Health & Wellness for Persons with Disabilities

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Director of the Annu Institute Qaasen Sealy teaching students from Ann Hill the basics in self defense fitness kick boxing.

YOUNG people from the Ann Hill School were taught the art of defence that was run under the auspices of the justice for all programme, which was implemented by the Barbados council of the disabled. The class which seeks to empower persons with disabilities and teach them self confidence, as part of recent initiatives that aim to ensure the rights of persons with disabilities within the justice system.


In an interview with the Barbados Advocate, Joey Harper, the President of the Barbados Council for the disabled spoke about the pressing need to arm persons with disabilities with the necessary skills needed to protect themselves:

“The Barbados council of the disabled is an advocacy organization who have embarked with the government to bring this Justice improvement programme and by doing this we were able to identify some very basic needs, and if we could cover those needs we were in an excellent position for those persons with disabilities to function in a world that has been very negative to them. A lot of persons with disabilities are persons who are very vulnerable and are taken advantage of because they do not even know the very basic of how to block and cuff and run”.

Stressing that the class is not intended to promote or incite violence in any form Sealy said:

“This programme is not designed for anybody to fight or to kill anybody, or to get into arguments, one of the things they are learning to o is not attack and not to be offences in language either. So we took these children who I am happy to see are really working well on the programme and we let them see that they don’t always have to learn to fight back but have to learn to defend and you have to have the capacity to be able to run away. So this programme is to ensure that justice is given, we want justice happen and persons to be comfortable”.

The principle underlying this Call to Action is that, with good health, persons with disabilities have the freedom to work, learn and engage actively in their families and their communities. Health and wellness are not the same as the presence or absence of a disability; they are broader concepts that directly affect the quality of a person’s life experience. Research and clinical experience have shown that persons with disabilities can be both healthy and well (Krahn 2003). And good health opens the door to employment and education for per sons with disabilities, just as it does for persons who do not have disabilities.

 

This Call to Action’s goals and strategies for action, too, are based on a growing body of scientific knowledge and evidence-based practice about disability, health and wellness. They also recognize the costs of inaction in both human and economic terms. The impetus for this Call to Action has been the recognition that health is a key to realizing the goals of the President’s New Freedom Initiative (NFI) for persons with disabilities. Only with accessible, comprehensive health care and wellness promotion services can all persons with disabilities enjoy the intent of the NFI: full, engaged and productive lives in their communities.

 

Healthy People 2010, the national health promotion agenda, has included health indicators designed to measure how America is promoting the health of per sons with disabilities, to prevent secondary conditions and to eliminate health disparities that now affect per sons with disabilities. It identified four main misconceptions that continue to plague how disability status has been perceived: (1) disability is equated with poor heath status; (2) public health should focus only on preventing disabling conditions; (3) no standard definition of disability is needed for public health purposes; and (4) the environment is not a factor in the genesis of disability.

 

These Healthy People 2010 goals are reflected in those of the Call to Action, which calls for: (1) public knowledge and understanding about disability, (2) provider training and capacity to see and treat the whole person and not just a person’s disability, (3) health and wellness promotion for persons with disabilities, and (4) access to needed health care services for persons with disabilities. The balance of this section discusses these goals.

 

GOAL 1:

People nationwide understand that persons with disabilities can lead long, healthy, productive lives.

Despite progress in science, technology and advocacy, disabilities of all kinds are still equated—incorrectly and by too many people—with ill health, incapacity and dependence. Welner and Temple (2004) point out that the misperception remains that “only a person who is physically agile and neurologically intact can be considered healthy.” Similarly, with regard to individuals with mobility difficulties, Iezzoni (2003) has observed that “much of society still holds persons with mobility difficulties individually responsible for problems….” Early disability advocate and sociologist Irving Zola (1982) suggested some believe that mobility difficulties are a weakness or personality defect to be overcome. Age-old perceptions, misunderstandings and fears, while still prevalent, are far from the reality of disability today.

The reality is that with accommodations and sup ports, ample access to health care, engagement in wellness activities and the impetus that comes from supportive friends and families, persons with disabilities can— and do—lead long, productive, healthy lives. Issues about disability and the lives of persons with disabilities increasingly are becoming part of the American consciousness and are beginning to be addressed.

 

Secondary Conditions

The presence of a particular disability is not the only factor a health care provider should consider when working to meet ongoing, quality health and wellness needs of a person with a disability. Rather, the health care provider should also pay close attention to the person’s full range of health concerns, including the onset of possible secondary conditions. These are medical, social, emotional, family, or community problems for which a person with a primary disabling condition is at increased risk (Marge 1988; Simeonsson and Leskinen 1999; Krause and Bell 1999; McMillen et al 1999; Wilber et al 2002).

Some have suggested that the high direct health care costs of disability are a result of insufficient attention early on to secondary and other health needs of individuals with disabilities. The result is increasing numbers of persons with multiple, complex and often preventable, chronic conditions and a health care system insufficiently prepared educationally, structurally and economically to recognize and address those needs (Panko Reis et al 2004; U.S. Department of Health and Human Services 2003; Institute on Disability and Development 2003). The vast majority of these secondary conditions can be mitigated with early intervention; many can be prevented altogether.

Some individuals with disabilities develop no specific secondary health issues related directly to the condition or conditions accompanying their disabilities. Rather, they require only a routine regimen of ongoing health care. However, many persons with disabilities experience secondary conditions directly related to their disability.

A recent Centers for Disease Control and Prevention-supported study by Kinne and colleagues (2004), the first population-based prevalence study of its kind, suggests why clinical attention to secondary conditions among persons with disabilities is a critical element in the quality-of-life equation. They found that 87 percent of persons with disabilities reported experiencing a secondary medical condition.

Persons of all ages with disabilities are susceptible to secondary conditions. For example, unrecognized and untreated depression coupled with another kind of disability potentially places children at risk for poor school performance, developmental delay lost potential as adults in the workforce and community, and suicide (U.S. Department of Health and Human Services 2003). Depression also is not an uncommon secondary condition among adults with such potentially disabling illnesses as diabetes, arthritis and heart disease. In persons of all ages, mobility limitations can lead to decubitus ulcers (pressure sores), lost muscle tone and gait instability. Substance use disorders occur more often in persons with a disability than in the general population. This includes problems related to the abuse of prescription medications as well as illicit drugs (Moore and Li 1998; Heinemann et al 1991; Fann et al 1995). Moreover, an injury such as a hip fracture, may give rise to fears about loss of independence, triggering depression, lowered immune function and factors that can exacerbate or increase the risk for still other secondary conditions. These issues take on particular significance for older adults, who run a greater-than-average risk of multiple disabling conditions than do younger individuals (National Institute of Mental Health 1999).

 

GOAL 3:

Persons with disabilities can promote their own good health by developing and maintaining healthy lifestyles. Healthy living is a positive concept—a concept that has been highlighted through health promotion and disease prevention efforts for people of all ages, from smoking cessation to obesity control, from the value of exercise to the benefits of mental health. Maintaining good health by adopting healthy lifestyle choices, both physical and mental, is a key component of a satisfying life. It is a goal of the U.S. Department of Health and Human Services, and embodied in both its Healthier US Initiative and the objectives for Healthy People 2010.

 

When it comes to persons with disabilities, healthy behaviors and a drive toward positive health across the life span need be no different than it is for persons who do not experience disabilities. Indeed, for persons with disabilities, health promotion efforts can be of critical importance. Studies have shown that individuals with disabilities can run a higher-than-average risk for such preventable chronic problems as osteoporosis, obesity, diabetes and heart disease (Center et al 1998; Walsh et al 2001; Coyle and Santiago 2000; Nosek 2000; Pitetti and Tan 1990; Rimmer et al 1993; Rimmer et al 1996). Similarly, research has shown that by engaging in healthful behaviors such as exercise, persons with disabilities can lower the risk of these common chronic problems. Further, they can prevent additional disability-related losses (for example, muscle tone, bone density and dexterity) and increase overall mental and physical wellbeing (Compton et al 1989; Janssen et al 1994; Santiago et al 1993; Thomas 1999).

 

However, significant data suggest that persons with disabilities do not participate in wellness programs or health screening activities at the same level as do persons without disabilities. For example, the 2004 National Health Interview Survey similarly found that the percentage of nonelderly adults with mobility limitations who received preventive health services, including cholesterol screening and blood pressure checks, was considerably lower than that of persons without disabilities in the same age range (ANNU Research 2004).

 

Persons with disabilities generally are not benefiting from health promotion screening and wellness programs because the focus of health care professionals often remains on their disabilities alone, and not the needs of the whole person. Further, health promotion and illness prevention information, programs and activities often are not tailored to the needs of individuals with particular disabilities.  Programs for screening, behavior change and exercise, for example, need to be highlighted and encouraged by primary care providers, perhaps working with health clubs and others to meet the individual needs of persons with disabilities. The Institute noted that persons with disabilities, particularly women, need health promotion efforts that address such issues as physical activity, clinical prevention and access to care. Such programs also should promote healthy lifestyles (for example, diet, smoking and alcohol consumption), with specific reference to data reflecting the rates of untoward health effects for individuals with disabilities.

 

Because health care and health promotion providers alike often focus solely on a person’s disability rather than on the full range of health and wellness needs of each person as an individual, they may fail to communicate health promotion messages that are given routinely to persons who are not disabled (Coyle and Santiago 2000). This counseling is necessary to empower individuals to take personal steps to improve their health and wellness. Behavioral Risk Factor  ( ANNN  Research  2004)  found that a higher percentage of persons with disabilities were obese, were current daily smokers and were physically inactive. Moreover, while a large percentage of individuals with disabilities reported engaging in some type of physical activity in their leisure time, a high percentage reported greater obesity and adverse effects from stress compared with persons who do not have disabilities. The higher prevalence of risk factors among disabled individuals suggests that counseling about good health practices can be increased above its current rates.

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