Commentaries from the APHA Disability Section - Chair's Forum
Evolving views of disability and public health: The roles of advocacy and public health

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Abstract

Promoting health, quality of life, and participation of persons with disabilities is a relatively recent development in public health. Its brief history reflects three distinct public health perspectives toward disability—a traditional approach that focuses on preventing disability, a contemporary approach that regards disability as a minority group experiencing disparities relative to people without disabilities, and an emerging perspective where disability status is considered one of multiple determinants of health. The field of disability and health has been influenced by the interaction of disability advocacy with the public health process of surveillance, epidemiology research, and intervention. Advocacy draws on political and legal arguments to press for action on issues such as health care access, control of services, and choice of residence. Public health uses surveillance to document magnitude of problems; epidemiology to identify specific groups, develop measures, and apply rigorous research methods; and intervention to improve health behaviors and health outcomes. The field of disability and public health, however, has lagged in addressing the role of environmental factors in the disabling process, in moving to societal participation as an outcome, and in implementing population scale interventions.

Section snippets

Evolving perspectives on disability in public health

The historical public health perspective of primary prevention of disability has evolved to recognizing people with disabilities as legitimate and valued participants in society. This is stated explicitly in the United Nations Convention on the Rights of Persons with Disabilities, signed by the United States in 2009 [8]. Drum and colleagues [9, p. 126] recently outlined 3 distinct perspectives of disability within public health that successively incorporate health-related quality of life

The public health process and advocacy

The public health process has been portrayed as a cycle involving surveillance of a health phenomenon, epidemiologic research, and intervention that, in turn, come back to surveillance of outcomes. Evaluation occurs throughout this process. Similar stages were recently depicted by Kilbourne and her colleagues [23]. Not typically included in this process, however, is the important role of advocacy. Historically, advocacy brought attention to the plight of people with disabilities and provided

Conclusion

There have been substantial improvements in how people with disabilities are considered and treated in the past 25 years in the United States. This progress has come about through legal and legislative advocacy that resulted in significant social policies to promote the education, health, and participation of people with disabilities. While legislation has increased educational access through Section 504 of the Rehabilitation Act of 1973 and the Individuals with Disabilities Education Act of

References (75)

  • J.H. Rimmer et al.

    Obesity prevalence among a group of Chicago residents with disabilities

    Arch Phys Med Rehabil

    (2005)
  • US National Council on Disability (formerly National Council on the Handicapped). Toward independence: An assessment of...
  • M. Marge

    Health promotion for persons with disabilities: moving beyond rehabilitation

    Am J Health Prom

    (1988)
  • V. Houk et al.

    The Centers for Disease Control program to prevent primary and secondary disabilities in the United States

    Public Health Rep

    (1989)
  • International classification of functioning, disability and health

    (2001)
  • D.J. Lollar et al.

    Redefining the role of public health in disability

    Annu Rev Public Health

    (2003)
  • M.J. Ward

    A personal perspective on historical views of disability

  • United Nations. Enable: Convention on the rights of persons with disabilities. Available at:...
  • C.E. Drum et al.

    Health of people with disabilities: determinants and disparities

  • M.A. Honein et al.

    Impact of folic acid fortification of the US food supply on the occurrence of neural tube defects

    JAMA

    (2001)
  • B.S. Armour et al.

    State-level prevalence of cigarette smoking and treatment advice, by disability status, United States, 2004

    Prev Chron Dis

    (2007)
  • V.A. Campbell et al.

    State specific prevalence of obesity among adults with disability: 8 states and the District of Columbia

    MMWR

    (2002)
  • Disability and health state chartbook, 2006: profiles of health for adults with disabilities

    (2006)
  • S.H. Havercamp et al.

    Health disparities among adults with developmental disabilities, adults with other disabilities, and adults not reporting disability in North Carolina

    Public Health Rep

    (2004)
  • H. Ouellette-Kuntz et al.

    Addressing health disparities through promoting equity for individuals with intellectual disability

    Can J Pub Health

    (2005)
  • E. Emerson et al.

    Contribution of socioeconomic position to health inequalities of British children and adolescents with intellectual disabilities

    Am J Ment Retard

    (2007)
  • M.C. Black et al.

    Adverse health conditions and health risk behaviors associated with intimate partner violence—United States, 2005

    MMWR

    (2008)
  • G.L. Krahn et al.

    Determinants of health: the BRFSS Health Behaviors and Outcomes Study

    J Intell Dis Res

    (2004)
  • Healthy People 2010

    (2001)
  • R.C. Brownson et al.

    Evidence-based decision making in public health

    J Public Health Manage Pract

    (1999)
  • A.M. Kilbourne et al.

    Am J Public Health

    (2009)
  • V.A. Campbell et al.

    The Healthy People 2010 process: difficulties related to surveillance and data collection

  • D.L. Braddock

    Public financial support for disability at the dawn of the 21st century

    Am J Ment Retard

    (2002)
  • J.E. Bickenbach

    Disability human rights, law, and policy

  • L.O. Gostin et al.

    What does social justice require for the public's health? Public health ethics and policy imperatives

    Soc Justice

    (2006)
  • H. Bersani et al.

    Governmental policies and programs for people with disabilities

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    Financial disclosure: The authors have no financial disclosures to report.

    The findings and conclusions in this paper are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The authors gratefully acknowledge the audience comments at the APHA 2009 Chair's Forum and comments of Michael Fox and Charles Drum to an earlier draft of this paper.

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