Public Health Perspectives on Disability (eBook)

Deborah Allen is an Associate Professor of Maternal and Child Health at the Boston University School of Public Health. Prior to this, she directed the Maternal and Child Health program in the Massachusetts Department of Public Health.

Dedication 6
Foreword 8
Societal Importance of Addressing Disability 9
Significance of Textbook on Public Health and Disability 10
Major Themes Related to Public Health and Disability 11
References 14
Preface 16
References 19
Contents 22
About the Authors 24
Part I: Introduction 30
Introduction 31
Introduction 31
Foundations of Public Health Education 33
Stretching Public Health 34
References 39
Part II: Disciplines 41
Epidemiology and Biostatistics 42
Introduction 42
Defining and Some Parameters of Disability Epidemiology 45
Contributing Epidemiology Disciplines 47
Disability Surveillance Data and Secondary Analysis 48
Introduction 48
Measures and Classification of Disability 49
Selected Methodological Issues in Disability Research 55
Introduction 55
Sample Size 56
Measurement Issues (Classification and Bias) 57
Multilevel Studies 59
Field Methods in Disability Epidemiology 59
Protection of Human Subjects in Disability Public Health Research 60
Future Directions and the Role of Epidemiology 61
Epilogue 62
Appendix: Incorporating Disability Examples into Epidemiology Coursework, Questions, and Examples 63
Prevalence, Odds Ratios, Stratified Analysis (Confounding or Effect Modification), Study Design, and Causal Inference 63
Relative Risk, Classification, and Confounding 65
Classification and Proxy Response 67
Study Designs 70
Answers 71
Classification Validity and Corrections to Prevalence Estimates 73
Answers 74
References 75
Social and Behavioral Dimensions of Health 82
Background on the Topic in Relation to Disability 82
Course Content 82
Examining Disability Within Social and Behavioral Dimensions of Health 84
Relevance of Scholarship to Health and Well-Being of Individuals with Disabilities 86
Disparities 86
Injuries and Other High-Risk Behavior Leading to Disability 87
Behavioral Issues 87
Group Differences in Incidence of Disability 88
Examining Differences 89
Interaction and People with Disability 90
Disability as Minority 90
The Social Construction of Disability 91
Incorporating Disability Content into Scholarship in the Topic Area 92
Methods 92
Content 94
Social Support and Disability 95
Social Support and Health in People with Disabilities 96
Goals and Objectives for Integration of Disability Content 98
References 101
Disability in the Health Services Curriculum 107
Introduction 107
History of Attention to Disability Issues 108
Core Topics in Health Services 109
Health Care Financing and Access 110
Organization and Structure of Care 112
Health Services Workforce 114
Planning and Management 114
Outcomes Measurement 115
Incorporating a Disability Perspective into Health Services Research and Research Methods 117
Identification 117
Survey Research 118
Health Status and Outcomes 118
Health Promotion and Prevention 119
Clinical Practice Guidelines 119
HEDIS and Quality Improvement 119
Incorporating Disability Content into the Classroom 120
Financing of Care: Favorable and Adverse Selection 120
Comparison of Benefit Packages 121
Designing a Quality Improvement Program 121
Conclusion 122
NY 122
Details for the Reimbursement Exercise 123
MA 123
References 124
Environmental Health and Disability 127
Assessment 129
Policy Development 131
Assurance 134
Potential Public Health Projects for Disability and Environmental Health 138
References 139
Part III: Key Cross-Cutting Areas 141
Disability and Health Inequity 142
Introduction: Inequities in Health Access and Health Outcomes 142
Definitions 145
Inequity and Inequality 145
Determinants of Health 146
Social Determinants 146
Disability 148
Disability as Inability 149
Secondary Conditions 150
Conceptual Frameworks of Disability 151
Nagi Model 151
International Classification of Functioning, Disability and Health (ICF) 152
The National Center for Medical Rehabilitation Research 152
The Politics of Inequity 153
Minority Health and Health Disparities Research and Education Act of 2000 154
Healthy People 2010 155
Areas of Inequity 155
Access to Health Care 156
Private Health Insurance 156
Specific Source of Ongoing Care 158
Health Behaviors and Risk Factors 160
Healthy Weight 161
Tobacco Use 162
Alcohol Consumption 163
Leisure Time Physical Activity (Exercise) 163
Preventive Care 165
Breast Cancer Screening 165
Papanicolau Tests 165
Addressing Health Inequities 166
Current Efforts 166
Future Directions 167
Defining Disability 167
Data Collection 168
Educating Persons with Disabilities 170
Educating Health Providers 171
Establishing Local Advisory Councils 171
Summary 172
Resources 172
Questions for Students 173
References 173
Disability and Maternal and Child Health 176
Background and Context 176
Disability in MCH Training Today 179
The Content of MCH Courses: A Closer Look 181
Unaddressed Issues in the MCH Curriculum 183
The Benefits of Broadening Disability Content in the MCH Curriculum for the Field of Public Health 184
For the Disability Community 184
Strategies and Resources 185
References 185
Aging, Disability, and Public Health 187
Introduction 187
Pathways to Disability 187
Late Life Disability 188
Disease and Comorbid Conditions as Pathway to Disability 189
Progressive and Catastrophic Onset of Disability 190
Measurement and Conceptual Frameworks for Aging and Disability 192
Aging with a Disability 194
Cross-Cutting Themes 195
Physiological Reserve 195
Secondary and Comorbid Conditions 196
Pain and Fatigue 197
Depression and Mood 198
Aging Among Those with Specific Conditions 198
Down Syndrome 198
Traumatic Brain Injury 199
Spinal Cord Injury 199
Health Promotion and Aging with a Disability 199
Injury 200
Caregiving 201
Conclusion 202
References 203
Disability and International Health 208
Overview 208
Introduction to Conceptual Issues: Morbidity and Disability 209
Differentiating Between Morbidity and Disability 209
Disability: A Burden of Disease? 210
Stigma and Discrimination 210
The Role of Health Classifications in Legislation, Policy Formulation, Program Planning and Statistical Measurement 212
The ICF Framework for the Study of HumanFunctioning and Disability 213
An Example of the Use of ICF in the Descriptionof the Disability Experience 215
Environmental Factors Classified in Chapters of ICF (WHO, 2001, 43–44) 217
Seeing and Related Functions (Illustrative Examples Taken from ICF Descriptions of Body Function) 217
Learning and Applying Knowledge (ICF Illustrative Example of Activities and Participation) 218
An Example of the Use of ICF in Emergency Preparedness Planning 218
An Example of ICF Contextual Factors: Population Planning 220
Disability Policies and Programs and International Health 220
The World Programme of Action Concerning Disabled Persons (WPA) 221
Standard Rules on the Equalization of Opportunities for Persons with Disabilities 221
Convention on the Rights of Persons with Disabilities 222
Millennium Development Goals 223
International Health and Disability: A Matrix of Activities 224
Prevalence Rates and Target Setting Differ According to Goals Set for Services 226
Future Directions in International Measurement and Assessment of Human Functioning and Disability 227
The Fundamental Principles of Official Statistics 228
Conclusions 230
References 231
Disability Issues in Health Care Ethics and Law in the Public Health Curriculum 234
Health Care Ethics and Law in the Public Health Curriculum 234
Health Care Ethics and Disability 236
Health Care Ethics and Disability in the Public Health Curriculum 237
Health Ethics and Disability Content Areas 238
Autonomy 238
Reproductive Rights 240
Prenatal Screening and Genetics 241
End of Life Issues 243
Resource Allocation and Health System Performance 244
Integrating Disability Content into Health Care Ethics 246
Exercises 247
References 248
Section 504 the Rehabilitation Act and the Americans with Disabilities Act in Public Health Education 250
Introduction 250
Section 504 of the Rehabilitation Act and the Americans with Disabilities Act 251
Section 504 of the Rehabilitation Act 252
Passage of the ADA 253
What the ADA Covers 253
Title I: Employment 253
Title II, Part A: Public Entities: State and Local Government 254
Title II, Part B: Public Transportation 254
Title III: Public Accommodations 254
Title IV: Telecommunications 254
Title V: Miscellaneous Provisions 254
Americans with Disabilities Act Amendment Act 255
How the ADA and Section 504 of the Rehabilitation Act Work? 256
Reasonable Accommodation at a Glance 257
Implementation of the ADA and Section 504 257
Common Accommodations 259
General Accommodations that Benefit Students with Disabilities 261
Where the Laws Fall Short 262
Creating an Inclusive Public Health Graduate Program 266
Step One: Assemble a Task Force 266
Step Two: Assess Your Current Program 266
Step Three: Create a Long-Range Plan 267
Step Four: Advocate 267
Admissions 267
Financial Assistance/Scholarships for Students with Disabilities 268
Best Practices by Disability Groupings 269
Mobility Disability 269
Psychiatric Disabilities 270
Deaf and Hard of Hearing 271
Low Vision Disabilities 271
Cognitive Disabilities 272
Chronic Illness and Medical condition Accommodations 272
Basic Description 272
Etiquette 273
Conclusion 273
Websites 274
Index 277