Is there a place for Disability Studies (DS) in public health education and the education of professionals in other health-related fields?

This is the question addressed in this special issue, the first one dedicated to this topic. The answer is not obvious for public health and other health-related fields. As an academic field, DS maintains marginal status and there are few public health faculty members pursuing DS as an area of research or teaching. While there seems to be occasional placement of the social model of disability in some courses, it is often part of a discussion on chronic conditions, aging, and disease prevention and rarely appears outside of this context.

The answer to the question is not obvious to those in DS either. To what extent can those in public health or other health-related fields appropriately address issues in DS--a field often critical of health professionals? Will health professional schools even be interested in discussing issues critical to us? What will be the purpose of introducing DS into schools of public health or other health professional schools? Given the tension between those in DS and those in health or clinical fields, this question may be one that has to be addressed more than once.

When given the opportunity to guest edit this special issue, I was honored to be part of the discussion that I think is important. As one trained in public health and the social sciences, I am deeply committed to introducing DS and believe it adds significant value to course work and research on health. Below are my remarks reflecting this perspective. DSQ has invited several authors to contribute their thoughts about Disability Studies from various perspectives, including public health, health science, occupational therapy, and medicine.

Pamela Block introduces strategies for creating a Disability Studies in a bachelor's program in health science based on her personal observations of the rehabilitation system. This well-written piece offers academic programs ways of addressing Disability Studies inside and outside the classroom.

Paula Minihan et al discuss one way to educate physicians about disability. This article documents the gaps in medical education as it relates to disability and suggests people with disabilities can be a critical part of educating physicians.

For this special issue, we wanted to keep the conversation open, and some of the papers do reflect the perspective of individuals from health-related fields newly entering an important discussion about DS. This is a challenging endeavor for these authors as well as for the readers—and editors of DSQ. While this may be challenging, it is a natural part of the process of opening new doors and new conversations. For example, three articles reflect these new kinds of conversations. Anita Farel's paper addresses Disability Studies from the perspective of someone who is teaching about special health needs of children. Beth Wright is coming from the field of occupational therapy, where Disability Studies is new. In Dana Gonzales' paper, public health students are addressing special health care needs of children by working across different health professional fields. These authors are talking about Disability Studies but are based in fields with frameworks that can be seen as problematic within DS. We welcome these new conversations, but are also aware of the contentious nature of their content.

In addition to the papers, there are several commentaries included in this issue from various fields. These thoughtful remarks represent epidemiology, rehabilitation psychology, public health, paraprofessionals, rehabilitation science, and medical humanities. These papers and commentaries promise to elicit more conversations about Disability Studies in public health curricula.

Guest Editor's Perspective: "Yes" to the opening question

The growing number of programs in Disability Studies in the U.S. and abroad suggests a recognition by some universities that disability is not only a medical or clinical topic but a source of political identity, an important part of social history and people with disabilities represent a subjective life experience with significant implications for other academic fields. Despite the growth of DS as an academic field, its place in public health education and health administration is conspicuously absent. The typical public health curriculum leaves open several locations for issues raised in DS courses and programs. Courses in health policy, long-term care, sociology of health and illness, health administration, health education, epidemiology, health promotion, global health, as well as topics that directly address cultural differences such as cultural competence and health disparities are all possible areas for integration of Disability Studies. Professional fields directly involved in patient care should also integrate Disability Studies. These include medicine, nursing, physical therapy, occupational therapy, and others.

Why is Disability Studies needed in public health and health sciences?

There are several reasons why DS should be integrated into public health and health sciences at the graduate and undergraduate levels. First, persons with disabilities experience health disparities. They are disproportionately represented among those who are uninsured or underinsured and experience greater health problems.

Second, the activities associated with the Independent Living Movement and the Disability Rights Movement have a significant place in the history of public policy, including health and social welfare policy.

Third, the historical and current reaction to disabilities by society-at-large, the medical community and other specialists has helped to create a shared identity among persons with disabilities as a minority group. An important part of this shared identity is accumulation of negative encounters with clinical professionals. Their shared experience of discrimination is parallel to the experience of other minority groups and the identity as part of a minority group with all its implications is worthy of inclusion in programs that educate health professionals. The implications for health among this minority group have not been fully recognized within public health. Recently, The Nation's Health (the newsletter of the American Public Health Association) published a brief article about the health disparities between people with disabilities and others in the population, but this source of disparities as a point of discussion, research or classroom debate is rare. People with disabilities have experienced discrimination and objectification by members of the medical community and their experience as persons living with disabilities is not fully recognized by the health care system or the social welfare system. In addition, the decisions of the Supreme Court since the implementation of the ADA have negatively affected the pursuit of civil rights for people with disabilities.

Fourth, for all academic programs that address human resources management, the implications of ADA are important and necessary. Several Supreme Court cases since the passage of ADA have created a changing legal definition of disability, which has significant implications for employer organizations—including health service organizations.

Fifth, in 2001, the World Health Organization, responding somewhat grudgingly to the arguments put forth by disability rights analysts, significantly revised its conceptualization of health and disability. This new definition, called the International Classification of Functioning, Disability and Health (ICF), is the basis of a coding system that, if fully adopted by the medical community, could ultimately affect not only the way health care professionals assess patients' health status, but also the way they are reimbursed for services. While the full effect of ICF is not yet known, since it is agreed by many that it more fully represents the environmental factors that create limitations for persons with disabilities, there is now a greater potential for a better match between their needs and demands and what technology, goods and services are available for them.

Sixth, Disability Studies can act as a platform for critical reflection on public health curricula as well as health services research. For example, Disability Studies questions the medical model bias of public health curricula. It also may help to improve research questions by looking at the full needs of individuals living in the community, not only their medical needs but goods, services, and forms of technology, including assistive devices and personal attendant care.

Seventh, and finally, persons with disabilities represent a growing proportion of the population due to longer life expectancies and the aging of the population. The needs and demands for services are expected to change as well. The current gaps in services will become greater as the population in need grows.

This thematic issue is sure to provoke some disagreement and equally sure to open some paths to collaboration among disciplines with very different stakes and experiences.

Acknowledgement: Corinne Kirchner, Co-Editor of DSQ, provided much assistance in conceiving and bringing this theme issue to fruition.