Shift from Disability Prevention to Health Promotion
Studies on health promotion for people with disabilities are almost nonexistent. Although the federal government has made an effort in the last two decades to improve the health of Americans, there has been little emphasis on addressing the needs of people with disabilities. The Healthy People 2000 report that was developed over the course of several years and became the nation's road map to improving the health of supposedly all its citizens, exposed the glaring absence of baseline data on people with disabilities. In the lengthy report released by the federal government, Healthy People 2000: National Health Promotion and Disease Prevention Objectives, an expert panel wrote:
"As with minority populations, the elements of this report that explicitly call for [health] improvements of people with disabilities are limited by the availability of data with which to set targets. One of the major challenges of the coming years is to improve our understanding of the needs of the full range of people with disabilities by improving the effectiveness of data systems. The panel also wrote: A clear opportunity exists for health promotion and disease prevention efforts to improve the health prospects and functional independence of people with disabilities. Gaps, overlaps, inconsistencies, and inequities in existing programs require the effective coordination of people with disabilities is to be promoted."
The emphasis on prevention of disease and disability that has been entrenched in the American health care system for many years may be the underlying reason why it has taken so long for the health promotion movement to address the needs of people with disabilities. The absence of information on health promotion for people with disabilities has, in my view, kept this subgroup out of the limelight and in the background of research agendas across the country. Only recently has health promotion been given a greater amount of attention concerning the lives of people with disabilities.
In the emerging paradigm shift from disease and disability prevention to prevention of secondary conditions in people with disabilities, physical therapists and other rehabilitation professionals can play an important role in the integration of health promotion into the fabric of a community. As noted by Renwick and co-workers, "Rehabilitation has strong potential as a collaborator in the process of making health promotion people-centered in that it has collective expertise in client centeredness at the individual level of analysis and application." According to Teague et al, "In restructuring health promotion services for people with disabilities, rehabilitation professionals are challenged to assume the roles of collaborator, educator, researcher, and program provider."