Mission Possible: Achieving Health Equity through Inclusive Public Health Practice

This month, we recognize the 28th anniversary of the Americans with Disabilities Act (ADA), the most comprehensive federal disability rights law that helps to ensure equal access. 

On a beautiful spring morning, with the air crisp and the sun gently beaming down a father gathers a backpack of daily essentials and maneuvers his wheelchair towards the front door with his young daughter riding on his lap. Together, the two make their way out of the house and onto the neighborhood sidewalks en route to a nearby community playground.  But despite the best of intentions and because of the community design, he encounters barrier after barrier—from cracked sidewalks, to non-existent crosswalks, and a playground that won’t accommodate wheelchair access. With great effort and extreme challenges, he is able to get to the playground with his daughter, but he struggles to feel as though he is included in the community.

And though the Americans with Disabilities Act was passed in 1990 ensuring the rights of people with disability to access public facilities, such as parks and playgrounds, it isn’t happening.  People with disabilities are being left out of everyday activities like playing with their children at a community playground.  Consequently, this lack of access has created an unrecognized population that faces many barriers to health promotion opportunities.  These barriers are widely recognized as contributors to health disparities in people with disabilities.

Barriers are created by factors in the environment, such as lack of transportation, inaccessible facilities and community architecture.  Barriers also exist within a programmatic space, which entail policies, procedures, and lack of training and professional competence.  Additionally, attitudes and beliefs can lead to discrimination and implicit bias.  These barriers contribute to health inequities because they can affect access to healthcare, participation in community and social activities, education, and employment.  But through inclusive public health practice, this can be a possible mission, and we can address these health inequities faced by people with disabilities to create inclusive, healthy communities that benefit society as a whole.

While many people don’t think about disability until it affects them, it actually impacts all of us.  In fact, 1 in 5 adults in the US have a disability and that equates to around 20 percent of the population¹.  Disability does not discriminate – it cuts across racial, ethnic, age, socioeconomic status, and gender lines while involving various physical, mental, emotional, and/or sensory conditions.  Though disability does not equate to being unhealthy, individuals with a disability are at a greater risk for health disparities. Sadly, people with disabilities experiences heath disparities at rates higher than any other demographic group in the country.

In fact, adults with disability

• are three times more likely to have a chronic health condition²,
• are 38% more likely to be obese³,
• are 36% more likely to be inactive⁴ and
• account for nearly 27% of all health care expenditures⁵.

Undoubtedly, the health status of people with disability is a major and significant public health concern.

At the National Center on Health, Physical Activity and Disability (NCHPAD), we are working to create health equity for people with disabilities by providing resources to individuals, promoting community and environmental change, accelerating research to practice and focusing national attention on the urgent need for inclusion.  As a National Center on Disability funded through the Centers for Disease Control and Prevention’s (CDC) National Center on Birth Defects and Developmental Disabilities (NCBDDD), we support the health, wellness, and quality of life of people with disabilities.  NCBDDD recognizes that people with disabilities need health care and health programs for the same reasons anyone else does – to stay well, active, and a part of the community.  They work to make sure that no one is left behind; that people of all different abilities are able to live their life to the fullest.

Using our Knowledge Adaptation, Translation, and Scale-up Framework, we are able to systematically facilitate, monitor, and evaluate inclusive programmatic, policy, systems, and environmental (PPSE) changes in communities and organizations at a local, state, and national level.  We believe the future is inclusion! Through inclusion, we can build communities that work together to defeat health inequities and it starts with our public health practices.  This is a mission that is possible.

Someday, that same dad will be able to take his daughter to the park with ease, and even have meaningful interaction with her while there. And, with all of us working together, maybe she will be part of the last generation that remembers a lack of inclusion for people with disabilities.

Are you interested in making your program or organization inclusive of all? Contact NCHPAD to find out more about inclusion in public health and what you can do to help your organization Commit to Inclusion.

Visit CDC’s Disability and Health website to learn more about CDC’s efforts to improve the health of people with disabilities.

Special thanks to Ms. Tubbs for contributing this blog in recognition of the anniversary of the Americans with Disabilities Act and as part of the celebration of the 30^th anniversary commemoration of CDC’s Office of Minority Health and Health Equity. Our theme for the 30^th anniversary commemoration is Mission: Possible. We believe “healthy lives for everyone” is possible and a goal that resonates in public health.   

1. Courtney-Long EA, Carroll DD, Zhang Q, et al. Prevalence of Disability and Disability Type among Adults, United States – 2013. MMWR Morb Mortal Wkly Rep 2015; 64: 777-783
2. US Department of Health and Human Services. The Surgeon General’s call to action to improve the health and wellness of persons with disabilities. Rockville, MD: US Department of Health and Human Services, Office of the Surgeon General; 2005. Available at http://www. surgeongeneral.gov/library/calls/index.html.
3. Bandini L, Danielson M, Esposito LE, et al. Obesity in children with developmental and/or physical disabilities. Disabil Health J. 2015; 8 (3): 309-316. doi: 10.1016/j.dhjo.2015.04.005.
4. Carroll DD, Courtney-Long EA, Stevens AC, et al. Vital signs: disability and physical activity—United States, 2009–2012. MMWR Morb Mortal Wkly Rep. 2014;63:407–13.
5. Anderson WL, Armour BS, Finkelstein EA, Wiener JM. Estimates of state-level health-care expenditures associated with disability. Public Health Rep 2010;125:44–51.