Public Health Issue

Arthur Marshall

Las Colinas Blvd, Texas, US

APHA and Disability Awareness

From Chicago to San Francisco…

Public Health and Disability

• Public health has historically been most important prevention oriented (e.g., immunizations, automobile safety belts).

• Those who produce disease or accidental injuries (e.g., polio, SCI) frequently “fall through the cracks.”

• Today we have 54 million Americans with disabilities -- 54 million--oopses!

Significance of the Problem

• Professional medical technology and advancements have increased rates of survivors with severe trauma or serious circumstances.

• Survivors experience long treatment, yet health care program capitation forces compressed therapy and recovery time.

• Public health can provide a beneficial contribution in the health of people with problems as they move from medical settings into group living.

Significance of the Problem• As of 9/30/03 there

were over 267,000 older people with disabilities living in nursing homes all over the US who want to live more separately in the community.

Source: www.cms.hhs.gov/states/mdsreports/res2.asp

Significance of the Problem• Over 70% of adults

with handicaps are jobless, in comparison to the typical unemployment amount for non-disabled persons of 6%.

• Source: N.O.D./Harris Survey of Americans with Disabilities, 2000; US Dept of Labor Bureau of Labor Statistics October, 2003.

HP 2010 Leading health indicators:• Overweight and Obesity  • Substance Abuse    • Mental Health  • Immunization  • Access to Health Care • Tobacco Use  • Injury and Violence  • Physical Activity  • Environmental Quality  • Responsible Sexual Behavior

HP 2010 Leading health indicators:• Physical Activity  • Overweight and Obesity    • Substance Abuse  • Mental Health  • Environmental Quality  • Immunization  • Responsible Sexual Behavior  • Injury and Violence • Tobacco Use

• Access to Health Care 

Reported by: VA Campbell, PhD, JE Crews, DPA, L Sinclair, MPH, Div of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, MMWR, September 13, 2002.

Getting Back to Work• Ticket to Work and

Work Rewards Enhancement Act of 1999 (TWWIIA).

• Gives people with handicaps resources to come back to work, or improve their current work situation (i.e., part time to full time).

Getting Back to Work• TWWIIA ticket tracker

• As of 11/03/2003 over 5,626,633 “Tickets to Work” have been issues to people with disabilities across 34 states.

• Only 3,168 have used them with employment networks.

Source: http://www.ssa.gov/work/Ticket/ticket_info.html

Attacking the Problems

• Public Health Research

• Public Health Practice

• Public Health Education

Public Health Research

• People with disabilities have at higher health risks for health problems than those without having disabilities.

• People have disabilities often have higher health disparities compared to non-disabled people.

• CDC and other federal companies are putting more interest on research to help increase positive health results for the 54 million Americans with disabilities.

Public Health Research• More exploration

needs to target both person and environment factors and their interactions to health outcomes.

• Essential progress is being made in the statistic of the natural environment and disability.

Person Factors

Environment F

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Public Health Research

• The IOM review, Allowing America noted that the majority of government funded disability research is focused on person factors (e.g., cure).

• Little public funding is being spent on environment risk and protective factors that affect health outcomes for individuals with present disabilities.

• CDC is one significant exception.

Public Health ScienceImportant milestonesHealthy People 2010 – Chapter 6

• 13 health and fitness objectives working specifically with people with disabilities and their health differences.

• The cornerstone of this chapter is objective one whose result is that “disability status” be included as a demographic variable in all health-related reviews.

Public Health ScienceImportant milestonesInternational Classification of Functioning (ICF)

• The ICF is the public health complement to ICD. ICD categorizes etiology to frame case definitions for primary protection.

• ICF classifies human functioning for improved public health science and policy.

• ICF also enables classification and coding of environmental factors impacting human function.

Public Health Practice

• There needs to be better interpretation and “technology transfer” from the researcher to the PH practitioner—to improve particular public health results.

• “Living Well With a Disability”

• Research needs to be both rigorous and relevant.

Public Health Practice

• All public health courses need to recognize the at-risk position of people with disabilities.

• This can be obtained by including people with disabilities in the planning and execution of the 10 necessary public health services.

• Like other minorities, people with disabilities carry a unique skills to creating and applying public health activities.

Disaster Planning and Disability• Among those people with disabilities employed full or

part time, 50% say no plans have been made to safely evacuate their workplace.

• 58% of people with disabilities do not know whom to contact about emergency plans in their community.

• A public health collaboration to address disaster planning and emergency response for people with disabilities is currently under way in 30 national FEMA declared disaster counties.

NOD/Harris Poll, November 2001

“To leave footprints in the sands of time… you must wear work shoes.”

Arthur Marshall, Original Posted by Old African Proverb