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Martha Ross and Nicole Bateman The Avenue A smaller share of people in their prime working years (25-54) are employed now than in decades past, and some have wondered whether disabilities and health problems have played a role in that decline. People with disabilities have much lower employment rates than people without disabilities, and disabilities are one of the most commonly cited reasons for not working. Moreover, a recent Brookings report identified particular subgroups among the out-of-work as having disproportionately high rates of disability. With that as context, we set out to better understand the role of geography and demography in patterns of disability among prime-age adults. Disability can take many forms, but the Centers for Disease Control provides a useful general definition: disability is any condition of the body or mind that makes it more difficult for the person with the condition to do certain activities and interact with the world around them. The onset of disability can also take many forms: it may present itself at birth, stem from an accident or injury, or result from a long-standing condition or disease, among other causes. Nine percent of adults aged 25 to 54, or 11 million Americans, reported at least one of six disabilities in 2016. Some patterns by place and demographics are already well-established: disability is disproportionately concentrated in the Southeast, Midwest and Appalachian areas (the so-called “disability belt”), and people with disabilities disproportionately include people with low levels of education and incomes. But analyses at the metropolitan level are less common, and given the regional nature of labor markets, regional-level data should inform efforts to help people with disabilities. This analysis uses data from the American Community Survey (ACS) to examine disability rates of the 100 largest metropolitan areas, as well as differences by education and race/ethnicity. We do not limit our analysis to those receiving disability benefits, but rather include all who report a disability, in order to provide a broad picture of those with disabilities in the United States and where they live. Metros show wide variation in disability rates Disability rates range considerably among the country’s 100 largest metropolitan areas, from just under 4 percent up to 13 percent. Places with the lowest disability rates have strong economies and well-educated populations, such as San Jose, Los Angeles, and San Francisco in California; Madison, Wisc.; Austin, Texas; and Washington, D.C. Metropolitan areas with the highest disability rates are located both within and outside of the disability belt. Some have historically manufacturing-based or industrial economies, such as Scranton, Pa.; Birmingham, Ala.; Toledo, Ohio; and Spokane, Wash. Others, like Tucson, Ariz.; Deltona, Fla.; and El Paso, Texas have large tourism or agricultural sectors that employ many workers with low levels of education. Disability by race/ethnicity varies within and between metros… At the national level, Native Americans have the highest disability rate among working-age adults (16 percent), followed by blacks (11 percent), whites (9 percent), Hispanics (7 percent), and Asians (4 percent). Yet disability rates by race and ethnicity also vary greatly among metro areas. As Figure 1 shows, Asians exhibit both low levels of disability and relatively small variation between places, ranging from 2 percent to 13 percent. Blacks and Hispanics both exhibit wider ranges, from the low single digits to about 20 percent. In most places, as at the national level, blacks have higher disability rates than whites, up to 2.5 times greater. In a number of metro areas, however (concentrated in Florida, North Carolina, and Connecticut), blacks have the same or lower disability rates than whites. Similarly, although Hispanics have lower disability rates than most other races/ethnicities at the national level, they are more likely to be disabled than whites and blacks in metro areas such as Spokane, Wash.; Springfield, Mass.; Deltona, Fla.; and Allentown and Pittsburgh in Pennsylvania. …but the differences by education are much larger Among the entire prime-age population in the United States, the disability rate among those with only a high school diploma is three times higher than among those with a bachelor’s degree (12 percent and 4 percent, respectively). In a number of places, however, that gap is even greater, particularly in formerly industrial metro areas in Ohio (Akron, Cincinnati, Columbus, Toledo, Youngstown), Pennsylvania (Scranton and Pittsburgh), and Massachusetts (Springfield and Worcester). In some ways, these data are not surprising. As noted above, people with disabilities have lower educational levels than people without disabilities, and education is a powerful predictor of health status in general. But the size of the gap is sobering and points to a complicated relationship between education and disability. Even in a post-ADA world, people with disabilities can face barriers to completing their education, and education is linked to overall health in myriad ways, including individual health knowledge and behaviors, access to health care, exposure to environmental toxins, and jobs that are more physically demanding or dangerous. Geography also interacts with education and disability. Low education is more strongly associated with disability in some regions than others, suggesting that education is one of a number of factors that influence local disability rates. But the relationship between disability and geography is long-standing: researchers have noted it for decades, suggesting the patterns have deep roots in industrial and sociocultural conditions. Our next post will dive deeper into employment trends among people with disabilities in their prime working years, with a continued focus on trends by race, education, and geography. Both job availability and demographics vary markedly around the country, requiring local leaders to craft employment and service interventions tailored to local needs. The authors thank Cecile Murray for her help conceptualizing and carrying out the data analysis for this blog. Disabilities are defined as having difficulties in the following areas: vision, hearing, the ability to walk or climb stairs, cognition (remembering, concentrating, or making decisions), self-care (dressing or bathing), and independent living (doing errands alone such as visiting a doctor’s office or shopping).
According to the Telegraph, the World Health Organization will change its definition of disabilities to classify people without a sexual partner as “infertile.” The controversial new classifications will make it so that heterosexual single men and women, as well as gay men and women who are seeking in vitro fertilization to have a child, will receive the same priority as couples. This could make access to public funds for IVF available to all. The move to extend the definition of a disability to include social conditions has, predictably, angered some who consider it overreach by a medical organization that sets global standards. Josephine Quintavalle, a pro-life activist and director of Comment on Reproductive Ethics told the Telegraph, “This absurd nonsense is not simply re-defining infertility but completely side-lining the biological process and significance of natural intercourse between a man and a woman.” The “natural intercourse” intercourse line is painful but expected. Quantaville took it a step further down the anti-science road by saying, “How long before babies are created and grown on request completely in the lab?” For the WHO’s Dr. David Adamson, one of the authors of the new standards, this move is about creating medical equality. He says, “The definition of infertility is now written in such a way that it includes the rights of all individuals to have a family, and that includes single men, single women, gay men, gay women.” Dr. Adamson adds that, “It puts a stake in the ground and says an individual’s got a right to reproduce whether or not they have a partner.” For countries with government provided healthcare and public funding for IVF procedures, this could have significant ramifications. “It fundamentally alters who should be included in this group and who should have access to healthcare. It sets an international legal standard. Countries are bound by it,” Adamson says. Under the American Disabilities Act, a person with a disability is defined as someone with “a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of such an impairment, or a person who is perceived by others as having such an impairment.” Because the ADA does not name all of the impairments that are covered, the new WHO guidelines could apply, or even be unnecessary. After all, having children is a major life activity for many people. The World Health Organization has still not made its new terms official but they seem to be moving forward. It remains to be seen what effects the move will have on individual countries’ health programs.