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Journal of General Psychology, 2 , Weigel, D. Journal of Adolescent Research, 13 2 , PI with Kristen Clements-Nolle. Co-PI with Charles Bullock. School of Community Health Sciences. The implications of recognizing individuals with disabilities as a health disparity population are presented in 5 areas: improved access to health care and human services,. The disparities in unmet health care needs of people with disabilities stand as a stark reminder of the work that must be done to improve access to care.
Health reform, through the ACA, 65 holds special importance for people with disabilities through a number of key provisions. Despite passage of the ADA more than 20 years ago, health facilities and services often are not fully accessible. National data are not available, but a recent survey of almost primary care facilities serving Medicaid patients in California noted that fewer than half of facilities were fully architecturally accessible; only 8.
As a result, many people with disabilities do not receive complete medical examinations because equipment such as weight scales, examining tables, and mammography equipment do not accommodate their disability. In late , the Architectural and Transportation Barriers Compliance Board Access Board released much-anticipated standards to define accessibility of medical equipment to be used on a voluntary basis.
Disparities in accessing health care and clinical preventive services can be reduced by implementing the standards for accessible equipment and close monitoring of ADA and ACA compliance. Several measures have been developed recently to assess accessibility of health care facilities, 68—71 but, to date, no requirements have called for the systematic collection of data on accessibility of facilities or medical equipment. By implementing the standardized disability identifiers across surveys, public health will be able to use existing data sets to compare health outcomes and health differences across multiple data systems, and to disaggregate disability into different functional categories e.
The resulting advance in scientific capacity and innovation in disabilities research should greatly improve knowledge of health outcomes, causes of health differences and disparities, and effectiveness of interventions. The next important step would be for public health researchers to routinely analyze their data by disability status to determine when disability is important as a demographic characteristic variable for the focus of their study. These data could provide health systems and professionals the much-needed information about where to focus to improve the health of people with disabilities across the life span.
Increasing the amount and coordination of disability research and routinely including people with disabilities in general health research will help close the knowledge gap on effective interventions. The Interagency Committee on Disability Research was established by Congress in to promote coordination, collaboration, and information sharing among federal agencies and stakeholders on disability and rehabilitation research. In , the Interagency Committee on Disability Research established a Federal Collaboration on Health Disparities Research Workgroup, which can provide critical leadership for active collaboration across agencies in planning health disparities research, including funding, monitoring, and dissemination of findings.
Every major report addressing the poor health of people with disabilities has called for improvements in training of health care providers about adults with disabilities. The Institute of Medicine 19 reported that health professionals are poorly prepared to meet the complex medical and psychosocial needs of people with disabilities.
However, disability competency is not currently a core curriculum requirement for medical school accreditation or for receipt of federal funding. Training can be improved at several levels: 1 basic disability awareness for all public health workers and clinical care providers, 2 discipline-specific training on select aspects of disability, and 3 a needed infrastructure for core leadership training of health professionals in disabilities that addresses the full life span. A foundation of knowledge on disability and public health has been emerging, 73,74 which lends itself to training an array of health and public health professionals.
Healthy People includes a disability and health objective that calls for increasing the number of public health programs with a course on disability. If implemented, these actions could build the foundation for a multitiered process to increase disability awareness in the clinical and public health workforce and develop the needed infrastructure and direction for future development of workforce leadership in disability competence. People with disabilities are often excluded from participation in mainstream public health programs and services. This resulted from many disadvantages, including historic segregation and isolation, explicit exclusion in developing the evidence base for interventions, provider discomfort in working with people with disabilities, and inadvertent exclusion by not recruiting for this population and not accommodating for their vision, hearing, mobility, or cognitive limitations.
Inclusion into effective mainstream health practices is a powerful tool for improving the health of people with disabilities. Some federal agencies, notably the National Institute on Disability and Rehabilitation Research within Department of Education , the Agency for Healthcare Research and Quality, and most recently, the Centers for Disease Control and Prevention, have initiated efforts that promote the explicit inclusion of people with disabilities in research and programs.
During times of emergency or in disaster situations, people with disabilities are less likely to be evacuated and can be especially vulnerable. Emergency preparedness means planning for the different phases of multiple disaster scenarios that could be natural or man-made. It involves system-level responsiveness that assures that people with disabilities and their support systems are included in all phases of preparedness, evacuation, and recovery within communities, including adaptive strategies for in-place and shelter accommodations on a community-wide scale.
It also requires individual-level planning and training in advance of, during, and following events. Public health faces a critical opportunity to improve the health of the public and achieve equity in health status for all people—the opportunity and responsibility to promote health equity for people with disabilities. This sizable population has generally been unrecognized as a health disparity population. Importantly, people with disabilities are over-represented in many target populations for public health intervention—from smoking to obesity to injury prevention—yet their presence in these target groups is not recognized nor accommodated.
As a group, people with disabilities experience more chronic diseases and conditions, and experience them at earlier ages, making this a critically important population to include to achieve success in health promotion campaigns. Federal and state agencies and national and state public health organizations can recognize people with disabilities as a health disparity population and address these disparities.
Proposed actions include improved access to health care and human services, collection and routine use of disability data for decision-making, strengthened health and human services workforce capacity, explicit inclusion of people with disabilities in public health programs, and improved preparation and coordination for emergencies.
By decreasing the disparities of people with disabilities, these actions can support public health in improving the health of all people in the United States. We are deeply indebted to the encouragement of Assistant Secretary for Health Howard Koh in the preparation of this article, and are grateful to Danice Eaton of the Centers for Disease Control and Prevention for analysis of the Healthy People data presented in Table 1.
Human participation protection was not required because human participants were not used specifically for the work reported in this article. PMID: Affiliation Gloria L. CopyRight Correspondence should be sent to Gloria L. Krahn Oregonstate.
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We examine whether the disability population experiences health disparities by: defining this population, describing its history of discrimination and exclusion, documenting the population-level differences in health outcomes, demonstrating that at least some of these differences are preventable, and recommending public health actions to reduce disability-related disparities. Defining Disability for Public Health Surveillance. Inequalities in Preparedness and Health Insurance. Acknowledgments We are deeply indebted to the encouragement of Assistant Secretary for Health Howard Koh in the preparation of this article, and are grateful to Danice Eaton of the Centers for Disease Control and Prevention for analysis of the Healthy People data presented in Table 1.
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