Disability is the quiet emergency at the heart of the global health agenda

Imagine a healthcare system that routinely overlooks one in six people.

This is not a hypothetical question – it is a global reality. More than one billion people live with disabilities worldwide. Yet, in nearly every country, health systems fall short when it comes to meeting their needs.

Clinics aren’t built for wheelchair access. Staff aren’t trained for inclusion. Health information isn’t shared in accessible formats, such as braille or large print. Even where care is available, the quality is often poor or the cost so expensive it remains out of reach for individuals.

These are not isolated oversights, but symptoms of structural exclusion – and the consequences are stark. People with disabilities live on average, 14 years less than those without. They are more likely to develop chronic conditions, less likely to receive timely treatment and more likely to die from preventable causes.

These poorer health outcomes are typically caused not by their impairments, but by the barriers they face within health systems, and in accessing inclusive care.

This is the quiet emergency at the heart of the global health agenda – and one that has been consistently underfunded, poorly understood and widely overlooked. Only 0.4 per cent of development health funding today is directed to disability-related health – a challenge that is especially acute in low- and middle-income countries, where health systems are often already strained.

Inclusive health systems don’t happen by default. They require sustained investment and intentional design, and this begins with better data.

Estimates show that up to a quarter of countries today collect no data on disabilities, and many that do, do so inconsistently. People with disabilities remain almost invisible: their health needs uncounted, their outcomes untracked and their rights to care unmet. The result is that when it comes to funding and policy decisions, they are also absent – either by design or default.

The first-ever Lancet Commission on Disability and Health, launched at this year’s World Health Assembly, seeks to change this. Supported by the Mohamed bin Zayed Foundation for Humanity, the Commission brings together researchers, economists, policymakers and advocates to generate much-needed evidence on how and why to create disability-inclusive health systems, providing a global roadmap for urgent investment and reform.

Among the questions the Commission will confront are: what works to solve health inequities, which interventions deliver the greatest impact, how much does inclusion cost and what is the return, in terms of healthier, thriving communities? And perhaps most importantly: why does disability remain a low priority for governments and funders, and how can this be solved?

In answering these questions, the ambition is not only to produce a blueprint for how health systems can and must adapt – but to help create lasting and tangible change.

Reflecting the call “nothing about us, without us”, the Commission will also centre people with disabilities at every stage – as co-chairs, commissioners, advisors and researchers – to shape the health systems that serve them.

This is reform that benefits us all. Inclusive health systems aren’t just more equitable; they are also more effective. They reduce long-term public spending, improve workplace participation, and are more resilient to global health emergencies.

They shrink the risk of preventable hospitalisations, delayed diagnoses and emergency interventions that could have been avoided with timely care. Estimates show that every dollar invested in inclusive care is returned tenfold in social and economic value.

The UAE’s leadership in inclusion demonstrates that systemic change is both possible and impactful. In 2019, the UAE hosted the Special Olympics World Games in Abu Dhabi, the first to be held in the Middle East and North Africa region.

This in turn seeded a long-term partnership between the UAE and Unified Champion Schools, an international initiative that uses the power of sport to foster inclusion in schools and communities. The programme represents a powerful example of how investing in inclusion in one sector can spark wider change and advance equity across society.

Domestically, the UAE has also established policies to protect the rights of people with disabilities in education, healthcare, and employment, reflecting the belief of leadership that inclusion is a right and not a privilege.

These are not symbolic gestures, but investments towards a world where everyone has the opportunity to thrive. They are also a reminder that the exclusion of people with disabilities from health systems is not inevitable. It is the result of decisions, and it can be changed by better ones.

The world can no longer afford to overlook one in six people. With improved data, greater funding, and shared resolve, we can help change the story for millions worldwide. Our hope is that this marks the start.

Prof Hannah Kuper is the founder and co-director of the International Centre for Evidence in Disability at the London School of Hygiene and Tropical Medicine

Tala Al Ramahi is spokeswoman for the Mohamed bin Zayed Foundation for Humanity and a former chief strategy officer for the Special Olympics World Games Abu Dhabi

Dr Ola Abu Alghaib is director of the UN Global Disability Fund