Disability & Public Health Research
During the past 30 years, the conceptualizations of “disability,” “health and wellness,” and the role of the “environment” in the disabling process have changed dramatically (Krahn, 2003). In the mid-1980’s, national policy-maker’s focus was on the primary prevention of disabilities began to be extended to the prevention of “secondary disabilities” (Marge, 1988). Subsequently transformed into “secondary conditions,” this concept highlights the increased risk that people with a primary disabling condition experience for additional health (and social) conditions that occur after their primary condition and result in poorer health. Secondary conditions are often regarded as substantially responsible for the health status differences that are observed between people with and without disabilities (Seekins, Clay, & Ravesloot, 1994; Wilber, Mitra, Walker, Allen, Meyers, & Tupper, 2003). Secondary conditions are defined as preventable health conditions by some authors (Simeonsson & Leskinen, 1999) but not others (Campbell, Sheets, & Strong, 1999).
Efforts at measuring and preventing secondary conditions date back to the work of Seekins in the early 1990s. Since then, numerous researchers have reported on the increased prevalence of particular physical (e.g., pressure sores, diabetes), mental (e.g., depression, anxiety) and social (e.g., social isolation, unemployment) conditions experienced by persons with specific diagnostic conditions (e.g., cerebral palsy, spinal cord injury), who self-identify with a disability (e.g., Kinne, Patrick, & Doyle, 2004; McDermott & Platt, 2004; Turk, 2004; Wilber et al., 2003).
Disability & Health Disparities
Defining the term “disparity” is an enterprise marked with nearly as many approaches as defining “disability.” Health disparity has been defined as broadly as population-specific differences in the presence of disease, health outcomes, or access to health care (HRSA, 2000), and as restrictively as differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention (Smedley, Stith, & Nelson, 2002). For the purposes of this article, health disparities are defined as population-specific differences in health indicators between people with disabilities and those without disabilities.
The need for ongoing surveillance of health and disability has been recognized in Healthy People 2010 with its call to add standardized disability identifiers to national surveillance instruments (Objective 6.1). Even with the irregular or limited number of large-scale population based data, information from a number of reports consistently document that people with disabilities, as a group, experience worse health than the general population. People with a variety of physical and cognitive disabilities are also more likely to experience early deaths, chronic conditions, and potentially preventable secondary conditions (Campbell et al., 1999; Lennox, Beange, & Edwards, 2000; Turk, Scandale, Rosenbaum, & Weber, 2001; USDHHS, 2001). People with disabilities have some of the highest rates of oral disease (NIDCR, 2002) and higher rates of diabetes than the general population (McDermott & Platt, 2004). Adults, adolescents, and children with mental retardation compared with other populations experience poorer health and more difficulty in finding, getting to, and paying for appropriate healthcare (USDHHS, 2002). These differences are underscored by disparities in other areas of wellness including lower rates of high school completion, higher unemployment, and fewer social activities (USDHHS, 2001).