Though this scan observes the move away from a medical model, important health issues and trends still intersect in important ways with the quest for accessibility.  Consider, as one small example, the enhanced risk that those with many types of chronic illness and disability had with respect to COVID-19 severity risk, or the challenges that accompany important public health and safety measures, such as the difficulties encountered by hearing-challenged lip readers amid ubiquitous mask-wearing.^[1]

Worldwide, according to the World Health Organization, “persons with disabilities have twice the risk of developing conditions such as depression, asthma, diabetes, stroke, obesity or poor oral health.”^[2]  The World Health Assembly Resolution WHA74.8 calls on all countries “to ensure that persons with disabilities receive effective health services as part of universal health coverage; equal protection during emergencies; and equal access to cross-sectoral public health interventions.”^[3] But while this might sound like a routinely attainable standard, adults with disabilities may require specialized health care services, including physical therapy, rehabilitation, and counseling services. They may also require assistance with accessing and navigating the health care system, including help with finding a doctor and arranging transportation to appointments. There are also significant areas of overlap in the health systems that older Canadians interact with, and the systems relating to disability.  For example, there are over 10,000 young people with a disability living in long-term care in Canada.^[4]

Timely, barrier-free access to health care is vital.  The World Health Organization calculates that, at least in the US, governments can expect a return on investment of around 10:1 for ensuring disability-inclusive health care access.^[5]

Scientific advances hold amazing promise for treatment, cures, and ultimately extending life expectancy, but the expense of new medications, procedures, and technologies will be a barrier to universal adoption and coverage.  And we will soon see the rise of med-tech converging with the internet of things; As Hyper Island’s Changes of Tomorrow report predicts: “We will all wear devices that capture detailed and personalized health data, measuring heart rate, blood glucose level, blood pressure, and more. Trusted doctors will have access to that data, giving them more information on which to make solid diagnoses, and we will understand the inner workings of our own bodies more intimately.”^[6]

The Health Care Crisis

To the extent disability is a medical or health care issue, some broad health care trends are also important to keep in mind: The Pandemic, and the lingering effects of “Long COVID” have placed additional demand and strain on the Canadian healthcare system.^[7]  People with disabilities were dying in greater numbers from COVID-19 than non-disabled people, in good measure due to the increased risk of contracting COVID-19 in congregate settings – rehabilitation facilities, state institutions (including prisons), group homes, and care homes.^[8]  Many people with disabilities during the pandemic were “cut off from the rest of society” with regular reports of overmedication, self-harm, or ill-treatment surfacing.^[9]  The pandemic also led to higher mortality rates among persons with intellectual disabilities.^[10]  The astronomically high cost of drugs for those with rare or orphan diseases is another issue that sits in the Venn between the health care crisis and accessibility.  The pharmaceutical system in North America tends to place the private (profit-driven) incentives of for-profit companies over public health needs, leading to suboptimal health outcomes.^[11]

Both medical and care professionals continue to experience high levels of stress, and are leaving these professions in numbers greater than we have previously seen.  This mass exodus is putting additional pressure on health care and extended care systems, beyond the added pressures of COVID 19.  Young people are attracted to health care professions in greater numbers, thanks to interest garnered during the pandemic, but little has been done to make this choice an affordable one. Universities tend to charge sharply differential rates for medical school tuition, and sometimes also for other health professions, the rationale being that students are more likely to get well-remunerated employment upon graduation.  But this remains a barrier for those from economically-barriered contexts.

An aging population is putting additional health care pressures on certain regions, like the Maritimes and Vancouver Island.  The current level of resources within health care across Canada may not only be sub-optimal – for example, the system doesn’t cover basic dental care (notwithstanding recent changes for low income Canadians), eye care, fitness, homecare, basic pharmacare etc., all areas with significant public return-on-investment – but increasingly are being seen as unsustainable, as health care eats up a greater and greater percentage of provincial and federal budgets.  Despite this, we may also finally see the launch of a Canada Pharmacare Act by the end of 2024 to set up a system of universal drug coverage, something that has been part of the NDP platform for 30+ years.^[12]

The Mental Health Crisis

The most prevalent disability type among younger Canadian adults (aged 15 to 24 years) in 2017 was mental health-related.^[13]  According to the Canadian Life and Health Insurance Association – mental health claims have climbed 75% since the start of the COVID-19 pandemic.^[14]  The mental health crisis is affecting young people and women disproportionately.  The National College Health Assessment reveals a nearly three-fold increase in reported anxiety among university-aged students over the past decade, along with a quadrupling in ADHD and a more than doubling of depression.^[15]  According to Statistic Canada, the proportion of employed women aged 16 to 24 years with mental health-related disability was 17.2% in 2021, an increase of 7.6 per cent from 2019, the largest increase of all major demographic groups.^[16]

We also have a bifurcated mental health class system in Canada.  An article in the Walrus asks the provocative question “Who gets to be mentally ill?”, pointing out that “those who have the means to seek and pay for professional therapy, and those whose material conditions, economic circumstances and identities prevent them from being poster children for mental illness.  If you are too mad, and especially black, Indigenous and unhoused, you can get roughed up and shot by police, [or] get your children taken away.”^[17]  The article adds that mental health interventions risk making things worse (as with policing) or are in the private realm, covered by individuals or company health plans, but not by the system until things get so bad that hospitalization is necessary.^[18]

SPOTLIGHT: A “Mass Disabling Event”: Long COVID