3.6 ACCESS TO GOODS AND SERVICES
The Nice Council decided to include among its
multidimensional objectives to fight against poverty and social exclusion, a
greater access to resources, rights, goods and services for all.
Despite improvements in some countries over the last years, disabled people
and their families are often excluded from a number of services, and by social
and community activities, because of environmental, and attitudinal barriers,
isolating them as a result from society.
Social exclusion, in our analysis, is not restricted to inadequate income, but
relates to barriers to labour market, transport, and social environment, as well to
limited access to a wide range of public and private services.
The 2001 Report on the World Social Situation by the United Nations
highlights the need to attain universal access to social goods and services.
"Attaining universal and equitable access to quality education, the
highest
standards of physical and mental health, and access of all to primary health
care, while rectifying inequalities without distinction as to race national
origin, age or disability"
Another important issue in constructing indicators of access
is the quality of services provided. There may be schools and hospitals but the existing equipment and
building infrastructure could be outdated and not accessible for disabled people. In
this sense, the World Health Organization has invited Governments to develop policies
ensuring
access to services, in partnership with those who should benefit from them.
"Care programmes for people with long-term needs,
such as those who are chronically ill, severely disabled or frail and
elderly, should be planned, developed and organized in partnership with the
people needing the services. The aim should be to maximize their capacity
to live an independent and fulfilling life"
The European Commission in its Communication "Towards a
barrier free Europe for People with Disabilities" invites Member States to develop policies
to combat discrimination and barriers to goods and services.
In line with the objectives adopted at Nice, we have decided to focus our
analysis investigation on the issue of access to goods and services by taking into
consideration the following areas: health services, social services, public administration,
transport, social environment (commercial facilities, sport centres, leisure and cultural
activities, etc.), and information and communication services and products.
Furthermore organisations participating in the survey were asked to indicate and evaluate
the nature of barriers disabled people faced for each of the products and
services considered. Furthermore, we thought that we should analyse the nature of
barriers envisaged by disabled people: financial barriers, legal barriers,
attitudinal/social barriers, physical/architectonical barriers, and communication barriers. In
the subsequent analysis we deal with each issue separately.
3. 6. 1 Health and Social services
In an attempt to investigate the level of access to health,
employment and social assistance services of the disabled persons in the
respective countries, we asked the respondents to make use of a scale
ranging from 1= no access to 10=maximum access. The aggregate results of
this evaluation are shown in the following diagram.
It is important to underline that no service in the areas analysed in the area
of health was considered as fully accessible. The highest score awarded
to hospitals does not reach 7 out of a 10-value scale.
In terms of access to health services, hospital care and primary care services
are considered slightly more accessible in comparison to doctors' practices,
showing the need to develop more accessible primary care services for the
disabled people.
In the areas of social assistance, employment services, and vocational
training, the respondents assigned relatively lower accessibility scores
(See diagram 24).
Diagram 24
However, significant differences exist among the Member States in the
evaluation of access to Health and Social services. Diagrams 25 to 27
present in a hierarchical order the scores assigned by the respondents
for health services. Austria, Finland and France appeared to be the countries
with the most accessible services to disabled persons and Sweden with
Italy the less accessible.
In the case of access to employment services, (see diagram 28) it was found
that Spain and Sweden again appeared to be in the lowest level of scores while
Finland and Austria are at the highest.
For vocational training (diagram 29) Greece and Finland appeared to be the
countries with the highest scores followed by Spain and Sweden at the
lower end.
Again a special remark has to be made on the low scores of a country with a
high level of social security and disability policies, such as Sweden in
comparison with the other countries considered in this survey. Due to the
qualitative nature of the study, issues like the self-perception of
people with disability, the political debate, and the economic situation
of the country have to be taken into account in the understanding of the
responses. The higher level of disability awareness, and the recent reforms
of the social security system in Sweden, which have led to a lower level
of protection, is among the reasons at the basis of the highly critical
analysis of the respondents in comparison with organisations of disabled
people in other countries.
Finally in the case of social assistance, we find a different hierarchical
order between countries with France and Austria being classified as the
best countries and Greece among the least preferable. There is an obvious
reason for such a classification because Greece is the only European
Country without a Guaranteed Minimum Income policy.
Diagrams 25-27
Diagrams 28-30
a) Barriers to Access in health care
The findings of this analysis are portrayed in diagrams 31 to
33.
It appears that the greatest sources of problems are the lack of communication
and the attitudinal and social barriers.
These problems are often linked together. Often information is not available
in alternate forms, such as Braille, or sign language, or in an easy to read form
making access to these services quite difficult for a number of disabled people.
However, more fundamental difficulties are related to the attitudes of the
medical and paramedical personnel. Often for instance medical personnel would talk
to the parent, or the person assisting the disabled person, rather than with
the disabled person, who as a consequence will find himself or herself
excluded from his/her own treatment and unable to express his/her needs.
This is due to an overall lack of awareness of the medical staff to
disability.
Moreover prejudice also comes from other patients.
b) Barriers to access in employment and vocational training services
The participation to employment services, vocational training
centres, and social assistance programmes is ensured through the public
and the voluntary sector without any significant economic or legal
barriers. However, there is often a lack of
information on the availability of these centres, and the opportunities
offered.
Examining the barriers reported in the employment and vocational
training programmes as well as in the social assistance field (see
diagrams 34-36) we find again that communication as well as attitudinal
and social barriers appear to be the most important. This is mostly due
to the lack of awareness of disabled people needs and abilities in a
majority of centres.
Moreover most of these services are designed for the mainstream population,
and people providing information, guidance, counselling or vocational
training have no experience or knowledge of problems encountered by
disabled people in accessing employment or training.
It is also interesting to compare the results of diagram 6 on the percentage
of disabled workers compared to non-disabled ones in the different EU
countries (Eurostat data) to diagram 28 from our own research. There we
can see that countries with the lowest participation of disabled people
in the labour market present also the lowest grade of accessibility to
employment services.
Diagrams 31-33 – Barriers to access in health care
Diagrams 34 to 36 - Barriers in employment and social services
Access to Health and Social Services – main findings
The accessibility to services both in the area of health or in the
social field is overall unsatisfactory for disabled people. It is
important to note as well that the level of accessibility varies
significantly from one country to the other according to the different
areas considered.
Health services are overall more accessible than social services for
people with disabilities. In the field of health, greatest barriers were
relating to access to doctors, in comparison with hospitals and medical
centres.
In the area of social services, greatest barriers were found in
employment and vocational training centres.
The greatest source of problems is attributed mostly to barriers in
communication, and negative social attitudes, followed by the lack or
insufficient accessibility of premises.
At the end of the list we find financial and legal barriers, that
although significant in some countries are not considered as important
in terms of participation.
The difficulties in communication derive often from the lack of
awareness of personnel on needs and difficulties of disabled people, but
also of their capabilities.
Moreover many services targeting the overall population fail often to
address the issues specific to the disabled population, because of the
way in which they are designed, and of general prejudice against people
with disabilities.
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3.6.2 Public Administration
Our research also aimed at assessing the level of
accessibility of public administration for disabled people.
Access to public administration relates to full participation in society and
to citizenship.
The greatest barriers, according to our research (see diagram 37) are in the
field of communication, scoring more than 7 out of a 10-scale value. It
means that citizens with disabilities have greatest difficulties in
accessing basic information. This is largely due to the lack of attention
to accessibility requirements, such as the provision of information in
alternate media (Braille, large print, easy-to-read language, and
sign language interpretation) and the accessibility of public web sites.
It is also interesting to note that attitudinal and social barriers are quite
significant for a number of people interviewed. This means that public
administrations are often disregarding disabled people's needs, and that
officials are also biased by prejudice.
Furthermore there is a lot to do in terms of removing physical and
architectonical barriers in order to grant equal access to all citizens
to public administration.
Diagram 37
Access to public administration – main findings
The possibility to exercise citizenship rights is often denied to
disabled people, who face considerable barriers to public
administration. The main obstacles relate to communication, as
little attention is paid to accessibility requirements (such
as alternate media – Braille, large print, easy-to-read language,
sign language- in written and oral communication, and
accessibility of public web sites), negative attitudes to
disability, and physical and architectonical barriers. |
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