The Inequality

Running head: The Inequality of Access to Healthcare

The Inequality of Access to Healthcare for the Disabled

Lycia L. Harris
Jacksonville State University

The Inequality of Access to Healthcare for the Disabled

The Inequality

Vulnerable populations are populations at risk. The American Journal of Medicine defines
a vulnerable population as: the economically disadvantaged, racial and ethnic minorities, the
uninsured, low-income children, the elderly, homeless, those with human
immunodeficiency virus (HIV), and those with other chronic health conditions, including severe
mental illness (ajmc.com, 2006). Disparities and issues in vulnerable populations must be
identified quickly and dealt with at both local and national levels. The Advanced Public Health
Nurse is in good position to assist those considered vulnerable with their issues. Some causes of
disparities include: ethnicity, race and socioeconomic factors.
Public health initiatives should be aimed at identification of those at risk. Careful
monitoring of at risk groups and proper reporting of data to focus groups and governmental
agencies should be done to aid that identification. People with disabilities are a vulnerable
population and often receive inadequate and unequal healthcare compared to those who do not
have disability. It is important for community health nurses to include those with disabilities when
mapping out health promotional activities.
The American government was based on the premise that every citizen is entitled to the
protection that is brought about under basic human rights (Stanhope & Lancaster, 2012). People
with disabilities, however, were in the last group of people in the United States to receive human
rights protection (Stanhope & Lancaster, 2012). The disabled often face discrimination that leads
to feelings that they are not actually a part of American society (Stanhope & Lancaster, 2012).
The Americans with Disabilities Act of 1990 was the first comprehensive civil rights legislation for
persons with disabilities (Stanhope & Lancaster, 2012). One of the most important impacts of the
passing of this bill was the emphasis that was placed on community care for the disabled instead
of institutionalizing them and the growing emphasis on providing care in as much of a home like

The Inequality

environment as possible (Stanhope & Lancaster, 2014). One of the biggest issues those with
disability face is access to appropriate and equal healthcare (Stanhope & Lancaster, 2014).
Healthy People 2020 is a governmental initiative designed to improve the health of the
American people. The vision, mission, and overarching goals provide structure and guidance for
achieving the Healthy People 2020 objectives (healthypeople.gov). While general in nature, they
offer specific, important areas of emphasis where action must be taken if the United States is to
achieve better health by the year 2020 (healthypeople.org). Developed under the leadership of the
Federal Interagency Workgroup (FIW), the Healthy People 2020 framework is the product of an
exhaustive collaborative process among the U.S. Department of Health and Human Services
(HHS) and other federal agencies, public stakeholders, and the advisory committee, Healthy
People 2020 identified and outlined topics of importance related to disabled Americans
(healthypeople.org). Objective DH-4: Reduce the proportions of people with disabilities who
report delays in receiving primary and periodic preventative care due to specific barriers,
addresses the differences and difficulties those with disabilities face in obtaining healthcare related
to those who do not have disabilities (heathypeople.gov).
Home visits, one of the ways to increase access to health care to disabled Americans, was
identified through data obtained by healthypeople 2020, as a means of increasing vaccination
rates. The home visits were conducted by nurses or social workers. In these visits, the
vaccination record of the client was reviewed and vaccinations were administered or referrals
were made to other vaccination resources after a brief educational session on the importance of
recommended vaccinations (thecommunityguide.org). Home visits to the disabled proved
effective. Home visits were either a primary or sole intervention or one component of a larger
healthcare system or community-based programs to increase vaccination rates
(thecommunityguide.org).

The Inequality

The Centers for Disease Control or, CDC, recommends surveillance efforts to monitor the
health of Americans with disabilities. Programs such as population based surveys to identify
important information about adults with disabilities serves to improve the health of the disabled
compared to those without disability (cdc.gov). The CDC found 40% of adults with disabilities
reported fair or poor health compared to the 10% of adults without disabilities (cdc.gov). Of
those with disability, African Americans, Hispanics and Native Americans reported fair or poor
health at disproportionately high rates compared to Whites or Asian American (cdc.gov). The
study also found that adults with disabilities are more likely to be obese, smoke and be physically
less active than adults without disability (cdc.gov).
CDC supports the development and implementation of health promotion interventions for
people with disabilities (cdc.gov). Many activitiesphysical activity, smoking cessation,
nutritious diets, preventive screeningspromote the same healthy behaviors as those encouraged
for people without disabilities (cdc.gov). Still, there are many barriers that exist for people with
disabilities that prevent them from participating in exercise and health sustaining activities
(cdc.gov). Barriers are things such as inaccessible health care facilities or health screening
equipment, discriminatory attitudes, poverty, and lack of knowledge among people with
disabilities or their health care providers (cdc.gov). Activities that promote healthier behaviors for
people with disabilities can include education and support for making healthier choices, thereby
improving their quality of life which is directly in line with government health promotion
objectives (cdc.gov).
Access to healthcare for the disabled is a very important issue facing our country.
Research has shown there is a great disparity between the types of health care Americans with
disabilities experience verses those Americans who do not have disabilities. Careful monitoring of
at risk groups and proper reporting of data to focus groups and governmental agencies should be

The Inequality

done to aid that identification. Public health nurses must focus care on prevention, education and
communication so those at risk dont fall between the cracks.
This is not always easy due to lack of available public health resources and changes to
healthcare policy. In order for the APHN to be effective, he or she must stay abreast of
information, community resources, and healthcare laws and intervene when necessary. This type
of community/population based behavior falls directly in line with the objective of Healthypeople
2020 which states: expandtheknowledgebaseandraiseawarenessaboutdeterminantsofhealth
forpeoplewithdisabilities(healthypeople.gov).

References
CDC Promoting the Health of People with Disabilities. (n.d.). Retrieved from:
http://www.cdc.gov/ncbddd/disabilityandhealth/pdf/aboutdhprogram508.pdf
Disability and Health. (n.d.). Retrieved from: http://www.healthypeople.gov/2020/topicsobjectives/topic/disability-and-health.

The Inequality

Guide To Community Preventive Services [Internet]. Atlanta: Centers for Disease Control and
Prevention (US), Office of Surveillance, Epidemiology, and Laboratory Services,
Epidemiology and Analysis Program Office, Community Guide Branch; [updated 2013 Mar
14]. Universally Recommended Vaccinations: Home Visits to Increase Vaccination Rates;
[updated 2012 Jun 19; cited 2013 Feb 11]. Available from
http://www.thecommunityguide.org/vaccines/universally/homevisits.html
Stanhope, M., & Lancaster, J. (2012). Public health nursing: Population-centered health care in
the community (8th ed.). Maryland Heights, MO: Mosby/Elsevier
Vulnerable Populations: Who are they? Retrieved from: The American Journal of MedicineOnline
http://www.ajmc.orgAnderson, Charles & Johnson (2003). The impressive psychology
paper. Chicago: Lucerne Publishing.

The Inequality

The Inequality