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Addressing Disability Inequities: Environments, Society and Wellbeing

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Disabilities".

Deadline for manuscript submissions: closed (31 July 2023) | Viewed by 48453

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Special Issue Editors

Dr. Meredith Perry

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Guest Editor

Centre for Health, Activity, and Rehabilitation Research, University of Otago, Dunedin 9016, New Zealand
Interests: disability; long term conditions; health inequities; physical activity; green space; accessibility

Dr. Ally Calder

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Guest Editor

Centre for Health, Activity, and Rehabilitation Research, University of Otago, Dunedin 9016, New Zealand
Interests: disability; physical activity; men’s health; health messaging; accessibility

Dr. Tristram Ingham

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Guest Editor

Department of Medicine, University of Otago – Wellington, Wellington 6021, New Zealand
Interests: disability; Māori health outcomes; health inequities; accessibility; policy; health systems; human rights

Special Issue Information

Dear Colleagues,

Over 15% of the world’s population live with disability (World Health Organization) [1]. Thus, persons with disabilities are a significant minority group in every population, but especially in low-income countries. Persons with disabilities experience inequalities, many of which arise from socio-economic, health, and environmental inequities.

Persons with disabilities experience barriers to their inclusion in society. Arguably, disability arises from policy, community values, organizational ethos, and inter- and intra-personal factors excluding persons with disabilities from meaningful participation. This type of discrimination leads to health inequities. Health inequities arise from avoidable, unfair, and unjust structural inequalities present in multiple domains of the social determinants of health. These include socio-economic, cultural, and environmental domains. When these sorts of biases are systemically present across multiple domains, health inequities are created and maintained. Furthermore, the effect is multiplicative. That is, persons with disabilities who are also from another marginalized group in society (for example, women children or from an Indigenous population) experience the greatest health inequities.

This Special Issue of the International Journal of Environmental Research and Public Health (IJERPH) focuses on the evidence for disability inequalities. Special consideration will be given to evidence between barriers to participation and outcomes for persons with disabilities (or specific cohorts of persons with disabilities). Furthermore, this Special Issue will give preference to research demonstrating effective paradigm transformation in the following areas: legislation, social perceptions, environmental and resource policy, and clinical practice.

New research papers (quantitative and qualitative), reviews, brief reports, case reports, and novel approaches to ensuring accessibility of the environment and resources for persons with disabilities are welcome.

World Health Organization. World report on disability. 2011; Available online: www.who.int/disabilities/world_report/2011/report.pdf.
United Nations. Convention on the Rights of Persons with Disabilities. 2007; Available online: https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html

Dr. Meredith Perry
Dr. Ally Calder
Dr. Tristram Ingham
Guest Editors

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Keywords

disability
participation
intersectionality
human rights
health beliefs
health inequalities
inequalities
accessibility
universal design
green space
blue space
built environment

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Published Papers (14 papers)

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Research

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15 pages, 365 KiB

Open AccessArticle

Disabled People or Their Support Persons’ Perceptions of a Community Based Multi-Sensory Environment (MSE): A Mixed-Method Study

by Amanda Wilkinson, Allyson Calder, Beth Elliott, Ryan Rodger, Hilda Mulligan, Leigh Hale and Meredith Perry

Int. J. Environ. Res. Public Health 2023, 20(19), 6805; https://doi.org/10.3390/ijerph20196805 - 22 Sep 2023

Viewed by 1993

Abstract

Multi-sensory environments (MSEs) are specialised spaces purposely designed to stimulate the senses, whilst providing a calming and relaxing environment for leisure and enjoyment, predominantly intended for disabled people. Most MSEs are in institutions, hospitals, or educational settings, with a few in community-based settings. We explored disabled users’ experiences of a community based MSE in a large metropolitan area in New Zealand, with a view to expanding access to MSE-type environments within the area. We used a convergent mixed method design with a web-based electronic survey (e-survey; n = 105), as well as semi-structured interviews (n = 14) with disabled MSE users (adults and children), who were supported, where necessary, by their support person/s. We collected the MSE users’ demographics, frequency of use with respect to age, disability, and ethnicity, and experiences of the room, equipment, and accessibility. The participants and their support persons’ perspectives about their experiences of using the MSE were represented by four themes: (i) Self-determination; (ii) Enhancing wellbeing opportunities; (iii) the MSE itself; (iv) Accessibility. While the MSE was considered positively, the MSE experience could be enhanced by addressing access challenges and broadening the scope of equipment to improve the usability and make it a more inclusive environment for all. Full article

(This article belongs to the Special Issue Addressing Disability Inequities: Environments, Society and Wellbeing)

17 pages, 1643 KiB

Open AccessArticle

Tides of Change—Barriers and Facilitators to Beach Accessibility for Older People and People with Disability: An Australian Community Survey

by Sasha Job, Luke Heales and Steven Obst

Int. J. Environ. Res. Public Health 2023, 20(9), 5651; https://doi.org/10.3390/ijerph20095651 - 26 Apr 2023

Cited by 2 | Viewed by 3267

Abstract

The beach is Australia’s most popular recreational destination with participation in beach-based activities associated with a wide range of health and wellbeing benefits. Unfortunately, access to beach environments is not possible for many older people and people with a disability. The purpose of this study was to investigate the barriers and facilitators of beach accessibility using a framework that recognises the complex interconnections between blue space, accessibility, physical activity, and health and wellbeing. A 39-item anonymous online cross-sectional survey was developed and administered to explore the perspectives of older people and people with a disability regarding beach accessibility. In total, 350 people completed the survey (69% female, age range 2–90 years (mean = 52)). Disability was reported by 88% of respondents, with 77% requiring a community mobility aid. Two-thirds (68%) of respondents were unable to visit the beach as often as they wanted, with 45% unable to visit at all. The most frequently reported barriers to beach access included difficulty moving on soft sand (87%), no specialised mobility equipment (75%), and inaccessible lead-up pathways (81%). If beach access was improved, respondents reported they would visit the beach more often (85%), for longer (83%), and have an improved experience (91%). The most frequently reported facilitators to beach access were the presence of accessible lead-up pathways (90%), sand walkways (89%), and parking (87%). Older people and people with disability have limited beach access, primarily due to a lack of accessible equipment, excluding them from the wide range of health benefits associated with visiting the beach. Full article

(This article belongs to the Special Issue Addressing Disability Inequities: Environments, Society and Wellbeing)

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15 pages, 3979 KiB

Open AccessArticle

Easy-to-Read: Evolution and Perspectives—A Bibliometric Analysis of Research, 1978–2021

by Marcela Alina Fărcașiu, Vasile Gherheș, Simona Șimon, Daniel Dejica-Carțiș, Liviu Cădariu and Annamaria Kilyeni

Int. J. Environ. Res. Public Health 2023, 20(4), 3359; https://doi.org/10.3390/ijerph20043359 - 14 Feb 2023

Cited by 2 | Viewed by 2131

Abstract

The purpose of this paper is to observe the use of the Easy-to-Read term in the international scientific literature. Therefore, a bibliometric analysis was carried out using the Web of Science database, focusing on the period between 1978 and 2021. From this, 1065 records that met the search criteria were further identified. After applying the PRISMA model, the final analysis was performed on a corpus of 102 documents, comprising an analysis of the keywords and expressions where the term was found, an authorship analysis, a citation analysis, as well as a co-occurrence analysis. The publications were grouped based on the research area, with the field of Computer Science standing out with most of the occurrences (25), followed by Education & Educational Research (14 occurrences) and Linguistics (9 occurrences). The results suggest that interest in this field of research is limited, as the maximum number of publications related to this topic was 16 in 2020 and 14 in 2021. The study is important as it sheds light on the current state of the topic and seeks to identify future trends in this field. Full article

(This article belongs to the Special Issue Addressing Disability Inequities: Environments, Society and Wellbeing)

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14 pages, 900 KiB

Open AccessArticle

Contextual Variables with an Impact on the Educational Inclusion of Students with Rare Diseases

by Ramón García-Perales, Ascensión Palomares-Ruiz, Andrea Gracia-Zomeño and Eduardo García-Toledano

Int. J. Environ. Res. Public Health 2022, 19(21), 14103; https://doi.org/10.3390/ijerph192114103 - 28 Oct 2022

Viewed by 1432

Abstract

The context of a school may play a fundamental role in students’ academic and personal progress. In this study, we focus on two contextual variables, the school type and school location or setting. The study used a questionnaire to assess teachers’ knowledge and thoughts about rare diseases based on these variables, with the participation of 574 school teachers. To broaden the research perspective, another questionnaire was administered to members of 152 rare disease patient advocacy groups to ask about their participation in educational processes and analyse their results according to one of the contextual variables: the setting or location of each association. The results indicated statistically significant differences according to the variables examined, which were larger for the type of school variable. In short, numerous variables that influence the teaching and learning processes need to be considered in educational praxis; in this study, we looked at those of a contextual nature (for example, the geographic characteristics of schools and associations), and this is essential for increasingly heterogeneous educational locations that demand multidimensional approaches. Full article

(This article belongs to the Special Issue Addressing Disability Inequities: Environments, Society and Wellbeing)

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16 pages, 359 KiB

Open AccessArticle

The Multidimensional Impacts of Inequities for Tāngata Whaikaha Māori (Indigenous Māori with Lived Experience of Disability) in Aotearoa, New Zealand

by Tristram Richard Ingham, Bernadette Jones, Meredith Perry, Paula Toko King, Gabrielle Baker, Huhana Hickey, Rangi Pouwhare and Linda Waimarie Nikora

Int. J. Environ. Res. Public Health 2022, 19(20), 13558; https://doi.org/10.3390/ijerph192013558 - 19 Oct 2022

Cited by 7 | Viewed by 5621

Abstract

People with lived experience of disability have poorer health and socioeconomic outcomes than people without it. However, within this population, certain social groups are more likely to experience poorer outcomes due to the impacts of multiple intersecting forms of oppression including colonisation, coloniality and racism. This paper describes the multidimensional impacts of inequities for Indigenous tāngata whaikaha Māori (Māori with lived experience of disability). Semi-structured in-depth interviews were conducted with 28 tāngata whaikaha Māori and their whānau (extended family) using a kaupapa Māori Research methodology. An equity framework was used to analyse the data. The results describe: (1) inequitable access to the determinants of health and well-being; (2) inequitable access to and through health and disability care; (3) differential quality of health and disability care received; and (4) Indigenous Māori-driven solutions. These data confirm that tāngata whaikaha Māori in the nation-state known as New Zealand experience racism, ableism and disablism, compounded by the intersection between these types of discrimination. Recommendations from the data support the inclusion of tāngata whaikaha Māori in decision-making structures, including all policies and practices, along with equal partnership rights when it comes to designing health and disability systems and services. Full article

(This article belongs to the Special Issue Addressing Disability Inequities: Environments, Society and Wellbeing)

16 pages, 1746 KiB

Open AccessArticle

Rare Diseases in the Educational Field: Knowledge and Perceptions of Spanish Teachers

by Ramón García-Perales, Ascensión Palomares-Ruiz, Lydia Ordóñez-García and Eduardo García-Toledano

Int. J. Environ. Res. Public Health 2022, 19(10), 6057; https://doi.org/10.3390/ijerph19106057 - 16 May 2022

Cited by 4 | Viewed by 2383

Abstract

Background: Education plays a fundamental role in everyone’s wellbeing. That means it is essential to provide quality inclusive activities to ensure equity and equality of opportunity in order to shape a cohesive, democratic, healthy society. Methods: In this study we focus on how inclusive educational practice addresses students with rare diseases, looking at teachers’ knowledge and opinions in this regard. A questionnaire was administered to 574 teachers who taught in various stages of non-university education to determine their knowledge and opinions about different dimensions: conceptualization, legislation, intervention, and diagnosis. Results: The results suggested various ideas for improvement in pursuit of positive, real inclusion, such as the need to improve teachers’ knowledge and understanding of these students’ characteristics and potential, with widespread specific training being urgently needed. Conclusions: in summary, students’ rights to education without discrimination is a basic premise of an educational system, leading to the need for a complete educational response that allows each student to develop as a person. Full article

(This article belongs to the Special Issue Addressing Disability Inequities: Environments, Society and Wellbeing)

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15 pages, 907 KiB

Open AccessArticle

Legislation on Disability and Employment: To What Extent Are Employment Rights Guaranteed for Persons with Disabilities?

by Mónica Pinilla-Roncancio and Nicolas Rodríguez Caicedo

Int. J. Environ. Res. Public Health 2022, 19(9), 5654; https://doi.org/10.3390/ijerph19095654 - 6 May 2022

Cited by 8 | Viewed by 4222

Abstract

Although the Convention on the Rights of Persons with Disabilities guarantees the right to employment and most countries in Latin America have signed and ratified the Convention, a large proportion of the population with disabilities still does not participate in the labour market. (1) Objective: The objective of this research was to understand how legislation in seven Latin American countries (Bolivia, Costa Rica, Chile, Colombia, Ecuador, Mexico, and Peru) has defined and enabled the inclusion of people with disabilities in the labour market. (2) Methods: We conducted a thematic analysis of the content of 34 documents and generated two thematic networks that summarise the results of the thematic analysis and represent the general relationships between the categories of analysis in each country. Using this information, we analysed the differences between countries and the advance in their legislation to fulfil the recommendations made by the Convention. (3) Results: Although all countries have enacted legislation promoting the employment rights of persons with disabilities, six of the seven countries (except Chile) have applied a medical perspective to the definition of disability in their labour legislation, thus imposing a barrier to the labour-market inclusion of this population and perpetuating the association of disability with lack of capacity to work. Full article

(This article belongs to the Special Issue Addressing Disability Inequities: Environments, Society and Wellbeing)

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17 pages, 6806 KiB

Open AccessArticle

Concrete Paving Slabs for Comfort of Movement of Mobility-Impaired Pedestrians—A Survey

by Magdalena Wojnowska-Heciak, Jakub Heciak and Adam Kłak

Int. J. Environ. Res. Public Health 2022, 19(6), 3183; https://doi.org/10.3390/ijerph19063183 - 8 Mar 2022

Cited by 5 | Viewed by 3411

Abstract

People with locomotion difficulties encounter many barriers in a pedestrian environment. Pavement quality has been shown to substantially affect pedestrian satisfaction in general, and its optimal design may contribute to reducing the stigma put on people with impairments. Our research involved a survey assessing perception and attitudes towards pavement quality and characteristics for pedestrian comfort. The classic correlation of the variables based on contingency tables was used to analyse data and to test whether respondents’ perceptions depended on certain profile features. The completion of the statistical inference was the use of advanced algorithms of the correspondence analysis method. The relationships between the variables were assessed optionally using the chi² test. The study results revealed desirable parameters and features of paving surfaces. People who use manual wheelchairs and declare limb loss prefer medium- and large-format concrete pavers with smooth finishing and no bevelling. People with skeletal abnormalities or peripheral neuropathy prefer concrete slabs and surfaces made of small- or medium-sized panels arranged in a regular pattern, made of smooth non-slip concrete with narrow joints. Further laboratory tests are necessary to investigate whether increased water permeability of pavements constructed on eco-friendly base layers can curb damage to the pavement surface and provide long-term durability. Full article

(This article belongs to the Special Issue Addressing Disability Inequities: Environments, Society and Wellbeing)

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14 pages, 536 KiB

Open AccessArticle

Attitudes of Students of Social Sciences and Humanities towards People with Physical Disabilities (MAS-PL)

by Dorota Tomczyszyn, Anna Pańczuk and Adam Szepeluk

Int. J. Environ. Res. Public Health 2022, 19(3), 1544; https://doi.org/10.3390/ijerph19031544 - 29 Jan 2022

Cited by 4 | Viewed by 3465

Abstract

Negative social attitudes towards people with disabilities are a serious barrier to their social, professional, and cultural functioning. Due to negative perception, disabled individuals are often homebound. The present study was an attempt to compare declared attitudes with the results of other studies using the Polish version of an international assessment tool. The aim was to verify the MAS-PL tool and to analyse the attitudes of students of social sciences and humanities towards people with physical disabilities. An additional aim was to compare declared attitudes with the results of other studies using the Polish version of an international assessment tool for students of medicine and health sciences. In total, 540 students were surveyed using the Polish adaptation of the Multidimensional Attitudes Scale towards Persons with Disabilities (MAS-PL). The study confirmed the high reliability of the MAS-PL Scale. The mean global score of the scale was 82.79. There were no significant differences in the global MAS-PL score depending on respondents’ sex; however, an effect of this variable on the subscales was found. The surveyed females exhibited more positive attitudes in terms of the cognitive and behavioural components, whereas the males showed more positive attitudes in the affective subscale. There was no significant impact of the place of residence, age, and majors. Along with the year of studies, the intensity of the global and affective scale slightly increased. The surveyed students of social sciences and humanities exhibited similar attitudes towards people with physical disabilities to those declared by Polish students of medical and health sciences surveyed by Radlińska et al. The authors recommend implementation of didactic classes, projects, and activities at the stage of planning and creation of student education programs to promote tolerance towards disabled people. Full article

(This article belongs to the Special Issue Addressing Disability Inequities: Environments, Society and Wellbeing)

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15 pages, 403 KiB

Open AccessArticle

The Influence of Decision Making on Social Inclusion of Persons with Disabilities: A Case Study of Khyber Pakhtunkhwa

by Shakeel Ahmad, Mazhar Islam, Muhammad Zada, Afraseyab Khattak, Rezwan Ullah, Heesup Han, Antonio Ariza-Montes and Luis Araya-Castillo

Int. J. Environ. Res. Public Health 2022, 19(2), 858; https://doi.org/10.3390/ijerph19020858 - 13 Jan 2022

Cited by 5 | Viewed by 3631

Abstract

Decision making is an essentially social process adopted by individuals or groups to identify and choose the best choice among several alternatives. Decision-making choices are influenced by the preferences, values, and beliefs of the individuals or groups involved in the decision-making process. This study was conducted to analyze the social inclusion of Persons with Disabilities (PWDs) in the context of their participation in decision making. The study area consisted of 8028 PWDs registered with the government of Pakistan, from which a sample of 488 PWDs was selected through a multistage stratified random sampling technique. These PWDs included physically disabled, blind, crippled, and deaf persons; however, the data were collected from those who were able to be interviewed. Chi-square and Kendall’s Tau-b tests were used to determine the strength, level, and direction of association among variables. At the multivariate level, the study found a spurious relation between social inclusion and participation in decision making when controlling for gender, monthly family income, and level of disability of the PWDs. The results highlighted that participation in decision making improved the social inclusion of male and moderately disabled PWDs more positively. However, participation in decision making was a universal feature explaining the social inclusion of PWDs irrespective of their monthly family income. The logistic regression model explained that the social inclusion of PWDs was more likely to occur when PWDs were married, had high monthly family income (PKR 16,500 and above), belonged to a joint family, and actively participated in decision making. The study recommends that ensuring the participation of PWDs in decision making in family, community, school, and other relevant institutions ultimately enhances their social inclusion. Full article

(This article belongs to the Special Issue Addressing Disability Inequities: Environments, Society and Wellbeing)

Review

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21 pages, 1948 KiB

Open AccessReview

The Representation of Children’s Participation in Guidelines for Planning and Designing Public Playspaces: A Scoping Review with “Best Fit” Framework Synthesis

by Rianne Jansens, Maria Prellwitz, Alexandra Olofsson and Helen Lynch

Int. J. Environ. Res. Public Health 2023, 20(10), 5823; https://doi.org/10.3390/ijerph20105823 - 15 May 2023

Cited by 4 | Viewed by 3100

Abstract

For children, meaningful participation in community life includes being able to access places for play. Such community playspaces are potentially important for all children, including those with disabilities. Yet, children are rarely asked for their views on the design of playspaces, which can further contribute to exclusionary practices and undermine children’s rights to share their views on matters that affect them. In this scoping review, we aim to analyze guidelines and identify strategies for supporting children’s participation rights when planning public playspaces. Guidelines are practical tools used by local policymakers when creating community playspaces, which are important sites for children’s outdoor play. In total, forty-two guidelines were identified that addressed children’s participation rights, along with community involvement. Qualitative evidence synthesis with a “best fit” framework approach was used, informed by Lundy’s model of children’s participation. The findings revealed the importance of initial community involvement as a critical prerequisite. Strategies for children’s participation mostly concerned “space and voice” (for children of diverse abilities), with little attention paid to giving their views due weight. This evidence shows that there is a significant gap in knowledge surrounding policy development and implementation to support adults and children to cooperate equally in designing playspaces. Future directions for research in children’s participation require a focus on combined community–children participation approaches in public playspace design. Such work could strengthen and facilitate the role of adults as bearers of the duty to implement the rights of children. This review generated inclusive strategies in planning public playspaces, which could support local policymakers in this complex multi-layered process. Full article

(This article belongs to the Special Issue Addressing Disability Inequities: Environments, Society and Wellbeing)

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22 pages, 1119 KiB

Open AccessReview

Social Support Initiatives That Facilitate Exercise Participation in Community Gyms for People with Disability: A Scoping Review

by Rachel A. Kennedy, Georgia McKenzie, Carlee Holmes and Nora Shields

Int. J. Environ. Res. Public Health 2023, 20(1), 699; https://doi.org/10.3390/ijerph20010699 - 30 Dec 2022

Cited by 7 | Viewed by 4078

Abstract

People with disability report social support facilitates participation in physical activity. A scoping review explored social support strategies used to facilitate exercise participation for people with disability (aged ≥ 15 years) in community gym settings. Seven electronic databases were searched. Studies were screened for eligibility based on title and abstract followed by full-text review. Data were analysed using content analysis and narrative synthesis. Forty-two articles reporting data from 35 studies were included. Eight types of social support were identified: supervision (n = 30), peer support (n = 21), specialist support (n = 19), orientation (n = 15), education (n = 7), logistical support (n = 6), motivational support (n = 5) and organised social activities (n = 4). Direct supervision was typically provided 1:1 or in small groups by staff experienced working with people with disability. Peer support typically involved support from exercise group participants or a peer mentor. Specialist support was usually provided by a health or exercise professional either directly to people with disability or to the people providing support to them (e.g., trainer). Orientation to the gym environment, equipment and exercise program was usually provided over 1 or 2 sessions. Gym staff may use these strategies to guide the implementation of social supports within their facilities to promote social connectedness and participation for people with disability. Full article

(This article belongs to the Special Issue Addressing Disability Inequities: Environments, Society and Wellbeing)

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21 pages, 1420 KiB

Open AccessReview

Assessing the Emergency Response Role of Community-Based Organizations (CBOs) Serving People with Disabilities and Older Adults in Puerto Rico Post-Hurricane María and during the COVID-19 Pandemic

by Alina Engelman, Mariana T. Guzzardo, Marley Antolin Muñiz, Laura Arenas and Aracely Gomez

Int. J. Environ. Res. Public Health 2022, 19(4), 2156; https://doi.org/10.3390/ijerph19042156 - 14 Feb 2022

Cited by 19 | Viewed by 5989

Abstract

In Puerto Rico, a host of factors makes the role of community-based organizations (CBOs) critically important in emergency preparedness and response (EPR) and disability-inclusive disaster risk reduction (DiDRR) addressing the needs of people with disabilities and older adults. The territory has been the site of recurring hurricanes, earthquakes, medical crises, and human-made disasters. Political, social, and economic problems unique to the archipelago have historically limited the preparedness and response capacity of governmental authorities, especially for its most at-risk populations. In a context of severe constraints on government resources, CBOs are positioned to play an outsized role in providing services for disabled and older adults before, during, and after emergencies. This study assesses the emergency preparedness and response capacity of CBOs (n = 22) for addressing the needs of people with disabilities and the elderly. Semi-structured, largely closed-ended interviews were conducted in Spanish with key informants at Puerto Rican CBOs. The interviews included questions about emergency preparedness and response training, as well as organizational capacity during COVID-19 and post-Hurricane María. This study posits that conditions in Puerto Rico place CBOs at the forefront of critical responsibilities including emergency preparedness and response, warranting assessment of their practices and resources to assist them in fulfilling their mission. Full article

(This article belongs to the Special Issue Addressing Disability Inequities: Environments, Society and Wellbeing)

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Other

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8 pages, 297 KiB

Open AccessCommentary

Addressing Disability Inequities: Let’s Stop Admiring the Problem and Do Something about It

by James H. Rimmer

Int. J. Environ. Res. Public Health 2022, 19(19), 11886; https://doi.org/10.3390/ijerph191911886 - 20 Sep 2022

Cited by 4 | Viewed by 1968

Abstract

The healthcare system and public health community are often underprepared to support the needs of people with disabilities and to include them equitably in wellness programs (e.g., exercise, leisure, nutrition, stress management) offered to the general community. Consequently, the vast majority of people with disabilities are unable to make the transition from “patient” to “participant,” which contributes to many of the health disparities reported in this population. People with disabilities have a disproportionately higher rate of acquiring secondary conditions such as obesity, cardiovascular comorbidity, pain, fatigue, depression, deconditioning, and type 2 diabetes, often resulting from poor access to home and community-based health promotion/wellness programs that include physical activity, nutrition, stress reduction, and sleep hygiene, among others. Achieving health equity in people with disabilities requires a multi-stage approach that includes person-centered referral to wellness programs, empowering people with disabilities to become self-managers of their own health and ensuring that community-based programs and services are inclusive. A three-stage model for addressing health and wellness needs across the home and community settings is described, which is currently being used in a large federally funded center in the US with potential generalizability across the world. Full article

(This article belongs to the Special Issue Addressing Disability Inequities: Environments, Society and Wellbeing)

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