James H. Rimmer, Ph.D., Director

People with disabilities often experience health disparities because of the many environmental barriers that they are confronted with when trying to improve their health. These include poor physical access, societal attitudes, and lack of quality medical care. Mounting evidence suggests that there are social, health and economic consequences to the isolated and sedentary lifestyles that are associated with barriers in the built environment. As a result of limited physical function and access to their environment, people with disabilities have a higher rate of social isolation compared to the general population. This isolation has resulted in a lack of social networks and diminished social capital, which has likely contributed to higher levels of obesity in the disabled population.

Research has demonstrated that the more supportive an environment is in terms of access to health promoting behaviors, the more likely people are to engage in these health-enhancing activities. One of the major barriers to health promotion and physical activity among people with disabilities is accessible transportation. In several research studies that have been conducted in NCPAD, transportation was shown to be one of the leading barriers for people with disabilities living in Chicago. It's very difficult for many individuals with disabilities to leave their homes in order to go grocery shopping, see their doctor, or visit with friends or family members. Sadly, as budget cuts proliferate across state, city and local governments, transportation services provided to people with disabilities are often among the first to be affected.

A recent case was reported by Access Living, an independent living center in Chicago: "This fall, the Chicago Transit Authority (CTA) approved a budget that will raise the cost of a paratransit ride from $1.75 to $3.50, and raise the cost of a monthly pass to $150. The service cuts and the fare increases were originally slated to go into effect on January 1. Many people with disabilities depend upon paratransit services as their only resource for transportation. For those who receive SSI [Social Security Income], the proposed rate hike will dramatically limit their ability to travel. At a board meeting on December 16, after strong protests from the disability community, the CTA agreed to postpone the fare increase. In addition, the CTA voted to postpone service cuts and layoffs. Congratulations to disability and transportation advocates."

Increasing fare rates for persons with disabilities would have a profoundly negative impact on their ability to access community services and to engage in health promoting physical activity. For some individuals, getting to the train station or bus stop requires such a high level of energy expenditure that it becomes almost impossible to do on a regular basis. This is the very reason why specialized transportation is necessary. Ironically, the proposed increase was not due to cost of living increases but rather a recommended doubling of the fare! It's difficult enough for people with disabilities to make ends meet. Proposed increases in transportation would make it impossible for many to visit their doctor regularly, go to the senior center for various services, or travel to a grocery store or fitness center to engage in health enhancing activities. Recently, my mother who has significant arthritis and is only able to walk a few hundred feet without stopping to rest, was administered a physical exam by the New York Health Department to determine if she was eligible for door-to-door transportation service. Based on her low performance on the test, she was issued a transportation card and is able to continue doing her own grocery shopping, visiting the doctor more regularly, and volunteering at a local elementary school a short distance from her apartment. It's wonderful to see someone with such significant mobility limitations able to maintain a fairly active schedule and stay engaged with her community. Apparently, what the New York Health Department has learned is that a few extra dollars budgeted for transportation on the front end likely saves substantial dollars on the back end. In times of budget crises, increasing transportation costs for the disabled may not be the most effective approach to balancing the budget.