You can get garden variety health advice from the daily newspaper, the "health" section of most book stores, and of course thousands of web sites. I'm hoping to present thought provoking and maybe change provoking thoughts about individual and community health. This blog is not just what to do about health, but how to think about it. I'm looking forward to an exchange of ideas with readers. July, 2010


Wednesday, July 28, 2010

Disability in America

This week marks the 20th anniversary of the passage of the federal Americans with Disabilities Act. Depending on your point of view, the law is a satisfying advancement for social justice or a notorious example of government overreach causing wasteful spending of tax dollars and intrusion into private property rights. It is all a matter of perspective.

When I was young, we had no one with a disability. No, I didn't live in Lake Woebegon ("all the women are strong, all the men are good looking, and all the children are above average"). It was just that people out of the mainstream were hidden away, shut out from common activities and events. If you were paralyzed or deaf, that was sad, but you were supposed to be out of sight in a specialized institution, not making the rest of us morose or inconvenienced. It was more true then, that people were defined by their limitation: they were "the blind" as opposed to a friend, a parent, a classmate who happened to have a vision impairment.

This was all changed with the passage of the Americans With Disabilities Act, passed by Congress (only 8 Senators and 28 Congressmen voted against) in 1989 and signed by President Bush in 1990. This was a landmark change of course for our treatment of people with disabilities and a model of American exceptionalism for the world. Some of the most recognized provisions are banning employment discrimination against those with disabilities, making sure all people are able to use public accommodations, with measures such as curb cuts, entry ramps, accessible public bathrooms, devices and technology for those with hearing problems, handicapped parking, and school services to assure equal opportunity for those with special needs.

The regulations stemming from the bill's precepts are still unfolding and evolving. For example, court cases have established that infectious disease ( e.g. HIV/AIDS) and mental illness can be considered disabilities, giving discrimination protection to those effected. As the scientific understanding of obesity proliferates, it is becoming apparent that body weight is not just a function of choices regarding eating and exercise, but that there are powerful physiological mechanisms playing a role, and that these mechanisms are not under voluntary control. Time will tell whether we will recognize that overweight people have unique civil rights concerns that should be protected by ADA rules.

Even before passage of ADA, there was a series of federal court cases dealing with disability discrimination in various settings and circumstances. The history of those cases shows an evolving consensus on the Court, from a starting point of strong doubts about the standing of disability as worthy of civil rights protections, but after relentless educating by disability advocates, the justices began to understand. As an aside, this is support for Obama's assertion that empathy is a useful trait for Supreme Court judges. In this case, judicial empathy grew as judges became better informed.

From time to time I ride a public bus to work. The bus has the capability to lower the entrance to the level of the side walk, to facilitate entrance by a person in a wheel chair. It also helps for someone pulling a suit case or cart with wheels. The entrance is wider than was true in years past, again to accommodate wheel chairs. Within the bus, there is a section of seats which fold up, revealing devices to secure a wheel chair to the bus, making it possible for people to ride safely. The stop cord is designed so that someone sitting low in a wheel chair is able to request the driver to stop at the next corner. On that same bus I see people guided by seeing eye dogs, and though I haven't seen this, the bus could also accommodate someone with a "hearing" dog. Finally, I also see mentally handicapped persons accompanied by a guide, helping them get to their destination. All of these provisions cost tax dollars. It is probably more efficient to just put people in institutions. But how much does our society gain by full, or almost full participation? Is Congress a better decision-making body because we have Jim Langevin serving, the first quadriplegic U.S. Congressman. The answer is most certainly yes.

Disability is related to health promotion in one important way. Both are about doing more and stretching limits. What is the limit on how far someone with a disability can overcome? In a similar way, what is possible with health improvement? Good health is a moving target; no matter where you are, it can always be better. You can never be so healthy that you can't be more so.

Some years ago, I first saw a group of blind skiers threading their way down a Colorado ski slope. It was nothing short of inspirational, and taught me that health truly is for all, that health promotion must be tailored for an individual’s needs, and anything is possible.

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