Health promotion has been defined as the process of enabling people to increase control over their health and to improve it. This process requires personal participation and supportive environments. For people with disabilities, however, personal participation is often limited by non-supportive environments. Lack of knowledge on how to modify programs to meet specific needs, poor attitudes, and unfriendly environments often creates insurmountable barriers to participation for many people with disabilities. While innovative medical technology has increased the life span of individuals with disabilities, little attention has focused on improving their health span.
The reportedly high incidence of chronic secondary conditions seen in persons with disabilities, including pain, fatigue, low functional capacity, obesity, and depression, is often related to environmental conditions that include poor health promotion practices.
Smith wrote: “People with disabilities therefore represent significant health needs and investment in health care resources, both in terms of the primary disability and secondary complications. Although the prevention of these conditions is important, of equal importance is to make living with them as healthy as possible, as many disabilities are life-long.
Although health promotion may be significant in leading to lower levels of premature mortality, higher quality of life and lower health care costs for the general population, it has the potential to be even more significant for those already with a disability, whose quality of life and independence rely critically on their ability to maintain their narrow margin of health.”
With the emerging concept that individuals with disabilities can improve their health in the same manner as anyone else, there is growing momentum for providing quality health promotion programs for people with disabilities. Maintaining health and wellness is especially important for people with disabilities because functional limitations that often accommodate a primary impairment (neurological dysfunction) may reduce a person’s capacity to engage in health promoting behaviors and result in a higher frequency of secondary conditions. These secondary conditions are defined as “…physical, medical, cognitive, emotional, or psychosocial consequences to which persons with disabilities are more susceptible by virtue of an underlying impairment, including adverse outcomes in health, wellness, participation and quality of life”.
The purpose of this paper is to provide an overview of health promotion for people with disabilities in the areas of exercise, nutrition and health education, and to describe a health promotion service delivery model that addresses the gap in services between rehabilitation and community-based health promotion. The vast majority of people with disabilities are not obtaining the recommended amount of physical activity needed to confer health benefits and prevent secondary conditions (e.g., heart disease, obesity, and osteoporosis). In a study by Rimmer, it was found that less than 10 percent of adults with physical disabilities engaged in structured physical activity programs. A possible reason for this high level of inactivity may be linked to the number of actual and perceived barriers to exercise reported by people with disabilities.
Transportation, cost of the exercise program, and not knowing where to exercise were listed as the three most common barriers. In a related study, Messent reported that the barriers to physical activity participation in adults with developmental disabilities were unclear policy guidelines in residential and day service programs; transportation and staffing constraints; limited financial resources; and limited availability of physical activity programs in the person’s community. While these external barriers may impose major limitations on exercise participation, internal barriers may also create obstacles to participation.
Kinne reported that exercise self-efficacy and motivational factors were significant predictors of exercise maintenance in a group of adults with disabilities. Health disparities refer to differences between groups of people. These differences can affect how frequently a disease affects a group, how many people get sick, or how often the disease causes death. Many different populations are affected by disparities. These include
•Racial and ethnic minorities
•Residents of rural areas
•Women, children, the elderly
•Persons with disabilities
While better nutritional habits are a major concern for most people with and without disabilities, there may be some specific differences in diet and nutrition guidelines pertaining to people with specific types of disabilities. Issues related to accessing healthy foods, determining food interactions with commonly used medications to control various secondary conditions ( pain, seizures, depression), and establishing specific requirements for food supplements ( vitamins, minerals, fluid intake) are all major concerns among people with certain disabilities. For example, people with spinal cord injury have a higher rate of bone loss after their injury, which increases their risk of osteoporosis. A few studies on persons with cerebral palsy and Down syndrome have also reported a higher incidence of osteoporosis. While it is the recommended daily allowance for calcium intake and vitamin D may need to be increased for certain types of disabilities to offset the rate of bone loss, recommended guidelines are not available. There are little data available to support this theory.
There is a pressing need to conduct more research on various types of disabilities that have a reportedly higher incidence of bone loss, to determine the effects of exercise and nutritional supplements (calcium, vitamin D) in reducing or slowing the progression of this condition. Health education can have a measurable impact on empowering people with disabilities to improve their own health. For example, people with depression, manic depression, schizophrenia etc. should practice medication management with the assistance of a physician or nurse practitioner. Many states offer education classes dealing with communication with family members and the public along with skills on how to cope with mental illness. There are also cooking, cleaning, and hygienic classes and job training skills. In my experience job coaches are available to help ease the transition from unemployment to gainful employment practices.
Many disabled individuals still experience discrimination from others who do not understand what mental illness is and don’t take the time to find out how to cope daily with a friend, family member or co-worker who may suffer from mental illness. In Belize Central America poverty is a big problem. In an article I read had this to say, “The Inter-American Development Bank (IDB) said Tuesday that it had approved a US$15 million loan to help Belize provide better basic health care, improve secondary education and strengthen its capacity to target, coordinate and evaluate social protection programs.”These measures will help the government achieve the goals of its National Poverty Elimination Strategy,” the IDB said in a statement. It said that one-third of the country’s population lives under the poverty line and the poorest sector of society lacks adequate basic health and secondary education services. “In some southern rural areas, like the Toledo district, 79 per cent of the population is poor and 56 per cent is classified as indigent.
“The IDB said that in order to strengthen primary health care for the most vulnerable sectors, the funds will support government plans to increase enrolment in the National Health Insurance (NHI) pilot program.”It will also protect the 2009-2010 budget lines needed to at least maintain NHI coverage at 95 per cent of the population in south-side Belize City and 84 percent in the Southern Region. The National Alliance on Mental Illness (NAMI) is also addressing the significant barriers to mental health care experienced by African American, Asian American and Pacific Islander, American Indian, and Latino/Hispanic populations. NAMI is developing national partnerships and strategies to overcome the crisis. There is also increasing emphasis on improving quality of health care within the existing services in the United States. To achieve quality, there must be: 1. Improved access to care for all people.
2. Appropriate and acceptable treatment plans that incorporate multidisciplinary knowledge. 3. A workforce of sufficient numbers and qualifications. 4. Agreement on indicators for health care quality.
5. Responsible practices and follow-through on the part of patients. One study of infants revealed the cost of hospitalizing premature infants, the need to improve prenatal care to women at high risk for delivering preterm or low-birth-weight infants, and the need to improve outcomes for those infant. There is still so much to be done to increase health and the quality of life in persons with disabilities and those with chronic health issues. Health promotion has been defined as the process of enabling people to increase control over their health and to improve it. This process requires personal participation and supportive environments.
Rimmer JH, (1999). Health promotion for people with disabilities: the emerging paradigm shift from disability prevention to prevention of secondary conditions Physical Therapy. 79(5), 495-502. Ravesloot C, Seekins T, Young Q, (1998). Health Promotion for People with Chronic Illness
and Physical Disabilities: The Connection between Health Psychology and Disability Prevention Clinical Psychology and Psychotherapy. 5, 76-85. Thierry JM, (1998). Promoting the health and wellness of women with disabilities. Journal of Women’s Health. 7(5), 505-507. Stuifbergen, Alexa K., PhD, RN, Heather Becker, PhD, and Dolores Sands, PhD, RN, (1990). Barriers to health promotion for individuals with disabilities Family & Community Health. Smith RD, (2000). Promoting the health of people with physical disabilities: a discussion of the financing and organization of public health services in Australia Health Prom Int. 15, 79-86. 13(1), 11-22. Belize to receive IDB funds for health, education. (2009, Oct 07). BBC Monitoring Americas. Retrieved from http://search.proquest.com/docview/460151112?accountid=32521