability” and this means that persons with disabilities should have “the same range, quality or standard of free or affordable health care and programs as provided to other persons, in-

Malcolm MacLachlan, Centre for Global Health and School of Psychology, Trinity College Dublin and Centre for Rehabilitation Studies, Stellenbosch University; Hasheem Mannan, CBM-Nossal Institute Partnership for Disability Inclusive Development, Nossal Institute for Global Health, Melbourne University and Centre for Global Health and School of Psychology, Trinity College Dublin. Correspondence concerning this article should be addressed to Malcolm MacLachlan, PhD, Centre for Global Health, Trinity College Dublin, 7–9 Leinster Street South, Dublin 2, Ireland. E-mail: [email protected] tcd.ie 117

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cluding in the area of sexual and reproductive health and population-based public health programs” (see also United Nations, 2006, Article 26 on “Habilitation and Rehabilitation,” discussed later). The Convention therefore provides the international moral and legal context for why we should act, and specifies our obligations to do so; including specifying obligations for highincome country aid programs to address disability in poorer aidrecipient countries. The Community-Based Rehabilitation (CBR) Guidelines, launched in 2010 (WHO, 2011), have provided a major impetus for how we should act. These guidelines provide a comprehensive and multisector approach that can contribute to implementation of the UNCRPD. The CBR Guidelines—launched in October 2010 — arose from a global collaboration between the World Health Organization (WHO), United Nations Educational, Scientific and Cultural Organization, International Labor Organization, and International Disability and Development Consortium, and reflect several years of consultative and highly collaborative work between multiple stakeholders (WHO & World Bank, 2011). With progress on the definition and conceptualization of who comprises persons with a disability (International Classification of Functioning, Disability, and Health), the development of a human rights framework for why action was needed (UNCRPD), and at least one means of how these challenges could be met (CBR Guidelines), it was clear that an authoritative statement on what was the current situation regarding disability worldwide, and what were the major challenges that needed to be confronted now, was needed. The WHO and the World Bank have collaborated on the production of a World Report, which has also incorporated— over several years—a lengthy consultative and collaborative process incorporating many stakeholders, including people with disabilities and disabled people’s organizations, practitioners, advocacy groups, researchers and policymakers. It is now becoming increasingly recognized that without addressing the rights and needs of people with disabilities, the Millennium Development Goals (a set of internationally agreed development and poverty-alleviation goals, which most aid efforts are targeted at addressing (United Nations Development Programme, 2011), cannot be met (Eide & Ingstad, 2011; MacLachlan & Swartz, 2009). In the next section, we highlight the main messages and recommendations of the World Report on Disability.

Messages and Recommendations of the World Report on Disability Tables 1 and 2, respectively, summarize the main messages and recommendations of the World Report on Disability. The Report—

Table 1 The World Report On Disability: Messages Main messages There has been a paradigm shift in approaches to disability. Disability prevalence is high and growing. Disability disproportionately affects vulnerable populations. Disability is very diverse. People with disabilities face widespread barriers in accessing services. People with disabilities have worse health and socioeconomic outcomes.

Table 2 The World Report on Disability: Recommendations Main recommendations Enable access to all mainstream systems and services. Invest in programs and services for people with disabilities. Adopt a national disability strategy and plan of action. Involve people with disabilities. Improve human resource capacity. Provide adequate funding and improve affordability. Increase public awareness and understanding about disability. Improve the availability and quality of data on disability. Strengthen and support research on disability.

which runs to over 320 pages— gives a level of detail not previously available in any one volume and warrants close reading. The paradigm shift from a medical to a more social understanding of disability is emphasized, and states that disability arises from an interaction between “inaccessible environments [that] create disability by creating barriers to participation and inclusion” (WHO & World Bank, 2011; p. 4). The removal of environmental barriers is therefore seen as a critical means to promoting social inclusion and participation and thus overcoming disabling conditions. Disability prevalence is provided at a higher rate than previous figures have estimated; moving from an estimate of 10% of the world’s population (in the 1970s) to now one of 15%, constituting one billion people. While some of this increase may be due to a more inclusive definition of disability, the World Report also notes that an aging population and more people living with chronic health conditions have likely contributed to this increased figure, along with road traffic accidents, natural disasters, conflict situations, diet and substance abuse. A very strong message is that disability disproportionately affects vulnerable populations, particularly the poor, women and children. Lower income countries have a much higher prevalence of disability than higher income countries and disability is both a cause and a consequence of poverty. The vast majority of people with disabilities therefore reside in “developing” countries and are least able to address their own needs and rights. Disability is very diverse and not all people with disabilities are equally disadvantaged. Children with physical impairments have a higher rate of participation in schooling than children with sensory or intellectual impairments. Women with disabilities face double disadvantages due to their gender and their disability. Access to services (health, education, employment, transport, and information) is hampered by inadequately inclusive public policies, as well as negative attitudes and stigma. Associated with these problems are the clear findings that people with disabilities—across the world— have poorer health, lower educational achievement, less economic participation, and higher rates of poverty, than those without disabilities. To address these challenges, the World Report on Disability makes nine specific recommendations (see Table 2). Emphasizing that people with disabilities have ordinary needs, the Report pushes for greater inclusion in mainstream programs and services, arguing that this does not only address human rights but can also be more cost-effective. However, the Report also recognizes that some people with disabilities may also require more specific services, such as rehabilitation, support services or vocational

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WRD IMPLICATIONS FOR REHABILITATION PSYCHOLOGY

training. To incorporate both of these approaches, a national disability strategy and action plan is recommended that can help to coordinate services both within and across sectors, and, most importantly, recommendations are made for consultation with and active involvement by people with disabilities. The Report recognizes that the human-resources capacity needs to be strengthened so that more people are able to deliver more appropriate services and opportunities for people with disabilities. Where these are publicly provided, increased funding will be needed, but so too will increased awareness and understanding of disability by the public at large. Any actions based on these recommendations, if they are to be accurately monitored and evaluated, will need an improved quality and availability of data on the experience of people with disabilities, particularly in lowincome countries. This also requires standardized and internationally comparable methods, with data-collection being both mainstreamed in national censuses and undertaken for specific purposes. In order for this to be of maximum value in promoting evidenced-based policy and practice, research on disability and social barriers needs to be greatly strengthened.

Rehabilitation Psychology and the World Report on Disability Rehabilitation Psychology Scherer et al. (2010) have defined rehabilitation psychology as A specialty area within psychology that focuses on the study and application of psychological knowledge and skills on behalf of individuals with disabilities and chronic health conditions in order to maximize health and welfare, independence and choice, functional abilities, and social role participation across the life span. Rehabilitation psychologists are uniquely trained and specialized to engage in a broad range of activities including clinical practice, consultation, program development, service provision, research, teaching and education, training, administration, development of public policy and advocacy related to persons with disability and chronic health conditions. (p. 1444)

Cox et al. (2010) have traced the development of rehabilitation psychology as a specialty arising from the unmet needs of the survivors from war-related injuries in the Second World War to the present day with more people surviving more serious injuries— both civilian and military—and more people living longer and with conditions that often result in disability (see also Hibbard, Layman, & Stewart, 2010; Larson & Sachs, 2000). Rehabilitation psychology appears to have admirable breadth of scope with strong areas of focused research and practice, be widely applicable across a range of disability and rehabilitation challenges, and to have developed rapidly in recent decades. Most of the references to psychology in the World Report on Disability occur in Chapter 4 on “Rehabilitation.” The Report defines “rehabilitation” as “a set of measures that assist individuals who experience, or are likely to experience disability, to achieve and maintain optimal functioning in interaction with their environments (WHO & World Bank, 2011; p. 96). The chapter covers rehabilitation measures and outcomes, rehabilitation medicine, therapy, assistive technology, rehabilitation settings, needs and unmet needs. Within these sections, the interdisciplinary ethos of

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rehabilitation psychology is clearly discernible. The chapter goes on to highlight the importance of addressing barriers to rehabilitation; reforming policies, laws and delivery systems; delivering funding mechanisms for rehabilitation; and increasing human resources for rehabilitation. Also stressed within the “Rehabilitation” chapter of the Report is the need for expanding and decentralizing service delivery; increasing the use and affordability of technology; and expanding research and evidence-based practice. Overall, Chapter 4 is contextualized within Article 26 (“Habilitation and Rehabilitation”) of the UNCRPD calling for: “. . . appropriate measures, including through peer support, to enable persons with disabilities to attain and maintain their maximum independence, full physical, mental, social and vocational ability, and full inclusion and participation in all aspects of life” (WHO & World Bank, 2011; p. 95). Despite the significant achievements of rehabilitation psychology, there are a number of factors that might reasonably be expected to limit its impact in low-income country settings, where the World Report on Disability is most strongly focused. Rehabilitation psychology remains much more extensively developed in the United States than in any other countries, including other high-income countries. Furthermore, despite the fact that rehabilitation psychology draws on many different aspects of psychology, psychology itself has had only a modest impact in those countries where the majority of people with disabilities live (Carr & MacLachlan, 1998; Carr, McAuliffe & MacLachlan, 1998; MacLachlan, Carr & McAuliffe, 2010). An additional factor may be that, arguably, rehabilitation psychology has aligned more with the use of and consequences of hospital-based high technology interventions, rather than the more community-based, poverty alleviation, and human rights thrust of the World Report on Disability. Nonetheless, the World Report should be seen as presenting exciting challenges and opportunities both for the application of rehabilitation psychology and for increasing the reach of the profession. Below we highlight some of the implications of the World Report. We do not suggest that the implications discussed here are either comprehensive or exhaustive. Rather, they reflect our own reading of the World Report and have been limited in number, for economy of expression, to five themes: human resources; prosocial rehabilitation psychology; access to services; measurement and assessment; and research, policy and advocacy. In each case, we highlight possible contributions that rehabilitation psychology can make.

Human Resources for Rehabilitation Psychology Health-service providers are the personification of a health system’s core values; the human link connecting knowledge to health action, as outlined in the 2006 World Health Report (WHO, 2006). To achieve national and global health goals requires capable, motivated, and well supported health workers. However, 75 countries have fewer than 2.5 health workers per 1,000 population, which is the minimum number estimated as necessary to deliver basic health services (Joint Learning Initiative, 2004). The World Health Organization Maximizing Positive Synergies Collaborative Group (2009) estimates a global deficit of trained health workers of over 4 million, and suggests that “new strategies are needed to improve staff retention that integrate in-service training of existing

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staff members with long-term investment in development. The production of new health workers through preservice education needs greater attention and resources” (p. 2157). The Global Health Workforce Alliance (2007) estimated that Africa alone needs 1.5 million new health workers to be trained to address current shortfalls in its health systems (p. 2157). The World Report on Disability cites the estimate of .04 –.6 psychologists per 100,000 population in low-income and lower middle-income countries; others predict a shortage of conventionally trained nurses and physicians of 800,000 in sub-Saharan Africa (Scheffler et al., 2009). Low-income countries have limited resources for training health care professionals and the migration of those who are trained to conventional international standards has made dependence on such cadres increasingly precarious (McAuliffe & MacLachlan, 2005). Beyond the national level shortages, imbalances in geographic distributions, especially between rural and urban areas, exacerbate the health human resources crisis (Dussault & Franceschini, 2006). Poor working conditions are reported to seriously undermine health system performance by thwarting staff morale and motivation, and directly contributing to problems in recruitment and retention (Troy, Wyness, & McAuliffe, 2007). Assistive devices are often not available and there are inadequate systems for delivery, adaptation and maintenance (Borg, Lindstrøm, & Larsson, 2009; Eide & Øderud, 2009). Unfortunately, many people working in the disability field have received little or no relevant formal training, and resources are wasted by not involving persons with disabilities, their families, and their organizations in the planning of programs and education (WHO, 2001b). It is widely recognized that resources are unlikely to become available to support the scaling up of training of practitioners along the conventional Western health professions paradigm (Joint Learning Initiative, 2004). A move away from the expensive production of clinically oriented health professionals to a more pragmatic production of health workers appropriate to a country’s “burden of disease,” availability of resources, and minimum standards of good care has therefore been suggested (Huddart & Picazo, 2003). This strategy has already been adopted through the use of “midlevel cadres,” such as medical assistants, clinical officers and enrolled nurses to provide health care (Buchan & Dal Poz, 2003). These so-called midlevel cadres are generally trained in a more narrowly defined set of task, with the training taking considerably less time, than is the case for more conventionally trained “Western” style doctors or nurses, for instance. Indeed more than 100 different categories of these “alternative cadres,” or “midlevel workers,” have been used to provide health care, particularly to underserved communities, and the use of midlevel workers has been widening in both high- and low-income countries (Lehmann, 2008). In many of the poorest countries, there are no psychologists with expertise in rehabilitation, and the prospect of developing such a profession would seem unrealistic, at least in the short to medium term. For instance, after noting the extreme shortage of physicians and nurses in low compared to high income countries, the World Report on Disability sates that: “Discrepancies are also large for other rehabilitation professions: .04 –.6 psychologists per 100,000 population in low-income and lower middle-income countries, compared with 1.8 in upper middle-income countries and 14 in high-income countries . . .” (WHO & World Bank, 2011; p. 108;

see also Saxena et al., 2007). Nonetheless, innovative human resource strategies may offer rehabilitation psychologists a real opportunity to contribute to service development in such countries. Recent studies in emergency obstetric care, for instance, provide strong evidence for the clinical efficacy (Chilopora et al., 2007; McCord et al., 2009) and economic value (Kruk, Pereira, Vaz, Bergstrom, & Galea, 2007) of midlevel cadres—showing that they are equally effective as conventionally trained health professionals with much longer training (see MacLachlan, 2012a). The optimal means of identifying the most appropriate types of task to be shifted from one cadre to another have yet to be fully developed, and should involve job analysis, skill set specification, training, and certain minimum levels of education. We argue that this sort of analysis is at the interface of and within the remit of organizational psychology and rehabilitation psychology (MacLachlan, Mannan, & McAuliffe, 2010). Within the context of the human resources crisis in health care as it applies to rehabilitation, rehabilitation psychologists might not only get involved in identifying more generic lower-level cadre in rehabilitation, but also identifying which tasks, including those carried out by rehabilitation psychologists, can most legitimately be shifted. What then becomes critical is the provision of adequate training, support, and supervision of such low-level cadre, perhaps through the plethora of electronic media developing through the “connected health” movement. Naturally, such an approach is fraught with political and professional sensitivities and rivalries; one reason why it should embrace as scientific and evidence-based approach as possible. The human resources crisis in health suggests that largescale training of rehabilitation psychologists—where they are most needed—is not realistic and that lower-level cadres, providing skilled psychological interventions, is a model worth exploring, particularly in the context of implementation of the CBR Guidelines on (MacLachlan, 2012b).

Prosocial Rehabilitation Psychology The ethos of social inclusion (including ethnicity, children, women, and others), participation, empowerment, and advocacy, resonates with social psychological applications to rehabilitation psychology (Dunn, 2010) and the need to address negative social attitudes and stigma (Wright, 1988) are all issues that are mentioned within the World Report and are the proper domain of psychology (as well as other disciplines). This “social engagement” role is an opportunity for rehabilitation psychology. While there are many interesting and innovative models developing within rehabilitation psychology, one of particular relevance to our discussion here may be that described by Hibbard, Layman, and Stewart (2010). Their “ABCs of Rehabilitation Psychology Interventions” have been described particularly within the context of rehabilitation neuropsychology but may have broader relevance. The key features include the (a) signifying interventions to assist with adjustment (although relating here to “disability onset,” it may also be more broadly applied to coping with existing disability) often involving individual counseling and psychotherapy; the (b) refers to behavioral interventions aimed at behavior change within the individual, family, and group contexts, and with behavioral and environmental modifications; there are several Cs, including cognitive remediation, compensatory skills building, and consultation and advocacy. Acknowledging the consultation and

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advocacy role of rehabilitation psychology is important. This can go beyond individual liaison; ranging from advocating for ethically sound and culturally sensitive interventions, to promoting community services that can enhance quality of life and independent living, inclusion, participation, and empowerment. Work on how people with disabilities themselves can be a resource for one another (Wegener et al., 2009) may be of great relevance to resource-poor settings. Wegener and colleagues explored the acceptance and effectiveness of a community-based self-management intervention designed to improve outcomes after limb-loss. Participants had nine 90-min group sessions delivered by trained volunteer leaders. They concluded that self-management interventions can improve the outcomes of persons with limb-loss beyond the benefits offered by regular support groups. While this research was carried out in the United States, its mode of intervention and ethos chime well with the idea of societal engagement, and particularly with the empowerment of people with disabilities, and could perhaps be modified to lower-income settings and different cultural contexts. The positive psychology movement aims to “catalyze a change in psychology from a preoccupation only with repairing the worst things in life to also building the best qualities in life” (Seligman, 2002; p. 3). This approach has been applied specifically to rehabilitation psychology (Dunn & Dougherty, 2005; Ehde, 2009), and again, developed in the United States, the low-cost attitudinal practices which it incorporates, may be, with care, transferable across different contexts and cultures (MacLachlan, 2006), even allowing for the fact that disability psychology and embodiment are constructed differently by different societies (MacLachlan, 2004). For instance, Marlene le Roux’s (2008) Look at Me project sought to empower African women with disabilities by presenting and discussing images of them as sexual beings. The women coconstructed their images and their narratives, with these challenging stereotypes of disability, and challenging the stigma associated with both disability and women with disability being sexual. Many of the participants in this ongoing project are exhilarated and empowered. Addressing such taboos is always important but not always easy, and this has been and continues to be a controversial project—indeed, it aims to make its greatest impact through being controversial. The importance of including human strengths and potentials is not a new focus for rehabilitation psychology (Wright & Lopez, 2002), but one which has considerable appeal in resource-poor countries where the costs of high-tech interventions may be prohibitive.

Access to Services Access is often difficult for people with disabilities even in wealthy countries, but in poorer countries the challenges are even greater, combining physical, financial, and attitudinal components. MacLachlan and Mannan (2012a) have argued that the General Comment of the United Nations Committee on Economic, Social, and Cultural Rights (United Nations Economic & Social Council, 2000) can be applied to health-care access, to better understand facilitators and barriers. The General Comment encompasses four intersecting elements that can be related to goods and services; “accessibility” refers to the need for health facilities, goods and services to be accessible to everyone without discrimination, and within the jurisdiction of the state. This first element of accessi-

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bility can be further broken down into the related dimensions of “nondiscrimination;” “physical accessibility;” “economic accessibility” (affordability), and “information accessibility;” “availability” concerns the quantity of services, facilities, and associated goods (such as medicines and assistive devices); “acceptability,” referring to ethical and cultural, gender, and life cycle requirements; and “quality,” relating to the scientific and clinical appropriateness of services. This final element, is poorly developed but related to the drive for more evidence-based practice, of which rehabilitation psychology is so prominent; and low-income settings may be particularly relevant to utilizing more than one type of research evidence (Tucker & Reed, 2008). We have also argued that from a health systems perspective, the extent to which the health service needs of people with disabilities are met is an ideal probe to research, monitor, and evaluate health, development, and equity in general in low-income country health systems (MacLachlan, Mannan, & McAuliffe, 2011). Thus, addressing access and service-related problems for people with disabilities also has the potential to improve access for all. Rehabilitation psychology could play an important role in developing methods and measures to promote greater access for people with disabilities, which also benefits people without disabilities. A psychological perspective may be able to reach across more service domains, complimenting other health and related services research, than is the case for other health professions.

Measurement and Assessment The World Report utilizes three unique perspectives when it comes to measuring disability: the world health survey (http://www .who.int/healthinfo/survey/instruments/en/); global burden of disease estimates (http://www.who.int/topics/global_burden_of_disease/ en/); and global and regional initiatives on disability statistics. These perspectives are presented with a good overview of conceptual challenges and opportunities for disability measurement. From a pragmatic viewpoint, one model should be adopted to further comparability across research studies. The world health survey and the global and regional initiatives have much in common and the differences among them could be conceptually addressed to get a “baseline” data point. The tradition of psychometrics in rehabilitation counseling and psychology (McGoey et al., 2010) suggests that this is an area that the profession could contribute much in. One of the World Report’s recommendations is for collection of data in line with the thinking of the United Nations Washington Group on Disability and the United Nations Statistical Commission, and these are both forums in which rehabilitation psychologists could seek much greater involvement.

Research, Policy, and Advocacy The idea of “research utilization” is increasingly valued and is perhaps mandatory in contexts where the affordability of and opportunities for research are restricted. Research should help people with disabilities advocate for what they want, allowing such advocacy to be evidence-based (Wazakili et al., 2011). Likewise, policies need to be evidence-based and to also give direction to the sort of research that needs to be done. Even in difficult contexts, research can influence policy and practice. For instance, we recently ran a workshop for the Ministry of Health in Malawi to assist them in revising their national health policy, with a view to

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making it more inclusive of vulnerable groups, including people with disabilities. Using our EquiFrame methodology (Mannan et al., 2011), we were able to assist policymakers to recognize shortcomings in their existing policy, and thus encourage them to formulate research questions concerning the sort of data that they needed to make informed decisions about providing services for people with disabilities. Advocacy and policy influence are still unfamiliar ground for many rehabilitation psychologists. Health care provision is moving away from “special treatment” to “equal treatment” (Reinhardt et al., 2009), and increasing a focus toward “inclusive health” (MacLachlan, Khasnabis, & Mannan, 2012) and a recognition of the need to also apply this ethos to children with disabilities (MacLachlan & Mannan, 2012b). Indeed, it has been argued that professional associations (for instance, the International Society of Physical & Rehabilitation Medicine) with their traditional mandate to promote professional and scientific aspects of their discipline, should also adopt a more explicit humanitarian, or civil society, role especially in low-income countries ( Reinhardt et al., 2009). Given that rehabilitation psychology also has a very broad and relevant skill set, perhaps this is something that it might consider, also. If so, we may wish to join forces with other groups in psychology—such as humanitarian work psychologists (see www .humworkpsy.org) who are trying to apply industrial/organizational/work psychology to humanitarian situations worldwide. The psychological dynamics of international aid projects play out in complex ways in rehabilitation projects just as in any other type of aid project (MacLachlan, Carr, & McAuliffe, 2010); and without due attention to these, such projects can do more harm than good. The training of rehabilitation psychologists prepares them well for contributing to these projects, either on-the-ground or in advisory roles, and such roles constitute important ways that we can address some of the challenges and opportunities outlined in the World Report on Disability.

Conclusion In conclusion, there are a range of different areas to which rehabilitation psychology could contribute in addressing the challenges highlighted in the World Report on Disability. Many of these may be related to research and practice at the interface between disability and health (Mannan & MacLachlan, 2013), while also recognizing that disability is much broader than health encompassing other aspects of well-being (MacLachlan & Mannan, 2013). But the World Report on Disability must surely also be an opportunity for rehabilitation psychology itself, as a profession, to enhance its profile both within and outside the psychology profession. Within psychology, few areas have the good fortune to be able to respond to a combined WHO and World Bank landmark report, targeted specifically at their distinctive domains of activity. Rehabilitation psychologists should embrace this opportunity by scrutinizing and reflecting on the World Report, exploring how it can contribute to disability globally, and embracing this opportunity to enhance the role and reach of the profession.

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World Health Organization, Maximizing Positive Synergies Collaborative Group. (2009). An assessment of interactions between global health initiatives and country health systems. The Lancet, 373, 2137–2169. Retrieved from http://www.google.ie/url?sa⫽t&rct⫽j&q⫽&esrc⫽s& source⫽web&cd⫽2&ved⫽0CDQQFjAB&url⫽http%3A%2F%2F www.healthsystems2020.org%2Ffiles%2F2333_file_the_Lancet_ article.pdf&ei⫽oyvpUtyqK-6S7Abw2YH4CA&usg⫽AFQjCNE MK274KxkQF8LAEUeESApLImK_nA&bvm⫽bv.60157871,d .ZGU doi:10.1016/S0140-6736(09)60919-3 Wright, B. A. (1988). Attitudes and the fundamental negative bias. In H. E. Yuker (Ed.), Attitudes toward persons with disabilities (pp. 3–21). New York, NY: Springer.

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Received August 24, 2011 Revision received May 11, 2012 Accepted January 22, 2013 䡲

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The World Report on Disability and its implications for rehabilitation psychology.

This study reviewed the World Report on Disability (World Health Organization & World Bank, 2011) and explored its implications for rehabilitation psy...
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