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Tufts Public Health » Disabilities, Disparities, Prevention » Disability and health disparities: The evolving role of public health

Disability and health disparities: The evolving role of public health

Historically, the role of public health has focused on prevention of disabilities. For example, the Centers for Disease Control promotes the use of folic acid in pregnant women and those who are trying to become pregnant to reduce the risks associated with the underdevelopment of a fetus’s brain and spinal cord. It also urges people to protect themselves and their families from traumatic brain injury through the use of helmets during sports and seatbelts in cars.

Despite these efforts, as an article in Public Health Reports points out, people still are born with or develop disabilities. Therefore, it is important for public health professionals to focus on the needs and well-being of people living with disabilities, and to make research efforts and interventions accessible to this population.

Definitions of “disability” vary widely and have changed a great deal over time. “Early medical models viewed disability as a defect to be remediated or prevented,” writes Katherine McDonald, PhD and Dora Raymaker, MS. “More recent models advance disability as a limitation in function.” They say, “Social models frame disability as something [created by] barriers embedded in social, political, and built environments.” For example, imagine that a person who uses a wheelchair has available in their neighborhood appropriately designed houses, buses, and places of business. While their physical status may be the same, that person’s ability to carry out daily activities is different than a person surrounded by facilities without features such as elevators, ramps, and accessible restrooms.

These concepts are not brand new. For example, the International Classification of Functioning, Disability and Health (ICF), established by the World Health Organization in 2001, incorporates the social model of disability, emphasizing the joint impact of conditions and environmental obstacles. However, the United States does not regularly use the ICF definition. For example, benefits such as Social Security Disability Insurance define disability narrowly and negatively as “inability to engage in any substantial gainful activity” due to a chronic or terminal condition. The Americans with Disabilities Act uses a broader definition that still focuses on functional limitations such as “a physical or mental impairment that substantially limit one or more major life activities.”

In defining people with disabilities as lacking, the field of public health has often failed to serve this population’s health needs. In fact, people with disabilities can be seen as a minority population that experiences health disparities, explains an article in the American Journal of Public Health. People with disabilities tend to have poorer health outcomes, including “higher rates of obesity, lack of physical activity, and smoking.” These individuals face a greater risk for injury and violence. They also tend to have limited social and economic opportunities – the social determinants that play a key role in health. For example, 34% of adults with disabilities (compared with 15% of adults without disabilities) live in a household with an annual income of less than $15,000. According to the same article, people with disabilities are “2.5 times more likely to report skipping or delaying health care because of cost.”

Public health practitioners are exploring ways to design programs, interventions, and research to better suit the needs of people with disabilities. There are some parallels to the disadvantages faced by other populations that experience health disparities. Healthcare providers may lack adequate training about effective ways to provide care for people with disabilities; for example, they may neglect to offer preventive services. Without input from the community, researchers may fail to address the health concerns and priorities of people with disabilities. In addition, people with disabilities may hesitate to engage in research due to a history of mistreatment and abuse by scientific professionals.

Kathryn Hayward, MPH, PhD, notes, “While prevention is not an unworthy effort…public health campaigns have alienated people with disabilities.” Hayward offers the example of an advertisement displaying the symbol for “disabled parking” and the words “Drink and drive and you could have the choicest parking spot in school. But who cares? You’ll lose your spot on the football team. The marching band. The prom dance floor…” Hayward, who has a disability, says, “Upon reading about such public health campaigns I felt my own sense of conflict. What was I doing in a field that promoted prevention of someone like me?”

Moving forward, public health efforts ranging from interventions to conferences to community participation in research must actively work to include people with disabilities. One place to begin is learning about ways to make public health efforts accessible for people with a variety of needs, such as arranging for an adequate amount of seating, American Sign Language interpretation, or sound systems that are monitored to avoid sensory overload. For more information, including resources for making research and community events more inclusive, visit:

 

by Cayla Saret, MPH Candidate ’17

Filed under: Disabilities, Disparities, Prevention

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