1. Empowering people with physical
disabilities through the use of cloud
computing so they could be brought
back in the “normal world”.
Thierry Rolina
MKT624 Winter 2011
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2. INTRODUCTION ...................................................................................................................................... 3
ENVIRONMENT ANALYSIS .................................................................................................................. 3
Overview................................................................................................................................................ 3
Current Interaction between the disabled and their environment ........................... 5
Value creation ...................................................................................................................................... 5
Current state of Co-creation in the existing value chain ..................................................... 7
Co-creation between the disabled and the government ................................................ 7
Co-creation between the disabled and the communities .............................................. 9
Conclusion and proposed way forward .................................................................................... 9
ENGAGEMENT PLATFORM OPPORTUNITIES .......................................................................... 10
Engagement between the government and the communities ....................................... 11
Current DAT ................................................................................................................................. 11
Proposed DAT .............................................................................................................................. 11
Engagement between the government and the disabled ................................................ 11
Current DAT ................................................................................................................................. 11
Proposed DAT .............................................................................................................................. 12
Engagement between the communities and the disabled .............................................. 12
Proposed DAT .............................................................................................................................. 12
Design of platforms ........................................................................................................................ 12
Capabilities required ......................................................... Error! Bookmark not defined.
Challenges -> human for most of them ....................... Error! Bookmark not defined.
Conclusion .............................................................................................................................................. 13
References .............................................................................................................................................. 13
(1) 2006 American Community Survey Content Test report .................................... 14
(2) The elephant in the waiting-room ................................................................................ 15
(3) HealthDay News .................................................................................................................. 17
(4) Creating Public Value through Private/Public Partnerships................................ 17
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3. INTRODUCTION
This paper aims at applying some of the co-creation concepts studied in MKT624 in
the public and social sectors to explore how people with physical disabilities can be
empowered and brought back in the normal life.
The first section provides some background data and highlights the current status of
co-creation.
The second section offers possible enhancements to the current situation.
ENVIRONMENT ANALYSIS
Overview
Census data provides meaningful insight into what disability really is. Disability was
first used in the 1880 census, and was used until 1910. At that time, disability had a
completely different connotation and was rather related to primary health
conditions such as sensory conditions, health conditions, deformities… Disability
then disappeared until 1970 when it re-surfaced in the census with a focus on its
economic impact and more specifically limitations to working at a job.
Based on this data, Congress passed the rehabilitation act of 1973.
Below are some excerpts of the Rehabilitation act of 1973:
Congress finds that--
(1) millions of Americans have one or more physical or mental disabilities and the number of Americans
with such disabilities is increasing;
(2) individuals with disabilities constitute one of the most disadvantaged groups in society;
(3) disability is a natural part of the human experience and in no way diminishes the right of individuals to-
-
(A) live independently;
(B) enjoy self-determination;
(C) make choices;
(D) contribute to society;
(E) pursue meaningful careers; and
(F) enjoy full inclusion and integration in the economic, political, social, cultural, and educational
mainstream of American society;
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4. (4) increased employment of individuals with disabilities can be achieved through implementation of
statewide workforce investment systems under title I of the Workforce Investment Act of 1998 that provide
meaningful and effective participation for individuals with disabilities in workforce investment activities
and activities carried out under the vocational rehabilitation program established under title I, and through
the provision of independent living services, support services, and meaningful opportunities for
employment in integrated work settings through the provision of reasonable accommodations;
(5) individuals with disabilities continually encounter various forms of discrimination in such critical areas
as employment, housing, public accommodations, education, transportation, communication, recreation,
institutionalization, health services, voting, and public services; and
(6) the goals of the Nation properly include the goal of providing individuals with disabilities with the tools
necessary to--
(A) make informed choices and decisions; and
(B) achieve equality of opportunity, full inclusion and integration in society, employment, independent
living, and economic and social self-sufficiency, for such individuals.
A recent report covering disability (1) (US census bureau) identifies four basic areas
of functioning that identified the largest component of population of people with
disabilities: vision, hearing, mobility, and cognitive functioning. According to the
2006 ACS survey, 15.1% of the population - about 41.3 million people - age 5 and
above reported a disability. Of the population 16 years and over, 5.5% reported a go
outside disability (mobility), and those 16 to 64 years old 7.1% reported an
employment disability. Disability prevalence was highest among the 65 years and
older population at 41% compared to rate for the 16 to 64 years age group (12.3%),
and 5 to 15 years age group (6.3%).
In summary, disability has societal and economic impacts and these impacts are
prone to worsen as people live older. It is urgent for the communities and the
government to act and try to mitigate these impacts by bringing the disabled back
into the “normal life”.
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5. Current Interaction between the disabled and their environment
Our baseline value chain consists of the following entities:
- The governments – comprising federal, and state
- The communities – comprising the cities, the working and living
communities
- The NGOs
- The disabled themselves
The federal government is the legislating body. The federal government, through the
social security administration, provides assistance to people with disabilities via
disability insurance (DI) and supplemental income (SSI). According to the
Economist (2), DI accounted for around 18% of social security spending in 2009, up
from 10% in 1989. Still according to the Economist, the rules defined by the federal
government for DI eligibility are ill defined.
Disabled interact with communities when they work, live, consume…
MIUSA.org references around 100 NGOs in the United States. These NGO, are usually
very focused, either geographically or around types of disability. Their goals vary
from the promotion of interests of the disabled to the improvement of their life.
In summary, there are numerous entities all along the value chain that have the
potential to interact independently with the disabled. There is little communication
between these entities if communication is not needed.
In the case of communities communication with government is reduced to
compliance.
All of this creates a climate in which the governments legislate, with the risk of
producing laws that areill effective and expensive.
Value creation
Unlike in the private sector there is no notion of shareholder value in the public and
social sectors. The notion of value is subjective and commensurate to the level of
service provided. In “creating public value through Private/Public Partnerships”,
Mark H. Moore (4) asserts that value may not be the maximum welfare for the
maximum number of individuals but rather what we can collectively agree we
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6. would like to achieve using the powers of the state. This ultimately requires new
models that can be inclusive for all stakeholders.
We can safely say that value is created for the disabled as soon as their condition
can be improved. In the case of physically disabled, that would mean improved
mobility and interaction with the outside world.
The equation is a little more difficult to describe when it comes to communities. For
instance, compliance to the fair housing act can be first perceived as a cost to
society. On the other hand, the first to comply will build an image of “fair player”,
which will ultimately bring respect and value. There is also the opportunity to
broaden the market by opening the services to a new segment of customers.
Value creation for the disabled
Value is created through solutions to needs of the disabled.
Numerous technologies today have the ability to bring value to the disabled by
providing some of the functions that they have lost. For instance,a person with
reduced mobility may enjoy his/her freedom again by using an electric wheel chair.
Another example comes to mind with earing aids, which have become very common
today.
Social groups are working closely with the disabled; they range from special interest
groups such as sports to general-purpose activities such as the best place to live.The
Guidestar database references 801 NGOs in the United States dedicated to the
physically disabled. More than half of these associations have less than $1M in
income and $1M in assets.
Facebook has a section dedicated to disabled.
Value created for the government
The social security insurance pays benefits to the insured disabled, which could be
an open door to a blank check if no close monitoring process is in place. This is the
case for mental illness and back pain – a subset of musculoskeletal disorder – which
represented respectively 22% and 31% of DI awards in 2009. The opportunity to
better legislate would translate into a cost saving opportunity for the social security
administration.
Another example is obesity - a subset of mobility disability –which is estimated to
cost $270 (3) billion per year of which $120 billion are in excess medical care.
Closed-loop monitoring of the condition (active diagnosis and suggestion of
procedures) would also translate directly into cost savings.
Value created for the communities
First, economic value is created as communities have access to a larger pool of
consumers. Disabled individuals and their families have a discretionary spending
power that tops $200 Billion annually. The challenge here will be to have the ability
to answer the special needs of the disabled. For instance, physically disabled often
need special housing.
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7. Second, greater awareness is required to make communities disabled-aware and
help elected official understand that people with disabilities are not burden or
charity cases but contributing members.
Current state of Co-creation in the existing value chain
In this section, we will look at the various co-creation initiatives that have been
taken by the stakeholder along the value chain.
Co-creation between the disabled and the government
The government has launched numerous initiatives to build awareness on disability.
disability.gov
Disability.gov is an award-winning federal government website that provides an
interactive, community-driven information network of disability-related programs,
services, laws and benefits. Through the site, Americans with disabilities, their
families, Veterans, educators, employers and many others are connected to
thousands of resources from federal, state and local government agencies,
educational institutions and non-profit organizations.
Since July 2009, Disability.gov has implemented both social media and
personalization tools, offering an enhanced experience for all visitors. Among the
new features is the ability to register for a My Disability.gov profile, which allows
users to vote and comment on resources participate in group forums and view
additional resources that are recommended based on their actions on the site.
Visitors can also follow daily tweets on Disability.gov’s Twitter account, connect
with other fans on Facebook and LinkedIn or read weekly guest blogs from experts
on disability issues on Disability.Blog.
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8. Yet, despite this effort, a brick wall exists between the disabled and public sector.
Statistically, seventy percent of all SSD (a.k.a. SSDI) and SSI claims are denied at
application. This practically means for SSD and SSDI applicants that they need to
seek help either from NGOs or from a disability attorney if the want to increase their
odds of having their application accepted.
I can campaign
This campaign airs on YouTube at
https://www.youtube.com/watch?v=BG_W7wAe1kw&feature=player_embedded
The Campaign for Disability Employment is a collaborative effort to promote
positive employment outcomes for people with disabilities by encouraging
employers and others to recognize the value and talent they bring to the workplace.
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9. The video had only 34,370 hits since its launch on September 2009.
Co-creation between the disabled and the communities
These efforts are mainly driven by non-profit organizations
Non profit organizations
Since 1991, project Genesis has been providing assistance to disabled in
Connecticut. The organization acts as a seeker-solver portal and provides job
development, job assistance and job coaching services through funding from the
bureau of rehabilitation. Project Genesis has a network of employers in every
industry and at every level of employment. Hiring employers get a federal tax credit
up to $2400 per employee.
Communities
Most large cities have a Mayor’s office for people with disabilities. The office
promotes participation and equal opportunity for people with disabilities.
Conclusion and proposed way forward
Insofar, our research shows an intent at co-creation from the federal government
through disability.gov but the site lacks on the three dimensions of accessibility,
dialog, and transparency.
On the dimension of accessibility, the government must address the concern raised
bywww.pewinternet.org. In essence, even though the disabled seem to be more
attached to technology in their home, computers are the exception. 56% of the
disabled have or use a computer compared to 72% of all Americans.
Regarding dialog, people with disabilities perceive the use of Internet to be
confusing and hard to use (21% of the disabled v. 9% of the non-disabled).
Finally, there is little –to no transparency to information in disability.gov.
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10. I have not found any similar initiative that links the communities to the disabled.
This is an area where non-profit organizations are active. From what I could see,
there seems to be a “do not care” attitude about the disabled from the communities;
the small amount of hits for the “I can“ campaign warrant this.
What we will explore next are ways to improve the government and the
communities understanding of the disabled needs so proper dialog and true co-
creation with the disabled can be started. But before co-creating between the blue
and the yellow, we will first pay close attention at co-creating within the blue world.
ENGAGEMENT PLATFORM OPPORTUNITIES
As previously stated, disability.gov can be tuned to become a co-creation platform.
The first motivation is that the disabled get medical coverage through Medicaid and
Medicare, so the platform could be used to enroll on line, check benefits, and access
services that would potentially bring the disabled into the stream of normal life. It
will be key to enroll all the stakeholders into the design of the platform, particularly
NGOs and city government, as they represent the closest link to the disabled.
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11. Engagement between the government and the communities
Current DAT
Dialog - Low
The dialog between the government and the communities is administered
through the Mayor’s office for people with disabilities in large communities.
Accessibility - low
Only a handful of large cities have a web portal: NYC, Chicago and Houston. In
other metropolis, there is no such facility.
Transparency – low
Whenever it exists, the site provides little transparency into the various
government initiatives.
Proposed DAT
There is a tremendous opportunity to build awareness for the disabled needs in the
communities regardless of their size. As stated previously, there is a need to make
the communities disabled-aware and help elected officials understand that disabled
are not a burden but rather represent an economic and social potential.
Dialog and Accessibility
Dialog between government and communities should be enhanced by NGOs and/or
charities through regular dialog with the communities. Several forums can be used
and among others: meetings, local radio talks come to mind.
Transparency
Increased transparency can be provided to communities by explaining the
economical and social benefit of transparently caring for disabled
Engagement between the government and the disabled
Current DAT
Dialog - Low
The current platform is used as a one-way channel from blue to yellow
although blog posting is available. There is no way for the disabled to post
what their expectations and aspirations are.
Accessibility - high
The website is always available, although there is apparently reluctance from
this users group to use the Internet.
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12. Transparency – medium
The site provides some level transparency into the various government
initiatives.
Proposed DAT
Dialog
First dialog should be initiated by the charities and the various NGOs working in the
field. They know most the needs of the disabled hence they will be able to overcome
their resistance to adopt and embrace the new engagement platform.
Accessibility
Disability.gov should be re-designed to be more user-friendly. A new voice-control
front end would be a plus so arm- and hand- disabled can also use the platform.
Transparency
We propose to extend disability.gov to include a secured access so disabled can log
in, and check their status, fill forms…
We propose to add a blogging section for the communication with the government
agency. For example, a physically disabled person may be interested to go back to
work, but he/she is encountering difficulties. A section dedicated to difficulties may
be appropriate too.
Engagement between the communities and the disabled
This is an area where NGOs and charities are very active and by no means do we
want to replace them.
Proposed DAT
We propose to extend disability.gov to extend its reach to the local community.
Disability.gov should provide a job portal available so the disabled can log their
resumes, capabilities, skills… for those who wish to return to work. A similar
capability should also be offered to employers.
Design of platform
The extensions proposed will require a re-design of disability.gov particularly in the
areas of:
- Providing a secured access
- Providing voice control access to the site
- Re-designing the site front end so it is user friendly and easy accessible to
non-computer literate people
- Providing blogging capability and semantic analysis– a key component to
analyze trends in needs
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13. In addition, NGOs and charities will have to work closely with the government, as
these organizations understand the needs of the disabled. Getting the new platform
adopted by both the communities and the disabled will decide of its success.
I view the new platform potentially evolving into a nodal component, which could
attract new businesses and ventures in the future.
Conclusion
For the first stage of the co-creation engagement, using cloud computing does not
seem to be a necessary component. It will be key to first engage the communities
through NGOs and charities and bring awareness that there is value for everybody
in bringing back the physically disabled in the normal world.
I would recommend pilotingthe engagement at a local level in a mi-size city that has
a diversified industrial landscape.
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14. References
(1) 2006 American Community Survey Content Test report
After reviewing the results of the 1996 NCS in terms of reliability and validity and
presenting the information to a group of experts, including the Interagency Subcommittee
on Disability Statistics, the Census Bureau found that still more questions remained and
the choice was not clear. Hence, another federal interagency work group was convened in
June 1997 by the Office of Management and Budget and charged with the development
of a short set of disability questions. The interagency work group faced three tasks in a
short period of time: (1) measuring disability using a definition in keeping with the ADA,
(2) meeting the needs of various agencies requiring specific information, and (3) having a
maximum of six questions. The work group agreed that three domains (sensory, physical,
and mental/emotional/cognitive) sufficiently represented the broad classification of
impairments and health conditions that generally resulted in disability. Additionally, the
work group concluded that it could meet an array of other policy and programmatic
requirements with three questions on difficulty with specific types of functional activities.
Their questions intended to address people with limitations in performing the following:
Activities of Daily Living, which generally include self-care type activities such
as bathing or dressing; Instrumental Activities of Daily Living, which are activities often
associated with independent living such as going out alone to shop or visit a doctor's
office; and, finally, working at a job or business. The work group’s consensus set of
questions was put on the Census 2000 long form and on the ACS. (For further discussion
of the research and analysis undertaken by this work group, see Adler et. al.)
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15. (2) http://www.economist.com/node/18332928?story_id=18332928
Disability payments
(2) The elephant in the waiting-room
Politicians are ignoring a big, dysfunctional programme
Mar 10th 2011 | LAKE COUNTY, INDIANA | from the print edition
It only hurts when I work
THOMAS SCULLY has a busy law office in Lake County, Indiana. He mainly practices disability law,
with good reason. Lake County is home to steel mills. Workers have aching backs and hands warped by
machinery. Mr Scully helps them win Social Security Disability Insurance (DI), which provides cash and,
after two years, access to Medicare, government-subsidised health insurance meant mainly for the elderly.
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16. DI is not supposed to be a safety net for the jobless. “I tell clients”, Mr Scully explains, “disability
insurance is not unemployment insurance.” But they should be forgiven for being confused.
Politicians like to deride expensive programmes. DI may be the least discussed and most muddled. The
programme is severely strained. The number of awards has spiked in the downturn, rising 28% since 2007.
This surge follows decades of growth. DI accounted for about 10% of Social Security spending in 1989 but
18% by 2009. This is not because beneficiaries are bending any rules; the real problem is that the rules are
a mess.
Congress created DI in 1956. Since then physical labour has become less common, while medical
technology has advanced. One might have thought that DI rolls would shrink, but the opposite has
occurred. Even compared with the Social Security Administration’s other costly programme for the
disabled, DI is huge. Supplemental Security Income (SSI), which gives help to the very poor, doled out $43
billion to adults and children in 2010, up 124% since 1990. DI gave $110 billion to disabled workers, up
almost 420%.
The reasons for this are debated. States have an incentive to keep their welfare rolls low, so they may be
pushing workers towards the federally funded SSI and DI programmes, argues Nancy Shor of the National
Organisation of Social Security Claimants’ Representatives, a lawyers’ group. But unlike SSI, DI is not a
substitute for welfare; DI requires beneficiaries to have worked for five of the past ten years.
Ageing would seem another obvious explanation, as those aged 50-64 account for almost 60% of DI
awards. But the rolls grew quickly even when the share of 50- to 64-year-olds was steady, according to
David Autor of the Massachusetts Institute of Technology and Mark Duggan of the University of
Maryland. Obesity does not seem to be the main cause either. Beneficiaries claiming problems such as
diabetes and heart disease comprised a sliver of the awards in 2009.
A more likely culprit is the programme’s structure. Messrs Autor and Duggan show that DI awards have
become more attractive to those struggling in the labour market. Those awards, meanwhile, have become
more accessible. In 1984 Congress made it easier for DI applicants to claim mental illness and
musculoskeletal disorders such as back pain—both inherently subjective ailments. In 2009 these two
conditions accounted for 22% and 31% of DI awards, respectively, about double their share in 1981. Even
if an applicant does not meet DI’s basic medical requirements, he may eventually win payments for other
reasons. DI’s rules, for example, allow an older worker unlikely to retrain to get benefits instead. Persistent
applicants can seek the help of lawyers. Of those who appeal their case to a judge, almost 90% are
successful.
Given DI’s design, it should come as little surprise that enrolment jumps during recessions. Till von
Wachter of Columbia University offers three explanations. First, impaired workers may be among the first
to be sacked. After they are laid off, they may find that they qualify for DI, as is the case for many of Mr
Scully’s clients. Second, DI’s criteria explicitly include economic factors, such as the ability to retrain.
Third, those desperate for cash may use more subjective criteria, such as mental illness and “bad back”, to
try to win benefits. Many will fail, but they can appeal.
The Social Security Administration has tried to fix some of these problems. The “ticket to work”
programme, for example, is intended to help DI and SSI beneficiaries get jobs. But as of November 2010,
just 2.4% of those offered job help actually received it (let alone found work). A newer pilot also
encourages those on the rolls to find jobs. Such programmes seemed doom to fail, trying to convince
beneficiaries that they can find work after they have spent years arguing otherwise. More effective, says
Richard Burkhauser of Cornell University and the conservative American Enterprise Institute, employers
should be given incentives to accommodate workers at the onset of their disability. A separate plan by
Messrs Autor and Duggan, for the centre-left Hamilton Project, calls for all employers to offer disability
insurance.
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17. A solution is needed, and soon. The DI trust fund is expected to dry up in 2018, 22 years before the trust
fund for Social Security retirees does. Nevertheless, budget hawks have flown over the issue. Barack
Obama’s deficit panel said proposals to reform DI would be “critical” but were “beyond the scope of this
commission.” Last year Paul Ryan, a Republican congressman, presented a bold plan for reforming
entitlements. Of DI, the plan said simply: “disability benefits will see no change.”
(3) HealthDay News
MONDAY, Jan. 24 (HealthDay News) -- The economic cost of overweight and obesity is estimated at
$300 billion per year in the United States and Canada, with 90 percent of the total cost attributed to the
United States, according to a study published in December by the Society of Actuaries.
Donald F. Behan, Ph.D., from the Georgia State University Center for Risk Management and Insurance
Research in Atlanta, and colleagues reviewed almost 500 research articles on obesity and associated
morbidity and mortality. The study examined the economic costs resulting from increased requirements for
medical care, loss of economic productivity due to excess mortality, and disability.
The investigators estimated the total economic cost of being overweight (body mass index [BMI] between
25.0 and 29.9) and of obesity (BMI at or over 30). The main economic costs included excess medical care
($127 billion), loss of productivity due to excess mortality ($49 billion), economic loss of productivity for
active workers due to disability ($43 billion), and loss of productivity caused by total disability ($72
billion).
"The total economic cost of overweight and obesity in the United States and Canada caused by medical
costs, excess mortality, and disability is approximately $300 billion per year. The proportion of this total
due to overweight is approximately $80 billion and approximately $200 billion is due to obesity," the
authors write.
(4) Creating Public Value through Private/Public Partnerships
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