The Surgeon General’s Call to Action to Improve the Health and Wellness of Persons with Disabilities
1973 Rehabilitation Act: A federal law that prohibits discrimination on the basis of disability in programs conducted by federal agencies (Section 504)), in programs receiving federal funding (Section 504), in federal employment (Section 501), and in the employment practices of federal contractors (Section 503). Section 508 of the Act requires federal electronic and information technology to be accessible to persons with disabilities. This means it must be able to be operated in a variety of ways and not rely on a single sense or ability of the user.
1999 Olmstead Decision: A decision by the U.S. Supreme Court that interpreted Title II of the Americans with Disabilities Act (ADA) and its implementing regulations to require states to administer services, programs, and activities "in the most integrated setting appropriate to the needs of qualified individuals with disabilities”, a setting that “enables individuals with disabilities to interact with persons with no disabilities to the fullest extent possible”. Settings may range from home or community-based settings to residential care settings (such as assisted living) to institutional settings. Paramount is the opportunity for persons with disabilities to participate in community life, including everyday life activities, such as family relations, social contacts, work, educational advancement, and cultural enrichment.
Accessibility: The degree to which an environment (physical, social, or attitudinal) makes appropriate accommodations to eliminate barriers or other impediments to equality of access to facilities, services, and the like, for persons with disabilities.
Activities of Daily Living (ADL): Basic tasks of everyday life or personal functional activities required for continued well-being, including eating or nutrition, mobility (such as walking and getting in and out of a chair or bed), and personal hygiene (such as bathing or showering, dressing, and using the toilet).
Adaptive or Assistive technology: Any item, piece of equipment, product, or system (whether off-the-shelf, modified, or customized) that is used to increase, maintain, or improve the functional capabilities of individuals with disabilities.
Americans with Disabilities Act of 1990 (ADA): A federal law (P.L. 101-226) that prohibits discrimination on the basis of disability in employment, in public accommodations, in commercial facilities, in transportation, in telecommunications, and by state, tribal, and local government. Under the act, persons with disabilities are to receive “reasonable accommodations”-adjustments or modifications provided by an employer-that enable each individual with a disability to enjoy equal employment opportunities. Accommodations vary based on the needs of the individual applicant or employee. Not all people with disabilities (or even all people with the same disability) will require the same accommodation; each must be accommodated based on his or her individual needs.
Attitudinal barrier: Negative viewpoints, behaviors, or actions by individuals or groups that limit another person’s ability to function in the environment, leading to the state of disability.
Attitudinal impediment: See Attitudinal barrier.
Behavioral factors: Individual responses or reactions to internal stimuli and external conditions. Social and physical environmental conditions and situations, many of which are not under an individual’s personal control, can exert a positive or negative effect on an individual or group.
Behavioral disorder: A condition characterized by displaying behaviors that significantly deviate from socially acceptable norms for the individual's age and situation over a long period of time. This term generally is used to avoid the stigma of the term “mental illness” when describing these conditions in children and youth.
Behavioral health: An integrated, interdisciplinary system of care related to mental health and substance use disorders that approaches individuals, families, and communities as a whole and addresses the interactions between psychological, biological, sociocultural, and environmental factors.
Behavioral Risk Factor Surveillance System (BRFSS): A national telephone survey conducted by the Centers for Disease Control and Prevention that monitors state-level prevalence of major behavioral risks among adults for death and disability. The survey collects these data to help plan, initiate, and evaluate federal and other health promotion and disease prevention programs.
Built environment: Any structures, spaces, and products that are created, modified, and used by people, such as buildings, parks, businesses, schools, and road systems.
Caregiver: An individual, not necessarily a family member, who provides assistance to another person who experiences limitations in activities of daily living (ADLs) or instrumental activities of daily living (IADLs), or both.
Chronic condition: Conditions lasting at least 3 months that, once acquired, currently are not able to be cured.
Chronic illnesses: See Chronic condition.
Cognitive impairment: A loss or abnormality in the various mental processes that underpin an individual’s ability to think or reason.
Cultural competence: The provision of services, supports, or other assistance in a manner responsive to and respectful of the beliefs, interpersonal styles, attitudes, languages, and behaviors of individuals receiving these services, supports, or assistance, and in a manner that has the greatest likelihood of ensuring their maximum participation.
Deinstitutionalization movement: An effort that began in the late 1950s to shift individuals with physical or mental illnesses or disabilities from institutional to community-based care settings.
Developmental disability: A severe, chronic disability of an individual attributable to a mental or physical impairment or combination of impairments that (a) manifests before the individual attains 22 years of age; (b) is likely to continue indefinitely; and (c) results in substantial functional limitations in three or more of the following areas of major life activity: self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living and economic self-sufficiency, and the continuous need for individually planned and coordinated services.
Direct cost: The economic cost incurred as a direct result of the presence of a disability.
Functioning: An umbrella term referring to an individual’s capacity related to body functions, activities, and participation in aspects of individual, family, and community life. It includes the positive aspects of the interaction between an individual and that individual’s environment.
Genetic predisposition: Susceptibility to a disease that is related to a genetic mutation, which might or might not result in actual development of the disease.
Health literacy: The ability to comprehend basic concepts and tasks related to health. Health literacy programs include information on how to read prescription labels, consent forms, and communicate effectively with health care providers.
HealthierUS Initiative: A White House initiative with the goal of helping Americans lead longer, better, and healthier lives by promoting physical activity, preventive screenings, balanced nutrition and healthy choices. Steps to a HealthierUS was established by the U.S. Department of Health and Human Services to advance the larger initiative. It targets public education and community-based grants to reduce the burden of diabetes, overweight, obesity, and asthma, and to address three related risk factors-physical inactivity, poor nutrition, and tobacco use.
Healthy People 2010: A decade-long set of national disease prevention and health promotion objectives for America designed to identify and respond to the most significant preventable threats to individual health. It provides a snapshot of the nation’s health at the beginning of the decade, establishes national goals and targets to be achieved within the decade, and monitors progress over time.
Instrumental Activities of Daily Living (IADL): Skills and abilities related to independent living related to home, work, and the social environment. In the home, this can include but is not limited to the ability to engage in such activities as preparing meals, managing money, shopping for groceries or personal items, performing light or heavy housework, and using a telephone without the need for assistance from others.
Impairment: A loss, abnormality, or deficit in body structure or physiological function (including mental functions). Abnormality refers to significant variation from a population mean within measured standard norms.
Indirect costs: The economic cost incurred collateral to, but not directly related to, the presence of a disability.
Institutional setting: A facility in which an individual lives, often on a long-term basis, to receive services, often for a particular health problem. Such settings stand in contrast to community settings, where services are available as part of the area or neighborhood in which one lives.
Intellectual disability: Once referred to as “mental retardation”, an impairment of thinking abilities that generally results in an intellectual quotient (IQ) equivalent that is two or more standard deviations below the average, or 70 or lower when the mean is 100. Intellectual disability often is a component of a developmental disability arising in an individual before he or she is 22 years of age.
Interdisciplinary: Collaboration involving two or more academic, scientific, or artistic disciplines working together toward a single purpose.
International Classification of Functioning, Disability, and Health (ICF): A classification of health, impairment, and disability created by the World Health Organization. The ICF is structured around three broad components: (1) body functions and structure; (2) activities (related to tasks and actions by an individual) and participation (involvement in a life situation); and (3) additional information on severity and environmental factors. Functioning and disability are viewed as a complex interaction between the medical condition of the individual and the contextual factors of the environment, as well as personal factors. The picture produced by this combination of factors and dimensions is of "the person in his or her world". The classification treats these dimensions as interactive and dynamic rather than linear or static. It allows for an assessment of the degree of disability, although it is not a measurement instrument. It is applicable to all people, whatever their medical condition. The language of the ICF emphasizes function rather than condition or disease. It also is designed to be relevant across cultures, as well as age groups and sex.
Major life activity: Activities an individual needs to be able to perform to function adequately during the conduct of daily life. These include self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living, and economic self-sufficiency.
Medical home: An approach to providing health care in a high-quality, cost-effective manner in which families and individuals receive health care from a physician they know and trust. When a child is the patient, the parents and physician partner to identify and access all the medical and nonmedical services needed to help the child and family achieve maximum potential.
Mental disorder: A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (for example, a painful symptom) or disability (that is, impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. In addition, this syndrome or pattern must not be a culturally sanctioned response to a particular event (for example, the death of a loved one). Whatever its cause, it must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual.
Mental illness: See Mental disorder.
New Freedom Initiative: A 2001 presidential initiative designed to help eliminate barriers to equality for many individuals with disabilities. Programs and proposals developed through the initiative are designed to (1) increase access to assistive and universally designed technologies; (2) expand educational opportunities; (3) promote homeownership; (4) integrate Americans with disabilities into the workforce; (5) expand transportation options; and (6) promote full access to community life.
National Health Interview Survey (NHIS): A multipurpose, questionnaire-based health survey conducted by the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) to provide national estimates for a broad range of health measures for the U.S. civilian adult noninstitutionalized population.
Noninstitutionalized population: The population of civilians who are not residing in institutions. Institutions include, but are not necessarily limited to correctional facilities, detention homes, and training schools for juvenile delinquents; homes for the aged and dependent (for example, nursing and convalescent homes); homes for dependent and neglected children; homes and schools for persons with mental or physical disabilities; and long-term and residential treatment centers.
People-first language: The practice of reshaping common language to refer to persons with disabilities in a manner that is more respectful and inclusive. By placing the “person” descriptor before the “condition” descriptor (for example, a woman who is deaf or a child with a developmental disability) people-first language recognizes that individuals with disabilities are-first and foremost-persons with inherent value, individuality, dignity, and capabilities.
Prevalence: The number of cases of a disease, number of infected persons, or number of persons with another quantifiable attribute at a particular point in time or during a particular period of time. Prevalence most often is expressed as a rate (for example, the prevalence of diabetes per 1,000 persons during a particular 12-month period).
Protective factor: Personal, family, and community elements that can improve a person’s response to an environmental hazard resulting in an adaptive outcome. Such factors do not necessarily foster normal development in the absence of risk factors, but they can help mitigate the influence of risk factors.
Quality of life: The relative degree of happiness and satisfaction with both one’s life and environment. It encompasses health, recreation, culture, rights, values, beliefs, aspirations, and the conditions that promote a life containing these elements. Health-related quality of life specifically refers to an individual’s sense of physical and mental health and well-being, and the ability to respond to the physical, social, and behavioral environment.
Rehabilitation: Comprehensive program to reduce or overcome deficits following injury or illness, or to assist the individual to attain an optimal level of mental and physical ability. Rehabilitation is seen as a process leading to recovery of capacity, albeit not necessarily at a level that preceded the illness or injury that led to the impairment.
Respite care: A short time of rest or relief for a person who acts as a caregiver for an individual with a disability. It allows the caregiver a break from day-to-day duties while the person with a disability receives care from another qualified individual or individuals. Such care can be provided in a home, community organization, or residential facility; for part of the day, evening, or overnight; by paid staff, volunteers, family, or friends; and occasionally or on a regular basis.
Secondary condition: Medical, social, emotional, family, or community problems that a person with a primary disabling condition likely experiences. Common secondary conditions include pressure sores, urinary tract infections, and depression; from a social perspective, such secondary conditions also can include decreased social participation and unemployment.
Secondary medical condition: See secondary condition.
Social Security Disability Insurance: A federal program, financed through Social Security taxes, providing wage replacement income for individuals with disabilities who also meet Social Security Administration disability rules. To be eligible, an individual (including disabled workers, widows, widowers, or children or adults disabled since childhood) must be unable to engage in any substantial gainful activity (SGA) due to any medically determinable physical or mental impairment(s) that can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. In addition to being unable to perform his or her previous work, the person cannot, considering age, education, and work experience, engage in any other kind of SGA in the national economy.
Substance use (or abuse) disorder: The misuse, dependence, and addiction to alcohol, or legal or illegal drugs, or both. The term encompasses a range of severity from “problem” through dependence and addiction.
Supplemental Security Income Program: A program, administered by the Social Security Administration (SSA) since 1972, that enables eligible persons of low income and few resources who also are 65 years of age or older, blind, or disabled to receive monthly benefit payments. To be eligible based on a disability, an individual must meet the SSA definition of disability: unable to engage in any "substantial gainful activity" (SGA) due to any medically determinable physical or mental impairment(s) that can be expected to result in death or that has lasted or can be expected to last for a continuous period of not less than 12 months.
Universal design: The creation of goods, products, and physical environments that are, to the greatest extent possible, both accessible and usable by all persons without the need for adaptation or specialized design.
1998 Workforce Investment Act: A law that offers a comprehensive range of workforce development activities through state, tribal, and local organizations. Available workforce development activities provided in local communities are intended to benefit job seekers, including persons with disabilities. The goal is to promote an increase in the employment, job retention, earnings, and occupational skills improvement by participants, thereby improving the quality of the workforce, reducing welfare dependency, and improving the productivity and competitiveness of the nation as a whole. Title IV of the act further reauthorizes programs under the Rehabilitation Act and links these programs to state, tribal, and local workforce development systems.
Last revised: January 10, 2007