Georgina Peacock, M.D., M.P.H., Lisa I. Iezzoni, M.D., and Thomas R. Harkin, J.D.
July 30, 2015DOI: 10.1056/NEJMp1508854
Twenty-five years ago, on July 26, 1990, President George H.W. Bush signed the Americans with Disabilities Act (ADA), designed to meet four goals for people with disabilities: equal opportunity, full participation in the community, independent living, and economic self-sufficiency. This landmark civil rights law aimed to prevent employment discrimination and give equal access to public and private services for all people with disabilities. At the signing ceremony, Bush exclaimed, “Let the shameful wall of exclusion finally come tumbling down.”
Since the passage of the ADA, there have been extensive gains in access to public services, the built environment (e.g., crosswalks with curb cuts for wheelchair access and accessible pedestrian signals to assist people who are blind or have low vision), and attitudes toward and understanding of the abilities of people with disabilities. The ADA established a right to equal access to public services offered by governments and private providers and has demonstrated the importance of contributions that people with disabilities can make to our economy.
Yet despite these advances, substantial disparities remain in areas of employment, earned income, access to the Internet, transportation, housing, and educational attainment. Each of these disparities contributes to poorer health for this segment of our population.1 The recent Affordable Care Act (ACA) may help improve access to health care for people with disabilities, but the persistence of health disparities and barriers to health care indicates that more remains to be done.
Approximately 56.7 million Americans live with disabilities, with rates ranging from 8.4% among children under 15 years of age to 70.5% among adults over 80 years of age.2 Over our life spans, most of us will acquire disabilities. The Centers for Disease Control and Prevention recently reported that among U.S. adults living in community settings, 22% have a disability, with prevalence in individual states ranging from 16% (Minnesota) to 31% (Alabama). These disability rates are similar to rates of key health problems such as diabetes and uncontrolled hypertension. The prevalence of disability is more than twice as high among unemployed adults as among employed adults (33.5% vs. 12.6%), about 25% higher among women than men (24.4% vs. 19.8%), and generally highest in the oldest age group (≥65 years).3 Given the increasing prevalence of diabetes, arthritis, and other chronic conditions, new interventions for extremely premature infants, and increased life expectancies for people with congenital conditions (e.g., spina bifida and congenital heart defects), the number of Americans with disabilities in all age groups is likely to increase.
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