HEALTHY
PEOPLE 2010 DISABILITY OBJECTIVES:
PRIVATE SECTOR AND CONSUMER PERSPECTIVES
Conference Proceedings
and Recommendations
Michael Marge, Ed.D., Editor
American Association on Health and Disability
(formerly the American Disability Prevention and Wellness Association)
October 1998
Return to Disability and Health Publications Page
Table of Contents
Conference
sponsors
Foreword
Acknowledgements
Conference planning and format
Conference agenda
Recommendations from Workgroups
Categories:
Participation
Health care access
Environment/infrastructure
Health
promotion and secondary conditions I
Health promotion and secondary conditions II
Summary and conclusions
Next steps in process
References
Appendices
Agency for Health Care Policy and
Research, DHHS
American Disability Prevention and Wellness Association
Association of State and Territorial Disability Prevention Programs
Centers for Disease Control and Prevention, DHHS
National Council on Disability
Paralyzed Veterans of America
National Center on Disability and Rehabilitation Research
Spina Bifida Association of America
UNUM Life Insurance Company of America
Conference Proceedings and Recommendations
April 19 - 20, 1998,
Holiday Inn Hotel and Suites, Alexandria, Virginia
American Association on Health and Disability
111 Clarmar Road, Fayetteville, NY 13066-1602
© 1998 by the American Association on Health and Disability. All rights reserved. Printed in the United States of America.
The opinions expressed herein are the views of the Editor, Dr. Michael Marge, the authors, and participants and do not necessarily reflect the official position of any sponsoring or supporting agency of the U.S. Government or non-governmental sponsors of the Conference.
Editor: Michael Marge, Ed.D.
Managing Editor: Dorothy K. Marge, Ph.D.
Editorial Assistant: Susan Martini
The first Surgeon General's Report on Health Promotion and Disease Prevention, Healthy People, was published in 1979. The report identified broad national health goals to be met by 1990 for the improvement of the health of Americans at the five major life stages. Although most of these goals were stated in terms of reductions in death rates, some made reference to disability. For example, the following is the goal for older adults: "To improve the health and quality of life for older adults and, by 1990, to reduce the average annual number of days of restricted activity due to acute and chronic conditions by 20 percent, to fewer than 30 days per year for people aged 65 and older" (Public Health Service, 1979).
The Surgeon General's Report was quickly followed by the 1980 publication, Promoting Health, Preventing Disease: Objectives for the Nation (Public Health Service, 1980), which delineates specific and quantifiable objectives for each of 15 priority health areas, including (1) high blood pressure control, (2) family planning, (3) pregnancy and infant health, (4) immunization, (5) sexually transmitted disease, (6) toxic agent control, (7) occupational safety and health, (8) accident prevention and injury control, (9) fluoridation and dental health, (10) surveillance and control of infectious disease, (11) smoking and health, (12) misuse of alcohol and drugs, (13) nutrition, (14) physical fitness and exercise, and (15) control of stress and violent behavior. Several objectives made reference to disability. Under Occupational Safety and Health, the report states, "in 1977, more than 2.3 million workers experienced disabling injuries (80,000 of which were permanently disabling)" (Public Health Service, 1980). It was recommended, therefore, that "By 1990, the rate of work-related disabling injuries should be reduced to 8.3 cases per 100 full time workers (In 1978, there were approximately 9.2 cases per 100 workers);" "By 1990, lost workdays due to injuries should be reduced to 55 per 100 workers annually (In 1978, approximately 62.1 days per 100 workers were lost)."
The National Council on Disability (NCD) recognized that few health objectives for people with disability were included in the 1980 national health plan. NCD recommended that an interagency committee comprised of key organizations dedicated to better health services for people with disabilities meet to develop disability objectives for Healthy People 2000. In 1987, the Interagency Committee was established and co-chaired by NCD and the Office of Disease Prevention and Health Promotion (ODPHP), DHHS. To our knowledge, this was the first time that an organized effort was instituted to develop national health objectives for people with disabilities.
The Interagency Committee worked assiduously during a two year period to develop essential objectives that address important health issues of children and adults with disabling conditions. Thirty two objectives were formulated and submitted to ODPHP for inclusion into Healthy People 2000. To the Interagency Committee's disappointment, only few of the 32 objectives were acceptable on the grounds that many of the disability objectives were not referenced to baseline data and therefore, were not measurable. It should be pointed out that at that time, there was a paucity of reliable information about the prevalence and incidence of disabling conditions and our ability to forge measurable objectives was limited. Most of the draft objectives were developmental but reflected significant health issues that should be included in a national health plan. Furthermore, a review of the objectives submitted by working committees in many of the traditional areas of health (nutrition, family planning, mental health and mental disorders, violent and abusive behavior, heart disease and stroke, and diabetes) were a mix of measurable and developmental objectives. Two concessions were made in order to address some of the needs of people with disabilities: (1) people with disabilities were included as one of the special populations that may be stated in a subobjective under the traditional categories and (2) Surveillance Objective 22.4, "Develop and implement a national process to identify significant gaps in the Nation's disease prevention and health promotion data, including data for racial and ethnic minorities, people with low incomes, and people with disabilities, and establish mechanisms to meet these needs. (Baseline: No such process exists in 1990)." (Public Health Service, 1990).
During the monitoring and implementation of the objectives for Healthy People 2000, more and more attention was given by the Office of Disease Prevention and Health Promotion and the Department of Health and Human Services to the health needs of children and adults with disabilities. In Healthy People 2000: Midcourse Review and 1995 Revisions, 24 objectives related to disability were included (Public Health Service, 1995).
Given this history of public health interest in disability, it is remarkable that a chapter has been dedicated to disability objectives for the next Public Health Plan, Healthy People 2010. In addition to a chapter, disability objectives relevant to the specific topics of other chapters will be considered. I view this development as an "historic opportunity" for those of us committed to the prevention of primary disabling conditions and the prevention of secondary conditions in people with disabilities.
Since we are in the process of developing a national health plan, our product must reflect the needs and concerns of all Americans, especially those with disabilities. One of the most socially healthy efforts we can institute is to encourage the participation of those whose lives will be affected by a new policy or program. A number of significant events during the past two decades have lead to practice of involving the "consumers" of services in decisionmaking and policysetting. These events include (1) the disability consumer movement, (2) the demand for the "right to know" and "full disclosure," (3) Federal education programs that required school-parent teams to create an educational plan for children with disabilities, and (4) the Americans with Disabilities Act of 1990. In keeping with this desirable and effective practice of involvement by those whose lives and welfare will be affected, the American Disability Prevention and Wellness Association (now the American Association on Health and Disability) recommended to the Centers for Disease Control and Prevention and the Agency for Health Care Policy and Research that they support a national conference on the current draft disability objectives for Healthy People 2010 for the private sector and consumers. Both agencies approved the proposal and the Conference was conducted on April 20, 1998, in Alexandria, Virginia.
The American Association on Health and Disability is most appreciative of the opportunity to assist the CDC and the ODPHP/DHHS in developing disability objectives. A substantial amount of teamwork resulted in a very successful conference as evidenced by the participants' evaluations and the outcomes and products.
After almost 25 years of endeavor to improve the lives of all Americans through prevention and health promotion, I have developed a historical perspective of where we have been and where we are going. From a desert of neglect and disregard to today's remarkable commitment to the development of a critical mass of disability objectives is truly historic and must be appreciated. But, we are allowed to pause for only a short time and must move on if we are to be successful in our efforts to assure a healthy and more qualitative life for persons with disabilities. It is because each of us respects the dignity and humanity of every individual that I predict we will realize further tremendous advances during the next decade. I foresee exciting challenges and accomplishments ahead.
Michael Marge, Ed.D.
President, AAHD
This Conference is the product of many individuals working together with the support of groups and organizations that believe in the value of prevention. Sincere thanks and appreciation are extended to the following:
1. Donald Lollar, Ed.D. and Larry Burt, Office of Disability and Health, National Center for Environmental Health, Centers for Disease Control and Prevention, for their support, advice and good counsel in the planning and implementation of the Conference and its sponsorship.
2. Denise Doherty, Ph.D. and Raymond Seltser, MD, Agency for Health Care Policy and Research, Department of Health and Human Services for their support, assistance and sponsorship of the Conference.
3. Donna Scandlin and Donald Wagner, Ed.D., Co-chairpersons of the Conference Planning Committee, who invested considerable time and effort to create and implement the Conference. Thanks to members of their Planning Committee: Ruth Azeredo, Roberta Carlin, Fred Krause, Paul Placek, and Fran Stevens, for their assistance and excellent advice.
4. Patricia Owens, President of Integrated Health Disability Management, UNUM Life Insurance Company of America, for her long-time commitment, steadfast support of prevention, and sponsorship of the Conference.
5. Marca Bristo, Chairperson, and Ethel Briggs, Executive Director, National Council on Disability, for their interest, support and sponsorship of the Conference. The National Council on Disability was the key agency to initiate efforts in the development of disability objectives for Healthy People.
6. Lisa Hudgins, Director of Research and Education, and Andrea Censky, Associate Director of Education, Paralyzed Veterans of America, for their support and sponsorship of the Conference. PVA is a leader in prevention, especially in the prevention of secondary conditions.
7. Roberta Carlin, Director of Governmental Affairs, Spina Bifida Association of America (SBAA), for her constant and steadfast support of prevention. Also, we appreciate the sponsorship of the Conference by the SBAA.
8. David Hamel, President, Association of State and Territorial Disability Prevention Programs, for his good advice and counsel and sponsorship of the Conference. He and his organization are committed to prevention and work closely with AAHD.
9. Dr. Katharine Seelman, Director and Frank Corrigan, Deputy Director, National Institute on Disability and Rehabilitation Research, for their interest and sponsorship of the Conference.
10. Dr. Dorothy K. Marge, President of SafetyNet International, Inc., who volunteered considerable time and energy in the implementation of the Conference. Her expertise and assistance were invaluable and AAHD salutes her efforts on behalf of the Conference.
In addition to these contributions, we sincerely thank each of the participants for their willingness to join us in this historic venture. Their input is essential so that the disability objectives for Healthy People 2010 are significant, viable and effective.
Respectfully submitted,
Michael Marge, President
Conference Planning and Format
Donna Scandlin, Don Wagner and Michael Marge, representing the AAHD (formerly the ADPWA), submitted a conference proposal which was approved and funded, in part, by the Centers for Disease Control and Prevention and the Agency for Health Care Policy and Research. Additional sponsors include Association of State and Territorial Disability Prevention Programs, National Council on Disability, Paralyzed Veterans of America, National Institute on Disability and Rehabilitation Research, Spina Bifida Association of America, and UNUM Life Insurance Company of America. A Conference Planning Committee was established with the following members: Donna Scandlin and Don Wagner, Co-Chairs, Ruth Azeredo, Roberta Carlin, Speed Davis, Fred Krause, Paul Placek, and Fran Stevens.
The rationale for the Conference is as follows:
While 15% of Americans have one or more disabilities, fewer than a dozen of the over 300 Healthy People 2000 objectives focus exclusively on persons with disabilities. To better address the needs of persons with disabilities, the Healthy People 2010 planning process includes a special task force, Healthy People with Disabilities 2010. The Office of Disease Prevention and Health Promotion/DHHS and the Office on Disability and Health/NCEH/CDC are coordinating the planning process. In the Winter 1997 and Spring 1998, five work groups drafted Healthy People 2010 Objectives that relate to disability. The five groups were: 1) nature and extent of disability; 2) disabilities associated with major specific disabling conditions; 3) health promotion and wellness; 4) participation and environment, including technology; and 5) public health and secondary conditions among persons with disabilities. From these workgroups, almost 400 measurable and developmental disability objectives were proposed. After several reviews by the special task force, a smaller number of objectives were identified and separated into two categories: Category One--draft disability objectives for the chapter in Healthy People 2010 and Category Two--draft disability objectives that should be directed to the planning teams of other chapters for their consideration. Sixty six (66) draft objectives were identified for further review and assessment.
In order to provide the important perspectives and insights of people with disabilities, representatives from the private sector and consumers were invited to the working conference. Although some people with disabilities and representatives of the private sector are currently involved in the process of setting objectives, it is important to bring a broader base of involvement and perspectives of these constituencies to be sure the objectives are credible and that the objectives are implemented in the states and disability community.
The specific purposes of the working conference are: (1) to provide stakeholders with education and information about the draft Healthy People 2010 objectives that relate to disability; (2) to provide a participatory forum to share perspectives and prioritize the draft objectives; and (3) to make consensus recommendations for additions or revisions to the draft objectives.
The Conference was held on April 20, 1998, at the Holiday Inn Hotel and Suites, Alexandria, Virginia. Initially, the Conference Planning Committee recommended that the conference be limited to 50 - 60 participants who were invited on the basis of the following criteria:
a. 20 participants from the private sector, including representatives of health care services, health care organizations, professional organizations devoted to disability issues and programs, business and industry and private foundations.
b. 20 participants who are consumers of disability services including individual leaders in the disability community who will speak from personal experience as a person with a disability.
c. 5 participants who are representatives of parent and consumer organizations dedicated to the improved health of persons with disabilities.
d. 5 representatives from Federal agencies, including CDC, ODPHP, AHCPR, NIDRR, and NCMRR.
During the implementation stage of the Conference, the number of invitees was increased to 64. A list of the participants with their affiliation and address is found in the Appendices (see Appendix 1).
Each of the participants received a preconference information packet that included the conference agenda, their specific assignments to workgroups, the draft objectives, the rating form for assessing the objectives, and other related information.
(see Appendix 2).
The final conference format and agenda was as follows:
ADPWA 1998 CONFERENCE AGENDA
"HEALTHY PEOPLE
2010 DISABILITY OBJECTIVES--PRIVATE
SECTOR AND CONSUMER PERSPECTIVES"
Sunday, April 19 and Monday, April 20, 1998
Holiday Inn Hotel and Suites, 625 First Street, Alexandria, VA
Sponsored by: Agency for Health Care Policy and Research, Department of Health and Human Services; American Disability Prevention and Wellness Association; Association of State and Territorial Disability Prevention Programs; Office of Disability and Health, National Center for Environmental Health, Centers for Disease Control and Prevention; National Council on Disability; Paralyzed Veterans of America; National Center on Disability and Rehabilitation Research; Spina Bifida Association of America; UNUM Life Insurance Company of America.
Sunday, April 19:
12 Noon to Registration (Front foyer of Ballroom)
7:30 p.m. Orientation meeting with Facilitators and Recorders. Presiders are Donna
Scandlin and Don Wagner, Co-Chairpersons of Conference. (Stevenson Room)
Monday, April 20:
7:30 a.m.- Registration (Outside of Ballroom D)
8:30 a.m. Welcome and discussion of the conference purposes and format and role of the
participants. (Ballroom D)
Presiders: Dr. Michael Marge, President of the American Disability, Prevention and
Wellness Association; Donna Scandlin, Co-chairperson of the Conference; Dr. Donald Lollar,
ODH, NCEH, CDC. Recognition of all Conference sponsors.
9:00 a.m. "Improved Health Care for Persons with Disabilities: Healthy People 2010
Disability Objectives." Keynote Speaker, Mr. Larry Burt, Director of the Office
of Disability and Health, National Center for Environmental Health, Centers for Disease
Control. Mr. Burt will be introduced by Dr. Michael Marge.
9:30 a.m. Setting the Challenge for the Workgroups
Presenter: Dr. Donald Wagner, Co-chairperson of the Conference.
10:00 a.m. Break
10:15 a.m. lst Workgroup Session: Conferees divide into workgroups on the five assigned
topics:
Group 1: Participation (Martin Room)
Facilitator: Speed Davis
Recorder: Fred Krause
Group 2: Health Care Access (Marshall Room)
Facilitator: Glen White
Recorder: Roberta Carlin
Group 3: Environment/Infrastructure (Pendleton Room)
Facilitator: Andrea Censky
Recorder: Ruth Azeredo
Group 4: Health Promotion & Secondary Conditions I (Wythe Rm)
Facilitator: Tom Seekins
Recorder: Dot Nary
Group 5: Health Promotion & Secondary Conditions II (Ballrm B)
Facilitator: Paul Tupper
Recorder: James Rimmer
Group Task: Discuss participant perspectives and reactions to the draft objectives.
Delineate the clarity, relevance, and measurability of each objectives assigned to the
workgroup.
12:15 p.m. Working lunch (Ballroom D)
Moderator: Don Wagner, Co-Conference Chair
Facilitators will share a brief summary of their morning session while dessert and coffee
are served.
1:30 p.m. Second workgroup session:
Participants reconvene in their assigned workgroups from the morning session with the same
facilitators.
Group task: Develop consensus recommendations for revisions and/or additions to the draft
objectives.
3:15 p.m. Closing Plenary Session: (Ballroom D)
Each facilitator will share the recommendations from their group. Brief discussion and
reaction from the participants will be entertained.
Presiders: Dr. Don Wagner and Larry Burt, ODH, NCEH, CDC.
4:15 p.m. Closing remarks and participant evaluation
(Conference evaluation forms will be completed and submitted before participants depart)
Presider: Dr. Michael Marge
4:30 p.m. Adjournment
Following the Conference a final report of the consensus recommendations and workgroup discussions will be prepared and submitted to the Centers for Disease Control and Prevention, Agency for Health Care Policy and Research and other sponsors.
Setting the Challenge for the Workgroups.
Dr. Don Wagner presented the instructions to the Workgroup Facilitators and Recorders at a meeting on the evening before the Conference. The Workgroups are expected to review the draft Healthy People 2010 Disability Objectives for the purpose of providing consensus recommendations about each objectives. The recommendations may include the exclusion of objectives, revision of objectives or the addition of objectives. (See Appendix 2 for copies of the "Facilitator's Guide" and the "Recorder's Guide").
Recommendations from the Workgroups
Participants in each workgroup had received the draft objectives at least one week before the conference and had been requested to carefully read and evaluate each objective according to prescribed criteria (see Appendix 2). At the Conference the workgroups met for about four hours followed by a plenary session of about one hour when the recommendations from each workgroup were read and discussed. The deliberations of the workgroups and all participants at the plenary session resulted in the next draft of HP2010 Disability Objectives. They are:
Objective #1: Reduce the percent of persons with disabilities who report they are limited by environmental factors, to include
a. physical environment--limited or no
access to buildings, housing, recreational facilities, and transportation;
b. social environment--negative attitudes of others toward disability;
c. learning environment--limited or no access to educational programs and relevant
information systems throughout life;
d. economic environment--limited or no career development, career opportunities, job
placement and job satisfaction;
e. political environment--limited or no participation in governmental decisionmaking on
issues that directly affect their lives, voting activity, and opportunities to run for
public office.
(Data Source: Module for BRFSS is being developed and will be piloted in 1998. These items will be included in BRFSS in 2000.)
Commentary: This is a developmental objective. Full participation in life activities is essential in attaining good physical and mental health. Physical, social, learning, economic and political environmental factors may present barriers to full participation and reduce access to resources that allow healthy growth and development. Baseline data are needed in order to adequately measure this objective.
Objectives from other sections which should include people with disabilities:
Objective #2: Increase the number of schools which provide access to physical activity spaces and facilities.
Objective #3: Increase the number of schools providing education/awareness programs on the relationship between human health and the physical, social, learning, economic, and political environment.
Objective #4: Increase the high school graduation rate to at least 90%, thereby reducing risks for multiple problem behaviors and poor mental and physical health (HP2000, Objective 8.2).
Objective #5: Achieve for all disadvantaged children and children with disabilities access to high quality and developmentally appropriate preschool programs that help prepare children for school, thereby improving their prospects with regard to school performance, problem behaviors, and mental and physical health. (HP2000, Objective 8.3).
Objective #6 : Increase to at least 75% of the Nation's elementary and secondary schools that provide planned and sequential K -12th grade comprehensive school health education. (HP2000, Objective 8.4).
Objective #7: Increase to at least 50% the proportion of the Nation's elementary and secondary schools that have a nurse to student ratio of 1:750.
Objective #8: Increase to at least 50% the proportion of the Nation's elementary and secondary schools that have a school health coordinator to oversee all aspects of the school health program.
Objective #9.: Increase to at least 90% the proportion of people aged 65 and older who has participated during the preceding year in at least one organized health promotion program. (HP2000, Objective 8.8).
Objective #10: Develop a health information system that collects data on the effects of physical, social, economic, learning and political environments on the lives of persons with disabilities.
Commentary: The health information system must be accessible and useful to both scientific and lay audiences.
Objective #11: Increase to 50% the proportion of households with children that report receiving injury prevention counseling at a medical visit in the past 12 months about the use of ipecac, emergency poison control phone number, storage of firearms, the use of bicycle helmets and the use of car seats and/or seat belts.
Objective #1: There will be no disparity in the degree of quality and access to health care services and benefits for people with and without disabilities.
Objective #2: Establish surveillance and health promotion programs for persons with disabilities in all states and territories.
Objective #3: Increase the percentage of health promotion, wellness and treatment programs that are accessible in compliance with the provisions of the Americans with Disabilities Act.
Objective #4: Increase the percentage of prevention and treatment programs for abused children and adults with disabilities that are in compliance with the provisions of the Americans with Disabilities Act.
Objective #5: Eliminate disparity in access to health care facilities and providers (to include telemedicine technology) between urban and rural-dwelling people with disabilities.
Objective #6: Persons with disabilities will have the same affordable comprehensive health insurance coverage as persons without disabilities
Objective #7: All persons with disabilities will receive appropriate assistive technology equipment, materials and/or training that is deemed necessary by consultation with certified specialists to realize the greatest degree of independence.
Objectives from other sections which should include people with disabilities:
Objective #8: Reduce to 0% the proportion of children and adults under 65 without health care coverage.
Objective #9: Increase to 90% the proportion of children and adults who have coverage through private or public insurance for representative clinical preventive services, that is immunizations, screening tests, and counseling about health promotion and prevention.
Objective #10: Increase to at least 95% the proportion of children and adults with and without disabilities who have an ongoing primary care.provider.
Objective #11: Reduce to no more than 5% the number of persons with disabilities who report that they did not obtain all necessary health care as needed.
Objective #12: Reduce to no more than 5% the number of persons with disabilities who report being in fair or poor health.
Objective #13: All primary care providers will obtain a functional assessment of all potential long term care patients.
Objective #14: All primary care providers will refer long term care patients to rehabilitative and related services (such as treatment for alcoholism and substance abuse) as needed.
Objective #15: All states and territories will have service systems for children at risk for chronic and disabling conditions, as required by Public Law 101-239.
Addendum
The following objectives were suggested by Pathways Awareness Foundation in response to the request for relevant disability objectives:
Objective #A: All infants will be
screened, using observational, physical and postural assessment for early identification
of developmental disabilities.
Source: American Academy of Pediatrics Policy Statement, RE 9414; Public Law 105-17.
Objective #B: All infants with
identified disabling conditions will be referred for care and treatment on a timely basis.
Source: American Academy of Pediatrics Policy Statement, RE 9414; Public Law 105-17.
Objective #C: All students in grades K
- 12 with learning problems will be screened for language, sensory and vision processing
difficulties.
Source: Public Law 105-17.
Category: Environment/Infrastructure
Objective #1: By the year 2003, develop and implement at the federal, state, and local levels new data collection systems to track health objectives for specific geographic areas and special populations, including people with disabilities. (Data sources: National Center for Health Statistics, CDC; Office of Disease Prevention and Health Promotion, DHHS).
The Mid-Course Review stated, "the elements of this report that explicitly call for improvement for people with disabilities are limited by the availability of data with which to set targets" (DHHS, 1995, p. 40). The Centers for Disease Control and Prevention, the Office of the Assistant Secretary for Planning and Evaluation, and the National Institute for Disability and Rehabilitation Research, along with university researchers in disability surveillance are engaged in a national effort to correct the problem of dearth of relevant data. The correction of this information gap will occur by the year 2000 and by the year 2003, an effort will be made to integrate these data sets. With this information the status and well-being of people with disabilities will be identified and appropriately studied. From these analyses, proper interventions will be developed and applied and the progress toward the objective of better health status will be evaluated and effectively tracked.
Objective #2: The core minimum data set of the patient encounter form for all people with and without disabilities receiving health care will include functional status and the taxonomy of the World Health Organization's current version of the International Classification for Impairment, Disability and Handicap.
Objective #3: Increase the percentage of health, wellness, and treatment programs and facilities which are in compliance with the Americans with Disabilities Act, including
a. Community-based health and fitness
programs 50%
b. Residential substance abuse treatment facilities 95%
c. Emergency housing programs for battered women 95%
Data sources: a.) State health department ADA compliance plans and b) Domestic Violence Statistical Survey.
Objectives from other sections which should include people with disabilities
Objective #4: Increase to at least 75% the number of children and adolescents with and without disabilities aged 6 - 17 who engage in vigorous physical activity that promotes the development and maintenance of cardiorespiratory fitness three or more days per week for 20 or more minutes per occasion. (Healthy People 2000 Objective 1.4).
Objective #5: Increase to at least 40% the number of people with and without disabilities aged 6 and older who regularly perform physical activities that enhance and maintain muscular strength, muscular endurance, and flexibility. (Healthy People 2000 Objective 1.6).
Objective #6: Increase to at least 50% the number of children and adolescents with and without disabilities in 1st - 12th grade who participate in daily in daily school physical education. (Healthy People 2000 Objective 1.8).
Objective #7: Increase to at least 50% the number of primary care providers and allied health professionals who routinely assess and counsel their patients with and without disabilities regarding the frequency, duration, type, and intensity of each patient's physical activity practices. (Healthy People 2000 Objective 1.12).
Objective #8: Increase to at least 90% the number of school lunch and breakfast services and child care food services for preschool and school aged children with and without disabilities with menus that are consistent with the nutrition principles in the Dietary Guidelines for Americans. (Healthy People 2000 Objective 2.17).
Objective #9: Increase to at least 75% the number of the Nation's schools that provide nutrition education to children with and without disabilities from preschool - 12th grade, preferably as part of comprehensive school health education. (Healthy People 2000 Objective 2.19).
Objective #10: Increase to 85% the number of children with and without disabilities in grades K - 12 who have received reproductive health education, preferably as part of comprehensive school health education. (see Healthy People 2000 Objective 5.8).
Category: Health Promotion and Prevention of Secondary Condition I
Objective #1: Increase to 90% the primary care providers for children who routinely screen or refer for screening newborns, infants, toddlers and children for impairments of vision, hearing, speech, language, physical and emotional behaviors, and other developmental milestones as part of well-child care.
Objective #2: Increase to 90% the primary care providers for adults who screen for impairments of vision, hearing, speech, language, cognition, voice, physical and emotional behaviors, and swallowing and refer to appropriate diagnostic and treatment services.
Objective #3: Increase healthy days for people with disabilities to at least 26 days during the past 30 days.
Objective #4: Increase to 28.7 days during the past 30 days the number of people with disabilities who able to perform usual activities due to good physical and/or mental health.
Objective #5: Reduce to 5.4 the number of days of depression in the past 30 days experienced by persons with activity limitations who need assistance.
Objectives from other sections which should include people with disabilities
Objective #6: Increase to 100% the proportion of Healthy People 2010 objectives that can be tracked for special populations, including people with disabilities according to age groups and type and degree of functional limitations.
Objective #7: Develop a set of summary measures of population health and the public health infrastructure and establish use at state and local levels with attention to people with disabilities.
Objective #8: Increase to at least 50% the number of counties that have established culturally appropriate, linguistically competent, and universally accessible health promotion and disease prevention programs for racial and ethnic minority populations and people with disabilities. (HP 2000 Objective 8.11).
Objective #9: Increase to 90% the number of managed care organizations, hospitals, and large group practices that provide accessible patient education programs and community disease prevention and health promotion programs addressing the priority of health needs for their community, including the needs of people with disabilities. (Hp 2000 Objective 8.12).
Objective #10: Increase to 50% the number of health care providers who receive pre-service and continuing education about disability and health.
Category: Health Promotion and Prevention of Secondary Conditions II
Objective #1: Increase to 13 the number of days in the past 30 when people with disabilities report that they feel their health is good.
Objective #2: All people with disabilities will receive effective psychological counseling when faced with serious personal and emotional difficulties.
Objective #3: All people with disabilities will report satisfaction with ten domains of life: health, work, relationship with significant other, housing, community, standard of living, social relationships, creative expression, education, and future prospects for growth and development.
Objective #4: Medicine labels, patient instruction materials, potential side effects and drug interactions, and syringe markings should be written in language understood by laymen and should be written in the format, size and style legible for 98% of the adult population, including people with disabilities. (This objective is also recommended for the section on Food and Drug Safety for Healthy People 2010).
Objectives from other sections which should include people with disabilities
Objective #5: Reduce dental caries so that children with and without disabilities experience one or more caries as follows: no more than 35% among children aged 6 - 8, and 60% among adolescents aged 15. (Healthy People 2000 Objective 13.1).
Objective #6: Reduce untreated dental caries so that the number of children with and without disabilities who remain untreated is no more than 20% among children aged 6 - 8, and 15% among adolescents aged 15 (Healthy People 2000 Objective 13.2).
Objective #7: Increase from 31% to at least 45% the number of dentate people with and without disabilities aged 35 - 44 who has never lost a permanent tooth due to dental disease or trauma. (Healthy People 2000 Objective 13.3).
Objective #8: Reduce the prevalence of gingivitus among people with and without disabilities aged 35 - 44 from 4% to no more than 30%. (Healthy People 2000 Objective 13.5).
Objective #9: Reduce the prevalence of destructive periodontal disease among people with and without disabilities aged 35 - 44 from 25% to no more than 15%. (Healthy People 2000 Objective 13.6).
Objective #10: Increase to at least 90% the number of all children with and without disabilities entering school programs for the first time who have received an oral health screening, referral, and follow-up for necessary diagnostic, preventive and treatment services. For those who are referred for treatment, 90% will begin treatment within 90 days. (Healthy People 2000 Objective 13.12).
Objective #11: All long term care facilities will provide oral examinations and services to people with and without disabilities no later than 90 days after entry into these facilities. (Healthy People 2000 Objective 13.13).
Objective #12: Increase to at least 70% the number of adults with and without disabilities aged 35 and older who use the oral health care system during each year (Healthy People 2000 Objective 13.14).
Objective #13: All persons with disabilities shall have access to information and educational programs about sexuality and sexual health throughout their lifespan.
Objective #14: All adults with disabilities will make the decision to live in housing of their choice.
Objective #15: Each state and U.S. territory will establish Disability Review Teams to screen for disabilities among infants, children and adults who are victims of violence, including child and elder abuse, suicide attempts, and domestic violence.
ADDITIONAL OBJECTIVES FROM APRIL 15,
1998 REVISIONS OF DISABILITY OBJECTIVES:
(Note: Some of these objectives are similar to those considered by the Conference
Workgroups.)
Objective #1: Increase to at least 90% the number of adults with disabilities reporting good, very good, or excellent general health. (Data Source: BRFSS).
Objective #2: Employment rates among people with disabilities will be equal to persons without disabilities. (Data source: Survey of Income and Program Participation).
Overall unemployment averages in the single digits for the U.S. population. SIPP data suggest that unemployment among persons with disabilities averages 40 - 60 percent.
Objective #3: Increase to 60% the number of children with disabilities who are included in regular education programs. (Data Source: U.S. Department of Education).
Current rates of inclusion is 45% for children with disabilities aged 2 - 21. It is believed that inclusion of children with disabilities in educational activities with non-disabled peers is important for healthy social and emotional development for all children.
Objective #4: All states and U.S. territories will have public health surveillance and health promotion programs for people with disabilities. (Data Source: Office on Disability and Health, National Center for Environmental Health, CDC; currently 14 states include health promotion and surveillance activities, with an additional 2 providing surveillance).
Summary and Conclusions
The Conference participants were unanimous in their agreement that the development of objectives for Healthy People 2010 is a significant activity because (a) for the first time, it provides the opportunity to address disparities in health issues for people with disability; (b) the planning document will play an important role in shaping health legislation, funding, and programs; and (c) it will result in better data for prevention of disabling conditions, especially secondary health complications. The participants understood that the current draft of objectives for a chapter on disability objectives will undergo considerably revision. The planning process utilized by the Office of Disease Prevention and Health Promotion is expected to review each draft chapter on a number of occasions, seeking ways to revise the draft so that it stays within certain parameters for a planning document and so that it most effectively describes proposed objectives. Some of the participants were concerned about the fate of the 400 objectives that were developed during the initial phase of the planning process during the Winter 1997 and Spring 1998. They recommended that these objectives are included in a companion planning document that supplements Healthy People 2010. This prospect was discussed and plans are underway to seek appropriate funding to publish the 400 objectives as a suplement.
Another outcome of the Conference was the active participation of persons with disabilities in the development of disability objectives. This is the first time that a substantial number of individuals with disabilitiesprovided their input to the development of Healthy People disability objectives. Their perspective shaped many of the proposed objectives into more feasible and realistic statements, representing essential health needs of people with disabilities. Furthermore, the role of social participation in attaining well-being, quality of life, and good health was highlighted throughout the Conference. The Conference evaluations recognized this outcome as one of the major contributions to the success of the meeting.
Despite the fact that a number of objectives were "developmental" and will require greater substantiation before they become really measurable, the participants believe that it is important they are included so that "essential data collection is instituted." It is gratifying to learn that since 1990, information about disability in America has been expanding at a substantial rate, providing us with excellent baseline data for the development of a number of measurable objectives. But it is important that questions about disability should be included in all national health data systems. Some of these data systems include the module on disability for the Behavioral Risk Factor Surveillance System (BRFSS), additional questions on the National Health Interview Survey (NHIS), the questions about disability on the Survey of Income and Program Participation SIPP), and the U.S. Census. Some participants remarked about the importance of the revision of the classification system of the World Health Organization (International Classification of Impairments, Disability and Handicaps) and its implications for establishing a standard and utilitarian nomenclature when assessing, discussing or communicating about individuals with special needs.
Many of the participants expressed their interest in continuing in the development of Healthy People 2010 Disability Objectives. Some felt that one day of deliberation did not allow sufficient time to complete the task of remarking on each draft objective. Their preference was to conduct a second conference in the Fall so that they have the opportunity to deliberate longer before making a final decisions. The timetable did not allow for a second meeting. Their input at the Conference, therefore, will serve as a significant contribution to the entire planning process.
It was announced that in the Fall 1998 the Office of Disease Prevention and Health Promotion will conduct five regional meetings to receive public comment and testimony about Healthy People 2010 Objectives Draft. Copies of the Draft Document will be available in September 1998. The Draft Document will represent the product of many individuals and many meetings when each section and chapter will be repeatedly reviewed and modified to suit the parameters of the total document as envisioned by Department of Health and Human Services planners.
After the issuance of the Draft Document, the public will be invited to comment and present testimony through the Internet, by fax, by the mails and in person at the regional meetings. The dates and sites of the Regional Meetings are as follows:
October 5-6, 1998 Philadelphia, PA
October 21-22, 1998 New Orleans, LA
November 5-6, 1998 Chicago, IL
December 2-3, 1998 Seattle, WA
December 9-10, 1998 Sacramento, CA
There is no registration fee, but people are encouraged to register because seating is limited to about 300 at each meeting. Registration information is available through a variety of sources:
Via the Internet, at
http://web.health.gov/healthypeople; or
Via phone, fax or mail, call (800) 367-4725 to receive materials.
Chapter 19 of the Draft Document: "Disability and Secondary Conditions" and Recommended Objectives for Other Chapters
In September 1998, the Chapter on disability objectives was distributed for public comment. It represents the current perception of the Office of Disease Prevention and Health Promotion and the HP2010 Workgroup Coordinators. A number of the recommendations emanating from this Conference are not included in the Draft Document. The period of public comment will occur from September 15 - December 15, 1998. The draft of Chapter 19 is found in Appendix 3.
Public Health Service. (1979). Healthy people, The Surgeon General's report on health promotion and disease prevention. Washington, DC: U.S. Government Printing Office.
Public Health Service. (1980). Promoting health/preventing disease, Objectives for the nation. Washington, DC: U.S. Government Printing Office.
Public Health Service. (1990). Healthy people 2000, National health promotion and disease prevention objectives. Washington, DC: U.S. Government Printing Office.
Public Health Service. (1995). Healthy people 2000, Midcourse review and 1995 revisions. Washington, DC: U.S. Government Printing Office.
Office of Public Health and Science. (1998). Healthy people 2010 objectives: Draft for public comment. Washington, DC: U.S. Printing Office.
Appendix 1: List of participants
Appendix 2: Draft objectives and other materials sent to participants before the Conference (available from the American Association on Health and Disability, 111 Clarmar Road, Fayetteville, NY 13066-1602)
Appendix 3: September 1998 draft of Chapter 19: "Disability and secondary conditions" (available from Office of Disability and Health, NCEH, 4770 Buford Highway,Atlanta, GA 30341)
Appendix 1: List of Participants
Mike Adams, M.D.
NCEH/CDC, 4770 Buford Highway, NE
Chamblee, MS F-34
Atlanta, GA 30341-3724
Michelle C. Adler, Ph.D.
Social Security Administration
6401 Security Boulevard
Baltimore, MD 21235
David Auxter, President
Research Institute for Independent Living
1645 Old Town Road
Edgewater, MD 21037
Ruth Azeredo, Ph.D.
Oklahoma State Dept. of Health
1000 N.E. 10th Street, Room 613
Oklahoma City, OK 73117-1299
Allan I. Bergman, Executive Director
Brain Injury Association
105 N. Alfred Street
Alexandria, VA 22314
James Billy, Executive Director
Harlem Independent Living Center
5-15 West 125th Street
New York, NY 10027
Ronald Blankenbaker, M.D., Exec. V.P.
Erlanger Medical Center
975 E. Third Street
Chattanooga, TN 37403
Dyanne Bostain, Ph.D.
Regent University
1000 Regent University Drive
Virginia Beach, VA 23464-9860
Scott Campbell Brown, Ph.D.
OSERS/OSEP
330 C Street, SW
Washington, DC 20202
David N. Brown, Member
National Council on Disability
7840 Warbler Court, SE
Olympia, WA 98513
Larry Burt, Program Officer
Office of Disability and Health
National Center for Environmental Health
CDC
4770 Buford Highway, N.E.
Atlanta, GA 30341
Roberta Carlin, J.D., Director
Governmental Affairs
Spina Bifida Assn. of America
4590 MacArthur Blvd., NW, Ste. 250
Washington, DC 20007-4226
Evey Cherow, Ph.D.
American Speech-Language-Hearing Assn.
10801 Rockville Pike
Rockville, MD 20852
Marie Clements, Director
Services for Independent Living
UNUM Life Insurance Company of America
Portland, ME 04122
Diane Coleman
Progress Center
7521 Madison Street
Forest Park, IL 60130
Fred Cowell, Ph.D., Staff Director
Health Policy Department
Paralyzed Veterans of America
Washington, DC 20006-3517
Speed Davis, Disability Advocate
1401 N. Taft Street No. 621
Arlington, VA 22201
Dennis Fitzgibbons, Executive Director
Independent Living Center, ALPHA I
127 Main Street
S. Portland, ME 04106
Gay Girolami, Executive Director
Pathway Awareness Foundation
123 North Wacker Drive, Suite 900
Chicago, IL 60606
Murray Goldstein, D.O., Director
UCPA Research and Educ. Found.
1660 L Street, NW Suite 700
Washington, DC 20036
David Hamel, Program Officer
Disability & Health Program
Rhode Island Department of Health
Providence, RI 02908-5097
James W. Hanson, MD
Epidemiology and Genetics Program
6120 Executive Boulevanrd MSC 7147
Bethesda, MD 20892-7147
Bryna Helfer, Director
TBI Technical Assistance Center
8737 Colesville Road, 9th Floor
Silver Spring, MD 20910
Gerry Hendershot, Ph.D.
National Center for Health Statistics
6525 Belcrest Road, Room 8-50
Hyattsville, MD 20782
Elaine Holland, Associate Director
American Academy of Pediatrics
601 13th Street, NW, Suite 400N
Washington, DC 20005
Anne-Marie Hughey, Executive Director
National Council on Independent Living
1916 Wilson Boulevard, Suite 209
Arlington, VA 22201
David Keer, Ph.D.
NIDRR/OSERS
Switzer Building, Room 3431
Washington, DC 20202
Corrine Kirchner, Ph.D., Executive
Director
American Federation of the Blind
11 Penn Plaza, Suite 300
New York, NY 10001
Richard Klein, Ph.D.
National Center for Health Statistics
6525 Belcrest Road
Room 7-30
Hyattsville, MD 20782
Fred Krause, Operational Officer
Brain Injury Association
15100 Interlachen Drive, Apt. 907
Silver Spring, MD 20906
Carol Locust, Ph.D.
Native American Res. and Trng. Ctr.
1642 East Helen Street
Tucson, AZ 85719
Donald Lollar, Ed.D., Director
Office of Disability and Health
National Center for Environmental Health
CDC
4770 Buford Highway, N.E.
Atlanta, GA 30341
Kathy Martinez
World Institute on Disability
510 Sixteenth Street, Suite 100
Oakland, CA 94612
Dr. Kathy McGinley, Associate Director
The Arc Governmntl Affairs Office
1730 K Street, NW, Suite 1212
Washington, DC 20006
Dorothy (Dot) Nary
Research and Training Center on Independent Living
University of Kansas, 4089 Dole Center
Lawrence, KS 66045-2930
Els R. Nieuwenhuijsen
Prevention Specialist
653 Watersedge Drive
Ann Arbor, MI 48105
Kathryn O'Connell, Rehabilitation
Counselor
Private Practice
207 Elm Street
Fayetteville, NY 13066
Judith Panko Reis, Administrative
Director
HRCWD
345 E. Superior, Room 106
Chicago, IL 60611
Diane Paul-Brown, Ph.D.
American Speech-Language-Hearing Assn.
10801 Rockville Pike
Rockville, MD 20852
Paul Placek, Ph.D.
National Center for Health Statistics
6525 Belcrest Road, Room 7 - 30
Hyattsville, MD 20782
Louis A. Quatrano, Ph.D.
NCMRR/NIH
6100 Executive Boulevard
Rockville, MD 20852
James Rimmer, Ph.D., Director
Center on Health Promotion Research
Dept. of Dis. and Human Development
University of Illinois at Chicago
1640 West Roosevelt Road
Chicago, IL 60608-6911
Sunny Roller, Project Manager
UMMC, Dept. of Physical Med. and Rehab.
1G202 University Hospital
Ann Arbor, MI 48109-0050
Colleen M. Ryan, Ph.D
NCHS/CDC
Presidential Building, Room 770
Hyattsville, MD 20782
Shirley Ryan
National Council on Disability
123 North Wacker Drive
Suite 900
Chicago, IL 60606
Donna Scandlin, Project Director
Office of Disability and Health
FPG-CDC, UNC-CH, CB#8185
Chapel Hill, NC 27599-8185
Thomas Seekins, Ph.D., Director
RTC: Rural Institute on Disabilities
University of Montana, 52 Corbin Hall
Missoula, MT 59812
Raymond Seltser, M.D., M.P.H.
4701 Willard Ave., Apt. 1714
Chevy Chase, MD 20815
Marie P. Strahan, J.D.
Social Security Administration
6401 Security Boulevard
Baltimore, MD 21235
Alexa K. Stuifbergen, Ph.D.
School of Nursing
University of Texas at Austin
Austin, TX 78701
Patricia M. Sullivan, Ph.D.
Boys Town National Research Hospital
555 North 30th Street
Omaha, NE 68131-9909
Sean Sweeney, Ph.D.
NIDRR/OSERS
Switzer Building, 330 C Street, SW
Washington, DC 20202
Paul Tupper
Office of Health and Disability
Mass. Dept. of Public Health
250 Washington Street, 4th Floor
Boston, MA 02108-4619
Donald Wagner, Ed.D.
Program of Health Promotion and Education
University of Cincinnati
P.O. Box 19198
Cincinnati, Ohio 45219-0198
Sylvia Walker, Ed.D., Director
Howard University R & T Center
2900 Van Ness Street
Washington, DC 20008
Richard Waxweiler, Ph.D.
NCIPC/CDC
2939 Flowers Road, South
Atlanta, GA 30341
Sandra Welner, MD
Private Medical Practice
8484 16th Street, Suite 707
Silver Spring, MD 20910
Glen White, PhD, Co-Project Dir.
R&T Center/IL
4089 Dole Center
University of Kansas
Lawrence, KS 66045-2930
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