Special communication
Health-Related Rehabilitation and Human Rights: Analyzing States' Obligations Under the United Nations Convention on the Rights of Persons with Disabilities

https://doi.org/10.1016/j.apmr.2014.07.410Get rights and content

Abstract

Globally, disability represents a major challenge for health systems and contributes to the rising demand for rehabilitation care. An extensive body of evidence testifies to the barriers that people with disabilities confront in accessing rehabilitation services and to the enormous impact this has on their lives. The international legal dimension of rehabilitation is underexplored, although access to rehabilitation is a human right enshrined in numerous legal documents, specifically the Convention on the Rights of Persons with Disabilities. However, to date, no study has analyzed the implications of the Convention for Rehabilitation Policy and Organization. This article clarifies states' obligations with respect to health-related rehabilitation for persons with disabilities under the Convention. These obligations relate to the provision of rehabilitation but extend across several key human right commitment areas such as equality and nondiscrimination; progressive realization; international cooperation; participation in policymaking processes; the accessibility, availability, acceptability, and quality of rehabilitation services; privacy and confidentiality; and informed decision making and accountability. To support effective implementation of the Convention, governments need to focus their efforts on all these areas and devise appropriate measures to monitor compliance with human rights principles and standards in rehabilitation policy, service delivery, and organization. This article lays the foundations for a rights-based approach to rehabilitation and offers a framework that may assist in the evaluation of national rehabilitation strategies and the identification of gaps in the implementation of the Convention.

Section snippets

Why a focus on rehabilitation?

Although human rights issues are increasingly discussed in areas of health such as reproductive health,37 human immunodeficiency virus/acquired immunodeficiency syndrome,38 and mental health,39 the rehabilitation sector has lagged behind. Rehabilitation is frequently seen as a relatively unimportant secondary service for people who have impairments. Rehabilitation needs are still sidelined in health policy programming, and the availability of specialized rehabilitation services, including

Legal basis to claim the right to access rehabilitation for persons with disabilities in relation to health

In the past 40 years, countries and multilateral agencies have acknowledged the importance of rehabilitation and affirmed their commitment to strengthen and promote rehabilitation for persons with and without disabilities in various declarations and resolutions. There are numerous human rights instruments, some of which address issues pertaining specifically to persons with disabilities while others view rehabilitation more broadly as a public health and social development issue. The most

Obligations of states under the CRPD

Article 4 sets out the “General Obligations” of the CRPD and provides interpretative context in the sense that “the obligations prescribed will attach themselves to the Article under consideration.”58(p9) Under standard rule of human rights interpretation, this entails that states have 3 kinds of obligations generated by each right: First, states are responsible not themselves to violate human rights directly; second, they are also responsible to protect their citizens from having their rights

Conclusions

This article explored the legal basis and range of state obligations with respect to the right to rehabilitation found in human rights law, most particularly the CRPD, and suggests a human rights–based framework for rehabilitation service planning and evaluation.

Human rights are expressions of moral values with legal implications on states as the principal duty bearers. Human rights are indivisible, interrelated, interdependent, and indispensable and therefore cannot be achieved in isolation.

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    Presented in part to the European Health Law Conference, April 28–30, 2014, Riga, Latvia.

    Supported by the Disability Rights Expanding Accessible Markets project (grant no. ITN-2010-265027) under the European Union 7th Framework Programme—Marie Curie Actions.

    Disclosures: none.

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    Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.