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Summer 2007 Vol. 7 No. 2

Table of Contents


Transforming the Future of Disability in America

By Alan Jette

Photo courtesy Boston University

In recent months, the nation's attention has turned to the thousands of military personnel returning from Iraq and Afghanistan to face new challenges. In many cases, these men and women will come home with disabilities that will change their lives from what they were before. An estimated one in four veterans from Iraq or Afghanistan has filed claims for a war-related disability. Although staggering, the number is dwarfed by the total number of Americans who experience disabilities. How individuals, families, and society will cope with the challenges of disability in America during coming decades is an underappreciated and uncomfortable question, but one that we must answer.

Today, between 40 million and 50 million people in the United States have disabilities. That number will grow significantly as the population ages 65 and over -- who are at the highest risk of disability -- doubles in the next 30 years. Considering the numbers who now have disabilities, those likely to develop a disability, and those who are or will be affected by the disabilities of family members or others close to them, it becomes clear that disability will affect the lives of most Americans.

A new report by the Institute of Medicine, The Future of Disability in America, underscores the growing evidence that disability is not an unavoidable consequence of injury and chronic disease, but is shaped by actions society and individuals take -- in the public arena, in commerce, and in our private lives.

In medicine and public health, a range of preventive measures have contributed to reductions in the incidence of certain kinds of injuries, developmental disorders, and other health conditions that contribute to disability. Recent reductions in the risk of disability among older Americans, in particular, are encouraging, although trend data for younger and middle-aged adults suggest a growing risk for disability. State Medicaid programs have increased resources to support community and home services that allow more beneficiaries with serious disabilities to avoid institutional care, and programs to serve children and adults with special health care needs have also increased.

While the Americans with Disabilities Act (ADA) enacted in 1991 raised awareness of disability and improved access to public facilities, significant environmental barriers remain, sometimes in places one would not expect. Too many hospitals and professional offices lack facilities, equipment, and services suitable for people with physical mobility, hearing, vision, or other disabilities. Particularly limiting are outmoded restrictions in Medicare and other health programs on coverage of assistive technologies, as well as health and personal care services known to improve the lives of individuals with disabilities.

The IOM report urges concerted action -- taken sooner rather than later -- to achieve changes that will help people with disabilities lead independent and productive lives. The IOM recommends more federal support for disability research; a national disability monitoring program to track trends in disability and inform policymakers; reform of coverage of assistive technologies and services in Medicare, Medicaid, and other health plan policies; the prevention of common secondary health problems among those with disabilities; the creation of more accessible environments for those with disabilities; and a national campaign to educate consumers and professionals about the availability and benefits of assistive technologies.

Disability is one of this nation's most significant social, public health, and moral challenges. Inaction will cost individuals and society with avoidable dependency, increased stress on individuals and families, and lost productivity. By working to harness the innovative spirit of American science and industry, promote compliance with civil rights laws, and remove outdated restrictions in public and private health plans, we can transform the future of disability in America.

Alan Jette, Ph.D., M.P.H., is a professor of health policy and management and director of the Health and Disability Research Institute at the Boston University School of Public Health.

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Copyright 2007 by the National Academy of Sciences