NL Journal of Medical and Pharmaceutical Sciences

Introduction

1. Overview of Disabilities and Urban Communities

Unorganized planning and management in the current situation lead to issues with overcrowding, hazardous environments, pollution, and sickness among inhabitants, particularly those with disabilities [1]. This review introduces the concept of disabilities, outlining the various types and prevalence of disabilities globally and within urban communities. Discussion of the challenges faced by persons with disabilities (PWDs) in urban settings, such as physical, social, and economic barriers. It also includes highlights of how urbanization impacts accessibility, inclusion, and the quality of life for PWDs [2,5].

2. Importance of Health and Well-being for Persons with Disabilities (PWDs)

A Country must emphasize to fulfil critical needs especially for PWDs to prioritize their health and well-being as part of inclusive urban development. One needs to be addressed by the unique healthcare challenges like Covid-19 or pandemic, societal stigmas, and mental health issues often experienced by PWDs and must work upon [3]. A country must focus on creating some NGOs that ink this discussion to the broader benefits of creating supportive urban environments that enhance the overall well-being of PWDs [4].

3. Objectives and Scope of the Study

A number of physical, social, and policy barriers exist for people with disabilities in pursuing a livelihood, including limited access to public restrooms and transportation, an absence of effective directory information (e.g., signs and displays) that risks their safety, a lack of job opportunities, and inadequate participation in policy decisions. Furthermore, females, the elderly, and low-income households are disproportionately represented in the group of those with disabilities, which exacerbates their difficulties in achieving an adequate livelihood.

Access to society and public services should be afforded to all individuals, including those with disabilities. When people are not treated equally, discrimination, which violates basic human rights, begins to take root. Although in some countries the government has issued access regulations, the design of the built environment has remained inconsistent. Urban green spaces are the best example of how access restrictions may make living more difficult for individuals with disabilities. For people with disabilities to have health equity in cities, their direct, acute care requirements must be taken into account. Simultaneously, the social, physical, and often place-based causes of poor health that have not been resolved must also be addressed. number of people 60 years of age and older is also increasing. Estimates predict that [1].

Hence main objectives of this review include:

• To assess the current state of health and well-being among PWDs in urban
• To identify barriers that includes inclusion and access in urban settings for
• To propose strategies for improving health, accessibility, and overall quality of life for PWDs in cities [4].

Defining Health and Well-being for Persons with Disabilities

1. Concept of Health for PWDs

According to World Health Organization (WHO) health is basically a state of complete physical, mental, and social well-being, but it does not encapsulate the experiences of PWDs and how health for PWDs is more about functionali- ty, autonomy, and access to necessary services rather than the absence of illness or disability [8]. Hence there should be rights-based approaches to health that emphasizes equity, inclusion, and empowerment of PWDs in Urban [5].

2. Well-being: Physical, Mental, and Social Aspects

Well-being for PWDs focuses mainly on 3 dimensions that includes:

• Physical well-being: It focuses on maintaining functionality, managing disabilities, and assessment to healthcare services and rehabilitation [10].
• Mental well-being: It address issues such as coping with stigma, stress, and mental health conditions that may arise from discrimination or isolation [6].
• Social well-being: It explore the importance of inclusion, social interactions, and the sense of belonging within urban communities [6,4].

3. Social Determinants of Health for PWDs in Urban Areas

It includes social, economic, and environmental factors that influence health outcomes for PWDs in urban settings. It includes:

• Economic stability: Employment opportunities and financial
• Education: Access to inclusive education
• Healthcare: Availability and affordability of disability-friendly healthcare
• Built environment: Accessibility of infrastructure, transportation, and
• Social environment: Community support systems, attitudes toward disabilities, and policy frameworks promoting inclusion [8,10].

Obstacles Faced by Persons with Disabilities in Urban Communities

1. Physical Barriers: Infrastructure and Accessibility
In comparison to individuals whom are fit (without any disability), those with disabilities face greater rates of privation, lower levels of economic engagement, less academic performance, and debilitated outcomes [2,8]. Due to insufficient infrastructure according to the feasibility of PWDs they do frequently face considerable hinderance in urban settings. Exclusion of PWDs results from common disregard for universal accessibility standards in the construction of public areas, structures, and transportation systems especially for PWDs. For instance: Inadequate walkways, ramps, lifts, and entrances impede independence, and a lack of accessible public transportation restricts movement [5]. These obstacles make already-existing disparities worse by raising poverty rates, decreasing economic engagement, lowering educational achievement, and negatively affecting PWDs’ health [1].

2. Healthcare Access and Quality

People with disabilities (PWDs) also do face trouble getting healthcare because of certain obstacles that include physical issues like the absence of ramps, lifts, and special equipment in healthcare places. Financial obstacles are also a major point to be concerned that arise from the high costs of medicine, assistive technology, and therapy services. There are also problems within the healthcare system, such as healthcare workers not being trained to understand the needs of disabled individuals and having biases [10].

3. Social Stigmatization and Isolation

PWDs frequently face discriminatory attitudes from society that result in limited academic, job opportunities, and social possibilities, as well as exclusion from cultural, recreational, and community events. This social marginalization has a substantial negative impact on their psychological wellness, causing anxiety, depressive disorders, and low self-worth. [2,8].

4. Employment and Economic Opportunities

PWDs face significant barriers to meaningful employment like biases during hiring processes or workplace exclusion, workplaces lacking necessary accommodations or higher unemployment rates that leads to limited career advancement opportunities [5,7]. Empowering persons with disabilities (PWDs) involves ensuring their independence and self-reliance by creating job opportunities for them. However, PWDs are marginalized when it comes to employment. In the Asia Pacific region alone, the unemployment rate for PWDs is 80% or more. One way to address this issue is to utilize social enterprise (a business for profit and social responsibility) as a mechanism for the inclusion of PWDs in the economy [16].

5. Housing and Independent Living

Accessible and affordable housing remains a critical issue for PWDs for ex- limited availability of housing designed to accommodate mobility aids or assistive devices and inadequate access to personal care and community-based support systems [7,8].

Urban Planning and Policy for Inclusive Cities

1. Role of Urban Planning in Health and Well-being

Urban planning plays a pivotal role in creating environments that promote the health and well-being of Persons with Disabilities (PWDs). Enhancement by designing cities with universal design principles that focuses on accommodation of every individual, Integration of green space, development of mixed-use neighbourhoods that must reduce dependency on transportation by ensuring that essential services, housing, and workplaces within accessible locations. And to focus on reducing urban noise, pollution, and other hazards that disproportionately affecting PWDs [1,9].

2. Accessible Transportation and Mobility Solutions

Universal designing in public transport must definitely focus on PWD for their access to basic buses, trains, and metro systems equipped with ramps, lifts, and priority seating, well-maintained sidewalks with tactile paving, curb cuts, and clear signage, mobile apps and GPS systems designed for PWDs to navigate transportation systems independently, services such as accessible ride-sharing or shuttle options for PWDs [7,11].

3. Policy Frameworks Supporting PWDs

Policies are fundamental for fostering that might focus on international agreements by aligning with the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). Enforcing legal protections and anti- discrimination laws. By funding for assistive technologies, housing adaptations, and healthcare subsidies [4,8].

4. Case Studies of Inclusive Urban Designs

According to the WHO data Denmark has renowned for its accessible public transportation, pedestrian zones, and cycling infrastructure. Singapore has adopted features like barrier-free design in housing, transport, and public spaces, supported by comprehensive policies. Spain government has emphasized on universal design principles, making cultural sites, parks, and public facilities accessible to PWDs [1,5].

Role of Healthcare Services

1. Availability and Accessibility of Healthcare for PWDs

Healthcare access for Persons with Disabilities (PWDs) is often limited by various barriers for ex- facilities lack ramps, elevators, high costs for medical services [10]. In the PWD group, the most frequently reported reasons for not receiving medical services when needed were lack of money (58.8%) and lack of transportation (18.6%). Problems accessing medical services were associated with sex, age, employment status, household income, health insurance type, chronic disease, and disability type and grade [13].

2. Specialized Healthcare Needs of PWDs

PWDs often require tailored healthcare services, that must include Rehabilitation services including Physical, occupational, and speech therapy to enhance functionality and independence, access to wheelchairs, prosthetics, hearing aids [5,10].

3. Integration of Mental Health Services

Mental health is a critical but often neglected aspect of healthcare for PWDs. Facing stigma and discrimination dealing with social isolation and negative societal attitudes, stress and trauma [9]. The COVID-19 pandemic has further highlighted the inadequate and outdated nature of mental health systems and services worldwide. It has brought to light the damaging effects of institutions, lack of cohesive social networks, the isolation and marginalization of many individuals with mental health conditions, along with the insufficient and fragmented nature of community mental health services [15].

Telemedicine and Technology for Better Health Access

Technological advancements are transforming healthcare for PWDs, particularly through telemedicine. Remote consultations include reduced need for travel to healthcare facilities, devices and apps to track health metrics, enhancing preventive care and self-management, virtual support networks and therapy sessions tailored to the needs of PWDs [10,11].

Social Inclusion and Community Participation

1. Building Inclusive Public Spaces

Creating public spaces that accommodate the needs of Persons with Disabilities (PWDs) fosters inclusion and enhances community engagement. Spaces should be accessible to all, incorporating features like ramps, tactile paving, and Parks, community centers, and recreational areas designed for diverse activities and accessibility. Strict adherence to accessibility standards in urban planning and construction projects [4].

2. Role of Community Support Systems

Strong community support systems are essential for the well-being and integration of PWDs. Government must focus on creating support groups and forums where PWDs can share experiences, access childcare, eldercare, and personal assistance [4]. There must be volunteer ship programs for encouraging community members to engage with and assist PWDs, fostering mutual understanding and solidarity [7]. Urban green spaces have been increasingly evidenced to not only improve human health (both body and mind) and well-being but also promote a sustainable way of living for citizens as well as cities. These positive health and sustainable advantages have even greater impacts when applied to people with disabilities, which can ultimately evaluate their quality of life in the long run [1].

3. Education and Advocacy for Reducing Stigmatization

Stigmatization is combatted by awareness campaigns by initiating programs that integrate students with and without disabilities, fostering early acceptance and empathy, to normalize PWDs inclusion and training for employers, educators, and policymakers to eliminate biases and promote equitable treatment [4]. To achieve social justice for people with disabilities, advocacy and continued research must be made for the removal of these obstacles, as well as efforts to ensure inclusion and acceptance in all facets of society [14].

4. Promoting Active Participation in Civic Life

PWDs should be empowered to contribute to and participate in civic life by encouraging and giving them opportunities to take on roles in governance, policymaking, and advocacy and giving them opportunities in arts, sports, and community events [5]. Social participation has been found to promote health and wellbeing for older adults. In this study, well older adults participated in photovoice to explore how they create and maintain social participation while living alone in an urban community [18].

Impact of COVID-19 on Health and Well-being of PWDs in Urban Areas

1. Challenges Amplified by the Pandemic

The COVID-19 pandemic exacerbated existing challenges faced by Persons with Disabilities (PWDs) in urban areas for ex- overburdened healthcare systems often deprioritized non-emergency needs, leaving PWDs without essential medical care. Lockdowns and social distancing gave rise to loneliness and mental health issues among PWDs, who already experience high rates of isolation and experiencing economic vulnerabilities [3].

2. Adaptive Responses and Resilience

Despite the challenges, PWDs and communities demonstrated resilience and adaptability during the pandemic many healthcare providers introduced virtual consultations, enabling PWDs to access medical services safely. Whereas NGOs, local groups, and volunteers stepped in to provide food, medicines, and emotional support to isolated PWDs [3,8].

3. Post-Pandemic Recovery Strategies

Recovery strategies should aim to build a more inclusive and resilient society for PWDs by expanding their access to rehabilitation, mental health services, and preventive care by creating targeted employment programs, skill-building initiatives, and financial aid for PWDs impacted by the pandemic. Providing them digital literacy programs, and affordable internet and ultimately establishing permanent community support systems to assist PWDs during future crises [3,4].

Recommendations for Improving Health and Well-being of PWDs in Urban Communities

1. Policy Interventions and Urban Reforms

To promote health and well-being for Persons with Disabilities (PWDs), policymakers and urban planners must adopt universal design principles by ensuring accessibility in public spaces, transportation, and housing. Consolidating laws and legislation in order to secure rights of PWDs and offering them accessible, disability-friendly medical care, especially psychological health assistance [8,9]. Setting priorities and improving the present infrastructure to eliminate physical obstacles in cities [9].

2. Role of Government, NGOs, and Private Sector

There are several schemes initiated by the government, that specifically aims at creating and implementing inclusive policies, anticipates funds and enforcing guidelines for projects designed for PWDs by community support services through NGOs [8]. Whereas health care professionals involved in R&D, formulation of policies do also play a very crucial role [12].

3. Leveraging Technology for Inclusive Solutions

Technology can revolutionize the lives of PWDs by providing them the remote healthcare access by incorporating sensors, apps, and IoT devices to enhance navigation and accessibility in urban areas [4]. The technologies related to telecommunications, wearables, virtual and augmented reality, artificial intelligence, and cloud computing are providing new opportunities to improve accessibility in rehabilitation and exercise for people with disabilities. In addition, we highlight new frontiers in digital health technology and emerging lines of scientific research that will shape the future of precision care strategies for people with disabilities [17].

4. Future Directions for Research and Advocacy

Investigating the intersection of disability with other social determinants like race, gender, and income, study the long-term impacts of urbanization on PWDs’ health and well-being, exploring innovative models for inclusive urban development are some of the topics for future study. While Advocacy strategies includes amplification of the voices of PWDs through storytelling and public campaigns, strengthen alliances among advocacy groups to drive systemic change, initiating international collaboration on disability rights and urban development [4,9].

Conclusion

This review highlights the multifaceted challenges and opportunities for improving the health and well- being of Persons with Disabilities (PWDs) in urban communities that includes Barriers to inclusion like physical, social, and economic challenges that hinder PWDs from fully participating in urban life. These include inaccessible infrastructure, limited healthcare access, stigmatization, and unemployment role of urban planning and policy, healthcare services and technology by addressing the unique healthcare needs of PWDs and leveraging technology which can significantly enhance their quality of life. Promoting their social inclusion, education, and advocacy is critical for reducing stigma and fostering equitable societies. Although the COVID-19 pandemic underscored the importance of adaptive strategies and the need for disability-inclusive recovery efforts.

To create truly inclusive urban environments for PWDs, stakeholders must focus on implementing progressive policies that prioritize accessibility, equity, and inclusion in urban planning and services. Strengthening partnerships between governments, NGOs, private sectors, and PWD communities to co-create solutions, enhance independence and self-advocacy. Promoting universal design principles in infrastructure, transportation, and technology.

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