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The United States has long judged the success of its efforts to improve the health of its citizens on the basis of mortality statistics. Gains in human longevity, however, have been accompanied by increases in the incidence and prevalence of disabling conditions. At this point in the evolution of the nation's health care system, emphasis has begun to shift from the quantity of life to the quality of life. As a result, attention is now being focused not only on the prevention and treatment of disease and injury but also on rehabilitation and health promotion for people with disabling conditions.
The population of people with disabilities is sizable in the United States—49 million Americans or about one of every seven citizens has some type of disabling condition. Approximately one third of these people have a disabling condition so severe that they are unable to carry out the major activities of their age group, such as attending school, working, or providing self-care. About another third are restricted in their major activities, and the remaining third are limited in other types of activities. In 1992, about one quarter of all disabling conditions stemmed from impairments such as sensory impairments, paralysis, or mental retardation, and the remaining three quarters were due to diseases or disorders such as emphysema, heart disease, or arthritis.
The economic costs associated with disability are enormous. Expressed in 1994 terms, the medical care expenditures (direct costs) amount to approximately $160 billion, and the indirect costs (lost productivity) amount to approximately $155 billion, for a grand total of over $300 billion annually—more than 4 percent of the gross domestic product. Cost savings, as well as clinical benefit, however, are clearly associated with early, aggressive intervention, vigilant and knowledgeable monitoring of chronic conditions, and appropriate use of assistive technology.
With a clear understanding of the importance of effective rehabilitation and an appreciation of the advances in rehabilitation science, Senator Dole (1995) stated the following in requesting an Institute of Medicine (IOM) study of federal programs in rehabilitation research:
Advances in rehabilitation science are essential to realizing the Nation's commitment to equal opportunity, economic self-sufficiency, and full participation of Americans with disabilities. There are important questions of the adequacy of Federal efforts in both meeting the needs of the rapidly growing number of Americans with disabilities, and in realizing the new opportunities of science and technology on behalf of people with disabilities. The committee believes an independent assessment of the current Federal efforts in rehabilitation science and engineering is warranted and requests that the Secretary [of Health and Human Services] make appropriate arrangements with the Institute of Medicine ... to undertake such a review.