According to the World Health Organization, health promotion is a process of enabling people to increase control over and improve their health by moving beyond a focus on individual behavior to develop a wide range of social and environmental interventions. Health promotion assists governments, communities and individuals to address health challenges through public policy, supportive environments, community action and personal skills. Health promotion addresses health disparities and aims to support people who have traditionally been marginalized in the community. While public health tends to consider disability to be a negative health outcome to be prevented, disability should not lessen rights to health or community access. Research explores factors behind health and disease as well as assesses the efficacy of interventions (Wingood and DiClemente, 2019). As disability is often not considered an identity in public health, however, disability experiences are generally not included in health promotion research. Moreover, interventions that emerge from research are often not accessible nor inclusive of disability. To create structures that are equitable to all members of the public, inclusivity of all identities is key to ensure that health promotion is healing and transformative (Corbin 2016).
With the complexity of public health challenges, marginalization of different identities, such as disability, must be addressed to best support communities as a whole. According to the Centers for Disease Control and Prevention, disability is “any condition of the body or mind (impairment) that makes it more difficult for the person with the condition to do certain activities (activity limitation) and interact with the world around them (participation restrictions).” Disability comes in many forms and impacts people in different ways. As a group, people with disabilities are the largest minority. Every person is likely to become disabled to some degree over the lifespan. Disability impacts health differently for each individual, but as a group, people with disabilities face significant barriers to healthcare. A healthcare access brief from the Disability Rights Education & Defense Fund highlights many barriers, such as gaps in insurance coverage, inaccessible offices, inaccessible medical equipment and provider practices that do not accommodate various disabilities, which lead to poor outcomes. Responses to health crises can also harm people with disabilities, and the Association of American Medical Colleges shows that people with intellectual disabilities are several times more likely to die from COVID-19 than people who do not have similar disabilities. Research to address factors contributing to health outcomes for people with disabilities should involve a participatory process that employs anti-ableist approaches to build scientifically valid knowledge that directly benefits the disability community.
Health promotion research must navigate the demands of scientific inquiry and the understanding of what constitutes good practice for the field. Similar to research in any area, health promotion research aims to improve professional practice in the field (M A Koelen, L Vaandrager, C Colomér, 2001; Corbin 2016). Research findings support the allocation of resources to support programs and are necessary for programs to receive support from decision-makers, such as policy makers or budget managers. While the process for biomedical research is based on the idea that expected outcomes are well-defined before a study begins, such ideas do not necessarily fit within health promotion models (M A Koelen, L Vaandrager, C Colomér, 2001). Health promotion aims to go beyond individual health behavior and address different social, cultural and organizational factors to facilitate change. With so many areas to consider, research methodologies that center marginalized groups invite better questions and obtain better data (Corbin, 2016). Ableism, which is bias against disabled people, is well-recognized by the disability community in all aspects of life, including research opportunities. Research projects often need to meet the demands of very particular structures, which means that projects may not be flexible enough to be accessible and accommodating of the needs of people with disabilities. Some efforts, such as Healthy People 2030, aim to raise awareness regarding the needs of people with disabilities, which is an important step towards addressing marginalization. While equity has received significant attention in modern American culture, the disability community must not be excluded from work. All people from all communities must feel valued to achieve the mission of public health.
Author
Ashira Greenberg (she/her/hers) graduated with her Master of Public Health from Columbia University’s Mailman School of Public Health. Following her graduation from Columbia University, Ashira also received CHES certification. Ashira is passionate about child, youth and family health with an interest in improving healthcare and educational experiences for all young people. Ashira is especially committed to advocacy and health promotion on behalf of youth with physical disabilities, chronic illness and complex health needs. Ashira has been involved in a variety of advocacy-related efforts as part of her local disability community for over 10 years.
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