Office on Disability
Access To Quality Health Services And Disability - A Companion To Chapter 1 Of Healthy People 2010
OFFICE ON DISABILITY
The Office on Disability (OD) was created by the Secretary of the U.S. Department of Health and Human Services in October 2002. The OD acts as the focal point for programs, policies, and initiatives designed to tear down barriers that prevent the 54 million Americans with disabilities from fully participating in an inclusive community life.
PURPOSE OF THE COMPANION DOCUMENT TO HEALTHY PEOPLE 2010
Eliminating health disparities is a key goal of Healthy People 2010. Persons with disabilities are represented in 207 of the 467 Healthy People 2010 objectives, and data on persons with disabilities are available for only 88 of these 207. Each companion document describes the particular challenges to health promotion and disease prevention affecting persons with disabilities in focus areas addressed in Healthy People 2010. The importance of including persons with disabilities in research is also stressed.
HEALTHY PEOPLE 2010 GOAL
Improve access to comprehensive, high-quality health care services.
“Health” has the same meaning for persons with and without disabilities. Disability itself is not an illness, and people living with disabling conditions can be healthy despite the disease or disorder causing the impairment. Being healthy includes having the knowledge and tools to promote wellness and prevent illness. With access to appropriate care to support their ongoing health and wellness needs, persons with disabilities can live long, healthy lives.
Why is access to quality health care important for persons with disabilities?
Healthy People 2010 emphasizes the importance of access to care in eliminating health disparities. In addition to issues of access that affect people regardless of disability status, persons with disabilities encounter unique challenges in accessing health care. For persons with disabilities, “accessibility” describes the usability of a product or service regardless of age, body dimension, or disability status.
Further, while at risk for the same ailments and conditions as people in the general population, persons with disabilities are also at specific risk for secondary conditions occurring as a result of the primary disabling condition that can damage their health status and the quality of their lives. Studies have shown that persons with disabilities can run a higher-than-average risk for such preventable chronic problems as osteoporosis, obesity, diabetes, and heart disease. A 2004 Centers for Disease Control and Prevention (CDC) study found that
- A substantially lower percentage of persons with disabilities than those without disabilities report their health to be excellent or very good (28.4% versus 61.4%).
- 87% of persons with disabilities reported experiencing a secondary medical condition.
- A substantially higher percentage of persons with disabilities experienced obesity, were current daily smokers, and were physically inactive than persons without disabilities.
Barriers to health care for persons with disabilities
Health care providers often focus on the disabling condition rather than on the health issues of concern to the individual. The disabling condition needs to be treated within the broader context of the individual, including other health care needs that may require medical attention. Some individuals with disabilities suggest that some doctors, under the misguided belief that the only acceptable outcome of treatment should be cure, distance themselves from their patients with disabilities because they represent failure.
Among non-elderly persons with disabilities, 25% reported that they had difficulty finding a doctor who “understands my disability”. In reality, many physicians lack the training to meet the full range of health care needs presented by an individual with particular disabling conditions, much less to evaluate and treat that individual in a culturally sensitive and competent manner.
Frequently, health care providers do not recognize persons with disabilities as knowledgeable partners in their own care or as experts in regards to their own conditions. Some individuals with disabilities are excluded from discussions of their health issues altogether, in much the same way as children are excluded from conversations between pediatricians and parents.
Significant data included in Healthy People 2010 suggest that persons with disabilities do not participate in wellness programs or health screening activities at the same level as do persons without disabilities.
- 68% of women over 40 years of age without disabilities have had a mammogram. Among women in that age group with disability, 54% have had a mamogram.
- The percentage of nonelderly adults with mobility limitations who receive preventive health services, including cholesterol screening and blood pressure checks, is considerably lower than that of persons without disabilities in the same age group.
Health care and wellness services are not accessible
Existing health care and wellness systems are not sufficiently responsive to the needs of persons with disabilities. As a result, access to education, prevention, screening, diagnosis, treatment, and wellness services can be limited, incomplete, or misdirected.
Because health care and health promotion providers often focus solely on a person’s disability rather than on the full range of health and wellness needs, they may fail to communicate health promotion messages that are given routinely to persons without disabilities. These topics include emotional health, diet, exercise, smoking, alcohol consumption, sleep, sexuality, and sunscreen use. This type of counseling is necessary to empower individuals to take steps to improve their health and wellness.
Health communication materials that target individuals with disabilities are scant. Materials that do exist are often inaccessible to persons with disabilities.
- Health promotion materials may be written at too high a reading level for a person with an intellectual disability. According to the Center of Disease Control National Prevention Information Network and the World Bank Organization, the global literacy rate for adults with disability is as low as 3%. For women with disability, the global literacy rate may be as low as 1%.
- Materials also might be unavailable in formats accessible to persons with visual impairments (e.g., Braille or interactive technology).
- Health promotion literature, videos, presentations, and materials found in print media, on television, and on the World Wide Web primarily show images of persons without disabilities engaging in healthy behaviors.
- Health care and wellness providers might not know how to educate persons who have disabilities that compromise mobility, vision, sensation, or cognition about how best to perform breast self-examinations, self-assessments for skin cancer, or identify other signs of disease.
Clinics and services are often inaccessible to those with physical disabilities. More than discomfort, the result might well be an incomplete, potentially inaccurate, examination.
- Transportation issues and sheer distance complicate access to health care centers for persons with disabilities.
- Once at a health care facility, other potential physical barriers arise. Frequently, treatment centers do not have adaptive equipment that can meet the needs of individuals with disabilities, including changing rooms with narrow doorways, examination tables too high or too flat for comfort, and inaccessible mammography machines.
- Cultural insensitivity by health care and health promotion providers may prevent persons with disabilities from seeking education and preventive care.
- Effective communication may be frustrated as a result of limited availability of assistive supports, such as interpreters for persons who are deaf or hard of hearing.
- Achieving optimal health is a goal for everyone. Health disparities exist for persons with disabilities, in part due to insufficient information about and available services for wellness promotion.
- Persons with disabilities, as all persons seeking health care and wellness services, benefit from access to care providers who have the knowledge and skills to address the full range of their health concerns, including their special needs.
- Persons with disabilities need access to health promotion materials that are culturally sensitive, linguistically accessible, and inclusive in order to meet their education and prevention needs.
- Persons with disabilities should be included in research and data statistics.
To Learn More…
Agency for Healthcare Research and Quality
Centers for Disease Control and Prevention
The National Institute on Disability and Rehabilitation Research
Unless otherwise stated, all data is drawn from
The Surgeon General’s Call to Action to Improve the Health and Wellness of Persons
with Disabilities, 2005. http://www.surgeongeneral.gov/library/disabilities/