The risk of developing cardiovascular disease, rheumatoid arthritis, and many other chronic diseases increases with age, as does the likelihood of disability caused by these conditions. If these chronic conditions cannot be prevented, then the focus of medical care and support services should be on the prevention of associated conditions with the purpose of increasing the number of disability-free years in the lengthened life span.
Beyond the demonstrated need for a national disability prevention program, circumstances suggest that the beginning of the 1990s is an especially appropriate time to develop such a program. For example, two decades of efforts by disability-rights groups to increase public awareness paved the way for passage of the Americans with Disabilities Act, which bans discrimination in employment and the provision of services. This legislation affirms the goals of equal opportunity and independence for Americans with physical and mental disabilities and acknowledges the importance of their participation in the affairs of society. The act includes protection against discrimination on the basis of disability in public and private transportation, public accommodations, employment, telecommunications, and local and state government activities.
The Americans with Disabilities Act will have several beneficial effects. For example, the expected increase in the employment of people with disabling conditions should result in their enjoying higher standards of living and fuller integration into society; in addition, more individuals will have jobs commensurate with their skills and training and will receive employer-provided health benefits. Collectively, these effects should help reduce the incidence of many secondary conditions, including depression, that commonly result from discrimination and the social and economic barriers now encountered by people with disabling conditions.
Also cause for optimism in disability prevention efforts is research progress toward understanding the biological, behavioral, and environmental (physical and social) risk factors of disability. New understanding of risk factors can be translated into intervention strategies to prevent or mitigate developmental conditions, injuries, chronic diseases, and secondary conditions that increase the risk of disability. Moreover, accumulating experience shows that continuing deterioration of physical or mental health and increasing dependency need not be the outcomes of chronic diseases and functional limitations. Opportunities are increasing to reverse, interrupt, or at least slow the progression to disability, as well as to prevent the development of secondary conditions in people who already have a potentially disabling condition. A few advances in this area have been dramatic. For example, in 1990 researchers reported that administering the steroid methylprednisolone within eight hours of the occurrence of a spinal cord injury can significantly reduce the severity of resulting functional limitations (Bracken et al., 1990). Thus a person who once would have been fully paralyzed in