Decision-making regarding accessing paediatric unscheduled healthcare during the COVID-19 pandemic: a mixed methods rapid review and thematic synthesis.

OBJECTIVE: Reductions in paediatric unscheduled healthcare utilisation were seen during the COVID-19 pandemic, with concerns around their impact on children's health. The reasons for these changes are not well described. This review aims to explore the factors reported by parents that influenced their decision-making around accessing paediatric unscheduled healthcare during the COVID-19 pandemic. DESIGN: Mixed methods rapid review and thematic synthesis based on the Enhancing Transparency of Reporting the Synthesis of Qualitative research framework. DATA SOURCES: MEDLINE, Embase, Web of Science, PsycEXTRA, PsycINFO, Global Health, Global Index Medicus, Dissertations and Theses Global, Google Scholar and OAISter. Studies published from January 2020 to July 2023 were included. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Qualitative, quantitative and mixed methods studies that assessed the perspectives of parents on decisions to access or delay or avoid accessing paediatric unscheduled healthcare during the COVID-19 pandemic. DATA EXTRACTION AND SYNTHESIS: Nvivo 14.23.0 was used to code results the of the primary studies and develop themes, following a thematic synthesis approach. RESULTS: Twelve studies were included, all from high-income settings, mainly in Europe. The studies were conducted across varying times and levels of COVID-19-related restrictions. The principal descriptive themes identified were (i) concerns about COVID-19 infection, (ii) balancing and navigating risks, (iii) perception of healthcare service status and conditions and (iv) perception of information and advice. These were developed into analytic themes to further describe the decision-making process. CONCLUSIONS: Parents balanced a range of risks, concerns, advice and responsibilities when considering accessing paediatric unscheduled healthcare during the COVID-19 pandemic. External sources of advice and information were important; misconceptions around public health advice may reflect the multitude of information sources and the rapidly changing circumstances of the pandemic. Public health policy and planning should consider parent perspectives when developing measures to ensure equitable access to appropriate paediatric healthcare services.

The WHO European framework for action to achieve the highest attainable standard of health for persons with disabilities 2022-2030.

There are approximately 135 million persons with disabilities in the WHO European Region. In order to address health inequities experienced by this population, Member States and WHO/Europe developed the 'WHO European framework for action to achieve the highest attainable standard of health for persons with disabilities 2022-2030', in close cooperation with organisations of persons with disabilities. The Framework, with its accompanying Resolution, was adopted by all 53 Member States in September 2022. The Framework is aligned with the core priorities of the WHO European Programme of Work 2020-2025, that is, achieving universal health coverage, protecting against health emergencies, and promoting health and well-being. It consists of four objectives, 13 targets, and 20 indicators that act as measures of progress and success, and as drivers for policy action and a roadmap for Member States towards a disability-inclusive health sector. The Framework is expected to have a significant impact on the health and well-being of all in the Region, and especially persons with disabilities, as it will advance inclusive health systems across the Region. Inclusive health sectors will aid towards the achievement of the Sustainable Development Goals, the protection of the human rights of persons with disabilities, and the promotion of their health.

Maternal Health in Crisis: A Scoping Review of Barriers and Facilitators to Safe Abortion Care in Humanitarian Crises.

During humanitarian crises, women are particularly vulnerable to unwanted pregnancy. Unsafe abortion is among the five leading causes of maternal mortality and it is the only one which is entirely preventable. This study aimed to identify the barriers and facilitators to the provision of safe abortion care by humanitarian organisations. We performed a scoping review of the literature in July 2020, covering the years 2010-2020, on the following databases: Medline, Global Health, CINAHL Plus and ReliefWeb. We critically appraised all included articles and we conducted a narrative synthesis of the findings. We retrieved 881 articles. After removing duplicates and excluding articles that did not meet the inclusion criteria, twenty-four articles published between 2015 and 2020 were included in the review. Nine of the included papers were non-research practise items. The findings revealed five main themes: legal environment; context; stigma; economic factors; and service delivery. Restrictive laws, stigma, and lack of funding were reported as the main barriers to safe abortion, while the main facilitators were the fact that abortion is permitted under some circumstances in most countries, humanitarian actors' ability to inform healthcare policies at the onset of a humanitarian crisis, and community engagement. This scoping review revealed a dearth of published research. Increased dissemination of studies on Termination of Pregnancy (ToP) could increase the visibility of unsafe abortion and the need to provide ToP in humanitarian settings. Moreover, humanitarian organisations need to have a clear protocol on safe abortion and an in-depth understanding of relevant legislation, including the International Humanitarian Law, in order to provide this service to the full extent of the law.

Socioeconomic Determinants of Participation in Cancer Screening in Argentina: A Cross-Sectional Study.

Low socioeconomic status is associated with late cancer diagnosis and mortality in Argentina. It is important that cancer screening services are accessible to the whole population so that cancer can be detected early. Our aim in this study was to investigate socioeconomic determinants for the disparities in the use of breast, cervical, and colorectal cancer screening services in Argentina, and to measure the country progress in reducing differences in cancer screening participation across socioeconomic levels. We performed a secondary analysis of cross-sectional data from the 2018 National Survey of Risk Factors of Argentina. The sample included data from 49,170 households. We also compared the results with data from the 2013 wave of the same survey in order to assess progress on cancer screening participation across income and education categories. Income, education, health insurance, disability, and marital status were associated with cancer screening underuse in Argentina. Comparison between 2013 and 2018 demonstrated that there has been some progress toward increasing cancer screening uptake, but this increase is not equitably distributed across the population. To further reduce disparities in cancer participation across socioeconomic levels, cancer screening programs in Argentina should reinforce strategies to become more accessible. It is important to proactively reach those populations that are underusers of cancer screening and ensure that barriers that stop people from accessing cancer screening are explored and adequately addressed.

The effectiveness of primary health care reforms in Greece towards achieving universal health coverage: a scoping review.

INTRODUCTION: Between 2010 and 2018, Greece implemented an Economic Adjustment Programme and underwent a series of extensive reforms, including in the health sector. We conducted a scoping review to examine whether the Primary Health Care reforms during that period assisted the country in moving towards Universal Health Coverage. METHODS: We performed a review of the literature on the following databases: Scopus, PubMed, Epistemonikos, Web of Science, and Google Scholar, including published research articles and grey literature. Findings were synthesised thematically, using the World Health Organization Universal Health Coverage dimensions: population coverage, service coverage, and financial protection. RESULTS: Forty-four documents were included in this review. Out of these, thirty-eight were research-based (thirty-three qualitative, two quantitative, and three mixed design studies), two grey literature, and four legislative bills. The evidence suggests that despite the systemic interventions addressing longstanding distortions, population coverage, service coverage and financial protection have not significantly improved. CONCLUSIONS: This review suggests that Primary Health Care reforms in Greece have not managed to substantially improve Universal Health Coverage, although some positive steps towards that direction have taken place with the establishment of community-based multidisciplinary health teams. Before further interventions are implemented, an evidence-based monitoring and evaluation mechanism is necessary in order to clearly evaluate their effectiveness and progress.

Examining the role of governmsent in shaping disability inclusiveness around COVID-19: a framework analysis of Australian guidelines.

BACKGROUND: The COVID-19 pandemic has uncovered the ways in which disabled people are made more vulnerable due to structural inequalities. These vulnerabilities are the result of the interaction between individual and structural factors that shape how risk is experienced by disabled people. In Australia, these vulnerabilities are influenced by the way disability services and care for disabled people are delivered through a consumer-directed approach. We analysed the policies and documentation made by the Australian Government and state and territory governments during the pandemic to explore whether these were disability-inclusive. We aimed to unpack how these policies shaped disabled people as vulnerable citizens. METHODS: Guided by documentary research, we used framework analysis to examine the policies of the Australian Government and state and territory governments. We analysed legislation that was given royal assent by the federal, state and territory governments, and documents (reports, fact sheets, guidance documents, etc.) published by the federal government and the state of Victoria (given that this state experienced the brunt of the epidemic in Australia) between February 2020 to August of 2020. RESULTS: We found that most of the resources were not aimed at disabled people, but at carers and workers within disability services. In addition, most policies formulated by the Australian Government were related to the expansion of welfare services and the creation of economic stimulus schemes. However, while the stimulus included unemployed people, the expansion of benefits explicitly excluded disabled people who were not employed. Most of the legislation and documents offered accessibility options, though most of these options were only available in English. Disability oriented agencies offered more extensive accessibility options. CONCLUSIONS: The findings indicate a large number of documents addressing the needs of disabled people. However, disability-inclusiveness appeared to be inconsistent and not fully considered, leaving disabled people exposed to greater risk of COVID-19. Neoliberal policies in the health and welfare sector in Australia have led to an individualisation of the responsibility to remain healthy and a reliance on people as independent consumers. Governments need to take a clear stance towards the emergence of such a discourse that actively disvalues disabled people.

Disability inclusiveness of government responses to COVID-19 in South America: a framework analysis study.

BACKGROUND: Disabled people are particularly exposed to the risks of COVID-19, as well as to the measures taken to address it, and their impact. The aim of the study was to examine the disability-inclusiveness of government responses to COVID-19 in four South American Countries: Argentina, Brazil, Chile, and Peru. METHODS: We conducted documentary research, using framework analysis to analyse reports, legislation, decrees, and other official documents that communicated measures taken in response to the pandemic, published from February 1st until May 22nd, 2020. We included documents reporting measures that affected disabled people either directly (measures specifically designed for disabled people) or indirectly (measures for the general population). We developed an analytical framework based on recommendations for disability-inclusive response to COVID-19 published by the Economic Commission for Latin America and the Carribean, the World Health Organisation, and other international organisations. RESULTS: We analysed 72 documents. The findings highlight that while some positive measures were taken, the needs of disabled people were not fully considered. Several countries published recommendations for a disability-inclusive response to COVID-19, without ensuring their translation to practice. All countries took at least some steps to ensure access to financial support, health, and education for disabled people, but at the same time they also implemented policies that had a detrimental impact on disabled people. The populations that are most exposed to the impacts of COVID-19, including disabled people living in institutional care, were protected in several cases only by recommendations rather by legislation. CONCLUSIONS: This study illustrates how the official government responses taken by four countries in the region - while positive, in several aspects - do not fully address the needs of disabled people, thus further disadvantaging them. In order to ensure response to COVID - 19 is disability inclusive, it is necessary to translate recommendations to practice, consider disabled people both in mainstream policy and in disability-specific measures, and focus on the long-term reconstruction phase.

Barriers to Accessing Maternal Care in Low Income Countries in Africa: A Systematic Review.

The new Sustainable Development Goals (SDGs) to 2030 aim to reduce maternal mortality and provide equitable access to maternal healthcare. Compromised access to maternal health facilities in low-income countries, and specifically in Africa, contribute to the increased prevalence of maternal mortality. We conducted a systematic review to investigate access barriers to maternal health in low-income countries in Africa since 2015, from the perspective of both community members and health providers. The findings show that the most important barriers to maternal health are transportation barriers to health facilities, economic factors, and cultural beliefs, in addition to lack of family support and poor quality of care. Further research is required to guide policymakers towards firm multi-sectoral action to ensure appropriate and equitable access to maternal health in line with the SDGs to 2030.

Barriers to, and facilitators of, access to cancer services and experiences of cancer care for adults with a physical disability: A mixed methods systematic review.

BACKGROUND: Cancer services need to be inclusive and accessible to everybody, including people with disabilities. However, there is evidence suggesting that people with disabilities experience poorer access to cancer services, compared to people without disabilities. OBJECTIVES: To investigate the barriers and facilitators of access to cancer services for people with physical disabilities and their experiences of cancer care. METHODS: A mixed-method systematic review was conducted following the Evidence for Policy and Practice Information and Co-ordinating Centre approach. We used the Mixed Methods Appraisal Tool (MMAT -Version 11) to assess the quality of the included studies. We employed thematic synthesis to bring together data from across both qualitative and quantitative studies and we assessed the strength of synthesised findings using the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) approach. RESULTS: Seven quantitative studies and 10 qualitative studies (across 18 publications) were included. The findings highlighted a dearth of research on the experiences of men with disabilities. Furthermore, only one study explored experiences of cancer treatment, with all other studies focusing on cancer screening. Five synthesised findings were identified that reflected barriers and facilitators, highlighting both what makes access to services difficult and what are the strategies that could improve it. CONCLUSIONS: Knowing what works for people with disabilities can enable the delivery of appropriate services. The findings of this review suggest that the mere existence of services does not guarantee their usability. Services need to be relevant, flexible, and accessible, and offered in a respectful manner.

Neurodegeneration and the Intersubjectivities of Care.

Caring for a family member or friend with a serious health condition is a common feature of social life. Often, such care is framed as a burden, an unwelcome rupture in the fabric of everyday life. We draw on research conducted in Australia and the UK to examine care in the everyday lives of people living with and caring for neurodegenerative diseases and to trouble care as a burden. Participants in our studies mobilized practices of care to collaboratively produce a "good life". We argue that above all, care is a relational, enacted practice requiring examination in its local context.

Socioeconomic determinants of cancer screening utilisation in Latin America: A systematic review.

INTRODUCTION: Cancer incidence and mortality in Latin America are rising. While effective cancer screening services, accessible to the whole population and enabling early cancer detection are needed, existing research shows the existence of disparities in screening uptake in the region. OBJECTIVE: We conducted a systematic review to investigate the socioeconomic determinants for the disparities in the use of breast, cervical and colorectal cancer screening services in Latin America. METHODS: We searched for studies reporting on socioeconomic determinants impacting on access to breast, cervical and colorectal cancer screening, published from 2009 through 2018. The studies that qualified for inclusion contained original analyses on utilisation of breast, cervical and colorectal cancer screening across socioeconomic levels in Latin America. For each study, paired reviewers performed a quality analysis followed by detailed review and data extraction. RESULTS: Twenty-four articles that met the eligibility criteria and were of sufficient quality were included in this review. Thirteen of the included articles were written in English, eight in Portuguese and three in Spanish, and they reported on the use of breast or cervical cancer screening. No studies were found on the socioeconomic determinants regarding the utilisation of colorectal cancer screening in Latin America. Low income, low education level, lack of health insurance and single marital status were all found to be determinants of underuse of breast and cervical cancer screening services. CONCLUSIONS: Cancer screening programs in the region must prioritize reaching those populations that underuse cancer screening services to ensure equitable access to preventive services. It is important to develop national screening programmes that are accessible to all (including uninsured people) through, for example, the use of mobile units for mammography and self-screening methods.

Barriers to accessing cancer services for adults with physical disabilities in England and Wales: an interview-based study.

OBJECTIVES: The aim of this study was to explore the barriers to accessing cancer services faced by adults with pre-existing physical disabilities. DESIGN: Cross-sectional, exploratory qualitative study. Data were collected by semistructured interviews and analysed thematically. SETTING: Participants were recruited through statutory and third sector organisations in England and Wales between October 2017 and October 2018. PARTICIPANTS: 18 people with a diagnosis of cancer and a pre-existing physical disability. RESULTS: The findings illustrate that people with physical disabilities in England and Wales face a variety of barriers to accessing cancer services. The overall theme that emerged was that participants experienced a lack of attitudinal and institutional preparation both from healthcare professionals and healthcare facilities. This overall theme is illustrated through three subthemes: lack of acknowledgment of disability, unseeing disability and physical inaccessibility. CONCLUSIONS: As the population ages and increasing numbers of people live with cancer and disability, it is important to develop knowledge to respond to the needs of this population. The mere existence of services does not guarantee their usability. Services need to be relevant, flexible, and accessible and offered in a respectful manner. It is important that healthcare professionals work towards inclusive healthcare provision, enabling the utilisation of services by all. Necessary steps to be taken include better communication between the various professionals and across the different teams involved in patients' care, raising awareness of how physical disability can affect or interact with cancer-related treatment and creating more accessible physical environments.

Utilisation of mammography by women with mobility impairment in the UK: secondary analysis of cross-sectional data.

OBJECTIVES: Research has shown that people with physical impairment report lower utilisation of preventive services. The aim of this study was to examine whether women with mobility impairments have lower odds of using mammography compared with women with no such impairment, and explore the factors that are associated with lower utilisation. SAMPLE AND DESIGN: We performed secondary analysis, using logistic regressions, of deidentified cross-sectional data from the European Health Interview Survey, Wave 2. The sample included 9491 women from across the UK, 2697 of whom had mobility impairment. The survey method involved face-to-face and telephone interviews. OUTCOME MEASURES: Self-report of the last time a mammogram was undertaken. RESULTS: Adjusting for various demographic and socioeconomic variables, women with mobility impairment had 1.3 times (95% CI 0.70 to 0.92) lower odds of having a mammogram than women without mobility impairment. Concerning women with mobility impairment, married women had more than twice the odds of having a mammogram than women that had never been married (OR 2.07, 95% CI 1.49 to 2.88). Women in Scotland had 1.5 times (95% CI 1.08 to 2.10) higher odds of undertaking the test than women in England. Women with upper secondary education had 1.4 times (95% CI 1.10 to 1.67) higher odds of undergoing the test than women with primary or lower secondary education. Also, women from higher quintiles (third and fifth quintiles) had higher odds of using mammography, with the women in the fifth quintile having 1.5 times (95% CI 1.02 to 2.15) higher odds than women from the first quintile. CONCLUSIONS: In order to achieve equitable access to mammography for all women, it is important to acknowledge the barriers that impede women with mobility impairment from using the service. These barriers can refer to structural disadvantage, such as lower income and employment rate, transportation barriers, or previous negative experiences, among others.

Determinants of utilisation rates of preventive health services: evidence from Chile.

BACKGROUND: Preventive health services play a vital role in population health. However, access to such services is not always equitably distributed. In this article, we examine the barriers affecting utilisation rates of preventive health services, using Chile as a case study. METHODS: We conducted a cross-sectional study analysing secondary data from 206,132 Chilean adults, taken from the 2015 National Socioeconomic Characterisation Survey of the Government of Chile. We carried out logistic regressions to explore the relationship between the dependent variable use of preventive services and various demographic and socioeconomic variables. RESULTS: Categories more likely to use preventive services were women (OR=1.16; 95%CI: 1.11-1.21) and inactive people (OR=1.41; 95%CI: 1.33-1.48). By contrast, single individuals (OR= 0.85 ; 95%CI: 0.80-0.91) and those affiliated with the private healthcare provider (OR= 0.89; 95%CI: 0.81-0.96) had fewer odds of undertaking preventive exams. CONCLUSIONS: The findings underline the necessity of better information campaigns on the availability and necessity of preventive health services, addressing health inequality in accessing health services, and tackling lifestyle-related health risks. This is particularly important in countries - such as Chile - characterised by high income inequality and low utilisation rates of preventive health services.

Depressive symptoms in people with disabilities; secondary analysis of cross-sectional data from the United Kingdom and Greece.

BACKGROUND: Evidence suggests there is an association between depressive symptoms and disability. OBJECTIVE/HYPOTHESIS: The objective of this study was to examine whether people with disabilities in the United Kingdom and Greece face more depressive symptoms than people without disabilities. The hypothesis was that people with disabilities in both countries are more likely to experience depressive symptoms. METHODS: We used data from the 2014 European Health Interview Survey (wave 2). After performing principal-component factor analysis, we carried out logistic regressions, in order to investigate differences in depressive symptoms between people with and without disabilities, and examine the factors affecting depressive symptoms for people with disabilities. RESULTS: People with disabilities in the UK were 2.8 times more likely to experience depressive symptoms compared to people without disabilities (95% C.I.: 2.51-3.05, p < .001), while in Greece, they were 2.2 times more likely to do so (95% C.I.: 1.90-2.64, p < .001). Our findings regarding people with disabilities showed that women, older people (in Greece), unemployed and inactive people (in Greece), and better-educated people (in the UK) were more likely to experience depressive symptoms. Married people, older people (in the UK), people living in densely-populated areas (in Greece), people who assessed their health as 'average' or 'good', and people who enjoyed social support (in Greece) were less likely to face depressive symptoms. CONCLUSIONS: Due to population-ageing and higher incidence of depressive symptoms in disabled people, it is important that policies are put in place to address the mental health needs of this population.

Heteronormativity and prostate cancer: A discursive paper.

AIMS AND OBJECTIVES: To discuss the risks that heteronormative assumptions play in prostate cancer care and how these may be addressed. BACKGROUND: There is international evidence to support the case that LGBT patients with cancer are less likely to report poor health or self-disclose sexual orientation. Gender-specific cancers, such as prostate cancer, require particular interventions in terms of supportive care. These may include advice about side-effect management (such as incontinence or erectile dysfunction), treatment choices and social and emotional issues. In this paper, we discuss and analyse the heteronormative assumptions and culture that exist around this cancer. We argue that this situation may act as a barrier to effective supportive care for all Lesbian women, Gay, Transgender and Bisexual patients, in this case men who have sex with men. [Correction added on 21 September 2017, after first online publication: The first sentence of the Background section has been revised for clarity in this current version.] DESIGN: Theoretical exploration of heteronormativity considered against the clinical context of prostate cancer. METHODS: Identification and inclusion of relevant international evidence combined with clinical discussion. RESULTS: This paper posits a number of questions around heteronormativity in relation to prostate cancer information provision, supportive care and male sexuality. While assumptions regarding sexual orientation should be avoided in clinical encounters, this may be difficult when heteronormative assumptions dominate. Existing research supports the assertion that patient experience, including the needs of LGBT patients, should be central to service developments. CONCLUSION: Assumptions about sexual orientation should be avoided and recorded accurately and sensitively, and relational models of care should be promoted at the start of cancer treatment in an appropriate manner. These may assist in reducing the risks of embarrassment or offence to nonheterosexual patients, or to professionals who may adopt heteronormative assumptions. RELEVANCE TO CLINICAL PRACTICE: Having an awareness of the risks of making heteronormative assumptions in clinical practice will be useful for all health professionals engaged in prostate cancer care. This awareness can prevent embarrassment or upset for patients and ensure a more equitable provision of service, including men with prostate cancer who do not identify as heterosexual.

Healthcare access for refugee women with limited literacy: layers of disadvantage.

BACKGROUND: Record numbers of people, across the world, are forced to be displaced because of conflict or other violations of their human rights, thus becoming refugees. Often, refugees not only have a higher burden of disease but also compromised access to healthcare, as they face many barriers, such as limited knowledge of the local language. However, there is very limited knowledge on the lived experiences of this population. Moreover, the strategies people might develop in their efforts to access healthcare have not been explored in depth, despite their value in establishing peer- support, community based programs. METHODS: In this article, we present the findings of a study aiming to explore the lived experiences of accessing healthcare in the greater Vancouver area for recently-arrived, government-assisted refugee women, who were non-literate and non-English-speaking when they arrived in the country. We carried out sixteen semi-structured interviews with eight refugee women, guided by descriptive phenomenology. RESULTS: The findings highlight the intersection of limited knowledge of the local language with low literacy, gender, and refugee status and how it impacts women's access to healthcare, leading to added layers of disadvantage. We discuss three themes: (1) Dependence, often leading to compromised choice and lack of autonomy, (2) Isolation, manifesting as fear in navigating the healthcare system, rejection, or shame for a perceived inadequacy, and (3) Resourcefulness in finding ways to access healthcare. DISCUSSION: We propose that a greater understanding of the intersections of gender, low literacy, and refugee status can guide healthcare workers and policy makers in improving services for this population. Furthermore, It is important to enable seldom-heard, hard to reach populations and facilitate their participation in research in order to understand how vectors of disadvantage intersect.

The effects of neoliberal policies on access to healthcare for people with disabilities.

Neoliberal reforms lead to deep changes in healthcare systems around the world, on account of their emphasis on free market rather than the right to health. People with disabilities can be particularly disadvantaged by such reforms, due to their increased healthcare needs and lower socioeconomic status. In this article, we analyse the impacts of neoliberal reforms on access to healthcare for disabled people. This article is based on a critical analytical review of the literature and on two case studies, Chile and Greece. Chile was among the first countries to introduce neoliberal reforms in the health sector, which led to health inequalities and stratification of healthcare services. Greece is one of the most recent examples of countries that have carried out extensive changes in healthcare, which have resulted in a deterioration of the quality of healthcare services. Through a review of the policies performed in these two countries, we propose that the pathways that affect access to healthcare for disabled people include: a) Policies directly or indirectly targeting healthcare, affecting the entire population, including disabled people; and b) Policies affecting socioeconomic determinants, directly or indirectly targeting disabled people, and indirectly impacting access to healthcare. The power differentials produced through neoliberal policies that focus on economic rather than human rights indicators, can lead to a category of disempowered people, whose health needs are subordinated to the markets. The effects of this range from catastrophic out-of-pocket payments to compromised access to healthcare. Neoliberal reforms can be seen as a form of structural violence, disproportionately affecting the most vulnerable parts of the population - such as people with disabilities - and curtailing access to basic rights, such as healthcare.