Introduction: Health Promotion for People with Disabilities: The Need for a Transitional Model in Service Delivery
Health promotion has been defined as the process of enabling people to increase control over their health and to improve it. This process requires personal participation and supportive environments. For people with disabilities, however, personal participation is often limited by non-supportive environments. Inaccessible exercise facilities, lack of knowledge on how to modify programs to meet specific needs, poor attitudes, and unfriendly environments often create insurmountable barriers to participation for many people with disabilities. While innovative medical technology has increased the life span of individuals with disabilities, little attention has focused on improving their health span. The reportedly high incidence of chronic secondary conditions seen in persons with disabilities, including pain, fatigue, low functional capacity, obesity, and depression, is often related to environmental conditions that include poor health promotion practices.
Smith wrote: "People with disabilities therefore represent significant health needs and investment in health care resources, both in terms of the primary disability and secondary complications. Although the prevention of these conditions is important, of equal importance is to make living with them as healthy as possible, as many disabilities are life-long. Although health promotion may be significant in leading to lower levels of premature mortality, higher quality of life and lower health care costs for the general population, it has the potential to be even more significant for those already with a disability, whose quality of life and independence rely critically on their ability to maintain their narrow margin of health."
With the emerging concept that individuals with disabilities can improve their health in the same manner as anyone else, there is growing momentum for providing quality health promotion programs for people with disabilities. Maintaining health and wellness is especially important for people with disabilities because functional limitations that often accommodate a primary impairment (e.g., neurological dysfunction) may reduce a person's capacity to engage in health promoting behaviors and result in a higher frequency of secondary conditions. These secondary conditions are defined as "...physical, medical, cognitive, emotional, or psychosocial consequences to which persons with disabilities are more susceptible by virtue of an underlying impairment, including adverse outcomes in health, wellness, participation and quality of life". The purpose of this paper is to provide an overview of health promotion for people with disabilities in the core domains of exercise, nutrition and health education, and to describe a health promotion service delivery model that addresses the gap in services between rehabilitation and community-based health promotion.