Category: Policy and Policy Development

Housing and health – a much needed partnership

A older man and woman are smiling at each other. The man is handing the woman a yellow tulip.Research collaborations between different disciplines are a good way to build knowledge and share resources. Housing and health is one area where more cross-sector collaboration is needed. But collaboration doesn’t just happen. Stuart Butler and Marcella Maguire say in their article that collaboration needs a supporting infrastructure. 

Butler and Maguire argue that health and housing partnerships remain in their infancy compared with other collaborations. So what is holding up the development of this essential partnership? They say it is the need for connective tissue.

“Connective tissue is a way of describing the infrastructure needed to support intentional alignment, coordination, and integration between sectors or organizations that serve the same or similar populations in a community.

By “infrastructure” we mean both tangible elements, such as information exchange systems, financing, personnel, shared language, and the intangible elements of trust and shared goals. Developing systems and trust that address cross-sector needs does not just happen; it requires a deliberate process that moves beyond the individual goals of any one system towards a community-wide approach.”

Why the partnership is important

Housing can be the platform for the range of services needed to promote good health. It is a foundational social driver of health. Housing and health partnerships are particularly valuable for addressing the needs of marginalised populations. Collaboration supports:

      • Ageing in the home and community
      • Meeting future pandemic situations 
      • Ending homelessness and housing instability
      • Supporting NDIS participants and their families
      • Addressing some of the impacts of climate change

Components of success

The authors say the components of success include clearly defined goals, network development, and working on projects together. And a good point is made about budgets and cost-shifting: 

“Partnerships are often weakened by the “wrong pockets” problem. This exists when one sector needs to invest in a way that benefits another sector but offers little or no direct cost savings to the first sector. In a housing-health partnership, for example, a housing authority might be considering improving safety features in all bathrooms for older residents. But the main cost saving would be to the Medicare program, not to the housing budget.”

The title of the article is, Building connective tissue for effective housing-health initiatives.  

See also the WHO Housing and Health Guidelines which includes a chapter on accessible housing. 

Inclusive Victoria – the plan

Front cover of the Inclusive Victoria state plan. The Victorian State Disability Plan has a great introduction that includes language and terminology. It acknowledges there is no one right, or universal way to conceptualise disability. That’s because people perceive disability in culturally specific ways. Some people are proud to identify themselves as disabled, whereas others don’t want their disability to define them. Similarly, many autistic and neurodiverse people don’t see autism as a disability. They just see autism at a different way of interacting with the world. The State Disability Plan 2022-2026 is titled, Inclusive Victoria. 

From the introduction

Here is a nicely worded section from the introduction on language:

“Language is a powerful tool for changing community attitudes,
promoting inclusion and fostering disability pride. Throughout
history, people with disability have fought for changes to
language that reflect their human rights. We know language
is always changing, and we recognise that words are powerful
and have different meaning for different people. We recognise
that people with disability have different preferences regarding
how they describe their disability.”

This introduction explains how language is used throughout the document. It highlights the real importance language plays in community attitudes towards people with disability. A good example for other government documents and policies that are based on a marginalised group. 

The plan contains facts and figures about the prevalence of disability and other statistics. The international, national, state and local government obligations are laid out in a straightforward table format. The key elements of the plan are:

      1. Inclusive communities: Changing attitudes, transport, digital inclusion, sport and tourism.
      2. Health, housing and wellbeing: Health, mental health housing, NDIS, children and families.
      3. Fairness and Safety: Emergencies, advocacy, abuse and neglect, justice system, and gender identity.
      4. Opportunity and pride: Education, employment, voice and leadership, pride and recognition. 

Systemic reform

Most disability plans are action plans. This document includes systemic reform which should underpin actions and outcomes. The six systemic reforms are listed as:

      1. Co-design with people with disability
      2. Aboriginal self-determination
      3. Intersectional approaches
      4. Accessible communications and universal design
      5. Disability confident and inclusive workforces’
      6. Effective data and outcomes reporting

Inclusive Victoria is nicely presented with relatively plain language throughout. 

Health, the digital divide and rural dwellers

A timber barn in a rural setting. Looks like it is on a farm. Health and digital divide. In the land of access and inclusion, the focus is usually on the built environment and services. But there is also virtual access and inclusion to consider. The pandemic has highlighted a lack of equitable access to the internet and therefore access to health services. This is particularly the case for rural dwellers. The issues of health, the digital divide and rural dwellers is discussed in a report from the US.

The context of the report is the social determinants of health and the digital divide. Broadband access and digital literacy are key for connecting to services such as employment, education and health services. While broadband infrastructure and computer hardware are necessary, true equitable access also requires focus on digital literacy and proficiency. However, there are other issues related to poor health outcomes. 

According to the report, rural residents are subject to additional social determinants including physician shortages, persistent poverty, and food insecurity. Excessive travel times, inadequate transportation options, environmental exposures are also problematic. And broadband internet services that are often poor quality, unaffordable, or unavailable. 

“Super-determinants” of health are poor transportation, lack of broadband access, and living with a disability. That’s because they cause disadvantage across other areas of life. 

The title of the report is Underfunded Infrastructure Impact on Health Equity. The study focuses on north America, but Australian rural dwellers share many of the same issues.

People are looking at bright orange pumpkins piled in rows in a field on a farmThe report recommends engagement and involvement by community members. Community health workers live and work in vulnerable communities, and they understand the real lives of people. Consequently, community health workers should lead community involvement in coming up with solutions. 

The report explains the social determinants of health, the cost of inequity, and the need for digital literacy training. 

Four key findings in the report

      1. Households with consistent broadband have increased health literacy, greater access to clinical and social services, make better informed healthcare choices, and stay closer connected to support systems of friends and family.
      2. A holistic approach led by health advocates from the local community has the best chance of improving health outcomes and successfully overcoming barriers caused by social determinants.
      3. Strategies for reaching vulnerable populations should center on community health workers (CHWs) who are trusted and respected members of that population. CHWs have an ability to better understand the reality of
        how people live and the obstacles that keep them from success.
      4. Program leadership should include meaningful representation from local community organizations with valuable experience in health equity and extensive community networks.

What do Ableism and Ableist mean?

A man in a wheelchair is separated from the crowd by a low concrete barrier. Ableism and ableist.Disability rights, accessibility and inclusion have come a long way. But we are not there yet. Despite legislation, public policy statements, and access standards, it’s taken more than 50 years to get to this point. Ableism and ableist attitudes are alive and well. Yet many people aren’t aware of how this undermines inclusion and equitable treatment. The same goes for ageism. 

An article in Forbes magazine sums up the sentiments well. The word ‘ableism’ gives voice and substance to real experiences. But it can also discredit people for an offensiveness they don’t see or don’t agree exists. The title of the article is, Words Matter, And It’s Time To Explore The Meaning Of “Ableism.”

The Wikipedia definition explains Ableism “is discrimination and social prejudice against people with disabilities or who are perceived to have disabilities. Ableism characterizes persons as defined by their disabilities and as inferior to the non-disabled. On this basis, people are assigned or denied certain perceived abilities, skills, or character orientations.”

Ableism is expressed in ideas and assumptions, stereotypes, attitudes and practices. Physical and social barriers in the environment is also a form of ableism. Usually it is unintentional and most people are completely unaware of the impact of their words or actions.

Different types of ableism

Andrew Pulrang discusses both personal and systemic ableism. Here is his list on personal ableism.

1. Feeling instinctively uncomfortable around disabled people, or anyone who seems “strange” in ways that might be connected to a disability of some kind. This manifests in hundreds of ways, and can include:

      • Being nervous, clumsy, and awkward around people in wheelchairs.
      • Being viscerally disgusted by people whose bodies appear to be very different or “deformed.”
      • Avoiding talking to disabled people in order to avoid some kind of feared embarrassment.

2. Holding stereotypical views about disabled people in general, or about certain sub-groups of disabled people. For example:

• Assuming that disabled people’s personalities fit into just a few main categories, like sad and pitiful, cheerful and innocent, or bitter and complaining.

• Associating specific stereotypes with particular conditions. For example, that people with Down Syndrome are happy, friendly, and naive.

• Placing different disabilities in a hierarchy of “severity” or relative value. 

3. Resenting disabled people for advantages or privileges you think they have as a group. This is one of the main flip sides of condescension and sentimentality towards disabled people. It’s driven by a combination of petty everyday resentments:

• Disabled people get good parking spaces, discounts, and all kinds of other little unearned favors.

• Unlike other marginalised groups, everyone likes and supports disabled people. They aren’t oppressed, they are coddled.

• Disabled people don’t have to work and get government benefits for life.

Overcoming ableism: challenging values

Small golden stars scattered on a table. Overcoming ableism challenges values.Overcoming ableism takes more than attending a disability awareness workshop. It’s also more than checking out the right words to use when talking about disability. If things are to change for people with disability, we have to challenge values and assumptions. 

Andrew Pulrang writes that the stereotype of people with disability is one of fragility and weakness – it’s associated with illness. Disability services are ‘care’ services, not just services for practical assistance. Workplaces assume people with disability can’t handle the pressures of work. 

He concludes his article with, “The roots of ableism run deep. Sometimes to get at them we have to dig deeper, and disrupt not just our habits, but some of our most basic ways of thinking.” 

The title of Pulrang’s article is, Fighting Ableism Requires Us To Challenge Some Of Our Most Cherished Values. 

A last word

Pulrang concludes with a few reminders. People with disability can be ableist too. They grew up in an ableist society. Ableism isn’t a new ‘ism’ – it is a word that sums up longstanding oppression and injustice. So when it is used, don’t take it as an insult. Ableism is a way of talking about a set of real experiences that people with disability experience. It’s a way to talk about them. 

The Longevity Revolution and the 100 year life

A man with white hair and beard sits at a desk with a younger man. The longevity revolution has arrived and the 100 year life is here. But what are the challenges and how do we meet them? An article from the World Economic Forum poses this question as part of The Davos Agenda. The first thing is to dismiss discussions about an ageing crisis – there are opportunities to be realised.

According to research, a child born in 2000 can expect to see their 100th birthday. The implications carry across the whole of society, business, and government.

The Stanford Center on Longevity has launched “The New Map of Life” initiative. New models of education, work, policies for healthcare, housing, and the environment are on the agenda. And researchers aim to redefine what it means to be “old”. 

The Stanford report says we are not ready, but we can meet the challenges. Here are their principles:

      • Age diversity is a net positive
      • Invest in future centenarians to deliver big returns
      • Align health spans to life spans
      • Prepare to be amazed by the future of ageing
      • Work more years with more flexibility
      • Learn throughout life
      • Build longevity-ready communities

Longevity is about babies not old people

“The impact on the global workforce is profound but also not yet realized. Before, we would have three or four generations in the workforce. Now, we have five and even six generations in the workforce. While stereotypes of all generations abound, many aren’t true. A growing body of research indicates that multigenerational workforces are more productive, see lower rates of employee turnover, have higher levels of employee satisfaction, and feel better about their employer.” (from the New Map of Life).

The Design Council also addresses the issues from a built environment perspective. See the post The 100 year life. 

Easy Read Disability Strategy

Front cover of Easy Read Disability Strategy.The National Disability Insurance Agency (NDIA) has an Easy Read guide to the Disability Strategy 2021-2031. However, you need good reading and web navigation skills to get to it. The information is spaced out over 44 pages in the PDF version. 

The key objective of the strategy is about living a life you want to live. The goals are:

      1. Working and earning money
      2. Inclusive homes and communities – living where you want to live
      3. Rights for fair treatment and feeling safe
      4. Getting support as an individual and to be part of the community
      5. Being independent
      6. Learning and getting skills
      7. Access to health services and enjoying life
      8. More inclusive community attitudes
      9. Getting the outcomes we want by working together

The text only Easy Read Word document is on the Disability Gateway website.

The NDIS website has two other reports:

Home and Living consultation summary report

Support for Decision Making consultation summary report  

There are Easy Read versions of the reports and a videos with Auslan if you scroll down the each report page. 

There is also an Easy Read version of the UN Convention on the Rights of Persons with Disability. 

 

Disability Reporting Handbook

Front Cover of Disability Reporting Handbook showing a young man and woman. They are laughing together. Media Diversity Australia has a handbook for reporting on disability issues. This is a well researched document that covers more than the usual topics. It also has specific “how to” guides for interviewing people with different disabilities. The Disability Reporting Handbook is a good companion to the ABC guide to disability content – see below. 

The Handbook covers the usual introductions to disability and golden rules about language and images. It also covers:

      • Intersectionality with disability in relation to women, First Nations people, people from linguistically diverse backgrounds and LGBTQIA+ communities. 
      • Violence and disability, including support services available.
      • How to guides for interviewing people with disability covering physical, sensory, cognitive, psycho-social and neurodiverse conditions. 
      • A list of Useful Contacts

 “The biggest barrier to full participation in the community for people with disability is attitude. Most Australian’s with disability experience the soft bigotry of low expectations”. (Graeme Innes, former Disability Discrimination Commissioner)

The  contributors have varied backgrounds in media and journalism. They consulted widely in the development of this comprehensive publication. Media Diversity Australia is a not for profit organisation that believes the media should reflect the cultural diversity of Australia. They have another publication, Who Gets to Tell Australian Stories?  

ABC guide to disability content

ABC journalist Nas Campanella. ABC guide to disability content.
ABC Journalist Nas Campanella

Australia’s public broadcaster, the ABC, has a guide to disability content. The guide covers appropriate behaviour and language in reporting and portraying disability content. It’s applicable to all ABC platforms including social media. It’s a good guide for all journalism and anyone new to interacting with people with disability.

The title of the guide is, Reporting and Portraying Disability in ABC Content. Arranging and conducting interviews, asking questions, language and terminology are all covered. Many journalists are up to date with their language now, but images are still a problem. And there is still a tendency to place people with disability into a victim or a hero role. 

The information about arranging and conducting interviews includes checking on any assistance or support they might need. Saying someone is inspirational is not appropriate. So check facts and don’t run with assumptions.

Photographers and camera operators need similar information to avoid showing pitying pictures or focusing on assistive equipment. Wheelchairs are not the sum total of people with disability.

Images of disability in journalism

The guide gives the following advice: 

    • Avoid portraying individuals as objects of pity. For example, photograph a person using a wheelchair at their level, not looking down on them. Powerful, positive reinforcing images are generally preferred, depending on the editorial context.
    • Only show the person’s disability if it is critical to the story.
    • Avoid focusing on equipment unless that is the focus of the story. Avoid gratuitous cutaways of wheelchairs, canes, hearing aids and other devices.
    • Avoid having the talent’s carers or family in photos or video unless they are also part of the story. Show the talent as having autonomy over their own lives.
    • Avoid showing the person with disability as isolated from the community unless that is the focus of the story.
    • Avoid using stock images as the majority reinforce stereotypes of disability and are of poor quality.
    • Avoid using images of mobility aids, such as photos of wheelchairs, as a generic image for a story about disability.
    • Do consider using people with disabilities to illustrate stories that are not about disability, to show they are a regular part of the community.
    • Do aim for diversity in imagery of people with disabilities – people from ethnic minorities and gender diverse people also live with disability and are often even more marginalised.
    • Do show people with disabilities doing normal things, such as catching public transport or shopping, but avoid making it ‘inspiration porn’. It’s just life.
    • Do show people with disabilities in positions of power and authority.

Image from ABC News website

 

Economics of meaningful accessibility

long view of a Perth city mall with shops and cafes under awnings and trees for shade. Tall buildings are in the background. Economics of meaningful accessibility.How can we measure the economic benefits of designing our built environments to ensure access for everyone? Good question. Tourism has a solid body of knowledge on the economics of inclusion, and housing studies cite savings for health budgets. However, we need a benchmark to show clear and direct economic benefits for stakeholders and society. But it has to be meaningful accessibility, not just minimal compliance to standards. That’s the argument in a paper from Canada.

 An article in the the Journal of Accessibility and Design for All has a good look at the literature on the subject. Research papers agree that there are overall economic benefits in making products and services more accessible. But we still need a way of getting hold of data and finding a good method for measuring. That’s the key argument in the paper.

The title of the paper is, Measuring economic benefits of accessible spaces to achieve ‘meaningful’ access in the built environment: A review of recent literature.

Meaningful accessibility

Meaningful accessibility is about how the built environment enables everyone to participate in social and economic life. As the authors say, “meaningful accessibility and universal design go hand in hand—meaningful accessibility is a goal of universal design”. They also note that accessible environments are perceived as an altruistic intention rather than a business choice. That is, the notion of special designs for a small group of people who need them. 

The aim of the paper is to draw attention to the gap in the research in areas such as planning, urban design and architecture. A strong voice from users of places and spaces calling for change remains essential. So too, is a change in discourse about disability being outside the frame of ‘normal’. 

Concluding comments

In the concluding comments the authors say meaningful accessibility is harder to sell than green buildings. And that’s despite reduced material costs and energy savings. From a human rights perspective accessibility shouldn’t be an option – it’s a fundamental requirement. 

Whether a better or more rigorous framework for economic analysis will win the day is still questionable. The political context is far more complex. The evidence in Australia on the economic benefits of accessible housing was not sufficient to sway all jurisdictions. The argument that “it costs too much” is consistent with the narrative of disability being outside the frame of normal. 

Editor’s note: The argument for change is not about economics, it’s about political will. It was only when the Victorian and Queensland governments took the lead on accessible housing that the building code was changed. People say to me that we should be explaining the economic benefits if we want accessibility and inclusion. Sadly, the many economic studies have fallen on stony ground and remain silent and ignored. 

This website has more than 20 articles on the economics of inclusion and universal design. Use the search box with “economic” to find them.

Universal design and cognitive accessibility

Partial view of a bronze statue of a man with his head in his hand. It represents thinking. Universal design for cognitive accessibility.Universal design is most commonly associated with the built environment. This is where the physical barriers to inclusion are most visible. But the concept of universal design goes beyond this to include cognitive accessibility.

Emily Steel writes a concise article on how universal design informs cognitive accessibility standards. There are many types of cognitive disability and it would be difficult to have separate standards for each one. So the working group has adopted the Universal Design for Learning framework to promote better design for all people.

Brightly coloured strips lay on top of each other, each one with the day of the week. Universal design for cognitive accessibility.The working group has published two standards since forming in 2015. The first provides guidelines for the design of products to support daily time management. The second is about the design and development of systems, products, services and built environments. A third standard is under development. This one sets out the requirements for reporting the cognitive accessibility of products and systems. 

As an international standard, working group participants come from around the world and include people with diverse cognition. Online meetings replaced the face to face workshops during the COVID pandemic. 

The article, published in Design for All India Newsletter, provides more detail about how the group works. It’s Article 2 in the October 2021 edition. The online Newsletter is produced in Verdana Bold and is fully justified and also includes a lot of Italicised text. This is not a universally designed publication. 

You can directly download the article titled, Universal design informs cognitive accessibility standards. 

Interested in this work?

The working group is keen to integrate lived experiences into the guidelines and any revisions. If you are interested in this work you can contact the Technical Committee Secretariat. 

Dr Emily Steel is the Australian delegate on the International Standards Organization (ISO) cognitive accessibility working group. She also conducted a workshop at the Australian Universal Design Conference UD2021. Dr Steel is also a CUDA board member.

European built environment access standard

CEN CENELEC logo in black and white for the built environment access standard.European Commission has published a built environment standard for accessibility. It describes basic, common minimum functional requirements using universal design principles. The accessibility and usability requirements relate to the design, construction, refurbishment and maintenance of indoor and outdoor environments. 

The standard was based on consensus between relevant stakeholders. The CEN-CENELEC webpage has more detail about the standard and what it contains. The document is titled, EN 17210:2021 Accessibility and usability of the built environment – Functional requirements. 

There is a related document about public procurement to support accessibility in the built environment. This is also part of their Active and Health Ageing strategy.

The “CEN-CENELEC Protocol on accessibility following a Design for All approach in standardization” outlines the procedure to help technical bodies decide whether accessibility, with a Design for All approach, should be addressed when developing or revising a standardization deliverable.

The European Committee for Standardization is one of three European Standardization Organizations (together with CENELEC and ETSI). They are officially recognized as being responsible for developing and defining voluntary standards at European level.

The websites are not the easiest to navigate but there is more information if you care to start searching their standards. 

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