Health Healthcare and Disability Status Essay

People with disabilities have largely been unrecognized as a population for public health attention, but recent efforts have made the poor health of this population visible.1 Adults with disabilities are 4 times more likely to report their health to be fair or poor than people with no disabilities (40.3% vs 9.9%).2 The core mission of public health, which is to improve the health of all populations,3,4 is increasingly framed in terms of health disparities or health inequities. Health Healthcare and Disability Status Essay.  Across the multiple definitions of health disparities and inequities,5–8 there is general agreement that health disparities refer to differences in health outcomes at the population level, that these differences are linked to a history of social, economic, or environmental disadvantages, and that these differences are regarded as avoidable.

The World Health Organization (WHO) differentiates avoidable and unjust health inequities from the broader category of health inequalities, which include both inequities and unavoidable differences. Comparable terms in the United States are health disparities, which refer to avoidable and unjust differentials, and health differences, which refer to avoidable and unavoidable causes. Within a disability context, determining disparities is complex, in that it requires considering which observed differences in health status are avoidable, and which may be unavoidable because they relate directly to the underlying health condition that led to the disability. In this article, we summarize the available evidence on health differences and disparities and recommend that people with disabilities be considered a health disparity population.

Race/ethnic health differences are recognized as inequities in health care and health outcomes, leading to recent concerted federal efforts to reduce these disparities.9 Similar recognition, however, has been lacking for disability-related health differences. Without such recognition and active measures to improve their health, people with disabilities are likely to be at risk for increasingly disparate health outcomes. As a consequence, public health will carry an unnecessary burden in poor health and high health care costs. We examine whether the disability population experiences health disparities by:

1. defining this population,

2. describing its history of discrimination and exclusion,

3. documenting the population-level differences in health outcomes,

4. demonstrating that at least some of these differences are preventable, and

5. recommending public health actions to reduce disability-related disparities. Health Healthcare and Disability Status Essay.

PEOPLE WITH DISABILITIES

Some people are born with a disabling condition (e.g., Down syndrome) or demonstrate a condition early in life (e.g., autism, bipolar disorder), whereas others acquire disabilities through injury (e.g., spinal cord injury) or a chronic condition (e.g., limb loss because of diabetes), and still others develop a disability in later stages of life (e.g., dementia, age-related mobility disability). The health needs of people with disabilities vary with the type of limitation (e.g., mobility or cognitive) and by the condition underlying the disability (e.g., spina bifida, Down syndrome). For some, such as people who acquire disability through injury, the nature of their disability can be differentiated more readily from their health status. For others, their health status may directly lead to their disability (e.g., diabetes leading to limb loss and vision loss). Race/ethnicity, age, language, sex or gender, poverty, and low education can compound the impact of disability, leading to even poorer health and quality of life.10,11 People with disabilities are a diverse group who share the experience of living with significant limitations in functioning and, as a result, often experience exclusion from full participation in their communities.

In 2001, the WHO published a framework that integrated previous models of disability. This framework, the International Classification of Functioning Disability and Health (ICF) for adults (2001) and for children and youth (2007),12,13 has been adopted internationally and is useful for many public health purposes. In the ICF framework, disability is used as an umbrella term to include bodily impairments, activity limitations, or participation restrictions that relate to a health condition. These limitations, which interact with personal and contextual factors of the environment, result in disability. That is, a disability results from the interaction of having a condition-based limitation and experiencing barriers in the environment. The environment includes not only the physical environment, but also social factors like culture, attitudes, economics, and policies that shape our life experiences. Environmental factors significantly affect health-related and functional outcomes, and can foster or impede good health and a high quality of life. Health Healthcare and Disability Status Essay.

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The ICF model is the most accepted model of disability in public health,14 but its adoption in the United States has been slow. This may be because the ICF is based on a model of social participation, and not on the medical model that is still predominant in the United States. Use of the ICF would require coding changes to billing and administrative systems that may not seem justified because of difficulties in applying ICF qualifiers in real-world situations, such as the clinical environment, and because of a lack of practical tools for its use. To address the latter problem, the WHO recently endorsed and released “How to Use the ICF: A Practical Manual for the ICF.”15 Two further developments are encouraging and may result in future adoption and adaptation of the ICF framework by different US federal agencies. First, on January 2, 2013, the US Social Security Administration, under federal register docket no. SSA-2012-007, published a notice to solicit collaboration from the public and federal agencies to evaluate the ICF for use by the Social Security Administration to assess disability and to capture data related to functioning.16 Second, on January 1, 2013, clinicians and administrators began a 6-month pilot test of Medicare’s mandated claims-based functional data collection. These new requirements apply to physical therapy, occupational therapy, and speech language pathology outpatient therapy services provided in any setting. This mandated functional status reporting system has associations with the ICF; general categories of functional impairment (G codes) that therapists can use to meet Centers for Medicaid and Medicare requirements are based on the ICF taxonomy and represent aspects of functioning addressed in rehabilitation therapies.17