摘要：Disability is an emerging field within public health; people with significant disabilities account for more than 12% of the US population. Disparity status for this group would allow federal and state governments to actively work to reduce inequities. We summarize the evidence and recommend that observed differences are sufficient to meet the criteria for health disparities: population-level differences in health outcomes that are related to a history of wide-ranging disadvantages, which are avoidable and not primarily caused by the underlying disability. We recommend future research and policy directions to address health inequities for individuals with disabilities; these include improved access to health care and human services, increased data to support decision-making, strengthened health and human services workforce capacity, explicit inclusion of disability in public health programs, and increased emergency preparedness. People with disabilities have largely been unrecognized as a population for public health attention, but recent efforts have made the poor health of this population visible. 1 Adults with disabilities are 4 times more likely to report their health to be fair or poor than people with no disabilities (40.3% vs 9.9%). 2 The core mission of public health, which is to improve the health of all populations, 3,4 is increasingly framed in terms of health disparities or health inequities. Across the multiple definitions of health disparities and inequities, 5–8 there is general agreement that health disparities refer to differences in health outcomes at the population level, that these differences are linked to a history of social, economic, or environmental disadvantages, and that these differences are regarded as avoidable. The World Health Organization (WHO) differentiates avoidable and unjust health inequities from the broader category of health inequalities, which include both inequities and unavoidable differences. Comparable terms in the United States are health disparities, which refer to avoidable and unjust differentials, and health differences, which refer to avoidable and unavoidable causes. Within a disability context, determining disparities is complex, in that it requires considering which observed differences in health status are avoidable, and which may be unavoidable because they relate directly to the underlying health condition that led to the disability. In this article, we summarize the available evidence on health differences and disparities and recommend that people with disabilities be considered a health disparity population. Race/ethnic health differences are recognized as inequities in health care and health outcomes, leading to recent concerted federal efforts to reduce these disparities. 9 Similar recognition, however, has been lacking for disability-related health differences. Without such recognition and active measures to improve their health, people with disabilities are likely to be at risk for increasingly disparate health outcomes. As a consequence, public health will carry an unnecessary burden in poor health and high health care costs. We examine whether the disability population experiences health disparities by: defining this population, describing its history of discrimination and exclusion, documenting the population-level differences in health outcomes, demonstrating that at least some of these differences are preventable, and recommending public health actions to reduce disability-related disparities.
