Addressing Health Disparities

A man in a wheelchair has a conversation with another man who is standing. Both are moving across a room where other adults are seated around a coffee table.

Understanding health disparities is key to addressing and eliminating them. Recent NICHD health disparities research has focused on women’s health and intellectual, developmental, or physical disabilities.

Researchers supported by NICHD evaluated the quality of care and knowledge of disability rights among physicians providing care to patients with disabilities. One survey of 714 U.S. physicians found that roughly 36% knew little or nothing about their legal responsibilities under the Americans with Disabilities Act (ADA), and only 56% welcomed patients with disabilities to their practice. About 71% answered incorrectly about who determines “reasonable accommodations,” and 68% felt that they were at risk for ADA lawsuits. The findings highlight the need in further education about disability among physicians to improve ADA compliance.

To follow up on this work, the research team conducted videoconference focus groups to learn more from healthcare providers. All 22 participants (mostly community physicians representing small practices of one or two physicians) reported feeling overwhelmed by the requirements of the ADA. They also reported a lack of accommodations for people with disabilities, such as inaccessible buildings and lack of proper equipment (e.g., adjustable-height examination tables and weight scales for wheelchair users). Many physicians expressed bias against people with disabilities and described strategies for discharging them from their practices. This study also highlighted several structural barriers to care for people with disabilities including procedural, policy, and financial. According to the study team, considerable improvements are needed to overcome the clinician- and system-level barriers to care for people with disabilities.

NICHD-funded investigators are also evaluating the reproductive health of adolescents with cerebral palsy (CP), a group of neurological disorders that begin in infancy or early childhood and that primarily affect body movement. One team reported that adolescents with cerebral palsy were three times less likely to start the vaccination series for human papillomavirus (HPV), which consists of two or three shots. However, for those adolescents with CP who initiated the immunization series, they were as likely as their non-CP peers to complete the immunization series. These findings highlight an opportunity to explore the psychosocial barriers and health disparities for people with disabilities. 

Researchers at NICHD also found that the risk of premature death in adulthood is influenced by patterns of early childhood adversity. Compared to children who did not experience early life adversity, childhood poverty combined with crowded housing was associated with a 41% higher risk for premature death, and early poverty combined with separation from a parent was associated with a 50% increase in premature death. The findings identify specific opportunities for intervention and policies to prevent the long-term health consequences of early disparities.

NICHD-funded investigators also seek to optimize care of teenage mothers and their infants. One team found that participation of teen mothers in “teen tot clinics” was low. Teen tot clinics provide integrated care for mom and child, who are both seen by healthcare professionals in the same medical visit. This type of integrated care is associated with better outcomes, including lower rates of repeat pregnancies and higher rates of vaccination. The findings suggest that improved implementation of this type of care would benefit teen mothers in the United States.

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