Defining Secondary Conditions for People with Disabilities
By Jennifer Rowland, Ph.D.
While there is agreement that secondary conditions can be debilitating, costly in terms of financial and social consequences, and potentially fatal in some circumstances, there is much debate within the disability community as to how to define secondary conditions.
Workshop on Disability in America: A New Look was published by the Institute of Medicine. In it, leading experts within the field of disability wrote about such topics as: (1) secondary conditions and disability; (2) impact of exercise on targeted secondary conditions; (3) secondary conditions with spinal cord injury; (4) depression as a secondary condition in people with disabilities; and (5) promoting health and preventing secondary conditions among adults with disabilities. This publication provides an excellent resource on the topic of secondary conditions, yet even within its pages lie differing opinions as to what constitutes a secondary condition.
Some views favor a narrow scope of identifying secondary conditions as primarily physiological in nature. Examples of these secondary conditions would include pressure sores, urinary tract infections, and deconditioning. Other, broader views of secondary condition definitions include environmental factors such as access to health services and structural barriers located within the environment that affect the health status of people with disabilities. Counter to this view is that environmental barriers actually represent issues of limited participation, not secondary conditions.
Those who argue for the narrower definition point out that when secondary conditions are thought of as expanding to include the larger issues of “disability,” this broad scope dilutes the larger need to promote access, modify attitudes, and increase societal participation. However, others point out that environmental barriers represent conditions affecting the health status of people with disabilities and therefore fall within a broad definition of secondary conditions. This broad definition is supported by the Healthy People 2010 Report (Chapter 6, Disability and Secondary Conditions), which lists secondary conditions as "medical, social, emotional, family, or community problems that a person with a primary disabling condition likely experiences."
What is needed is a clear way in which to define secondary conditions, which has not yet been determined based on differences within the literature. For example, some researchers include psychosocial factors such as 'feelings of being isolated' and 'problems getting around' in the definition of secondary conditions, whereas others adhere to a strictly body systems/structures [medical] definition. Some difficulties such as 'problems getting around' could be attributed to internal problems such as muscular atrophy and fatigue, or to environmental conditions such as difficulty accessing a transportation system. Missing from the literature is scientific evaluation of secondary conditions in ways that allow for evidence-based practice using tested prevention interventions. A universal definition of secondary conditions would contribute to this level of examination and would allow for comparison of results across studies and populations.
While both sides agree that environmental barriers are often the key to successful participation for all people with disabilities, there is disagreement as to where these barriers fit within the definitional framework of secondary conditions.