“Disability is possibly the largest, silent health inequity of our time,” says Vinson Lee, a senior business analyst at McKinsey. Through the firm’s nonprofit fellowship program, Vinson has spent the past year, along with colleague Lena Galinson, working at The Missing Billion Initiative (MBI), an organization dedicated to improving health outcomes for people with disabilities.
Vinson has long worked to find solutions and advocate for disability. He was the first to do a rotational fellowship with Access McKinsey, the firm’s affinity group for people with disabilities, chronic illnesses, and mental health challenges, where he expanded the chapter network in 2022 from five offices to 25 offices, which has grown to 40 today. And Lena, through McKinsey’s social sector practice, has worked for the last three years on public health issues.
Globally, 1.3 billion people live with disabilities. On average, they face a 10–20-year reduction in life expectancy compared to those without. A 2023 joint report from MBI with McKinsey Health Institute on people with disabilities revealed alarming gaps. For instance, 63 countries are not collecting relevant data to understand the needs of people with disabilities. Issues such as mammograms being inaccessible for women using a wheelchair because the machine doesn’t lower remain commonplace.
MBI works to change this through research, policy partnerships, health worker training, and advocacy.
Most organizations on the front lines of disability advocacy don’t have the capacity to generate evidence like this,
Putting disability on the global health agenda
At its core, MBI is a “systems change catalyst,” says Lena. That means forging partnerships with global health organizations that may not view disability as part of their mandate.
Vinson helped build these bridges—sometimes unexpectedly. While checking into an event at the 2024 United Nations General Assembly, he struck up a conversation with the person in front of him, who turned out to be a board director from Women in Global Health (WGH), a nonprofit advocating for gender equity in healthcare with over 60 chapters globally.
Their impromptu exchange sparked a meaningful partnership. Together with Lena, they co-hosted a side event at the UN’s CSW69 conference on the leadership of women with disabilities. Later, MBI authored the first-ever global report on the state of healthcare for women with disabilities, launched at the Global Disability Health Summit in Berlin.
The report, led by Lena, delivered a sobering message: women with disabilities face profound health gaps from routine screenings to reproductive care. Worse, these disparities are often invisible—absent from major global women’s health strategies.
“Most organizations on the front lines of disability advocacy don’t have the capacity to generate evidence like this,” says Lena. “It was so gratifying to present this report and hear from people how meaningful it is to have a data document to use for advocacy.”
These insights reinforce research from the McKinsey Health Institute and World Economic Forum which found that globally, women live longer than men but spend 25 percent more time in poor health.
Training health workers in Kenya and beyond
Community healthcare workers—often the first point of contact in rural health systems—may lack the experience or confidence to treat patients with disabilities and may have been exposed to harmful myths, such as witchcraft or curses being causes of disability. For women, assumptions that disability makes them uninterested in relationships or motherhood lead to neglect in areas like family planning, STI testing, and reproductive health.
To help shift this narrative, Lena led the development of a base training curriculum for health workers. Drawing on research from the London School of Hygiene & Tropical Medicine, the team designed an open-source module adaptable across different care settings.
In Kenya, Lena worked with the Lwala Community Alliance to deliver this training to 400 community health workers.
After the training, “the community health workers reported a dramatic increase in their knowledge and confidence,” Lena says. “They said they now had the information to offer people with disabilities appropriate care and advocate for them.”
Fostering disability health collaboration
From the start, Vinson aimed to strengthen the global ecosystem for disability health. He regularly convened 20 leading global health organizations to share learnings, identify synergies, and spark new collaborations.
“Several of these leading health organizations were eager to act but couldn’t know what worked for others and how to push ahead—until these peer discussions brought it all together,” says Vinson.
Through the network, several organizations engaged with the World Health Organization (WHO), contributed to technical working groups, and influenced its policy approaches across sub-Saharan Africa.
The group also led to collaborations at international health forums, such as the World Health Assembly and World Health Summit, and led to a new a report on the state of disability health financing, co-developed with the Clinton Health Access Initiative and Special Olympics.
At the heart of MBI’s multi-pronged mission is a simple principle: health systems must be designed for everyone—by default, not exception.
“What we're advocating for,” Lena says, “isn’t separate or special programs—it’s for health systems that already exist to be inherently accessible from the start.”