Brief Historical View of Disability and Related Legislation

Disability is not a new concept and not something that has emerged as a result of increasing numbers of people affected. Rather, disability is an ancient concept that has existed for as long as people have existed. Although disability has not changed, our views of the meaning of disability have changed over time-for the better.

Early Views of Disability

In the medieval era, disability was considered a punishment from God for one’s sin or misbehavior or that of one’s ancestors. Others over the centuries have viewed disability as the work of the devil. Disability was seen as a failure, deformity or defect of the individual. As a result of the myths about disability, people with disabilities were feared and often stigmatized, shunned, abused, or condemned. People with visible disabilities were even used for entertainment (e.g., court jesters or oddities in circuses and freak shows). Children and adults with severe disability were kept at home, isolated and hidden from public view. They were often denied what others received, including education, care, employment, and a place in the family or in society. They were considered “different” and their differences were viewed negatively. Disability was viewed as inability and those with disabilities were often viewed as a burden to their families and to society as a whole. In societies that required travel to escape danger or to obtain food, children and adults with disabilities were often abandoned. In some societies, adults and children with disabilities were forced to beg on the street for money because they had no other means of support or were pitied by others. Unfortunately, this still exists in some countries. Many persons with disabilities were powerless to do anything else and institutionalization was often the only option for those with disabilities to receive care and food.

People with disabilities have been considered sick or unhealthy. Being healthy and having a disability have been perceived as a contradiction in terms. Disability was seen as an issue blamed on the individual with a disability. Quality of life of individuals with disability was often seen---and still is by some---to be poor by others who have very negative views about disability, even though only an individual can determine the quality of life of his or her own life.

Changing Views about Disability

By the 1800s disability began to be viewed as an issue that had individual health and public health implications, as well as social and policy implications. Disability was seen as a medical problem due to disease, trauma, or other health conditions. This generally led to the medical model of disability, which viewed disability as an issue of the person with a disability. The goal of medical management was cure of the disabling condition or modification of behaviors of the individual with a disability. The medical model viewed physicians as the experts who knew what was best for those with disabilities. Those with disabilities were not seen as capable of knowing what they needed in the way of health care and other services.

More recently, disability has been viewed as a result of environmental and societal factors that serve as barriers to the ability of persons with disabilities to participate fully in their communities or families or to obtain the care and services they need. Individuals with disability, their families, and advocacy groups have viewed disability as a consequence of an inaccessible environment and rejected the medical model in favor of other models, such as the social and biopsychosocial models of disability that address barriers to health care from different perspectives.

Health Care for Persons with Disability

Policies and laws that extend back to 1857 have promoted the inclusion of individuals with disabilities in society. Many of the early policies and laws addressed employment or income

support, housing, and transportation rather than health and access to health care. Those federal agencies that addressed disability focused largely on its prevention, with little attention paid to the health of individuals with existing disabilities. Although not the first federal legislation to address disability, the Americans with Disabilities Act (ADA), was the first comprehensive civil rights law designed to prevent discrimination of people with disabilities in employment and access to public and private services. The ADA, signed into law on July 26, 1990, was enacted for inclusion and nondiscrimination based on disability in employment, government services, public accommodations including medical facilities, telecommunications, and other services, such as insurance. The ADA was amended in 2008 to ensure broad coverage of individuals who fit the definitions of the ADA of 1990. The overall purpose of the ADA is to provide a national mandate for the elimination of discrimination against persons with disabilities. Its goals are identified in Chart 1.