Michael Ashley Stein

Surviving polio in a post-polio world

Excitement mounts as the global health and international development communities anticipate a polio-free world. Despite substantial political and logistical hurdles, only 223 cases of wild poliovirus in three countries were reported in 2012. Down 99% from the estimated 350,000 annual cases in 125 countries in 1988-this decline signals the imminent global eradication of polio. However, elimination of new polio cases should not also signal an end to worldwide engagement with polio. As many as 20 million continue to live with the disabling consequences of the disease. In developed countries where polio immunization became universal after dissemination of the polio vaccine in the 1950s, almost all individuals who have had polio are now above age 50. But in many developing countries where polio vaccination campaigns reached large segments of the population only after 1988, millions disabled by polio are still children or young adults. Demographically, this group is also different. After three decades of immunization efforts, those children unvaccinated in the late 1980s were more likely to be from poorer rural and slum communities and to be girls-groups not only harder to reach than more affluent members of the population but also individuals who, if they contract polio, are less likely to have access to medical and rehabilitation programs or education, job training, employment and social support services. The commitment to eradicate polio should not be considered complete while those living with the disabling sequelae of polio continue to live in poor health, poverty and social isolation. This paper reviews what is currently known about disabled survivors of polio and highlights areas of need in public health research, policy and programming. Based on a literature review, discussion and field observations, we identify continuing challenges posed by polio and argue that the attention, funding and commitment now being directed towards eradication be shifted to provide for the rehabilitative, medical, educational and social needs of those for whom the disabling sequelae of polio will remain a daily challenge for decades to come.

Same Struggle, Different Difference: ADA Accommodations as Antidiscrimination

The Americans with Disabilities Act (ADA) was heralded as an emancipation proclamation for people with disabilities, one that would achieve their equality primarily through its reasonable accommodation requirements. Nevertheless, both legal commentators and Supreme Court Justices assert that the ADAs employment mandates distinguish the ADA from earlier antidiscrimination measures, most notably Title VII, because providing accommodations results in something more than equality for the disabled. The Article challenges this canonical belief by arguing that ADA-mandated accommodations are consistent with other antidiscrimination measures in that each remedies exclusion from employment opportunity by questioning the inherency of established workplace norms, and by engendering cost when altering those norms. It then places the ADA within historical context by illustrating how now-outdated social conventions about other workers with atypical biological identities, particularly women and African Americans, persist in keeping workers with disabilities from equal labor market participation. Finally, the Article demonstrates how ADA accommodation expenses are an appropriate and reasonable remedy, and explains why, for both economic and prudential reasons, disability-related accommodations must operate as antidiscrimination provisions (rather than as tax-and-spend subsidies) in order to alter social attitudes towards the disabled. The Article concludes with some thoughts on what extra-judicial factors could facilitate the ADAs transformative agenda.

Human Rights and Genetic Discrimination: Protecting Genomics’Promise For Public Health

We argue in this article for a much broader approach, an equality-based protection similar to the bans against race and sex discrimination. In doing so, we identify some problems that have made current prohibitions against disability discrimination less effective than was originally hoped, and we show that the prevailing approach to protection against genetic discrimination is subject to a similar weakness. In particular, we show that neither existing federal law banning disability discrimination nor proposed federal genetic discrimination law protects asymptomatic individuals with genetic anomalies who pursue prophylactic or mitigating measures. The diseases associated with these anomalies may never be expressed or, if expressed, may not manifest as unmitigatable functional impairments. Yet genetic anomalies may be used as proxies to disqualify their possessors from opportunity, as biological properties associated with race and female sex have been used in the past. We therefore advocate a novel civil rights paradigm that safeguards individuals from being discriminated against on the basis of genetic identity, as they now are protected from discrimination based on their identities in respect to race and sex.

Danger, danger! Evaluating the accessibility of Web-based emergency alert sign-ups in the northeastern United States

Abstract People with disabilities need access to emergency-related information at the same time that the general public receives that information. Many county and municipal-level governments suggest that citizens sign up on a Web page to receive emergency alert information. While the messages being sent out via e-mail or text message might be accessible, the sign-up processes are often inaccessible, preventing people with disabilities for signing up for these important information services. In this paper, all of the county-level emergency alert sign-ups in Massachusetts, New York, and Maryland, were evaluated for accessibility. A total of 156 evaluations took place (6 evaluations for each of the 26 counties evaluated). Of the 26 counties evaluated, 21 of them had accessibility violations. Legal, policy, and design-related implications are presented in the following discussion.

Employment, social capital and community participation among Israelis with disabilities

BACKGROUND Employment, social capital, and community participation have emerged in recent years as significant concepts for realizing the human rights of individuals with disabilities. Yet the theoretical interrelationship of these concepts remains largely overlooked, as does the empirical basis for understanding the underlying connections. OBJECTIVES This study explores the relationship between employment status, social capital, community participation, and well-being among Israelis with disabilities. It also explores the unique contribution of social capital to the well-being and integration of individuals with disabilities. METHOD 274 participants with self-reported disabilities completed a questionnaire containing measures of individual social capital, community participation, well-being, and background data. Correlation and Univariate analysis were used to compare scores between employed (n=131) and non-employed (n=143) participants, and logistic regression analysis was conducted to test the unique contribution of employment to social inclusion and well-being. RESULTS Employed participants reported significantly higher levels of social capital and were more integrated in leisure and civic activities than their non-employed counterparts. Moreover, employment status was found to have a significant contribution to the variance in the subjective well-being of participants. CONCLUSIONS By more fully understanding the importance of social capital for community inclusion, practitioners can better address the importance of network-building during the rehabilitation process as a means of promoting social and vocational integration.

Inheritance, poverty, and disability

Inheritance is a significant means of transferring wealth from one generation to the next, and therefore increasingly attracts attention from researchers and policy-makers working on intergenerational and multidimensional poverty. However, until now disabled persons have been overlooked in these discussions. This oversight is particularly unfortunate because, as a group, the estimated one billion people with disabilities (some 15% of the world’s population) are among the poorest and most marginalized of the global population. Over the past decade, a small but growing literature has examined the recursive connections between poverty and disability throughout the developing world. In this paper, we argue that disabled individuals are routinely denied inheritance rights in many low-income and middle-income countries, and that this is a significant and largely unrecognized contributor to their indigence. The denial of inheritance is both a social justice issue and a practice that can no longer be overlooked if disabled persons are to be brought into the development mainstream.

Self-Perception of Disability and Prospects for Employment Among U.S. Veterans

BACKGROUND Barriers to employment in the civilian labor force are increasingly difficult problems for returning veterans with disabilities. Reduced self-perception of disability status because of predominant military norms can be particularly harmful to reintegration efforts. OBJECTIVE We analyze rates of self-identified and externally determined disability status among U.S. veterans. Evidence of a lower self-report rate would confirm the hypothesis that armed forces culture might hold back truly deserving veterans from seeking the benefits owed, including specialized employment training programs. METHODS We use data from the Current Population Survey Veterans Supplement over the sample period 1995-2010 on disability status and associated demographic characteristics to present descriptive measures and limited statistical inference. RESULTS Over the entire sample period, federal agencies considered 29% of the survey respondents to have a service-connected disability versus a 9% self-identification rate. The rate of more severe service-connected disabilities has risen steadily, while less drastic disability rates have fallen. Non-white respondents and those with lower education levels were less likely to self-identify. CONCLUSIONS Large disparities in internal and external disability status identification raise questions about targeting soldiers re-entering the labor force. Employment policy should focus on overcoming negative cultural stereotypes and encouraging self-identification.

The Convention on the Rights of Persons With Disabilities: What Is at Stake for Physiatrists and the Patients We Serve

In 1945, in the aftermath of World War II, former First Lady Eleanor Roosevelt (and wife of our first president with a disability when elected) was appointed by President Harry Truman to chair the United Nation’s (UN) Human Rights Commission. By all accounts, she relished the experience and recognized the moral force that a Universal Declaration of Human Rights could have in establishing international norms. In 1948, the UN Assembly adopted the Declaration. What followed over the subsequent decades were a series of UN human rights treaties and conventions that called out and underscored that various vulnerable populations (such as children, women, racial minority groups) deserved human rights protections too. Whereas, a UN declaration was intended to be aspirational and not legally binding, such was not the case with a human rights convention or treaty [2]. In addition to being a commitment to the international community, a convention also would require appropriate oversight and monitoring and reporting of the signatory countries. Unfortunately, concerns about national sovereignty have often impeded U.S. Senate ratification of UN human rights conventions, including the Convention on the Elimination of All Forms of Discrimination against Women, the Convention on the Rights of the Child, and, more recently, the Convention on the Rights of Persons with Disabilities (CRPD) [3]. Attention to the rights of people with disabilities has gained traction since the 1970s, both in the United States and internationally. In 1971, the UN General Assembly adopted The Declaration on the Rights of Mentally Retarded Persons, followed 4 years later by The Declaration on the Rights of Disabled Persons [4]. A push for civil rights laws for people with disabilities in the United States began in the 1960s, which culminated in such landmark legislation as Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA) in 1990. Not surprisingly, those who helped to draft the ADA in the United States also became leaders in the international movement for disability civil rights and helped to craft the language for the UN CRPD. The document, whose stated purpose is “to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity” [5] was adopted by the UN in 2006 and has been ratified by 141 countries to date [4]. Despite being signed by President Obama in 2009, efforts to obtain the supermajority (two-thirds or 66 votes) needed for U.S. Senate ratification have thus far fallen short. The reasons for opposition include concerns that the CRPD will infringe on parental rights, endorse abortion rights, and compromise U.S. sovereignty. To learn more about these issues, please see the fact sheet prepared by the U.S. International Council on Disabilities that addresses these concerns (http://www.usicd.org/doc/CRPD%20MythsFacts%200719%202013.pdf).

Psychosocial adjustment of Israeli veterans with disabilities: Does employment status matter?

BACKGROUND Since its establishment in 1948, the state of Israel has been deeply committed to reintegrating veterans with disabilities into mainstream society. Prominently, the Israeli Ministry of Defences rehabilitation division provides veterans with disabilities with a wide array of benefits and services aimed at restoring their physical and psychosocial functioning, especially in the workplace. The focus on employment is motivated by a prevailing assumption among professionals that successful adjustment to disability is contingent on an individuals ability to reacquire normative occupational function. To date, however, this widely accepted wisdom has not been empirically scrutinized. OBJECTIVE To empirically explore whether employment status is associated to psychological, social, and behavioural adjustment attributes. METHODS One hundred and one employed veterans were compared to 111 non-employed veterans in respect to their self-reported levels of hope, acceptance of disability, social networks size and social participation patterns. RESULTS Employed veterans reported significantly higher levels psychological adjustment as manifested in elevated hope and acceptance of disability and lighter social network than their non-employed counterparts. However no differences were found between employed and non-employed veterans with respect to their social participation patterns. CONCLUSIONS The value of these findings, as well as wider implications for rehabilitation professionals and policy makers, is discussed.

Private Law and Social Inequality in the Industrial Age

INTRODUCTION LANDOWNERS, PEASANTS, AND LABOURERS HUSBANDS AND WIVES EMPLOYERS AND EMPLOYEES LANDLORDS AND TENANTS PRODUCERS AND CONSUMERS LIST OF CONTRIBUTORS INDEX