"An Environment Built to Include Rather than Exclude Me": Creating Inclusive Environments for Human Well-Being.

Natasha Layton,Emily Steel

doi:10.3390/ijerph120911146

Abstract

Contemporary discourses which challenge the notion of health as the “absence of disease” are prompting changes in health policy and practice. People with disability have been influential in progressing our understanding of the impact of contextual factors in individual and population health, highlighting the impact of environmental factors on functioning and inclusion. The World Health Organization’s (WHO) more holistic definition of health as “wellbeing” is now applied in frameworks and legislation, and has long been understood in occupational therapy theory. In practice, however, occupational therapists and other professionals often address only local and individual environmental factors to promote wellbeing, within systems and societies that limit equity in population health and restrict inclusion in communities. This paper presents an in-depth analysis of the supports and accommodations identified by a cohort of individuals (n-100) living with disability. A range of environmental facilitators and barriers were identified in peoples’ experience of “inclusive community environs” and found to influence inclusion and wellbeing. The roles and responsibilities of individuals, professionals, and society to enact change in environments are discussed in light of these findings. Recommendations include a focus on the subjective experience of environments, and application of theory from human rights and inclusive economics to address the multiple dimensions and levels of environments in working towards inclusion and wellbeing.

Highlights

If I lived in a society where being in a wheelchair was no more remarkable than wearing glasses, and if the community was completely accepting and accessible, my disability would be an inconvenience and not much more than that
These results demonstrate an overall struggle for the population of people with disability to achieve the quality of life of the general Australian population, and a lower level of functioning across the six domains of the Assessment of Quality of Life (AQoL) than is the Australian norm
The environment provides context for human endeavor and is a critical variable to be considered in relation to inclusion of people with disability

Summary

Introduction

If I lived in a society where being in a wheelchair was no more remarkable than wearing glasses, and if the community was completely accepting and accessible, my disability would be an inconvenience and not much more than that It is society which handicaps me, far more seriously and completely than the fact that I have Spina Bifida [1] The social model of disability deconstructs and debunks traditional biomedical discourses that draw a causal relationship between impairment and disability without regard for the environment [5,6]. Neither biomedical nor social models acknowledge a mutual relationship between the environment and health, instead asserting either no role at all for the environment or a causal role in disability

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Conclusion