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"I'm a healthy person. My disability really doesn't have an impact on my health."
By her own assessment, Heidi Hellsten, a Winnipeg woman who has spina bifida is one of the relatively few Canadians with disability who consider themselves to be in excellent health. In fact, when people with disability were asked in a national health survey to rate their own health, only 8.1% reported a high degree of well-being, compared to 36.3% of Canadians without disabilities.
The same health survey showed that, like any member of society, people with
disabilities may be physically healthy but report a low-degree of wellbeing
if their career hopes are stunted, if finances are a constant concern, if they
can't access their public library or doctor's office, or if a lack of support
leaves them isolated. Income security, education and work opportunities, quality
housing and social supports are influences that are known as the determinants
of health and they work together to make us healthy—or not.
Frances Seca, clinical social worker for Fredericton's Extramural Program, has worked with young men who use wheelchairs as a result of accidents. She confirms that these broader social factors have a huge impact on the lives of people with disabilities. "Maybe they're experiencing relationship issues, equipment and financial issues. They might be very healthy; it's just that their lives have changed totally."
Disability—just another way of being
"There's often a perception that people with a disability are ill or dying," says Dr. Nancy Hansen, Director of the University of Manitoba's Masters Program in Disability Studies. She acknowledges that there can be health issues associated with impairment and disability, "but in large measure," she says, "disability is just another way of being; it's not better or worse, it's just different."
According to a 2004 survey, the image of a person in a wheelchair is what pops into most Canadians' minds when they're asked to define disability.
But disability can't be summed up in one picture, or even one paragraph. It is complex and multifaceted. Our perceptions of what disability means have evolved over the last century and they're still evolving – as demonstrated by these definitions:
- Impairment or Medical Perspective: This medical model of disability was articulated in the late 19th century. It views disability as a disease, disorder, medical condition or biological abnormality.
- Functional Limitations Perspective: Nearly a century later, the medical impairment approach expanded to consider disability in terms of a person's degree of functioning in daily life.
- Ecological
Perspective: First shaped in the 1970s, this approach gained popularity
in the 1990s as criticism of the previous models grew. It recognizes a person's
biological reality, but takes into account the limitations and restrictions
of the social and physical environment. The Quebec model, developed
by a team at Université Laval, further developed this concept, and says that
a disability can change or even disappear if the environment adapts to the
person.
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Many barriers affect quality of life for people with disabilities
Many Canadians with disability face barriers that prevent them from achieving
personal goals and fully participating in their communities—and their health
suffers for it:
- Lack of access to services:
14.6%
of people with disabilities report being able to access the health care
they need.
"We need to throw away the words ability and disability."
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- Isolation:
People with disabilities report lower levels of social support
and positive social interaction than people without disabilities.
- High unemployment:
Among people with disabilities, the employment rate
is 41% for men and 32% for women.
- Low income:
- Financial concerns are the main reason individuals cannot
obtain the assistive devices they need.
- Among urban Canadians, 36.1% of people with disabilities live in poverty,
compared to the average city resident poverty rate of 24.5%.
- In Ontario, people with disabilities make up 12.4% of the population, but
account for more than 20% of those who need the services of the Ontario Association
of Food Banks.
Beyond the label of disability
David Steen, CEO of the Society of Manitobans with Disabilities Alliance
and himself a person with a disability, wants to do away with what he considers
an artificial distinction between disability and ability.
"We need to throw away those words," he says. "We need to talk about characteristics of the individual on many dimensions along continuums, and recognize that we all have different abilities and different limitations."
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Disability is a possibility for all of us
Although people living with disabilities currently represent 12.4% of the Canadian population, our aging population, longer life expectancy and increased levels of chronic disease mean that disability is a distinct possibility for many more people than is currently the case.
Statistics Canada (2001) reports that:
- 3.6 million Canadians living in households reported having activity
limitations
- Disability increases with age: the disability rate among adults aged
15 to 24 was about 4%; this rose to 7.1% among people aged 25 to 44
and 16.7% among those 45 to 64 years of age
- Disability rate for people aged 65 and over is 40%.
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Moving to wellness
"Wellness is something that is unique to the individual," says David Steen, a theme which is reinforced by the work of Dr. Ivan Brown, Associate Professor in the Faculty of Social Work at the University of Toronto.
Dr. Brown has devoted much of his career to studying quality of life for people with a developmental disability. Before 1990, he says, "The thinking was, so long as people were well cared for, why wouldn't they be happy? But as we well know from people in nursing homes, that's not always the case. You need something that is meaningful to you, that is particularly enjoyable and of value before you can move toward that state which we call happiness."
Breaking down the barriers through inclusion
"People with a disability want to have health, however that's defined," says Dr. Hansen. "I think it's about making the most of your unique body and recognizing that there's always potential. And recognizing that people with disabilities have the same needs and wants and desires that any person without a disability would."
Inclusion is a health promotion strategy that seeks to break down the barriers
that have caused so many people with disabilities to lead what Dr. Hansen describes
as a parallel existence. Count
Me In! is an inclusion program that defines this relationship between inclusion
and health:
"An inclusive society is one that creates both the feeling and reality of belonging. Belonging makes us feel good. It makes us healthy. It makes us want to reach out to others. Belonging makes our communities healthy, too."
Building an inclusive society involves everyone
Promoting awareness to the community as a whole is a big part of health promotion for people with disabilities. As Community Development Officer at Winnipeg's Independent Living Resource Centre (ILRC), Heidi Hellsten devotes much attention to bridging the gaps in knowledge and understanding that can separate people with disabilities from the rest of their community.
The consumer-run ILRC promotes and enables people with disabilities to live as independently as possible. Programs like Peer Support and Life Skills Training provide consumers with opportunities to exchange ideas and information, build empowering relationships and develop abilities that support their independent living goals. For the wider community, ILRC offers Disability Awareness Resource Training (DART), a national program designed to promote the inclusion of people with disabilities in all aspects of life.
David Steen believes everyone has a part to play in reaching out. "The folks with disabilities also have the ability through the inclusion process to influence change and educate mainstream society as well. The more visible disability is, the more accepted it is, the more it creates a willingness on people's part to open their minds to other ways of seeing the world."
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This article was written by the 
