Healthy communities begin with inclusion

1. Healthy communities begin with inclusion Anjali R. Truitt, MPH (artruitt@uw.edu) 1, Megan A. Morris, PhD, MPH, CCC-SLP2 1 Institute for Public Health Genetics, School of Public Health, University of Washington, Seattle, Washington, USA. 2Institute for Healthcare Studies, School of Medicine, Northwestern University, Chicago, Illinois, USA. • About this Project • Background • Disability has been ever-present in our communities and is becoming more evident, especially as veterans return from war, Baby Boomers age, and autism prevalence rises. • Given these changing demographics, the purpose of this project is to describe practices that public health students and professionals can utilize to foster inclusion of people with disabilities in community health planning and policies. • Methods • Problem Identification • What are the health needs of people with disabilities and how can they be more adequately addressed in community health planning and policies? • Policy Selection • We identified public policies and public planning agendas that directly and indirectly addressed health outcomes for people with disabilities. • For each identified policy or agenda, we reviewed the influence of key stakeholders in the policy development process, the scope of the problems and solutions articulated, as well as the reach. • Because of the involvement of disability groups and health professionals committed to improving health outcomes of people with disabilities, the range of health issues that were addressed, and the impact on a national scale, we conducted a targeted analysis of the Americans with Disabilities Act and the Healthy People 2020 Disability and Health objectives. • Americans with Disabilities Act • Legislative act passed in 1990 • Offers prescriptive guidelines about accommodations made to ensure access for people with disabilities • A person is defined as having a disability if s/he meets at least one of the following requirements: • 1. has a physical or mental impairment that substantially limits a major life activity, or • 2. has a record of such an impairment, or • 3. is regarded as having such an impairment. • The interpretation of “disability” experienced notable narrowing within the court system. • In 2008, the ADA Amendments Act revised and clarified this definition to provide the intended broad scope of protections to individuals with disabilities. Accessibility Toolkit for Health Professionals Access to Medical Care for Individuals with Mobility Disabilities This technical assistance publication outlines the ways that healthcare professionals can ensure than they are meeting the requirements of the Americans with Disabilities Act for healthcare facilities and services. Accessibility of State and Local Government Websites to People with Disabilities This technical assistance publication outlines the ways that public, web-based information, including health-related information, are meeting the requirements of the Americans with Disabilities Act. Deaf MD: Health Education in American Sign Language This web-based resource provides a collection of health education in American Sign Language on a range of health topics, including descriptions of screenings and diagnostic tests, as well as Deaf-friendly doctors listed by geographic location. Dental Services for Children with Special Health Care Needs: Treatment Guidelines and Medicaid Reimbursement Options This document provides an example of the treatment and insurance-related issues that might need to be assessed when thinking about accessible services for children with special health care needs. Involving People with Disabilities as Members of Advisory Groups: Rural Practice Guidelines (The University of Montana Rural Institute) This practice guideline provides suggestions about how to involve people with disabilities in the public decision-making process through participation in advisory groups. Making Community Emergency Preparedness and Response Programs Accessible to People with Disabilities This technical assistance publication outlines the ways that those involved in emergency preparedness can ensure the needs of people with disabilities are addressed during community planning. Making conferences and events accessible to people who are blind This article provides some basic tips to promote participation of persons who are blind or have visual impairments. Removing Barriers (North Carolina Office on Disability and Health) This publication series provides guidance about how to promote full and equal access to healthcare facilities and services for for people with disabilities. These 4 booklets address accessibility in both health services and public planning. This is by no means a comprehensive list of resources, but it does provide a starting place for health professionals looking to advocate for equal access to health facilities and services for people with disabilities. All of the resources described here are publically available on the web. Please feel free to contact the authors for direct links. • Key Terms and Concepts • Taken together, these policies highlight several components of inclusion that may help to promote health in our communities. • Health Needs • People with disabilities face similar chronic conditions as people without disabilities. • The health needs of people with disabilities most often relate to inaccessibility: • Environmental barriers • Discrimination and negative attitudes • Unequal educational and employment opportunities • Lack of reliable transportation • Inadequate communication methods • Health professionals who lack training and awareness about disability culture • Lack of community housing and supports • Universal Design • Different people have different needs. Across our lifespan and even day-to-day our needs change. • Universal design as a concept suggests that many of the needs of people with disabilities are not unique to people with disabilities, but rather are shared with other people. • From the frame of universal design, the best way to address our range of needs is to design our policies and practices in such a way that they work well for most people. • The classic example of this is curb cuts (the gradual grade change between a street and sidewalk). • The use of plain language is another applicationof universal design in public health. • Healthy People 2020 • Disability and Health Objectives • This evidence-based, 10-year public health planning agenda outlines specific objectives to address the health needs of people with disabilities. • Highlights the health disparities that exist for people with disabilities in comparison to the general population • Suggests that inclusion of people with disabilities in public health activities, every day life activities, and timely health interventions and services will help to mitigate these disparities • Offers relevant strategies to address these areas: • Encourage accessibility of communities, including promotion of community-based living • Promote equitable access to education, employment, and health services • Raise awareness about determinants of health for people with disabilities • The project's findings suggest several key areas for community-centered health planning and policy: • recognizing the diversity among those whom identify as people with disabilities and their health needs; • creating health information in multiple, alternative formats that goes beyond language translation; • advocating for physical and programmatic access to and participation in healthcare and community activities. We would like to acknowledge the Disability Studies Program at the University of Washington for facilitating the critical, formative discussions that led to the development of this presentation. Conclusions