Health Equity and Disability
By Chris Mackey
There are several definitions of “health equity,” but most would agree with the Centers for Disease Control and Prevention’s (CDC) definition, which states that “Health equity is achieved when every person has the opportunity to ‘attain his or her full health potential’ and no one is ‘disadvantaged from achieving this potential because of social position or other socially determined circumstances.’”  There are two very important words to emphasize in this description: every person.
In the United States, between 12 and 22 percent of people identify as having a disability. [2,3] This means that on the high end, people with disabilities represent the nation’s largest minority group. They cut across racial, ethnic, age, and gender lines and experience varying challenges related to physical, mental, emotional, and/or sensory conditions. These limitations usually fall on a spectrum. No two individuals are exactly alike, even if they have the same condition.
We also know that this population experiences significant health disparities when compared to people without disabilities.  For instance, according to 2016 public health surveillance data, people with disabilities were more likely to be obese and have higher rates of smoking. 
So what can we do to ensure that people with disabilities are included in efforts to achieve health equity?
Re-think the word “disability.” When we see this word, it is often used to describe a deficiency that an individual has. Disability is talked about as a negative and intrinsic condition that disadvantages a person and therefore must be cured or fixed. This way of thinking is known as the Medical Model of Disability. In contrast, the Social Model of Disability states that disability results not from any physical or mental condition, but rather from environments and programs that do not accommodate or are not accessible to a person’s unique functional level. For example, it’s not a person’s physical disability that prevents them from going for a walk in their neighborhood, but rather the lack of sidewalks, curb cuts, and safe public crossings that are accessible to wheelchairs and other mobility supports. Likewise, it’s not a person’s intellectual disability that prevents them from learning how to manage a chronic illness, but rather the lack of programs that accommodate their learning needs.
Commit to inclusion. Creating healthy communities for people of all ability levels requires a focus on inclusion from the beginning. The National Center on Health, Physical Activity and Disability (NCHPAD) defines inclusion as transforming communities based on social justice principles in which all community members:
Are presumed competent;
Are recruited and welcomed as valued members of their community;
Fully participate and learn with their peers; and
Experience reciprocal social relationships.
Inclusive built environments, such as physical activity spaces, healthcare facilities, healthy food venues, and other locations, are accessible to everyone, regardless of their ability level. At a minimum, they should comply with accessibility laws like the Americans with Disabilities Act (ADA). Ideally, the places where people live, learn, work, play, and age should incorporate concepts of Universal Design, which creates environments that are usable by as many people with as many varied ability levels as possible. Programs should also be inclusive for people with disabilities. This means that there are accessible accommodations, services, and supports for people with disabilities so that they can participate in a program. Examples include ensuring effective communication by providing information in a variety of formats, using sign language interpreters, and providing staff to participants who may need extra help to take part in an activity.
Learn best practices for including people with disabilities in healthy community efforts. A good place to start is the newly-developed Competencies for Including People with Disabilities in Public Health. The Association of University Centers on Disability, in partnership with the CDC and others, developed four competencies designed to offer public health professionals knowledge, skills, and skills for including people with disabilities in public health practice.
Partner with people with disabilities. Reach out to disability organizations, such as centers for independent living (CILs), non-profits that focus on a specific condition, local government entities like a Mayor’s Committee for Persons with Disabilities, and professionals with adapted recreation or allied health disability expertise.
Use resources to help you develop, assess, and sustain healthy community efforts that include people with disabilities. For example, NCHPAD’s Inclusive Community Health Implementation Package provides guidance on creating healthy communities for all.