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DISABILITY IN AMERICA TOWARD A NATIONAL AGENDA FOR PREVENTION Andrew M. Pope and Alvin R. Tarlov Editors Committee on a National Agenda for the Prevention of Disabilities Division of Health Promotion and Disease Prevention INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D. C. 1991i About this PDF file: This ne... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N. W. Washington, D. C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academyof Sciences, the National Academy of Engineering, a... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
COMMITTEE ON A NATIONAL AGENDA FOR THE PREVENTION OF DISABILITIES ALVIN R. TARLOV (Chair), Director, Division of Health Improvement, The Health Institute, New England Medical Center; Professor of Medicine, Tufts University School of Medicine; and Professor of Health Promotion, Harvard School of Public Health, Boston, M... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
ARTHUR T. MEYERSON, Professor and Chairman, Department of Psychiatry and Mental Health Sciences, Hahnemann University School of Medicine,Philadelphia, Pennsylvania DOROTHY P. RICE, Professor in Residence, Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco JULIUS B. ... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
Preface In 1985 the National Research Council and the Institute of Medicine released the landmark report Injury in America, which identified injury as the leading cause of death and disability among children and young adults and, indeed, the principal public health problem facing America. The primarymeasure used in the... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
presents an opportunity to intervene and prevent the progression toward disability. Thus, the report sets forth a model developed by its authoring body,the Committee on a National Agenda for the Prevention of Disabilities, thatdescribes disability not as a static endpoint but as a component of a process. The report is ... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
in employment, transportation, public accommodations, telecommunications, and local and state government activities. This act also provides guidance forgovernmental policies and services, as well as for businesses and otherorganizations. Other NCD initiatives have led to major steps forward in addressing disability pre... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
report. There was no suppression of any argument. Discussions were free-ranging and open, and voluminous amounts of information from varioussources with differing perspectives were considered, analyzed, discussed, anddebated. The contents of the report represent the committee's consensus on theissues it was charged to ... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
Acknowledgments The following colleagues in both the public and private sectors generously shared information, resource material, and expertise: M. J. Adams, Jr., Monroe Berkowitz, Betty Jo Berland, Scott C. Brown, Larry Burt, Jose Cordero, Philip Graitcer, Robert Griss, Lawrence Haber, James Harrell, Judith Heumann,Ve... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
ACKNOWLEDGMENTS x About this PDF file: This new digital representation of the original work has been recomposed from XML files created from the o riginal paper book, not from the original typesetting files. Page breaks are true to the original; line lengths, word breaks, heading styles, and other typesett ing-specific ... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
Contents EXECUTIVE SUMMARY 1 1 INTRODUCTION 32 Disability: Definition and Concept 34 Public Health and Disability Prevention 37 Scope and Organization of the Report 39 2 MAGNITUDE AND DIMENSIONS OF DISABILITY IN THE UNITED STATES 41 Data Sources 41 Prevalence of Disability 45 Trends in the Prevalence of Disability 53 C... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
5 PREVENTION OF INJURY-RELATED DISABILITY 147 Injury in America: Magnitude of the Problem 147 Central Nervous System Injuries 150 Surveillance: Counting the Survivors and Assessing Their Needs 156 Primary Prevention: The Strategy of Choice 159 A Systems Approach to Acute Care and Rehabilitation 164 6 PREVENTION OF DISA... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
DISABILITY IN AMERICA xiii About this PDF file: This new digital representation of the original work has been recomposed from XML files created from the original paper book, not from the original typesetting files. Page breaks are true to the original; line lengths, word breaks, heading styles, and other typesett ing-s... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
xiv About this PDF file: This new digital representation of the original work has been recomposed from XML files created from the original paper book, not from the original typesetting files. Page breaks are true to the original; line lengths, word breaks, heading styles, and other typesett ing-specific formatting, ho... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
Executive Summary Disability is an issue that affects every individual, community, neighborhood, and family in the United States. It is more than a medical issue; it is a costly social, public health, and moral issue. About 35 million Americans (one in every seven) have disabling conditions that interfere with their ... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
summarize. For young adults, mobility limitations such as those caused by spinal cord injuries, orthopedic impairments, and paralysis are the mostcommon causes. For middle-aged and older adults, chronic diseases, especiallyheart and circulatory problems, predominate as causes of limitation. Figure 1 shows the age-speci... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
of life, it is important to foster programs that emphasize rehabilitation and the prevention of secondary conditions. Partly for this reason the committeefocused its report on prevention strategies for people who already havepotentially disabling conditions, that is, on secondary and tertiary levels ofprevention. In ot... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
related to conceptual clarity and data needs and presents a model for studying the progression of conditions toward disability. The disability model describedin this report should facilitate the development of improved surveillancesystems, an epidemiology of disability, and more effective means of prevention. Interferi... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
injury-related disabilities, specifically those related to spinal cord injury and traumatic brain injury ( Chapter 5 ); disabilities associated with chronic diseases and aging ( Chapter 6 ); and secondary conditions associated with primary disabling conditions ( Chapter 7 ). Needs and challenges specific to each catego... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
but also on the larger context of social and physical environments. Conceptual clarity, however, seems to be a problem with some of theclassifications in the ICIDH. As discussed in the literature, some of the ICIDHclassifications are confusing; for example, certain social role limitations (e. g.,family role, occupation... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
complication (secondary conditions) that can greatly exacerbate existing limitations or lead to new ones. Figure 3 summarizes the four stages of the framework. As mentioned above, the committee's model for disability builds on the conceptual frameworks of Nagi and the WHO, placing disability within theappropriate conte... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
Risk Factors Risk factors are biological, environmental (social and physical), and lifestyle or behavioral characteristics that are causally associated with health-related conditions. Identifying such factors can be a first step towarddetermining a mechanism of action in the disabling process and then developingprevent... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
FIGURE 4 Model of disability showing the interaction of the disabling process, quality of life, and risk factors. Three types of risk factors are included: biological (e. g., Rh type); environmental (e. g., lead paint [physical environment], access to care [social environment]); and lifestyle and behavior(e. g., tobacc... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
social interaction. Also, the effects of specific stages in the model can be moderated by such interventions as assistive devices. Similarly, environmentalmodification (e. g., elimination of physical obstacles and barriers) is animportant form of disability prevention, as is such landmark antidiscriminationlegislation ... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
surgery, and social and intellectual deprivation. These conditions, which usually persist throughout an individual's lifetime, are diagnosed in an estimated 80,000children each year. Because of their early onset, developmental disabilitiesaccount for a large percentage of the cumulative total of disability years 1 for ... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
In this report, the committee focused on head injuries and spinal cord injuries, which can cause significant physical, neurological, and psychosocialdeficits and result in economic costs per person that are among the highest forinjury-caused pathologies and impairments. Each year, about 1. 3 million peoplesuffer head i... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
pose low risks of activity limitation, whereas the least prevalent conditions, such as multiple sclerosis and lung or bronchial cancer, pose very high risks ofdisability. Thus conditions that frequently result in disability may be moreappropriate targets for primary prevention strategies, and those that pose lowerrisks... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
Also requiring greater attention, in both research and service delivery, is the role of assistive technology. Such technology promotes personalindependence, facilitates the performance of tasks related to personal, familial,and social roles, and helps prevent debilitating, costly secondary conditions. However, outmoded... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
A NATIONAL AGENDA FOR THE PREVENTION OF DISABILITY GOAL To reduce the incidence and prevalence of disability in the United States, as well as the personal, social, and economic consequences of disability in order to improve the quality of life for individuals, families, and the population at large. STRATEGIES Organizat... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
Leadership of the National Disability Prevention Program The congressionally mandated role of the National Council on Disability (NCD) is to provide advice and make recommendations to the President and to Congress with respect to disability policy. In keeping with its charter, thecouncil has been and should continue to... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
RECOMMENDATION 1: Develop leadership of a National Disability Prevention Program at CDC To advance the goal and carry out the strategies of the national agenda, the committee recommends that the CDC Disabilities Prevention Program beexpanded to serve as the focus of a National Disability Prevention Program (NDPP). In a... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
a broad array of scientists and informed leaders from both the private and public sectors. The purpose of the forum would be to improve policymaking through acontinuing dialogue among individuals and groups that play a significant role inshaping policy and public opinion. Areas for consideration might include accessto ... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
coordination of health and medically related rehabilitation activities and social services is a long-standing problem that is not easily rectified. Improvementswill require energy and direction, a focus on prevention, and a clear strategy forcoordination, cooperation, and integration among several federal programs asth... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
Surveillance Although information on the incidence and prevalence of disability is available, it is organized in so many different ways that accurate, useful analysisis impeded. Estimates of the prevalence of disability vary by more than 100percent. One difficulty is the conceptual confusion surrounding disability andi... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
with the WHO and other international agencies should be encouraged in developing a classification system to obtain comparable disability data across nations. A National Disability Surveillance System Despite its significance as a public health and social issue, disability has received little attention from epidemiologi... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
and diseases that cause functional limitations and disability; and (3) secondary conditions resulting from the primary disability. The system should also monitor causal phenomena, risk factors, functional status, and quality of life, and provide state-specific data for program planning and evaluation of interventions. ... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
the course of disability and identify the most strategic points for effective intervention. RECOMMENDATION 12: Emphasize longitudinal research A research program of longitudinal studies should be developed to determine the course of conditions and impairments that lead to disability and to identify the strategic points... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
of current approaches in the wide variety of situations in which disability occurs. All areas of prevention require critical evaluations of the effectivenessof the tools and methods used in the prevention of disability and secondaryconditions. The federal government spends about $60 billion annually for medical coverag... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
it difficult for them to purchase insurance, make required copayments, or purchase essential services and equipment for their rehabilitation. In addition,poverty compounds the difficulties faced by those with disabilities in gainingrecognition of their needs (which are often complicated by the socialcircumstances assoc... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
preventing disability; however, assessing or evaluating their cost implications was not part of the charge to this committee. RECOMMENDATION 16: Provide comprehensive health services to all mothers and children Preventing disability will require access by all Americans to quality health care. An immediate step that cou... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
arbitrarily defined ''medical necessity" requirement that does not permit reimbursement for many types of preventive and rehabilitative services andassistive technologies. Insurance policies tend to mirror the acute careorientation of the U. S. medical system and generally fail to recognize theimportance and value of l... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
job training, job placement, work-site modification, and postemployment services (e. g., Projects with Industry) to ensure satisfactory adjustment andassistance in sustaining employment. RECOMMENDATION 22: Provide comprehensive vocational services Vocational services aimed at reintegrating persons with disabilities int... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
appropriate modes of preventive intervention. The longitudinal care described in this report is sometimes provided by specialists in physical medicine andrehabilitation, but most typically it will be provided by general internists, familyphysicians, psychiatrists, psychologists, social workers, and others. Any long-ter... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
pursue an independent lifestyle. Being able to share experiences with peers who are independent brings to light those coping mechanisms that aid in preventingsecondary conditions. Independent living centers are also effective advocatesfor attitudinal and architectural changes in society that would improveaccessibility,... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
LIST OF RECOMMENDATIONS A NATIONAL AGENDA FOR THE PREVENTION OF DISABILITY ORGANIZATION AND COORDINATIONDevelop leadership of National Disability Prevention Program at CDC Develop an enhanced role for the private sector Establish a national advisory committee Establish a federal interagency council Critically assess pr... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
1 Introduction About 35 million Americans —one person in seven —have physical or mental impairments that interfere with their daily activities (National Center for Health Statistics, 1989a). The functional limitations of more than 9 million of these people are so severe that they cannot work, attend school, or maintain... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
The risk of developing cardiovascular disease, rheumatoid arthritis, and many other chronic diseases increases with age, as does the likelihood ofdisability caused by these conditions. If these chronic conditions cannot beprevented, then the focus of medical care and support services should be on theprevention of assoc... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
the legs might now retain sufficient functioning to walk with the aid of crutches and braces. Failure to seize emerging opportunities and develop a comprehensive strategy for disability prevention is tantamount to allowing the health andquality of life of a large portion of the U. S. population to deteriorate. A growin... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
many factors that underlie the disabling process and the occurrence of secondary conditions. They also impede the design and evaluation of preventiveinterventions. As one aspect of its work, the committee has attempted toimprove conceptual clarity and sharpen the definitions of terms. The term disability as used in thi... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
In common parlance, disability is a value-laden, stereotyping term that categorizes people according to their impairments. People who have reducedability to perform expected activities —that is, those who are said to have "disabilities" —are often viewed as permanently sick. Such a perception deprives many people with ... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
with society as a whole. The perceptions of the public and the willingness of society to accommodate the specific needs of people with disabilities oftendetermine whether those individuals can carry out their chosen roles in life andbe productive members of society, or whether their conditions becomedisabilities. PUBLI... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
collisions. These also lend themselves to focused prevention strategies, such as seat belt laws and passive restraints, stringent drunk-driving laws andenforcement, and educational programs to encourage bicyclists to wear helmets. The obvious target population is teenagers and young adults, for whom trafficinjuries are... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
promotion helps people develop lifestyles to maintain and enhance their well-being through both community and individual measures. Disease preventionprotects people from the consequences of a threat to health, such as a disease orenvironmental hazard (U. S. Department of Health, Education, and Welfare,1979). Chronic il... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
67 chronic health conditions or groups of health conditions, mental health conditions ranked as the ninth leading cause of activity limitation (La Plante,1989a). Moreover, depression and other mental health conditions are criticallyimportant determinants of the progression to physical disability, a point notedthroughou... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
2 Magnitude and Dimensions of Disability in the United States Disability is a serious public health and social issue in the United States. About 35 million Americans experience activity limitations owing to chronic health problems or impairments, and many of them are deprived economically and socially because of these ... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
Research Council, 1990). As defined and described throughout this report, much of "disability" is a social issue, going beyond biological or functionallimitations and relating to people's ability to perform their expected social roles. This chapter, however, attempts to avoid the debate about how disability shouldbe de... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
one such as arthritis or heart disease that would normally continue for at least three months. Respondents who have more than one limiting condition areasked to identify one of them as the main cause of their limitation. Identificationof these causes depends on the respondents' understanding of their conditions,their p... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
For adults, the degree of functional limitation was based on ability to perform activities of daily living (ADLs),1 three of the standard instrumental activities of daily living (IADLs)2 (Katz, 1983), and six other sensory and physical functions. Individuals needing assistance with ADLs were the mostseverely limited, f... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
IADLs, the presence of specific health impairments, and the respondents' work histories and disability benefits. The SOA also served as the baseline of alongitudinal study, the Longitudinal Study of Aging (LSOA), intended to studythe impact of changes in functional status and living arrangements oninstitutionalization.... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
definition of major activity from work to activities of daily living. Another factor in this pattern is that older people are more likely to reside in nursinghomes and similar institutional facilities. Because nursing home residents tendto have more severe activity limitations, adding in the institutionalizedpopulation... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
FIGURE 2-2 Prevalence of activity limitation due to chronic conditions, by degree of limitation and family income, 1988. Source: National Center for Health Statistics, 1990a. Activity limitation is substantially more prevalent among people with lower family incomes, as Figure 2-2 shows. The prevalence of activity limit... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
In general, people with activity limitations are substantially older and poorer than those without limitations. With regard to age, 32 percent of peoplewith activity limitation are over 65, compared with 9 percent of people withoutlimitations. Only 10 percent of the population with activity limitations are under18, com... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
TABLE 2-1 Alternative Estimates of Functional and Activity Limitation by Age: United States Survey Under 18 18-44 45-64 65 and Over Numbers (in thousands) Activity limitation National Health Interview Survey (1985)3,221 8,391 10,405 10,709 ICD-Louis Harris (1985) — 8,800a10,200 8,000 Functional limitation Survey of Inc... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
TABLE 2-2 Alternative Estimates of Work Limitation Among Persons Ages 18 to 64: United States Survey Any Work Limit Unable to Work Numbers (in thousands) National Health Interview Survey (1983-85) 14,347 7,785Survey of Income and Program Participation (1984)17,950 8,025 Current Population Survey (1985)a13,336 6,893 Dis... | Disability in America Toward a National Agenda for Prevention etc. Z-Library.pdf |
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