Hannah Kuper

• ScD
• Professor (Full) at London School of Hygiene and Tropical Medicine

Background: People with disabilities on average experience health care barriers, poorer health and higher mortality.Objectives: This study aims to review and synthesise life expectancy (LE) and years of life lost (YLL) comparing people with disabilities to those without in low and middle-income countries (LMICs).Method: A systematic review was cond...

Background Globally, one in six people have disabilities. They often experience health inequities and many of them arise from system-level failures. This study aimed to assess the inclusion of people with disabilities in the health system of Chile and define recommendations for improvement on the basis of the evidence. Methods A health system asse...

Background People with disabilities are consistently falling behind in educational outcomes compared to their peers without disabilities, whether measured in terms of school enrolment, school completion, mean years of schooling, or literacy levels. These inequalities in education contribute to people with disabilities being less likely to achieve e...

Background People with disabilities often incur higher costs for healthcare, due to higher needs, greater indirect costs, and the need for services not offered by the public system. Yet, people with disabilities are more likely to experience poverty and so have reduced capacity to pay. Health insurance is an important social protection strategy to...

This paper explores the use of participatory video (PV) in a case study conducted in Arcoverde, Brazil, to address the call for greater participation of individuals with disabilities in health and social care planning and research. PV is grounded in similar concepts to the Disability Rights Movement’s principle of “Nothing About Us, Without Us” and...

Multiple health system components, supported by good policy, are needed for the provision of quality rehabilitation care. This study used the Missing Billion Health System Framework to structure a situational analysis of publicly funded rehabilitation services within the Unified Health System in Brazil, focusing on: governance, leadership, health f...

Introduction Early Hearing Detection and Intervention (EHDI) programmes were established to reduce the impact of hearing loss on children. High-income countries (HICs) have resources and knowledge to execute these programmes. However, financial and other resource constraints limit the availability of these programmes to low-income and middle-income...

Objective The aim of the research was to explore the barriers to healthcare access for persons with various disabilities in rural Luuka district of Uganda. The findings will assist in appreciating the challenges persons with disabilities face in accessing Healthcare in a rural setting. These insights will contribute to the development of an interve...

OBJECTIVE To investigate perspectives of people with disabilities in Brazil regarding the access to primary healthcare. METHODS In-depth interviews were conducted with 44 individuals with disabilities in Pernambuco, Distrito Federal, and São Paulo between March 2020 and November 2021. These interviews were transcribed, coded, and analysed thematic...

Despite the large number of children in India, there is little information on the impact of children’s disability on school enrolment, and how this differs by population. We estimated the prevalence of childhood disability in two sites in Tamil Nadu, southern India, and the effect of functional difficulty on school enrolment. We used a parent-repor...

Eye health and disability are both common among older people, and it is important to understand how disability relates to visual health status and access to services. While people with disabilities face barriers to accessing health services, few studies have measured participants’ functional status in domains other than vision and little evidence e...

Background School-based approaches are an efficient mechanism for the delivery of basic health services, but may result in the exclusion of children with disabilities if they are less likely to participate in schooling. Community-based ‘door to door’ approaches may provide a more equitable strategy to ensure that children with disabilities are reac...

Background There are 1.3 billion people with disabilities globally, and they frequently face barriers to accessing healthcare, contributing to their worse health and higher mortality. However, little research has explored patient-reported approaches to improve healthcare for persons with disabilities. Consequently, this study aimed to explore possi...

Background Around 18% of the population in Chile has disabilities. Evidence shows that this population has greater healthcare needs, yet they face barriers to accessing healthcare due to health system failures. This paper aims to assess the inclusion of people with disabilities in health policy documents and to explore the perceptions of key nation...

This study describes findings from a case study conducted on access to healthcare for people with disabilities based on the perspective of primary care unit professionals and managers in three Brazilian municipalities, considering the dimensions of Availability and Accommodation and Appropriateness. A total of 16 primary care unit healthcare provid...

Introduction A key Sustainable Development Goal target is to eliminate all forms of malnutrition. Existing evidence suggests children with disabilities are at greater risks of malnutrition, exclusion from nutrition programmes and mortality from severe acute malnutrition than children without disabilities. However, there is limited evidence on the n...

Background Interest in modifiable risk factors (MRFs) for dementia is high, given the personal, social, and economic impact of the disorder, especially in ageing societies such as the United Kingdom. Exploring the population attributable fraction (PAF) of dementia attributable to MRFs and how this may have changed over time remains unclear. Unravel...

Background Around 18% of the population in Chile has disabilities. Evidence shows that this population has greater healthcare needs, yet they face barriers to accessing healthcare due to health system failures. This paper aims to assess the inclusion of people with disabilities in health policy documents and to explore the perceptions of key nation...

Background: People with disabilities face more barriers accessing healthcare and, on average, experience worse health outcomes. Strengthening health access for people with disabilities requires coordinated action across the health system. The Missing Billion Inclusive Health System Framework is a new tool to support policy makers assess levels of d...

Background There are 1.3 billion people with disabilities globally, and they frequently face barriers to accessing healthcare, contributing to their worse health and higher mortality. However, little research has explored patient-reported approaches to improve healthcare for persons with disabilities. Consequently, this study aimed to explore possi...

People with disabilities frequently experience barriers in seeking healthcare that lead to poorer health outcomes compared to people without disabilities. To overcome this, it is important to assess the accessibility of primary health facilities – broadly defined to include a disability-inclusive service provision – so as to document present status...

Importance Overweight and obesity affect 340 million adolescents worldwide and constitute a risk factor for poor mental health. Understanding the association between body mass index (BMI) and mental health in adolescents may help to address rising mental health issues; however, existing studies lack comprehensive evaluations spanning diverse countr...

This study investigates the association between price inflation and mental health conditions in the general population during the post-coronavirus disease 2019 (COVID-19) era in England, beginning from April 2022. Here, utilizing data from the Office for National Statistics and the National Health Service, we examined the association between price...

Around the world, there are approximately 1.3 billion people living with disabilities. They often face more challenges to accessing health services compared to those without disabilities, but it has been unclear how much their risk of premature death is increased. We reviewed studies from low-income and middle-income countries and analysed data fro...

Introduction More than 170 countries have implemented disability-targeted social protection programmes, although few have been rigorously evaluated. Consequently, a non-randomised controlled trial is being conducted of a pilot ‘cash-plus’ programme implemented by UNICEF Laos and the Laos government for children with disabilities in the Xiengkhouang...

Despite the large number of children in India, there is little information on the impact of children’s disability on school enrolment, and how this differs by population. We estimated the prevalence of childhood disability in two sites in Tamil Nadu, southern India, and the effect of functional difficulty on school enrolment. We used a parent-repor...

Background Cervical cancer screening is an important public health priority, yet many marginalized groups are not reached by existing programs. The nearly 700 million women with disabilities globally face substantial barriers in accessing cervical cancer screening and have lower coverage, yet there is limited evidence on what would support enhanced...

Background Approximately 1.3 billion people worldwide face barriers in accessing inclusive healthcare due to disabilities, leading to worse health outcomes, particularly in low and middle-income countries (LMIC). However, there is a lack of training of healthcare workers about disability, both globally and in Uganda. Objectives To use mixed resear...

Background There is little evidence on how to support ultra-poor people with disabilities to adopt sustainable livelihoods. The Disability-Inclusive Graduation (DIG) programme targets ultra-poor people with disabilities and/or women living in rural Uganda. The programme is an adaptation of an ultra-poor graduation model that has been shown to be ef...

In Latin America and the Caribbean (LAC), there are 85 million people with disabilities (PwD). They often experience barriers accessing healthcare and die, on average, 10-20 years earlier than those without disabilities. This study aimed to systematically review the quantitative literature on access to general healthcare among PwD, compared to thos...

Purpose: This review and meta-synthesis of qualitative studies aims to provide an overview of qualitative evidence on primary healthcare access of people with disability in Latin America and the Caribbean, as well as to identify barriers that exist in this region. Methods: Six databases were searched for studies from 2000 to 2022. 34 qualitative...

There are 1.3 billion people with disabilities globally. On average, they experience greater healthcare needs and more barriers accessing healthcare. Yet, health systems have failed to adequately include people with disabilities. The purpose of this study was to develop and pilot-test a tool for assessing disability inclusion in health system perfo...

Background Globally, women with disabilities are less likely to have access to family planning services compared to their peers without disabilities. However, evidence of effective interventions for promoting their sexual and reproductive health and rights remains limited, particularly in low- and middle-income settings. To help address disparities...

Background Play is essential for the cognitive, social, and emotional development of all children. Disparities potentially exist in access to play for children with disabilities, and the extent of this inequity is unknown. Methods Data from 212,194 children aged 2–4 years in 38 Low and Middle-Income Countries were collected in the UNICEF supported...

Resumo Este artigo aborda o acesso das pessoas com deficiência às ações e serviços de saúde a partir da percepção de profissionais e gestores de unidades da atenção primária de três cidades do país, considerando as dimensões “Disponibilidade e acomodação” e “Adequação”. Trata-se de um estudo de caso, que entrevistou 16 profissionais e gestores de u...

Resumo: O objetivo foi identificar os relatos de sintomas de depressão, ansiedade e estresse entre cuidadores de crianças sem deficiência visual, com baixa visão e com cegueira e sua relação com o grau de apoio social, emocional, material e afetivo. Estudo transversal e multicêntrico, realizado no Município do Rio de Janeiro, Brasil, entre 2019 e 2...

Background Over 1.3 billion people, or 16% of the world’s population, live with some form of disability. Recent studies have reported that people with disabilities (PwD) might not be receiving state-of-the-art treatment for cancer as their non-disabled peers; our objective was to systematically review this topic. Methods A systematic review was un...

There are few impact evaluations of social assistance programmes amongst people with disabilities, despite the increasing popularity of disability-targeted programmes. The Disability Allowance in the Maldives is a non-contributory, non-means-tested and unconditional cash transfer of MVR 2000 (US$130) per month. This study explores the impact of the...

Background There is a lack of evidence on the effectiveness of livelihood interventions amongst people with disabilities. In many countries, self-employment or microentrepreneurship is a dominant source of livelihoods for people with disabilities and their caregivers. However, this group may face heightened barriers to successful microentrepreneurs...

Dementia is an important and growing issue in sub-Saharan Africa, but epidemiological data are lacking. Risk factors may differ from other regions due to high stroke incidence and HIV prevalence. Understanding the epidemiology of cognition in older adults in Africa is crucial for informing public health strategies to improve the lives of people wit...

Background: Play is essential for the cognitive, social, and emotional development of all children. Disparities potentially exist in access to play for children with disabilities, and the extent of this inequity is unknown. Methods: Data from 212,194 children aged 2-4 years in 38 Low and Middle-Income Countries were collected in the UNICEF supporte...

It is estimated that 3.75 billion people worldwide lack access to healthcare services. Marginalized populations, such as people with disabilities, are at greater risk of exclusion. People with disabilities not only face the same barriers as people without disabilities, but also experience a range of additional barriers in accessing healthcare due t...

Introduction On average, people with disabilities face many difficulties in accessing healthcare and experience worse health outcomes. Yet, evidence on how to overcome these barriers is lacking. Participatory approaches are gaining prominence as they can generate low-cost, appropriate and scalable solutions. This study protocol is for the pilot tes...

Background The pandemic has placed considerable strain on health systems, especially in low- and middle-income countries (LMICs), leading to reductions in the availability of routine health services. Emerging evidence suggests that people with disabilities have encountered marked challenges in accessing healthcare services and supports in the conte...

Background: The most common management option for hearing loss is hearing aids. In addition to devices, patients require information and support, including maintenance and troubleshooting. Mobile health (mHealth) technologies can support hearing aid management, acclimatization, and use. This study developed an mHealth acclimatization and support p...

Background There is little evidence on how to support ultra-poor people with disabilities to adopt sustainable livelihoods. The Disability-Inclusive Graduation (DIG) programme targets ultra-poor people with disabilities and/or women living in rural Uganda. The programme is an adaptation of an ultra-poor -graduation model that has been shown to be e...

Background: Approximately 1.3 billion people worldwide face barriers in accessing inclusive healthcare due to disabilities, leading to worse health outcomes, particularly in low and middle-income countries (LMIC). However, there is a lack of training of healthcare workers about disability, both globally and in Uganda. Objectives: To use mixed metho...

Background: Disability and HIV are intricately linked, as people with disabilities are at higher risk of contracting HIV and HIV can lead to impairments and disability. Despite this well-established relationship, there remains limited internationally comparable evidence on HIV knowledge and access to testing for people with disabilities. Methods an...

Background There is a lack of evidence on the effectiveness of livelihood interventions amongst people with disabilities. In many countries, self-employment or micro-entrepreneurship is a dominant source of livelihoods for people with disabilities and their caregivers. However, this group may face heightened barriers to successful microentrepeurshi...

Background: The 2015 – 2016 Zika epidemic highlighted gaps in health and social care services for parents of children with developmental disabilities. In response, we developed the ‘Juntos’ intervention, a 10 week community-based early intervention support group for parents of children with congenital Zika syndrome (CZS). The intervention's compone...

Objectives: To undertake a systematic review and meta-analysis to estimate the relative risk of COVID-19-related mortality among people with disabilities compared to people without disabilities. Study design: Systematic review and meta-analysis. Methods: We systematically searched four databases from March 1, 2020, to August 15, 2022. We inclu...

Background: The 2015 – 2016 Zika epidemic highlighted gaps in health and social care services for parents of children with developmental disabilities. In response, we developed the ‘Juntos’ intervention, a 10 week community-based early intervention support group for parents of children with congenital Zika syndrome (CZS). The intervention's compone...

Nearly 240 million children are estimated to have a disability globally. We describe inequities by disability status and sex in birth registration, child labour, and violent discipline outcomes. Data come from Round 6 of the Multiple Indicator Cluster Survey programme and includes 323,436 children, aged 2–17 years in 24 countries. We estimated non-...

Background: Dementia and hearing loss are both highly prevalent conditions among older adults. We aimed to examine the association between hearing aid use and risk of all-cause and cause-specific dementia among middle-aged and older-aged adults, and to explore the roles of mediators and moderators in their association. Methods: We used data from...

Background Children and young people (CYP) with complex neurodisability experience multiple physical, communication, educational and social challenges which require complex packages of multidisciplinary care. Cerebral palsy, an exemplar complex neurodisability condition, is the most common cause of serious physical disabilities among children globa...

Background: There are at least one billion people with disabilities globally. On average they have poorer health, yet worse healthcare access. We aimed to systematically review the association between disability and mortality in low- and middle-income countries (LMICs). Methods: We searched MEDLINE, Global Health, PsycINFO and EMBASE from 1st Janua...

Background People with disabilities—more than a billion people worldwide—are frequently excluded from social and political life, and often experience stigmatising attitudes and behaviours from people without disabilities. This stigma, coupled with inaccessible environments and systems and institutional barriers (e.g., lack of inclusive legislation)...

Research has demonstrated that persons with disabilities, despite their greater need for healthcare services, often experience greater barriers to accessing healthcare including primary healthcare. Data and interventions on access to primary healthcare for persons with disabilities to date appear to concentrate more on access and quality issues onc...

Background Early hearing detection and intervention (EHDI) measures initiated in high-income countries (HICs) were attempted in low-income and middle-income countries (L&MICs). However, information regarding the models of EHDI, context-specific adaptations made to strategies and outcomes are not known. Aims The aims of this systematic review were...

BACKGROUND The most common management option for hearing loss is hearing aids. In addition to devices, patients require information and support, including maintenance and troubleshooting. Mobile health (mHealth) technologies can support hearing aid management, acclimatization, and use. This study developed an mHealth acclimatization and support pro...

Cataract is the leading cause of blindness globally. Surgery is the only proven treatment and estimating the target cataract surgical rates (CSR) necessary to relieve existing backlogs is crucial to inform surgical planning. We sought to determine whether crosssectional, age-stratified prevalence data could be used to accurately model the target CS...

The National Disability Policy was launched in Zimbabwe in June 2021 and includes a range of commitments for the provision of disability-inclusive health services and rehabilitation. Fulfilment of these pledges is important, as at least 7% of the population have disabilities, and people with disabilities face greater challenges accessing healthcare...

Background The rising prevalence of hearing loss is a global health concern. Professional hearing services are largely absent within low- and middle-income countries where appropriate skills are lacking. Task-shifting to community healthcare workers (CHWs) supported by mHealth technologies is an important strategy to address the problem. Objective...

Objective To assess access to general and disability-related health care among people with disabilities in the Maldives. Methods This study uses data from a case-control study (n = 711) nested within a population-based, nationally representative survey to compare health status and access to general healthcare amongst people with and without disabi...

Introduction There is little evidence on the impact of livelihood interventions amongst people with disabilities. Effective programmes are critical for reducing the heightened risk of poverty and unemployment facing persons with disabilities. STAR+ is a skills development and job placement programme targeted to out-of-school youth with disabilities...

Background Women with disabilities are at heightened risk of experiencing intimate partner violence [IPV], although the mechanisms through which disability acts as a risk factor for IPV are not clear. Objective We analyzed cross-sectional data (n=867) from Wave 3 of the MAISHA longitudinal study, conducted in Mwanza, Tanzania, to i) describe the l...

It is well established that access to preventative care, such as breast or cervical cancer screening, can reduce morbidity and mortality. Certain groups may be missed out of these healthcare services, such as women with disabilities, as they face many access barriers due to underlying inequalities and negative attitudes. However, the data have not...

Background : This study explores the acceptability and feasibility of the use of two different Participatory Visual Methods (Participatory Video and Digital Storytelling) in gathering information on the experiences and perspectives of carers of children with Congenital Zika Syndrome within Colombia. Methods : Participatory Video was used to assess...

Background The aim of this paper is to estimate the economic burden of children with congenital Zika Syndrome (CZS) in Brazil over 5–10 years. Methods We conducted a modelling study based on data collected in a case–control study in Brazil, including children with CZS (cases) and typically developing children (controls), born in 2015 and 2016. In...

Background People with disabilities—more than a billion people worldwide—are frequently excluded from livelihood opportunities, including employment, social protection, and access to finance. Interventions are therefore needed to improve livelihood outcomes for people with disabilities, such as improving access to financial capital (e.g., social pr...

The purpose of this article is to analyse the circumstances in which the National Health Policy for Persons with Disabilities (PNSPCD) came into place in 2002, and factors supporting or impeding its implementation from 2002 to 2018. The analysis was based on the Comprehensive Policy Analysis Model proposed by Walt and Gilson, and focussed on unders...

Background: On average, people with disabilities have greater healthcare needs, yet face a range of barriers in accessing care. Objectives: Our objectives were to explore the experiences of people with disabilities in accessing care and identify opportunities for the health system to be designed for inclusion in Zimbabwe. Methods: In-depth qualit...

Background: People with disabilities are at higher risk of adverse coronavirus disease 2019 (COVID-19) outcomes. Additionally, measures to mitigate COVID-19 transmission have impacted health service provision and access, which may particularly disadvantage people with disabilities. Objectives: To explore the perspectives and experiences of people...

Disability-targeted cash transfers are increasingly used by governments in low- and middle-income countries as a tool to address poverty and exclusion among people with disabilities. However, in many settings, accurate estimates of coverage and an understanding of factors affecting uptake are needed for effective delivery. This study explores cover...

Introduction Dementia is an important and growing issue in sub-Saharan Africa, but epidemiological data are lacking. Risk factors may differ from other regions due to high stroke incidence and HIV prevalence. Understanding the epidemiology of cognition in older adults in Africa is crucial for informing public health strategies to improve the lives...

Abstract: This study analyses the use of the self-reported Washington Group (WG) question sets as a first stage screening to identify people with clinical impairments, service and assistive product (AP) referral needs using different cut-off levels in four functional domains (vision, hearing, mobility and cognition). Secondary data analysis was und...