Disability-inclusive health systems & the quest for Viksit Bharat

Governance and policy

The National Health Policy 2017 identifies equity as a core principle and calls for affirmative action to minimize disparities arising from disability¹⁰. The NHP’s section on health research (Section 25.1) mandates prioritisation of neglected health issues, including disability and transgender health. Our studies with transgender and disability communities in India revealed significant mistrust in health systems influencing vaccine decision-making^11,12. When we adapted the WHO Behavioral and Social Drivers framework to the Indian context, we found that barriers to vaccination were not primarily attitudinal but structural—rooted in stigma, inaccessible digital systems, non-inclusive health facilities, and poor communication¹². Our policy recommendations therefore focus on improving vaccine access, reducing stigma, and fostering trust in healthcare, thereby realizing the NHP’s promise in both letter and spirit.

However, major implementation gaps persist. Over 18 million deaf and hard-of-hearing people in India continue to struggle with access to sign language interpretation¹³. In contrast, best practices from the United States demonstrate how sustained advocacy by researchers with disabilities led the National Institutes of Health (NIH) to designate people with disabilities as a population experiencing health disparities, a model that India can adapt¹⁴.

Leadership and representation

Although the WHO mandates health ministries to provide stewardship for disability inclusion¹, in India, disability-related issues remain largely relegated to the Ministry of Social Justice and Empowerment. Furthermore, since both health and disability are State subjects, weak inter-ministerial coordination continues to impede progress.

Researchers with disabilities bring unique perspectives that can drive transformative scientific advances. Yet their representation in research pipelines continues to decline. NIH data show that applicants reporting a disability decreased from 1.9 per cent in 2008 to 1.2 per cent in 2018¹⁵. The Indian Council of Medical Research (ICMR) should take proactive steps to enhance representation and inclusion of researchers with disabilities in the biomedical workforce. Taking a cue from the NIH, ICMR—whose stated mission is to prioritise the health of vulnerable and marginalized populations—could establish a National Institute on Disability and Health Equity, aligned with the WHO 2022 Global Report and India’s NHP, to advance its Strategic Plan Agenda 2030¹⁶ and truly leave no one behind.

Health system financing and data

The WHO’s Global Report¹ estimates a tenfold return on every dollar spent on disability-inclusive prevention and care for non-communicable diseases¹.Yet only 0.4 per cent of global health funding addresses disability across OECD countries¹⁷.In India, disability-specific expenditure accounts for just 0.04 per cent of Gross Domestic Product and 0.14 per cent of government spending¹⁸. Persons with disabilities bear disproportionate costs for equal participation. For instance, in Tamil Nadu, the costs of goods and services necessary for equal participation of persons with deafblindness are equivalent to ten times the average monthly income¹⁸. Budgetary provisions must therefore include costs for accessible transportation, accessible venues, accessible documents (such as screen-reader compatible files, Easy-to-Read, and large-print versions), sign language interpreters, and reasonable accommodations.

Reliable data is the foundation of equitable policy. Globally, the Washington Group of Questions provides a standard measure for disability in surveys. The Telangana Disability Study, which used these questions, found an overall prevalence of 12.2 per cent —far higher than the 2.2 per cent reported in the 2011 Census¹⁹. Unfortunately, the latest National Family Health Survey dropped disability questions altogether, despite the addition of 14 new disabilities in India’s new disability law²⁰. Excluding people with disabilities from research perpetuates invisibility. A review of 2,710 trials found that 35.3 per cent explicitly excluded disabled participants²¹, violating the revised Declaration of Helsinki, which mandates inclusion with safeguards. All public health interventions and ICMR-funded research must collect and report disability demographic data alongside age, gender, race, and ethnicity.

Human resources for health must be trained in disability competencies—now a mandatory part of the medical curriculum thanks to our sustained advocacy²², which was recognized as one of India’s 17 lighthouse initiatives for achieving SDG 10²³. However, these competencies remain absent in nursing, dentistry, allied health professions, and Institutions of National Importance²⁴. The launch of The Lancet’s first ever Commission on Disability and Health,²⁵ WHO’s Workforce Competency Standards on Disability Inclusion and the WHO Disability Health Equity Network²⁶ provide exemplary models, with leadership by persons with disabilities themselves. ICMR has also joined this network along with five other organizations from India. These global learnings must now translate into action by linking disability health-equity indicators and relevant SDG targets with national policy.

The month of December commemorates both World Disability Day and Human Rights Day — a timely reminder that health and human rights are inseparable, and that inclusion is not charity, but justice. Nearly a decade after launching both the Accessible India Campaign and NITI Aayog, it is time for reflection. Disability is not merely a medical condition; it is a matter of human rights and inclusive development. The health of a nation cannot advance if its largest minority remains invisible in its health policies and planning. Addressing health inequities for persons with disabilities benefits everyone. The dream of Viksit Bharat and the promise of Agenda 2030 will remain unfulfilled until we invest in health equity for persons with disabilities — because investing in them means investing in Health for all.