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Addressing Health Inequities for People with Disabilities

This session focuses on health inequities faced by people with disabilities and the role of social determinants of health in driving these inequities. It highlights the Health and Disability Program and how Independent Living Centers (ILCs) can address major issues. The importance of this topic for ILCs and the Massachusetts Department of Public Health (DPH) is emphasized.

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Addressing Health Inequities for People with Disabilities

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  1. Access to Health: Meeting the Needs of Everyone We ServeKimberley Warsettand Nassira NicolaDPH Office of Health Equity, Health and Disability ProgramSeptember 27, 2018MA Statewide Independent Living Conference

  2. overview Why we’re here

  3. Learning Objectives By the end of the session, you should be able to: • Decribe health inequities facing people with disabilities • Recognize the role of social determinants of health in driving health inequities • Describe the role of the Health and Disability Program in the disability field • Explain how the ILCs can play a role in addressing major issues facing people with disabilities

  4. Why is this important for ILCs? People with disabilities are more likely to be affected by: • Preventable illnesses and medical conditions • Violence, including abuse and sexual assault • Homelessness and poverty ILC staff are in a unique position to make a difference through the five core services and other efforts!

  5. Why is this important for DPH? It’s built into the “health house.”

  6. VISION Optimal health and well-being for all people in Massachusetts, supported by a strong public health infrastructure and healthcare delivery MISSION prevent illness, injury, and premature death; to ensure access to high quality public health and health care services—and promote wellness and health equity for all people in the Commonwealth. DATA We provide relevant, timely access to data for DPH, researchers, press and the general public in an effective manner in order to target disparities and impact outcomes. DETERMINANTS We focus on the social determinants of health - the conditions in which people are born, grow, live, work and age, which contribute to health inequities. DISPARITIES We consistently recognize and strive to eliminate health disparities amongst populations in Massachusetts, wherever they may exist. EVERYDAY EXCELLENCE PASSION AND INNOVATION INCLUSIVENESS AND COLLABORATION

  7. Health INEQUITIES Unequal opportunities for wellness

  8. What Are Inequities? A health inequity (sometimes called a disparity) is “a particular type of health difference that is closely linked with social or economic disadvantage.” Source: us Office of minority health

  9. What Are Inequities? “Health [inequities] adversely affect groups of people who have systematically experienced greater social and/or economic obstacles to health and/or a clean environment based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation; geographic location; or other characteristics historically linked to discrimination or exclusion.” Source: us Office of minority health

  10. What Are Inequities? In other words, people with disabilities are less healthy in ways that are caused by discrimination, not a natural result of having a disability.

  11. Difference vs. Inequity A person with Osteogenesis Imperfecta (OI) is more likely to have broken bones than someone without OI. This is a normal difference in health, caused directly by the person’s disability. No amount of social change will stop this from being true.

  12. Difference vs. Inequity A person who is blind or has significant vision impairment is more than twice as likely to have arthritis than someone who doesn’t have a vision-related disability. Vision impairment isn’t naturally related to joint problems! However, you’re more likely to develop arthritis if you don’t havean accessible place to exercise and good access to your doctor, and ifyou have a history of physical injuries. If the environment were more accessible, the disparity in arthritis rates might decrease.

  13. Difference vs. Inequity A person who uses a wheelchair or spends a lot of time lying down is much more likely to get pressure sores than someone who doesn’t: natural difference or health inequity?

  14. Difference vs. Inequity Disabilities can affect our minds and bodies in ways that make it harder to stay healthy, but barriers in society mean that people with disabilities are often sicker than we have to be.

  15. People with Disabilities in MA • 1 out of 5 children and adults report having one or more physical or cognitive disabilities. • 18.8% of public middle school students and 28% of public high school students report having a physical disability, long-term health problem, emotional problem or learning disability. • Among adults reporting a disability, 28.4% require assistance with personal care or routine activities. Source: MA YHS 2011, BRFSS 2016

  16. People with Disabilities in MA: Race/Ethnicity Source: ma brfss, 2016

  17. Health Status Among People with Disabilities • Mental Health: 15 or more days of poor mental health • 22% of adults with disabilities • 7% people without disabilities • Depression: ever having had depression • 33% of adults with disabilities • 12% those without disabilities • Oral Health: Six or more teeth missing • 26% of adults with disabilities • 9% those without disabilities • Smoking: Current smoker • 24% of adults with disabilities • 16% of adults without disabilities SOURCE: 2013, HEALTH NEEDS ASSESSMENT OF PEOPLE WITH DISABILITIES IN MA (ACS DATA)

  18. Health Status Among People with Disabilities • Heart Attack: Ever told by a doctor they had a heart attack • 11% of adults 35 and older with disabilities • 3% of adults 35 and older without disabilities • Sexual Violence History: Ever experienced sexual violence • 7% of adult men with disabilities • 4% of adult men without disabilities • 24% of adult women with disabilities • 19% of adult women without disabilities SOURCE: 2013, HEALTH NEEDS ASSESSMENT OF PEOPLE WITH DISABILITIES IN MA (ACS DATA)

  19. Health Status Among People with Disabilities • Drug use: Ever used heroin (MA & RI combined) • up to 1.4% of youth without disabilities • 3.3% of youth with learning disabilities • 4.5% of youth with physical disabilities • Diabetes: Told by a doctor they have diabetes • 6% of adults without disabilities • 26% of adults with mobility disabilities • 39% of Hispanic adults with mobility disabilities • 11% of adults with other disabilities • 16% of Black adults with other disabilities SOURCES: MA & RI YRBS 2015; MA BRFSS 2015

  20. Health Status Among People with Disabilities • Can you think of ways that these differences might result from system-wide discrimination and access barriers? • Are these just differences, or are they inequities?

  21. Top 10 Health Problems Reported by People With Disabilities in MA SOURCE: 2013, HEALTH NEEDS ASSESSMENT OF PEOPLE WITH DISABILITIES IN MA

  22. People with Disabilities in MA: Education SOURCE: 2013, HEALTH NEEDS ASSESSMENT OF PEOPLE WITH DISABILITIES IN MA (ACS DATA)

  23. Health Status Among People with Disabilities • People with disabilities experience higher rates of social isolation, poverty, unemployment, food insecurity, difficulty accessing medical care, and other social factors that interfere with health and wellness. • People with disabilities are disproportionately affected by preventable chronic conditions and other health problems. This is health inequity in action.

  24. Functions of the Health and Disability program Making health accessible

  25. Social Determinants of Health Economic Stability:- Employment - Food Insecurity - Housing Instability - Poverty Social Context:- Civic Participation- Discrimination- Incarceration- Social Cohesion • Neighborhood and Built Environment:- Access to Healthy Food- Crime and Violence- Environmental Conditions- Housing Quality Education:- Early Childhood - Higher Education - HS Graduation - Literacy • Health Care:- Access to Health Care- Health Literacy Source: CDC “Healthy People 2020” guidelines on Social determinants of health

  26. Health and Disability Program Mission • We promote the health and well-being of people with disabilities in Massachusetts • We work to ensure that the needs of people with disabilities are included in public health programs, services, data collection, policies, and systems. • We focus on supporting the Health and Disability Partnership, data collection and reporting, advancing policy initiatives, helping health promotion and disease prevention programs and services, • We focus on improving access to health care programs and facilities and ensuring emergency preparedness include people with disabilities and their care providers.

  27. Some of Our Activities • Work with other DPH departments and national partners to promote accessibility and inclusion in local health and wellness activities • Provide trainings on inclusive health promotion (inside DPH, to medical/dental students, in public health grad programs) • Work with nine other states to create public service announcements on diabetes management for people with intellectual or developmental disabilities

  28. Some of Our Activities • Analyze data on health inequities affecting people with disabilities, and publicize the results • Diabetes data brief almost ready to release! • Coming in 2018-2019: physical activity and people with mobility disabilities; health needs of d/Deaf and HOH people; health needs of disabled people of color • Upcoming: people with disabilities and opioids; health inequities affecting people with intellectual and developmental disabilities

  29. Some of Our Activities • Work with community experts to revise and implement the Massachusetts Facility Assessment Tool • Facilitate the Health and Disability Partnership • Promote the collection of data that addresses disability within DPH programs • Provide technical assistance around disability issues • Mentor our sister program in Maryland

  30. HOW THE INDEPENDENT LIVING MOVEMENT CAN ADDRESS INEQUITIES Promoting Health In the five core services

  31. Social Determinants of Health Economic Stability:- Employment - Food Insecurity - Housing Instability - Poverty Social Context:- Civic Participation- Discrimination- Incarceration- Social Cohesion • Neighborhood and Built Environment:- Access to Healthy Food and Activity- Crime and Violence- Environmental Conditions- Housing Quality Education:- Early Childhood - Higher Education - HS Graduation - Literacy • Health Care:- Access to Health Care- Health Literacy Source: CDC “Healthy People 2020” guidelines on Social determinants of health

  32. Economic Stability • Preparing for, getting, and keeping jobs • Help getting and keeping benefits • Help getting and keeping affordable, accessible housing Economic Stability:- Employment - Food Insecurity - Housing Instability - Poverty

  33. Education • IEP advocacy • Youth mentorship • Pre-college preparation Education:- Early Childhood - Higher Education - HS Graduation - Literacy

  34. Social Context • Transition to the community • Voter registration and poll monitoring • Accessibility training and advocacy • Peer mentoring and support Social Context:- Civic Participation- Discrimination- Incarceration- Social Cohesion

  35. Health Care • Help getting and keeping MassHealthor other insurance • Coordinating long-term support services • Connecting consumers with RLCs or other mental-health supports • Explaining health information and peer mentoring about health concepts • Health Care:- Access to Health Care- Health Literacy

  36. Neighborhood and Built Environment • Transition to the community • Individual advocacy with landlords, housing authorities, local service providers • Systems advocacy aroundhealthy and accessible neighborhoods, transportation,housing, recreation, and community programs • Neighborhood and Built Environment:- Access to Healthy Food and Activity- Crime and Violence- Environmental Conditions- Housing Quality

  37. Ways to Do More(and how we can help!) • Join the Health and Disability Partnership • Train staff or consumers as Diabetes Prevention Coaches • Connect with your local health department to share information and skills • Incorporate information about social determinants of health into peer mentoring, skills training, and other core services

  38. Ways to Do More(and how we can help!) • Above all: • Think systematically about what’s keeping your consumers from living their healthiest lives, and how you and your programs can help break down inequitable barriers

  39. Contact Information Kimberley Warsett: kimberley.warsett@state.ma.us (617) 624-5540 Nassira Nicola:nassira.d.nicola@state.ma.us(617) 624-5685 www.mass.gov/dph/healthanddisability 40

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