How to Address Health Iniquities for Disabled People
Or: Basic Accessibility and Open Attitudes Can Go a Long Way
Image Description: A hand holds onto a bandage on a person’s arm.
While it may appear there is a lot of work needed to make health care more accessible for disabled people (because there is), there is also a lot of resources already available and people working hard to make it happen. We just need to listen, learn, and apply these good sense ideas.
Make Health Spaces Physically Accessible
First, let’s ensure that our health spaces are physically accessible. How do we do this? Abracadabra! It’s easy! Follow the already existing regulations for the Americans with Disabilities Act.
Mostly, it’s accessibility 101 stuff. Make your buildings accessible with ramped entry, wide doors, and nearby accessible parking (or even better — good public transportation access). If the building has multiple floors, make sure there are several working elevators. Install accessible restrooms. Make sure that exam rooms are large enough to fit a wheelchair and be able to turn inside the room (clears throat: this is still not the case for most of the doctor’s offices I visit).
Since 1990 (the year the Americans with Disabilities Act became law) what percentage of health care facilities are either brand new or renovated? It would have been very easy to ensure accessibility during construction. Plus, remember: there is no such thing as grandfathering under the ADA. (Unfortunately, an ongoing myth people still continue to believe.) There is a proactive responsibility to make buildings used by the public accessible. And yet, people who should really know better like those who run health care facilities frequently fail in these very minimum responsibilities.
The National Council on Disability published a report in 2021 about the need for accessible exam equipment as well. Most of my doctors don’t have an exam table that lowers to wheelchair height or there is just one room with such a table and is mysteriously never available for me. So, for most of my life I have my medical exams from my wheelchair. Maybe this is OK, but there are many situations where this is not adequate.
While accessible exam equipment is available on the market, it is not (yet) required under the law for health care facilities so many medical facilities have not bothered to purchase accessible equipment. (As a side note, how infuriating and irresponsible it is that the medical sector has fought accessible exam equipment requirements or even voluntarily following them for so many decades.) In my case, I have to seek out accessible exam equipment and request it. There are certain exams I would not be able to have at all, which is important to preventive health care, if I did not have accessible equipment available for use. It aggravates me that I have to insist on this and remind providers that I have seen for years about my need for accessible exams.
Even beyond what the current legal requirements are and the best practices (like accessible exam equipment), there’s so much more providers could think about and do to make their spaces more accessible. For example, don’t block door opener buttons with trash cans as it makes them impossible to reach by those of us who need them. Rearrange or take out some of the waiting room chairs to make room for wheelchairs. Lower the check in/out counter or have a lower area where people with wheelchairs can roll up for assistance. Keep records of patients with accessibility needs and provide these accommodations without them having to repeatedly ask (for more than a decade in my case).
The ADA also has requirements for communications, such as providing American Sign Language interpreters when requested. Improving communications practices all around (such as plain language documents and materials in different formats, including digital) can improve the experience for all patients.
Make Health Spaces Welcoming for Disabled People
If I have not said it before, attitude is everything. I can give guidance on improving accessibility if people are open and willing to ask and listen. A bad attitude is a huge blockade when it comes to addressing ableism, especially the institutional form. I don’t know how many times medical staff have given me a look of annoyance when I request an accessible room while they are trying to show me into a room where my wheelchair cannot fit.
It is my hope that my providers have learned from me about living with a disability—that all I am doing is living my life! I have surprised them when I tell them I work, that I am married, that my husband and I like to travel, and so forth. But after the surprise, we can get down to business. How can they help support my health so that I can live my life with my disability?
This only works if they are willing to learn, listen, and adapt. I have found great medical professionals who “get it”, but finding them was not easy. I knocked on many doors and found many duds.
It’s not up to me to fix the duds, but I can advise the medical training profession that ableism is baked into their education. It’s time to think long and hard about how to unravel medicine from a discriminatory point of view when it comes to people with disabilities. This means incorporating education and experiences in all training. It means refresher courses. It means hospital systems need to retrain current staff. It means all these things and much more.
The CDC has a pretty good resource for starting to provide more inclusive medical care for disabled people. Medical schools are also doing more to incorporate disability competency training. These are great starts, but we need more of it and more widespread adoption for a variety of medical professionals.
Perhaps the most powerful way to get started is to ask disabled people. Ask them about their experiences, listen (even though it may be painful), then take action to correct problems. I’ll be honest that I have not always complained after a poor experience, because I was just glad I survived it and am in a hurry to leave. If you gave me a couple days to recover, then asked me—I might be more forthcoming and would have suggestions on what to do better.
Make Health Maintenance Accessible for Disabled People
In addition to medical facilities, we need to be thoughtful about making health maintenance spaces accessible as well for people with disabilities. This includes swimming pools, whirlpools, saunas, playgrounds, gyms, and so on. There are really great descriptions of the accessibility requirements already set for recreation areas.
Accessibility for recreation facilities begins with the fundamentals of ramped entry, wider doors, and space for moving a wheelchair (or other mobility device). It could also mean clear signs directing where there is access, audio cues, and other sensory accommodations. In classes, provide variations and accommodations so that people with different abilities can participate. (For example, I do a great seated jumping jack!)
Most of all, be welcoming to disabled people and open to requests for accommodations. Trust that they know their health and body.
Ultimately, everyone can and should participate in their own health. Disabled people just need the access and opportunity to do so.
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Thanks, Kelly!