Tokyo, Japan, 4-5 February 2013 The Accessibility Imperative for e- Health: Demographic Realities and Barriers to Usage Axel Leblois President and Executive Director, G3ict ITU Workshop on E-health services in low-resource settings: Requirements and ITU role (Tokyo, Japan, 4-5 February 2013)

Topics 1. Disability and ICT Accessibility 2. Demographic data points for e- Health applications and services 3. Global legislative and regulatory agenda 4. Recommendations Tokyo, Japan, 4-5 February

Persons with Disabilities Persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others. Source: Convention on the Rights of Persons with Disabilities, Art. 1 Tokyo, Japan, 4-5 February

What Does Accessible ICTs Mean for Persons with Disabilities? Accessibility means what the user requires to gain functional access to ICT: Perceives the information Understands it Can act upon it Sensorial, cognitive and physical disabilities: well documented barriers (ISO, ITU definitions of Human Factors) Accessible solutions are available for TV, mobile phones, Computers, web sites, fixed phones, kiosks, electronic documents 4

Example of Alternative Modes of Communication for Mobile Visual Text-to-Speech for Menus, SMS and Hearing Video Relay Service with sign language Speech Peer-to-peer video for sign language Dexterity Wireless switches or voice recognition for controls and input Cognition Icon interfaces

Who Risks to Be Excluded from e-Health Services? One billion persons live with a disability, 2/3 with a severe disability* 80% in the developing world Strong correlation with poverty Over half of persons aged 65+ live with a disability, fast growing population segment** Disability affects all age groups: 13.2% of all public school students K to 12 in the United States live with a disability*** *WHO World Bank Report on Disability 2011 **US Census Bureau ***US Department of Education

57% of Microsoft Windows Users Likely to Benefit from its Accessibility Features 57% of adult computer users (age in the US) are likely or very likely to benefit from accessibility features 1 in 4 users experiences a visual difficulty. 1 in 4 experience pain in wrists or hands. 1 in 5 has a hearing difficulty. Study commissioned by Microsoft, Conducted by Forrester Research in 2003 Not likely to benefit 43% Very likely to benefit 17 % Likely to benefit 40%

People with disabilities are often invisible in official statistics Source: UNESCO, Education for All Global Monitoring Report 2006

Many Countries Lack Proper Statistics as Evidenced by Inconsistent National Data

Caused by Types of Questions Yielding Widely Different Disability Rates

Evidence of Exclusion: Gaps in Broadband Adoption by Persons with Disabilities One third of the U.S. population has not adopted broadband at home although it is available in most cases 39% of those non adopters have some type of disability, more than twice the proportion of Americans living with a disability: 15% Only 35 percent of Senior citizens (those over the age of 65) have broadband-at-home Similar gaps in other countries: UK, close to 50% of non adopters live with disabilities, Korea, 25% gap. Source: FCC Report by John Horrigan, February 2010

12 Adopted by the United Nations General Assembly on December 13, 2006 after 5 years of international multi-stakeholders negotiations 156 Countries signatures, 126 ratifications Article 9 defines accessibility obligations including ICTs Article 25 defines the Rights to Health for Persons with Disabilities The Convention on the Rights of Persons with Disabilities

ICT Accessibility: a Prerequisite for Persons with Disabilities to Exercise their Rights Preamble (v): Recognizing the importance of accessibility to the physical, social, economic and cultural environment, to health and education and to information and communication, in enabling persons with disabilities to fully enjoy all human rights and fundamental freedoms.

Right to Health without Discrimination Requires e-Health to be Accessible States Parties recognize that persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability (Article 25 on Health) Denial of Reasonable Accommodation which includes ICTs, equals discrimination (Article 2 on Definitions) Tokyo, Japan, 4-5 February

Global Impact of CRPD ICT Accessibility Obligations for e-Health

e-Health Accessibility Policies Lagging Behind other Areas Percentage of Countries with Existing ICT Accessibility Policies in Specific Areas Source: G3ict CRPD ICT Accessibility Progress Report 2012 – 52 countries Primary and Secondary Education55.3% Rehabilitation Services53.3% Reasonable Accommodation at Workplace53.2% Higher Education52.2% Community Services44.4% Independent Living43.5% Emergency Response Services38.3% Voting systems37.0% Health Services29.5% Judicial Information and Legal Procedure25.6%

Recommendations Develop WHO-ITU joint guidelines for e- Health accessibility G3ict/UNITE available to assist with ITU-D Ensure that ICT accessibility is required when procuring e-Health projects Leverage standards for: Web accessibility Electronic documents accessibility Mobile accessibility Fixed line telephony accessibility Tokyo, Japan, 4-5 February

Thank You For Your Attention

Appendixes Tokyo, Japan, 4-5 February

G3ict Mission To Facilitate the Implementation of the ICT Accessibility dispositions of the Convention on the Rights of Persons with Disabilities

G3ict – ITU Toolkit for Policy Makers

Georgia: A Hub for Digital Accessibility Innovation Atlanta, Georgia, USA, 1 October 2008

G3ict Web Resources Publications CRPD Progress Report Meeting proceedings G3ict – ITU Toolkit for Policy Makers G3ict summit to promote accessible mobile

Making TV Accessible Report 24 Prepared by Peter Looms, Chairman of ITU-T Focus Group on Audiovisual Media Accessibility Looks at how TV can be made more accessible Timely given the transition from analogue to digital TV

Making Mobile Phones and Services Accessible Report 25 Prepared by a team of experts Explains in concrete terms, what is meant by accessible mobile phones Developments in accessible mobile apps Business opportunities and case studies Policy guidelines

Useful References UN Washington Group on Disability Statistics Measuring Disability PrevalenceMeasuring Disability Prevalence, D. Mont et al, World Bank, March 2007 Making Inclusion Operational: Legal and Institutional Resources for World Bank Staff on the Inclusion of Disability Issues in Investment Projects,Making Inclusion Operational: Legal and Institutional Resources for World Bank Staff on the Inclusion of Disability Issues in Investment Projects, K. Guernsey et al, World Bank, October 2006 Beyond compliance: Business advantage of accessibilityBeyond compliance: Business advantage of accessibility, IBM Executive brief, Human Ability and Accessibility Center, 2007 G3ict CRPD ICT Accessibility Progress Report ITU – G3ict Policy Toolkit for Policy Makers: accessibilitytoolkit.orgwww.e- accessibilitytoolkit.org ITU – G3ict accessibility guides: