The scope of concern

Incidence of disability among minority populations. Race and ethnicity are among the factors that have "the strongest association with disability" (Smart & Smart, 1997, p. 13). Bradsher (1995) notes that, whether one is considering the overall disability rate in the United States, rates for people ages 15-64 (i.e., what is often considered "working age"), or rates of severe disability, African Americans and American Indians consistently have the highest rates of disability. Drawing on data from 1991-1992, Bradsher reports the following statistics:

TABLE 1
Percent of Americans with a disability/severe disability
1991-1992, by racial/ethnic group
[ Text version of Table 1 ]

	African American	American Indian	White	Hispanic Origin	Asian/Pacific Islanders
Percent with a disability	20	21.9	19.7	15.3	9.9
Percent with a disability, ages 15-64	20.8	26.9	17.7	16.9	9.6
Percent with a severe disability	12.2	9.8	9.4	8.4	4.9
Percent with a severe disability, ages 15-64	12.7	11.7	7.4	9.1	4.5

Source: Bradsher, J.E. (1995). Disability among racial and ethnic groups. Disability Statistics Abstract, 10, 1-4.

Bradsher also reports that women in each of these racial/ethnic groups, except for American Indians, have a higher rate of disability than men. However, when considering persons of working age, "there are no significant differences observed between disability rates for men and women aged 15-64, overall or within any racial/ethnic group" (p. 2).

Walker and Brown (1996), analyzing data from the National Center for Health Statistics, found African Americans and Hispanic Americans to be over-represented in all disability categories, including chronic health conditions; physical, sensory, and language impairments; and nervous and mental disorders. Similarly Walker et al. (1996), using data from the 1990 Federal census, report that although African Americans represent only 12.1 percent of the total U.S. population, they represent 14 percent of all persons with disabilities in this country. Among African Americans who have a disability, 71.8 percent have a severe disability, as opposed to only 52 percent of white Americans with a disability. In addition, 78.2 percent of African Americans with disabilities are unemployed or not working, and 41 percent are at or below poverty-level income. Among Hispanic Americans with a disability, 67.8 percent have a severe disability, and 27 percent live at or below poverty-level income.

Smart and Smart (1997) observe that "most Asians and Pacific Islanders do not fit the disability or socioeconomic profile of other minorities" (p. 10). However, recent immigrants, including Hmongs, Laotians, Vietnamese, and Cambodians, are exceptions; many of these are refugees and tend to be both poorer and less well educated than other Asians in the U.S. According to Leung (1996), "Asian Pacific Americans are the fastest growing population in the United States today, with the primary growth of the last decade due to immigration" (p. 2).

An examination of data on public health reveals similar disparities in risk rates between white and minority populations. For example, in announcing a new health initiative in 1998, the White House released the following statistics:

Infant mortality rates are twice as high for African Americans as for white Americans. African American men suffer from heart disease at nearly twice the rate of whites. African Americans are more likely to die from breast cancer and prostate cancer. Overall, cancer fatalities are disproportionately high among both Latinos and Blacks. And Hispanic rates for diabetes are twice the national average; Native American rates are three times the national average… Asian Americans suffer from Hepatitis B in greater numbers than other groups. Vietnamese women are five times as likely to have cervical cancer, Chinese Americans four to five times as likely to have liver cancer. (Brooks, 1998, p. 11)

It is likely that race or ethnicity is not the root cause for the higher incidence of disabilities and chronic or life-threatening health problems among minority groups, but rather "is fundamentally a measure of exposure to health risks" (LaVeist, 1996, p. 24). As Ficke (1992, quoted in Smart & Smart, 1997, p. 13) warns, "It is important to note that the issue of causality between… demographic factors and disability often cannot be determined at all from the data."

LaVeist (1996) concludes that "at the core of race-associated differences in health status are social and political factors" (p. 23). McNeil (1993, cited in Smart & Smart, 1997) found that, among adults aged 25 to 64, the incidence of severe disability was 22.8 percent among persons who did not complete high school, but among college graduates, the rate was only 3.2 percent. Smart and Smart report that "African Americans, Hispanics, and Native Americans are consistently found to lag behind the general U.S. population in the number of years of school completed… This is also true of some subgroups of Asians and Pacific Islanders" (p. 12). Similar statistics can be cited regarding income levels among minority populations. Education, income, and discrimination (which often results in disparities in employment, education, and income) may be more primary influences on disability than race or ethnicity per se.

Inequitable treatment of minority populations. As the National Council on Disability noted in its report to the President and Congress (Wright & Leung, 1993), "Many minority persons with disabilities face discrimination on the basis of both minority status and disability" (p. 2). Considerable evidence exists that people with disabilities who are African American, Hispanic, American Indian, or Asian Pacific American do not have the same opportunities for assistance, employment, or income as their white counterparts. Findings from Section 21 of the 1992 Amendments to the 1973 Rehabilitation Act (quoted in Flowers, Edwards, & Pusch, 1996), conclude that:

Patterns of inequitable treatment of minorities have been documented in all major junctures of the vocational process. As compared to White-Americans, a larger percentage of African-American applicants to the vocational rehabilitation system are denied acceptance. Of the applicants accepted for service, a larger percentage of African-American cases are closed without being rehabilitated. Minorities are provided less training than their white counterparts. Consistently, less money is spent on minorities than on their white counterparts. (p. 22)

These findings are supported by a series of studies conducted by the Howard University Research and Training Center for Access to Rehabilitation and Economic Opportunity (Walker & Brown, 1996; Walker, et al., 1996). One study found that "white clients tended to have more money spent on their program services than did any other group" (Walker & Brown, p. 31). Santiago, Villarruel, and Leahy (1996) conclude that "rehabilitation in the United States can be a very selective process whereby only individuals identified as being most likely to succeed are referred to, and participate in, services" (p. 11). Standards regarding who is "most likely to succeed" tend to be based on white, middle-class perspectives. For example, Locust and Lang (1996) describe an incident in which "an Indian man, dignified and proud of his long braids, was told that vocational rehabilitation services for him would not begin until he cut his hair" (p. 6). Smart and Smart (1992) describe a state rehabilitation program in which "Anglo clients are often asked if they would be willing to relocate in order to facilitate job placement, but Hispanic clients are routinely assumed to be unwilling to do so and, therefore, are not asked about the possibility of relocation" (p. 30).

LaVeist (1996) describes discriminatory treatment in medical care, noting that "several studies have demonstrated race differences in clinical diagnosis as well as race differences in the intensity of medical services provided for a similar diagnosis" (p. 26). Research on utilization of mental health services among minority populations reflects similar patterns of inequity. Ridley (1989, quoted in Leong, Wagner, & Tata, 1995; see also Mohr, 1998; and Yamashiro & Matsuoka, 1997) concludes:

Compared to White clients, ethnic minority clients are more likely to receive inaccurate diagnoses; be assigned to junior professionals, paraprofessionals, or nonprofessionals rather than senior professionals; receive low-cost, less preferred treatment consisting of minimal contact, medication, or custodial care rather than individual psychotherapy; be disproportionately represented in mental health facilities; show a much higher rate of premature termination; and have more unfavorable impressions regarding treatment. (pp. 417-418)

Leong, Wagner, and Tata (1995) further note that "African Americans are disproportionately hospitalized" even though "studies have found no racial differences in the prevalence of psychological disorders among African Americans." They conclude that "the misuse of hospitalization for African Americans is probably due to clinician bias and/or problems in misdiagnosis (e.g., African Americans are more likely to be misdiagnosed as experiencing schizophrenia)" (p. 418).

Minority populations — particularly African Americans and American Indians — also are underserved by the national network of independent living centers (ILCs) (Richards & Smith, 1992). In a survey of 32 independent living centers in six midwestern states (including Illinois and Michigan, states with substantial proportions of African Americans and other minority populations), Flowers, Edwards, and Pusch (1996) found that 58 percent reported having no plans or programs "focusing on outreach to culturally diverse consumers." Of those who did, only three ILCs stated that they "felt that their plans were effective" (p. 26). The centers reported serving more than 8,000 people in the preceding year. Of the approximately 4,600 for whom racial/ethnic demographic information was reported, 89 percent were listed as "Caucasian." African Americans, at seven percent, were the largest minority group served.

The ILC survey also found that fewer than 20 percent of the centers" administrative staff (which include clerical staff and office managers as well as executive and finance directors and other professionals) were identified as members of culturally diverse groups. Twenty-two percent of direct services staff were from "diverse cultural backgrounds," as were 12 percent of members of the centers" boards of directors.

In terms of employment, Leung (1993) reports:

The statistical data for Blacks with disabilities indicates that while they constitute 19% of all persons of working age with disabilities, they constitute just 8.6% of year round full-time workers with disabilities. Similarly, Bowe (1992) indicates that adults with disabilities of Hispanic origin constitute 7.5% of all persons of working age who have disabilities, yet they are just 5% of year round full-time workers with disabilities… James et al. (1993) utilizing data from the National Spinal Cord Injury Statistical Center, found that Black persons with SCI were less likely to be employed than their White counterparts. (p. 94)

Walker and Brown (1996) found that, in three of four major categories of disability, "African Americans had the highest proportion of persons who were not in the labor force. Hispanics were also hard hit by unemployment" (p. 30). The authors also found a "consistent tendency for minority persons across disability categories to be at the bottom of the economic ladder and for whites to be at the top" (p. 29). Seelman and Sweeney (1995), in discussing the fact that people with disabilities tend to have lower incomes than nondisabled people, observe that "White persons with disabilities are generally in the low income ranks ($18,000), but not as destitute as Hispanics ($12,000) or African Americans ($8,000), whose family income levels fall below the poverty index reported in the latest census ($12,091)" (p. 3).

Some studies indicate that collateral factors such as education and income may contribute to differential treatment. Santiago, Villarruel, and Leahy (1996) conducted a "pilot survey" of 124 disabled working-age Latino adults in 1990-91 and found that "respondents who were high school graduates had 4 times higher odds of receiving Michigan Rehabilitation Services (MRS) than respondents with less than high school degrees" (p. 15). Similarly, a study by the Howard University Research and Training Center found that "clients with higher education levels and more economic independence at program entry had higher weekly earnings at closure and had more services provided to them during the program" (Walker & Brown, 1996, p. 31). As noted earlier, it is important to keep in mind that minority populations, whether disabled or nondisabled, continue to face discrimination in both education and employment.

Although most of the data regarding the treatment of specific populations within the rehabilitation system focus on racial or ethnic minorities, there is some evidence that women suffer inequitable treatment as well. Westbrook, Legge, and Pennay (1995) conclude that:

Compared to men with disabilities women are more likely to be stigmatized, have poor self concepts, be unmarried, condemned for having children, left by their partners following disablement and denied access to education, employment, and financial assistance… Discrimination against women with disabilities is also apparent in health care. Research… has indicated that such women are less likely than men to receive rehabilitation. (p. 26)

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