Globally over 1 billion people, or approximately 15% of the world’s population, are estimated to experience disability1. People experiencing a disability face a number of barriers to leading healthy and productive lives, including stigmatisation, discrimination and a lack of appropriate support1. Disability affects many individuals and their families, both directly as well as indirectly. Increasingly, disability is recognised as something that affects most people at some point in their lives.
Defining and measuring disability
The definition of disability is broad, and includes any limitation, restriction or impairment which restricts everyday activities and has lasted, or is likely to last, for at least six months2. Disability includes a spectrum of impairments including physical, intellectual, sensory, learning, neurological or immunological3. Disability is highly correlated with age, with people expected to live around one fifth of their lives with some form of disability3. Disability is not always visible, and many people live with chronic diseases or mental health impairments, which known as invisible disabilities. Regardless of the manifestation of disability, it can significantly reduce quality of life and impair the ability of people to complete daily activities.
Disability can occur in any human activity and across multiple settings. Moreover there is the added complexity that disabilities do not always exist in isolation and many people live with more than one type of disability making it even more challenging to measure impact on the individual. Instruments measuring disability differ with regard to the outcome (to measure either capacity, performance, symptoms or severity) as well as the functional domains included4. Consequently, there are a plethora of tools to measure disability focusing on tasks or activities4. A common metric used by the World Health Organization (WHO) is the Disability Adjusted Life Year (DALY), a time-based measure that combines years of life lost due to premature mortality (YLLs) and years of life lost due to disability (YLDs)5. Globally, the leading causes of DALYs include neonatal disorders, ischemic heart disease, stroke and lower respiratory tract infections6.
Disability in Australia
According to the Australian Institute of Health and Welfare (AIHW)3, around 1 in 6 people are currently estimated to be living with a disability, equating to around 4.4 million Australians. For approximately three-quarters of people with a disability, their main form of disability is physical, such as back problems or chronic diseases including multiple sclerosis. For the remaining quarter of people, their main form of disability is mental or behavioural, such as an intellectual disability or autism. Around 3 in 5 people living with disability require help with activities of daily living and around half are participating in the labour force. Although the disability free life expectancy for people living with disability has improved over time in Australia, more work is needed to continue to promote the inclusion of people with disability in society including the workplace.
The NDIS
In 2011, a report released by the Productivity Commission noted that the disability support system was unfair, fragmented, underfunded and inefficient, which gave people with disability little choice and no certainty of access to appropriate supports7. Importantly patients were required to fit the existing programs, rather than programs being designed to meeting their needs7. This report called for the establishment of the National Disability Insurance Scheme (NDIS) which led to the establishment of the NDIS Act 2013 and the creation of the National Disability Insurance Agency (NDIA)8.
The NDIS covers approximately half a million Australians who have a permanent and significant disability. A permanent disability means the disability is likely to be lifelong9. A significant disability is defined as a substantial impact on a person’s ability to complete everyday activities9. A key part of the rationale for the creation of the NDIS was providing people with individualised services so they can play a more productive role in society7. Since being established, the NDIS has helped between 25,000 and 40,000 people to return to work as well as over 30,000 carers also resume careers10. The additional employment has been estimated to lead to between $18B and $23B of economic returns per annum10.
Although the NDIS has revolutionised the care of people with permanent and significant disability, the scheme has recognised issues related to a mixture of design limitations, implementation problems, and political decisions11. In addition, millions of Australians with a disability currently do meet the criteria for the NDIS and suffer from a lack of support. A recent study analysed data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey – to estimate the costs of disability in Australia using a high quality, large, nationally-representative longitudinal data set. Results demonstrated people with a disability need to increase their adult-equivalent disposable income by 50% to achieve the same standard of living as those without a disability12.
Getting people with disabilities into work
Improving employment outcomes for people with disability will provide significant benefits to workplaces, the economy, the community and individuals themselves. Employment can provide increased income for people with disability, and with this, higher living standards and financial independence7. Employment can also contribute to an improved sense of identity and self-worth creating positive health impacts for many people with disability13. Improved employment outcomes for people with disability can also reduce demand on welfare systems, and this was a key rationale to establish the NDIS7.
Businesses who employ people with a disability benefit from the diverse range of skills, talents and qualifications. Research has shown that workers with disability have higher rates of retention, better attendance and fewer occupational health and safety incidents than those without a disability14. Research also demonstrates that diverse perspectives drive better business outcomes, and that when people feel a sense of belonging at work, they are healthier and more engaged15. Initiatives such as the Valuable 500 are providing resources to help companies increase employment opportunities for people with disabilities16.
Unfortunately people with disabilities still face several employment barriers, including societal prejudice, environmental obstructions, institutional discrimination and a lack of training opportunities.
Beyond employment
Experience during the COVID-19 pandemic has raised several questions about how society treats and prioritises people with disabilities. During the pandemic, people with disabilities experienced additional barriers in accessing health care and support17, despite the obvious impacts of the pandemic on this vulnerable population. The Convention on the Rights of Persons with Disabilities and its Optional Protocol (A/RES/61/106) was adopted over 15 years ago, and includes over 82 signatories18. This agreement sets out what countries must do to make sure that people with disability have the same rights as everybody else, including making rules and laws to ensure fairness, reducing discrimination and making sure the physical environment is designed to facilitate access for people with disabilities18. Yet people with disability still face significant hurdles to lead a normal life. This is exemplified in a news story covering a visually impaired journalist who is preparing for motherhood19:
“In talking to both mums with and without disability, I realised that parenting isn’t easy for anyone. I decided it was an experience I deserved. And if my child had disabilities then my lived experience meant I’d be the best mum for them.”
Conclusion
Disability has a broad definition and can include a spectrum of impairments. In Australia around 1 in 6 people are currently estimated to be living with a disability, equating to around 4.4 million Australians. However only around half a million people with disabilities are covered by the NDIS. There are clear benefits in supporting people with disabilities to gain meaningful employment, both to the individual and the family as well as more broadly for the advantage of businesses, communities and the welfare system. Despite much progress, people with disabilities still face significant hurdles to lead a normal and productive life. Efforts must continue to drive and promote the inclusion, engagement and full participation of people with disability in all aspects of our society.
