Progress made with enactment of ADA, but people still face challenges: Disability and Health Journal

20 years after enactment -- progress made but challenges still facing people with disabilities

In recognition of the 20th anniversary of the enactment of the Americans with Disabilities Act (ADA), the October issue of Disability and Health Journal has brought together a series of articles to examine whether the ADA has in fact improved the health of people with disabilities. Areas of progress are identified, most notably acknowledging physical barriers and need for better staff training and communication about and with people with disabilities. However, there continue to be ongoing challenges, including recurrent barriers to health care for people with disabilities, discrimination in health care decisions against people with disabilities, limited health insurance coverage, and, in general, poorer health care, and health for people with disabilities.

"When the ADA was enacted 20 years ago, we had not fully identified that there were differences in health and health care for people with disabilities," commented Margaret A. Turk, M.D., Co-Editor, Disability and Health Journal and Professor, Physical Medicine & Rehabilitation and Pediatrics SUNY Upstate Medical University, Syracuse, NY. "Research since 1990 has identified that there are differences, and has tried to clarify which of these differences in the health status of people with disabilities can be attributed to health care access, universal design principles, care provider knowledge, or social justice. We continue to actively pursue these areas of research to address and hopefully further resolve these issues."

The issue describes how the ADA can be and has been used to promote the health of people with disabilities.

CONTENTS & KEY POINTS

Editorial: Has the ADA Improved the Health of People with Disabilities?
Margaret A. Turk, M.D.

Yes, somewhat. The contributors hope that the articles in this issue will prove useful in making changes within facilities, institutions, staff, and social interactions, as well as provide a first step to improving access at all levels to promote the health of people with disabilities.

Introduction
Timothy P. Shriver, Ph.D.

This dedication to Eunice Kennedy Shriver, a longstanding advocate for improving environmental, program, and social access for people with disability, is contributed by her son, Dr. Timothy Shriver.

This article has been made freely available as a service to the health care community at: http://www.disabilityandhealthjnl.com/article/S1936-6574(10)00046-4/fulltext

The Surgeon General's Call to Action to Improve the Health and Wellness of Persons with Disabilities: Historical Review, Rationale, and Implications 5 Years after Publication
Richard H. Carmona, M.D., M.P.H., F.A.C.S., Margaret Giannini, M.D., F.A.A.P., Brian Bergmark, B.A., and Jennifer Cabe, M.A.

The authors provide a history of early legislation leading to the ADA, and then a further forward history from the ADA to the 2005 Call to Action. Dr. Richard Carmona, U.S. Surgeon General in 2005, developed this Call to Action to further the understanding that disability does not equate with poor health.

Health Care under the ADA: A Vision or a Mirage?
Nancy R. Mudrick, M.S.W., Ph.D., and Michael A. Schwartz, J.D., Ph.D.

Drs. Mudrick and Schwartz focus on the past 10 years of ADA enforcement related to health, and highlight the many barriers the deaf community encounters. The settlements associated with these and other health access issues show the effectiveness of the ADA, but also the enforcement choices of the Department of Justice.

This article has been made freely available as a service to the health care community at: http://www.disabilityandhealthjnl.com/article/PIIS1936657410000610/fulltext

The California Kaiser Permanente Health System: Evolving to Meet the Needs of People with Disabilities
M. Elizabeth Sandel, M.D., Jed Appelman, Ph.D., Mary Jean Kotch, M.S.N., C.R.R.N.-A., Gina Biter-Mundt, M.A., Nitasha Lal, M.P.H., Shari Samuels, B.A., and Yvette Crespo

The Kaiser Permanente Health System's response to an ADA lawsuit and settlement has resulted in a model approach to providing health care to people with disabilities by recognizing barriers at all levels. Their leadership in this area has been recognized nationally and internationally, along with their willingness to share developed products and practices.

The ADA in Action at Health Care Facilities
Molly F. Story, Ph.D., June I. Kailes, M.S.W., and Christie Mac Donald, M.P.P.

This survey of medical centers and staff covers compliance with the ADA, conducted through their consulting work to advise medical centers in decreasing barriers for people with disabilities receiving health care. They provide guidance and recommendations for equipment, interior design, and staff training and policies.

Achieving Accessible Health Care for People with Disabilities: Why the ADA Is Only Part of the Solution
Silvia Yee, L.L.B., B.Mu.S., M.A., and Mary Lou Breslin, B.A., M.A.

The authors outline the limitations of the ADA regarding improvements in health care for people with disabilities. They posit that lawsuits and other judicial policy tools have only a narrow focus to create change, and that changes in the social view of disability and public policy are needed to renovate the health care system for people with disabilities.

In the introduction to this issue Timothy P. Shriver, Ph.D., Chairman & CEO of Special Olympics, writes about the vision and legacy of his mother, Eunice Kennedy Shriver, and applauds the editors and contributors to the issue. He states, "No act of care is too small to matter; no moment of healing too small to go unnoticed. Your dedication to fulfilling the ideals of the ADA for all Americans is the fuel that keeps us all going. Your contributions to this volume are a resounding reminder that there are still heroes among us."