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Disability and Health

Disability and Health

Goal

Maximize health, prevent chronic disease, improve social and environmental living conditions, and promote full community participation, choice, health equity, and quality of life among individuals with disabilities of all ages.

Overview

Individuals with disabilities represent 18.7% (about 56.7 million people) of the U.S. population.1 Disability is part of human existence, occurring at any point in life,2 with conditions ranging from mild to severe even among those with the same diagnosis. A diagnosis of impairment or disabling condition does not define individuals, their talents and abilities, or health behaviors and health status. Consistent with the World Health Organization’s (WHO) model of social determinants of health,3 Healthy People 2020 recognizes that what defines individuals with disabilities, their abilities, and their health outcomes more often depends on their community, including social and environmental circumstances. To be healthy, all  individuals with or without  disabilities must have opportunities to take part in meaningful daily activities that add to their growth, development, fulfillment, and community contribution. This principle is central to all objectives outlined in this topic area. Meeting the Disability and Health objectives over the decade will require that all public health programs develop and implement ways to include individuals with disabilities in program activities.

Why Is Disability and Health Important?

The first objective in this topic area, DH-1, is critical for understanding why disability and health is important. DH-1 calls for including measures of disability in all health data collection systems as well as analyzing and publishing the data in a standard demographic format to help monitor progress toward reducing health disparities and achieving health equity. Until recently, people with disabilities have been overlooked in public health surveys, data analyses, and health reports, making it difficult to raise awareness about their health status and existing disparities. Emerging data indicate that individuals with disabilities, as a group, experience health disparities in routine public health arenas such as health behaviors, clinical preventive services, and chronic conditions.4,5,6 Compared with individuals without disabilities, individuals with disabilities are: 

  • Less likely to receive recommended preventive health care services, such as routine teeth cleanings and cancer screenings
  • At a high risk for poor health outcomes such as obesity, hypertension, falls-related injuries, and mood disorders such as depression
  • More likely to engage in unhealthy behaviors that put their health at risk, such as cigarette smoking and inadequate physical activity 

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Understanding Disability and Health

There are many factors that determine or influence one’s health. Healthy People 2020 organizes the social determinants of health around 5 key domains: (1) Economic Stability, (2) Education, (3) Health and Health Care, (4) Neighborhood and Built Environment, and (5) Social and Community Context. Within each of these domains, compared to individuals without disabilities, individuals with disabilities are more likely to experience challenges finding a job,7 being included in regular educational classrooms or attending college, receiving preventive health care services, being able to visit homes in the neighborhood, using fitness facilities, using health information technology, and obtaining sufficient social-emotional support. 

To address these and other health determinants, the following WHO principles of action3 are recommended to achieve health equity among individuals with disabilities.

  1. Improving the conditions of daily life by:
    • Encouraging communities to be accessible so all can live in, move through, and interact with their environment
    • Encouraging community living
    • Removing barriers in the environment using both physical universal design concepts and operational policy shifts
  2. Addressing the inequitable distribution of resources among individuals with disabilities and those without disabilities by increasing:
    • Appropriate health care for individuals with disabilities
    • Education and work opportunities
    • Social participation
    • Access to needed technologies and assistive supports
  3. Expanding the knowledge base and raising awareness about determinants of health for individuals with disabilities by increasing:
    • The inclusion of individuals with disabilities in public health data collection efforts across the lifespan
    • The inclusion of individuals with disabilities in health promotion activities
    • The expansion of disability and health training opportunities for public health and health care professionals

Emerging Issues in Disability and Health

There are three critical emerging issues in disability and health:
  • The first is the need for better disability health data to inform policy and program development regarding critical issues of health disparities and health equity. A solution is to ensure that standard disability items are included in all public health surveillance instruments and that data is analyzed for individuals with disabilities where disability is in the data source.
  • The second is the need to increase the implementation of evidence-based health and wellness programs that have been demonstrated to be effective among people with disabilities in community settings, including adequate strategies for preparedness and response for individuals with disabilities. Related to this is the need to translate existing evidence-based interventions demonstrated to be effective in clinical settings for people with disabilities to community programs.  A solution is to add individuals with disabilities to community-based health promotion efforts where possible.
  • The third is the need to improve environmental designs and public infrastructure. Solutions include: 
    • Ensuring the accessibility of technology, health information technology tools and systems, broadly defined, for people with physical, sensory, and cognitive disabilities. This includes electronic health records and personal health records as well as wearable technologies and home monitoring systems.
    • Designing homes and community spaces that are fully accessible to individuals with disabilities.
    • Ensuring that professional degree programs offer coursework in disability and health.

References

1Brault MW. Americans with disabilities: 2010 [brief]. Current Populations Report, p70−131; 2012 Jul. Accessed from http://www.census.gov/prod/2012pubs/p70-131.pdf on 2015, Nov 2.

2World Health Organization (WHO). International classification of functioning, disability and health (ICF). Geneva, Switzerland: WHO; 2001.

3World Health Organization (WHO), Commission on Determinants of Health. Closing the gap in a generation: Health equity through action on the determinants of health. Final report. Geneva, Switzerland: WHO; 2008.

4Centers for Disease Control and Prevention. Disability and health data system [online database]. Atlanta, GA: author; 2010. Accessed from http://dhds.cdc.gov on 2015 Nov 2.

5Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. DATA2020 [Internet database]. Hyattsville, MD: author; 2010. Accessed from http://www.healthypeople.gov/2020/data-search/Search-the-Data on 2015 Nov 2.

6Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. DATA2010 [Internet database]. Hyattsville, MD: author; 2010. Accessed from http://wonder.cdc.gov/data2010/focus.htm on 2015 Sep 30.

7Institute on Disability. Annual Disability Statistics Compendium [online]. Durham, NH: University of New Hampshire. Accessed from http://www.disabilitycompendium.org/docs/default-source/2013-compendium/2013_compendium.pdf.

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