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Disability in America: Toward a National Agenda for Prevention
Critique of the Report
The agenda suggested in the majority report is composed primarily of vague slogans (e.g., "enhance the role of the private sector," "critically assess progress") and calls for more research, training, education, data collection, and coordination. Only 7 of the 27 recommendations (nos. 16 through 22) would provide services directly to people who could benefit from them, or would directly prevent disability. The remaining recommendations call for more bureaucracy, more training programs, and more jobs for educated, middle-class, mostly nondisabled people.
The report fails to set an agenda or even to suggest how policymakers might go about setting one. It merely provides a long list of things that could be done, without any indication of the relative importance of the various disabilities or the relative effectiveness of the various prevention measures, or any discussion of how policymakers ought to think about evaluating these questions. The "conceptual model" of disability developed in the report (a model that has been around since 1969) is useless as a policy tool. It provides no guidance for setting priorities among the items in the "wish list" of new research, data collection, training, and services that the committee recommends, nor does it suggest any criteria for setting priorities among the many types of disabilities discussed in the report.
Although the report pays lip service in many places to social, cultural, physical, and legal barriers as causes of disability, there is no analysis of any of these factors in the report. Important topics that are neglected in the report include the following:
Handicap discrimination is now a major legal field, with federal and state statutes, a sizable body of case law, and scholarly studies of the nature and impact of discrimination as well as the usefulness and limitations of civil rights remedies. The report makes brief mention of the Americans with Disabilities Act but provides no analysis of how and to what extent job market barriers prevent people with impairments from working. Apart from recommendation 26, which calls only for educating the public about the civil rights of the disabled, not one of the recommendations deals with discrimination, or with defining, enforcing, or funding the enforcement of civil rights.
Although many statements in the body of the report recognize the importance of access to medical care in preventing disability, the only recommendation to deal with this problem (no. 16) calls for comprehensive health services for mothers and children. A recommendation for universal health insurance that had been in earlier drafts was dropped from the final report. No recommendation deals with access to health insurance for people with chronic disease and disabilities, despite the acknowledged severity of this problem in Chapter 8.