"Improving the Health of People with Disabilities Through Inclusion in Broad Public Health Interventions"

Vincent A. Campbell, Ph.D.

Various pyramidal models have been proposed to demonstrate the likely population impact of health interventions and health care (e.g., United States Public Health Service, 1994; Hamilton & Bhatti, 1996; Grizzell, 2007; Frieden, 2010).  Generally, these models suggest that broad population-oriented public health activities cover the largest proportion of the public, and form the lower levels of the pyramid, and that individually-oriented clinical activities cover the smallest proportion, which form the upper portion of the pyramid.  Interventions toward the lower levels in these models have been proposed as more effective as they have broader reach through contextual changes that alter social, economic, and psychological factors that bear on health and depend less on individual effort (Frieden, 2010).

Many of the interventions and health promotions that have been developed for people with disabilities are clinical in nature or involve counseling and education, which are toward the upper portion of the Frieden pyramid.  As a result, they are subject to individual access, adherence, and lack of availability.  These services are paid for out of pocket, a service provider, or third party payer.  Payment by third party payers is dependent on demonstration of a threshold of effectiveness.   

This presentation will discuss prevention activities and health promotions targeted at people with disabilities and consider the impact of these interventions with regard to reach (number of people enrolled on an annual basis), immediate and long-term health outcomes, and costs.  The presentation will include a discussion of evidence-based interventions under a CDC cooperative agreement.  Consideration will be given to difficulties involved in taking promising interventions to population scale in a manner that results in cost effective health outcomes. Consideration will also be given to promoting a policy of inclusion of people with disabilities into mainstream public health promotion and prevention services.     

Frieden TR.  A framework for public health action: The health impact pyramid.  Am. J. Public Health.  100(4):590-595, 2010

Grizzell J.  High reach/low cost health agenda programming.  Pomona CA:  California State Polytechnic University,2007.  Available at: http://www.csupomona.edu/~jvgrizzell/healthagenda/ Accessed August 16, 2010.

Hamilton N, Bhatti T.  Population health promotion: An integrated model of population health and health promotion.  Ottawa:  Health Canada, Health Promotion Development Division,; 1996.

United States Public Health Service.  For a healthy nation:  Return on investments in public health.  Hyattsville MD:  US Public Health Service, 1994.