Reducing Health Disparities in People with Disabilities through Improved Environmental Programmatic and Service Access

  • Date: Nov 09 2004
  • Policy Number: 20042

Key Words: Disabled Persons, Environment, Health Care, Quality

Recognizing that individuals with disabilities constitute a significant segment of the United States population; that the 2000 Census estimated 49.7 million persons in the United States, or nearly 20 percent of the population, are individuals with disabilities;1 that the population of people with disabilities is increasing among all age groups;2,3 that the disability experience includes a wide range of impairments and conditions, variability in functioning, and barriers to interacting with the social and built environments;4,5 and that public health definitions of disability should integrate medical, functional, and social dimensions such as the approach taken by the World Health Organization in its

International Classification of Functioning.6

Recognizing that people with disabilities as a group experience poorer health status than the general population.2,7-13

Recognizing that health status is dependent upon a number of factors including individual behaviors influenced by access to health promotion and preventive health services, environmental factors, access to primary care, increasing age, as well as social circumstance and genetics.14,15

Recognizing that health promotion and preventive health services are especially important to reduce health disparities; and that people with disabilities experience lower rates of preventative health services utilization such as blood pressure checks, cholesterol screening, and mammography,16,17 and lower rates of health behavior counseling around issues such as alcohol and substance abuse, diet and eating habits, regular physical exercise and smoking cessation;2,18 and that people with disabilities are more likely to smoke, be sedentary, and be obese than people without disabilities.9,19-21

Noting that the American Public Health Association has previously been concerned that people with disabilities have been denied access to health services and programs22,23 and that the American Public Health Association has adopted policies to ensure the accessibility of public health meetings.24

Noting that the Americans with Disabilities Act of 199025 requires that persons with disabilities be provided equal access -- both environmentally through the amelioration of physical barriers and programmatically by the elimination of attitudinal barriers or discriminatory policies -- to all services offered by state and local public health entities; that Section 504 of the Rehabilitation Act of 197326 forbids the exclusion of individuals with disabilities from participating in any program or activity conducted by any federal agency or entity receiving federal financial assistance; that the Architectural Barriers Act27 requires that buildings and facilities that are designed, constructed, or altered with federal funds, or leased by a federal agency, comply with federal standards for physical accessibility.

Noting that people with disabilities continue to report numerous barriers to accessing facilities and programs that provide health promotion and preventive health services,2 including inaccessible facilities, inaccessible examination tables, and a lack of materials in alternate formats such as Braille, large print, or cognitively apropriate language.19,28-30 

Recognizing that a number of promising environmental assessment instrument tools have been developed (e.g., the Craig Hospital Inventory of Environmental Factors and Craig Hospital Inventory of Environmental Factors-Short Form,31 Community Health Environment Checklist,32 Participation Survey of Mobility Limited People,33 and Facilitators and Barriers Survey for Mobility Limited People [D. Gray, PhD, Unpublished data, 2000]); promising methodologies (e.g., Community Action Guide34) and classification systems (e.g., International Classification of Functioning, Disability, and Health) which include consideration of environmental factors.6

Recognizing that the study of the environment and environmental health has expanded from only examining the impact of chemical, physical, and biological agents to include broader physical (i.e., structural) and social aspects,2,35 and that the concept of "environmental accessibility" includes all of these dimensions.

Recognizing that Healthy People 20102 states that federally funded surveys and surveillance instruments do not routinely include a standard set of questions that identify people with disabilities.

Acknowledging that accurate and complete information on the prevalence of disability and on the nature and extent of environmental barriers to health promotion and preventive health services for people with disabilities at the national as well as state and local levels is essential to the development of policies and programs to overcome these barriers.

Therefore, the American Public Health Association urges that:

  1. Federal financial support be given to the Centers for Disease Control and Prevention and other government agencies to conduct disability and environmental surveillance and research to quantify the impact of environmental barriers on the health status of persons with disabilities; 
  2. Standardized disability-related identifiers be included on all health status surveys through which sample size and design strategies will allow for valid measurement to facilitate disability and environmental surveillance and research
  3. Federal financial support be given for training students, current public health staff, and other professionals on the disease prevention and health promotion needs of people with disabilities; and that
  4. Federal, state, and local public health entities ensure that people with disabilities can receive public health programs and services by, for example, removing physical barriers such as steps or attitudinal barriers such as bias, providing materials in alternate formats such as large print, Braille or cognitively appropriate language, relocating services to accessible locations, or providing other auxiliary aides and services, and fully comply with the accessibility laws and regulations contained in the Americans with Disabilities Act, Architectural Barriers Act, and the Rehabilitation Act of 1973.


  1. U.S. Bureau of the Census. Census Data Brief: Disability Status: 2000. Washington, DC: U.S. Bureau of the Census; 2003. 
  2. U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. Washington, DC: Office of Disease Prevention and Health Promotion; 2001.
  3. U.S. Department of Health and Human Services, Administration on Aging. A profile of older Americans: 2002. Washington, DC: U.S. Department of Health and Human Services; 2003.
  4. Drum CE. The social construction of policy: implications for people with disabilities. J Disability Policy Stud 1998;9:125-150. 
  5. Humphrey JC. Researching disability politics, or, some problems with the social model in practice. Disability Soc 2000;15:63-85.
  6. World Health Organization. International classification of functioning, disability and health. Geneva, Switzerland: World Health Organization; 2001.
  7. Campbell ML, Sheets D, Strong PS. Secondary health conditions among middle-aged individuals with chronic physical disabilities: implications for unmet needs for services. Assistive Tech 1999;11:105-122.
  8. Drum CE, Horner-Johnson W, Krahn GL. Understanding the self-defined health status of people with disabilities. Paper presented at: Annual Meeting of the American Public Health Association, November 18, 2003; San Francisco, CA. 
  9. Jones GC, Bell, K. Health and employment among adults with disabilities. Data brief. Washington, DC: National Research Hospital Center for Health & Disability Research; 2003.
  10. Drum CE, Horner-Johnson W, Krahn GL, Culley C. Disparity, difference, and inequality: examining the health of people with disabilities. Paper presented at: Annual Meeting of the Association of University Centers for Excellence in Disabilities, October 30, 2002; Bethesda, MD.
  11. Turk MA, Scandale J, Rosenbaum PF, Weber RJ. The health of women with cerebral palsy. Phys Med Rehab Clinics North Am 2001;12:153-168.
  12. U.S. Bureau of the Census. Americans with Disabilities: Household Economic Status. Washington, DC: U.S. Bureau of the Census; 2001.
  13. Wilber N, Mitra M, Walker DK, Allen DA, Meyers AR, Tupper P. Disability as a public health issue: findings and reflections from the Massachusetts Survey of Secondary Conditions. Millbank Q 2003;80:393-421.
  14. Iezzoni LI, McCarthy EP, Davis RB, Siebens H. Mobility impairments and use of screening and preventive services. Am J Public Health. 2001;90:955-961. 
  15. McGinnis MJ, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Aff (Millwood) 2002;21:78-93.
  16. Iezzoni LI, McCarthy EP, David RB, Harris-David L, O’Day B. Use of screening and preventative services among women with disabilities. Am J Med Quality 2001;16:135-144.
  17. Nosek MA, Howland CA, Breast and cervical cancer screening among women with physical disabilities. Arch Phys Med Rehabil. 1997;78(suppl 5):S39-44.
  18. Krahn GL, Drum CE, Culley C, Sherry M. Health disparities and disabilities. Rehabilitation Research and Training Center on Health and Wellness for Persons with Long Term Disabilities. Oregon Health & Science University; 2003.
  19. Centers for Disease Control and Prevention. State-specific prevalence of obesity among adults with disabilities--eight states and the District of Columbia, 1998-1999. MMWR 2002;51:805-808.
  20. Horner-Johnson W, Drum CE, Krahn G. BRFSS health behaviors and outcomes project. Paper presented at: Annual Conference of the North American Federation of Adapted Physical Activity, September 27, 2002; Corvallis, OR. 
  21. Weil E, Wachterman M, McCarthy E, Davis R, Iezonni L, Wee C. Obesity among adults with disabling conditions. JAMA 2002;228:1265-1268.
  22. American Public Health Association. Public Policy Statement 9307: People With Disabilities in National Health Care Reform. Washington, DC: American Public Health Association, current volume.
  23. American Public Health Association. Public Policy Statement 8811: Discrimination Against the Disabled in the Health Care Field. Washington, DC: APHA, current volume.
  24. American Public Health Association. Public Policy Statement 2000-25: Eliminating Access Barriers in Public Health Meetings. Washington, DC: APHA, current volume. 
  25. Americans With Disabilities Act, 42 USC §12101 (1990).
  26. Rehabilitation Act, 29 USC 791 (1973).
  27. Architectural Barriers Act, 42 USC §4151 (1968).
  28. Cardinal BJ, Spaziani MD. ADA compliance and the accessibility of physical activity facilities in western Oregon. Am J Health Promot 2003;17:197-201
  29. Rimmer JH, Rubin SS, Braddock D. Barriers to exercise in African American women with physical disabilities. Arch Phys Med Rehabil 2000;81:182-188.
  30. Rimmer JH, Riley B, Wang E, Rauworth A, Jurkowski J. Physical activity participation among persons with disabilities: barriers and facilitators. Am J Prevent Med 2004;26:419-425.
  31. Craig Hospital Research Department. Craig Hospital inventory of environmental factors, version 3.0. Englewood, Colorado: Craig Hospital Research Department; April 2001.
  32. Gray DB, Morgan K, Sutter D, Deery K, Jurkowski E. Community Resource Index for Individuals with Mobility Limitations. Paper presented at: Annual Meeting of the American Public Health Association; November 11, 2002, Philadelphia, PA.
  33. Gray D, Gould M, Bickenbach JE. Environmental barriers and disability. J Archit Plann Res 2003;20:29-37.
  34. Drum CE, Goff T, Horner-Johnson W, Pobutsky A, Ritacco B, Weaver A. Community action guide: a process for improved community accessibility. Portland, OR: Oregon Health & Science University; 2002.
  35. World Health Organization. Indicators for Policy and Decision Making in Environmental Health. Geneva, Switzerland: World Health Organization; 1997.

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