|
|
Disability
|
 |
Include
in North Carolina surveillance instruments and special studies a standardized
set of questions that identify "people with disabilities."
Developmental
Objective, baseline data to be collected in 2001. Increase
the proportion of adults with disabilities reporting sufficient
emotional support.
Increase
the proportion of adults with disabilities reporting sufficient
emotional support.
Target:
73.9 percent.
Baseline, 1998: 65.4 percent adults 18 years and older
with disabilities reported sufficient emotional support.
Target Setting Method: 13 percent improvement (parity
with adults without disabilities in 1998).
Increase
the proportion of adults with disabilities reporting satisfaction
with life.
Target:
96.8 percent.
Baseline, 1998: 88.0 percent adults 18 years and older
with disabilities reported satisfaction with life.
Target Setting Method: 10 percent improvement (parity
with adults without disabilities in 1998).
|
 |
|
Disability
|
Disability is an issue
that affects every individual, community, neighborhood, and family
in North Carolina, either directly or indirectly. There are hundreds
of different disabilities. Some are present from birth; many come
later in life. Some are chromosomal, like Down-Syndrome. Some are
progressive, like muscular dystrophy and cystic fibrosis. Some are
episodic, like seizure conditions. Others have both aspects like multiple
sclerosis, which is progressive and episodic. Some conditions happen
in an instant, like the loss of a limb or paralysis. Some disabilities
are visible, while others, like diabetes and epilepsy, are invisible.
Disabilities are numerous and different in nature and form. However,
regardless of specific condition, people with disabilities encompass
a population of people who have too often been discriminated against
in many of aspects of society. Disability is a natural part of the
human experience that does not diminish the right of the individual
to enjoy the opportunity to live in and contribute to the mainstream
of American society. Most people with disabilities have the potential
to lead healthy and productive lives if given the opportunity to attain
it and fully participate in all aspects of community life.
It is estimated that 54 million Americans,
or nearly 20 percent of the population, currently live with disabilities.
National data for the period 1970 to 1994 suggest that the proportion
is increasing. The increase in disability among all age groups indicates
a growing need for public health programs serving people with disabilities.
According to the 1998 North Carolina Behavioral Risk Factor Surveillance
System an estimated 23 percent of noninstitutionalized adults experience
activity limitation and/or perceive themselves to be a person with
a disability. In another study based on the National Health Interview
Survey 20.5 percent of North Carolina children ages 3-17 reported
having one or more special needs (disability or chronic health condition).
Because disability status has been
traditionally equated with health status, the health and well being
of people with disabilities has been addressed primarily in a medical
care, rehabilitation, and long-term care financing context. Four
main issues emerge from this contextual approach: 1) the belief
that all people with disabilities automatically have poor health;
2) the belief that preventing disabling conditions should be the
major focus of public health; 3) the lack of a crosscutting, standard
definition of "disability" or "people with disabilities"
for public health; and 4) the absence of discussion about the role
of the environment in the disabling process.
People with disabilities need quality
health promotion and disease prevention services. They are at risk
for developing the same chronic conditions as the rest of the population,
including high blood pressure, heart disease, cancer, diabetes,
and substance abuse. In some instances, people with disabilities
may even be at increased risk. Prevention including self-care and
counseling, screening for early detection, appropriate and timely
treatment, and early recognition and reduction of known risks, are
as important for people with disabilities as they are for everyone
else. Much of the health promotion developed for use in the general
population can be used directly with people with disabilities. In
some cases, new strategies will need to be adapted or developed.
|
| |
|
Disparities
|
Disparity issues related to disability are
complex. People with disabilities, like other groups that have been
historically disadvantaged, have higher rates of unemployment, lower
incomes, fewer educational opportunities, fewer living options, and
face an ongoing struggle for inclusion. Although the Americans with
Disabilities Act (ADA), enacted in 1990, was created to address many
of the barriers to participation in society, full implementation has
not yet been realized.
People with disabilities also encounter
significant structural, financial, and personal barriers that limit
their access to health and health-related care. Those who are elderly,
members of minority groups, or who live in rural areas face additional
barriers. Structural barriers, such as the unavailability of services
and the lack of accessible transportation, buildings, and programs
are a major concern for people with disabilities. People with disabilities
also face a number of financial barriers in accessing services including
obtaining affordable insurance that does not restrict or exclude
coverage of needed services. Personal barriers, including attitudes,
knowledge, and communication also influence access to care for people
with disabilities. Consumers report that many health care providers
focus on their disability and fail to deal with critical primary
care issues. Communication with people with disabilities may involve
adapting the print size or content of written materials, using interpreters,
working with special communication devices, or recording instructions.
Few data systems identify people
with disabilities as a subpopulation. Disparities need to be identified
to plan appropriate public health programs. Despite the paucity
of data, some disparities between people with and without
disabilities have been noted. These disparities include excess weight,
reduced physical activity, increased stress, and less frequent mammograms
for women over age 55. People with disabilities also report more
days of pain, depression, anxiety, and sleeplessness than people
without disabilities. In addition, many people with disabilities,
particularly those with mobility impairments, report they experience
one or more conditions generally associated with aging (pain, fatigue,
loss of function, and loss of independence) beginning as early as
their twenties. Although more research is needed to understand the
incidence and cause of certain secondary conditions, evidence indicates
that many of these complications are preventable.
|
| |
|
Determinants/Risk
Factors
|
| Birth defects, developmental disabilities,
injury, illness or disease, genetics, and aging |
| |
|
|
|
| Disability |
|
|
|
