Achieving Health Equity is Delaware's Next Goal

July 30, 2015

Twenty-five years after the Americans with Disabilities Act was signed into law, it's easy to see the inclusion of Delawareans with disabilities in all aspects of community life. More people with disabilities are our neighbors, more children are mainstreamed into schools, more adults are employed, and everything from transportation to communications is more accessible.
That's why we will join Delaware's ADA Celebration on July 18 in Dover to applaud along with scores of Delawareans who have benefited from the landmark civil rights law. But we'll also be there to note too few gains in health care for people with disabilities. For that reason, achieving health equity must be included in the next evolution of inclusion.
A 2013 Delaware public health assessment published this year by the Center for Disabilities Studies at the University of Delaware indicated that people with disabilities require improvements in systems and services for achieving optimal health care, accessing recreational facilities, and inclusion within health promotion activities and emergency planning and response initiatives. The data indicate that compared to their counterparts with disabilities, adults with disabilities are:
• More likely to report a delay in seeing a doctor due to cost (19.8 percent vs. 11.3 percent).
• More likely to be obese (39.7 percent vs. 23.7 percent).
• Less likely to be physically active in the past month (59.7 percent vs 80.6 percent).
• More likely to be a current smokers (25.1 percent vs. 18.4 percent).
• More likely to report chronic conditions of diabetes (20.4 percent vs. 7.0 percent), coronary heart disease (13.4 percent vs. 2.9 percent), and depression (33.8 percent vs. 10.1 percent).
And because those and other disparities are unacceptable to us and to so many of our partners, we will also be taking part in a special announcement at the Dover festival that addresses how we are going to make progress in bringing health equity to the one in five Delawareans with disabilities.
To start, the Delaware Department of Health and Social Services will announce an initiative urging, among other things, that a person's disability status be included when demographic information is collected by the department. That information should allow DHSS to identify when public health programs and services are failing to reach people with disabilities. And that, in turn, should help the department remove barriers and increase the access to improved health care for people with disabilities.
DHSS is making health equity for Delawareans with disabilities a department-level priority, consistent with objectives and suggestions in the Plan to Achieve Health Equity for Delawareans with Disabilities, which it crafted this year with CDS and a diverse contingent of 60 community advocates. Funding for the project came from the Centers for Disease Control and Prevention.
That plan's "blueprint for action" lays out a design with the potential to strengthen the state's ability to promote health equity, and to foster a culture that's conducive to achieving health equity for people with disabilities. Its recommendations call for increasing training and awareness for those who provide services and supports to people with disabilities; making physical education part of Individualized Education Plans for students with disabilities; and implementing awareness campaigns that detail available health services and nutrition programs. There are more than 80 recommendations in all.
The ADA prohibits exclusionary practices that prevent people with disabilities from fully participating in community life. The societal gains since 1990 have been life-changing: people with disabilities are engaged in their communities, classrooms and workplaces; adaptive technology and universal design are flourishing; and accessible restrooms, automatic doors and blue paint in the parking lots are now the norm. But, in addition to advancing employment opportunities for people with disabilities, the focus for the next decade also needs to be on the health and wellness of this population.
Today's disparities are artifacts of decades of exclusion, in which the culture that fostered it finds it acceptable to skip weighing an individual in a wheelchair at an annual exam if the scale isn't accessible, or to turn away a person with a disability from an emergency shelter, or to discount the benefits of oral health.
The blueprint for action we've highlighted can kick-start "system change." But eliminating health disparities will require "buy-in" and a concerted effort from all. Health care providers will need accessible exam tables and scales. Health educators will need materials that are available in large print and offer the technology that supports users who rely on screen readers. Insurers will need to provide access to therapies, assistive technology and accommodations that will ensure full access to medical care. Policy makers will need to identify and embrace funding and policy options that can advance this change.
The exciting work of the Delaware Center for Health Innovation and its partners target high-risk patients to achieve the triple aim of better health outcomes, better patient experience and lower cost. Ensuring that individuals with disabilities are a focus of this work would be a sound, effective approach to aligning health equity with the goal of the triple aim.
We need to make better health outcomes for Delawareans with disabilities a reality, further fulfilling the promise of the Americans with Disabilities Act. We and our partners are committed to making that happen. Please join us.
Rita Landgraf is the Secretary of the Department of Health and Social Services. Eileen Sparling is the Healthy Delawareans with Disabilities Project Director at the University of Delaware's Center for Disabilities Studies.
The two reports are available online:
The Plan to Achieve Health Equity for Delawareans with Disabilities (http://www.gohdwd.org/documents/healthequityplan0215.pdf)
The Current Landscape for Disability and Health in Delaware Public Health Assessment Report Summary 2015 (http://www.gohdwd.org/documents/pha0215.pdf)

This op-ed published in the Wilmington News Journal was written by Rita Landgraf and Eileen Sparling.