Where in health is disability? Public health practices to include people with disabilities

Where in health is disability? Public health practices to include people with disabilities


>>>GOOD AFTERNOON, EVERYBODY. IT’S 1:00. WELCOME TO THIS THE CDC “GRAND
ROUNDS.” HERE IS SOME GENERAL INFORMATION
FOR THOSE OF YOU WHO I THINK IT’S A VERY SMALL NUMBER, I
HOPE, MAY BE JOINING US FOR THE FIRST TIME, ABOUT THE VENUES
WHERE YOU CAN FIND INFORMATION ABOUT CDC “GRAND ROUNDS.” HERE IS SOME INFORMATION ABOUT
THE TOPICS THAT WILL BE DISCUSSED IN THE UPCOMING YEAR. WE HAVE CONDUCTED 35 “GRAND
ROUNDS” SO FAR SINCE SEPTEMBER OF 2009. SO HERE’S A LIST OF THINGS THAT
ARE COMING IN THE NEXT FEW MONTHS. TODAY’S TOPIC IS DISABILITY AND
PUBLIC HEALTH PRACTICES TO INCLUDE PEOPLE WITH
DISABILITIES. AS WE ALWAYS DO, WE COORDINATE
CDC TOPICS IN THEM WITH THOSE THAT WE COVER IN OUR MONTHLY
“GRAND ROUNDS.” HERE IS A LIST OF ARTICLES THAT
HAVE BEEN FEATURED IN THIS WEEK’S SCIENCE CLIPS. AND WE THANK MICHAEL FOX FOR THE
SELECTION OF THIS WEEK’S CLIPS THAT COORDINATES WITH OUR
PRESENTATION. LET ME SAY A FEW WORDS ABOUT OUR
PRESENTERS THIS WEEK. THIS MONTH, THIS IS BLESSED
AMONG WOMEN. THAT’S DR. GEORGES BENJAMIN. THIS IS INDEED A SPECTACULAR
GROUP OF WOMEN AND I HAVE TO SAY THAT THIS IS OUR 36th “GRAND
ROUNDS.” AND THE FIRST ONE WHERE WE HAVE
ACTUALLY COMPLETED EVERYTHING 24 HOURS AHEAD OF SCHEDULE. SO WE HAVE HAD A GYMNASTICS
FABULOUS FIVE AND THIS IS REALLY A FABULOUS FOUR. THE FABULOUS FOUR IN ADDITION
TO DR. BENJAMIN, ARE JENNIFER HOOTMAN, MONIKA MITRA, CATHERINE GRAHAM. I WANTED TO ENCOURAGE YOU TO GO
TO THIS WEBSITE THAT WAS BROUGHT TO OUR ATTENTION BY OUR
ASSOCIATE DIRECTOR FOR COMMUNICATION AT THE HUMAN
DEVELOPMENT AND DISABILITY. SO YOU CAN TAKE A DEEPER LOOK
INTO THE LIVES OF PEOPLE WITH DISABILITIES AS THEY OVERCOME
BARRIERS TO LIVE, WORK AND PLAY. THIS ALBUM HIGHLIGHTS THEIR FULL
AND ACTIVE LIVES WITH DISABILITY TELLING THEIR STORIES IN
PICTURE. IT REALLY IS FANTASTIC.>>GOOD AFTERNOON. JUST AS THE LAST FEW DECADES
HAVE SEEN THE INCLUSION OF PEOPLE WITH DISABILITY INTO THE
BROADER SOCIETY, I THINK WE’RE NOW FINALLY BEGINNING TO SEE THE
INCLUSION OF DISABILITY INTO ALL OF PUBLIC HEALTH. THAT TO A GREAT EXTENT IS WHAT
THIS SESSION IS ALL ABOUT. DISABILITY DOESN’T HAVE TO MEAN
ILL HEALTH AND YET, FOR FAR TOO MANY PEOPLE IT DOES. AT CDC, WE’RE THE NATION’S
PREVENTION AGENCY AND WE THINK ABOUT BOTH PREVENTING DISABILITY
AND PREVENTING THE LOSS OF FUNCTION THAT PEOPLE WITH
DISABILITY CAN AVOID. SO I THINK THE VISION FOR
SUCCESS HERE IS IMPORTANT BECAUSE WE RECOGNIZE THAT THE
NUMBER OF PEOPLE WITH DISABILITY IN THIS COUNTRY IS GROWING. WE RECOGNIZE THAT ELIMINATING
HEALTH INEQUALITIES IS A CORE MISSION FOR PUBLIC HEALTH AND A
CORE MISSION FOR THE CDC. AND WE KNOW THAT DISABILITY CUTS
ACROSS EVERYTHING WE DO IN THE CDC. WE KNOW THAT IT’S NOT MERELY A
PUBLIC HEALTH ISSUE, BUT AN ISSUE FOR SOCIETY MORE
GENERALLY. AND IF WE’RE GOING TO BE
EFFECTIVE AT ADDRESSING BOTH PREVENTION AND LIVING OPTIMALLY
WITH DISABILITY, WE’RE GOING TO HAVE TO HAVE TO A MULTISECTIONAL
APPROACH THAT INVOLVES ALL OF SOCIETY. THIS I THINK IS NOT JUST A
CHALLENGE, BUT AN OPPORTUNITY TO WORK CREATIVELY AND EFFECTIVELY
AND ACHIEVE EVEN BETTER RESULTS AS WE WORK IN THE FUTURE. I THINK WE’RE VERY WELL
POSITIONED TO MAKE REAL PROGRESS. WE HAVE MORE INFORMATION THAN
EVER BEFORE. WE HAVE MORE TOOLS ON WHAT WORKS
THAN WE’VE EVER HAD BEFORE. AND WE HAVE THE ABILITY TO USE
THE TOOLS THAT WE HAVE AND USE THE INFORMATION THAT WE HAVE TO
IMPLEMENT PROGRAMS, SEE IF THEY’RE WORKING AND CONTINUOUSLY
IMPROVE THEM. THERE ARE MANY THINGS THAT WE
NEED TO DO. WE NEED TO INCREASE THE
AVAILABILITY OF SURVEILLANCE INFORMATION ON DISABILITY. WE NEED TO SCALE UP EXISTING
PROGRAMS THAT WORK USING A MULTISECTIONAL APPROACH AND I
WOULD HIGHLIGHT ONE AREA THAT CUTS ACROSS BOTH PREVENTION OF
DISABILITY AND OPTIMAL LIVING WITH DISABILITY AND THAT
INVOLVES PHYSICAL ACTIVITY. YOU KNOW, HERE’S SOMETHING ABOUT
PHYSICAL ACTIVITY, BUT IT’S KEY. BECAUSE NOT ONLY CAN IT PREVENT
DISABILITY IN MANY CASES, BUT FOR VIRTUALLY EVERYONE WITH A
DISABILITY IT CAN REDUCE FUTURE DISABILITY AT ALMOST EVERY LEVEL
OF DISABILITY. IT CAN IMPROVE HEALTH OVERALL. THAT ULTIMATELY IS WHAT WE’RE
ALL ABOUT. SO I WANT TO THANK THE
PRESENTERS FOR BEING HERE AND THANK THE AUDIENCE FOR
PARTICIPATING.>>GOOD AFTERNOON. MY NAME IS GLORIA KRAHN AND I
DIRECT THE DIVISION OF HUMAN DEVELOPMENT AND DISABILITY AT
CDC. SORRY, WE’RE HAVING TROUBLE
WITH — TRY THIS ONE. PEOPLE WITH DISABILITIES IS A
SOMEWHAT AMORE SIS TERM THAT THEY NOT COMMUNICATE WHOM WE’RE
TALKING ABOUT. THEY INCLUDE CHILDREN BORN WITH SPINAL BIFF ADA OR SOMEONE WHO
LOSES A LIMB DUE TO INJURY. A PERSON WITH CHRONIC ILLNESS
LIKE DIABETES THAT’S LED TO A FUNCTIONAL AND A LIMITATION LIKE
AMPUTATION OR VISION LOSS. OR AN ELDER WITH INCREASING
FRAILTY OR DEMENTIA. PEOPLE WITH DISABILITIES ARE
PEOPLE WITH LIMITATIONS IN HEARING, VISION, MOBILITY,
COGNITION AND EMOTIONAL AND BEHAVIORAL DISORDERS. THEY ALL EXPERIENCE A SERIOUS
LIMITATION IN FUNCTIONING THAT CAN MAKE IT HARDER FOR THEM TO
ENGAGE IN VARIOUS ACTIVITIES WITHOUT ACCOMMODATION OR
SUPPORT. ACCORDING TO THE WORLD HEALTH
ORGANIZATION, THERE ARE THREE WAYS OF CONSIDERING DISABILITY. THE FIRST IS IMPAIRMENT IN BODY
FUNCTION OR STRUCTURE LIKE LOSS OF A LIMB OR COMPLETE RETINAL
DETACHMENT. THE SECOND A LIMITATION IN
ACTIVITY LIKE PROBLEMS SEEING, WALKING AND THE THIRD, A PERSON
EXPERIENCES RESTRICTIONS IN PARTICIPATING IN ACTIVES LIKE
DIFFICULTY IN PREPARING A MEAL OR DRIVING A CAR. SHOWN GRAPHICALLY, THESE THREE
TYPES OF LIMITATIONS RELATE TO A HEALTH CONDITION OF AN
INDIVIDUAL THAT IS EXPERIENCED WITHIN THE ENVIRONMENT IN WHICH
PEOPLE LIVE AS WELL AS OTHER PERSONAL FACTORS. ENVIRONMENTAL BARRIERS CAN BE
PHYSICAL BARRIERS LIKE STAIRS BUT NOT HAVING RAMPS AVAILABLE. COMMUNICATION BARRIERS LIKE
WEBSITES THAT CAN’T BE READ BY SCREEN READERS. DISCRIMINATORY POLICIES LIKE
PHYSICAL WORK REQUIREMENTS FOR EMPLOYMENT. OR SOCIETAL ATTITUDES THAT ARE
MORE OR LESS WELCOMING TO DISABILITY DIFFERENCES. CONSEQUENTLY, DISABILITY IS NOT
THE HEALTH CONDITION ITSELF, BUT IS THE LIMITATION VIEWED IN THE
CONTEXT OF THE COMMUNITY AND SOCIETY IN WHICH A PERSON LIVES. SOCIETAL AND ENVIRONMENTAL
ACCOMMODATIONS ARE CRITICAL IF PEOPLE WITH DISABILITIES ARE TO
PARTICIPATE IN PUBLIC HEALTH PROGRAMS THAT PREVENT DISEASE
AND PROMOTE HEALTH. USING THE NEWLY ADOPTED
DEPARTMENT OF HEALTH AND HUMAN SERVICES IDENTIFIERS FOR
DISABILITY IN SURVEYS, IN OUR COUNTRY ONE IN SIX ADULTS HAVE A
DISABILITY. THAT’S 37.5 MILLION ADULTS OR
16% OF THE U.S. POPULATION. HEALTH CARE COSTS ASSOCIATED
WITH DISABILITIES ARE ESTIMATED AT ABOUT $400 BILLION PER YEAR. MORE THAN ONE-QUARTER OF ALL
HEALTH CARE EXPENDITURES. THIS GRAPH SHOWS THE ESTIMATED
PROPORTION OF PEOPLE WITH DISABILITIES BY AGE AS REPORTED
ON THE NATIONAL HEALTH INTERVIEW SURVEY IN 2010. WHILE THE PROPORTION OF PEOPLE
WITH DISABILITIES INCREASES WITH AGE, THE MAJORITY OF PEOPLE WITH
DISABILITIES IS STILL UNDER THE AGE OF 65. MORE THAN ONE-THIRD OF ALL
PEOPLE WITH DISABILITIES ARE THOSE BETWEEN THE AGES OF 45 AND
64, THOSE PRIME YEARS OF WORK FORCE. SO WHAT ARE THE KINDS OF
LIMITATIONS REGARDLESS OF THEIR CAUSE? WELL, 46% OF PEOPLE WITH
DISABILITIES REPORT SERIOUS TROUBLE WALKING OR CLIMBING
STAIRS. ALMOST 39% HAVE PROBLEMS TROUBLE
SOLVING. THAT’S TROUBLE CONCENTRATING OR
REMEMBERING OR MAKING DECISIONS. 21% HAVE SERIOUS DIFFICULTY
SEEING, EVEN WHEN WEARING GLASSES. AND 35% NEED HELP WITH SELF-CARE
LIKE BATHING OR HAVE TROUBLE DOING ERRANDS ALONE LIKE
SHOPPING. THESE PERCENTAGES TOTAL MORE
THAN 100 BECAUSE 43% OF PEOPLE REPORTING DISABILITIES REPORT
HAVING MORE THAN ONE LIMITATION. SO WHAT ARE THE CAUSES OF
DISABILITY? THE MOST COMMON CAUSES ARE
ARTHRITIS AND BACK PROBLEMS. FOLLOWED BY HEART, RESPIRATORY,
EMOTIONAL PROBLEMS, DIABETES, HEARING, LIMB PROBLEMS, VISION
AND STROKE. NOW, PEOPLE WITH DISABILITIES
HAVE THE SAME HEALTH NEEDS AS NONDISABLED PEOPLE. THEY ALSO MAY EXPERIENCE A
NARROWER MARGIN OF HEALTH BECAUSE OF POVERTY AND OTHER
SOCIAL DETERMINANTS OF HEALTH OR THEY MAY BE SUSCEPTIBLE TO
PRESSURE SORES AND THEY HAVE PROBLEM ACT SELSSING HEALTH AND
PUBLIC HEALTH SERVICES AND YOU’LL
YOU’LL MORE ABOUT THE DOCUMENTED HEALTH DISPARITIES. THERE WAS INCREASING RECOGNITION
THAT DISABILITY IS PART OF THE NORMAL HUMAN EXPERIENCE. AND THAT PUBLIC HEALTH HOLDS THE
RESPONSIBILITY TO IDENTIFY HEALTH DISPARITIES THROUGH DATA,
PROMOTE THE HEALTH OF PEOPLE WHO HAVE DISABILITIES AND CLOSE THE
GAP IN HEALTH DISPARITIES. AT CDC, WE STRIVE TO ACHIEVE THE
BROADEST IMPACT BY FOLLOWING THIS STRATEGY. FIRST, WE WORK TO HAVE PEOPLE
WITH DISABILITIES INCLUDED IN MAINSTREAM SERVICES WHEREVER
POSSIBLE BY ACCOMMODATING TO THEIR LIMITATIONS. AND WE ADDRESS THE HEALTH NEEDS
THAT ARE UNIQUE TO THOSE WITH DISANDS SUCH AS ENVIRONMENTAL
ACCESS. THIRD, WE USE CONDITION SPECIFIC
FOCUS WHERE THAT IS ESSENTIAL. AT CDC, WE’RE WORKING TO INCLUDE
PEOPLE WITH DISABILITIES IN OUR SURVEYS, PROGRAMS, POLICIES AND
COMMUNICATION. WE FUND A NETWORK OF 18 STATES
DISABILITY AND HEALTH PROGRAMS THAT WORK WITHIN THEIR STATE TO
IMPROVE HEALTH CARE ACCESS, HEALTH PROMOTION AND THE
EMERGENCY PREPAREDNESS. WE ALSO FUND A NETWORK OF PUBLIC
HEALTH RESOURCE CENTERS TO REACH KEY POPULATIONS ON HEALTH
COMMUNICATIONS AND INTERVENTIONS. THESE CENTERS ADDRESS
INTELLECTUAL DISABILITIES, LIMB LOSS, PARALYSIS AND PHYSICAL
ACTIVITY. AND NEXT PRESENTER IS DR. MONIKA
MITRA.>>THANK YOU. GOOD AFTERNOON. I’M MONIKA MITRA, AN ASSISTANT
PROFESSOR OF FAMILY MEDICINE AND COMMUNITY HEALTH AT THE
UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL. THIS AFTERNOON I’LL BE TALKING
ABOUT HEALTH DISPARITIES AMONG PEOPLE WITH DISABILITIES IN
MASSACHUSETTS. IN 1990, THE AMERICANS WITH
DISABILITIES ACT WAS PASSED. IT WAS FIRST CIVIL RIGHTS LAW TO
SPECIFICALLY ADDRESS THE NEEDS OF PEOPLE WITH DISABILITIES IN
THE UNITED STATES. THERE’S BEEN AN INCREASEING
INCLUSION OF THOSE IN FEDERAL EFFORTS RELATED TO HEALTH CARE. ONCE THE EFFORT WAS THE
INCLUSION OF ELIMINATING DISPARITIES BETWEEN THOSE WITH
OR WITHOUT DISABILITIES. IN CONTRAST TO THE EARLIER FOCUS
ON DISABILITY BEING PREVENTABLE OUTCOME OF DISEASE. HOWEVER, DESPITE ALL OF THESE
EFFORTS, PEOPLE WITH DISABILITIES CONTINUED TO FACE
ENORMOUS HEALTH DISPARITY. THE DATA IN MY PRESENTATION IS
PRIMARILY BASED ON TWO SOURCES. THE BEHAVIOR RISK SYSTEM AND
THEY’RE BOTH CDC FUNDED. IT’S A RANDOM DIGITAL TELEPHONE
SURVEY OF ADULTS IN THE U.S. IT’S THE PRIMARY SOURCE OF
STATE-BASED HEALTH INFORMATION AND TWO QUESTIONS IDENTIFYING
DISABILITY HAVE BEEN INCLUDED IN THE BUREAU SINCE 1998. IT COLLECTS STATE-BASED
POPULATION BASED DATA ON WHATTERNAL ATTITUDES — MATERNAL
ATTITUDES, BEFORE, DURING AND AFTER PREGNANCY. IT’S CONDUCTED IN 40 STATES AND
NEW YORK CITY, HOWEVER, ONLY TWO OF THE STATES INCLUDE — IN
THEIR SURVEY, MASSACHUSETTS AND RHODE ISLAND. THIS AFTERNOON, I WILL PRESENT
DATA ON SPECIFIC DISPARITIES WE LATING TO THE HEALTH OF
MASSACHUSETTS WITH DISABILITIES AND COMPARING THEM TO THOSE
WITHOUT DISABILITIES. I WILL FOCUS ON DISPARITIES IN
GENERAL ON THE MENTAL HEALTH STATUS, RISK FACTORS, PREVENTIVE
BEHAVIORS AND HEALTH CARE ACCESS. I WILL START WITH ILLUSTRATES
DIFFERENCES IN THE OVERALL HEALTH AND SPECIFICALLY IN THE
MENTAL HEALTH OF PEOPLE WITH DISABILITIES. APPROXIMATELY 20% OF ADULTS WITH
DISABILITIES IN MASSACHUSETTS SELF-REPORTED — BASED ON THE
HEALTH STATUS QUESTION. COMPARED TO ALMOST 6% OF
NONDISABLED ADULTS. THESE STARK DIFFERENCES ARE
COMPARABLE TO THE OVERALL NATIONAL PICTURE. THE DIFFERENCES IN SELF-REPORTED
FOR HEALTH REMAINS UP TO THE DATA STRATIFIED BY EDUCATIONAL
LEVEL. PEOPLE WITH DISABILITIES WERE
MORE LIKELY TO REPORT THE HEALTH IRRESPECTIVE OF THEIR LEVEL OF
EDUCATION. WE ALSO LOOKED AT — FOR MENTAL
HEALTH. PEOPLE WITH DISABILITIES IN
MASSACHUSETTS AND IN THE COUNTRY OVERALL ARE MORE LIKELY TO
REPORT EXPERIENCING 14 OR MORE DAYS OF POOR MENTAL HEALTH IN
THE PAST MONTH COMPARED TO THOSE WITHOUT DISABILITIES. ALMOST 25% OR ONE IN FOUR ADULTS
REPORTED POOR MENTAL HEALTH IN THE PAST MONTH, COMPARED TO 6%
OF NONDISABLED ADULTS. THESE DIFFERENCES IN
SELF-REPORTED MENTAL HEALTH REMAINS AFTER WE STRATIFIED THE
DATA BY EDUCATIONAL LEVELS. OVER THE NEXT FEW SLIDES I WILL
ILLUSTRATE DIFFERENCES IN THE RISK FACTORS AND PREVENTIVE
BEHAVIORS OF ADULTS. IN MASSACHUSETTS, 22% OR MORE
THAN ONE IN FIVE ADULTS REPORTED SMOKING COMPARED TO 13% OF
NONDISABLED ADULTS. WE KNEW THAT SMOKING DURING
PREGNANCY IS RECOGNIZED AS ONE OF THE MOST IMPORTANT
PREVENTABLE RISK FACTORS FOR A PREGNANCY OUTCOME. WE USED DATA FROM THE 2007 TO
2009 MASSACHUSETTS GRANTS AND FOUND THAT MOTHERS WITH RECENT
DISABILITIES WERE MORE LIKELY TO SMOKE BEFORE, DURING AND RIGHT
AFTER THE PREGNANCY AND MORE LIKELY TO SMOKE THROUGHOUT THEIR
PREGNANCY COMPARED TO THOSE WITHOUT A DISABILITY. ONE OUT OF THREE ADULTS WITH
DISANDDIS DISABILITIES IN MASSACHUSETTS IS
OBESE COMPARED TO ONE OUT OF FIVE NONDISABLED ADULTS. 20% REPORTED A DISABILITY
COMPARED TO 17% OF THOSE WHO ARE NOT OBESE. SIMILARLY, 34% OR ONE OUT OF
EVERY THREE ADULTS REPORTED NO LEISURE TIME ACTIVITY COMPARED
TO 16% OF NONDISABLED ADULTS. REGARDLESS OF AGE THERE ARE
DIFFERENCES IN OBESITY BETWEEN PEOPLE WITH OR WITHOUT
DISABILITIES. FOR THOSE WITH OR WITHOUT
DISABILITIES PEOPLE IN THE YOUNGER AND OLDER AGE GROUPS ARE
LESS OBESE THAN THOSE BETWEEN 25 AND 64 YEARS OF AGE. OBESITY RATES FOR CHILDREN WITH
DISABILITIES IN THE UNITED STATES ARE APPROXIMATELY 38%
HIGHER THAN THOSE CHILDREN WITHOUT DISABILITIES. GIVEN THAT THE BODY WEIGHT IS A
SIGNIFICANT ISSUE FOR MULTIPLE MEDICAL PROBLEMS, IMAGINE THE
HEALTH FUTURE OF THESE CHILDREN AS THEY AGE. MEN AND WOMEN WITH DISABILITIES
ARE AT A HEIGHTENED RISK FOR LIFETIME AND CURRENT SEXUAL
VIOLENCE VICTIMIZATION. WOMEN WITH DISABILITIES ARE AT A
GREATER RISK FOR ATTEMPTED RAPE AND SEXUAL VIOLENCE IN THE PAST
YEAR. INTERESTINGLY THE PRESENCE OF
SEXUAL VIOLENCE, COMPLETED AND ATTEMPTED RAPE WERE AGAINST MEN
WITH DISABILITIES WERE MORE — WITH COMPARABLE TO THOSE AGAINST
NONDISABLED WOMEN. IN FACT, THE VICTIMIZATION RATE
AGAINST MEN WERE DISABILITIES WERE GREATER OR EXCEEDED THAT OF
WOMEN WITHOUT DISABILITIES. OTHER RESEARCH HAS SHOWN THAT
INDIVIDUALS WITH INTELLECTUAL DISABILITY OR MENTAL ILLNESS ARE
AT A GREATER RISK OF VIOLENCE COMPARED TO THOSE WITH OTHER
DISABILITIES. USING THE MASSACHUSETTS BRAND
DATA, WE EXAMINE PHYSICAL ABUSE BY A CURRENT OR FORMER PARTNER
AGAINST RECENT MOTHERS WITH OR WITHOUT DISABILITIES AND FOUND
THAT WOMEN WITH DISABILITIES WERE AT GREATER RISK OF PHYSICAL
ABUSE. THAT IS BEING PUSHED, KICKED OR
PHYSICALLY HURT BEFORE OR DURING THEIR PREGNANCIES. IN THE FINAL SECTION OF MY
PRESENTATION, I WILL HIGHLIGHT THE DIFFERENCES IN HEALTH CARE
ACCESS BY DISABILITY STATUS. WHILE THERE ARE STRIKING
DIFFERENCES BETWEEN NATIONAL AND MASSACHUSETTS PERCENTAGES,
PEOPLE WITH DISABILITIES IN MASSACHUSETTS AND IN THE U.S. OVERALL ARE MORE THAN TWICE AS
LIKELY TO REPORT NOT SEEING A DOCTOR DUE TO COSTS IN THE PAST
YEAR. THESE DISPARITIES ARE EVEN
GREATER FOR RACIAL AND ETHNIC MINORITIES WITH DISABILITIES
COMPARED TO WHITES WITH DISABILITIES. PEOPLE WITH DISABILITIES AS
COMPARED TO THOSE WITHOUT WERE MORE LIKELY TO NOT SEEK MEDICAL
CARE BECAUSE OF COST. REGARDLESS OF THEIR EDUCATIONAL
LEVEL. EVEN PEOPLE OF COLLEGE LEVEL
EDUCATION EXPERIENCE DISPARITIES IN ACCESSING CARE. 9% OF COLLEGE GRADUATES WITH
DISABILITIES COULD NOT SEE A DOCTOR DUE TO COST COMPARED TO
3% OF THOSE WITHOUT DISABILITIES. LACK OF ACCESS TO DENTAL CARE IS
A SIGNIFICANT ISSUE WITH THOSE WITH DISABILITIES. COMPARED TO THE NONDISABLED
COUNTERPARTS REPORTED SEEING A DENTIST IN THE PAST YEAR. WOMEN 40 YEARS AND OVER WITH
DISABILITIES IN MASSACHUSETTS AND IN THE U.S. OVERALL WERE
LESS LIKELY TO HAVE A MAMMOGRAM IN THE PAST YEAR. AND RATES ARE EVEN LOWER WHEN WE
LOOK AT WOMEN WITH GREATER FUNCTIONAL NEEDS INCLUDING WOMEN
WITH MOBILE IMPAIRMENT. PEOPLE WITH DISABILITIES
EXPERIENCED SIGNIFICANT HEALTH DISPARITIES IN VARIOUS CARE
COMPARED TO THOSE WHO DO NOT HAVE DISABILITIES. THE NUMBER OF PEOPLE WITH
DISABILITIES BOTH CHILDREN AND ADULTS ARE RISING. THEREFORE, ELIMINATING HEALTH
DISPARITIES SHOULD BE A NATIONAL PUBLIC HEALTH PRIORITY. A MULTIPRONGED APPROACH IS
REQUIRED TO ELIMINATE THIS HEALTH DISPARITY AND TO
STRUCTURE THE HEALTH CARE SYSTEM FOR THOSE FACED WITH
DISABILITIES. WHAT CAN WE DO ABOUT IT? MULTIPLE STRATEGIES ARE NEEDED
TO ADDRESS THESE COMPELLING DISPARITIES. FIRST INCLUSION OF STANDARDIZED
DISABILITY SCREENERS AND DATA COLLECTION INSTRUMENTS. THE ADVANCEMENT ON INTERVENTION. THE TRAINING OF HEALTH CARE
PROFESSIONALS AND PUBLIC HEALTH PROFESSIONALS IS CRITICAL. WE NEED TO MOVE TOWARDS A
BARRIER FREE ENVIRONMENT SO THAT PEOPLE WITH DISABILITIES CAN
ACCESS MEDICAL OFFICES, DIAGNOSTIC EQUIPMENT, GYMS AND
THE COMMUNITY AT LARGE. AND FINALLY, TO QUOTE THE
DISABILITY ADVOCACY MANTRA. NOTHING ABOUT US, THE INCLUSION
AND THE MEANINGFUL INVOLVEMENT OF THOSE WITH DISABILITIES IN
THE DEVELOPMENT AND IMPLEMENTATION OF PUBLIC HEALTH
PROGRAMS IS NEEDED. THANK YOU VERY MUCH. OUR NEXT SPEAKER IS JENNIFER
HOOTMAN.>>GOOD AFTERNOON. MY NAME IS JENNIFER HOOTMAN AND
TODAY I’LL BE SPEAKING ABOUT THE CDC’S ARTHRITIS APPROACH TO THE
EVIDENCE BASED OUTREACH PROGRAMS FOR THOSE LIVING WITH ARTHRITIS. ARTHRITIS IS ONE OF THE MOST
COMMON CHRONIC DISEASES AFFECTING 50 MILLION U.S. ADULTS
AND ABOUT 300,000 CHILDREN. AMONG THE 50 MILLION ADULTS, 40%
REPORT BEING LIMITED IN THEIR USUAL ACTIVITIES BECAUSE OF
THEIR ARTHRITIS. 33% REPORT HAVING SEVERE PAIN
AND 11% REPORT BEING RESTRICTED IN VALUED SOCIAL ACTIVITIES. ALL OF THESE FACTORS CONTRIBUTE
TO POOR QUALITY OF HEALTH. BY 2030 WE EXPECT 67 MILLION
ADULTS WILL HAVE ARTHRITIS, OF WHICH 25 MILLION WILL BE LIMITED
IN THEIR USUAL ACTIVITIES. THESE ESTIMATES ARE LIKELY
CONSERVATIVE BECAUSE THEY ONLY ACCOUNT FOR THE AGING OF THE
POPULATION AND DO NOT TAKE INTO ACCOUNT THE CURRENT OBESITY
EPIDEMIC WHICH IS EXPECTED TO CONTRIBUTE TO RISING ARTHRITIS
PREVALENCE. ARTHRITIS IS THE MOST COMMON
CAUSE OF DISABILITY AND IT’S MAINTAINED THIS NUMBER ONE
RANKING FOR AT LEAST TWO DECADES. AMONG ADULTS ARTHRITIS IS MORE
COMMON AMONG WOMEN THAN MEN AND THIS IS TRUE AT ALL AGES. THE HIGHER PREVALENCE OF
ARTHRITIS AMONG WOMEN IS NOT JUST DUE TO THE HIGHER NUMBERS
OF WOMEN IN THE POPULATION. IT ACTUALLY HAS HIGHER RATES OF
ARTHRITIS AMONG WOMEN PARTICULARLY OSTEOARTHRITIS AND
RHEUMATOID ARTHRITIS. SURPRISINGLY ARTHRITIS IS NOT
JUST A DISEASE OF THE ELDERLY. IT’S TWO-THIRDS OF ADULTS WITH
ARTHRITIS ARE UNDER AGE 65 AND ALMOST HALF OF THESE AGED 45 TO
64. FORTUNATELY, PREVENTING
PROGRESSION OF ARTHRITIS DUE TO WORSENING OF SYMPTOMS AND LOSS
OF FUNCTION IS POSSIBLE. TYPICALLY, PHYSICAL FUNCTION
DECLINES WITH AGE. HOWEVER, MAINTAINING REGULAR
PHYSICAL ACTIVITY CAN ACTUALLY REDUCE THIS AGE-RELATED DECLINE
BY ABOUT 32%. PHYSICAL ACTIVITY MAY ALSO
REDUCE THE RISK OF LIMITATIONS AN LOSS OF FUNCTION. FOR EXAMPLE, ONE RANDOMIZED
CONTROL TRIAL AMONG ADULTS WITH KNEE OSTEOARTHRITIS REPORTED THE
RISK OF INCIDENT ACTIVITY OF DAILY LIVING DISABILITY WAS
REDUCED BY 43% OVER 18 MONTHS. CDC IS FUNDING 12 STATE
ARTHRITIS PROGRAMS TO IMPLEMENT ARTHRITIS MANAGEMENT PROGRAMS IN
THE COMMUNITY. I WILL FOCUS ON PHYSICAL
ACTIVITY AS A STRATEGY TO PREVENT ARTHRITIS RELATED
DISABILITY AND OUR WORK WITH THE STATE HEALTH DEPARTMENT. THE CDC ARTHRITIS PROGRAM IS A
EVIDENCE-BASED, ACTIVITY PROGRAM AS ONE THAT CAN ACCOMMODATE
PEOPLE WITH DIFFERENT LEVELS OF FUNCTION, HAS BEEN SHOWN TO
REDUCE ARTHRITIS SYSTEM AND CAN BE EASILY IMPLEMENTED IN
COMMUNITY SETTINGS. WE CURRENTLY HAVE SIX
EVIDENCE-BASED PHYSICAL ACTIVITY PROGRAMS THAT ARE APPROVED. THE FIRST THREE ARE OFFERED BY
THE ARTHRITIS FOUNDATION AND THE LAST THREE ARE OFFERED BY OTHER
COMMUNITY ORGANIZATIONS. WE JUST COMPLETED A FOUR-YEAR
COOPERATIVE AGREEMENT WITH 12 STATE HEALTH DEPARTMENTS WHO ARE
CHARGED WITH IMPLEMENTING EVIDENCE-BASED PROGRAMS. OVERALL, ALL 12 STATES INCREASED
THEIR REACH AND SOME STATES DOUBLED THEIR REACH IN THE FIRST
THREE YEARS. THE TOTAL REACH OVER FOUR YEARS
WAS 132,443 ADULTS WITH ARTHRITIS. BUT THREE-YEAR EVALUATION STUDY
WE CONDUCTED FOUND THAT THE FACTORS THAT WERE MOST
SIGNIFICANTLY CORRELATED WITH INCREASED REACH INCLUDED WORKING
WITH MULTISITE DELIVERY SYSTEMS AND ARTHRITIS PROGRAM FOCUSING
THEIR EFFORTS ON INCREASING PROGRAM REACH. ON JULY 1, 2012, THE ARTHRITIS
PROGRAM FUNDED A NEW ROUND OF 12 STATES TO IMPLEMENT ARTHRITIS
MANAGEMENT PROGRAMS. THESE STATES SHOWN HERE IN
PURPLE ARE AWARDED AN AVERAGE OF $427,000 A YEAR FOR THE NEXT
FIVE YEARS. DURING THIS FUNDING CYCLE,
REQUIRED ACTIVITIES INCLUDE INCREASING THE AWARENESS OF THE
IMPORTANCE OF PHYSICAL ACTIVITY, AND IDENTIFYING AND IMEMBEDDING
PROGRAMS INTO EXISTING DELIVERY SYSTEM. WE DEFINE A DELIVERY SYSTEM AS
THREE OR MORE DELIVERY SITES, ACTUAL PHYSICAL LOCATIONS IN THE
COMMUNITY AND AREAS OF AGING AND PARKS AND RECREATION DEPARTMENT. REACH IS DEFINED AS THE NUMBER
OF ADULTS WITH ARTHRITIS ENROLLING IN EVIDENCE-BASED
PROGRAMS. AND CAPACITY IS DEFINED AS THE
NUMBER OF DELIVERY SYSTEMS, DELIVERY SITES, CLASSES AND
ACTIVE INSTRUCTORS. THE PRIMARY GOAL FOR ALL 12
STATES OVER THE NEXT FIVE YEARS IS TO REACH 5% OF THEIR STATE’S
POPULATION WITH ARTHRITIS. THAT TRANSLATES TO ABOUT 12,500
ADULTS IN SMALLER STATES LIKE RHODE ISLAND AND 50,000 ADULTS
IN LARGER STATES LIKE CALIFORNIA. IF EACH STATE REACHES THE REACH
GOAL, 8,000 NEW ADULTS WILL BE REACHED WITH NEW EVIDENCE-BASED
ARTHRITIS PROGRAMS BY THE YEAR 2017. AN ADDITIONAL GOAL IS TO
DECREASE THE PROPORTION OF ADULTS WITH ARTHRITIS WHO REPORT
DOING NO LEISURE TIME ACTIVITY BY 5% OVER FIVE YEARS. THIS WOULD MEAN ALMOST 300,000
FEWER ADULTS WITH ARTHRITIS WILL BE PHYSICALLY INACTIVE BY 2017. ARTHRITIS AFFECTS 50 MILLION
ADULTS IN THE U.S. AND IS THE MOST COMMON CAUSE OF DISABILITY. PHYSICAL ACTIVITY AND OTHER
PUBLIC HEALTH STRATEGIES THAT IMPROVE PAIN AND FUNCTION AND
MAINTAIN INDEPENDENCE. THERE ARE EVIDENCE-BASED
PHYSICAL ACTIVITY PROGRAMS THAT CAN BE FURTHER SCALED UP. SUCCESSFUL INGREDIENTS ARE
INCREASING THE AWARENESS OF THE IMPORTANCE OF PHYSICAL ACTIVITY
THROUGH HEALTH COMMUNICATION CAMPAIGNS AND EMBEDDING PHYSICAL
ACTIVITY PROGRAMS INTO EXISTING DELIVERY SYSTEMS. OUR NEXT SPEAKER WILL BE
CATHERINE GRAHAM.>>GOOD AFTERNOON. I’M A REHABILITATION ENGINEER
WITH THE SCHOOL OF MEDICINE. I’M EXCITED TO BE HERE TO TELL
YOU ABOUT THE PROGRESS WE’RE MAKING IN SOUTH CAROLINA TO
ACTUALLY REDUCE SOME OF THESE HEALTH DISPARITIES. PEOPLE WITH DISABILITIES LIVING
IN SOUTH CAROLINA ARE ALMOST SIX TIMES MORE LIKELY TO REPORT FAIR
TO POOR HEALTH AS FAR AS THEIR STATUS, THEIR HEALTH STATUS. IN SOUTH CAROLINA, KEY
PARTNERSHIPS ARE A VERY CRITICAL ROLE AND WE FORMED OURS ABOUT 15
YEARS AGO WHICH INCLUDED THE STATE UNIVERSITY AS THE
COORDINATOR, THE HEALTH DEPARTMENT WHICH PROVIDES HEALTH
PROMOTION AND AWARENESS THROUGHOUT THE STATE. THE MAIN DISABILITY SERVICE
AGENCY WHICH HAS A REALLY STRONG INFRASTRUCTURE AND THEN THE
DEVELOPMENTAL DISABILITIES COUNCIL WHICH ACTS AS THE
ADVISORY COMMITTEE. THE COMMON GOAL OF ALL OF THESE
GROUPS WAS HEALTH AND WELLNESS FOR THOSE WITH DISABILITIES. SO I’M GOING TO TALK ABOUT THE
PROGRESS IN THREE MAJOR AREAS. HEALTH PROMOTION AND EMERGENCY
PREPARENESS, AND I’LL START WITH ACCESS TO HEALTH CARE. THE ISSUE WITH PHYSICAL ACCESS
TO PHYSICIANS’ OFFICES FOR PEOPLE WITH DISABILITIES IS THAT
THEY MUST BE ABLE TO PARK, ENTER THE BUILDING, CHECK IN, GET LAB
WORK DONE, GO TO AN EXAM ROOM AND EVEN USE THE RESTROOM IN
ORDER FOR THEM TO EVER RECEIVE EQUAL QUALITY CARE. OUR GOAL WAS TO ASSESS AND THEN
IMPROVE THE ACCESSIBILITY OF OUR PRIMARY CARE SITE. OUR PARTNERS INCLUDED THE HEALTH
DEPARTMENT BEST CHANCE NETWORK WHICH PROVIDES FOR FREE BREAST
AND CERVICAL CARE SCREENINGS AND THEN WE PARTNERED WITH THE
OFFICE OF RURAL HEALTH TO RECRUIT PARTICIPANT SITES THAT
COULD THEN APPLY FOR LOW INTEREST LOANS TO MAKE THE
MODIFICATION. WE HAVE ALSO LEVERAGED MONIES
FROM SOUTH CAROLINA, BLUE CROSS/BLUE SHIELD IN THE PAST IN
ORDER TO PROVIDE MINIGRANTS TO SOME OF THE SITES TO HELP OUT
WITH MODIFICATIONS. WE HAVE ASSETED OVER 150,000
PRIMARY CARE SITES SO FAR WITH THE PATIENT LOAD OF OVER
750,000. ABOUT ONE-THIRD OF THOSE
PRACTICES HAVE MADE CHANGES THAT WE’RE AWARE OF SO FAR. AND WE ARE EXPANDING INTO OTHER
CARE PRACTICES. AS FAR AS THE EQUIPMENT, THE
ISSUE — SOMETIMES PEOPLE WITH PHYSICAL DISABILITIES OFTEN
RECEIVE PHYSICAL EXAMS WHILE STILL SITTING IN THEIR
WHEELCHAIRS. DUE TO A DIFFICULTY GETTING ON
AND OFF THE REALLY HIGH EXAMINATION TABLES. SUCH PHYSICAL EXAMS DON’T EVEN
ALLOW FOR THE HEALTH CARE PROFESSIONAL TO FEEL THE
ABDOMEN, THE PELVIS, THE BACK LIKE THEY SHOULD. SO OUR GOAL WAS TO ASSESS THESE
SITES AND THEN INCREASE THE NUMBER OF PROVIDERS THAT HAVE A
HEIGHT ADJUSTABLE EXAM TABLE, UTILIZING THE SAME PARTNERS THAT
WE HAD BEFORE. OF THE SAME 150 SITES THAT WE
HAVE ASSESSED, ONLY 34% HAD THE HEIGHTED AABLE
HEIGHT ADJUSTABLE EXAM TABLE AND ONLY TWO HAVE AN ADJUSTABLE EXAM
TABLE, AND SAID COST WAS THE LIMITING FACTOR. ONE OF THE PARTNERS, THE ONE FOR
BREAST AND CERVICAL CANCER SCREENING, THEY NOW INCLUDE A
DISABILITY SCREENER QUESTION FOR THEIR PARTICIPANTS SO THAT THEY
CAN BE DIRECTED TO A SITE THAT IS ACCESSIBLE AND WILL ACTUALLY
MEET THEIR NEEDS. SO WE HAVE TALKED ABOUT WEIGHT
AND OBESITY AND WEIGHT CAN ONLY BE MANAGED IF A PERSON CAN
ACTUALLY GET ON THE SCALE. AND WE FOUND A LOT OF SITES HAVE
A LACK OF AN ACCESSIBILITY SCALE. AT THAT
COUNSELLED ON WEIGHT MANAGEMENT AND PHYSICAL ACTIVITY. OUR GOAL WAS TO INCREASE AND
IMPROVE THE NUMBER OF THOSE WITH AN ACCESSIBLE SCALE. LESS THAN 2% OF THOSE 150 SITES
THAT WE SAW, SO THREE OUT OF 150, HAD WHEELCHAIR ACCESSIBLE
SCALES. SINCE THE ASSESSMENT, 11 SITES
HAVE PURCHASED THE SCALES AND THAT’S AT A COST OF ABOUT
$1,500. SO NOW I’M GOING TO GIVE YOU A
COUPLE OF EXAMPLES OF PROGRESS WE HAVE MADE IN THE AREA OF
HEALTH PROMOTION. A STAGGERING 29% OF SOUTH
CAROLINIANS ARE OBESE. BUT AN EVEN HIGHER PERCENTAGE AT
42% OF SOUTH CAROLINIANS WITH DISABILITIES ARE OBESE. HUGE NUMBER. 23% OF SOUTH CAROLINIANS ARE
PHYSICALLY INACTIVE. BUT ONCE AGAIN, ALMOST DOUBLE
THAT AT 43% OF SOUTH CAROLINIANS WITH DISABILITIES ARE INACTIVE. SO AS FAR AS BODY MASS INDEX,
SOUTH CAROLINIANS WITH DISABILITIES WERE LESS LIKELY TO
HAVE A NORMAL BMI COMPARED — AND BE OVERWEIGHT. SO 26% COMPARED TO 35% HAD A
NORMAL BMI. AND THEN OVERWEIGHT, 37% OF
PEOPLE WITH DISABILITIES AS OPPOSED TO THE 32%. OF COURSE, THOSE WITH
DISABILITIES AS MENTIONED WERE MUCH MORE LIKELY TO HAVE A BMI
OF OVER 30. WE UTILIZED AN EVIDENCE BASED
PROGRAM CALLED STEPS TO YOUR HEALTH WHICH WAS SPECIFICALLY
DESIGNED FOR PEOPLE WITH DISABILITIES. IT’S AN EIGHT-WEEK PARTICIPATORY
PROGRAM COVERING HEALTHY EATING, AND PHYSICAL ACTIVITY AND WE HAD
OVER 1,300 PARTICIPANTS USING A TRAINER MODEL. PARTICIPANTS HAVE HAD A WEIGHT
LOSS OF AT LEAST FIVE POUNDS AND AN INCREASE IN THEIR KNOWLEDGE
OF HEALTHY FOOD CHOICES. IN 2012, WE BEGAN COLLABORATING
WITH THE ARTHRITIS FOUNDATION EXERCISE PROGRAM. WHICH IS AN EIGHT-WEEK PROGRAM
THAT USES THE SAME TYPE OF TRAIN THE TRAINER MODEL WITH SENIOR
CENTERS AND DISABILITY SERVICE PROVIDERS. WE’RE NOW STUDYING THE EFFICACY
OF THAT PROGRAM WITH PEOPLE WITH DISABILITIES. SO SO FAR WE HAVE TRAINED OVER
700 MEDICAL STUDENTS AND HEALTH PROFESSIONALS ABOUT CARE OF
PEOPLE WITH DISABILITIES. AND THAT INCLUDES WEIGHT
MANAGEMENT, PROPER NUTRITION, NOT SMOKING AND PHYSICAL
ACTIVITY. WE’RE NOW EXPANDING TO OTHER
SPECIALTIES IN PROFESSIONS SUCH AS HEALTH CARE PROFESSIONALS
THROUGH THE TECHNICAL COLLEGES. WE HAVE CONDUCTED IN-PERSON
STAFF TRAININGS AT FEDERAL, STATE AND LOCAL PARKS AND
RECREATION CENTERS. GYMS, YMCAs AND HEALTH
DEPARTMENTS AND COVER DIFFERENT TOPICS SUCH AS COMMUNICATING
WITH PEOPLE WITH DISABILITIES, AND THEN HOW TO MODIFY YOUR
POLICIES, PROCEDURES AND SERVICES AND EQUIPMENT
MODIFICATION TO INCLUDE PEOPLE WITH DISABILITIES. SUCH AS AT A PARK, A WHEELCHAIR
ACCESSIBLE MAT TO GET OVER THE SOFT SAND SO THAT SOMEONE CAN
GET TO THE HARD PACKED AREA OR ALTERNATE WAYS TO USE PHYSICAL
FITNESS CENTER EQUIPMENT. WE HAVE ALSO COLLABORATED WITH
OUR DEPARTMENT OF TRANSPORTATION TO UPDATE THE AMERICANS WITH
DIFFICULTIES ACT TRANSITION PLAN. THAT’S SO THEY HAVE DRAWINGS,
MEETINGS, PLANNING, ET CETERA. THEIR NEW TRANSITION PLAN CALLS
FOR ACCESSIBLE SIDEWALKS, CURB CUTS, PEDESTRIAN ACCESS SIGNALS. AND ALL OF THESE SPECIFICATIONS
ARE NOW IN PLACE SO THAT NEW CONSTRUCTION AND ANY
MODIFICATIONS ARE INCLUSIVE NOW FOR PEDESTRIANS OF ALL
ABILITIES. WE HAVE TRAINED OVER 95% OF
THEIR ENGINEERS AND PLANNERS ON THIS ACCESSIBILITY ISSUE. AND IT INCLUDED BOTH A LECTURE
PORTION AND A HANDS ON EXPERIENCE. AND NOW SOME EXAMPLES OF THE
THIRD CATEGORY OF EMERGENCY PREPAREDNESS. SO SOUTH CAROLINA IS A COASTAL
STATE, WE’RE HURRICANE PRONE, RURAL STATE, HIGH LEVEL OF
POVERTY. MAKES YOU WANT TO MOVE THERE,
RIGHT? SO WE FORMED AN EMERGENCY
PLANNING COMMITTEE FOR PEOPLE WITH FUNCTIONAL NEEDS. THAT’S FEMA’S TERM WITH A WHOLE
DIFFERENT GROUP OF STAKEHOLDERS. ONE OF THE THINGS IS SHELTER
ACCESSIBILITY. SO WE COLLABORATED WITH THE RED
CROSS, THE RED CROSS ASSESSES ALL OF THE HURRICANE SHELTERS
AND OUR COMMITTEE WORKS WITH THEM ON THE ACCESSIBILITY
PORTION OF THAT SHELTER CHECKLIST TO LOOK AT THINGS LIKE
DISPENSER HEIGHT AND CURB CUT SLOPES. THEN AT THE END OF THEIR SHELTER
CHECKLIST IS A SMALL PORTION THAT SAYS IS THIS SHELTER
ACCESSIBLE, DOES IT NEED A LITTLE WORK OR SHOULD WE NOT USE
THE SHELTER AT ALL? WE HAVE ALSO COLLABORATED TO
CREATE A WELCOME TO YOUR SHELTER DVD. IT INCLUDES PICTURES, IT
INCLUDES SIGN LANGUAGE AND IT’S LOOPED ON A DVD WHENEVER A
HURRICANE EMERGENCY SHELTER IS OPEN. IT CAN ALSO BE FOUND ON YOUTUBE
IF YOU’RE INTERESTED IN WATCHING THAT ONE. OUR SHELTER MANAGERS SOMETIMES
HAVE NO CLUE ON WHAT ASSISTIVE TECHNOLOGY IS AND HOW THAT CAN
HELP SOMEONE MAINTAIN THEIR INDEPENDENCE IN THE SHELTER SO
WE INCLUDE A DEFINITION SHEET IN THEIR SHELTER TO GO KITS. WE ALSO INCLUDE THINGS LIKE A
PLASTIC MAGNIFIER AS AN AID, A PICTURE
PICTURE AID AND THEN WASH CLOTHS AND RUBBER BAND TO BUILD UP THE
EATING UTENSIL, TO BRUSH YOUR HAIR, WRITE, SO PEOPLE CAN
MAINTAIN THEIR INDPENCE DENSE IN THE SHELTER. WE CONSIDER IT A HUGE SUCCESS TO
BE ADDING TWO QUESTIONS TO THE SOUTH CAROLINA BRFS IN 2013 IN
SOUTH CAROLINA TO DETERMINE THE PREPAREDNESS OF PEOPLE WITH
DISABILITIES. SPECIFICALLY LOOKING AT DO THEY
HAVE A PROPER EMERGENCY SUPPLY KIT AND A PROPER DISASTER
EVACUATION PLAN? FOR THE CDC IS CURRENTLY FUNDING
18 STATE DISABILITY AND HEALTH PROGRAMS. OVERALL OBJECTIVE IS THIS
IMPROVING THE QUALITY OF LIFE OF PEOPLE WITH DISABILITIES. THE PROGRAM SHARE INFORMATION
ALL THE TIME. SO IT WOULD BE VERY VALUABLE IF
WE COULD HAVE THAT IN EACH ONE OF THE STATES. SO IN ORDER TO DO THIS IN A
STATE, YOU HAVE TO BUILD A PROGRAM AND TO DO THAT YOU HAVE
TO HAVE COLLABORATORS AND TO BUILD COLLABORATIONS, IT TAKES
TIME AND SOME REALLY SUSTAINED EFFORT. IT’S AGENCIES AND PERSONNEL
CHANGE, YOU HAVE TO GO BACK IN AND MAKE SURE YOU HAVE THEIR
BUY-IN AND WHY THIS IS SO IMPORTANT. YOU HAVE THE HAVE COLLABORATORS
WHO ARE FUNCTIONING AT A HIGH LEVEL WITHIN THEIR STATE. THEY HAVE POWER. AND HAVE COMMON GOALS. WE DON’T WANT TO DUPLICATE
EFFORTS HERE. THE PUBLIC HELP HAS TO IMPLEMENT
PEOPLE 2020 SO IT INTEGRATES PEOPLE WITH DISABILITIES INTO
ALL FACETS WHICH IS SURVEILLANCE, PROGRAMMING,
PLANNING, MARKETING, ET CETERA. AND THEN WITH THE CDC SUSTAINED
EFFORTS AND SUPPORT AS WELL AS IDENTIFICATION OF PEOPLE WITH
DISABILITIES, AS A MANDATE FOR PROGRAMS AND SURVEILLANCE IS
CRUCIAL. I REALLY THINK THAT TOGETHER WE
CAN MAKE A DIFFERENCE WITH THIS PROBLEM. THANK YOU. OUR NEXT SPEAKER IS GEORGES
BENJAMIN.>>WELL, HELLO. I’M GEORGES BENJAMIN, I’M THE
EXECUTIVE DIRECTOR OF THE AMERICAN PUBLIC HEALTH
ASSOCIATION. MY PRESENT EIGHTATIONATION IS
GOING TO BE DIFFERENT. I’M GOING TO SHOW YOU OF
INCLUDING THE PEOPLE WITH DISABILITIES IN ALL ASPECTS OF
ACTIVITIES. BUT MORE IMPORTANTLY OUR NEW
EFFORT TO THE GOOD — TO BECOME A NATIONAL MODEL, HOPEFULLY FOR
OTHER ORGANIZATIONS TO EMULATE. FOR THOSE OF YOU WHO ARE
UNAWARE, APHA IS THE OLDEST AND LARGEST PUBLIC HEALTH
ASSOCIATION IN THE ORDINARY. WE’RE A NONPARTISAN ORGANIZATION
THAT STRIVES TO PROTECT ALL AMERICANS FROM PREVENTABLE AND
SERIOUS HEALTH THREATS. WE HAVE MANY INTEREST GROUPS AND
SEVERAL MAJOR PROGRAMS THAT SUPPORT OUR WORK. WE HAVE THREE STRATEGIC
PRIORITIES THAT DRIVE OUR WORK. ONE IS ADVOCATING FOR
INSURANCE — ENSURING THAT WE HAVE INFRASTRUCTURE AND PUBLIC
HEALTH. NUMBER TWO, BY CREATING HEALTH
EQUITY BY ADDRESSING AND ELIMINATING HEALTH DISPARITIES. FINALLY, ENSURING THE RIGHT TO
HEALTH AND HEALTH CARE BY RECOGNIZING THAT HEALTH
INSURANCE COVERAGE IS NOT ENOUGH. NOW, WE HAVE WORKED FOR MANY
YEARS TO BE A MODEL MOYER FOR OUR STAFF. AND TO THAT END WE HAVE
SUPPORTED A SUCCESSFUL WORKPLACE, SPECIFICALLY WHEN WE
BUILT OUR BUILDING, OUR HEADQUARTERS BUILDING IN 1999. WE PRACTICED NONDISCRIMINATION
IN OUR HIRING PRACTICES AND PROVIDE UNIVERSAL HEALTH
INSURANCE COVERAGE TO ALL EMPLOYEES. AND COVERAGE FOR THEIR FAMILIES
TO INCLUDE DOMESTIC PARTNERS. WE INCLUDE SCIENTIFIC
PROGRAMMING AROUND PUBLIC HEALTH DISABILITY ISSUES. WE HAVE A STRONG ACCESSIBILITY
PROGRAM AROUND THE MEETING. AND I NEED TO POINT OUT THOUGH,
WE DO HAVE A WAYS TO GO HERE. NOW, OUR DISABILITIES — CLEARLY
OUR SUBJECT MATTER ARE EXPERTS AND THEY BRING THE INCLUSION OF
DISABILITY ISSUES TO OUR BROADER PROGRAMS. PARTICULARLY OUR BROADER POLICY
AGENDA. OUR ANNUAL MEETING HAS BEEN THE
BENCHMARK OF OUR WORK. SO HERE ARE SOME OF THE THINGS
THAT WE DO AT OUR MEETING. ONE OF THE HALLMARKS IS WE HAVE
A WEB PAGE DEDICATED TO ACCESSIBILITY RESOURCES AND
SERVICES FOR PEOPLE AT TENDING THE MEETING. SOME OF THE OTHER THINGS ARE
SHOWN ON THIS SLIDE. INCLUDING THE FACT THAT WE HAVE
AN ACCESSIBILITY GUIDE TO THE CONVENTION CITY. OBVIOUSLY, MOST CONVENTION
CENTERS HAVE THAT, BUT WE SPECIFICALLY DO ONE FOR OUR
MEETING ATTENDEES. LIKE MOST ASSOCIATIONS, WE HAVE
A RANGE OF ONLINE EDUCATIONAL TOOLS TO INCLUDE WEBNARIES AND
PODCASTS. WE DO WORK TO CLOSE CAPTION ALL
OF THE VIDEOS, ALTHOUGH I HAVE TO ADMIT ANOTHER PLACE WE CAN
IMPROVE. BUT IT SOMETIMES DOES TAKE TIME
TO DO THIS. BUT WE’RE GETTING BETTER. AND DOING THAT IN EACH AND EVERY
WEBCAST OR VIDEO THAT WE DO. WE HAVE A WEBSITE THAT ALLOWS
FOR MOST ASSISTIVE TECHNOLOGIES. AND WE INCLUDE MESSAGING ON THE
PUBLIC. WE TALK ABOUT DISABILITIES
THROUGHOUT OUR PROGRAMMING. THIS YEAR IS NATIONAL PUBLIC
HEALTH WEEK IS AN EXAMPLE OF THAT INCLUSION. SO FOR EXAMPLE, PUBLIC HEALTH
WEEK IS CELEBRATED AS A FIRST FULL WEEK IN APRIL AND THIS YEAR
WE SPECIFICALLY ADDRESSED MENTAL HEALTH AS A PUBLIC HEALTH ISSUE
ON ONE OF THOSE FIVE DAYS IN WHICH WE CELEBRATED PUBLIC
HEALTH WEEK. WE HAVE A VERY STRONG ADVOCACY
AGENDA. EXAMPLES INCLUDE OUR WORK TO
LEAD THE HEALTH COMPONENT OF A NATIONAL COALITION CALLED
TRANSPORTATION FOR AMERICA. THIS COALITION WAS PUT TOGETHER
TO HELP REAUTHORIZE THE FEDERAL TRANSPORTATION BILL. ONE OF OUR MANY GOALS IS TO GET
HEALTH ISSUES INCLUDED IN THE BILL INCLUDING ISSUES AROUND THE
ACCESSIBILITY. PARTICULARLY AROUND WHERE YOU
BUILD THESE TRANSPORTATION CENTERS, HOW DO YOU INCENTIVIZE
STATES TO INCLUDE ACCESSIBILITY AS PART OF THAT PROCESS. WE RECENTLY PASSED A NEW POLICY
ON PUBLIC HEALTH INFORMATION ON MUSCULOSKELETAL DLZISEASES LIKE
ARTHRITIS. WE HAVE BEEN AN ADVOCATE FOR
OCCUPATIONAL HEALTH AND SAFETY AND WE HAVE ADVOCATED FOR
INCLUSION AROUND ACCESSIBILITY IN THE AFFORDABLE HEALTH CARE
ACT AND WE’RE ONE OF THE LONG-STANDING SUPPORTERS OF
MENTAL HEALTH PARITY. WE’RE EXCITED THAT WAS ACTUALLY
SIGNED INTO LAW. OF COURSE WE’RE LOOKING TO
STRENGTHEN OUR CAPACITY. WE BELIEVE WE SHOULD WALK THE
TALK SO WE HAVE MADE A COMMIT COMMITMENT TO ENSURE FROM BEING
PROBLEM SOLVERS. MY STAFF IS GOOD WITH PROBLEMS. SOMEONE WITH AN ACCESSIBILITY
ISSUE, MY STAFF ARE EXCITED ABOUT SOLVING THE PROBLEM. BUT THAT’S NOT GOOD ENOUGH. WE WANT THIS ORGANIZATION TO
BECOME ONE THAT ADDRESSES THE ISSUES WITH PROACTIVITY AND
INTENT THAT MEANS YOU THINK ABOUT IT BEFORE IT ACTUALLY
HAPPENS. THAT’S WHERE WE’RE TRYING TO
MAKE A BIG CHANGE IN THE WAY WE THINK ABOUT THINGS WITHIN OUR
ORGANIZATION. IS IT A MODEL FOR OTHERS TO
FOLLOW? BOTH AS AN EMPLOYER AND AN
ORGANIZATION AS WE GO FURTHER? NOW, TO ACCOMPLISH OUR GOALS, WE
HAVE EMBARKED — AN ASSESSMENT. WE BROUGHT A CONSULTANT IN WHO
SPENT SOME TIME IN OUR MEETING IN SAN FRANCISCO THIS YEAR. KIND OF WATCHING WHAT WE DO. AND THEY’RE LOOKING AT BOTH US
AS AN EMPLOYER, AS AN — IN TERMS OF OUR PROGRAMS. AS AN ASSOCIATION. THAT REPORT IS GOING TO BE DUE
EARLY NEXT YEAR. WE ALREADY DO PERIODIC REVIEWS
ON THE ONLINE TECHNOLOGY. WE KNOW THERE ARE IMPROVEMENTS
THAT NEED TO BE MADE THERE. WE HAVE DONE SOME THINGS
ALREADY. WE HAVE BEEN VERY AGGRESSIVE IN
ENSURING OUR STAFF HAS TRAINING IN DIVERSITY IN THE WORKPLACE
AND IN THEIR PROGRAMMING AND WE’RE WORKING TO HELP THEM
INCLUDE THAT IN ALL ASPECTS OF WHAT THEY DO. WE’RE GOING TO THEN TAKE A
COURSE WHERE WE HAVE LEARNED AND THE GENERAL CONSULTANTS,
CONFIDENTIAL ASSESSMENT OF OUR ORGANIZATION, OUR FACILITIES AND
OUR WORK PRACTICES AND OF COURSE CRAFT A PLAN TO FIGURE OUT HOW
WE GET TO BE AT THE TOP OF THE HEAP IN TERMS OF ASSOCIATION —
ASSOCIATIONS THAT DO THIS. AND OF COURSE THAT PLAN WILL
INCLUDE MILESTONES AND SOME DEFINED MEASURES OF SUCCESS. I THINK AT THE END WE HOPE THAT
THERE WILL BE CHANGES IN OUR POLICIES, PROCEDURES, MAYBE IN
OUR PHYSICAL PLAN THAT WILL MAKE US MUCH MORE ACCESSIBLE AND FOR
PEOPLE WHO HAVE DISABILITIES BE MUCH MORE COMFORTABLE IN WHAT
WE’RE DOING. NOW, THE BEHAVIORAL CHANGE WE
SEE AGAIN IS FOR STAFF AND ASSOCIATION MEMBERSHIP TO SEE
AND ADDRESS THE ACCESSIBILITY AS A NORMAL COURSE OF BUSINESS AND
NOT SIMPLY AS AN ADDITIONAL TASK. NOW, FROM OUR PERSPECTIVE, THIS
IS GOING TO BE EASY, BUT WE BELIEVE FAILURE IS NOT AN OPTION
FOR US. WE BELIEVE AS THE NATION’S
LARGEST ASSOCIATION AND OLDEST ASSOCIATION WITH THE STRONG CORE
BELIEF IN THE CIVIL RIGHTS THIS IS IMPORTANT FOR US TO
ACCOMPLISH. WE THINK THE PRICE OF NOT DOING
THIS MEANS OUR MEMBERS WILL NOT BE ABLE TO FULLY PARTICIPATE IN
THE ACTIVITIES OF ACHA AND BECAUSE WE HAVE A MAJOR
INFLUENCE ON THE HEALTH OF THE PUBLIC AS DO YOU HERE AT CDC WE
BELIEVE THE PUBLIC CANNOT GET THE HEALTH CARE THEY DESERVE AND
THAT MOST FOLKS WON’T ACHIEVE THE QUALITY OF LIFE THAT THEY
DESERVE. SO WE THINK WE CAN BE EFFECTIVE
FROM A HEALTH IMPACT PERSPECTIVE IF WE WALK THE TALK. SO TO SPEAK. WITH THAT, I THANK YOU VERY
MUCH.>>THANK YOU TO ALL OF OUR
SPEAKERS. AND THIS IS THE FUN PART. OPEN FOR QUESTIONS AND ANSWERS. IN COMING FORWARD WITH A
QUESTION, PLEASE INTRODUCE YOURSELF AND THEN KEEP THE
QUESTIONS SIMPLE AND KEEP IT TO ONE QUESTION, PLEASE. DO WE HAVE A QUESTION TO START
FROM THE AUDIENCE? WELL, WHILE YOU’RE WARMING UP
AND GETTING OVER YOUR BASHFULNESS, I’M GOING TO ASK A
COUPLE OF QUESTIONS TO THE PANELISTS. DR. BENJAMIN, WE’RE THRILLED TO
HEAR ABOUT APHA’S COMMITMENT TO ACCESSIBILITY AND ALL OF US WANT
TO DO THINGS AS QUICKLY AND CHEAPLY AS WE CAN. SO COULD YOU TELL US WHAT THE
SIMPLEST, BUT MOST PROFOUND CHANGE WAS THAT YOU’VE MADE
WITHIN APHA TO INCREASE ACCESSIBILITY?>>YEAH, WE HAD AN ACCESSIBILITY
TEAM THAT WAS VERY FOCUSSED ON OUR ANNUAL MEETING. YOU KNOW, THAT’S OUR BIGGEST
EVENT. SO WE’RE VERY FOCUSED ONLY
MAKING SURE THAT WAS ACCESSIBLE. WE HAVE EXPANDED THAT. SO IT INCLUDES NOT ONLY MEMBERS
OF MY STAFF BUT ALSO MEMBERS OF THE ASSOCIATION. AND THE BREADTH OF INVOLVEMENT
AND THE IDEAS THAT HAVE COME UP HAVE REALLY CHANGED THE WAY WE
THINK ABOUT EVERYTHING. WE LEARNED THAT LESSON AS WE’RE
MOVING TO BECOME — REDUCE OUR CARBON FOOTPRINT. WE PUT TOGETHER A GREEN TEAM AND
WE TOOK THAT LESSON AND WE APPLIED IT TO ACCESSIBILITY AND
DISABILITY ISSUES. AND WE HAVE ALREADY BEGUN TO SEE
BEHAVIOR CHANGE LIKE I DESCRIBED IN OUR STAFF.>>THANK YOU.>>AND IT WAS FREE.>>WE HAVE A QUESTION OVER HERE.>>THANKS. TOM SINKS WITH ENVIRONMENTAL
HEALTH. COLLEEN BOYLE ASKED ME TO ASK A
QUESTION, SO THANKS, COLLEEN. I DON’T NEED THE ENCOURAGEMENT. IN ENVIRONMENTAL HEALTH WE
FREQUENTLY HAVE BEEN LOOKING AT COMMUNITIES THAT ARE CHALLENGED
BY HAZARDS. HAZARDOUS COMMUNITIES ARE POISON
COMMUNITIES AND WE’RE STARTING TO LOOK AT BUILDING HEALTHY
COMMUNITIES. WHAT’S IMPORTANT IS INSTEAD OF
LOOKING AT HAZARDS, HOW DO WE DESIGN COMMUNITIES THAT ARE
HEALTHY AND SUSTAINABLE? AND WHEN I THINK ABOUT
DISABILITIES ACROSS CDC, I THINK ABOUT THE OPPORTUNITY FOR ALL OF
US TO BE THINKING ABOUT PERSON’S WITH DISABILITIES IN OUR
PROGRAMS AND HOW DO WE TAKE ADVANTAGE OF THAT AND ARE THERE
WAYS THAT WE CAN THINK ABOUT BUILDING HEALTHY COMMUNITIES
THAT SPECIFICALLY LOOK AT PEOPLE WITH DISABILITIES AND FOCUSING
ON HEALTHY COMMUNITIES FOR EVERYBODY INCLUDING THOSE WHO
ARE DISABLED?>>YEAH, YOU KNOW, IT STARTS
WITH BOTH MAKING SURE THAT THE COMMUNITIES THAT NEED TO GET
REPAIRED, YOU KNOW, WE FIX SIDEWALKS, WE MAKE SURE THEY’RE
CUT OUT AND THOSE KIND OF THINGS AND OF COURSE AS WE’RE BUILDING
NEW COMMUNITIES WE BUILD THEM WITH THE CONCEPT IN MIND. WHAT WE WERE DOING WITH
TRANSPORTATION FOR AMERICA IS OF COURSE TALKING TO THAT COALITION
A LOT ABOUT THE IMPORTANCE OF JUST STEPPING BACK AND ASKING
YOURSELF — BECAUSE PEOPLE THINK OF THE WORLD HERE. THAT’S GREAT. BUT, YOU KNOW, HOW WOULD A
PERSON SIMPLY GET — IF YOU HAD A BABY IN A STROLLER, HOW WOULD
YOU GET FROM POINT “A” TO POINT “B.” JUST THINK OF THAT. IF YOU CAN GET A BABY IN A
STROLLER FROM POINT “A” TO POINT “B” ASSUMING THAT THE DOORS ARE
WIDE ENOUGH, ET CETERA, YOU CAN GET A PERSON IN A WHEELCHAIR,
CANE, ET CETERA. BUT TRYING TO GIVE YOU A MENTAL
PICTURE OF WHAT IT’S LIKE FOR EVERYBODY TO JUST MOVE IN ONE
POINT TO ANOTHER. AND THEN BUILDING SYSTEMS THAT
ACCOMMODATE ALL OF THOSE FOLKS. BUT AGAIN, THINKING ABOUT IT
PROACTIVITY. NOT TRYING TO FIX IT ONCE YOU
HAVE A PROBLEM.>>WE OFTEN CALL THAT UNIVERSAL
DESIGN. A QUESTION HERE?>>YES. THIS IS FROM OUR TWITTER
FOLLOWERS FOR GRAHAM, HOW CAN ALL OF US WORK TOGETHER WITH
LEADERSHIP PROVIDED BY CDC TO LAUNCH NATIONAL PUBLIC AWARENESS
CAMPAIGNS ABOUT THE NEED TO INTEGRATE DISABILITY INTO THE
OVERALL PUBLIC HEALTH AGENDA?>>WELL, THAT IS A GREAT
QUESTION. IT IS A QUESTION WE’RE ACTIVELY
ENGAGEING WITH OUR PARTNERS ON RIGHT NOW. I’LL TAKE A STAB AND THEN ASK
OTHERS TO RESPOND TO THAT AS WELL. THE ISSUE OF REALLY INCREASING
VISIBILITY WITH DISABILITY IS A BIG ISSUE WE HAVE BEEN TALKING
ABOUT. THIS “GRAND ROUNDS” IS A KICKOFF
FOR THAT. FOR CDC, THERE’S A HEALTH WORK
GROUP THAT’S WORKING ACTIVELY AROUND GETTING DISABILITY
INCLUDED IN THE POLICY, PROGRAMS AND THAT’S A LEADERSHIP ROLE
THAT CDC IS PLAYING. THAT’S WORKING UNDER THE OUT OF
OF DIRECTOR. DR. FRIEDENS’ OFFICE.>>I THINK ONE OF THE CRITICAL
THINGS IS ONCE AGAIN, THE HEALTH DEPARTMENT AND PUBLIC HEALTH ARE
DOING SUCH GOOD WORK WITH HEALTH PROMOTION, WELLNESS ACTIVITIES. ARTHRITIS PROGRAMS THAT ARE OUT
THERE, BUT GETTING PEOPLE TO UNDERSTAND THAT DISABILITY IS A
DEMOGRAPHIC AND IT’S NOT A SEPARATE GROUP. SAD TO SAY PEOPLE WITH
DISABILITIES WE ARE A GROUP THAT INFILTRATES EVERY OTHER GROUP,
WHETHER IT’S GENDER, RACE, ETHNICITY. SO IF WE CAN GET PEOPLE TO MOVE
FROM THE SILO EFFECT TO INCORPORATING PEOPLE WITH
DISABILITIES INTO THEIR LITTLE SILOS, WHICH WE’RE PART OF, I
THINK THAT MAKING THAT MENTAL ADJUSTMENT, THAT THOUGHT PROCESS
ADJUSTMENT, GOES A LONG WAY BECAUSE THEN THEY WILL MARKET TO
DESIGN INCLUSIVELY, HAVE UNIVERSAL DESIGN.>>AND THE OTHER PART IS ALSO,
YOU KNOW, THE INTEGRATION OF PEOPLE WITH DISABILITIES IN
PUBLIC HEALTH PROGRAMS. FOR EXAMPLE, SMOKING CESSATION
PROGRAM HERE. WHEN YOU’RE PROVIDING FUNDS TO
THE STATE HEALTH DEPARTMENT AND YOU INCLUDE DISABILITY AS ONE OF
THE DEMOGRAPHIC GROUPS, JUST AS YOU WOULD INCLUDE RACIAL ETHNIC
MINORITIES AND THAT’S GOING DOWN TO THE STATE LEVEL AND THE LOCAL
LEVEL. I THINK IT’S A GREAT QUESTION.>>ANOTHER QUESTION IN THE BACK. OKAY. THANK YOU.>>HI, I’M MARY McDONALD FROM
THE OFFICE OF HEALTH DISPARITIES. THANK YOU FOR YOUR REALLY
EXCELLENT PRESENTATIONS. I LEARNED A LOT BEING HERE
TODAY. I JUST WANTED TO ASK A QUESTION
IN LIGHT OF WHAT’S BEEN HAPPENING IN THE NATION. I THINK WE’RE REELING FROM SANDY
HOOK AND I WONDER IF ANY OF YOU MIGHT HAVE ANY COMMENTS ABOUT
THE SOCIAL DETERMINANTS OF MENTAL HEALTH DISABILITIES? PROBLEMS WITH THESE NOT ACTUALLY
BEING IDENTIFIED AND ACKNOWLEDGED AND HOW THIS MIGHT
REQUIRE SOMETHING DIFFERENT FROM THE KINDS OF RESPONSES YOU HAVE
TALKED ABOUT. THANK YOU.>>SOMEBODY WANT TO TAKE THAT
QUESTION?>>I’LL TAKE MY GENERAL STAB AT
IT. I — THIS IS ME PERSONALLY
SPEAKING, I THINK ONE OF THE KEY ASPECTS WITH ALL DISABILITIES
BUT PARTICULARLY WITH MENTAL HEALTH IS THE STIGMA ASSOCIATED
WITH IT. NO MATTER WHAT YOU SAY, THE FACT
THAT I USE THE WHEELCHAIR PEOPLE IN SOCIETY VIEW ME AS LESS THAN
OR HAVE FEWER EXPECTATIONS OF OR IT MUST BE HORRIBLE TO BE HER. AND IT’S THE SAME WAY WITH
MENTAL HEALTH, BUT I THINK PROBABLY EVEN INCREASED BECAUSE
PEOPLE UNDERSTAND IT EVEN LESS. THEY CAN SEE THAT MY LEGS DON’T
WORK, SO OKAY, SHE USES WHEELS. WITH MENTAL HEALTH IT’S HARDER
FOR THE GENERAL SOCIETY TO GRASP IT. AND I THINK PERSONALLY — I
THINK THAT HAS TO HAPPEN BEFORE WE MAKE SOME REALLY GREAT
STRIDES IN IT WHICH MEANS PEOPLE HAVE TO BE WILLING TO SEEK OUT
SERVICES AND SAY THAT THEY HAVE WHATEVER THE DISABILITY IS.>>WE HAVE TIME FOR ONE MORE
QUESTION. THANK YOU.>>[ INDISCERNIBLE ]. — INDIVIDUAL PEOPLE WORKING AS
A TEAM. FOR EXAMPLE, PEOPLE — OH, WE
DON’T — BUT THAT’S NOT ME. THAT’S NOT HOW IT SHOULD BE. I’M PLANNING ON HAVING A MEETING
WITH A GROUP CALLED DIDA, A GROUP WITH DISABILITIES, AND
TALKING ABOUT THE VARIETY OF DISABILITIES. WHEELCHAIR. PEOPLE WHO ARE DEAF. AND SO WE CAN ALL BE WORKING
TOGETHER AND FEEL COMFORTABLE TOGETHER INSTEAD OF BEING IN
SEPARATE GROUPS. I’M TRYING TO DEVELOP THAT
ALLIANCE. SO I CAN SEE THOSE PEOPLE —
OTHER PEOPLE WHO HAVE DISABILITIES, NOT JUST FOCUSING
ON OUR OWN DISABILITY IN THE COMMUNITY. I THINK THAT’S AN IMPORTANT PART
THAT WE WORK TOGETHER.>>THANK YOU. THANK YOU FOR THE COMMENTS. THANK YOU.>>THANK YOU VERY MUCH FOR
REALLY GREAT QUESTIONS. I THANK OUR FABULOUS FOUR AND
FABULOUS SIX. AND I APOLOGIZE FOR SOME
TECHNICAL DIFFICULTIES WE HAD FOR THOSE WHO WERE NOT ABLE TO
PARTICIPATE AND VIEW US IN THE ENTIRETY OUTSIDE OF CDC. BUT THE ENTIRE SESSION IS GOING
TO BE POSTED SHORTLY. THANK YOU ONCE AGAIN AND SEE YOU
IN TWO WEEKS. SAME TIME, SAME PLACE.

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