Twenty Years After the Convention
The Health Gap for Persons with Disabilities

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2026 marks twenty years since the adoption of the Convention on the Rights of Persons with Disabilities (CRPD). On April 30 of that year, PAHO (the Pan American Health Organization) and ECLAC (the UN Economic Commission for Latin America and the Caribbean), in collaboration with RIADIS (the Latin American Network of Non-Governmental Organizations of Persons with Disabilities and their Families), released a regional report. Titled "Disability Inclusion in Health Systems and Emergency Management in Latin America and the Caribbean," it lays out, alongside a series of structural challenges, just how wide the gap remains between the convention's ideals and conditions on the ground.

This is not a story told through flashy figures or headlines. Yet it is a quiet, heavy matter that decides whether tens of millions of people across the region can reach a hospital, or can evacuate when disaster strikes. As someone who has worked in assistive devices and health systems, I could not let this theme pass by.

What Happened

The report points out that persons with disabilities living in Latin America and the Caribbean face continuous barriers in both routine medical settings and emergencies. The problem is layered. It ranges from physical access to hospitals and health posts (steps, the absence of transport) to shortages in the supply of assistive devices such as prosthetics, orthotics, hearing aids, and visual aids, and on to the fact that health workers often lack sufficient knowledge and training to respond to disability (source: PAHO).

In emergencies, the situation becomes even more severe. Persons with disabilities are systematically excluded from evacuation plans for hurricanes, floods, and pandemics, and it is documented that this raises their risk of death. The COVID-19 pandemic made this gap visible in a particularly cruel way. The report was launched at a congress in Bogotá titled "Our Voice, Our Rights: 20 Years of the CRPD," where organizations of persons with disabilities, governments, and international bodies debated the priorities for the next decade (source: PAHO).

Background

The CRPD, adopted by the UN General Assembly in December 2006, was the first major human rights convention of the twenty-first century. It demanded a shift in thinking worldwide: not "granting healthcare and welfare as a favor," but "treating persons with disabilities as holders of rights." Latin American countries have ratified it almost across the board, which on paper makes the region remarkably progressive. The question is how far that ratified convention has actually been translated into domestic law, budgets, and services on the ground.

The first of the report's axes of analysis is "data and information management." Because definitions of disability and survey methods differ greatly from country to country, there are surprisingly few statistics that allow the situation to be grasped across the region. The data that should serve as the foundation for designing reality-based policy is simply not in place, and this keeps generating delays in support measures and mismatches in the allocation of funding (source: ECLAC). On the question of how to build comparable disability statistics, standardized instruments such as WHODAS (the WHO Disability Assessment Schedule) are well known internationally. That is not a statement from the report but my own footnote, as someone who has followed this field.

The Debate / The Contrast

Even calling it "a region where nearly everyone has ratified the CRPD" hides enormous variation. Take access to assistive devices: between countries where a public provision scheme actually functions and countries where the supply chain barely works at all, the distance travelled under the convention is entirely different. The report itself is a regional analysis drawing on information from ten participating countries and does not rank them one against another—but that the actual destinations reached under a single yardstick differ enormously matches what I have seen on the ground.

The report frames its analysis around four axes: (1) data and information management, (2) the provision of inclusive health services, (3) the building of inclusive capacities, and (4) public health and emergency management (source: ECLAC). Of these, what struck me hardest was the connection between building data, inclusion in emergency management, and the access to assistive devices that runs through both. These three may look like separate issues, but they are in fact deeply connected. Without data on who needs what kind of support and where, both evacuation plans and assistive-device distribution plans will be full of holes. The underlying work of building data holds the key to the effectiveness of the other two.

The Author's View

Reading this report, the first thing I recalled was what I have seen firsthand in Costa Rica. Even in a country with a relatively solid health system by regional standards, a person who needs a prosthesis or orthosis must pass through a long sequence—assessment, prescription, casting, fitting, and repair—and if any single step gets clogged, you end up with a state of "the right exists, but the device never arrives." Translating the convention's ideals into a real supply chain is genuinely unglamorous work that genuinely takes time. From the standpoint of someone who has long researched the funding systems for assistive devices, what matters here are the financial design of those systems and the data on who needs what. I felt it made complete sense for the report to place "data and information management" first among its four axes of analysis.

And there is one more point I take especially seriously: inclusion in emergencies. Disasters and pandemics suddenly magnify the inequalities that existed in normal times. Being unable to clear a single step, information arriving only as sound or only as text, an evacuation shelter without an accessible toilet—what would be mere "inconvenience" in ordinary times becomes a matter of life and death in an emergency. From my experience on the ground as a physical therapist, I feel that the habit of building evacuation plans around the "healthy adult" as the default is a weakness shared the world over. At the twenty-year mark of the CRPD, the very fact that Latin America is trying to re-ask not "do we have the convention?" but "can we flee alongside our disabled neighbors in the midst of a disaster?" gives me hope. Closing, step by step, the distance between the rights written into the convention and the reality of reaching a hospital or a shelter—through data and through systems—is what should sit at the core of the coming decade.

Glossary

CRPD = Convention on the Rights of Persons with Disabilities, adopted in 2006; in Spanish, Convención sobre los Derechos de las Personas con Discapacidad. Órtesis (orthosis) and prótesis (prosthesis) appear constantly in regional policy documents and together correspond to "assistive and prosthetic devices." Gestión de emergencias means "emergency management"—the systems for preparing for and responding to disasters and crises.

Twenty years on, there is still a wide distance between writing a right into a convention and actually being able to reach a hospital.

※ This article is the author’s commentary based on public information. Please confirm the latest figures, dates and procedures with governments and primary sources. Quotations are kept minimal and sources are cited.