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Accessibility in Health Care
- 1. ACCESSIBILITY IN HEALTH CARE Raven Ellison Tulane University Health Equity, Fall 2021
- 2. • Disability is the interaction between individuals with a health condition and their personal and/or environmental factors. Source: American Foundation for the Blind
- 3. ACCESSIBILITY IN THE UNITED STATES People who live with disabilities find a number of barriers accessing health care. These barriers have some crossover with ‘able’ individuals but are largely unique to their condition and position in society. This includes: -Cost -Limited services -Physical barriers -Lack of skill among health care workers
- 4. NOTABLE MOMENTS IN DISABILITY HISTORY
- 5. ACCESSIBILITY IS A PUBLIC HEALTH ISSUE • One billion (or 15%) of individuals worldwide live with some form of disability as of December 2020. This number is trending upward as incidence of chronic illnesses increases and populations continue to age. • Disability is quite diverse, some individuals require significant health services while others have disabilities that are “hidden,” that is, they do not present themselves outwardly. • Disability is not often included in public health conversations and is often left out of the social determinants of health.
- 6. ACCESSIBILI TY DURING THE COVID- 19 PANDEMIC • Vision impaired individuals found it difficult to schedule vaccination appointments as scheduling sites were not compatible with screen readers. • Types of disability had not been collected in health care settings, making data- driven, tailored outreach difficult. • For hearing impaired individuals, masks made it difficult to communicate, as many health care workers are not trained in sign language and the hearing- impaired person could not read their lips.
- 7. ACCESSIBILITY DURING THE COVID-19 PANDEMIC • Frequent hand washing and distancing proved difficult for those living in group settings. • Lack of resources within those homes as well as difficulties with distancing was reflected in high rates of infection and death among group and senior
- 8. SOCIAL AND INDIVIDUAL EFFECTS OF DISABILITY • Disability can change many aspects of a person’s life from the personal, to the social, to their position in society, job prospects, and values. Source: Public Health Perspectives on Disability
- 9. SOLUTIONS AND GUIDANCE • The Biden-Harris administration rolled out the COVID-19 Health Equity Task Force to research and address the inequities caused by and exacerbated by the pandemic. • John Hopkins Disability Health Research Center launched the COVID-19 vaccine priority dashboard. This will allow them to assist states in prioritizing disabled communities. This will also provide the data needed to target treatments in the future. • Telehealth services have been improved to include remote symptom monitoring, however; adoption of telehealth services remains relatively slow.
- 10. SOLUTIONS AND GUIDANCE • Increase use of mobile, drive-up, and/or temporary medical facilities especially in remote or rural areas where access to care is limited. • Use of clear masks by healthcare workers would allow for hearing impaired patients to lip read, making communication easier. • Virtual sign-language interpreters allow for social distancing while allowing patients to speak with their providers more efficiently. Source: theclearmask
- 11. CHANGING THE WAY WE THINK AND SPEAK ABOUT DISABILITY Source: Public Health Perspectives on Disability
- 12. REFERENCES • Fernandez, G. F. (2021, March 31). COVID-19 Continues to Highlight Gaps in Accessibility for People with Disabilities. Johns Hopkins Bloomberg School of Public Health. https://publichealth.jhu.edu/2021/covid-19-continues-to-highlight-gaps-in-accessibility-for-people-with-disabilities • Froehlic-Grobe, K., Douglas, M., Ochoa, C., & Betts, A. (2020). Social Determinants of Health and Disability. Public Health Perspectives of Disability. In: Lollar D.J., Horner-Johnson W., Froehlich-Grobe K. (eds) Public Health Perspectives on Disability. Springer, New York, NY. https://doi.org/10.1007/978-1- 0716-0888-3_3 • Hartman, M. H. (2021, March 31). COVID-19 Continues to Highlight Gaps in Accessibility for People with Disabilities. Johns Hopkins Bloomberg School of Public Health. https://publichealth.jhu.edu/2021/covid-19-continues-to-highlight-gaps-in-accessibility-for-people-with-disabilities • Oulton, A. O. [TEDxTalks]. (2015, February 18). Changing the Way We Talk About Disability [Video]. YouTube. https://www.youtube.com/watch?v=4WIP1VgPnco • McKee M, Moran C, Zazove P. Overcoming Additional Barriers to Care for Deaf and Hard of Hearing Patients During COVID-19. JAMA Otolaryngol Head Neck Surg. 2020;146(9):781–782. doi:10.1001/jamaoto.2020.1705 • Using Telehealth to Expand Access to Essential Health Services during the COVID-19 Pandemic. (2020, February 11). Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html
Editor's Notes
- Cost: Healthcare costs are a barrier to many individuals. Over half of individuals living with a disability cannot afford healthcare compared to a third of the population without disability. Limited service availability: Services available to disabled individuals are limited, especially in rural or remote areas. The services that are available leave disabled individuals with many needs still unmet. Physical barriers: Lack of accessibility to buildings, inaccessible medical equipment, and even poor internal building design are some of the factors disabled individuals must deal with when attempting to access care. The World Health Organization points to the fact that cancer screening devices are often unable to be adjusted to accommodate patients who cannot stand for testing. Lack of skill among healthcare workers: Disabled individuals reported that their providers were unable to meet their specialized needs at a rate more than double that of individuals who do not have a disability. They also reported being denied care at more than triple the rate of non-disabled individuals, and report poor treatment by healthcare workers at a rate more than four times than that of non-disabled individuals. https://www.who.int/news-room/fact-sheets/detail/disability-and-health
- Disability came into the American consciousness following the American civil war, which caused 30,000 amputations in the union army alone. However, throughout history disabled individuals were treated as an afterthought at best and a nuisance at worse – banished to poorly funded hospitals and group-homes. A century later, disability advocates began to make significant headway in obtaining equal rights and accessibility for the community. Accessibility standards were created and adopted beginning in 1961, and in 1990 the Americans with Disabilities act was signed into law by former President George HW Bush. http://www.ncld-youth.info/Downloads/disability_history_timeline.pdf https://ds.gmu.edu/disability-history/
- One billion individuals over the age of 15 live with some form of disability. Many of these individuals have signification difficulties with everyday functions and require constant healthcare services. Disability is often not included in public health conversation and is therefore left out and overlooked in national health strategies. When considering the social determinants of health, disability must be included to achieve the goal of optimal care for all. Think about what we have learned about how racism and gender plays a part in health outcomes. People who occupy multiples of the intersections of race, sexuality, and disability are at an even bigger disadvantage and tend to experience poorer health.
- The covid 19 pandemic disrupted traditional care and services. Healthcare workers largely shifted to treating surging cases, minimizing risk, and testing. The pandemic shone a light on where we fall short when it comes to accessibility in healthcare. For example Many vaccination sites were not compatible with screenreaders making it difficult for vision impaired individuals to schedule vaccine appointments. Health officials largely could not target disabled individuals living outside of care facilities because they did not know what kind of disability they were living with (unlike race, ethnicity demographics which ARE collected and could be used for outreach).
- The basic COVID-19 guidelines implored individual actions such as masking, hand washing, and social distancing. However, for those that lived in group settings this proved difficult and it showed in the infection and death rates among those populations. However, we can make some changes that will allow us to take care of these populations more intuitively.
- Disabilities can change everything about a person’s life. Persons living with a disability can experience greater rates of poor health and higher rates of depression. However, while a disabled person’s needs may increase, disability does not automatically correlate to poor health status. Many of the difficulties they face are modifiable with better access to services, support, and medical equipment when necessary – necessitating a need to reframe how we speak and think about disability
- Thankfully, there has been some movement in addressing the issues the pandemic exacerbated.
- A person’s physical and social environment has a direct effect on how they live with their disability. With the right resources, disabled individuals can live full and healthy lives. We can continue with the ineffective measures of the past, and risk excluding many wonderful people and all the multitudes they contain from society. Or, we can endeavor to make a few adjustments that allow them to fully participate in society.