Copy - Disabilities Timeline

Disability Healthcare & Stigmas: A Historic Perspective

Rachel Cotsoradis, Polan Santos, Keshawnna McCallum, Lauryn Smith, Emily Nesemeier, Kerel Gerard

General Description of Disabilities in Healthcare

Our timeline begins in the 1800’s and ends in the 21st century. The purpose of this timeline is to establish a reputable record of history that will consist of various crucial events that reflect the evolution of disability in healthcare and the persistent stigma faced by these special populations.The historical context of disability in healthcare is essential to understanding the disparities that these populations face. Over the years, pivotal legislation and societal shifts have aimed to protect the rights of individuals with disabilities and improve their access to healthcare services. However, this specialized population is scrutinized and remains at risk for dangerous and harmful behaviors by others. Research indicates that individuals with disabilities often encounter negative biases from healthcare providers, which can lead to inadequate treatment and poorer health outcomes (Iezzoni, 2011). Moreover, the recent pandemic has showed that existing inequities among people with disabilities, are exposing critical gaps in America's healthcare systems.While the timeline ends in the 21st century, challenges and stigmas toward individuals with disabilities will continue, even if it is only on a small scale. By examining key events in this timeline, we aim to illuminate the progress made and the ongoing challenges in achieving equitable healthcare for all individuals despite any disability that may impact or affect their quality of life.

Disability Healthcare & Stigmas: A Historic Perspective

1999

1982

1960

1914-1918

1800's

1990

1965

1940-1950

1882

1973

1975

1988

Disability Healthcare & Stigmas: A Historic Perspective

2024

2017

2023

2016

2020

2022

2008

2001

2013

2010

Stigmas & Healthcare: The Impact Disabilities Have

Populations with disabilities are often an example of many populations who suffer from limited access to healthcare. These populations often experience:

• Denial or delayed care based on their disability
• Substandard care: Many healthcare professionals don’t view or respect individuals with disabilities as they would those without.
• Physician bias: Doctors may have their own preconceived notions and opinions of the said person’s treatment, which leads to a poor rapport and an unsafe environment for the patient.
• Referral to other providers: Doctors may refer disabled patients to physicians who specialize in the specific disability. For example, a doctor who treats diabetes in patients with down syndrome.
• Emotional trauma for those with disabilities given that they have to switch providers, are not taken seriously, are not as respected, etc.

References

Centers for Disease Control and Prevention. (2024, July). Disability and Health Data System (DHDS). https://www.cdc.gov/ncbddd/disabilityandhealth/features/COVID-19-and-disabilities.htmlLezzoni, L. I. (2011). Eliminating health and health care disparities among the growing population of people with disabilities. Health Affairs, 30(10), 1937-1944. https://doi.org/10.1377/hlthaff.2011.0611 Lau, D. T., & Sosa, P. (2022). Disparate impact of the COVID-19 pandemic and health equity data gaps. American Journal of Public Health, 112(10), 1404–1406.https://doi.org/10.2105/AJPH.2022.307052National Council on Disability. (2023). Framework to end health disparities of people with disabilities. ncd-framework-to-end-health-disparities-of-people-with-disabilities.pdfNational Institutes of Health. (September 26, 2023). NIH designates people with disabilities as a population with health disparities. News Releases. https://www.nih.gov/news-events/news-releases/nih-designates-people-disabilities-population-health-disparitiesNyblade, L., Stockton, M.A., Giger, K. et al. Stigma in health facilities: why it matters and how we can change it. BMC Med 17, 25 (2019). https://doi.org/10.1186/s12916-019-1256-2United States Census Bureau. (2023). DP02 | Selected Social Characteristics in the United States. https://data.census.gov/table?q=DP02World Health Organization. (March 7, 2023). Disability. https://www.who.int/news-room/fact-sheets/detail/disability-and health#:~:text=Structural%20factors:%20Persons%20with%20disabilities,are%20mostly%20women%20and%20girls).

Executive Order on Advancing EquityPresident Joe Biden signed an executive order that directed federal agencies to address systemic racism and health disparities, including those affecting people with disabilities. The executive order emphasized the need for equity across all sectors, including healthcare.

HHS Health Disparities ReportAcknowledged disability as a major health disparity.

Olmstead v. L.C. Supreme Court RulingThe U.S. Supreme Court ruled that unjustified segregation of people with disabilities constitutes discrimination under the ADA. This ruling reinforced the right of people with disabilities to live in the community rather than be institutionalized.

NIH Designates Disability as a Health DisparityOfficially recognized disability as a health disparity, leading to more research, funding, and policy change.

President Franklin Delano Roosevelt, the first president with a disability was born and was pivotal in becoming an advocate for the rehabilitation of people with disabilities.

President Franklin D. Roosevelt

Social Security Act of 1965The Social Security Act was amended to create Supplemental Security Income (SSI), which helped people with disabilities gain financial support.

Disability Health Data TrackingExpanded federal data collection on health disparities affecting people with disabilities. The increased data collection helped to better understand the scope of health disparities in the disability community.

Disabilities during World War 1The marginalization of people with disabilities continued until World War I when veterans with disabilities expected that the US government provide rehabilitation in exchange for their service to the nation.

NCD Report on Health DisparitiesThe National Council on Disability (NCD) published a 2008 report on healthcare disparities, specifically focused on the health challenges faced by people with disabilities. The report found that people with disabilities face disproportionately high rates of chronic health conditions, such as obesity, diabetes, and cardiovascular disease, and lack equal access to healthcare services.

The Education for All Handicapped Children Act (now IDEA) was passed, mandating public schools to provide free and appropriate education to children with disabilities.

Education for All Handicapped Children Act

NIH Expands Disability Health ResearchThe National Institutes of Health (NIH) increased its funding and focus on disability health research, particularly through the National Institute on Minority Health and Health Disparities (NIMHD). NIH began prioritizing research on how disabilities intersect with other forms of health disparities, such as race, ethnicity, and socioeconomic status.

The National Council on Disability (NCD) was established to advise the President and Congress on disability policy.

National Council on Disability (NCD)

The Rehabilitation Act was passed giving individuals with disabilities civil rights protection by the law.

The Rehabilitation Act of 1973

Americans With Disabilities Act (ADA) of 1990Prohibited discrimination in healthcare, ensuring accessibility and equal treatment. It was the most significant legislative victory for the disability rights movement. It prohibited discrimination on the basis of disability in all areas of public life, including employment, transportation, public accommodations, and more. The law fundamentally altered the relationship between people with disabilities and the larger society, framing disability as a civil rights issue.

NIDILRR Report on Disability and Health ResearchCalled for more research on disability-related health disparities.

Advocacy for the Americans with Disabilities Act (ADA) gained ground, with the disability community pushing for federal protection from discrimination.

Americans with Disabilities Act (ADA)

Classification of DisabilitiesThe International Classification of Functioning, Disability and Health was developed and approved by the World Health Organization to describe and organize information about functioning and disabilities. Intended to shift provider attitudes and behaviors towards people with disabilities.

Affordable Care Act (ACA)Expanded healthcare access and prohibited discrimination based on pre-existing conditions.

The expansion of the Civil Rights Movement influenced disability rights activists. The growing push for equality, justice, and access for racial minorities and women provided a model for the disability rights movement.

Civil Rights Movement

Continued Focus on Disability and Health DisparitiesFollowing the NIH’s 2023 designation of disability as a health disparity, further efforts are expected to strengthen the integration of disability into public health research and policy. Key areas for future development include expanding access to healthcare services, improving training for healthcare providers, and addressing barriers to care such as physical accessibility, transportation, and communication for people with disabilities.

The Recognization of DisabilitiesDisabilities were recognized as a medical issue, and people with these issues were stigmatized and marginalized. These people were often institutionalized and sent to asylums.

Rise of Disability Advocacy and Early Legal ProtectionsIncreased awareness of disability through veterans’ organizations and the rehabilitation movement, which promoted the idea of vocational training and rehabilitation.