Disability in America: Toward a National Agenda for Prevention : Summary and Recommendations (1991)

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Summary and Recommendations Disability is an issue that affects every individual, community, neighbor- hood, and family in the United States. It is more than a medical issue; it is a costly social, public health, and moral issue. • About 35 million Americans (one in every seven) have disabling conditions that interfere with their life activities. • More than 9 million people have physical or mental conditions that keep them from being able to work, attend school, or maintain a household. • More than half of the 4-year increase in life expectancy between 1970 and 1987 is accounted for by time spent with activity limitations. • Disabilities are disproportionately represented among minorities, the elderly, and lower socioeconomic populations. • Of the current 75-year life expectancy, a newborn can be expected to experience an average of 13 years with an activity limitation. • Annual disability-related costs to the nation total more than $170 bil- lion. Disability is the expression of a physical or mental limitation in a social context—the gap between a person's capabilities and the demands of the environment. People with such functional limitations are not inherently disabled, that is, incapable of carrying out their personal, familial, and so- cial responsibilities. It is the interaction of their physical or mental limita- tions with social and environmental factors that determines whether they have a disability. Most disability is thus preventable, which will not only significantly improve the quality of life for millions of Americans but also could save many billions of dollars in costs resulting from dependence, lost productivity, and medical care. The pattern of conditions that cause disability is complex and difficult to

2 DISABILITY IN AMERICA summarize. For young adults, mobility limitations such as those caused by spinal cord injuries, orthopedic impairments, and paralysis are the most common causes. For middle-aged and older adults, chronic diseases, espe- cially heart and circulatory problems, predominate as causes of limitation. Figure 1 shows the age-specific prevalence rates for activity limitation ac- cording to five groups of causes; Figure 2 shows the proportion in each age group ascribed to each of the groups of conditions. Modern medicine's success in averting the death of many people who sustain life-threatening diseases and injuries often entails, as a consequence, the loss of at least some functional capacity. Indeed, the successful life- saving techniques of modern medicine are adding to the population of people with disabilities. For example, in the 1950s, only people with low-level paraplegia were generally expected to survive; today, even people with high-level quadriplegia are surviving and living lives of high quality. Indeed, one commentator has characterized the growing numbers of people with chronic conditions as the "failures of successes" achieved with medical technology. To help these individuals restore functional capacity, avert 600 500 400 300 200 100 Rate per 1,000 Conditions: I I Intellectual limitation I I Sensory limitation ^i::::i| Chronic diseases Hi Mobility limitation • Other < 18 18-44 45-69 70-84 Age group 85+ Figure 1. Prevalence of main causes of activity limitation, by age, 1983-1985. Source: Calculated from LaPlante, 1988.

SUMMARY AND RECOMMENDATIONS Percent with condition 100 h 75 50 25 Conditions: I I Intellectual limitation I I Sensory limitation iiiiiiiiii Chronic diseases 1H Mobility limitation •• Other < 18 18-44 45-69 70-84 Age group Figure 2. Percentage distribution of main causes of activity limitation, by age, 1983-1985. Source: Calculated from LaPlante, 1988. further deterioration in functioning, and maintain or improve their quality of life, it is important to foster programs that emphasize rehabilitation and the prevention of secondary conditions. Partly for this reason the commit- tee focused its report on prevention strategies for people who already have potentially disabling conditions, that is, on secondary and tertiary levels of prevention. In other words: • What can be done to prevent an impairment or functional limitation that results from injury, a birth defect, or chronic disease from becoming a disability? • What are the risks for developing a disability (or secondary condition), and how can they be controlled? • How is quality of life affected by disabling conditions, and what can be done to improve it? Good disability prevention strategies must be built on strong basic knowledge of the relationships between risk factors, disabling conditions, quality of life, and secondary conditions. Until now, approaches to the prevention of