Disability Disparities in Social Determinants of Health
This report uses data from the 2018 National Health Interview Sample Adult File (n=18,120) to explore differences between working-age (18-65) adults with disabilities (n=2,705) and those without disabilities (N=15,415). It starts by describing estimated rates of work limitation, activity limitation, functional limitation, and disability participation in the general population, then compares rates of disabilities in specific minority groups. It then compares disparities in social determinants of health, ending with a discussion of the research and policy implications of recognizing people with disabilities as a disadvantaged minority population.
What are health disparities?
A health disparity is a type of health difference that is closely linked with social or economic disadvantage. Health disparities “adversely affect groups of people who have systematically experienced greater social or economic obstacles to health based on their racial or ethnic group, religion, socioeconomic status, gender, mental health, cognitive, sensory, or physical disability, sexual orientation, geographic location, or other characteristics historically linked to discrimination or exclusion” (Healthy People 2020).
Why aren’t people with disabilities a priority population in federally-sponsored health disparities research?
The United Nations describes people with disabilities as “the world’s largest minority,” but US research agencies and foundations direct few resources to studying and addressing health disparities within this population. The National Institutes of Health (NIH) designate the following minority groups as US health disparities populations: racial and ethnic minorities, socioeconomically disadvantaged populations, sexual and gender minorities, and rural populations. People with disabilities are absent from this list.
The paucity of disability-based disparities research is likely due to the continuing influence of the biomedical model of disability in the health sciences. Disability research in this paradigm is typically framed by clinical diagnosis and is considered an outcome, not an identity.
In contrast, the sociopolitical model of disability recognizes that people with disabilities are a distinct minority group that is subject to pervasive social stigma and institutional discrimination. Significant civil rights laws (e.g. the Americans with Disabilities Act, the Rehabilitation Act, and the Individuals with Disabilities Education Act) protect the rights of this population. Their minority group status is conceptually distinct from their chronic health conditions.
As with other minority groups, while some differences in health may be attributable to the underlying traits that are associated with group affiliation, the observed disparities are driven by the complex interaction of minority group status with “social determinants of health.”
What are social determinants of health?
Social determinants of health are defined as “conditions in the environments in which people are born, live, learn, work, play, worship, and age, that affect a wide range of health, functioning, and quality-of-life outcomes and risks” (Healthy People 2020)
Healthy People 2020 classifies social determinants in 5 domains:
Economic stability
Education
Neighborhood and built environment
Social and community context
Healthcare
How do working-adults with disabilities compare to those without disabilities in terms of social determinants of health?
Economic Stability: People with disabilities are less likely to be employed, three times as likely as those without disabilities to live in households with annual incomes below the federal poverty level, more likely to rely on food stamps and rental assistance, more likely to be food-insecure, and more likely to report high levels of financial worry.
Education: People with disabilities are less likely to graduate from high school or college.
Neighborhood and Built Environment: People with disabilities are less likely to describe their neighborhoods as cohesive or supportive.
Social and Community Context: People with disabilities are more likely to live alone, less likely to live with children, and less likely to be married or cohabiting.
Health and Healthcare: People with disabilities are more likely to rely on public insurance programs like Medicare and Medicaid. They use significantly more healthcare services and are more likely to report difficulties in obtaining and paying for their healthcare services.
What are the research implications of this work?
Researchers in the field of health and healthcare disparities should recognize people with disabilities as a distinct minority group and partner with members of the disability community to better understand and address the challenges they encounter in managing their health. Researchers should also systematically investigate the intersectional relationship between disability status and other minority group memberships.
What are the policy implications of this work?
Congress and the National Institutes of Health should support research that treats people with disabilities as a marginalized and disadvantaged population. We call on policymakers to create statutory language that recognizes people with disabilities as a health disparity population and to invest in a program of federal research on disability-based disparities.