Disability as a Public Health Issue

Glen W. White, Ph.D.

University of Kansas

APHA and Disability Awareness

From Chicago to San Francisco…

Public Health and Disability

• Public health has traditionally been primary prevention oriented (e.g., immunizations, vehicle safety belts).

• Those who develop disease or injuries (e.g., polio, SCI) often “fall through the cracks.”

• Today we have 54 million Americans with disabilities -- 54 million--oopses!

Significance of the Problem

• Medical technology and advances have increased rates of survivors with severe trauma or chronic conditions.

• Survivors face long rehabilitation, yet health care system capitation forces compressed treatment and recovery time.

• Public health can provide a positive contribution in the health of people with disabilities as they move from medical settings into community living.

Significance of the Problem• As of 9/30/03 there

were over 267,000 adults with disabilities living in nursing homes across the US who want to live more independently in the community.

Source: www.cms.hhs.gov/states/mdsreports/res2.asp

Significance of the Problem• Over 70% of adults

with disabilities are unemployed, compared to the typical unemployment rate for non-disabled persons of 6%.

• Source: N.O.D./Harris Survey of Americans with Disabilities, 2000; US Dept of Labor Bureau of Labor Statistics October, 2003.

HP 2010 Leading health indicators:• Physical Activity  • Overweight and Obesity  • Tobacco Use  • Substance Abuse  • Responsible Sexual Behavior  • Mental Health  • Injury and Violence  • Environmental Quality  • Immunization  • Access to Health Care 

HP 2010 Leading health indicators:• Physical Activity  • Overweight and Obesity  • Tobacco Use  • Substance Abuse  • Responsible Sexual Behavior  • Mental Health  • Injury and Violence  • Environmental Quality  • Immunization 

• Access to Health Care 

Reported by: VA Campbell, PhD, JE Crews, DPA, L Sinclair, MPH, Div of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, MMWR, September 13, 2002.

Getting Back to Work• Ticket to Work and

Work Incentives Improvement Act of 1999 (TWWIIA).

• Gives people with disabilities resources to return to work, or improve their existing work situation (i.e., part time to full time).

Getting Back to Work• TWWIIA ticket tracker

• As of 11/03/2003 over 5,626,633 “Tickets to Work” have been issues to people with disabilities across 34 states.

• Only 3,168 have used them with employment networks.

Source: http://www.ssa.gov/work/Ticket/ticket_info.html

Attacking the Problems

• Public Health Research

• Public Health Practice

• Public Health Education

Public Health Research

• People with disabilities have at greater health risks for health problems than those without disabilities.

• People with disabilities often have greater health disparities compared to non-disabled populations.

• CDC and other federal agencies are placing more attention on research to help increase positive health outcomes for the 54 million Americans with disabilities.

Public Health Research• More research needs

to address both person and environment factors and their relationships to health outcomes.

• Important progress is being made in the measurement of the environment and disability.

Person Factors

Environment F

actors

He

alt

h O

utc

om

es

Public Health Research

• The IOM report, Enabling America noted that the majority of federally funded disability research is focused on person factors (e.g., cure).

• Little public funding is being spent on environmental risk and protective factors that affect health outcomes for people with existing disabilities.

• CDC is one notable exception.

Public Health ScienceImportant milestonesHealthy People 2010 – Chapter 6

• 13 health objectives dealing specifically with people with disabilities and their health disparities.

• The cornerstone of this chapter is objective one whose outcome is that “disability status” be included as a demographic variable in all health-related surveys.

Public Health ScienceImportant milestonesInternational Classification of Functioning (ICF)

• The ICF is the public health complement to ICD. ICD classifies etiology to frame case definitions for primary prevention.

• ICF classifies human functioning for improved public health science and policy.

• ICF also allows classification and coding of environmental factors affecting human function.

Public Health Practice

• There needs to be better translation and “technology transfer” from the scientist to the PH practitioner—to improve specified public health outcomes.

• “Living Well With a Disability”

• Research needs to be both rigorous and relevant.

Public Health Practice

• All public health programs need to acknowledge the at-risk status of people with disabilities.

• This can be achieved by including people with disabilities in the planning and implementation of the 10 essential public health services.

• Like other minorities, people with disabilities bring a unique expertise to framing and implementing public health activities.

Disaster Planning and Disability• Among those people with disabilities employed full or

part time, 50% say no plans have been made to safely evacuate their workplace.

• 58% of people with disabilities do not know whom to contact about emergency plans in their community.

• A public health collaboration to address disaster planning and emergency response for people with disabilities is currently under way in 30 national FEMA declared disaster counties.

NOD/Harris Poll, November 2001

Public Health Education• More needs to be

done to address the topic of disability and health in overall public health training curricula.

• Universal approach – where disability and health is woven in to all curricula.

• Targeted approach– where specific disability and health courses are taught in schools of PH.

Public Health Education• Schools of Public Health

should affirmatively recruit and retain qualified students with disabilities into their programs.

• Schools of Public Health should establish working relationships with disability organizations as possible sites for student practica or internships.

TAKE HOME MESSAGES

• Increase visibility of people with disabilities in public health.

• Increase the full participation of people with disabilities in public health activities.

• Reduce health disparities among people with disabilities.

“To leave footprints in the sands of time… you must wear work shoes.”

Old African Proverb