defined, disability is not an inherent attribute of the individual but, rather, is the result of the interaction of the individual with the environment, including social norms. Also, as described in Chapter 2, the International Classification of Functioning, Health and Disability (ICF) (WHO, 2001) stresses this interaction.

Over several decades, legislative and regulatory changes as well as technological innovations, advances in biomedicine, and shifts in attitudes about disability have helped to reduce or mitigate some kinds of environmental barriers. To cite a few examples of the environmental progress that has been made since the 1991 IOM report was published, technological advances and telecommunications regulations have made it easier for people with vision, hearing, and other impairments to communicate electronically with clients, coworkers, friends, family, and others, although keeping pace with product innovation and building in access from the outset are significant policy challenges (see Appendix F). Getting around the community and traveling beyond it are becoming easier for many people with disabilities because of the barrier removal and accessibility requirements of the Americans with Disabilities Act (ADA) and other policies—notwithstanding continuing problems with compliance, enforcement, and financing and the need for more research to evaluate the effectiveness of policies (GAO, 1993, 1994a; NCD, 2000c, 2001; Harrison, 2002; see also Appendix G).

In addition to the removal of barriers, interest is growing in strategies of universal and accessible design. The goal for these strategies is to create—from the outset—physical environments and products that are easily used and accessible to as wide a range of potential users as practicable. The aging of the baby boom generation is one force driving greater attention to transgenerational design, including the design of attractive, broadly accessible housing and public spaces (see, e.g., Pirkl [1994], Luscombe [2003], and the AARP web page at In general, the more that universal design principles are applied to products, services, and environments, the less the need for assistive or adaptive technologies will be, although the latter will continue to be necessary for many tasks and environments.

Despite progress in barrier removal and advancements in universal design-based practices, significant environmental barriers remain, sometimes in places where one would not expect them, for example, hospitals and physicians’ offices that lack buildings, equipment, and services suitable for people with physical mobility, sensory, and other impairments. The persistence of such environmental barriers will only become more serious as the number of people at the highest risk of disability grows substantially in coming decades. Still, growing numbers should mean a larger market for accessible products and an increasing demand for accessible environments.

Part of the charge to the IOM included examination of the role of assis-

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