In order to understand the situation that we are about to discuss, it is important to clarify two important concepts in the disability debate: integration and inclusion.
Integration and inclusiveness: different and complementary concepts
According to the most authoritative dictionary of the Italian language:“Unlike integration, whose main axis is the individual as a segment of a clearly delimited organic totality, inclusivity postulates the construction of contexts sensitive to diversity, within which social action guarantees equal dignity, power and representation for each subject, in full respect of individual orientations, capacities and aptitudes”.
Thus, integration involves bringing people together physically and takes place in society as a whole, but it does not always provide the same possibilities to be and to act.
On the other hand, inclusion is represented by a set of actions that allow everyone, without distinction of any kind, to be active citizens. It is not enough to integrate diversity but, starting from the richness of differences, to give them the possibility to do and to exist.
Toachieve full inclusion, as indicated by the UN Convention on the Rights of Persons with Disabilities, we must act in synergy and full inclusion must be pursued with the intention of placing frailty at the centre of all present and future decisions. In doing so, we will become a better and fairer society for the weakest.
Health barriers in Italy: the survey in hospitals and schools
Accessibility to hospitals and schools is a fundamental right that should be guaranteed to all, regardless of their physical or cognitive abilities. However, a close look at the Italian reality reveals a worrying picture: many hospital and school facilities in the country are not adequately equipped to welcome and support people with disabilities.
According to a study carried out in 2016 by the non-profit organisation “Spes contro spem”,in collaboration with the National Observatory of Health in the Italian Regions of the Catholic University of Rome, 78% of Italian hospital facilities do not offer spaces for assistance to people with intellectual, motor, and sensory disabilities.
Even more worryingly, only 29% of clinics and wards in northern Italy and 6.5% in southern Italy offer specific health pathways for people with cognitive disabilities.
This gap highlights a significant disparity between regions and underlines the urgent need for targeted interventions to ensure equal and inclusive care for all citizens.
The consequences of this lack of accessibility are severe: people with disabilities face significant barriers in accessing health services, with long waiting times in emergency rooms and difficulties in undergoing diagnostic and therapeutic procedures. This not only compromises their physical well-being, but also contributes to their social isolation and emotional distress.
Moreover, this situation highlights a profound disparity between northern and southern Italy, where people with disabilities are particularly disadvantaged in accessing health services.
The lack of sensitivity and resources on the part of Italian hospitals to the needs of disabled patients is a complex problem that requires urgent and coordinated action. It is crucial that healthcare institutions adopt inclusive policies and practices that take into account the diverse needs of patients and ensure personalised and dignified care. This could include:
– The implementation of priority health care pathways for people with disabilities;
– Training of hospital staff in care sensitive to the specific needs of patients;
-The installation of accessible equipment and technology.
The situation at school
Similarly, the accessibility of Italian schools represents a major challenge that Italy is not addressing. According to a survey conducted by the National Institute of Statistics (ISTAT), in the school year 2022/2023,, 42% of schools will not be accessible to pupils with motor and sensory disabilities:tactile maps and suitable routes for the blind and visually impaired are lacking, while the presence of technological aids varies greatly from one region to another.
The survey addresses many variables related to both integration and inclusion. Although the number of disabled pupils has increased – 338,000 disabled pupils attending schools at all levels, 4.1% of the total enrolment, +7% compared to the previous school year – 50% of schools have no liftor have a lift but it does not meet the standards; high percentages of inadequate toilets are also reported (26%); educational excursions involving overnight stays are very rare (32%).
The supply of support teachers is improving (+10%). The pupil-teacher ratio of 1.6 is better than required by law, but among teachers 1 in 3 has no specific training and 12% are assigned late.
Discontinuity in education remains strong: 60% of disabled pupils change their support teacher from one year to the next, 9% during the same school year. This creates significant barriers to education and social inclusion for disabled pupils and underlines the need to redouble efforts to ensure equal access to education for all.
Disability and inclusion: Italy through the lens of the OECD
EIn recent times, the long-standing challenges facing Italy have been the subject of an investigation into the state of disability policy reform.. As the Organisation for Economic Co-operation and Development (OECD) report “Disability, work and inclusion in Italy: better assessment for better care” reveals, there are three main problems:
– Inconsistencies with the UN Convention on the Rights of Persons with Disabilities.
– Fragmentation of disability assessment and support.
– The resulting disparities between Italian regions in the provision of services and the use of disability benefits.
Social and employment indicators for people with disabilities in Italy are therefore ambivalent and complex to interpret. Although employment and poverty gaps between people with and without disabilities are relatively low and below the OECD average, this is not due to higher employment or lower poverty rates among people with disabilities. Rather, these lower gaps are due to low income and employment levels also for people without disabilities, which underlines the need for further reforms to improve social and employment outcomes for all people in Italy, including people with disabilities.
Moreover, although benefits and services for people with disabilities exist, take-up remains low due to the complexity of the system and lack of resources. Many people excluded from benefits are particularly vulnerable and face significant barriers to employment and social integration.
There is also confusion and inequality caused by differences in the assessment of disability, both between and within regions. Currently, Italian legislation provides for five different assessments of disability status in parallel, which makes the system inefficient and difficult to understand.
The needs assessment, which determines access to services, varies greatly between different areas of the country, with a strong focus on the actual needs of disabled people.. However, the two main assessments – the civil disability assessment and the needs assessment – are disconnected from each other.
The recent enabling law indicates the need for a reform of disability assessment, with the integration of the WHO Disability Assessment Form (WHODAS) to ensure a more accurate and multidimensional assessment.
To make disability policies more efficient and effective, the government should consider several actions, such as unifying disability status assessments, using WHODAS scores to highlight discrepancies between the medical and functional dimensions of disability, reducing discretion in disability assessment, and strengthening single points of access to help people with disabilities navigate the system.
In addition, it is essential to reduce territorial disparities by improving the capacity to deliver effective services in the southern regions and by prioritising the integration of people with disabilities into the labour market.
In conclusion, improving accessibility and inclusion is not only a social imperative, but also an opportunity to build a fairer, more equitable and inclusive society for all its citizens. It is time for Italy to make a serious commitment to overcome the remaining material and cultural barriers and to create a future in which every individual has the opportunity to develop their full potential, regardless of their physical or cognitive abilities.
