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Women, Disability, and Health Care Reform

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Department of Physical Medicine and Rehabilitation. Baylor College of Medicine. Topics ... Baylor College of Medicine. 1475 West Gray, Suite 165. Houston, TX 77019 ... – PowerPoint PPT presentation

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Title: Women, Disability, and Health Care Reform


1
Women, Disability, and Health Care Reform
  • Margaret A. Nosek, PhDExecutive DirectorCenter
    for Research on Women with DisabilitiesProfessor
    Department of Physical Medicine and
    RehabilitationBaylor College of Medicine

2
Topics
  • Why women with disabilities constitute a health
    disparities populationand why nobody
    acknowledges that
  • Current and upcoming characteristics of the
    population of women with disabilities
  • Disability-related health disparities
  • Training women with disabilities to be advocates
    for health care reform

3
Background
  • Health-care reform debate is escalating in volume
    and importance as the presidential elections of
    2008 approach.
  • The voice of women with disabilities in this
    debate is particularly important but has not been
    heard to date.
  • Evidence that this rapidly growing population
    experiences significant health and healthcare
    disparities.
  • By incorporating requirements in health care
    reform that address their needs, the needs of the
    rest of the United States population will also be
    met.

4
Robert Wood Johnson Foundation
  • Awarded 12 grants through its Community Catalyst
    program to promote grassroots organizing around
    this issue at the state level
  • Each was asked if they are currently receiving
    input about the intersection of women's issues
    and disability issues in health care reform
  • Four responded--they had not heard specifically
    about health care and women with disabilities
  • This omission has two causes
  • organizations involved in health care reform are
    not aware of the critically important concerns of
    women with disabilities
  • there is no organized cadre of women with
    disabilities trained as advocates for health care
    reform

5
Why Women with Disabilities Constitute a Health
Disparities Population
6
Majority of literature examines disability as a
consequence of disparity factors
Disability is only mentioned in terms of its
detection, diagnosis, prevention, treatment, or
efforts to delay its onset or progression as it
contributes to health disparities
income
location
sexual orientation
gender
education
race
ethnicity
income
7
What are disability-related health disparities?
People with disabilities constitute an
unrecognized minority population that faces
many health disparities
Prevalence of common health conditions Access to
health care Access to preventive health
services Treatment in health care settings
Access to health information Inclusion in
health-related research
8
Current and Upcoming Characteristics of the
Population of Women with Disabilities
9
U.S. Women (132 million)2000 U.S. Census
24-25 have disabilities
10
Disabling Conditions in Women
11
Disability in Women by Age
12
Status of Women with Disabilities
  • Compared to women in general, women with physical
    disabilities are significantly more likely to
  • Be single
  • Have less than a high school education
  • Be unemployed
  • Live in poverty
  • Have inadequate access to health care
  • Many are too disabled to work but not disabled
    enough to obtain benefits

13
Disability-related Health Disparity 1
Prevalence of Common Health Conditions
14
Health Disparities Faced by Women with Physical
Disabilities
  • 6 times more likely to have depression
  • 5 times more likely to have diabetes
  • 5 times more likely to have osteoporosis
  • more than twice as likely to be obese
  • almost 2 times more likely to have high blood
    pressure

15
Disability-related Health Disparity 2Access to
Health Care
16
Health Care Disparities Faced by Women with
Physical Disabilities
  • 7 times more likely to be unable to access care
  • 4 times more likely to have a specialist as their
    usual source of care
  • 3 times more likely to delay care due to cost
  • more likely to have difficulty obtaining
  • mental health care
  • eyeglasses
  • dental care
  • prescriptions
  • less likely to have private insurance

17
Removing Barriers
  • Implement the accessibility and equal opportunity
    provisions of the Americans with Disabilities Act
  • Equal access to services in the most integrated
    setting
  • Nondiscrimination
  • Ideal physicians office
  • Hallways and exam rooms able to accommodate
    people in wheelchairs
  • Adjustable height, extra wide, padded examination
    tables
  • Platform scale
  • Staff trained to assist with transfers and
    dressing
  • Written materials available in alternative formats

18
Consequences of Barriers To Care
  • Inappropriate use of specialists for primary care
  • Transition problems from pediatric to adult care
    comprehensive care difficult to obtain
  • Inappropriate use of emergency departments for
    preventable problems
  • Low rates of preventive cancer screenings
  • Failure to detect problems that may be obscured
    by disability
  • sexually transmitted infections, pelvic
    inflammatory disease
  • cervical cancer
  • ectopic pregnancy

19
Disability-related Health Disparity 3 Access to
Preventive Health Services
20
Health Promotion Programs
  • Need accessible exercise and recreation
    facilities
  • Need disability-related information for
    appropriate dietary recommendations
  • Need smoking cessation programs that are
    sensitive to disability issues
  • Physicians need to ask about sexual activity and
    health promoting behaviors

21
Cancer Screening
  • Physicians should refer for cancer screening
  • Significant disparities in rates of cervical and
    breast cancer screening for women with physical
    disabilities
  • Single greatest barrier to pelvic exams is the
    lack of elevating exam tables
  • Greatest barriers to mammography
  • Non-adaptable equipment
  • Radiologists uninformed, lack time
  • Physicians dont refer
  • Diagnosis at later stages of cancer

22
Disability-related Health Disparity 4 Treatment
in Healthcare Settings
23
Refusal to Treat
  • Reported by 31 of women with physical
    disabilities in one study
  • Expectation that rehabilitation centers can meet
    all needs
  • Expectation that everyone has access to
    rehabilitation
  • Violation of the Americans with Disabilities Act
  • Physicians unprepared to deal with wellness in
    the context of disability

24
Unfounded and Damaging Assumptions
  • Women with disabilities have no interest in sex
    and are not sexually active
  • Push to hysterectomy
  • Failure to discuss birth control
  • Failure to check for sexually transmitted
    infections
  • She cant feel anyway, so
  • _______(fill in the blank osteoporosis,
    depression) is to be expected and there is
    nothing you can do about it
  • She doesnt walk anyway, so
  • Medicaid wouldnt pay for it anyway

25
Proposed Training Program to Prepare Women with
Disabilities as Advocates for Health Care Reform
26
Design of the Proposed Training Program
  • Internet-based
  • 4 webinars
  • Train women in each of the 12 RWJF grantee states
  • Website and listserv
  • Follow-up technical assistance
  • Training content

27
Women with disabilities as a health disparity
population
  • Disadvantage in obtaining health care coverage
  • Disparities in access to health care
  • Disparities in quality of health care
  • Deficits in knowledge of healthcare providers
  • Healthcare in support of wellness in the context
    of disability

28
Health Care Reform State-of-the-Art
  • Local level
  • State level
  • National level
  • Work with NWLC, Physicians for National Health
    Care, National Womens Health Network, other
    project advisors

29
Advocacy Strategies
  • Stay informed
  • Need for internet-based information resources
  • Listserv
  • Keep up to date on what is happening in your
    state
  • Demand your place at the table
  • Demand answers
  • Organize
  • Educate
  • Use the power of the peer
  • Use the media

30
Center for Research on Women with
DisabilitiesDepartment of Physical Medicine and
RehabilitationBaylor College of Medicine1475
West Gray, Suite 165 Houston, TX 77019 Phone/Fax
713-523-0909 or 713-661-4678mnosek_at_bcm.eduwww.bc
m.edu/crowd
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