“There is no such thing as a single-issue struggle because we do not live single-issue lives”-Audre Lorde

Health disparities among people with disabilities are a significant public health concern. Despite advancements in healthcare, individuals with disabilities often experience poorer health outcomes, limited access to healthcare services, and higher rates of chronic conditions. For local health departments (LHDs), advocating for inclusive health policies is not just a matter of equity but a necessity to ensure the well-being of all community members.

Understanding Health Disparities

People with disabilities are more likely to experience chronic health conditions, such as diabetes, heart disease, and obesity. Additionally, they often encounter barriers to accessing healthcare services, including physical obstacles, communication challenges, and a lack of provider knowledge about disability-specific health needs.

A study in Women’s Health Issues revealed that women with disabilities are less likely to receive preventive healthcare services, such as mammography and Pap smears, compared to those without disabilities. This disparity highlights the urgent need for targeted interventions and inclusive policies and demonstrating the intersectional nature of health disparities among women with disabilities.

Intersectionality: Race, SDOH, and Disability

Health disparities are further exacerbated when disability intersects with race and other social determinants of health (SDOH). People with disabilities from racial and ethnic minority groups often face compounded disadvantages, including socioeconomic challenges, discrimination, and limited access to resources.

A study in Frontiers in Rehabilitation Sciences investigated the intersection of race and disability to understand better if the healthcare needs of Black and Hispanic adults with disabilities are being met in comparison to Black and Hispanic adults who did not have disabilities. This study concluded that racial and ethnic minorities living with disabilities are likely to experience intersecting disparities.

Inclusive Policies to Address SDOH

Creating policies that address SDOH is crucial for reducing health disparities among people with disabilities. LHDs can advocate for:

1. Affordable Housing: LHDs can ensure that housing policies consider the needs of people with disabilities, including accessibility features and proximity to healthcare services. The Chicago Healthy Homes Initiative, an outcome of the Healthy Chicago 2025 plan, addresses health inequities, including housing issues. This initiative includes improving housing accessibility and safety, particularly focusing on reducing hazards like lead poisoning in high-risk communities. The Chicago Department of Public Health (CDPH) collaborates with community partners to ensure homes are safe and accessible, addressing both environmental health risks and the specific needs of residents with disabilities.

2. Education and Employment Opportunities: LHDs can promote inclusive education and employment practices to enhance economic stability and health outcomes. Local governments are required to have Americans with Disabilities Act (ADA) Coordinator since they are government agencies covered by Title II of the ADA. These ADA Coordinators are subject matter experts available to co-create inclusive communication and accessible programs. Identify and connect with your local ADA Coordinator to develop collaborative strategies for the empowerment of people with disabilities through education and employment opportunities.

3. Accessible Transportation: LHDs can improve transportation options to ensure people with disabilities can easily access healthcare facilities and community resources. The Healthy Chicago 2025 plan has made accessible transportation a priority in improving neighborhood vibrancy and quality of life.

Initiatives to Close the Gaps

Several initiatives can help address health disparities among people with disabilities:

1. Training and Education: LHDs can provide disability competency training for healthcare providers to improve their understanding and responsiveness to disability-related health needs. The Colorado Department of Health Care Policy & Financing offers disability competency training for healthcare providers. This training focuses on improving access to appropriate care and addressing the physical and cultural competencies of healthcare facilities. The program includes modules and resources designed to help providers deliver more effective and equitable care to patients with disabilities​

2. Community Outreach: LHDs can effectively address the health needs of the disabled community by engaging with disability advocacy groups. This collaboration involves partnering with disability-led organizations and disability service organizations to conduct comprehensive assessments, create specialized training programs, lead focus groups for data collection, and develop and update policies and resources. For example, The New York City Department of Health and Mental Hygiene engages with various disability advocacy groups such as Disability Rights New York (DRNY) and the NYC Mayor’s Office for People with Disabilities. Such partnerships ensure that the interventions are tailored to the unique needs of the disabled community, thereby enhancing the effectiveness and inclusivity of health programs.

3. Data Collection: LHDs can educate stakeholders on the importance of including disability status in health research and data collection efforts to better identify and address health disparities. This advocacy is essential for identifying and addressing health disparities among people with disabilities. To achieve this, LHDs often collaborate with academic institutions and disability-led organizations to conduct comprehensive research and disseminate findings. The Johns Hopkins Disability Health Research Center uses data-driven approaches to shift the focus from “living with a disability” to “thriving with a disability”. They have successfully advocated for the designation of people with disabilities as a “health disparity population” by the National Institutes of Health (NIH). This designation has enabled more inclusive health research funding and programs.

4. Enhancing Accessibility of Health Services: Accessibility in healthcare is essential to ensuring that medical facilities are equipped to accommodate individuals with disabilities. This includes structural features such as ramps, wide doorways, and accessible restrooms. Equally important is the presence of healthcare professionals who are competently trained to support patients with disabilities, ensuring they receive respectful and effective care. The Special Needs Dental Surgery Program at Washington University in St. Louis (WUSTL) exemplifies this approach by collaborating with academic institutions such as A.T. Still University, Affinia Healthcare, and Barnes-Jewish Hospital to provide dental care under general anesthesia for adults with severe disabilities. This program addresses a critical gap in dental care access for vulnerable populations with disabilities, ensuring comprehensive treatment in a hospital setting.

5. Emergency Preparedness and Response: People with disabilities often face greater risks during emergencies due to mobility issues, communication barriers, and other factors. To address these challenges, it is crucial to develop inclusive emergency preparedness plans that support the needs of individuals with disabilities. This includes conducting training and drills that incorporate scenarios involving people with disabilities and ensuring that shelters and emergency response services are accessible to all. The Hamilton County Health Department and Southeast Regional Health Department in Tennessee have enhanced emergency preparedness for people with disabilities by creating an emergency management interpreting team, conducting inclusive simulation exercises, and developing resources to support individuals with specific needs during emergencies​

Conclusion

Addressing health disparities among people with disabilities requires a multifaceted approach that includes inclusive policies, targeted initiatives, and community engagement. Local health departments play a pivotal role in this effort by advocating for and implementing policies that promote health equity. LHDs can commit to ongoing education, policy review, and community partnerships to support people with disabilities. By prioritizing the health and well-being of people with disabilities and addressing the gaps in health disparities we can create a more inclusive and healthier community for all.