Global Health Institute

Disability and health; associating the two together seems like an obvious correlation. The following words are often used interchangeably with disability in discussions about disability as a “health” problem: “impairment,” “handicap,” and “sick.” The biomedical model of disability, focusing on health purely, is the most dominant model of disability that is used to understand disability in the context of global health. 

I am able-bodied, and throughout most of my life, my perception of disability was primarily based on a determined dynamic between myself and my younger sister who was diagnosed with “cerebral palsy.” I was also accustomed to the aforementioned biomedical model of disability. I understood disability as an absolute, inferior condition and a pathology in need of treatment, rehabilitation, and mitigation. While there is no right or wrong model to understand or view disability, I learned over the course of many years that focusing on disability solely as resulting from an individual person’s physical or mental limitation results in individualizing the problem. Furthermore, this tends to reinforce systems in place that tend to perpetuate discriminatory practices against persons with disabilities in able-bodied spaces, including clinical and health care facilities as exemplary global sites.

So what? How can we rethink about global health with respect to disability? What can we do to promote inclusiveness in global health? 

Considering the relationship between disability and health is complex and complicated as disability is a cross-cutting issue that interacts with a wide range of issues such as sustainability, development, business, and education to name a few. Furthermore, persons with disabilities are a very heterogeneous group, including people with a wide range of disabilities, age, gender, race/migrant situation, and environments. 

Increasingly, the question is no longer if people with disabilities are included in global health efforts. The disability movement’s credo, “Nothing About Us Without Us,” has resulted in many initiatives, with well-intentioned statements and disability inclusive policies, in mainstream global health efforts. Beginning in the 1970s, the global disability rights movement led by persons with disabilities themselves, led to the landmark UN Convention on the Rights of Persons with Disabilities (CRPD) adopted in 2006, and ratified by more than 170 countries today. In addition, persons with disabilities are mentioned 11 times in the Sustainable Development Goals in keeping with CRPD, implicitly adhering to the call to “leave no one behind” and explicitly that the goals and targets are related to disabilities.

However, much remains to be done. To achieve global health and beyond, we need to do more than just mainstreaming disability-related issues and including persons with disabilities in able-bodied spaces. We, as a diverse group of both disabled and able-bodied people, need to work together to promote measures to have representations of persons with disabilities in leadership positions and ensure that the global health landscape is also for and by persons with disabilities. 

Jinseul Jun (MAAS ’20) is a graduate in the Arab Studies program (MAAS) at Georgetown – School of Foreign Service, and a student fellow with the Global Health Initiative.

According to the Organization for Economic Cooperation and Development (OECD), Palestine or the Palestinian territories of Gaza and the West Bank are considered highly fragile. This fragility comes from the absence of territorial, economic and political sovereignty due to the ongoing Israeli-Palestinian conflict. The political conflict in the Palestinian territories as well as the territorial fragmentation of the West Bank make an integration of basic health care services a very difficult. In investigating the association between political instabilities/humanitarian crises and the re-emergence of infectious diseases I have seen how many historical epidemics have been associated with political conflicts. For instance, in 2016 there was a devastating cholera outbreak in Yemen as a result of the ongoing war and the Saudi Arabian-led intervention against the Houthi movement. Airstrikes targeted and damaged hospital infrastructure as well as water supply. Furthermore, I attended the 2017 Harvard National Model United Nations Conference, where I represented the Republic of Botswana at the Special Summit on Terrorism. During the conference, I learned about the re-emergence of wildtype poliovirus that occurred during the Syrian Civil War, which was declared a public health emergency by the World Health Organization (WHO). Another example is the recent outbreak of the Ebola virus in the Democratic Republic of the Congo, a country that has been affected by various political conflicts and the widest interstate war in modern African history.

As a fellow with the Georgetown Global Health Initiative, I am working as a research assistant with Dr. Wolfgang Rennert, MD, DMSc, DTM&H, at MedStar Health. The project focuses on the safety and immunogenicity of ROTAVAC, a rotavirus vaccine, in the Palestinian territories of Gaza and the West Bank. Rotavirus is considered the most common cause of severe diarrheal disease accounting for up to 45 percent of hospitalizations for children under the age of three. The high poverty rates and the limitation of movement of goods and people between the territories continue to worsen the status of the disease in Gaza and the West Bank. Furthermore, the Gaza strip is suffering from a devastating water crisis; 97 percent of drinking water is unfit for consumption by international standards. This collapse of water infrastructure has led to a sharp rise in various pathogens, among which are rotavirus, cholera and salmonella. "When you have political instability, public health always suffers," Jeremy Farrar, PhD, an infectious disease expert at the University of Oxford.

It is interesting to note that low-income countries often tend to have better access to vaccines than middle income countries. Low-income countries receive global support from organizations such as Gavi, the Vaccine Alliance.  While the Palestinian territories are very poor, they do not receive Gavi support. According to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), 53 percent of Palestinians in Gaza live in poverty. This means poverty has increased by 14 percent in a six-year period. “Palestine is very poor. But unfortunately, Palestine is not even seen as a country,” Dr. Rennert. Palestine can be safer and healthier if it is fully recognized as an independent state.

One of the main health challenges that poses global concerns is the fact that public health threats, health emergencies and infectious diseases do not recognize or respect political borders. The safety and well- being of the Palestinian territories are essential for the safety and well-being of the State of Israel as well as the Global community. 

Mohammed Jibriel (G’20) is a graduate student at the Department of Microbiology and Immunology studying Biohazardous Threat Agents and Emerging Infectious Diseases and a student fellow with the Global Health Initiative.