W3 Journal
Students will be expected to write and submit weekly journal entries throughout the semester, in which they reflect on disability issues that we will address during the course. In these reflective entries, students select a disability issue and elaborate on how their own experiences, discussions, the course readings, and current events relate to this issue. Through the journal entries, students will demonstrate their understanding of the issues discussed and the readings for the week, and use these ideas and reflections to enhance their own awareness and understanding of disability. Each Journal entry should be 3/4 to 1 page. Points will be awarded based on the student’s self-reflection, relevance to course, understanding of the topic, and use of complete sentences and proper grammar.
https://www.ssa.gov/disability/
State Strategies for Promoting Wellness and Healthy
Lifestyles for People with Disabilities
© Association of State and Territorial Health Officials 2013 2231 Crystal Drive, Ste 450, Arlington, VA
(202) 371-9090 www.astho.org
Inadequate access to preventive health and other health promotion services among people with
disabilities compared to the general population is a public health concern. More than 54 million
people—one in five Americans—have a disability with which they were either born or acquired through
injury, age, or illness.2,3 In 2006, disability-associated healthcare expenditures for adults in the United
States totaled $397.8 billion (26.7% of all expenditures).4 Of
this national total, $118.9 billion was for the Medicare
population, $161.1 billion for Medicaid recipients, and $117.8
billion for non-public (privately insured or uninsured) sources.5
Medicaid serves an estimated 9.9 billion children and adults
with disabilities and is the primary way of providing healthcare
services to people with disabilities.6
A disability is a feature of the body, mind, or senses that can
affect a person’s daily life. People with disabilities need healthcare and health promotion programs for
the same reasons that the general population does. Despite this knowledge, people with disabilities
experience barriers to preventive healthcare services, which can lead to poor health status, delayed
treatment of chronic illnesses, and failure to prevent secondary conditions or health problems related to
a disability. Research indicates that people with disabilities may be disproportionately affected by excess
weight or obesity; increased risk for diabetes, hypertension, substance abuse, injury, depression, and
stress; and receive less frequent cancer screenings compared to people without disabilities.7 Health
disparities for people with disabilities vary by ethnicity, age, gender, and income level.8
Several national initiatives are focused on people with disabilities and provide leadership for an
increased public health focus on the health issues that affect people with disabilities. Some of these
include:
• The American Public Health Association (APHA) Disability Section.9
• The Healthy People 2020 inclusion of a focus area on disability and health.10
• The U.S. Surgeon General’s Call to Action to Improve the Health and Wellness of Persons with
Disabilities.11
• HHS’s National Partnership for Action to End Health Disparities.12
In addition, CDC’s National Center on Birth Defects and Developmental Disabilities (NCBDDD)13 supports
18 state-based programs to ensure that individuals with disabilities are included in ongoing state disease
prevention, health promotion, and emergency response activities.
More people with disabilities are living longer, higher-quality lives due to the positive impact of public
health, medical, and other interventions. State and territorial health agencies play a key role in ensuring
people with disabilities have access to these healthcare and health promotion services. This issue brief
provides some background on the barriers and challenges to accessing preventive healthcare and health
promotion services and highlights some of the initiatives that state public health agencies have
undertaken to remove those barriers.
A disability is a feature of the body,
mind, or senses that can affect a
person’s daily life. People with
disabilities need healthcare and
health promotion programs for the
same reasons that the general
population does.1
State Strategies for Promoting Wellness and Healthy
Lifestyles for People with Disabilities
© Association of State and Territorial Health Officials 2013 2231 Crystal Drive, Ste 450, Arlington, VA
(202) 371-9090 www.astho.org
Barriers to Preventive Health and Health Promotion Activities and Services
There are significant health inequities that lead to inadequate access to preventive health and other
health promotion services among people with disabilities. People with disabilities are more likely to
experience disadvantages in health and well-being compared to the general population, and barriers to
preventive health services can often delay treatment of chronic conditions and failure to prevent
secondary conditions. Widespread challenges to accessing healthcare services and health promotion
activities for people with disabilities include physical, environmental, programmatic, and attitudinal and
cultural barriers. To begin removing these barriers, public
health needs to consider a new approach where accessibility
and accommodation for people with disabilities is part of the
overall agenda. Public health can also help eliminate health
inequities by addressing social determinants of health (e.g.,
education and poverty) that exist among people with
disabilities.
Physical Barriers
Due to the lack of accessible places to be physically active (e.g., sidewalks, parks, fitness centers, green
spaces), individuals with disabilities are more likely to be less physically active than people without
disabilities. In 2008, the National Health Interview Survey reported that 27.3 percent of people with
disabilities met the 2008 Physical Activity Guidelines for Americans, whereas 46.9 percent of the general
population met the same guidelines. Engaging in regular physical activity is one of the most important
things that people of all ages and abilities can do to improve their health, well-being, and quality of life.
Although the causes of obesity are diverse and complex, lack of accessible places to be physically active,
combined with other food access factors (e.g., difficulty preparing and shopping for healthy foods),
create additional barriers for people with disabilities. Having access to places and spaces to be physical
active may also help to prevent some secondary conditions. Consequently, when public spaces—
schools, offices, healthcare facilities, and parks—are built, they should be designed using the Universal
Design14 principles so they can be used by all people, regardless of age and ability.
People with disabilities also often lack access to basic primary and preventive health services due to
medical equipment that is not accessible.15, 16 Despite being at higher risk of developing certain chronic
and secondary conditions, these individuals are frequently prevented from receiving routine physical
exams and weigh-ins, dental exams, x-rays, mammographies, Pap tests, colonoscopies, and vision
screenings.
Environmental Barriers
Environmental features affect a person’s ability to participate in various preventive health and health
promotion activities and services. The built environment includes a community’s physical form (e.g.,
urban design, land use patterns, and the transportation system) as well as the accessibility of public
buildings, facilities, and housing. When communities are not walkable/bikable/rollable, it contributes to
inadequate healthcare service access, levels of physical inactivity, and social isolation of people with
disabilities. In addition, finding accessible housing can be a challenge for people with disabilities who
want to live independently. When a home is not accessible, there is greater potential for falls, decreased
independence, and isolation. 17
To begin removing the health
barriers that people with disabilities
face, public health needs to consider
a new approach where accessibility
and accommodation for people with
disabilities is part of the overall
agenda.
State Strategies for Promoting Wellness and Healthy
Lifestyles for People with Disabilities
© Association of State and Territorial Health Officials 2013 2231 Crystal Drive, Ste 450, Arlington, VA
(202) 371-9090 www.astho.org
Programmatic Barriers
Programmatic access to primary and preventive healthcare
services can refer to both the practices and policies that
are part of the delivery system. Medical equipment that is
not accessible, healthcare professionals who are not
appropriately trained, lack of interpreters during exams,
and lack of individual accommodations prevent many
people with disabilities from accessing basic medical
services.21,22 Access can be particularly challenging in rural
areas where workforce challenges are more prevalent. In
addition, people with disabilities often lack health
insurance or coverage for specialty care services, including
long-term care, care coordination, prescription
medications, durable medical equipment, and assistive
technologies.23
Obtaining treatment and achieving recovery can be
challenging for anyone struggling with substance abuse,
but people with disabilities are often inhibited by
additional obstacles. A number of risk factors, including
lack of access to prevention and treatment services, make
people with disabilities more vulnerable to encountering
problems associated with substance abuse.24 Research
shows that substance abuse prevalence rates are higher
for people with disabilities (e.g., traumatic brain injuries,
spinal cord injuries, or mental illness) compared to the
general population.25,26
Attitudinal and Cultural Barriers
Attitudinal and cultural barriers related to healthcare
services often lead to discrimination toward people with
disabilities and can be more challenging to overcome than
physical, environmental, and programmatic barriers.
Healthcare providers may overlook mental health and
substance abuse needs because they are focused on a
patient’s disability, often leading to misdiagnosis or not
being diagnosed at all.27 If left untreated, non-disability-
related health conditions could exacerbate other
secondary conditions.
Providers may also mistakenly assume that people with
disabilities are not sexually active, especially if the disability is severe or disfiguring. Therefore, this
population often is not screened for sexually transmitted diseases (STDs), and women are not given
regular gynecological exams or advised about preconception health and healthy pregnancies.28
Women with Disabilities
About 27 million women in the United
States have disabilities. Research
indicates that women with disabilities
may not receive health screenings
regularly or screenings that adhere to the
recommended guidelines.18 Failure to
provide comprehensive services for
women with disabilities can have
significant implications on their health.
Breast Health
• Women with disabilities may have
delayed diagnosis or treatment of
breast cancer due to inaccessible
mammography equipment. Self-
reported mammography use is lower
for women with a disability (72.2%
for 40 years of age or older; 78.1%
for 50-74 years of age) than women
without a disability (77.8% and
82.6%, respectively).19
Reproductive Health
• Women with disabilities are less
likely than women without
disabilities to report having a Pap test
in the past three years.20 Inadequate
service utilization may be due to: not
being aware of the importance of
having the exam, difficulty getting on
the exam table, or finding a provider
who is knowledgeable about their
specific disability. In addition, women
with disabilities may not receive
regular gynecological exams or STD
screenings due to providers assuming
they are not sexually active.
State Strategies for Promoting Wellness and Healthy
Lifestyles for People with Disabilities
© Association of State and Territorial Health Officials 2013 2231 Crystal Drive, Ste 450, Arlington, VA
(202) 371-9090 www.astho.org
Strategies for State and Territorial Health Agencies
State and territorial health agencies play an important role in expanding health promotion and wellness
activities for people with disabilities. CDC currently supports 18 states with implementing disability and
health programs, 11 of which are a collaboration with or housed within the state health agency. Even
when states do not have specific disability and health programs, state health agencies can include
people with disabilities in health promotion services and activities. Strategies that states may consider
to reduce the barriers for people with disabilities include the following:
• Work with healthcare providers to ensure medical equipment (e.g., exam tables, scales),
facilities, and buildings are accessible to increase the utilization of preventive services.
• Encourage providers to advocate for their patients with disabilities and ensure that all available
resources are used to treat a patient.
• Work with healthcare providers to ensure that staff are adequately trained to provide
preventive services to people with disabilities.
• Develop policies to encourage health insurers to provide provisional transition services to
ensure continuity of care in the event of provider or service plan change.
• Develop, strengthen, and enforce policies that further the Americans with Disabilities Act’s
scope. Many healthcare providers lack awareness of what is required to ensure patients with
disabilities have access to culturally-appropriate care.
• Include people with disabilities in the planning, reporting, and evaluation of topics such as
medical reimbursement, health service delivery, community planning, communication, and
transportation.
• Include people with disabilities in the design, planning, and implementation of community
interventions. Have individuals with disabilities conduct staff trainings.
• Target people with disabilities in all health promotion, preventive health, mental health, and
substance abuse outreach and programs.
• Partner with organizations that advocate and serve people with disabilities to leverage the work
they are already doing, expand efforts, and create greater reach.
• Educate people with disabilities about the importance of preventive health services. Encourage
them to advocate for their health needs and speak up when they are not being met.
• Work with wellness and fitness centers to reduce the barriers to physical activity programs by
ensuring access to facilities and equipment. Encourage implementation of programs that target
individuals with disabilities.
• Facilitate partnerships with a variety of state, local, and private agencies (including mental
health services, social services, Medicaid, transportation, and other programs) to coordinate
efforts to increase services and decrease physical, environmental, attitudinal, and cultural
barriers for all programs and interventions.
• Develop materials in accessible formats (e.g., braille, large print, audio tape, e-text) that are at
the appropriate reading level and available in different languages.
• Include pictures of people with disabilities and of different ethnicities in program materials and
messaging (posters, flyers, brochures, PSAs, videos) to encourage participation.
State Strategies for Promoting Wellness and Healthy
Lifestyles for People with Disabilities
© Association of State and Territorial Health Officials 2013 2231 Crystal Drive, Ste 450, Arlington, VA
(202) 371-9090 www.astho.org
State Disability and Health Activities
State disability and health programs are collaborating with other state and local agencies to promote
wellness and healthy lifestyles for people with disabilities. These programs have developed a variety of
initiatives around issues related to access, women’s health, health promotion training and curricula for
consumers and providers, emergency preparedness, physical activity, and worksite health promotion.
The following state examples highlight some of these activities.
The Illinois Disability and Health Program
collaborated with the Illinois Department of
Public Health’s Office of Women’s Health to
include language in its Women’s Health Mini-
Grant Program application, encouraging
grantees to include women with disabilities as a
target group. There are three different health
promotion programs offered through the mini-
grants: Women Walking Out, Building Better
Bones, and Life Smart for Women. Specific
disability-related questions were also added to
the mini-grant quarterly reports in fiscal year
2013 to identify the number of women with
disabilities who participate in the programs. By
continuing to collect this data in 2014 and
beyond, the programs will learn how many
women with disabilities participate in women’s
health programs and increase disability
awareness among grantees.
The Massachusetts Department of Public
Health promotes and provides sensitivity
training to healthcare providers on the unique
health needs of people with disabilities. With
CDC funding, the state Health and Disability
Program (HDP) adapted its “Welcoming
Workshops” presentation to include
“Navigating the Patient with a Disability” for
patient navigators. This modification includes
information on the Massachusetts Facility
Assessment Tool, accessible print materials, and
planning accessible meetings. HDP also tailors
its workshops to include audience-specific
information to achieve high impact. By
strengthening ties to other programs within the
state, HDP has a direct impact on healthcare
providers working with people with disabilities.
The Michigan Department of Community
Health (MDCH) has been promoting the
evidence-based, chronic disease self-
management, Personal Action Toward Health
(PATH) program to people with disabilities, so
about half of the PATH participants have a
disability. This goal has been achieved by
offering workshops at disability-friendly
locations throughout the state; collaborating
with disability service, advocacy, and behavioral
health organizations; training people with
disabilities as PATH leaders; and targeting
marketing. In addition, MDCH developed a
postcard to market disability-friendly physical
activity options to people with disabilities. The
postcards are placed in disability advocacy and
service locations statewide. MDCH has also
worked with the state American Cancer Society
chapter and the state’s Breast and Cervical
Cancer Prevention Program to determine the
building and equipment accessibility of
mammography facilities throughout the state.
Through an online portal, women with
disabilities are able to search for accessible
facilities in their county.29
The Montana Disability and Health Program
(MTDH) works to infuse disability health and
wellness goals into the plans, policies,
programs, and procedures of state agencies and
community service providers by having people
with disabilities serve as “disability advisors” in
public health standing committees. As part of
the planning process, disability advisors identify
disability-specific resources to protect and
promote or barriers to remove. MTDH has
created practice guidelines that offer
suggestions on how to involve people with
State Strategies for Promoting Wellness and Healthy
Lifestyles for People with Disabilities
© Association of State and Territorial Health Officials 2013 2231 Crystal Drive, Ste 450, Arlington, VA
(202) 371-9090 www.astho.org
disabilities as members of advisory groups.30 In
addition, MTDH and the Montana Housing Task
Force support and advocate for visitability in
home design through a statewide educational
campaign. To date, approximately 8,300
consumers, builders, architects, policymakers,
and other stakeholders have been educated
about visitability in home design.31
The New York State Department of Health
(NYSDOH) Disability and Health Program (DHP)
developed an inclusion policy that requires all
NYSDOH requests for proposals and
applications to incorporate strategies to ensure
people with disabilities are integrated into
public health programs and services. In
addition, all programs must include an
evaluation component to assess the policy’s
effect and reach. DHP also developed a
Medicaid Buy-In Program for Working People
with Disabilities (MBI-WPD),32 which allows
working people with disabilities to earn
additional income without the possibility of
losing critical healthcare coverage. A toolkit has
also been created to help New Yorkers
determine if they would like to apply for MBI-
WPD and assist with the application process.33
The North Carolina Office on Disability and
Health (NCODH) collaborated with the Center
for Universal Design to develop “Removing
Barriers to Health Clubs and Fitness Facilities: A
Guide for Accommodating All Members,
Including People with Disabilities and Older
Adults”.34 NCODH developed a community-
centered training model based on this guide
with the goal of creating fitness environments
that are accessible, safe, and support people of
all abilities. NCODH also offers the Work
Healthy, Live Healthy program, which focuses
on providing environmental supports for health
promotion at worksites to promote healthy
lifestyle choices. The program targets adults
with disabilities who receive services at
community rehabilitation agencies.
The South Carolina Interagency Office of
Disability and Health (SCIODH) has partnered
with the University of South Carolina to teach
future medical professionals and
paraprofessionals about the specials needs of
people with disabilities. Students are taught
how to lift patients from wheelchairs and onto
an examination table, how to communicate in a
sensitive way, and what it means to have a
disability. SCIODH also partnered with the state
Department of Disabilities and Special Needs
and the state health agency to develop the
Steps to Your Health program, which is
designed for people with intellectual
disabilities. Program participants reported
increased knowledge, healthier self-reported
diet, more frequent physical activity, and
reduction in body mass index following the
program.35 SCIODH follows up with class
attendees after one year to see if they have
maintained the healthy lifestyles they learned.
Conclusion
State health agencies are increasingly focusing on health and wellness promotion initiatives for people
with disabilities. However, these programs currently exist in a limited number of states, indicating room
for growth at the national and state levels. Research indicates that disability and health programs are
beneficial not only for people with disabilities, but for the population and economy as a whole because
these programs decrease healthcare expenditures due to preventable illness, reduce disparities, and
promote inclusiveness and access for all. As public health moves toward integrating disability into its
overall agenda, state health agencies need to continue to prioritize accessibility; accommodations and
alternative formats; messaging and communications; and disability sensitivity, cultural awareness, and
etiquette to ensure that people with disabilities can participate to their full extent.
State Strategies for Promoting Wellness and Healthy
Lifestyles for People with Disabilities
© Association of State and Territorial Health Officials 2013 2231 Crystal Drive, Ste 450, Arlington, VA
(202) 371-9090 www.astho.org
Resources
American Association on Health and Disability (AAHD)
www.aahd.us
AAHD Health Promotion Resource Center
http://www.aahd.us/resource-center/
AAHD Susan G. Komen Race for the Cure Grants
Amputee Coalition
http://www.amputee-coalition.org/
ASTHO Disability Case Studies
http://www.astho.org/Programs/Access/Maternal-and-Child-Health/Disability-Case-Studies/Disability-
Case-Studies/
Association of University Centers on Disabilities
http://www.aucd.org
CDC National Center on Birth Defects and Developmental Disabilities (NCBDDD)
http://www.cdc.gov/ncbddd/index.html
CDC NCBDDD State Disability and Health Programs
http://www.cdc.gov/ncbddd/disabilityandhealth/programs.html
National Association of County & City Health Officials
http://www.naccho.org/topics/HPDP/healthdisa/
Substance Abuse and Mental Health Service Administration Wellness Initiative
http://promoteacceptance.samhsa.gov/10by10/
1 HHS. “The Surgeon General’s Call to Action to Improve the Health and Wellness of Persons with Disabilities.” HHS,
Office of the Surgeon General, 2005. Available at:
http://www.surgeongeneral.gov/library/calls/disabilities/calltoaction . Accessed 11-14-2013.
2 American Association on Health and Disability. “Health Promotion and Wellness for People with Disabilities.”
April 2011. Available at: http://www.aahd.us/2011/04/health-promotion-and-wellness-for-people-with-
disabilities/. Accessed 10-16-2013.
3 HHS. “The Surgeon General’s Call to Action to Improve the Health and Wellness of Persons with Disabilities.” HHS,
Office of the Surgeon General, 2005. Available at:
http://www.surgeongeneral.gov/library/calls/disabilities/calltoaction . Accessed 11-14-2013.
4 Anderson WL, Armour BS, Finkelstein EA, Wiener JM. “Estimates of state-level health-care expenditures
associated with disability.” Public Health Rep 2010;125(1):44–51. Available at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2789815/. Accessed 10-16-2013.
5 Ibid.
http://www.aahd.us/resource-center/
http://www.amputee-coalition.org/
http://www.astho.org/Programs/Access/Maternal-and-Child-Health/Disability-Case-Studies/Disability-Case-Studies/
http://www.astho.org/Programs/Access/Maternal-and-Child-Health/Disability-Case-Studies/Disability-Case-Studies/
http://www.aucd.org/
http://www.cdc.gov/ncbddd/index.html
http://www.cdc.gov/ncbddd/disabilityandhealth/programs.html
http://www.naccho.org/topics/HPDP/healthdisa/
http://promoteacceptance.samhsa.gov/10by10/
http://www.surgeongeneral.gov/library/calls/disabilities/calltoaction
http://www.surgeongeneral.gov/library/calls/disabilities/calltoaction
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2789815/
State Strategies for Promoting Wellness and Healthy
Lifestyles for People with Disabilities
© Association of State and Territorial Health Officials 2013 2231 Crystal Drive, Ste 450, Arlington, VA
(202) 371-9090 www.astho.org
6 Association of University Centers on Disabilities. “Medicaid.” Available at:
http://www.aucd.org/template/page.cfm?id=277. Accessed 10-29-2013.
7 CDC. “CDC Health Disparities and Inequalities Report – United States, 2011.” Morbidity and Mortality Weekly
Report. 2011; 60(Supplement): 1-114. Available at: http://www.cdc.gov/mmwr/pdf/other/su6001 . Accessed
10-29-2013.
8 American Association on Health and Disability. “Health Promotion and Wellness for People with Disabilities.”
April 2011. Available at: http://www.aahd.us/2011/04/health-promotion-and-wellness-for-people-with-
disabilities/. Accessed 10-16-2013.
9 American Public Health Association. “Disability.” Available at:
http://www.apha.org/membergroups/sections/aphasections/disability/. Accessed 10-29-2013.
10 HHS. Office of Disease Prevention and Health Promotion. “Healthy People 2020 – Disability and Health.”
Available at: http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=9. Accessed 10-
16-2013.
11 HHS. “The Surgeon General’s Call to Action to Improve the Health and Wellness of Persons with Disabilities.”
HHS, Office of the Surgeon General, 2005. Available at:
http://www.surgeongeneral.gov/library/calls/disabilities/calltoaction . Accessed 10-16-2013.
12 HHS, National Partnership for Action to End Health Disparities. Available at: http://minorityhealth.hhs.gov/npa/.
Accessed 10-16-2013.
13 CDC, National Center on Birth Defects and Developmental Disabilities. Available at:
http://www.cdc.gov/ncbddd/index.html. Accessed 10-16-2013.
14 UniversalDesign.com. “What is Universal Design?” Available at: http://www.universaldesign.com/about-
universal-design.html. Accessed 10-16-2013.
15 Kirschner KL, Breslin ML, Iezzoni, LI. “Structural impairments that limit access to health care for patients with
disabilities.” JAMA. 297: 10:1121-1125. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17356035. Accessed
10-16-2013.
16 National Council on Disability. “The Current State of Health Care for People with Disabilities.” September 2009.
Available at: http://www.ncd.gov/publications/2009/Sept302009. Accessed 10-16-2013.
17 Association of University Centers on Disabilities, State-Based Disability & Health Program. “Visitability
Testimonies Increase Affordable, Accessible Housing in Montana.” Available at:
http://www.aucd.org/docs/ncbddd/MT%20Success%20Story . Accessed 10-16-2013.
18 Armour BS, Thierry JM, Wolf LA. “State-level differences in breast and cervical cancer screening by disability
status: United States, 2008.” Women’s Health Issues. 2009 Nov-Dec;19(6):406-14. Available at:
http://www.ncbi.nlm.nih.gov/pubmed/19879454. Accessed 10-16-2013.
19 CDC. “Mammograms for Women With/Without a Disability.” Available at:
http://www.cdc.gov/Features/dsmammograms/. Accessed 10-16-2013.
20 Access to Disability Data. Chartbook on Women and Disability. “Section 4: Living arrangements, family life, and
medical experiences.” Available at: http://www.infouse.com/disabilitydata/womendisability/4_4.php. Accessed
10-16-2013.
21 Kirschner KL, Breslin ML, Iezzoni, LI. “Structural impairments that limit access to health care for patients with
disabilities.” JAMA. 297: 10:1121-1125. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17356035. Accessed
10-16-2013.
22 National Council on Disability. “The Current State of Health Care for People with Disabilities.” September 2009.
Available at: http://www.ncd.gov/publications/2009/Sept302009. Accessed 10-16-2013.
23 Ibid.
24 HHS. Office on Disability. “Substance Abuse and Disability.” Available at:
http://www.hhs.gov/od/about/fact_sheets/substanceabuse.html. Accessed 10-16-2013.
25 Ibid.
26 Ibid.
http://www.aucd.org/template/page.cfm?id=277
http://www.cdc.gov/mmwr/pdf/other/su6001
http://www.apha.org/membergroups/sections/aphasections/disability/
http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=9
http://www.surgeongeneral.gov/library/calls/disabilities/calltoaction
http://minorityhealth.hhs.gov/npa/
http://www.cdc.gov/ncbddd/index.html
http://www.universaldesign.com/about-universal-design.html
http://www.universaldesign.com/about-universal-design.html
http://www.ncbi.nlm.nih.gov/pubmed/17356035
http://www.ncd.gov/publications/2009/Sept302009
http://www.aucd.org/docs/ncbddd/MT%20Success%20Story
http://www.ncbi.nlm.nih.gov/pubmed/19879454
http://www.cdc.gov/Features/dsmammograms/
http://www.infouse.com/disabilitydata/womendisability/4_4.php
http://www.ncbi.nlm.nih.gov/pubmed/17356035
http://www.ncd.gov/publications/2009/Sept302009
http://www.hhs.gov/od/about/fact_sheets/substanceabuse.html
State Strategies for Promoting Wellness and Healthy
Lifestyles for People with Disabilities
© Association of State and Territorial Health Officials 2013 2231 Crystal Drive, Ste 450, Arlington, VA
(202) 371-9090 www.astho.org
27 HHS. Office on Women’s Health. “Illnesses and Disabilities.” Available at:
http://www.womenshealth.gov/illnesses-disabilities/index.html. Accessed 10-16-2013.
28 Ibid.
29 Michigan Department of Community Health. Partnership for Health & Disability. “Disability Health Resources.”
Available at: http://www.midisabilityhealth.org/resources.aspx. Accessed 10-16-2013.
30 Montana Disability & Health Program. “Involving People with Disabilities as Members of Advisory Groups.”
Available at: http://mtdh.ruralinstitute.umt.edu/?page_id=1031. Accessed 10-16-2013.
31 Montana Disability & Health Program. “Visit-ability.” Available at:
http://mtdh.ruralinstitute.umt.edu/blog/?page_id=310. Accessed 10-16-2013.
32 New York State Department of Health. “Medicaid Buy-in Program.” Available at:
http://www.health.ny.gov/health_care/medicaid/program/buy_in/. Accessed on: 10-31-2013.
33 New York State Department of Health. “Medicaid Buy-In Program for Working People with Disabilities Toolkit.”
Available at:
http://www.health.ny.gov/health_care/medicaid/program/buy_in/docs/working_people_with_disabilities_03041
3 . Accessed 10-31-2013.
34 North Carolina Office on Disability and Health. “Removing Barriers to Health Clubs and Fitness Facilities: A Guide
for Accommodating All Members, Including People with Disabilities and Older Adults.” Available at:
http://www.fpg.unc.edu/node/4110. Accessed 10-16-2013.
35 McDermott S, Mann J. “Steps to Your Health: Healthy Behavior Change of Adults with Mental Retardation.”
Available at: http://www.reinventingquality.org/docs/McDermott07-1 . Accessed 10-31-2013.
http://www.womenshealth.gov/illnesses-disabilities/index.html
http://www.midisabilityhealth.org/resources.aspx
Involving People with Disabilities as Members of Advisory Groups
http://www.health.ny.gov/health_care/medicaid/program/buy_in/
http://www.health.ny.gov/health_care/medicaid/program/buy_in/docs/working_people_with_disabilities_030413
http://www.health.ny.gov/health_care/medicaid/program/buy_in/docs/working_people_with_disabilities_030413
http://www.fpg.unc.edu/node/4110
http://www.reinventingquality.org/docs/McDermott07-1
Disabilityin Older Adults comprises public domain material from the National Institutes of Health.
http://report.nih.gov/nihfactsheets/Pdfs/DisabilityinOlderAdults(NIA)
Disability in Older Adults
FACT SHEET – Disability in Older Adults
National Institutes of Health
Updated October 2010
1
Yesterday
Thirty years ago, America was steadily aging. In 1980,
approximately 26.1 million people were 65 years of age or
older, compared with 3 million in 1900. And Americans
were living notably longer than they had in the past –
average life expectancy for a child born in 1980 was 73.7
years, up from 47.3 years in 1900. Disability was on the
rise among older people. Studies from the 1970s and early
1980s pointed to modest increases in the prevalence of
disability. For example, in 1976, 4.8 million older people
reported limitations in the number or kinds of major
activities they could undertake.
It was widely believed that aging invariably brought with it
frailty and loss of independence. One study, for example,
predicted that technology would save people’s lives, but
still leave them disabled and an increasing burden on
society. However, groundbreaking research from projects
such as the Baltimore Longitudinal Study of Aging
(http://www.grc.nia.nih.gov/branches/blsa/blsanew.htm),
initiated in 1958, began to suggest that disease and
disability were not inevitable consequences of aging.
The growth in the aging population, the increase in life
expectancy, and concerns about disability led to the
founding in 1974 of the National Institute on Aging (NIA)
within the National Institutes of Health (NIH). The Institute
was charged with “the conduct and support of biomedical,
social, and behavioral research, training, health
information dissemination, and other programs with
respect to the aging process and diseases and other
special problems and needs of the aged.”
Today
People continue to live longer and the U.S. population is
increasingly older. The leading edge of the Baby Boom
turns 65 in 2011, part of a rapid growth in population
aging in the United States – and worldwide. 39 million
people in the United States are age 65 or older, and life
expectancy at birth has reached 78.3 years. Most notable
is the growth in the population of individuals age 85 and
older who are at highest risk for disease and disability.
Research demonstrates that disease and disability are not
an inevitable part of aging. Disability rates can be reduced,
as evidenced by data from the National Long Term Care
Survey (http://www.nltcs.aas.duke.edu/), which found
that between 1982 and 1999, the prevalence of physical
disability in older Americans decreased from 26 percent to
20 percent. Additionally, there is evidence from the Health
and Retirement Study (http://hrsonline.isr.umich.edu/)
that the probability of being cognitively impaired at a
given age has been decreasing (from the mid-1990s up
until at least 2004), although the rapidly increasing
population of older adults means that the absolute
number of cognitive impaired individuals is still increasing.
However, it remains unclear whether the decline in rates
of disability has continued since 1999, and researchers are
analyzing multiple data sources to ascertain the trend.
There is some evidence suggesting that while the decline
in disability may have continued among the oldest old
(those age 85+), the decline in disability ended or was
reversed in the new cohorts recently entering old age.
Factors thought to have contributed to this decline in
disability rates include improved medical treatment
(particularly treatments such as beta blockers and ACE
inhibitors for cardiovascular disease), positive behavioral
changes, more widespread use of assistive technologies,
rising education levels, and improvements in
socioeconomic status. The NIH supports research to
understand the underlying causes of this decline in order
to develop behavioral and multi-level interventions to
maintain and accelerate this trend.
Scientists are identifying factors that contribute to
healthier aging and longer life expectancy. Epidemiologic
studies suggest that lifespan and health are determined by
both genetic and environmental influences, with genetics
accounting for about 35 percent of lifespan and modifiable
environmental factors contributing most to this complex
interaction.
Interventions are being developed to improve how older
people function. Researchers at the NIH-supported Claude
D. Pepper Older Americans Independence Centers
(https://www.peppercenter.org/public/home.cfm), for
example, have developed effective ways to prevent falls,
FACT SHEET – Disability in Older Adults
National Institutes of Health
Updated October 2010
2
improve muscle function (size, strength and power), and
reduce delirium related to hospital stays. One NIH study
dramatically demonstrated that even 90-year-olds can
improve muscle strength and mobility with simple weight
training exercises.
However, downward trends in disability may be
threatened by recent increases in obesity levels. According
to the National Health Interview Survey
(http://www.cdc.gov/nchs/nhis.htm), the disability rate
among people ages 18 to 59 rose significantly from the
1980s through the 1990s, with the growing prevalence of
obesity factoring into the trend. Obesity and overweight
put people at increased risk for potentially disabling
chronic diseases such as heart disease, type 2 diabetes,
high blood pressure, stroke, osteoarthritis, respiratory
problems, and some forms of cancer.
Tomorrow
Researchers may find ways to identify those most at risk
for specific types of disability. NIH investigators have
identified several markers, including grip strength, gait
(walking) speed, circulating levels of the protein IL-6, and
measures of lung function, that can be used to predict the
onset of limitations in mobility. Researchers are currently
conducting a genome-wide association study to identify
genes and genomic regions associated with trajectories of
change in each of these markers.
The National Health and Aging Trends Study
(http://web.jhu.edu/popaging/nhats.html), a new
nationwide NIH-funded study of 12,000 people age 65 and
older, will provide data to disentangle the physical, social,
technological and environmental factors in disability
prevalence, onset, and recovery. The study will also help
us understand the social and economic consequences of
late-life disability for individuals, families and society.
The Health and Retirement Study
(http://hrsonline.isr.umich.edu/), a nationwide NIH-
funded survey of more than 22,000 people age 50 and
older, is allowing researchers to examine the interactions
among physical and mental health, insurance coverage,
financial well-being, family support, work status,
retirement planning and the impact of these variables on
disability. Improved ability to forecast disability trends will
help give policymakers more accurate projections of
national expenditures for the Social Security and Medicare
programs. Researchers will also assess disability risks in
understudied populations within the United States,
minorities, and the medically underserved.
Research may bring new treatments to prevent or
minimize disability from stroke, diabetes, and other acute
and chronic health problems. For example, NIH-supported
researchers are developing interventions to improve
quadriceps muscle function after total knee replacement
and muscle conditioning (muscle size, strength and power)
in community dwelling individuals at high risk for falls and
mobility disability. Other studies are evaluating the ability
of an exercise and health promotion intervention to
facilitate maintenance of physical and cognitive function in
older adults with mild cognitive impairment (often a
precursor condition to Alzheimer’s disease). In addition,
researchers are conducting a clinical trial of testosterone
in men with impaired physical functioning.
Interventions are being developed to prevent disability in
older people. For example, the ongoing Lifestyle
Interventions and Independence for Elders (LIFE) Study
(https://www.thelifestudy.org/public/index.cfm) will
assess the effect of an exercise intervention to prevent
mobility disability in older adults. NIA also funds a
randomized trial of a social engagement intervention, the
Experience Corps
(http://www.experiencecorps.org/index.cfm), which
places older volunteers, mostly inner-city residents, in
elementary schools in cognitively demanding and socially
productive roles. Preliminary data have shown
improvements in both mental and physical health for
seniors, as well as benefits for the schools.
Contact:
Medical aspects of disability: Lyndon Joseph, Ph.D.,
Josephlj@nia.nih.gov
Disability trends: Richard Suzman, Ph.D.,
SuzmanR@mail.nih.gov
National Institute on Aging (NIA) website:
http://www.nia.nih.gov