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Assistive products and the Sustainable Development Goals (SDGs)
Globalization and Healthvolume 12, Article number: 79 (2016)
The Sustainable Development Goals (SDGs) have placed great emphasis on the need for much greater social inclusion, and on making deliberate efforts to reach marginalized groups. People with disabilities are often marginalized through their lack of access to a range of services and opportunities. Assistive products can help people overcome impairments and barriers enabling them to be active, participating and productive members of society. Assistive products are vital for people with disabilities, frailty and chronic illnesses; and for those with mental health problems, and gradual cognitive and physical decline characteristic of aging populations. This paper illustrates how the achievement of each of the 17 SDGs can be facilitated by the use of assistive products. Without promoting the availability of assistive products the SDGs cannot be achieved equitably. We highlight how assistive products can be considered as both a mediator and a moderator of SDG achievement. We also briefly describe how the Global Cooperation on Assistive Technology (GATE) is working to promote greater access to assistive products on a global scale.
The 2030 Agenda for Sustainable Development has a tremendous scope, spanning the three dimensions of economic, social and environmental development. Considered by the United Nations (UN) to be “a universal call to action to end poverty, protect the planet and ensure that all people enjoy peace and prosperity,”  its 17 Sustainable Development Goals (SDGs) will stimulate global action over the next 15 years.
The SDGs build on the Millennium Development Goals (MDGs) and focus on the key gaps in the progress made by the MDGs. At the heart of this is the pledge that “no-one will be left behind” and that governments will endeavour to reach “the furthest behind first” . Persons with disabilities and older people, especially women, are among the groups of people who are most likely to remain left behind, despite collectively numbering between one and two billion [3, 4]. They are also the two largest groups of people who need assistive products. Without assistive products people are often excluded and locked into poverty and isolation; also increasing the impact of functional decline, disease and disability on the person, his/her family and on society.
Older people are living longer and have the potential to contribute to family and society in many ways. However, this potential for contribution is heavily dependent on good health. For many older people today added years are often lived with disability, mostly as a result of chronic disease .
Persons with disabilities have poorer health outcomes, lower education achievements and less economic participation than people without disabilities . They are overrepresented among the poor, and are vulnerable in situations of natural and man-made disasters as well as in conflicts . Children with disabilities experience poorer health, limited opportunities for education and economic opportunities and encounter greater inequalities than children without disabilities ; UNESCO has estimated that literacy rates of women and girls with disabilities are as low as 1% . Persons with disabilities face disproportionate unemployment, depriving societies of an estimated 1.37 to 1.94 trillion US dollars in annual loss of GDP . A study of ten low- and middle-income countries concluded that the losses constitute 3-7% of GDP .
Assistive products can greatly reduce inequalities experienced by all people living with impairments - children and adults with disabilities, and those living with chronic conditions and functional decline - by enabling them to be productive and participate in all areas of life. Achieving the SDGs and leaving no-one behind will not be possible if the people who need essential assistive products do not have access to them.
Assistive products, such as wheelchairs, artificial limbs, spectacles, hearing aids, pill organizers, and accessible information communication technology (ICT), have been developed to maintain or improve the functioning and independence of people with impairments . Assistive products enable people to live healthy, productive, independent, and dignified lives, and to participate in education, the labour market and civic life. They are also important for primary and secondary prevention and management of noncommunicable and communicable diseases, like diabetes and leprosy, respectively. Moreover, they reduce the need for formal health and support services, long-term care and the work of caregivers . The diversity of need for assistive products extends across the life span, across the continuum of health care and across all domains of human activity; representing a very large variety of products.
Access to good quality and affordable assistive products has been mandated by the Convention on the Rights of Persons with Disabilities (CRPD) for ten years but still only 10% of people in need of assistive products have access to them . If this urgent need is not addressed, the percentage of people with access will decrease, as demand increases and access to services remains stagnant. The need is acute everywhere, especially in low-and middle-income countries. To support countries in their efforts to comply with the CRPD, the World Health Organization (WHO) launched the Global Cooperation on Assistive Technology (GATE) in 2014 in partnership with organizations of and for persons with disabilities; UN agencies, donor agencies, professional organizations, academia and industry. With the SDGs comes another international mandate and a platform to further raise awareness and build on existing efforts to improve access. The objective of this paper therefore is to highlight the importance of population-wide access to assistive products as a prerequisite for and facilitator of achieving the SDGs.
We used our own familiarity with the literature and where necessary undertook a literature search (using Google Scholar, Pubmed and Psychinfo) to identity relevant examples of assistive products being used in a way that was related to achievement of each of the SDGs. Table 1 lists the 17 SDGs and for each goal provides a conceptualisation for how assistive products are relevant. Each conceptualisation is illustrated with an example relating to one of the specific targets associated with each goal.
Table 1 highlights how assistive products can help to achieve the SDGs. Some of these may be more intuitively clear than others. For instance, assistive products may mediate the relationship between an intervention to achieve a particular SDG and actual outcomes associated with it. Figure 1a illustrates this mediating relationship for SDG 3, which focuses on ensuring healthy lives and promoting well-being. People who have diabetes, and who have a need for and are provided with therapeutic footwear (an assistive product), can often avoid ulcers and in some cases the need for amputation; thus allowing them the potential to experience better quality of life and wellbeing. So in this example the achievement of the goal works directly through – is mediated by – provision of an appropriate assistive product.
At other times an intervention to achieve an SDG may be effective in its own right, but unavailable to all who may benefit from it. For instance, in regard to SDG 13 and its reference to disaster mitigation; Fig. 1b illustrates how a community may install an alarm system to warn people of the need to evacuate in the case of an impending flood. Without hearing aids many members of the community will not be able to hear and respond to the warning. This is a case of assistive products moderating the effectiveness of an intervention. With appropriate provision of assistive products the intervention is more effective; with inadequate provision of assistive products it is less effective. Thus, at a population level, assistive products can facilitate - or moderate - interventions that are not necessarily concerned with impairment, but for which the provision of assistive products can strengthen their effect. The moderating and mediating effects of assistive products are relevant across all areas of life – at both individual and population levels.
This paper illustrates how achievement of the SDGs and the use of assistive products can be conceptualised; and provides examples of how achieving specific targets can be facilitated through the use of assistive products. Thus, universal access to assistive products represents a fundamental criterion and missing link between people who are likely to remain left behind and achievement of the goals. They are a necessity not only for the achievement of each SDG, but they also facilitate the relationship between the goals. For example, many people with impairments need assistive products in order to access education and jobs and therefore escape poverty and hunger.
Attempting to achieve the SDGs without appropriate population-level access to assistive products would not only be inherently discriminatory, but would also negate the fundamental principle of equity underscored in each goal. Indeed very few interventions have the potential to generate such significant cross-cutting impact, or the potential multiplier effect across different areas of life, for instance, from health and education to employment and justice.
In an effort to address the huge unmet need for assistive products, in May 2016, GATE launched the first WHO Priority Assistive Products List (APL)  with an aim of increasing access to high quality and affordable assistive products. The APL includes 50 priority assistive products, selected through an extensive consultative process which included users and potential users of assistive products as well as experts and other stakeholders.
The APL must be complemented by the establishment of appropriate national infrastructure. In addition to a national Priority Assistive Products List, three additional components are necessary: policy, service provision and trained personnel. GATE is developing tools to address these components. A policy framework will provide guidance for countries to develop assistive products policy and programmes. It will address existing barriers in relation to financing, procurement, standards, training of personnel and service provision. A model of service provision will give guidance on the integration of assistive products service provision into existing health or other services. Finally, a community-level training package will support the development of workforce capacity. Trained personnel are essential for the proper prescription, fitting, maintenance, user training and follow up of assistive products .
Assistive products need to be prioritized by development partners and governments as an essential component for inclusive sustainable development. Universal access to essential assistive products will not only create advances in human rights, but will also benefit society economically, socially and environmentally. As the number of people in need of assistive products globally increases, so does the urgency with which Member States must address this long neglected situation. To ensure no-one is really left behind and that the SDGs are achieved equitably, universal access to high-quality affordable assistive products needs to be prioritized, both across sectors and in the planning and implementation of rehabilitative and assistive services .
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We are very grateful to USAID and to members of the GATE community for their continuing collaboration, support and commitment.
The writing of this paper was in-part supported by funding from the United States Agency for International Development (USAID).
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ET, RB, JB and MM conceived and wrote the paper, CK and RH commented on drafts of the paper. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated. All authors read and approved the final manuscript.
The authors declare that they have no competing interests.
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About this article
- Assistive products
- Assistive technology
- Sustainable Development Goals
- People with disabilities
- Global Cooperation on Assistive Technology