People with disabilities are disproportionately affected by obstacles to their health when compared to the general population. Among other health status inequities, they are more likely to be obese, and smoke, and less likely to be included in emergency preparedness planning. The Centers for Disease Control and Prevention (CDC) is currently highlighting the need for whole community inclusion in preparedness planning during National Preparedness Month.
NACCHO works to reverse such oversight by advocating for the inclusion and engagement of people with disabilities in the planning, implementing, and evaluating of public health programs. Through its Health and Disability Program, NACCHO supports local health departments (LHDs) in this effort with numerous strategies, recommendations, tools, and resources.
The issue is gaining more and more visibility, especially in the wake of lawsuits such as the one the Brooklyn Center for Independence of the Disabled brought against the city of New York. The class action suited charged the New York City Emergency Preparedness Program with numerous failures in accommodating the needs of people with disabilities. The court ruling pointed to a number of program shortcomings, including: high rise evacuation plans and shelter plans that did not accommodate the needs of people with disabilities; the lack of a plan to canvas for people unable to leave their building after a disaster; and the lack of plans to provide people with disabilities information about the existence and location of accessible services in an emergency, among other failings.
NACCHO’s numerous tools and resources ensure that LHDs include people with disabilities in their planning, and are prepared to accommodate them during emergencies.
Health and Disability Program Overview
According to the 2010 U.S. Census, one in five Americans lives with at least one disability, a percentage likely to increase as baby boomers age. The Americans with Disabilities Act defines a disability as a person who has a physical or mental impairment that substantially limits one or more major life activities, a person who has a history of such an impairment, or a person who is perceived by others as having such an impairment. Disabilities range from the obvious to the subtle, to the temporary and lifelong, and often lead to secondary conditions such as cardiovascular disease and high blood pressure. And, as a result of lack of inclusion, people with disabilities are more likely to experience negative outcomes after a disaster or emergency.
Including people with disabilities in public health activities is a goal of Healthy People 2020, and NACCHO’s Health and Disability Program helps LHDs work toward that. NACCHO’s program is a vehicle to educate LHDs about health and disability activities and resources, maintain a peer assistance network, and to develop and share model practices related to health promotion activities for people with disabilities.
In the eight years since it was established, the Health and Disability Program has had numerous successes, including: formation of the Health and Disability Workgroup, which includes local and state health departments, national partners, experts in the field, and people with disabilities; developing tutorial videos on how to use the Centers for Disease Control and Prevention’s Disability and Health Data System; providing funding and technical assistance programs to more than 30 LHDs; performing a baseline data assessment on LHD efforts; publishing journal articles and presenting at national conferences; publishing a monthly newsletter; incorporating people with disabilities into policy statements; and adding more than 100 applicable tools to the NACCHO Toolbox.
The Program is currently focusing its work on recruiting for the Health and Disability Fellowship Program, providing education on seasonal flu vaccinations for children with special healthcare needs, adults with disabilities and pregnant women, and maintaining partnerships with organizations also focused on inclusion, such as The Arc of the United States.
Strategies for Inclusion
There are a number of ways, internally and externally, to include people with disabilities in LHD planning. As one of its numerous resources, NACCHO developed an inclusion guide detailing tips and strategies to do just that. To promote awareness within, LHDs should identify a health disabilities champion inside their agency: someone who has a personal history with or interest in disabilities, and who can connect the health department to appropriate organizations serving the population. LHDs should also take logistical steps to make programs and services accessible to people with disabilities, including budgeting in advance for programs. And, implementing policy change will help raise awareness among health department staff.
But, raising awareness within the agency only addresses part of the challenge. LHDs need to work directly with the community to include people with disabilities. Solicit people for their input on programs and services; ask about their health needs and encourage their involvement in programming and planning. Data examination and the establishment of new partnerships can also provide insights into what health topics are most relevant to the community, and how people with disabilities can most benefit from inclusion efforts.
Northeast Texas Public Health District preparedness staff utilized such strategies in the wake of Hurricane Katrina, when they realized that educational medical resources weren’t available to members of the deaf community. To remedy that, they created a video series to be used in points of dispensing. The videos deliver information through American Sign Language and closed captioning, and provide information on the relevant disease, how to complete forms, types of medication being administered and possible side effects, where to report adverse reactions, and how to crush pills.
On the Horizon
Inclusion of people with disabilities supports preparedness. NACCHO continues to further this goal by reviewing all policy statements to ensure they promote inclusion of people with disabilities, to add additional tools and resources to the NACCHO Toolbox, develop additional practices for the Model Practices Program, and perform baseline data collection on LHD efforts.