Given that accessibility plays a major role in the lives and quality of life of people with SCI and those with other disabilities, it importance has been reflected in the United Nations Convention on the Rights of Persons with Disabilities (See Box 1).6 Article 9 of the convention seeks “to enable persons with disabilities to live independently and participate fully in all aspects of life, State Parties shall take appropriate measures to ensure to persons with disabilities access, on an equal basis with others, to the physical environment…” (Article 9 excerpt, UN Convention on the Rights of Persons with Disabilities; see the full text in Box 2).
This UN convention, adopted in 2006, has now been signed by 136 countries, establishing a critical human rights instrument with an “explicit social development dimension.” Importantly, the convention regards persons with disabilities as “subjects” with rights who can freely make decisions regarding their own lives as members of society. It lays out the basic rights of persons with disabilities around the world, emphasizing autonomy and self-determination. This being so, there are specific and concrete steps that can be taken from a city planning perspective to increase environmental accessibility. Box 3 (in the discussion section) provides two examples of detailed policy recommendations that can help improve access. The first example highlights the importance of increasing the accessibility of walkways in Europe for those with disabilities, while the second outlines recommendations on appropriate wheelchairs for individual patients.
People with disabilities continue to face major challenges in communities where the physical environment remains inaccessible.
In 1987, in the midst of the “UN Decade of the Disabled Person,” a global meeting of experts recommended that the UN General Assembly draft an international convention for eliminating discrimination among persons with disabilities. In 2007, after two decades of draft outlines and debate, the UN Convention on the Rights of Persons with Disabilities - an international human rights instrument intended to ensure the rights and dignity of persons with disabilities - was opened for signing.
As many countries have yet to enact specific legislation that ensures such rights, ratification of the convention establishes a legally binding instrument under international law with corresponding obligations. At the time of writing there have been 46 ratifications and 137 signings (signatories intend to become parties to the convention are not obliged to further action; ratification involves a legal obligation). The convention emphasizes independence and participation in all aspects of life
and is based upon eight principles:
- Respect for inherent dignity, individual autonomy, including the freedom to make one’s own choices, and independence of persons;
- Full and effective participation and inclusion in society;
- Respect for difference and acceptance of persons with disabilities as part of human diversity and humanity;
- Equality of opportunity;
- Equality between men and women;
- Respect for the evolving capacities of children with disabilities and respect for the right of children with disabilities to preserve their identities.
The convention’s 50 articles elaborate on general principles and definitions, rights to education, health, participation, voting, as well as accessibility and non-discrimination. There is also an optional protocol to the convention that recognizes the Committee on the Rights of Persons with Disabilities to hear individual complaints. Twenty-six nations have ratified this protocol. The convention came into force on May 3, 2008 following the 20th ratification.
Box 2 | Article 9: Accessibility, UN Convention on the Rights of Persons with Disabilities
1. To enable persons with disabilities to live independently and participate fully in all aspects of life, States Parties shall take appropriate measures to ensure to persons with disabilities access, on an equal basis with others, to the physical environment, to transportation, to information and communications, including information and communications technologies and systems, and to other facilities and services open or provided to the public, both in urban and in rural areas. These measures, which shall include the identification and elimination of obstacles and barriers to accessibility, shall apply to, inter alia:
- Buildings, roads, transportation and other indoor and outdoor facilities, including schools, housing, medical facilities and workplaces;
- Information, communications and other services, including electronic services and emergency services
2. States Parties shall also take appropriate measures to:
- Develop, promulgate and monitor the implementation of minimum standards and guidelines for the accessibility of facilities and services open or provided to the public;
- Ensure that private entities that offer facilities and services which are open or provided to the public take into account all aspects of accessibility for persons with disabilities;
- Provide training for stakeholders on accessibility issues facing persons with disabilities;
- Provide in buildings and other facilities open to the public signage in Braille and in easy to read and understand forms;
- Provide forms of live assistance and intermediaries, including guides, readers and professional sign language interpreters, to facilitate accessibility to buildings and other facilities open to the public;
- Promote other appropriate forms of assistance and support to persons with disabilities to ensure their access to information;
- Promote access for persons with disabilities to new information and communications technologies and systems, including the Internet,
- Promote the design, development, production and distribution of accessible information and communications technologies and systems at an early stage, so that these technologies and systems become accessible at minimum cost.
As of 2002, there are 1.1 million persons with disabilities in Thailand (1.7% of the population). In July 2008, Thailand became one of the countries to ratify the United Nations Convention on the Rights of Persons with Disabilities. Needless to say, ratification of this convention establishes an important legal framework and has the potential of positively impacting the lives of many Thais living with disabilities. Additionally, the Thai government has undertaken continuous efforts to develop disability policies that improve quality of life, promote anti-discrimination and increase access to social welfare, services and assistive devices.8
In 2005, regulations were introduced requiring new buildings to be accessible for those with disabilities and a committee was established for the monitoring, evaluation and promotion of environmental accessibility.8 Nevertheless, many challenges remain to improving access to built environments and public transportation for those with disabilities. In order for a person with SCI to successfully reintegrate into his or her community, rehabilitative efforts focusing on an individual’s resources must be complemented by government policies, laws and broader societal efforts that increase accessibility in the public environment.
The World Health Organization’s (WHO) International Classification of Functioning, Disability and Health (ICF)9 provides a useful framework for describing and addressing a person’s experience of disability, including barriers and facilitating factors within the environment.4 Consequently, this classification can help identify the needs and interventions at both an individual level and through public policy and planning. There are a number of key areas covered by the ICF that may directly impact environmental accessibility.
Two categories stand out:
- Mobility - describing a person’s own abilities - involves a number of activities that range from changing body positions to driving and using public transportation. Here, the integrity of body functions, body structures and activities play a large role.
- Environmental factors - comprising aspects external to a person - describes the “physical, social and attitudinal environment in which people live and conduct their lives.” At the individual level, these include assistive devices, technologies and assets. From a broader population-focused perspective, these include externalities such as the natural environment, available services and systems, governmental policies and legal frameworks.
The interaction between an individual’s mobility and his environment contributes to the level of community participation. Access to, and the use of wheelchairs in, the public environment is one good example of this interaction (See Box 2).
This case study will illustrate the importance of accessibility to the environment for participation through the story of one SCI patient from Thailand.