Abstract
Over the past two decades, there has been increasing recognition of the importance and merits of increasing representation of historically underrepresented minorities in the health professions. However, people with disabilities are less discussed in these efforts. More than one in four of U.S. adults have a disability; yet it seems that these individuals are less represented in the field of health education. This commentary discusses the merits of increasing representation of people with disabilities in the health education/promotion profession and calls for preparation programs and professional organizations to reduce systemic barriers and facilitate increased representation.
Health professions have recognized the importance of increasing representation of minoritized professionals in their fields: increased innovation, better patient safety and health outcomes, and social justice. This recognition has led to calls to action to increase gender and racial/ethnic diversity within these fields, wherein representation is indeed increasing (Boatright et al., 2018; Phillips & Malone, 2014). More than 22% of U.S. adults have a disability (Courtney-Long et al., 2015); yet people with disabilities (PWDs) are frequently excluded from diversity and inclusion efforts. Unfortunately, PWDs are underrepresented in many health professions including, it seems, the health education and promotion (HE/P) profession.
PWDs in the United States experience a range of health disparities including poorer financial resources and disability-related access to medical professionals (Bauer et al., 2016; Drainoni et al., 2006; Graham & Mann, 2008); higher prevalence of health risk behaviors and conditions including obesity, diabetes, and cardiovascular disease (McKee et al., 2011; McPhee et al., 2019); and poorer communication with health care providers (Kushalnagar et al., 2020; Streur et al., 2019). In response to these disparities, Healthy People 2020 and Healthy People 2030 (U.S. Department of Health and Human Services, 2013, 2020) have called for efforts to improve the health of PWDs. Unquestionably, the field of HE/P has a responsibility to address these health disparities upstream by developing prevention programs and policies. HE/P best practices (e.g., community participatory programs; Green & Kreuter, 2005) call for engaging communities and culturally tailoring these programs and services. However, PWDs often experience barriers to engagement due to society’s denial of PWDs’ personal experiences, widespread infantilization, and assumptions of homogeneity and helplessness (e.g., East & Orchard, 2014; Mertens, 2009), resulting in disempowerment.
Inarguably, increasing the representation of PWDs in the HE/P profession can lead to innovation and better individual and community health outcomes. Furthermore, although it is not the responsibility of PWDs to serve as ambassadors or otherwise focus on disability health–related issues, increased representation of PWDs in the HE/P profession will serve to passively and actively combat stereotypes and disentangle biases. This could result in increased recognition of the importance of engaging PWDs in planning efforts and service delivery, thus improving health outcomes for PWDs. To address underrepresentation of PWDs in the field, we must be proactive in taking steps to reduce systematic exclusion from professional preparation and development opportunities in both higher education and professional organizations.
Recommendations for Higher Education
There has been a marked increase in the prevalence of college students with disabilities in the past 20 years (National Center for Education Statistics, 2000, 2019). Still, students with disabilities face systemic barriers to accessing and successfully completing college (Lyman et al., 2016). Higher education programs and instructors must ensure that their educational curriculum is accessible to students with disabilities.
Typically, accommodations for course materials are provided through a college’s disability resource center (DRC) after (1) the student has provided medical documentation of the disability and (2) consulting with the student on reasonable accommodations. Unfortunately, a subpopulation of students exist who are unable to provide documentation for various reasons including lack of health care access, stigma, and feeling vulnerable (Lyman et al., 2016; Marshak et al., 2010). For students who do engage with DRCs, navigating access is a continual process requiring multiple meetings with DRC professionals to revise accommodations and ensure that the classroom environment is accessible. Furthermore, DRC policies and guidelines differ by institutions—presenting access barriers for students with disabilities as they progress through their education.
Implementing Universal Design for Learning (UDL) strategies in the classroom can ensure that all students have equal access to course materials, without mandates from DRCs. UDL strategies include using (1) multiple modalities to provide course content (e.g., podcasts, visual presentations, and textbooks), (2) multiple strategies to present content (e.g., case studies, hands-on activities, and guest speakers), and (3) a variety of assessment methods, without relying solely on written assessments (CAST, 2018). 1
Access to the learning environment and content is critical. However, social norms may influence access if a student with a disability seeks or uses classroom accommodations. Thus, training students, faculty, and staff on disability awareness and cultural competency is critical—not only to ensure that students, visitors, and staff with disabilities feel welcome but also to influence future health promotion work with PWDs. Professional preparation programs should consider integrating a social aspects of disability course in their student curriculum, and hosting disability awareness trainings. For example, the University of Florida’s College of Public Health and Health Professions partners with the Florida Disability and Health Program, jointly funded by the Centers for Disease Control and Prevention and the Florida Department of Health, to provide disability awareness training to undergraduate and graduate students. There are 19 Centers for Disease Control and Prevention–funded disability and health programs nationwide, and many of these programs provide these types of training. An additional benefit of these trainings is that faculty and staff can also receive training on providing protections for students with disabilities and how to appropriately communicate with students.
Recommendations for Professional Organizations
Each of the authors has separately experienced or witnessed HE/P professional organizations limiting access to, or having barriers to engaging in, professional development opportunities. Deaf and hard-of-hearing health educators have been denied access to effective communication through sign language interpreters or captions at plenary sessions; professionals with mobility disabilities have faced physical barriers accessing meeting rooms and stages; and professionals who are blind/with low vision may encounter barriers to accessing presentation content. Not only are inaccessible programs placing our professional organizations at increased liability (for failing to comply with federal mandates); it is also in direct violation of the Code of Ethics of the Health Education Profession (Coalition of National Health Education Organizations, 2020), and it also hinders our efforts to recruit and retain members with disabilities. Thus, we call for partners within the Coalition of National Health Education Organizations to facilitate a multipronged approach.
First, HE/P organizations should collaborate with disability advocacy organizations and organizations that serve health professionals with disabilities. These partnerships would help demonstrate the field’s dedication to increasing the representation of PWDs and providing opportunities for members of both organizations to engage in meaningful dialogues regarding the provision of health education to PWDs. Additionally, these partnerships could help facilitate trainings to professional organization staff and officers and educate them of their responsibility to comply with accessibility laws.
Second, HE/P organizations and their members must recognize the two legal and ethical responsibilities of providing accessibility to professional meetings and events. First, organizations must ensure that reasonable accommodations are provided when requested. We have interacted with first-time meeting attendees who have no intention of remaining involved in the organization due to inaccessibility. Second, organizations should adopt accessibility standards for presenters to ensure that content is accessible: for example, (1) standards for instructional material (e.g., PowerPoint and posters) to be visually accessible, (2) train moderators to remind attendees to use the microphone when asking questions, and (3) assign program planning committee members the responsibility of collecting, organizing, and fulfilling reasonable accommodations.
Summary
Higher education programs and health education organizations can, and should, be doing more to promote recruitment and retention of health educators with disabilities. Increasing the representation of PWDs in the HE/P profession will help increase innovation and improve the health of PWDs. We provided two strategies for higher education programs and two strategies for professional organizations that will improve accessibility to instructional and professional development content, thus reducing systematic exclusion of PWDs in the field, which is a primary barrier to increasing representation. Our hope is that these strategies can encourage reflection and action by these two stakeholders on how they may be unintentionally harming priority populations, and how they can actively support PWDs entering the field.
Footnotes
Authors’ Note
Tyler G. James is a member of the editorial board for the journal Pedagogy in Health Promotion. The authors of this article were not supported by specific grant funding. The opinions within this article are those of the authors and do not necessarily represent those of their employers or their employers’ funding agencies.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
