One in 4 US adults lives with a disability.1 People with disabilities are present in every community. This means every public health agency serves people with disabilities. While many public health agencies acknowledge and respect the important role disability inclusion plays in achieving health equity, they may encounter difficulties implementing it in practice. To this end, health agencies need to engage in meaningful collaboration with members of the disability community.
“Nothing About Us Without Us” is a clarion call of the disability rights movement to involve people with lived experience in the decisions that affect them. This principle also applies to public health agencies in their efforts to improve health and well-being for people with disabilities. By working alongside and learning from the disability community, health agencies move closer to achieving health equity for all the people they serve.
Build a Foundation for Partnership
To create more inclusive, accessible, and informed initiatives, public health agencies must incorporate the voices and needs of people with disabilities. Working in tandem with people who have lived experience ensures that public health programs are carried out competently and respectfully.
Outreach to local disability activists, educators, and other members of the community goes a long way toward improving disability inclusion at health agencies and in the communities they serve. Disability organizations and advocates provide an outside perspective that can help move from conversation to action to address gaps in programs and services.
Embrace Accountability, Trust, and Understanding
A crucial early step in inclusion requires acknowledgment of any historical or current harms people with disabilities may have experienced. Recognizing harms done—even if unintentional—is necessary to build trust. From there, staff and community members can determine ways to move forward without repeating past mistakes.
Collaboration with disability-focused organizations and individuals should be continuous, not a one-time event. After implementing a program, policy, or activity with input from people with disabilities, health agencies should maintain open communication and regularly update those who provided input. People want to know how their feedback is used, regardless of success of the initiative. Health agencies are also encouraged to compensate people with disabilities for contributing their time and input, similar to any subject matter expert or consultant.
Data comprise an important driver of accountability and understanding. Disability data demonstrate evidence of barriers, challenges, and the impact of public health programs on people with disabilities, but disability status is not typically collected in data systems. Missing data on health and disability can exacerbate existing health disparities. Collecting and reporting disability data are essential in raising concerns to policy makers and the community.
Engage in Internal Reflection
To make a genuine commitment to disability inclusion, health agencies and public health professionals need to engage in internal reflection. This includes examining health agency practices and policies and any personal biases. As an agency, this process may involve discussions with human resources staff and supervisors to audit the agency’s support and accommodations for employees with disabilities. Additional considerations include reflecting on how proactive the agency may be in hiring people with disabilities and establishing genuine connections with disability community members who interact with the health agency. These conversations can illuminate the need for further training or education or point to areas for improvement within the agency.
Fortunately, many accommodations have relatively simple solutions. For example, health agencies can often make small adjustments to their built environment for ADA (Americans with Disabilities Act) compliance: setting up a ramp or using accessible door handles are easy work-arounds to improve physical accessibility. Similarly, a community event does not always require advanced technology to be inclusive and accessible; providing an ASL interpreter, captions, or printing materials in a large, easy-to-read font are necessary accommodations that are not resource-intensive. Such accommodations go a long way in making both health agency activities and the health agency as a workplace more accessible.
Recognize Intersectionality and Its Implications
Disability inclusion, access, and etiquette need to be viewed through an intersectional lens. People have multiple identities—such as race, class, gender identity, sexual orientation, and others—that influence their experiences as a whole person.
Furthermore, the disability community is not a monolith. It is critical that public health agencies understand the diversity of people represented within these groups. Disability itself is multifaceted; people may have intellectual disabilities, developmental disabilities, and/or invisible disabilities. It is not agency leadership’s responsibility to guess what disabilities people may have but, rather, to create an environment where people feel comfortable self-identifying if and how they choose. Instead of asking people to request specific accommodations based on their disabilities, workplaces should adopt accessible practices as the norm. For example, policies such as using plain language in verbal and written communications benefit everyone, including people with disabilities who may have a greater need for them.
Getting started may feel daunting, but taking a learning mindset with an openness to collaboration can be helpful. Leadership and staff of public health agencies can lean on a range of experts in pursuing disability inclusion. Health agencies can take advantage of various resources to help them become more inclusive of people with disabilities. Some of these resources include councils on developmental disabilities, councils on independent living, governmental disability agencies, and jurisdictional ADA coordinators.
Other resources are as follows:
- The Association of State and Territorial Health Officials’ 10 Essential Questions for Disability Inclusion in Health Agencies provide a helpful starting point when developing inclusive programs, policies, and activities.2
- The Association of University Centers on Disabilities (www.aucd.org), specifically its Including People with Disabilities: Public Health Workforce Competencies resource.3
- Disability advocacy groups, some with state, territorial, local, and tribal chapters, such as The Arc, Family Voices, Hands & Voices, and Parent to Parent.
- Other national/international organizations such as the World Institute on Disability or American Association on Health and Disability.
- Inclusively (www.inclusively.com), a hiring platform that allows employers to share their organizations’ inclusive services, benefits, and accommodations and job seekers to disclose the accommodations they need.
Creating a workplace, and by extension, a community, in which people with disabilities are empowered in their health and well-being, is a continuous journey. There is always room for improvement, but most important is getting started, and being open to learning along the way.
1. Okoro CA, Hollis ND, Cyrus AC, Griffin-Blake S. Prevalence of disabilities and health care access by disability status and type among adults—United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67(32):882–887. https://www.cdc.gov/mmwr/volumes/67/wr/mm6732a3.htm?s_cid=mm6732a3_w. Accessed March 11, 2023.
2. Association of State and Territorial Health Officials. 10 Essential Questions for Disability Inclusion in health agencies. https://www.astho.org/globalassets/brief/10-essential-questions-for-disability-inclusion-in-health-agencies.pdf. Accessed March 22, 2023.
3. Haworth SM, Griffen AK. Including People with Disabilities: Public Health Workforce Competencies. Disability in Public Health. Silver Spring, MD: Association of University Centers on Disabilities; 2016. https://disabilityinpublichealth.files.wordpress.com/2016/06/competencies-_-executive-summary_updated_8-16-16.pdf. Accessed March 11, 2023.
This column first appeared in the July/August 2023 issue of the Journal of Public Health Management & Practice. See the final authenticated version.