Traductor

06 October 2011

Health Affairs article focuses on health care disparities facing people with disabilities

Two decades after the Americans with Disabilities Act went into effect, people with disabilities continue to face difficulties meeting major social needs, including obtaining appropriate access to health care facilities and services. In an article in the October issue of Health Affairs, Lisa Iezzoni, MD, director of the Mongan Institute for Health Policy at Massachusetts General Hospital, analyzes available information on disparities affecting people with disabilities and highlights barriers that continue to restrict their access to health services. "A lot of attention has been paid to how health disparities affect people in racial and ethnic minority groups, and this report details how people with disabilities are also disadvantaged," she says. "Most of the literature about these problems has appeared in disability-centered journals that are not very accessible to many people, so one of my goals in putting together this analysis was bringing this information to a high visibility, broadly accessible journal."
Iezzoni, who has used a wheelchair for nearly 25 years because of multiple sclerosis, explains, "An analogy I use to illustrate how disparities among racial and ethnic minorities differ from those affecting people with disabilities is that Rosa Parks made progress towards civil rights when she could get onto that bus and sit anywhere she wanted to. I can't even get onto a bus unless it is adapted for my needs, the bus driver notices me, recognizes my disability, and reacts to it. That kind of need for proactive accommodation applies to health care facilities as well."
The 2010 census found that 54 million Americans -- nearly 20 percent of the population -- were then living with disabilities. Less than half of adults with disabilities were employed, and 27 percent of those with severe disabilities fell below the poverty rate, compared with 9 percent of those without disabilities. Iezzoni's review of several broad-based surveys found that people with disabilities were significantly more likely to report being in fair or poor health than were those without disabilities. They also had higher levels of risk factors such as obesity, smoking and physical inactivity, some which could be linked to a decreased likelihood that primary care physicians would address those issues during routine visits.
In her review of how disability is defined and addressed by the health care system, Iezzoni cites a significant change from an approach centered on available medical solutions coupled with patients' adjusting to their limitations -- the prevalent viewpoint of the 19th and early 20th century -- to the more recent focus on changing the physical, attitudinal and social barriers that compound restrictions imposed by specific physical impairments. She writes that a 2001 report from the World Health Organization "shift(s) the focus from prevention or cure to maximizing functioning and well-being," adding that the Institute of Medicine, in recommending that the WHO framework be broadly adopted, acknowledged that "no single definition of disability can serve all societal needs."
Reported disparities in preventive health care services include lower rates of mammography and Pap tests among women with disabilities. A review of data from National Cancer Institute registries -- coupled with Medicare data -- indicated that women with disabilities diagnosed with early-stage breast cancer were less likely to receive breast-conserving surgery and that those who did were less likely to receive the radiation therapy that treatment protocol requires. Similarly, patients with disabilities diagnosed with the most deadly form of lung cancer were less likely to receive surgery, the only definitive treatment. For both types of tumor, people with disabilities were significantly more likely to die from their cancers.

**Source: Massachusetts General Hospital

No comments:

Post a Comment

CONTACTO · Aviso Legal · Política de Privacidad · Política de Cookies

Copyright © Noticia de Salud