Preventive care crisis: 1.3 billion people with disabilities face barriers worldwide

A team of researchers has urged the global health community to take immediate action to bridge systemic gaps in preventive healthcare for people with disabilities (PwD).

Published in Healthcare, their analysis titled “Preventive Healthcare and Disability: Challenges and Opportunities” highlights persistent disparities in cancer screening, immunization, dental care, and mental health services, particularly in low- and middle-income countries (LMICs).

Persistent Barriers Undermining Preventive Care

According to the study, an estimated 1.3 billion people worldwide, about 16% of the global population, live with disabilities, yet they consistently face inequities in accessing preventive healthcare. These disparities are driven by a complex interplay of structural, financial, provider-related, communication, and socio-cultural barriers.

Physical inaccessibility remains a critical issue, with many clinics and diagnostic centers lacking ramps, elevators, or accessible equipment. Transportation challenges further limit access, particularly in rural and underserved regions. Financial barriers also play a key role, as individuals with disabilities often face increased living costs while struggling with limited insurance coverage or out-of-pocket expenses.

Healthcare provider attitudes and preparedness contribute to the problem, with a lack of disability-specific training leaving many practitioners uncertain or hesitant when engaging with patients who have intellectual or psychosocial disabilities. Communication barriers compound these challenges. The absence of sign language interpreters, easy-read materials, or navigators for deaf or deafblind individuals can discourage care-seeking and erode trust in healthcare systems.

Socio-cultural factors add another layer of complexity. Low health literacy, internalized stigma, and fear of discrimination often prevent individuals from advocating for their healthcare needs. The authors emphasize that these barriers are deeply interconnected, creating a cycle of exclusion that undermines the promise of universal health coverage.

Critical gaps in screening, vaccination, and preventive services

The research provides compelling evidence of systemic gaps across multiple preventive health services. In the area of cancer screening, participation among people with disabilities remains substantially lower than in the general population. Meta-analyses reveal that women with disabilities have 22% lower odds of receiving mammography screenings and 37% lower odds of undergoing cervical cancer screenings. Disparities are even greater for individuals with visual or psychosocial disabilities, underscoring the urgent need for targeted interventions.

Colorectal cancer screening also reflects troubling inequities. Across multiple disability types, including functional, intellectual, and psychosocial impairments, participation rates lag by as much as 20%, with the steepest drops seen in fecal occult blood tests and other early-detection procedures. These gaps translate into delayed diagnoses and poorer treatment outcomes, further widening health inequities.

Vaccination coverage tells a similar story. Globally, people with disabilities have lower uptake of routine immunizations, despite their increased vulnerability to preventable diseases. In high-income countries, gaps persist across childhood and adult vaccine schedules, while in LMICs the situation is particularly alarming. In Fiji, only 55% of children with disabilities receive full basic immunization compared with much higher rates in the general population. In Vietnam, children with cerebral palsy showed a coverage rate of 82.7% versus 96.4% for their peers without disabilities.

During the COVID-19 pandemic, systemic failures were amplified. Despite heightened health risks, many individuals with disabilities were not prioritized for vaccination in the early rollout phases. Although surveys revealed strong willingness to be vaccinated, delays and logistical barriers limited timely access to life-saving protection.

Other preventive services such as dental care and mental health screenings also show significant shortcomings. Dental visits for individuals with cognitive or intellectual disabilities often occur only in emergencies, with few providers equipped or willing to offer routine care. In mental health, despite the higher prevalence of depression among people with disabilities, access to consistent screening and support remains patchy, with tools like the PHQ-9 underutilized or inconsistently applied.

Pathways to inclusive, equitable preventive healthcare

The authors outline actionable solutions to close these critical gaps and ensure equitable access to preventive care. Central to their recommendations is the principle of co-design, involving people with disabilities and their representative organizations in every stage of health service planning, implementation, and evaluation.

First, physical and organizational accessibility must be prioritized. This includes retrofitting existing facilities, integrating universal design principles into new construction, and ensuring adaptive equipment is readily available. Transportation solutions, such as designated drop-off zones or mobile clinics, can further reduce logistical barriers, particularly in rural and remote areas.

Second, provider education and training are essential. Ongoing professional development programs should include disability-specific competencies and practical guidance for inclusive communication and care strategies. Hospitals and clinics should adopt standardized accessibility protocols, including the use of easy-read materials, sign language interpretation, and dedicated care navigators.

Third, robust monitoring and accountability are equally important. Governments are encouraged to implement independent oversight mechanisms in line with Article 33 of the UN Convention on the Rights of Persons with Disabilities. Countries such as Italy, Germany, France, the UK, India, Nigeria, Kenya, and South Africa have initiated such frameworks, offering models that can be adapted elsewhere.

Accurate data collection and standardized assessment tools are also vital for shaping effective policy and resource allocation. The authors highlight several widely used instruments, including the Washington Group Short Set (WG-SS), WG-SS Enhanced, WG-Extended Set, Model Disability Survey (MDS), Extended Analysis of Disability Data (EADD), and Global Activity Limitation Indicator (GALI), while noting that context-appropriate selection of tools is crucial to capture the true scale of disability and related needs.

The researchers also call for expanded research in LMICs, where evidence remains scarce. More inclusive, high-quality data will enable tailored interventions and support equitable global health strategies that leave no one behind.