Health Disparities in Persons With Disabilities

Persons With Disabilities: An Unrecognized Health Disparity Population

• This presentation highlights the significant health disparities experienced by people with disabilities.
• The WHO defines disability as impairments, activity limitations, or participation restrictions related to a health condition.
• The social model emphasizes the interaction of having a health condition limitation with environmental barriers.
• Environmental factors encompass physical, social, attitudinal, and policy barriers impacting health and quality of life.

Prevalence of Disability

• 12.5% of US adults report having a disability according to HHS standards.
• 46% of US adults report mobility disability.
• 39% report cognitive limitations.
• 43% report multiple limitations.

Disability Across the Life Course

• Some disabilities are present from birth (e.g., Down syndrome, autism).
• Others develop in adulthood through injury or chronic conditions (e.g., spinal cord injury, diabetes-related limb loss).
• Many disabilities emerge in later life (e.g., dementia, age-related mobility).

Historic Disadvantage

• Historically, individuals with disabilities were often institutionalized.
• Mid-20th century saw media exposure of poor conditions in institutions leading to closures and advocacy for deinstitutionalization.
• 1960s-1970s witnessed advocacy for deinstitutionalization and community integration.
• 1990-present saw legislation like the ADA promoting equality.

Key Legislation and Programs

• The 1935 Social Security Act, Title V, provided resources for children with crippling conditions.
• The 1973 Rehabilitation Act, Section 504, was a landmark piece of federal legislation.
• The 1990 Americans with Disabilities Act (ADA) declared equality for people with disabilities.
• The 1999 Olmstead decision upheld the right for people with disabilities to live in integrated settings.

Health Disparities: Access to Care

• Adults with disabilities are 2.5 times more likely to skip or delay healthcare due to cost.
• Women with mobility limitations are less likely to be current with mammograms and Pap tests.
• People with cognitive limitations may receive less adequate management care.

Health Disparities: Chronic Conditions

• People with disabilities face higher rates of cardiovascular disease (3-4x compared to the general population).
• Individuals with cognitive limitations are up to 5 times more likely to have diabetes.
• Obesity rates are higher in adults with disabilities (44.6%) compared to those without (34.2%).

Health Disparities: Mental Health and Violence

• People with disabilities experience higher rates of depression and anxiety.
• They are less likely to report getting adequate social and emotional support.
• They are 1.5 times more likely to be victims of non-fatal violent crimes.
• There is a significantly increased risk of intimate partner violence for both men and women with disabilities.

Health Disparities: Injury Risk

• Disability status is a major factor in unintentional injury risk, exceeding those based on age, sex, race, or education
• Children and adults with disabilities have a higher risk of injury.
• Risk is influenced by a combination of disability type, environmental factors, and social determinants.

Emergency Preparedness Concerns

• 38% of people who did not evacuate Hurricane Katrina had mobility disabilities or were care providers for others with disabilities.
• People with disabilities are vulnerable during emergencies and disasters due to inadequate planning and lack of data on emergency planning.

Health Insurance Coverage

• Rates of insurance coverage are generally comparable between disability and non-disability populations.
• Less than 50% of people with complex limitations have private insurance compared to 75% of those without disabilities.
• 28% of people with emotional disabilities are uninsured.

Social Determinants of Health

• 13% of adults with disabilities lack a high school education vs 9.5% of those without.
• Employment rate for adults with disabilities is 17.8% vs 63.6% without.
• 34% of households with disabilities have income under $15,000 vs 15% without.
• 34% of people with disabilities report inadequate transportation compared to 16% without.

Barriers to Healthcare Access

• Inaccessible medical equipment (weight scales, examination tables) is a significant problem in healthcare facilities.
• Fewer than half of primary care facilities for Medicaid patients are architecturally accessible.
• Lack of sign language interpreters or alternative communication methods creates communication barriers.

Preventable Health Inequalities

• Lower rates of mammograms and other screenings in people with disabilities.
• Higher rates of obesity in children with disabilities suggest early onset of health problems.
• Higher smoking rates among young and middle-aged people with disabilities.
• Higher cancer rates and more advanced stages are common among people with disabilities.

Recognizing Disability as a Health Disparity Population

• A long history of discrimination and exclusion has created lasting disparities.
• Documented differences in health outcomes are apparent at the population level.
• Many health differences disproportionately affect people with disabilities.
• Significant disparities in education, employment, and income affect this population.

Economic Impact of Disability-Related Health Disparities

• Estimated annual health expenditures for disabilities are $400 billion.
• Public programs cover about 70% of disability-related health costs.
• Estimated annual public spending on disability-related health care is $280 billion.

Affordable Care Act: Key Provisions for Disability

• The ACA prohibits denial of coverage based on pre-existing conditions.
• Lifetime caps on benefits have been eliminated.
• Medicaid coverage has been expanded.
• Disability status is now collected in national health surveys.

Improving Access to Health Care and Human Services

• Implementing standards for accessible medical equipment is critical.
• Close monitoring of ADA and ACA compliance is essential.
• Assessing accessibility of facilities and equipment is crucial to ensuring inclusivity.
• Providers should offer resources to assist people with disabilities in finding suitable facilities.

Inclusion in Public Health Programs and Emergency Preparedness

• People with disabilities should be included in mainstream health programs.
• Interventions should address unique needs.
• Improved system-level responsiveness and individual-level planning are essential in emergencies.

Conclusion: A Call to Action

• Acknowledging disabilities as a health disparity is crucial for improving public health.
• Research, policy changes, and actions are essential to address the disparity.

This presentation sheds light on the health disparities faced by people with disabilities, emphasizing the importance of recognizing their unique challenges. It discusses the prevalence of various disabilities and the impact of environmental factors on health and quality of life. Understanding these disparities is crucial for improving health outcomes and access to care.