Health Promotion and Wellness for People with Disabilities

Under the Americans with Disabilities Act, an individual with a disability is someone who:

1) has a physical or mental impairment that substantially limits one or more major life activities; or (2) has a record of such an impairment; or (3) is regarded as having such an impairment (the Americans with Disabilities Act, 1990).

More than 54 million people — one in five Americans — have a disability. Some were born with a disability, while others acquired a disability from injury, age or illness. People with disabilities live in cities, towns and rural areas throughout the United States. Just like people without disabilities, they go to school, attend church, have jobs, work out at the gym, vote for their favorite candidates, pay taxes, marry and have families. People with disabilities need health care and health programs just like everyone else, so they can remain as healthy as possible, stay active and participate in their communities. But they often face additional daily challenges pertaining to mobility, accessibility, social and attitudinal barriers, and communication.

Health promotion has been defined as any combination of educational, organizational, economic, and environmental supports for behavior conducive to health (Green and Johnson 1983). Educational materials and programs designed for people with disabilities should consider the target audience’s disabilities and needs. Specific disabilities that may need to be accommodated in the program or material design include learning disabilities, visual impairments, hearing impairments, mobility impairments, cognitive impairments, and emotional impairments.

Additionally, those who design and implement health promotions for people with disabilities should always be sensitive to the environment and its effect on health behavior. People with disabilities need to live in an accessible environment in order to fully participate in every aspect of life. And people with disabilities will find it difficult to change their health behaviors unless their environment supports the desired behavior change. Health professionals need to be aware of existing barriers and work to remove them.

Health educator Dorothy Nyswander once said that the “success of health promotion would be measured not only by improvements in health behavior, mortality, and morbidity but also in changes in the social structure and actual perceived control that people have over their lives” (Minkler 1989). This social structure and perceived control, along with the educational, organizational, economic and environmental supports that Green mentioned, pertain directly to the mobility, accessibility, social barriers and communication challenges that people with disabilities face on a daily basis in the United States.

Any useful definition of health promotion should also incorporate Dr. Jonas Salk’s definition of health as “not merely a passive state of freedom from disease but as an active condition of being, in growth, development, and evolution” (Salk 1978). Dr. G. M. Hochbaum provides yet another definition: “Health is what makes it possible for a person to be what he wants to be and to do what he wants to do” (Hochbaum 1978).

Those who design, develop and implement health promotion and wellness programs for people with disabilities should define health not merely as the absence of disease or disability, but as a concept of optimal growth, development and evolution that enables that person to be what he or she wants to be, and do what he or she wants to do. In addition, when planning a health promotion intervention, health professionals should ask: Will this effort enable that individual with a disability to grow, develop, and attain an optimal level of physical and mental well-being?

The National Wellness Institute defines wellness as “an active process of becoming aware of and making choices toward a more successful existence” (Hettler 1977). Wellness is multidimensional covering six dimensions: social, occupational, spiritual, physical, intellectual, and emotional (Hettler 1977). These six dimensions can be addressed by changing the individual’s environment as necessary to facilitate a path to wellness. Health and wellness are multidimensional concepts that apply to everyone and address many levels. These concepts should be applied not only to the physical body, but also to the emotional, social, occupational, and spiritual dimensions of existence. Health professionals should address all these wellness dimensions in their health promotion and wellness activities, programs, and interventions.

To summarize, health professionals should consider health promotion and wellness for people with disabilities as a combination of educational, organizational, economic, and environmental supports that encompass emotional, social, spiritual, and intellectual health. Their efforts must go beyond the disability, bringing about the necessary changes in social structure, personal awareness and autonomy necessary to improve the everyday lives of people with disabilities.

References

The Americans with Disabilities Act. (1996). A Guide to Disability Rights Laws. U.S. Department of Justice Civil Rights Division Disability Rights Section.

Green L.W., Johnson K. W., (1983). Health Education and Promotion. In Handbook of Health, Health Care, and the Health Professionals, Mechanic E (ed). New York: Macmillian.

Hettler B., (2007). Defining Wellness; the Six Dimensional Model of Wellness. The National Wellness Institute (2007). Retrieved January 14, 2007 from http://www.nationalwellness.org/index.php?id=391&id_tier=381

HochBaum G. M., (1978). What is my definition of health? Health Education 9, 122-24 Jan-Feb.

Minkler M., (1989). Health education, health promotion and the open society: An historical perspective. Health Education Quarterly 16:17-30.

Salk J., (1978). What do we mean by health? Health Education 9, 1 33-35 Jan-Feb.

U.S. Department of Health and Human Services. (2005).The 2005 Surgeon Generals Call to Action to Improve the Health and Wellness of Persons with Disabilities: What It Means to You. U.S. Department of Health and Human Services, Office of the Surgeon General.