Universal Livability: A Dream for Tomorrow, A Plan for Today

Appendices

Appendix A - Definitions

Access:
The usability of a product or service by people with disabilities a; inclusion for all persons, made possible by an environment free of physical and social (e.g., attitudinal, communication) barriers, as required by the federal ADA and other civil rights laws and policies.
Built Environment:
 Constructed rather than natural environment such as homes, schools, workplaces, parks, and roadways.
Disability:
Difficulties in the interaction between the characteristics of persons and the context in which they live. b The difficulties people have doing ordinary things because of a mismatch between their capacities and the demands of their environment. c
Medical Model of Disability: Disability is a characteristic of the person, directly caused by disease, trauma, or other health condition, requiring professional medical care to "fix the person's problem." b
Social Model of Disability: Disability is a socially-created problem and not an attribute of an individual. From this perspective, disability demands a political response, because unaccommodating social and physical environments create the problem. b This model focuses on creating or changing the environment to provide access, free of social and physical barriers, to all people regardless of their functional abilities.
Disabling Condition:
Any physical or mental health condition, including pathology (active disease) as well as impairment (loss of mental, anatomical, or physiological structure or function) that can cause a disability. d
Empowerment training (health-related):
See definition under Section II, Goal 4.
Environmental Intervention:
A public health approach that employs strategies to improve physical and social environments to reduce disability and increase participation and opportunity. Establishing physical and social access is the first step in promoting participation. e
Functional Ability:
Physical, mental, or social ability to carry on the normal activities of life.
Health:
Not just the absence of disease or chronic conditions but maximizing one's physical, social, emotional, spiritual, and intellectual well-being. In this view, most people with disabilities are healthy because they have the ability to function effectively in given environments, meet their needs, and adapt to major stresses. This perspective includes the inter-connected relationship between the persons, the community, and the health and social services system. The desired outcomes of this approach are:
Independence and self-determination in choices, opportunities, and activities;
Experience of physical and emotional well-being; and
Not being held back by pain. f
Health Promotion:
Behaviors and activities (e.g., eating a healthier diet, becoming more physically active, quitting smoking, finding ways to cope with stress) that increase a person's level of well-being and prevent the onset or reduce the effects of secondary conditions for people with disabilities.
Impairment:
Any loss or abnormality of psychological, physiological, or anatomical structure or function. a
Preventive Services:
Services provided by physicians or other licensed health care practitioners within the scope of their practice under state law to:
Prevent disease, disability, and other health conditions or their progression;
Prolong life; and
Promote physical and mental health and efficiency. [Federal definition under Title 42, Code of Federal Regulations 440.130(c)]. Examples include annual physical and screenings such as mammogram, Pap smear, prostate exam, and osteoporosis check.
Primary Care:
Provision of integrated, accessible, health care services by clinicians who address a broad range of personal health care needs, involving a sustained partnership with patients, and practicing in the context of family and community; g medical care provided at the individual's first point of contact with a health care system, except for emergencies. It includes treatment of illness and injury, health promotion and education, identification of persons at high risk, early detection of serious disease, an emphasis on preventive health care, and referral to specialists as appropriate. h
Primary Condition:
An initial "disability-related" medical diagnosis such as spina bifida, cerebral palsy, arthritis, traumatic brain, or spinal cord injury. (See Secondary Conditions.)
Quality of Life:
 A person's perception of their position in life in relation to their goals, expectations, standards, and concerns. Any level of assessment of quality of life of a population as diverse as that of persons with disabilities must recognize that people experience similar circumstances differently and respect that subjective experience. i
Secondary Conditions:
The medical and psychosocial conditions that people with disabilities often experience following the onset of a disabling injury or disease. j For example, pressure sores and pain are secondary conditions common to many people with paralysis. Depression is another secondary effect of disability; people with disabilities are twice as likely to report being sad as those without disabilities. Reduced social participation, emotional support, and ability to work and enjoy recreation are conditions secondary to primary conditions that must be addressed to ensure the highest quality of life for all citizens, regardless of functional limitations. k
The current approach is based on the premise that environmental (e.g., physical and social) factors external to people with disabilities are more limiting to well-being and quality of life than those of a medical nature. For example, a medical secondary condition may cause a person with a mobility impairment to have increased difficulty with basic activities, but it is the lack of access to assistive technology, personal assistance services, social supports, health and wellness activities, and transportation which keeps that person from full participation.
The public health community has recently begun to address the health needs of people with disabilities, especially the consequences of secondary conditions. As a result, public health professionals are beginning to appreciate that secondary conditions are not chance occurrences, but rather preventable and predictable.
Universal Access:
A concept that ensures that facilities, products, services, and information are usable by all people. Everyone, regardless of ability, benefits from universal access. l
Universal Design:
A method of designing information, products, and environments that everyone can use regardless of body dimension, age, or disability status. Employing universal design from the onset prevents the need to retrofit environments and makes objects easier to interact with, for everyone. l
Universal Livability:
The application of universal design to create communities where universal access and design are an integral and seamless part of life that benefit everyone.
  1. Centers for Disease Control and Prevention, Disability and Health Branch, 1997.
  2. Towards a Common Language for Functioning, Disability and Health International Classification of Functioning, World Health Organization, Geneva, 2002.
  3. Enabling America: Assessing the Role of Rehabilitation Science and Engineering, Washington DC: National Academies Press, E. Brandt, A. Pope, 1997.
  4. Vision to Action: A Strategic Plan for Preventing Disabilities in California 1997-2001.
  5. To mitigate, resist or undo: addressing structural influences on the health of urban populations. American Journal of Public Health 90:867-872, AT. Geronimus.
  6. Health and Wellness Among Persons with Disability, a brief from a study entitled — Health Warriors: People with Disabilities Discuss Definitions of and Facilitators and Barriers to Being Healthy and Well, Michelle Putnam, Sarah Greenen, Laurie Powers, Oregon Health and Science University; Marsha Saxton, World Institute on Disability; Sharon Finney and Pamela Dautel from Independent Living Research Utilization.
  7. Medicaid Alabama Primary Medical Provider Agreement, 2003.
  8. Medicaid Montana Agreement, 2003.
  9. North Carolina Plan for Prevention of Secondary Conditions Experienced by Persons with Disabilities 1997-2002.
  10. Research and Training Center on Disabilities in Rural Communities, The University of Montana Rural Institute: A Center for Excellence in Disability Education, Research and Services, August 2003.
  11. Christopher and Dana Reeves Paralysis Center's Website, 2002.
  12. Removing Barriers to Health Care, A Guide for Professionals, and The Center for Universal Design, The North Carolina Office on Disability and Health.

Appendix B - Acknowledgements

We appreciate the individual and collective contributions to this Strategic Plan by our Living Healthy Advisory Committee's Members, Technical Consultants, and staff.

Members

Technical Consultants

DHS Epidemiology and Prevention for Injury Control (EPIC) Branch

Office on Disability and Health

Lisa Hershey, Galatea King, and Roger Trent

EPIC Branch

Alexander Kelter, Claudia Angel, Stacy Alamo-Mixson, Barbara Alberson, Nancy Bagnato, Jennifer Harper, and Pam Shipley

Others

Resources

ODH utilized several documents in developing this Plan, including: Disability in America -Toward a National Agenda for Prevention; Healthy People 2010: Disability and Secondary Conditions, Chapter 6, Vision for the Decade; Vision to Action: Strategic Plan for Injury Prevention and Control in California 1993-1997; A Strategic Plan for Preventing Secondary Conditions in California 1997-2001; North Carolina Plan for Prevention of Secondary Conditions Experienced by Persons with Disabilities1997-2002.