Currently, there are approximately 56 million people in the United States living with a disability.1 Research suggests that people with disabilities experience disparities in their health, and are more likely to participate in negative health risk behaviors than people without disabilities.2,3 People with disabilities are 58% more likely to be obese than their peers without disabilities, and people with disabilities smoke at higher rates than those without disabilities (25% vs 17%).4,5

The World Health Organization suggests that people with disabilities should have access to all mainstream policies, systems, and services.6 People with disabilities can greatly benefit from inclusive health promotion and educational activities already being implemented by local health departments (LHDs), which can help reduce their risk and minimize the severity of secondary conditions.7 The inclusiveness of programs and services offered by LHDs has yet to be studied; therefore, the National Association of County & City Health Officials (NACCHO) decided to conduct a baseline assessment to better understand LHD administrators' knowledge and awareness about people with disabilities and how LHDs are including people with disabilities in their programs and activities.

Methods and Findings

In the spring of 2014, NACCHO randomly selected a representative sample of 550 LHDs from across the country. NACCHO asked health department administrators to complete a brief online survey to assess administrators' levels of knowledge and awareness about including people with disabilities in local public health practice and better understand how people with disabilities were being included in public health practice at the local level. A total of 159 LHD administrators completed the survey, which yielded a final response rate of 29%.

Of the LHD administrators who completed the survey (n = 159), 45% were from small jurisdictions (population <50 000), 31% were from medium jurisdictions (population size 50 000-499 999), and 24% were from large jurisdictions (population size 500 000+); this was consistent with the distribution of LHD sizes across the country. When asked about their awareness of the number of people with disabilities in their jurisdictions, 48% reported that they were "aware/very aware," 46% reported being "somewhat aware," and 6% reported being "not aware." When asked about awareness of the secondary conditions experienced by people with disabilities, 54% reported being "aware/very aware," 35% reported being "somewhat aware," and 11% reported being "not aware." Fifty-eight percent of respondents indicated that they were "knowledgeable/very knowledgeable" about accommodations needed to support people with disabilities, whereas 42% reported being "somewhat knowledgeable/unknowledgeable." Only 11% of LHD administrators perceived people with disabilities as being a group that experienced health inequity, whereas 68% did not, and 21% did not know whether people with disabilities experienced inequities in their health status.

Administrators reported on the programs/services offered by LHDs and then indicated whether or not people with disabilities were included in the programs/services offered by LHDs. LHDs were most likely (up to 73% were inclusive) to include people with disabilities in emergency preparedness planning efforts (eg, emergency shelter operations, emergency preparedness education, response plans) and less likely (16%-47% were inclusive) to include people with disabilities in health promotion programming (eg, tobacco cessation, obesity prevention, screenings).

Discussion

While nearly 60% of the respondents reported having knowledge about the accommodations needed to support people with disabilities in public health activities, less than 50% of LHDs were aware of the number of people with disabilities living in their jurisdictions. Being able to accurately estimate the number of people with disabilities is an important step for LHDs in planning and developing programs and activities that are inclusive of people with disabilities. While more than half of the LHD administrators indicated being aware of the secondary conditions experienced by people with disabilities, only 11% considered people with disabilities as a population that experiences health disparities. This finding suggests a need for LHD administrators to become better educated and informed about the health of people with disabilities so that people with disabilities can be better included in LHD programs and services.

One particularly interesting finding from this assessment was that a few of the LHD administrators noted that they thought that they were being inclusive of people with disabilities by providing materials to non-English-speaking populations. This finding highlights the importance of raising awareness among LHDs about people with disabilities as an unique population group separate from non-English-speaking and minority populations; perhaps, a clearer definition of the population of people with disabilities is needed for the public health workforce.

Conclusion

NACCHO was able to collect preliminary baseline information on the knowledge and awareness of LHD administrators regarding people with disabilities and the extent to which LHDs across the country are currently including people with disabilities in public health programs and services. While the majority of people with disabilities are being included by LHDs in emergency preparedness efforts, there is still a great need for LHDs to consider including people with disabilities in all other public health programmatic areas. The inclusion of people with disabilities in the programs and outreach activities implemented by LHDs will help support the health promotion of people with disabilities and thus, hopefully, lead to better health outcomes for this population. If LHDs across the United States begin to make a concerted effort to include people with disabilities in already existing public health programs and services, there is a great potential to lessen the health disparities experienced by this population. NACCHO's Health and Disability program has developed several resources for LHDs looking to become more inclusive of people with disabilities in public health practice. NACCHO's Health and Disability program continues to strive for the inclusion of people with disabilities in local public health practice and, with support from the Centers for Disease Control and Prevention, will develop an e-learning training module about the importance of disability inclusion for health department staff in late 2016.

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