The Assistant Secretary for Health chaired this first cross-cutting review of progress on Healthy People 2000 objectives for the health of people with disabilities. Staff of the Office of the Assistant Secretary for Planning and Evaluation and the National Center for Health Statistics, Centers for Disease Control and Prevention, provided an overview of the data. The DHHS Acting Assistant Secretary for Aging and the Director of the Department of Education's National Institute on Disability and Rehabilitation Research focused on opportunities for promoting health among people with disabilities and reducing conditions that lead to impairment. The following objectives were considered in the overview and discussion:

1.5b The proportion of people with disabilities who are sedentary, i.e., who report no leisure-time physical activity, declined from the 1985 baseline of 35 percent to 30 percent in 1991. The year 2000 target is 20 percent.

6.6 There has been improvement in the proportion of people with severe mental disorders who use community support programs, as well as in the proportion of people seeking help with personal and emotional problems (6.8). There has been little change, however, in the prevalence of depression (6.15) and the proportion of people with depression who seek treatment (6.7).

9.9 Since 1988, the rate of hospitalizations for nonfatal head injuries has declined by nearly 30 percent. The 1994 rate of 84 per 100,000 people is more than 20 percent below the year 2000 target of 106.

9.10 While the rate of hospitalizations for nonfatal spinal cord injuries has fluctuated since the 1988 baseline of 5.3 per 100,000 people, the 1994 rate of 3.9 per 100,000 was considerably below the year 2000 target of 5.

14.4 Rates of fetal alcohol syndrome (FAS) have increased. In 1993, the incidence of FAS reached 0.67 per 1,000 live births for the total population and 5.4 for Blacks. The most recent data for American Indians/Alaska Natives are from 1990 and show a rate (5.2) that was more than 10 times the rate for the total population in that year. The year 2000 targets are 0.12 cases per 1,000 live births for the total population, 2 per 1,000 for Native Americans, and 0.4 per 1,000 for Blacks.

14.17 An objective was added during the 1995 Midcourse revisions to reduce the incidence of spina bifida and other neural tube defects from the 1990 baseline of 6 cases per 10,000 live births to a year 2000 target of 3 per 10,000. The rate in 1993 was 7 per 10,000. In 1993, the Public Health Service recommended that all women of childbearing age consume 0.4 mg of folic acid daily for the purpose of reducing their risk of having a pregnancy affected by spina bifida or other NTDs.

17.2 Limitation of major activity due to chronic conditions increased from the 1988 baseline of 9.4 percent to 10.3 percent in 1994 for the total population. Similar increases have been recorded for most of the special population subgroups. The year 2000 target is 8 percent for the total population.

17.5 The rate of activity limitation due to chronic back conditions increased from the 1986-88 baseline of 21.9 per 1,000 people to 28.1 per 1,000 in 1992-94.

17.6 The rate of hearing impairment was estimated as 91.9 per 1,000 people for the total population in 1992-94 (1986-88 baseline = 88.9 per 1,000). For people aged 45 and older, the rate in 1992-94 was 207.4 per 1,000 (1986-88 baseline = 203 per 1,000). These updates move away from the year 2000 targets of 82 and 180 per 1,000, respectively.

17.7 Visual impairment for the total population has remained virtually unchanged. The rate in 1992-94 was estimated as 35.1 per 1,000, as compared with the 1986-88 baseline of 34.5 per 1,000. The year 2000 target is 30 per 1,000. For people aged 65 and older, the rate has fluctuated around the 1986-88 baseline of 87.7 per 1,000 and was estimated as 88.3 per 1,000 in 1992-94. The target is 70 per 1,000.

17.8 In 1991-92, the prevalence of serious mental retardation (IQ lower than 50) in 10-year old children was estimated as 4 per 1,000, an increase from the 1985-87 baseline of 3.1 per 1,000. The year 2000 target is 2 per 1,000.

21.2 In 1994, the proportion of people with disabilities who received recommended clinical preventive services (CPS) increased between 1991 and 1994. In spite of these increases, people with disabilities receive CPS at rates consistently below those of the total population.

HIGHLIGHTS

• Of the U.S. population living in the community, over 47 million people--almost one in every five Americans--have a functional disability. The majority of these are under age 65; 15.8 million are aged 65 and over. Another 2 million or so people with functional disabilities reside in nursing homes or other institutions.
• One in five mothers receiving assistance under the Aid To Families with Dependent Children (AFDC) has a functional disability; almost one in three AFDC mothers has a child or another family member with a disability or is disabled herself.
• The incidence of two leading causes of disability, nonfatal head injuries and nonfatal spinal cord injuries, has decreased since the 1980s. However, the incidence of several illnesses and conditions that can contribute to disability has risen in the 1990s, e.g., fetal alcohol syndrome, overweight, visual impairment, asthma, and certain complications of diabetes.
• The new paradigm of disability shows greater awareness of the biopsychosocial and environmental dimensions of disability, rather than taking a purely medical approach as in the past.
• Forty percent of children with a disability enter some form of out-of-home placement before age 18. Tax credits for adoption may provide incentives for families to give up children who have a disability.
• Currently, an average of four infants are born daily with hearing impairments that will not be identified soon enough for appropriate intervention to prevent lifelong communication disabilities. Today, the average age for identification of newborn hearing impairment is 2 and one-half years.
• Fetal alcohol syndrome is often not diagnosed until the affected child is 5-6 years old.
• As the proportion of the population aged 65 and over increases and as more people live longer with disabilities, intervention strategies to maximize years of healthy life take on greater importance.

Receipt of Clinical Preventive Services

Source: National Health Interview Survey, CDC, NCHS

FOLLOW-UP

• Encourage medical schools to make disability management and functional capacity preservation part of their curricula.
• Work on data collection activities to ensure more precise information about the nature and degree of disability and secondary conditions in the United States.
• Examine trends in enrollment of people with disabilities and receipt of services in managed care plans.
• Promote transition from the current practice of testing only high risk newborns for hearing impairment to the screening of all infants in the first 3 months of life.
• Expand collaborative programs to identify preventable etiologies of birth defects.
• Seek to determine the extent to which improved reporting has led to an apparent increase in the prevalence of fetal alcohol syndrome.
• Evaluate the efficacy of early intervention strategies to prevent or ameliorate disabilities in young children.
• Develop tracking systems to follow up on initial visits to screening and diagnostic facilities for young children.
• Focus additional research on violence as a cause of disability.
• Accelerate the application of bioengineering research into practice.
• Use the 1994-95 National Health Interview Survey on Disability and other new sources of information to develop health promotion and disease prevention objectives for 2010 for people with disabilities.

PARTICIPANTS
Administration on Aging
Administration for Children and Families
Agency for Healthcare Research and Quality (AHRQ)
American Academy of Pediatrics
American Disability Prevention and Wellness Association
Centers for Disease Control and Prevention
Department of Education
Department of Transportation
Health Care Financing Administration
Health Resources and Services Administration
Indian Health Service
Kaiser Family Foundation
National Academy of Sciences
National Council on Disability
National Institutes of Health
Office of the Assistant Secretary for Planning and Evaluation
Office for Civil Rights
Office of Disease Prevention and Health Promotion
President's Committee on Employment of People with Disabilities
Substance Abuse and Mental Health Services Administration
United Cerebral Palsy Association
U.S. Bureau of the Census

Jo Ivey Boufford, M.D.
Acting Assistant Secretary for Health

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