The definition of disability varies often based on the purpose of the data obtained and the mechanism used for data collection. For example, the National Center for Health Statistics uses the National Health Interview Survey, an extensive face-to-face survey of 32 questions used to determine a person’s disability. In contrast, in the Behavioral Risk Factor Surveillance System, disability is determined by answering yes to one of two questions related to limitations in any activity related to physical, mental, or emotional problems, or use of assistive equipment like a cane or special bed. Healthy People 2020 is attempting to tackle this definitional inconsistency by including a standard set of disability questions in all data systems used.
A National Issue
In January 2011, the Centers for Disease Control & Prevention (CDC) released their Health Disparities and Inequalities Report. Disability status was used for the first time as a measure by the CDC in the 2011 report, recognizing that disability is a source of health care disparities. According to this report, disability includes impairments or limitations in activities or social participation as a result of an interaction between a person’s environment and his or her health condition.
The CDC report finds that persons with disabilities have greater disparity in health and socio-economic status including high school competition rates, living below the federal poverty level, and higher rates of chronic health conditions.
Health Status
According to the CDC Health Disparities and Inequalities Report, released in Jan 2011, persons with disabilities are more likely than the general population to have health insurance, 17.7% vs. 20.5%. But in spite of better coverage and more expense, they are less healthy than the general population. For example, 14.9% of those with disabilities have diabetes, vs. 4.5% of the rest of the population; 57.3% of those with disabilities have hypertension, vs. 28.6% of the rest of the population. It is estimated that individuals with multiple chronic conditions cost up to 7 times as much as patients with only one chronic condition. Health care for persons with disabilities is particularly expensive, because of the existence of multiple health conditions. According to a report by the National Institute for Health Care Management in July, 2011, health care spending is distributed very unevenly, with 50% of the population at the low end of the cost scale accounting for 3% of the national health care spending, and 5% of the population responsible for almost 50% of the spending.
Housing
Unhealthy housing is another area of disparity for persons with disabilities. According to the 2011 CDC Health Disparities and Inequalities Report, 27% of persons with disabilities lived in unhealthy housing in 2007, increasing to 30.2% in 2009, while those able-bodied noticed a decline from 23.7% to 23.2% over the same period. Unhealthy housing characteristics (in addition to inadequate housing) consist of peeling paint, presence of rodents, recent leaks and no working smoke alarm.
Employment
Employment and household income for those with disabilities continues to lag behind those without a disability. According to the 2009 Cornell Rehabilitation Research and Training Centeron Employment Policy for Persons with Disabilities Progress Report, the employment rate among persons with disabilities was 36% and 76.8% for those without a disability. According to the same report, the median household income of working age people with disabilities in 2008 was $32,161 and $60,946 for those without disabilities.
