Disability and Health

Goal

Promote the health and well-being of people with disabilities.

Overview

This section of Healthy People 2020 focuses on promoting the health and well-being of people with disabilities. The U.S. Census 2000 counted 49.7 million people with some type of long-lasting condition or disability.1 An individual can get a disabling impairment or chronic condition at any point in life. Disability is part of human life, and an impairment or condition does not define individuals, their health, or their talents and abilities.

People with disabilities play an important and valued role in every community. All people, including people with disabilities, must have the opportunity to take part in important daily activities that add to a person’s growth, development, fulfillment, and community contribution. This principle is central to all objectives outlined in this topic.

The Disability and Health objectives highlight areas for improvement and opportunities for people with disabilities to:

• Be included in public health activities.
• Receive well-timed interventions and services.
• Interact with their environment without barriers.
• Participate in everyday life activities.

Without these opportunities, people with disabilities will continue to experience health disparities, compared to the general population. The 2020 objectives were developed with extensive input from disability communities, and this partnership between the public health and disability communities must continue over the decade in order to meet the Healthy People 2020 objectives.

Why Is Disability and Health Important?

The largest set of U.S. health data for people with disabilities, DATA2010, measures health at the population level.2 These data highlight improvements in health over the previous decade and clearly reveal specific health disparities for people with disabilities. Compared with people without disabilities, people with disabilities are more likely to:

• Experience difficulties or delays in getting the health care they need.
• Not have had an annual dental visit.
• Not have had a mammogram in past 2 years.
• Not have had a Pap test within the past 3 years.
• Not engage in fitness activities.
• Use tobacco.
• Be overweight or obese.
• Have high blood pressure.
• Experience symptoms of psychological distress.
• Receive less social-emotional support.
• Have lower employment rates.

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Understanding Disability and Health

Public health efforts, from the individual to the national level, can affect the health and well-being of people with disabilities. These efforts must respond to known determinants of disability and health.

There are many social and physical factors that influence the health of people with disabilities. The following 3 areas for public health action have been identified, using the International Classification of Functioning, Disability, and Health (ICF)3 and the 3 World Health Organization (WHO) principles of action for addressing health determinants.4

1. Improve 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. Address the inequitable distribution of resources among people with disabilities and those without disabilities by increasing:

• Appropriate health care for people with disabilities
• Education and work opportunities
• Social participation
• Access to needed technologies and assistive supports

3. Expand the knowledge base and raise awareness about determinants of health for people with disabilities by increasing:
• The inclusion of people with disabilities in public health data collection efforts across the lifespan
• The inclusion of people 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 several emerging issues related to disability and health, including the need to:

• Include disability and health courses.
• Assess drug and alcohol abuse and their treatment among people with disabilities.
• Include and improve strategies for emergency preparedness and response for people with disabilities.
• Include people with disabilities in all health promotion efforts.

Removing Barriers to Participation (Organizations)

• Center for Universal Design, North Carolina
• National Center on Accessibility, Indiana
• Center for Inclusive Design and Environmental Access, New York
• Access Board, Washington, DC
• U.S. Department of Justice, Washington, DC

Including People With Disabilities in Community and Health Promotion Activities (Publications)

• Fair Housing Act Design Manual (1998)
• Removing Barriers to Health Clubs and Fitness Facilities (1999)
• Access Board ADA Guidelines for Recreation Facilities (2002)
• Access Board Guidelines on Play Areas (2005)
• Making Conferences & Events Accessible to People Who Are Blind (2000)
• Involving People With Disabilities as Members of Advisory Groups: Rural Practice Guidelines

Equipping Service Settings/Providing Appropriate Services

• Removing Barriers to Health Care: A Guide for Health Professionals (1998)
• Dental Services for Children With Special Health Care Needs: Treatment Guidelines and Medicaid Reimbursement Options (2004)
• Oral Health Care For Children With Special Health Care Needs: A Guide for Family Members/Caregivers and Dental Providers (2008)
• Preventative Women’s Health Care for Women With Disabilities, Australia
• A Provider's Guide for the Care of Women With Physical Disabilities and Chronic Medical Conditions by North Carolina (1999)
• Guidelines for the Use of Assistive Technology: Evaluation, Referral, Prescription, 2nd edition (1996)

References

1Waldrop J, Stern SM. Disability status: 2000 [Census 2000 brief]. Washington: U.S. Department of Commerce, Census Bureau; 2003 Mar.

2Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. DATA 2010 [Internet database]. Hyattsville, MD: CDC; 2010 [cited 2010 Sep 30]. Available from: http://wonder.cdc.gov/data2010/focus.htm

3World Health Organization (WHO). International classification of functioning, disability and health (ICF). Geneva, Switzerland: WHO; 2001.

4World 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.

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