For over 30 years, people with disabilities have called for the elimination of barriers to their full participation in society. 1 Many barriers affect the likelihood that persons with disabilities will lead healthy lives. The idea that persons with disabilities are capable of living healthy lives has not been obvious in most health science literature; the subject is focused on and written by persons with disabilities and is also present to some extent in the social science literature. Instead, the emphasis of health science literature has been on disability as a medical pathology with an emphasis on cure and/or rehabilitation.
The purpose of this issue is to encourage discourse on barriers within the health care arena to inspire new approaches to the study of such barriers and the elimination of them. Family and community health professionals should remain aware that health is an achievable state for many persons with disabilities. Evidence suggests that persons with disabilities may view health as a process of self-actualization, role achievement, and/or environmental adaptation. 2 In one study, 2 73% of the 135 persons with disabilities in independent living centers ranked their health as excellent.
Multiple barriers have been described within the literature that may be classified as attitudinal and/or environmental. Attitudinal barriers are preconceived perceptions that create stereotypes and negative emotional responses to persons with disabilities, and these responses may affect family relations, work opportunities, and educational attainment. 3 Attitudinal barriers can limit the person's ability to lead a fulfilling life-to achieve the full range of possibilities that life has to offer. These attitudes also influence what services will be provided through legislation and economic programs. 4
Environmental barriers for people with disabilities are physical obstacles to goods, services, and activities that are otherwise accessible to those without disabilities. Environmental barriers prevent access to public and private buildings and prevent people with physical impairments from riding public transit or operating motorized vehicles. 3 Varying degrees of legislation have been implemented in many countries to eliminate environmental barriers; however, many barriers may exist in trying to obtain effective health care in the home and community instead of institutionalized health care.
In our issue, Nosek and colleagues' exploration of women with disabilities adds support to the position that health is a multidimensional state, which may be achieved if analyzed from the perspective of the woman with the disability. Jones and Bell provide evidence of the negative health consequences of barriers to health for women with disabilities. Both articles demonstrate how gender and disability interact to create attitudinal and environmental barriers for women.
Three of our articles focus on environmental barriers that may be eliminated through changes in attitudinal barriers. Fox and Kim's description of Kansas' experience with the Medicare waiver program provides an analysis of how the provision of community-based care is affected by public policy. Mulvihill and colleagues description of the best practices for out-of-school care helps to define ways communities can better provide the services needed by children with disabilities. Nyamathi and colleagues analysis of how mental health is influenced by veteran status is evidence for how health care access can influence perceived health outcomes.
Becker and Stuifbergen's work assess both environmental and attitudinal barriers to health promotion. Interestingly, they describe barriers to health promotion across three different groups, which demonstrate the commonalities in experiences for persons with different medical diagnosis.
Harrison and Kahn offer a possibility for understanding how barriers may be created within a culture. This model is from a cultural perspective that no longer relies on medical diagnosis for the designation of disability. This builds upon prior work on disability as a rite of passage, and it could inspire new studies of disability within various cultures.
As stated earlier, our goal is to encourage discourse on barriers to health for persons with disabilities in order to inspire new approaches to the study of these barriers and, thus, to their elimination. One topic that remains unexplored in this issue relates to how age interacts with barriers in persons with various disabilities. Intervention studies aimed at the elimination of attitudinal and environmental barriers are also needed. The success of this issue will be seen in the discourse it produces on the topic and to the extent that such discourse eventually leads to social change.
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