Do poverty and disability imply poor health?

Objective: To identify the barriers to maintaining good health among impoverished or low-income adults with physical disabilities.

Methods: Using a cross-sectional study design, we conducted city-wide face-to-face interviews with 91 low-income working-age adults with a physical disability who required the use of an assistive device and lived in an apartment or house in Washington, DC. A mixed-method approach was used to examine the accessibility of living environments, health status, functional capacity, and unmetneeds for health and social services.

Results: The majority of participants were African American (93%), reporting an average monthly income of $722, paralysis (22%) as their primary disability and wheelchair (41%) as their primary ambulatory equipment. All participants needed assistance (e.g., person, equipment, or both) to perform daily activities. Chronic conditions, such as diabetes (68%) and high blood pressure (63%), were also prevalent. Although nearly 40% of the participants lived in publicly funded housing, over one-third participants rated “poor” on the accessibility of their housing, and 47% rated their neighborhoods being ‘somewhat,' ‘slightly,' or ‘not at all' safe. Inaccessible and unreliable public transportation, limited insurance coverage, and lack of knowledge on available services were main reasons for not receiving needed health care and social services.

Conclusions: Low-income adults with physical disabilities often have competing needs and challenges that prevent them from receiving timely health care and social services. Cost-effective interventions, such as enhancing their knowledge and skills in navigating the systems, are needed to reduce barriers and improve the health and quality of life of this vulnerable population.