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Disability in America: Toward a National Agenda for Prevention
The report makes no assessment of major national efforts in adapting buildings and public transit for accessibility. (Four sentences in Chapter 4 assert that adaptive devices and environmental modifications are useful and essential components of a prevention program.)
There is no analysis of occupational causes of disability, although they are known to be important factors in injury and some chronic disease. The major national effort to prevent occupationally caused disabilities (the Occupational Health and Safety Act, in place since 1973) is ignored in the report.
There is also a major national effort to prevent what might be called secondary learning disabilities, in the form of the Education for All Handicapped Children's Act and the early intervention program added in the 1986 amendments to that law. The aim of these programs is to ensure that children with physical, developmental, and emotional deficits receive whatever services are necessary for them to derive maximum benefit from their education and to prevent their being handicapped later on in social, intellectual, and vocational skills. These two programs merit half a page in Chapter 4. The report neither evaluates the experience of these programs nor considers how to make better use of them to prevent disability.
Within the area of injury control, automobile safety programs, various methods to curtail drunk-driving, and gun control measures are extremely important aspects of disability prevention. Although the report mentions these measures, it does not examine the large empirical literatures relevant to them. Nor does the report simply recommend that programs be instituted in these areas, although, as I show below, the committee makes recommendations for major national programs in other, less controversial areas (research, education, and training) without examining the empirical evidence of need or effectiveness.
The report neglects (except for some cursory mentions with intense obfuscation) prenatal genetic testing, mass screening for genetic defects, and abortion of affected fetuses. I take up this topic in more detail below because it is the issue that most clearly revealed the politicization of the committee's deliberative process.
Bland as the recommendations are, there is still a puzzling disparity between the body of the report and its recommendations. Most of the report is concerned with epidemiological and clinical information of the sort that would be useful in designing primary prevention programs (i.e., preventing disability before it happens). Most of the recommendations, on the other hand, are aimed not at primary prevention but at developing the "infrastructure" for a prevention policy—that is, data bases, research programs, training programs to develop manpower, government leadership programs, and coordinating agencies.
The decision to focus the recommendations on infrastructure instead of