People With Disability Face Barriers to Basic Health Care
FOR THE PAST FIVE years, a friend of mine has lived with a spinal cord injury, losing the use of her legs as a result of a car accident. Following rehabilitation, she returned to doing almost everything she loves in life – working as a pharmacist, raising her two kids, skiing and cooking. Yet despite being able to help her own clients and considering herself savvy at navigating the complexities of today’s health care system, she has found her access to basic health care extremely limited, with an obstacle that before her spinal cord injury she never would have considered: the basic equipment doctors, nurses and technicians use every day to deliver fundamental medical care.[
October marks National Disability Employment Awareness Month, a national campaign to draw attention to the employment issues disabled persons face. But as people with disability know all too well, they also face significant problems accessing primary and preventative health care. The barriers faced by persons with disabilities trying to access basic medical equipment must receive more attention.
Women with disability are 30% less likely to receive breast cancer screening services, for example, and mortality from breast cancer is reported as “highly statistically significant” compared with women without disabilities. This inequity extends to other forms of cancer screening, eye exams and dental checkups, and is directly linked to disparate health outcomes unrelated to a patient’s disability.America’s 25 Healthiest CommunitiesView All 27 Slides
The statistics of exclusion from basic health care for all people with physical disability are eye-opening: In one past study, fewer than 10% of primary care clinics in California reported having accessible exam tables, even though 1 in 7 American adults live with physical disability affecting their mobility. Exam tables, X-ray equipment, weight scales and exam chairs are the four most basic and vital pieces of routine medical diagnostic equipment that providers use. They also have been the four most inaccessible to people with physical disability, because they are missing design features that would make using the equipment simpler and safer for both the patient and the provider.
If you are a person with physical disability in need of basic health care, evidence shows you will not receive the same level of care as your nondisabled peer. In my own research exploring health care equity, people with disability report having avoided or delayed necessary care because of memories of discriminatory attitudes and behaviors from providers in response to requests for an accommodation.[
The Americans with Disabilities Act and Section 504 of the Rehabilitation Act prohibit discrimination on the basis of disability. Clear-cut guidelines have long existed for the physical structure of a building – set widths for doorways, dimensions for ramps – that help eliminate confusion on what access into a clinic means. However, access to health care services provided by use of common medical diagnostic equipment such as exam tables, weight scales and mammogram machines have had no standards to guide health care administrators until very recently.
Under the Affordable Care Act, the U.S. Access Board issued accessibility standards for medical equipment in early 2017. These medical diagnostic equipment (MDE) standards provide design criteria for examination tables and chairs, including those used for dental or optical exams, weight scales, radiological equipment, mammography equipment and other equipment used for diagnostic purposes by health professionals.
But these standards have not been adopted by any enforcing authorities and, as such, are not mandatory requirements of health care providers or organizations. However, they can and should serve as a guideline for medical providers, administrators, facilities and allied health care providers when choosing medical equipment, as well as for the disability community in efforts to increase equity within the U.S. health care system. The spirit and intent of the Americans with Disabilities Act was to create a transformative effect of social justice, equality and inclusion of people with disabilities in all aspects of everyday participation. Yet as disability scholar Thomas Shakespeare accurately claims, “Without health, nothing else is possible.”[
Health care providers, therefore, must embrace and adhere to the MDE standards for all new equipment purchases, especially height-adjustable examination tables, wheelchair-accessible weight scales and height-adjustable mammography machines. Adhering to principles of medical ethics is intended to assure all members of society have the opportunity to achieve optimal health and wellness, including people with disabilities.