North Carolina

Since 1994, the North Carolina Office on Disability and Health (NCODH) has been organized as a partnership initiative between the Women’s and Children’s Health Section, Division of Public Health and the FPG Child Development Institute at the University of North Carolina at Chapel Hill. With funds from the Centers for Disease Control and Prevention, the North Carolina Office on Disability and Health works to promote the health and wellness of persons with disabilities, and eliminate health disparities between people with and without disabilities in North Carolina.

The North Carolina Strategic Plan for Health Promotion for Persons with Disabilities: 2003-2008 was developed through the Advisory Committee on Disability and Health (ACDH) and forms the foundation for health promotion for persons with disabilities in North Carolina. The architects of this plan, the Advisory Committee on Disability and Health, embodies the collaborative relationships the NCODH has established with individuals with disabilities, state agencies and community organizations that provide services and advocacy for persons with disabilities. This plan is the second in a series and builds on the earlier work, the North Carolina Plan for Prevention of Secondary Conditions Experienced by Persons with Disabilities: 1997-2002. The Plan will be used to mobilize individuals with disabilities, health providers, and the public-at-large to recognize that persons with disabilities can and do benefit from health promotion opportunities.

Measurable health objectives for the nation are established every decade in a process known as "Healthy People." Healthy People 2010 defines health promotion among persons with disabilities as "Efforts to create healthy lifestyles and a healthy environment to prevent medical and other secondary conditions, such as teaching people how to address their health care needs and increasing opportunities to participate in usual life activities." The Advisory Committee on Health and Disability endorses a similar definition of health promotion, while increasing access to needed health services and improving community environments for people with disabilities.

After much discussion and consultation with persons with disabilities and experts in the field of health and wellness for person with disabilities, the Advisory Committee elected to focus the NC Strategic Plan on the following areas: health promotion and wellness, access to health care, information and resources, and data and surveillance. The plan reflects recommendations from the full Advisory Group as well as its workgroups.

Data indicates that approximately 20 percent of Americans, or about 54 million people, experience an activity limitation due to an impairment or health condition. North Carolina data is consistent with national estimates. The 1998 and 1999 North Carolina Behavioral Risk Factor Surveillance System indicated that 21% of non-institutionalized adults experience activity limitation as a result of a health condition and/or perceive themselves to be a person with a disability. In another study based on the National Health Interview Survey 20.5% of North Carolina children aged 3-17 reported having one or more special needs (disability or chronic health condition). Overall, Americans are living longer, which has contributed to persons with disabilities and chronic conditions becoming one of the largest and fastest growing minority groups in America.

Disability has historically been equated with inferior health status, with the assumption that since the health status of individuals with disabilities is poor they cannot benefit from health promotion or protective practices. As a result, generally accepted health promotion / interventions, such as encouraging physical activity and good nutrition, or mammography, prostate or other cancer screening, are often not considered, offered, or made accessible to persons with disabilities.

Until recently, the variety of diagnoses or conditions that cause activity limitation has prompted both the medical profession and advocates to concentrate on condition-specific issues. However, current models suggest that persons, regardless of diagnosis, who experience similar activity limitations share common risks for additional complications, known as secondary conditions. For example, persons who are wheelchair users are at increased risk for developing pressure sores, whether they are diagnosed with spinal cord injury or cerebral palsy. Many secondary conditions can be prevented by applying known interventions.

Because this initiative is led by the state’s health agency, recommendations tend to focus on health care and health-related behaviors. This is not to diminish the impact of other social issues, such as transportation, employment and communication barriers for persons with disabilities, but rather to build an initiative in which the lead agency leverages its unique potential to impact the direction and outcome of activities.

The plan outlines objectives in four areas, health promotion and wellness, access to care, information and community support, and research and surveillance. This plan also details the activities to be initiated in the next six years. While the emphasis is on health and wellness, the impact of the social and physical environment will be addressed in all activities supported by the office. The activities outlined in this plan are consistent with and were developed in consort with the NC Health Objectives for 2010.

The objectives and their related activities vary considerably in breadth and specificity. The extent of progress toward goals may depend on the potential for collaboration among various players to identify resources and strategies that facilitate the conduct of proposed activities.

Because minority racial and ethnic minority groups are often at higher risk for disabilities, modifications in the focus and design of programmatic efforts will be made as appropriate. Such adjustments may include increased attention to broader risk factors such as poverty, unemployment, and discrimination.

The North Carolina Plan for Promoting the Health of People with Disabilities: 2003 - 2008 will be revisited annually to review progress and adjust priorities. An annual progress report will provide a description of performance in meeting plan recommendations as well as outline objectives and timeframes for the upcoming year.

In order to put this plan into action, the Advisory Committee on Disability and Health has been restructured into task-oriented work groups to assist in the design and implementation of interventions for each priority recommendation. The NCODH will provide the staff support to convene each work group, and will share the progress of each team with all members of the work groups and other interested parties. A full meeting of the Advisory Committee on Disability and Health will be held annually to share successes and discuss strategies to overcome identified barriers. An executive committee consisting of NC Office on Disability and Health staff and chairpersons of the Physical Activity Workgroup, the Task Force on Women’s Health and Disability, and the Health Access Task Force will provide ongoing guidance.

It is well documented that attention to diet and exercise can reduce the risk of osteoporosis, obesity, heart disease, arthritis, diabetes, high blood pressure and cholesterol in the general population. It is also recognized that routine exercise is associated with less depression and anxiety and improved mental outlook. Many people with disabilities have health profiles similar to that of the general population and are at risk for developing these chronic conditions.

Health promotion is the process of enabling people to increase control over and to improve their health. Health promotion programs can help people develop lifestyles or behaviors to maintain and enhance their well-being in areas such as physical activity and nutrition, preventive health, and injury prevention. Many of the health promotion programs that are in place in the community and clinical setting for the general population can include or be modified to be inclusive of and responsive to persons with disabilities.

Attention should be given to the accessibility of community health and fitness services. Recreation programs, school systems and fitness gyms need to be prepared to meet individual needs in an informed manner. Providing physical and communication access, adaptive equipment and programmatic accommodations will support the participation of many individuals who might not otherwise participate in wellness activities. In general programmatic application and equipment which promote participation of persons with disabilities also benefit a wide segment of the population who are aging or have a chronic disease.

People with disabilities cannot adequately address their situational needs without knowledge of their options. Increasingly, information on federal, state and community services and resources on ADA, accessibility, health promotion, assistive technology and home and community support are available to persons with disabilities and their families. However, accessing this information can be challenging. Having materials and resources that are accessible or available in alternative formats facilitates the inclusion of people with disabilities and enhances communication and understanding. Educational sessions, conferences, and meetings that are truly accessible will increase the interaction and participation of persons with disabilities. Health promotion information that reflects the commonalties of experience across disability, chronic disease, and aging can be applicable and appropriate to the needs of broad groups of individuals.

Living with developmental or acquired disability is often accompanied by a cycle of lifestage and transition issues. An example is the need to find new sources of social supports and services as a young adult moves from school to work and living independently in the community. Another example is the change in abilities and needs inherent in the dynamic process of aging and living with a disability or experiencing an acquired disability. Because persons with disabilities constitute a minority group which typically does not transmit culture from generation to generation via family, it is important for people to have contact with others who have similar life experiences and who can help them address current needs and anticipate solutions to future ones. This kind of peer support may also have a positive effect on the mental health and well being of persons with disabilities.

Data serves as the foundation for public health action. It informs the design, monitoring, and evaluation of intervention strategies. Efforts to collect information should integrate with existing surveys and data collection projects to ensure inclusion of persons with disabilities and disability as a demographic variable. Emphasis should be on data that has application for state and local health promotion, planning, intervention, program evaluation, resource allocation and reporting. The data will assist government policymakers, advocates, researchers, and providers to make better informed choices to promote the health status and well being of people with disabilities.