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Executive Summary
Disability affects people of every race, culture, age and economic class, with subsets of chronic disabling conditions affecting different populations at different rates. Yet people with disabilities are perhaps the largest underserved population in the United States experiencing health care disparities resulting from preventable secondary conditions. Such disparities include a higher prevalence of poor physical and mental health status within the disability population when compared to the non-disabled population. As this report will show, these disparities do not necessarily result from the presence of disability.
One cause of health disparities affecting people with disabilities has been a lack of awareness and responsiveness to preventable secondary conditions in the population by clinical and public health professionals. Fortunately however, positive changes are taking place. Once viewed solely as a "medical" issue, disability is today recognized as also being a social phenomenon. New paradigms conceptualize disability as resulting from "an interaction between multiple characteristics of the individual…and characteristics of the natural, built, cultural and social environments." 1 Government and public health entities are now working proactively with disability advocates to formulate policies and undertake initiatives that reflect these new models of disability to address the health disparities affecting people with disabilities.
In 2000, the U.S. Department of Health and Human Services created an ambitious set of national health goals for this decade. People with disabilities are represented in 207 of the 467 objectives of Healthy People 2010. One of these goals is to promote the health of people with disabilities, prevent secondary conditions, and eliminate disparities between people with and without disabilities in the U.S. population." 2
In 2002 the National Center for Disparity Research requested all states to:
Reduce health disparities for people with disabilities.
Include disability as an integral component of disparity reform.
In 2005, the Surgeon General released "A Call to Action to Improve the Health and Wellness of Persons with Disabilities," a report on the need to address healthcare disparities in the disability community.
The increased emphasis on decreasing disparities in the disability population and reducing secondary conditions is also not surprising when one considers that as a group, people with disabilities are:
The poorest, most under-educated and most vulnerable members of society.
The costliest population in terms of healthcare dollars. Adults with annual household incomes of less than $25,000 (44%) were more likely to report having a disability than adults with an annual household income of $25,000 or more. 3
In many ways, the least understood population in society. The 2003 National Healthcare Disparities Report states, "We are only beginning to understand the magnitude of differential burden of illness in populations with special healthcare needs." 4
A snapshot of healthcare indicators shown in greater detail in this paper reveals that:
Nationally, adults with disabilities have:
- Significantly lower self-reported health status:
- 33% of people with disabilities rate their health as either excellent or very good, compared to a sizeable majority,
- 62%, of people with no disability.
- 31% rank their health as fair or poor, compared to 7% of people without a disability.
Increased disease rates:
- 400% elevated risk of developing diabetes.
- 4.6% of deaf people infected with HIV/AIDS-four times that of the African American population, the most at-risk racial group.
- Three times more likely to commit suicide.
Higher incidences of unhealthy behaviors:
- 66.2% are overweight or obese, a 20% increase over the general population.
- 37% have not exercised in the past month, a 60% increase above the general population.
- 40% are more likely to be cigarette smokers than the general population.
- 200% to 400% are more likely to be substance abusers (50% of those with traumatic brain or spinal cord injuries are substance abusers).
- 31% of people with disabilities report fair or poor health in comparison to 6% of the general population.
- 15% of people with disabilities report not seeing a doctor due to cost in comparison to 6% the general population.7
- 24% of people with disabilities report being current smokers in comparison to 17% of the general population. 8
In Massachusetts people with disabilities comprise 22% of the state's residents, an increase from 14% in 1998.5
Disparities statewide include:
- 31% of people with disabilities report fair or poor health in comparison to 6% of the general population.6
- 15% of people with disabilities report not seeing a doctor due to cost in comparison to 6% the general population.7
- 24% of people with disabilities report being current smokers in comparison to 17% of the general population. 8
Barriers to healthcare voiced by people with disabilities in Massachusetts include:
- Attitudinal
- Physical, communication and cost.
- Lack of information targeting the needs of people with disabilities.
- Misinformation.
- Lack of early intervention.
Reducing healthcare disparities and secondary conditions within such a complex population requires leadership in the development and implementation of effective:
- Preventive care.
- Primary care.
- Health promotion.
To be effective, public health officials and primary care providers must:
- Adapt a lifespan approach to disability, recognizing disability as a fluid aspect of the human experience
- Use a common language to assess health status, and improve data collection and communication between different stakeholders seeking to decrease healthcare disparities affecting people with disabilities.
- Address the health status of people with disabilities beyond their disabling condition. (continued)
- Embrace a philosophy that recognizes participation and inclusion in society as critical to the personal health of people with disabilities.
- Decrease environmental barriers to the personal activity of people with disabilities
- Partner with grassroots disability advocacy organizations to increase the capacity of healthcare entities to address the health access needs of people with disabilities.
Immediate steps needed to decrease healthcare disparities and secondary conditions include but are not limited to:
- Passage of legislation at the state level that supports inclusion of people with disabilities in committees, conferences and other health policy decision-making bodies.
- Addressing problematic policies, practices and procedures in the Commonwealth Connector.
- Partnering with advocacy groups with the cultural competency to help shape public health initiatives.
Note: The full report may be downloaded from the Publications menu of the DPC website, www.dpcma.org.
The direct link is http://www.dpcma.org/Publications/tabid/423/Default.aspx
Disability Policy Consortium
March 2009