Communication Disparities
The dearth of interpreters and health professionals trained in American Sign Language and the lack of assistive listening devices, TV decoders, and TTYs can create barriers for deaf and hard of hearing people in accessing healthcare and health promotion activities (Cardinal & Spaziani, 2003; O’Day et al., 2002; USDHHS, 2001). For people with vision impairments, the lack of readable signs and resources in alternative print formats can make participating in clinical encounters and in the healthcare system (such as reading a prescription) difficult. People with mental retardation and cognitive impairments experience a great deal of communication difficulty in accessing effective healthcare, including the lack of accessible documents in easy to understand “plain language” (Tuffrey-Wijne, 1997). According to the Surgeon General (USDHHS, 2002), these challenges are even more daunting for people with mental retardation from minority communities where services are not provided in their primary language or that follow their traditional cultural practices.
Health Promotion and Disease Prevention Disparities
The Surgeon General has stressed the importance of individual responsibility with regard to healthy behaviors and the importance of individuals with disabilities engaging in health-promoting activities to maintain wellness and prevent the occurrence of secondary conditions (USDHHS, 2002; 2005). People with disabilities are at higher risk of being overweight and obese, engaging in less physical activity, being sedentary, and using alcohol and tobacco (Patrick, 2002). The associations are well known between smoking and lung cancer, alcohol and other drug use and cardiovascular problems, hypertension and stroke, and being overweight and sedentary and experiencing diabetes and cardiovascular problems. Individuals with disabilities can take responsibility for a portion of their own health by becoming joint managers of their own rehabilitation program (Marge, 1994), engaging in healthy behaviors (such as maintaining a well balanced diet and engaging in a recommended program of physical exercise) and avoiding harmful behaviors such as tobacco use and substance abuse (Rimmer & Braddock, 2002). A number of factors may contribute to disparities in accessing disease prevention and health promotion programs. For example, the cost of participating in fitness programs, transportation difficulties, and lack of disability-knowledgeable staff are major barriers to successful health promotion (Rimmer, Braunscweig, Hedman, & Heller, 2002). Other important barriers to participating in health promotion programs may include the physical inaccessibility of health promotion facilities and equipment and a lack of information in accessible formats (Cardinal & Spaziani, 2003).