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Table of Contents
Year : 2019  |  Volume : 1  |  Issue : 1  |  Page : 63-65

Health and built environment: Promoting accessibility to the persons with disabilities

Department of Physiotherapy, Shree Krishna Hospital, Karamsad, Anand, Gujarat, India

Date of Submission27-Dec-2018
Date of Acceptance05-Apr-2019
Date of Web Publication3-Jul-2019

Correspondence Address:
Prof. Harihara Prakash
K M Patel Institute of Physiotherapy, PSMC Campus, Shree Krishna Hospital, Karamsad, Anand, Gujarat
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijptr.ijptr_22_19

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How to cite this article:
Prakash H. Health and built environment: Promoting accessibility to the persons with disabilities. Indian J Phys Ther Res 2019;1:63-5

How to cite this URL:
Prakash H. Health and built environment: Promoting accessibility to the persons with disabilities. Indian J Phys Ther Res [serial online] 2019 [cited 2021 Oct 21];1:63-5. Available from: https://www.ijptr.org/text.asp?2019/1/1/63/261997

In India, with its many religions and differing beliefs based on caste and customs, it is difficult for the people with disabilities, who form 2% of the entire population, to lead an ordinary life as the normal people.

In addition to these beliefs based on religion and customs, the rural population which forms almost 70% of the country's population disregards the needs of the differently abled people.

Many people, even in modernized urban societies, consider disability as a burden to the family and non-contributory. They face problems in everyday life, right from basic education to earning a living.

The problem is with the attitude and outlook of the people in looking into a person's disability. While a person wearing corrective glasses for his vision improvement may be considered normal, the same may not be the case in respect of a person with a walking stick to correct his gait or a person in a wheelchair to assist in his mobility.

The government and non-government organizations have taken steps to create awareness as to their special needs and to change the mindset of the general population toward them. The creation of awareness about the disability and the usage of the term specially abled instead of disabled has brought a change in the minds of many people and led to the acceptance of the specially abled people as part of the society.

I remember one anecdote which is a life-changing event in my professional life to make me enter into the field of built environment to enhance the in of life of an individual. During one of the international conferences which we organized in our campus in the year 2014, we had one resource faculty from New Delhi (name not disclosed due to obvious reasons) who was wheelchair bound due to spinal cord injury. She was also the resource person to conduct a workshop as part of the conference. The academic auditorium in which we hosted the event was having an architectural barrier with multiple steps and the workshop was arranged in the first floor and the building was not having an escalator. It was a great embarrassment for me to shift the workshop to the ground floor and her talk in the main auditorium was conducted by having her on the floor. This was an eye-opener for me that how a physical barrier could affect an individual's morale though she did not mind and was least bothered and concerned about these issues. My journey toward creating a barrier-free environment that influences the well-being of a person started from there and continues even now by conducting regular access audits of various public places such as hospitals, railway station, malls, industries, and schools to promote universal design and accessibility to all.

The places around us, be it a home, office, street, open parks, and other buildings, affect our lifestyle. These built structures affect the movement of even normal people. We have seen normal people using an elevator instead of a staircase, people with children in prams finding it difficult to climb few stairs in a mall, people with elderly in a wheelchair looking for assistance to make them comfortable, etc.

The structures of the buildings affect our daily movements. For example, the absence of ramps in a foot overbridge, inaccessible sidewalks, slippery floors, and unused bicycle lanes hinder people from using the same. Sedentary habits in normal people lead to poor health outcomes such as obesity, cardiovascular disease, diabetes, and even some types of cancer.

In India, where there are still kuchcha roads and inaccessible spaces, it is difficult for persons with disabilities to access even public places and transportation. While huge sums are being spent for infrastructure, it would be indeed sad that a certain community would not be able to access it for want of a minor change in the platform gaining entry to the same.

It is the society that makes a differently abled person feel himself as “handicapped” by denying the opportunity to access public spaces. By making a few changes in the access structures, it would be easy even for the normal population to gain entry into the public spaces. For example, a ramp close to a staircase, railings on the sides of the staircase, and nonslippery floors will enable both differently abled and normal elderly people to easy access.

Health conditions of urban inhabitants and their economic productivity in India have been significantly impaired by poor and unregulated urbanization which leads to degradation of built environment. Just to recall, the recent incident in Delhi where >15 vehicles collided one behind the other in the early morning hours due to smog, Kerala and Chennai floods, all these incidents are due to poor town planning and haphazard urbanization. Can we really afford not to?

Well-designed buildings, streets, neighborhoods, and districts are essential for successful social, economic, and environmental regeneration. To provide a barrier-free environment to provide easy accessibility to all, there arises the need for interprofessional education (IPE) and interprofessional practice (IPP) where there is a collaboration across differently abled people, their health-care professionals, authorities of transportation, urban planning, architecture, and public health and law, to promote global health.

Let me bring in here two important terms:

Accessibility: Basic access and use of all facilities and products and services for people with disabilities.

Universal design: Promote independence and social participation for all, through continual improvement.

If we remove and reduce the barriers (both physical and attitudinal), it automatically gives access and inclusion of the persons with disabilities and promotes their participation in the activities and functions of a society.

Information, services, built environment, and facilities should be accessible and welcoming to people with various disabilities.

The built environment should aim at enhancing the quality of life, reductions in environmental impacts, and improvement in system efficiency. The current generation now faces its own challenges. One challenge is to better understand the broad impact of our built environment on health and then to build future communities that promote physical and mental health.[1]

Uneven access to buildings (hospitals and health centers) leads to various problems. For example, the high-raised reception counters in the department cause difficulty to the patient to reach and collect his medical file. Built environment features such as high level of traffic, poor quality of housing, lack of quality green places in the public places, poor-quality streetscape, limited access to travel even by bicycle or walk, and amenities/facilities which promote unhealthy behavior (e.g., fast food outlets) pose a potential threat to health well-being.

The public health emphasizes on the need for accessibility for persons with disabilities, apart from workplace safety, fire codes, sanitation, etc. In the recent past, there are notable contributions by the physiotherapists in promoting equal opportunities and protecting the rights of people with disabilities.

As physiotherapists deal with disabilities in their routine practice, they are more empathetic toward persons with disabilities (PwDs) and have undertaken access audits of various public places, such as bus stand, railway station, schools, and temples, to identify the inaccessibility and help in promoting universal design as per the National Built Code and comply with the Central Public Works Department requirements as mentioned in the Persons with Disabilities Act.

Social inclusiveness is not alone for people with disabilities but also for the normal population, for example, senior citizens, persons with temporary illness, persons with diversified cultures, and children.

What can be done to achieve this goal?

A small change would bring a majority of the differently abled people into the normal fold, such as:

  • Internal modifications (lowering counters, accessible lift controls, low commodes in the bathrooms, and nonslippery floors)
  • Adequate number of accessible parking lots
  • Dedicated pedestrian and cycle pathways
  • Space into doorways and within rooms to allow for wheelchair dimensions and turning circles
  • Signage with clear lettering and good color contrast
  • Color contrast strip on steps to provide visual cues.

Importantly, access audits at regular intervals and appropriate modifications thereafter would bring the desired accessibility to the differently abled people.

In the present scenario, India has come a long way in providing universal design. The railway stations and airports now have elevators, ramps, separate parking lots for persons with disability, Braille signage at public places, provision of wheelchairs at various places, low-floor buses, provision for wheelchair lift in public buses, separate seats in railway coaches, toilets with special seats, etc.

Disabled people are often offered low wage and less skilled work. However, there are certain organizations such as the Lemon Hotel Chains and Sakthi Masala Company where there is a reservation for people with disabilities and they are offered skilled and high-wage posts based on their qualification. The government also has job reservations for differently abled people.

When God closes one door, He opens the bigger other door for these differently abled people. We must have observed that those with disabilities are gifted with some other talents. We must tap those talents and give them equal opportunities. There are spas that offer massages by blind people who are trained in different types of massages. By this, we provide equal opportunities and protect their rights.

Mobile apps such as “AccessEarth” and “BillionAbles” enable the disabled people to easily locate places that have disabled friendly atmosphere.

Physiotherapy has got lot of scope in the field of built environment and health. With a little vision, a lot of good science and hard work,[1] we shall make our country universally accessible. This will, in turn, promote social inclusiveness and enhance the physical and the mental well-being of our country people.

Collaborations with various professionals such as architects, assistive technologists, engineers, and software producers will bring in IPP which is the need of the hour for health promotion for everyone in this universe.

It is normal to be different. Knowing our customer is the key to universal design.

May we henceforth look at the person on the wheelchair and not the wheelchair at the first sight?

“Design is not just what it looks like and feels like. Design is how it works” - Steve Jobs

  References Top

Jackson RJ. The impact of the built environment on health: An emerging field. Am J Public Health 2003;93:1382-4.  Back to cited text no. 1


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