Introduction
People with disability form one of the vulnerable populations. As a vulnerable population, people with disabilities require extra attention in different spheres. With regards to health care, this population is often overlooked because of the disadvantages they suffer as a result of their conditions. It is important to understand their needs, their interaction with the environment and the vulnerabilities they suffer. Such and understanding is important in order to approach health care provision in a way that overcomes their vulnerabilities to create access. This paper will consider this vulnerable population with regards to prevalence, policies on health care and the role of nurses to this population.
People with Disabilities
Nies & McEwen (2013) argue that disability is often confused for what it is not. There are different models and definitions of disability. However, for each of these models, there is a general tendency to allude to the old paradigms that use functional limitations to decide whether a person is disabled. It is important to highlight different definitions of disability in order to further understand this premise. A disability entails the inability to perform activities within the confines of socially constructed ranges. Conversely, impairment entails an abnormality, mental, anatomical or psychological loss. On the other hand, a handicap entails a disadvantage that results from a disability or an impairment thereby preventing an individual from fulfilling an expected role.
As stated earlier, old paradigms focus on functional limitations. As such, a handicapped person, going by the definition that such a person has disadvantage that impedes him from fulfilling an expected role would be classified as disabled. Additionally, people with a disability, going by the definition that they are unable to perform activities within the confines of socially constructed ranges would be classified as handicapped. However, impairments will not always result in a disability and neither will disabilities always produce handicaps. This emphasizes the influence of the perspectives of the society and the environmental barriers on the models of disability. Alternative frameworks have been coined in order to mitigate the adverse concepts in previous frameworks, and to also to prevent disabilities under such models Nies & McEwen (2013).
The National Agenda for Prevention of Disabilities provides a framework that delineates the disabling process, hence affording community health workers with opportunities to prevent disability. This framework allows health promotion activities that include prevention of disability at the primary level, the reversal of the disability and the restoration of lost functions at the secondary level and the prevention of associated complications at the tertiary level. This framework tempers earlier definitions while also offering opportunities for health workers to prevent, reverse and/or mitigate the complications associated with disabilities (Nies & McEwen, 2013).
Nature of Vulnerability for the Disabled
People with disabilities suffer various vulnerabilities. The vulnerabilities suffered by people with disabilities influence the quality of life they lead. The access to social and environmental barriers poses vulnerabilities to the people with disabilities. Such barriers include language barriers to those with speech impairments leading to disabilities, the cost of health care services, transportation to access care and financial issues since many of them rely on their families. This is compounded further by the fact some of them may not be covered by insurance program. Due to these vulnerabilities, people with disabilities are denied or get delayed access to requisite health services. This might have adverse effects in their health, especially when disability is accompanied by health concerns (Nies & McEwen, 2013).
Chronic health problems might transform into acute problems because of delayed or denied access to care. People with disabilities also suffer attitudinal barriers that result in vulnerabilities. For instance, people with disabilities might experience attitudinal barriers when seeking appointments to see health practitioners. People with disabilities also suffer economic vulnerabilities. For instance, Brault (2008) reported that 12% of people with non-severe disability as well as 27.1% with a severe disability lived in poverty. This is because of the disparities in employment between people with no disabilities and those with disabilities. More precisely, 45.6% and 30.7% of people with a form of disability and severe disability respectively between 21 and 64 years were unemployed in data from 2009.
National and Community Statistics
Over 56.7 million people in America have some form of disability. This represents a prevalence rate of 18.7%. The prevalence of people with severe disabilities amounted to 2.6% in 2010. Between 2005 and 2010, the increase in the number of people did not statistically change the percentages. However, there were 2.2 million more disabled people in 2010 than there were in 2005. Data reported by Brault (2008) show significant differences between the prevalence of disability by race and sex. For instance, blacks had a higher prevalence at 20.5% compared to the Hispanics at 13.1%, Asians at 12.4% and non-Hispanic whites at 19.7%. With regards to sex, females had a higher prevalence rate at 20.1% compared to 17.3 for males. However, the difference in the prevalence between the sexes can be attributed to the fact that there are more adult females than males.
The community statistics relate different to the nationals statistics. For instance, the prevalence rate in New York City is 11% compared to the national rate of 18.7%. The prevalence rate in other boroughs in New York City relate closely. For instance, Brooklyn has a prevalence rate of 10.8%, Bronx at 13.7%, Manhattan at 10.4%, Queens at 10% and Staten Island at 10.1% (Center for Independence of the Disabled, 2011). These statistics show the extent of the problem at the community and national level. This information is not only important for community health workers, but also policy makers. Affirmative action is required to address the vulnerabilities discussed earlier in order to improve the quality of life that people with disabilities lead.
Federal and State Policies on Disability
The policy formulation process is an important avenue through which the issues affecting people with disabilities can be addressed. Nies & McEwen (2013) argue that early policies on disability focused on government provision and protection. There was little focus on capacity building to enhance independence and self-support. Policies in the contemporary society focus on minimizing the disadvantages and vulnerabilities and maximizing opportunities available for people with disabilities. Federal and state policies regarding disability assumed a wide range of approaches. For instance, the Rehabilitation Act seeks to protect their civil rights (Nies & McEwen, 2013).
As discussed earlier, these are some of the vulnerabilities that this population suffers and this policy program seeks to protect this vulnerable group. There are skills enhancement programs such as vocational rehabilitation, work incentives, special education and Ticket to Work programs. There are programs with a social perspective such as in-kind assistance and income programs. These include Medicare, Social Security Disability Insurance and Medicaid. These policies underscore the commitment of the government to capacity build people with disabilities so that they can lead productive, independent and self-reliant lives (Nies & McEwen, 2013).
Healthy People 2020 Objectives
The Healthy People 2020 objectives regarding people with disabilities are very sensitive to the environmental and social barriers and the vulnerabilities that people with disabilities suffer. For instance, one of the objectives endeavors to reduce to number of people experiencing delayed care as a result of specific barriers. This objective responds to the effect of barriers to access to health care. By achieving this objective, the government and other involved organizations will help reduce the disparities to the access of health care services for the people with disability (Healthy People 2020, 2014).
Another objective endeavors to reduce the effect of environmental barriers to access to recreational facilities, residential buildings, employment and school. This affects issues of quality of life for people with disabilities. The other objective seeks to address disparities in participation of people with disabilities. These include addressing issues of under participation in the labor market and participation in recreational, sporting and religious activities. The application of these objectives inclusively improves the quality of life for people with disabilities (Healthy People 2020, 2014).
Role of Nurses with regards to People with Disabilities
Nurses have a very vital role to play in providing health care for people with disabilities. Of importance is the fact that people with disabilities have some unique needs. As such, the role of the nurse reflects ample knowledge of these needs. Additionally, community health nurses have a role to address the underutilization of preventive health care services, social, environmental and communication barriers and the underutilization of treatment services for comorbid conditions. This role is justifiable by the fact that the community health nurses are the custodians of information on the health of the community (Nies & McEwen, 2013).
Conclusion
Although the increase in the number of people with disabilities between 2005 and 2010 was not statistically significant, the vulnerabilities that this population suffers are worth considering. The discussion has highlighted these vulnerabilities ranging from economic vulnerabilities, disparities in access to social amenities, health care and social attitudes. However, there is reprieve in the re-conceptualization of the definition of disability. This is because the new models recognize the fact that people with disabilities are not necessarily disabled, and where previous policies focused on assistance rather than capacity building. However, recent policies, as witnessed in the objectives of Healthy People 2020 characterize a new approach where emphasis is on building the capacity of people with disabilities to lead independent, self-reliant and productive lives.
References
Brault, M. (2008). Americans with disabilities: 2005, Current Population Report 70–117, December 2008, US Census Bureau Available at> www.census.gov/2008pubs/p70- 117.pdf .
Center for Independence of the Disabled, (2011). Disability matters: Unequal treatment and the status of people with disabilities in New York City and New York State. Retrieved from> http://www.cidny.org/resources/News/Reports/Disability%20Matters.pdf
Healthy People 2020, (2014). Disability and health. Retrieved from> http://www.healthy people.gov/2020/topics-objectives/topic/disability-and-health/objectives
Nies, M. & McEwen, M. (2013). Community/Public health nursing: Promoting the health of populations. St. Louis. Elsevier Saunders.
