Health and Health Care Disparities

1. BACKGROUND INFORMATION

 

The summit explored ways in which health care professionals and health care facilities can overcome barriers to the best possible care for women with disabilities. It featured promising effective programs and new paradigms for approaching the health of women with disabilities that have helped improve access and, ultimately, quality of care including projects that focus on educating health care professionals

In a national telephone survey of 1,505 non–elderly adults with permanent physical and or mental disabilities, this study identified the healthcare experiences of non–elderly adults across a broad array of disability types and sources of health insurance.

This article presents the results of a series of focus groups with people with disabilities, in which researchers took a cross-disability, lifespan perspective of disability. Consumers were asked about a broad set of barriers, such as problems with communication, transportation, and insurance, as well as about barriers related to physical accessibility. Authors used the Institute of Medicine’s framework to categorize barriers as either structural, financial, or personal/cultural. Results suggest that individuals with disabilities experience multiple barriers to obtaining health care and that these barriers are more pronounced for some types of health care than others. In addition, regardless of disability type, consumers consistently spoke about similar barriers. The results underscore the importance of taking a broad perspective when making policy decisions and the need for continued change and improvement in this area.

In 2006, 37 million adults in the United States had trouble hearing (ranging from a little trouble to being deaf), representing a substantial increase since 2000 when 31.5 million U.S. adults reported trouble hearing. Self-reported trouble hearing is a measure of hearing loss that is defined as “the total or partial inability to hear sound in one or both ears.” The National Healthy People Objectives for 2010 include goals to reduce prevalence of hearing loss as well as goals to eliminate health disparities among persons with disabilities. Accommodations are needed for adults who do not hear well to ensure equal access to health services. Services mandated by the Americans with Disabilities Act have improved access for this group of Americans, but disparities in access to health care and health information remain. The goal of this report is to highlight disparities in health status and health risk behaviors of interest to the health community working to meet the needs of adults with hearing loss. Based on a nationally representative sample of U.S. adults, this report describes selected sociodemographic characteristics, health status and conditions, and health risk behavior characteristics of adults who were deaf or had a lot of trouble hearing and adults who had a little trouble hearing compared with adults with good hearing.

This report presents a national Blueprint to improve the health of persons with intellectual and developmental disabilities (IDD) (formerly known as mental retardation). The Blueprint identifies problems and solutions proposed by the community of people with IDD and those who care about their health. It consists of multiple action steps that were developed by work groups at the Surgeon General’s National Conference on Health Disparities and Mental Retardation, December 5-6, 2001, in Washington, DC. The action steps are organized under six broad goals that emerged from Conference discussions and analysis of work group recommendations.

ARTICLES

  • Michele Capella-McDonnall, “The Need for Health Promotion for Adults Who Are Visually Impaired,” Journal of Visual Impairment and Blindness 101, no. 3 (March 2007).

Health promotion interventions for adults who are visually impaired have received little attention. This article reports what is currently known about the health, overweight and obesity, and levels of physical activity reported by these adults. Conclusions about the need for health promotion activities based on this information are provided, and suggestions for implementing these activities or interventions are offered.

  • Gloria L. Krahn, Laura Hammond, and Anne Turner, “A Cascade of Disparities: Health and Health Care Access for People with Intellectual Disabilities,” Mental Retardation and Developmental Disabilities Research Reviews 12, no. 1 (2006), pp. 70–82.

This article presents recent conceptualizations that begin to disentangle health from disability, summarizes the literature from 1999 to 2005 in terms of the cascade of disparities, reviews intervention issues and promising practices, and provides recommendations for future action and research. The reconceptualization of health and disability examines health disparity in terms of the determinants of health (genetic, social circumstances, environment, individual behaviors, health care access) and types of health conditions (associated, comorbid, secondary). The literature is summarized in terms of a cascade of disparities experienced by people with ID, including a higher prevalence of adverse conditions, inadequate attention to care needs, inadequate focus on health promotion, and inadequate access to quality health care services.

  • Ellen P. McCarthy, Long H. Ngo, Richard G. Roetzheim, Thomas N. Chirikos, Donglin Li, Reed E. Drews, and Lisa I. Iezzoni, “Disparities in Breast Cancer Treatment and Survival for Women with Disabilities,” Annals of Internal Medicine 145, no. 9 (2006): 637-645.

Researchers used 2 large government databases to identify women who were receiving disability benefits when localized breast cancer was diagnosed. They then compared women with disabilities who received mastectomy and breast-conserving surgery with those without disabilities who underwent these surgeries. They also compared the women’s survival from the time of diagnosis on the basis of disability and type of treatment. Women with disabilities were less likely than those without disabilities to be treated with breast-conserving surgery. Women with disabilities also did not survive as long after breast cancer was diagnosed. The shorter survival was not explained by the difference in treatment.

  • Susan L. Parish and Jungwon Huh, “Health Care for Women with Disabilities: Population-Based Evidence of Disparities,” Health and Social Work 32, no. 1 (2006).

This study examined the health care of a national sample of 8,721 disabled and 45,522 non–disabled women living in the United States.  Findings indicate that despite having similar potential access to healthcare, women with disabilities experience worse health care and worse preventive care than non–disabled women.