of current approaches in the wide variety of situations in which disability occurs. All areas of prevention require critical evaluations of the effectiveness of the tools and methods used in the prevention of disability and secondary conditions.

The federal government spends about $60 billion annually for medical coverage and to supplement the incomes of people with disabilities; it spends a relatively small amount on research to identify practices and technologies that can prevent the initial occurrence of disability or limit complications among people with disabilities to help them lead more productive lives. Moreover, the federal funding agencies that support biomedical research have not made prevention a high priority, and there has been little effort devoted to developing research programs on the prevention of disability and secondary conditions.

RECOMMENDATION 14: Expand research on preventive and therapeutic interventions

Research on the costs, effectiveness, and outcomes of preventive and therapeutic interventions should be expanded. The expanded research program should also include acute care services, rehabilitative and habilitative services and technologies, and longitudinal programs of care and interventions to prevent secondary conditions. The National Institute on Disability and Rehabilitation Research, the Department of Veterans Affairs, the National Institutes of Health, the Alcohol, Drug Abuse, and Mental Health Administration, and the Agency for Health Care Policy and Research should join with CDC to develop cooperative and collaborative research programs in the biological, behavioral, and social sciences as they relate to disability prevention. These programs should also emphasize the translation of new findings into national prevention efforts that inform and educate people with disabilities, their families, personal attendants, and advocates, as well as clinical practitioners. Consideration should be given to approaches used in other countries (e.g., the Netherlands, Sweden, England, and France), where disability prevention is viewed from a broad perspective that includes social and ethical implications and socioeconomic costs.

Access to Care and Preventive Services

Many persons with disabilities are not covered by Medicare or Medicaid and have little access to private coverage because they either are unemployed or have been rejected for insurance because of their disabilities. Thus the problem of access to care is even greater for people with disabilities than for the general American population. Moreover, persons with disabilities and those at risk of disability are disproportionately poor, making



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