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Disability Rights, Health, and Medicine

Disability Symbols. Wikipedia, Creative Commons.

What is a disability?

“A disability is a condition of the body or mind that makes it more difficult for the individual to do certain activities and interact with the world around them.”

Approximately one in five adults in the United States has some type of disability. There are numerous types of disabilities that impact people’s daily lives through sight, movement, learning, or communication, although there are many others. Furthermore, even if two people have the same disability that doesn’t mean they are impacted the same way. Thus, individuals who have a disability do not consist of one general population, but instead a diverse population with various needs. Now the focus is more on how the word disability refers to the three components mentioned in the next paragraph and how there are numerous factors that go into having a disability.

The World Health Organization created the International Classification of Functioning, Disability, and Health (ICF). The ICF introduces the word disability into three main categories that are impairment, activity limitation, and participation restrictions. The term disability and impairment do not mean the same thing. Before the 1970s, the common view was that a disability is measured by whether or not an individual has an impairment or a health condition. In the 1970s there was the disability rights movement, which geared people away from this medical view. However, many people still focus on the more traditional, medical model of disability.

Disability and Health

Those with disabilities tend to face health care disparities such as less access to adequate care, both in terms of promoting health and preventing diseases. Some people even go as far as labeling those with disabilities as a medically underserved population. There has been some research on how people with disabilities usually have a lower quality of health and are more likely to experience secondary conditions. Some examples of the health disparities include not having interpreters during medical examinations, adults with developmental disabilities being at risk for secondary conditions such as obesity, seizures, and cardiovascular disease, and women who have disabilities are less likely to get Pap tests and mammograms. Furthermore, some other issues include misconceptions and stigmas surrounding the word disability, shortage of suitable training, lack of proper medical equipment and facilities, lack of accessibility, and little to no individualized accommodations.

The Stigma

While there are medical advances over the years in regards to individuals with disabilities, there is a stigma surrounding people with disabilities. They tend to be seen as individuals incapable of making decisions or helpless. There are implicit or even unconscious biases against individuals who have a disability. Furthermore, there are several articles on how the medical community treats those with disabilities as having less value than non-disabled people. The medical interpretation of a disability is viewed as a pathological disorder and so this perspective focuses on how one can treat or cure it, rather than a social problem. In contrast to the medical model, there is the social model of disability, which focuses on how disability is formed from a social situation or construct, rather than a person’s characteristics. This viewpoint focuses on dividing impairment from disability, rather than recognizing that one is a component of the other.

The National Council on Disability says, “people with disabilities comprise the largest and most important health care consumer group in the United States, yet the Institute of Medicine and others have warned that Federal agencies, policymakers, and health care systems have not yet responded to the broad-ranging implications, for individuals, and for society, of the demographic increase in disability as the population ages.”

Health Insurance

Another barrier is that people with disabilities tend to lack health insurance or adequate coverage for healthcare. The National Council on Disability conducted research and found that few health care training programs address disability issues in their curriculum and most federally funded health disparities research do not look at people with a disability as a disparity population. Furthermore, while Medicaid and Medicare cover some people with disabilities, these programs do not cover those who have private insurance. Private group plan insurances are usually given through employers; however, not all employers offer health insurance and not all people who have disabilities are working. Those who have private group plans through their employer are required to cover basic care for the average working population. Medical equipment such as wheelchairs, ventilators, and crutches are limited in terms of annual payments.

Individual plans charge higher premiums to individuals with disabilities. Persons with emotional disabilities consist of those most uninsured, closely followed by persons with visual or hearing disabilities.

The three key elements of health care insurance are availability, affordability, and coverage for critical benefits. Important benefits can include long-term care, mental health, and medications. There have been national surveys that found people with disabilities have a hard time figuring out the insurance system, visiting specialists, and obtaining medical equipment that is durable. Additionally, numerous essential health care services can be out of their budget, meaning that they go without certain things because they simply cannot afford it.

According to the Journal of Disability Policy Studies, “estimates suggest that these factors obstruct or delay care for as many as 30 – 50 percent of adults with disabilities.”

The Henry J Kaiser Family Foundation conducted a national survey that found, “health insurance is inadequate for more than one in three people with disabilities who reported delaying care, skipping medication, or going without needed equipment because of cost.”

Accessibility

Accessibility can be broken down into many different components. The two main sections to focus on are communication and physical access.

Physical barriers are objects that are either natural or manmade that hinder or block mobility or access. These barriers can include inadequate transportation, accessibility to the facility and offices, and lack of accessible exams. Something as simple as getting a mammogram exam can provide numerous difficulties because the mammogram machine cannot adjust for height or health professionals are not adequately trained for lifting assistance. Thus, some health professionals conduct exams while patients are in their wheelchairs, which can yield inaccurate results. Other physical barriers include parking at the medical facility, entering the building, and the bathroom facilities, making it more difficult for someone with a disability to receive proper care.

Proper communication and education are required to make a change. Individuals with disabilities should feel they can discuss their challenges without fearing discrimination, while, those in the healthcare field should appropriately discuss, support, and address the challenges people with disabilities face. Research shows there is a lack of awareness and inadequate instruction among health care providers. For example in Connecticut, “91% of primary care physicians said they had no training in intellectual and developmental disabilities.” Without proper training, people tend to make assumptions about people with disabilities and often times they are incorrect. Some stereotypes include thinking that those with developmental disabilities cannot feel pain so they do not need anesthesia, people who are deaf have problems with their cognitive functioning because they are not fluent in standard English, or women who have disabilities do not need reproductive care because they are assumed to be sexually inactive. Making assumptions is not only harmful to the health of the patient but also it undermines who they are as a person. This can lead to damaging the patient-provider trust and provoke people with disabilities to not even bother to seek care. Ultimately, having access to appropriate health care can prevent new health conditions and could possibly stop current health conditions to worsen. In order to be effective and efficient, health care must be inclusive and accessible.

Keep up with the latest announcements related to the upcoming Symposium on Disability Rights by following the IHR on Facebook, Twitter, and Instagram.

Amendment Four: Voting Restoration In Florida

A sticker that says "I Voted Today." — I Voted Republican Today. Source: PJ Nelson, Creative Commons

On November 6, 2018, Florida voted on the Voting Restoration Ballot (also known as Amendment 4) and restored the right to vote of over one million citizens of the state. This is a true success in the improvement of access to voting rights in America. As a country, we have come a long way in terms of civil rights, but the area of voting rights is one that we can still improve.

Voting Rights History

The fight for voting rights in the United States has been in progress for centuries. Ratified on February 3, 1870, the 15th Amendment of the United States Constitution recognizes that the right to vote of all citizens should not be denied based their “race, color, or previous condition of servitude.” This amendment did not make a lot of immediate progress in granting the voting rights of people of color, but it was a step in the right direction.

From the time the 15th Amendment took effect, to the enactment of the Voting Rights Act of 1965, many different measures were used to prevent citizens of color, particularly black citizens, from utilizing their right to vote. One way through which this occurred was literacy tests, which were given to potential voters “at the discretion of the officials in charge of voter registration.” These tests were comprised of questions regarding processes and history of the United States government, and the officials in charge of registration could even decide what questions an individual had to answer. These questions could range from as simple as “Who is the president of the United States?” to ones that most everyday citizens are unlikely to be able to answer, such as one regarding the limits placed on the size of the District of Columbia by the Constitution. The more difficult questions were often intentionally given to potential black voters in order to prevent them from voting. Since the Voting Rights Act of 1965 passed, literacy tests can no longer be used to prevent someone from exercising their right to vote.

What Is the “Voting Restoration Ballot”?

The Voting Restoration Ballot is an amendment that was made to the constitution of Florida through the election on November 6, 2018. The amendment allows for the automatic restoration of the right to vote of citizens who have been convicted of felonies and have served their sentences (excluding those who were convicted of murder or felonies involving sexual offenses). In order to pass it needed to receive support from at least 60% of voters and it actually received support from 64% of voters. The passing of this amendment resulted in the restoration of voting rights for over one million people in Florida and goes into effect January 8, 2019.

The Issue of Felony Voting Laws

The laws regarding the right to vote for people convicted of felonies vary from state to state. People convicted of felonies never lose their right to vote in Maine or Vermont, even when they are serving their sentence in prison. In addition to Florida, 14 other states and the District of Columbia automatically restore the right to vote immediately after those convicted of felonies have finished serving their sentences, and in 21 states this occurs after a set amount of time following the end of their sentence. In 13 states (including Alabama) there are specific steps that must be taken in order to restore their right to vote, such as a governor’s pardon.

These laws are discriminatory, as they are more likely to have a negative impact on communities of color than white communities. According to the Sentencing Project, potential black voters “are more than four times more likely to lose their voting rights than the rest of the adult population.” This disparity results from the discrimination found in incarceration rates. For example, black people make up 36% of drug arrests and 46% of drug related convictions, even though they only make up 13% of drug users. Evidence suggests that black and white people have nearly the same rate of drug use, but black people are far more likely to be arrested and convicted.

It is also important to note that felonies include a wide range of offenses. In Alabama, they include not only violent crimes, such as assault and battery, murder, and sex related crimes, but also some non-violent offenses, such as drug possession and theft. As a result of this, someone who is convicted of a felony for drug possession in their twenties could potentially never have access to their right to vote again.

A sign that says "Vote Here Today." — Vote Here Today Sign 11-3-09. Source: Steven Depolo, Creative Commons

Voting Rights Are Human Rights

The right to vote is more than just a privilege–it is truly a human right. According to Article 21 of the Universal Declaration of Human Rights, all people have the right to participate in the government they live under, at least through representatives. The article states that “the will of the people shall be the basis of the authority of government” and that this right should be met through elections “by universal and equal suffrage” that should be “held by secret vote or by equivalent free voting procedures.”

Through the passing Voting Restoration Ballot, the people of Florida promote upholding of the rights given in Article 21 and recognize the fact that people convicted of felonies are still human beings who should have access to their human rights.

Another Issue in Voting Rights: Voter ID Laws

In addition to the progress that still needs to be made in restoring the voting rights of people who have been convicted of felonies, the impact of voter ID laws on people’s access to their right to vote also needs to be addressed. There are currently 34 states that either require or request some form of identification to be shown by voters at the polls. There are more than 21 million American who do not possess any form of government-issued photo identification–that is 11% of the population. This prevents many people from being able to exercise their right to vote.

It costs money to get identification issued by the government. There are even costs to getting the documents, such as birth certificates, required to apply for an ID. The American Civil Liberties Union (ACLU) estimates that “the combined cost of document fees, travel expenses and waiting times” can range from $75 to $175. Many people cannot afford this cost. No one should be deprived of their right to vote based on not having enough money.

Voter ID laws also discriminate against minority groups. For example, black citizens are more likely to be harmed by these laws than white citizens, as 25% of potential black voters lack the qualified forms of identification, compared to 8% of potential white voters. The forms of identification excluded by these laws are also discriminatory. In Texas, for example, concealed weapons permits are accepted, but not student IDs. A study performed by Caltech/MIT even found that there is discrimination in the enforcement of these laws, as voters of minorities are more likely to asked about identification than white voters are.

According to the ACLU, these laws are not remotely necessary. One study found that “there were only 31 credible allegations of voter impersonation” since 2000. ACLU also states that these laws are “a waste of tax-payer dollars” due to the costs of “educating the public, training poll workers, and providing IDs to voters.”

Celebrate the Successes

While it is clear there is still much work to be done in ensuring that everyone has access to their right to vote in the United States, it is important that we take time to celebrate successes in the process and recognize positive impact these successes have on the country. Florida’s passing of Amendment 4 restored the right to vote of over one million people! During the same election, Nevada and Michigan approved automatic voter registration for citizens who are eligible to vote. Michigan and Maryland now allow voters to register on the day of the election. By recognizing and celebrating these successes, we can remind ourselves that progress is possible and that things really can change for the better.