Disability-based Discrimination Research Articles

Ableist microaggressions and psychological distress among adults with disabilities: The role of disability visibility.

Experiences of disability-based discrimination among adults with disabilities (AWD) span individual, interpersonal, and structural domains that are implicated in mental health disparities. Ableist microaggressions, a subtle and contemporary form of disability-based discrimination, are positively associated with psychological distress. Additionally, disability characteristics may impact mental health outcomes differently. This study investigated (a) the association between lifetime experiences of ableist microaggressions and psychological distress and (b) the moderating effect of disability visibility. A cross-sectional survey-based online study through Amazon's Mechanical Turk was conducted among 995 AWD whose ages ranged from 18 to 70 (M = 34.73, SD = 9.45). After adjusting for confounds linear regression analyses revealed a significant, positive relationship between ableist microaggressions and depressive, anxiety, and stress symptoms. Models explained approximately 18%-23% of the variance in psychological distress. Moderation analyses indicated that associations were stronger among participants with less visible disabilities. Findings underscore disability visibility as an important correlate in AWD mental health disparities. Results should be interpreted within the scope of the sampling procedures and sample demographics. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Unveiling affective disablism at work: a structural approach to microaggressions

Ableist microaggressions are ubiquitous experiences for workers with an impairment, chronic illness or neurodivergence in the daily execution of their job. These (un)intended everyday (non)verbal negative messages based on disability status affectively disable people, momentarily and with lasting effects on mental health and positive identity. Past research provided either psychological accounts, locating the origins of microaggression in the minds of individuals, failing to highlight the role of an ableist society, or sociological accounts, stressing exclusionary structures and marginalising discourses, neglecting to fully account for the inner experience. This paper puts forward an alternative, combined account by empirically zooming in on three vignettes in work contexts. It contributes to expanding knowledge on subtle forms of ableism, showing the entanglement between material arrangements, negative co-worker affect, and their internalisation by the disabled worker. By locating the microaggression concept firmly in the structural oppression of ableist societies, we hope to inspire organisational programs aimed at detecting and preventing microaggressions. Finally, we prepare the ground for future research to look into even more subtle forms of disability-based discrimination present in everyday interactions.

Impact of disability-based discrimination in healthcare on parents of children with medical complexity.

To qualitatively assess the impact of disability-based discrimination in healthcare on the parents of children with medical complexity (CMC). In this qualitative study, we conducted in-depth, semi-structured interviews with the parents of CMC. Data collection and analysis occurred iteratively; constant comparison methods were used to identify themes describing the impact of disability-based discrimination in pediatric healthcare on the parents of CMC. Thirty participants from 15 US states were interviewed. Four themes were developed regarding the impact of disability-based discrimination in healthcare on parents. The themes were: (1) discrimination leads to a loss of trust in healthcare providers; (2) discrimination increases the burden of caregiving; (3) discrimination impacts parental well-being; and (4) racism and poverty-based discrimination amplifies disability-based discrimination. The experience of discrimination toward their child results in loss of trust and therapeutic relationship between provider and parent, causes increased burden to the family, and contributes to decreased parental well-being. These experiences are magnified in minoritized families and in families perceived to have a lower socioeconomic status based on insurance type.

DISABILITY CHARACTERISTICS AND ABLEIST MICROAGGRESSION EXPERIENCES AMONG AGING ADULTS WITH DISABILITIES

Abstract People with disabilities (PWD) report experiencing overt and subtle interpersonal disability-based discrimination that is related to poorer functional and health outcomes. Moreover, associations between disability-based discrimination and mental and physical health outcomes are stronger among younger middle-aged than older adults. However, differences in this pattern across disability characteristics and mental health have not been explored. This study investigated associations between disability visibility, age, ableist microaggressions, and mental health symptoms among middle-aged and older adults with disabilities. Participants included 236 middle-aged and older adults recruited online using Amazon’s Mechanical Turk whose ages ranged from 45 to 70 (M=51.44; SD=5.68). Participants were largely non-Hispanic, white, female, employed full-time, graduate educated, and most reported a mobility/physical disability. Participants provided personal demographics and perceived disability visibility (visible, sometimes visible, not visible) and self-reported ableist microaggression experiences and mental health symptoms. A linear multiple regression model controlling for key demographics examined differences in the association between ableist microaggressions and mental health symptoms moderated by age and disability visibility. Results showed a main effect of microaggressions on mental health symptoms (b=.16, p=.044, f2=.02). An interaction effect was found between age and microaggressions (b=.02, p=.003) indicating that as age increased, the association between microaggressions and mental health symptoms increased as disability visibility decreased. Findings illustrate the importance of considering disability characteristics when evaluating subtle disability discrimination among aging adults. Disability discrimination impedes health outcomes and equity, and future research is needed to explore stigma-reduction interventions at local and policy levels.

Inclusive elections? The case of persons with disabilities in the European Union

ABSTRACT The Convention on the Rights of Persons with Disabilities (CRPD) clarifies that persons with disabilities have the right to participate in political life and enshrines their right to vote and stand as candidates in elections. This article evaluates compliance and current practices in the European Union, finding a great variety of implementation to facilitate the electoral participation of persons with disabilities. Despite CRPD ratification by all EU member states, inaccessibility of elections, lack of suitable information, removal of legal capacity, and other disability-based discrimination remain barriers to political participation. Nevertheless, there are increasingly good practices of inclusion by which legislators and election administrators can learn from each other. Based on the example of the EU, the judicial activism of disabled persons organisations in particular highlights the key role of civil society organisations and their cooperation with public authorities to make electoral processes more inclusive, alleviating political inequality overall.

Perceived Disability-Based Discrimination in Health Care for Children With Medical Complexity.

Disability-based discrimination in health care can lead to low quality of care, limited access to care, and negative health consequences. Yet, little is known regarding the experiences of disability-based discrimination in health care for children with medical complexity and disability. An understanding of disability-based discrimination in pediatrics is needed to drive change and improve care. We conducted in-depth, semistructured interviews with caregivers of children with medical complexity and disability. Participants were purposefully recruited through national advocacy and research networks. Interviews were conducted via video conferencing, recorded, and transcribed. Data collection and analysis occurred iteratively. An inductive thematic analysis approach with constant comparison methods was used to identify themes that form a conceptual framework of disability-based discrimination in health care. Thirty participants from diverse backgrounds were interviewed. Six themes emerged, forming a conceptual framework of disability-based discrimination in health care. Three themes described drivers of discrimination: lack of clinician knowledge, clinician apathy, and clinician assumptions. Three themes described manifestations of discrimination: limited accessibility to care, substandard care, and dehumanization. Children with medical complexity may face disability-based discrimination in health care. Themes describing the drivers and manifestations of discrimination offer a conceptual framework of disability-based discrimination. Understanding the drivers and acknowledging perceived manifestations can provide insight into improving patient care for children with disabilities.

Recalibrating Transplant Eligibility Criteria: Ensuring Equitable Access to Organ Transplantation for Intellectually Disabled Persons

The American with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act have made little progress towards preventing disability-based discrimination within the organ transplant evaluation process. Intellectual and developmental disabilities (I/DD) pose a unique problem for transplant teams and transplant physicians because I/DDs can simultaneously be a legitimate contraindication for transplantation and a mechanism for invidious discrimination against intellectually disabled persons. A culprit for ongoing disability-based discrimination is a transplant center's authority to develop its own eligibility criteria. While medical criteria for eligibility are generally well-settled, psychosocial criteria - an amorphous constellation of risk factors for post-transplant success - can serve as a facially neutral disguise for social worth determinations of individuals with I/DDs. Consequently, individuals with I/DDs are unjustifiably denied eligibility for organ transplantation and transplant-related services.This Article begins by identifying the pitfalls of current federal antidiscrimination legislation. It then discusses the foreseen benefits and drawbacks of House Resolution (H.R.) 8981, a recently proposed federal bill, that expressly prohibits disability-based discrimination within the organ transplant evaluation process. The Article ends by offering potential solutions for professional organizations and transplant centers that aim to provide for equitable access to organ transplantation and transplant-related services for intellectually disabled individuals.

Dismantling barriers and advancing disability-inclusive education: an examination of national laws and policies across 193 countries

ABSTRACT Disability-inclusive laws and policies – while not sufficient on their own to advance substantive equality – are an essential step that all countries can take to advance non-discrimination and equity in education for children and youth with disabilities. This is the first study to comprehensively review national law and policy guarantees in 193 countries to assess the extent to which countries have harmonized national laws and policies with international commitments to inclusive education articulated in the Convention on the Rights of Persons with Disabilities and the Sustainable Development Goals. While strong guarantees exist across diverse countries, we find that notable gaps remain. Forty-six percent of countries do not broadly prohibit disability-based discrimination through the completion of secondary education. Legislation in 35% of countries does not guarantee persons with disabilities access to integrated education in mainstream education environments along with necessary individualized accommodations through the completion of secondary school. Thirty-one percent of countries that make primary education compulsory do not pair compulsory education with guarantees to integration in mainstream education environments and individualized supports for students with disabilities. These findings can inform reforms in countries without national guarantees and bolster support for implementation in countries where strong legal guarantees to inclusive education already exist.

Protection or Restriction: An Analysis of the Blind Massage Policy for Employment Rights of Persons With Visual Impairments in China

Introduction The United Nations Committee on the Rights of Persons with Disabilities identified the Chinese blind massage policy as “reserved employment” in its Concluding Observations in 2012. In response, this paper reviewed the policy on blind massage in China and discussed its effectiveness and social impact. Methods: Adopting a historical perspective, this paper describes the development stages of the blind massage policy in China. It reveals the social construction process of the blind massage policy. Government data were provided to help analyze the positive and negative effects of the policy according to the United Nations’ Convention on the Rights of Persons with Disabilities. Results: The blind massage policy is a national strategy involving semi-reserved employment to improve the low employment rate of people with visual impairments in China. It promoted employment of people with visual impairments at the start, but, as the system of the blind massage gradually took shape, it restricted these individuals from choosing a career freely. The blind massage policy has resulted in deep-rooted social prejudices, and it demonstrates disability-based discrimination and charity-oriented practices. Discussion: The Chinese blind massage policy is discriminatory and does not reflect the modern concept of disability rights advocated in the United Nations’ Convention on the Rights of Persons with Disabilities. Implications for Practitioners: The Chinese government needs to promote institutional reforms to provide better education and employment for people with visual impairments to change the limited content of vocational training and eliminate discriminatory policies.

Mobile-Based Transportation Companies, Mandatory Arbitration, and the Americans with ‎Disabilities Act ‎

Uber, Lyft, DoorDash and similar mobile-based transportation network companies (TNCs) have ‎been involved in numerous legal battles in multiple jurisdictions. One contested issue concerns ‎TNCs’ use of mandatory (pre-dispute) arbitration clauses in their standard form service ‎agreements with both drivers and passengers. These arbitration clauses purport to obligate such ‎future plaintiffs to resolve any dispute with the defendant TNC outside of court and, typically, ‎on an individual rather than a class basis. In particular, TNCs have been increasingly litigating ‎disability-based discrimination claims brought against them and/or their drivers pursuant to the ‎Americans with Disabilities Act (ADA). These claims have largely arisen in two situations, ‎examined in this article. ‎ The first situation is where the plaintiffs have not downloaded or used the defendant TNC’s ‎mobile application due to the absence of accessible vehicles. These “potential passengers” have ‎brought discrimination claims against the defendant TNC in court for its failure to provide ‎accessible vehicles that they could use. TNCs in such cases have raised two main lines of ‎arguments: an ADA-based argument and an arbitration-based argument. The TNCs’ ADA-based ‎argument posits that the plaintiffs do not have standing to bring the discrimination claims under ‎the ADA since they had not in fact used the TNC’s mobile application and therefore have not ‎suffered the required “injury” to have standing under the Act. Where the plaintiff potential ‎passengers have been found to have such standing nonetheless, the TNCs have put forward an ‎alternative arbitration-based argument — that the plaintiffs should be bound by the arbitration ‎clause contained in the service agreement, which they did not sign, and that their claims should ‎therefore be referred to arbitration. ‎ The second situation in which disability-based discrimination claims under the ADA have been ‎brought against TNCs is where the plaintiffs downloaded the mobile application, agreed to the ‎terms of service, and used the ride-share services. These plaintiff passengers are then typically ‎obligated to argue their discrimination claims in arbitration in light of the arbitration clause ‎contained in the TNCs service agreement. Indeed, TNCs seem to prefer arbitration to litigation ‎in court, a preference that some have criticized as a strategy designed to prevent plaintiffs from ‎vindicating their legal rights. However, a recent arbitration decision rendered against Uber in an ‎ADA discrimination case discussed in this article illustrates that arbitration is able to provide ‎the same legal protection to plaintiffs’ rights as a court. ‎

Mobile-Based Transportation Companies, Mandatory Arbitration, and the Americans with Disabilities Act

Uber, Lyft, DoorDash and similar mobile-based transportation network companies (TNCs) have been involved in numerous legal battles in multiple jurisdictions. One contested issue concerns whether TNC drivers are employees or independent contractors. Uber recently lost this battle to some extent in the UK, but won it in California. Another issue concerns the TNCs’ use of mandatory (pre-dispute) arbitration clauses in their standard form service agreements with both drivers and passengers. These arbitration clauses purport to obligate such future plaintiffs to resolve any dispute with the defendant TNC outside of court and, typically, on an individual rather than a class basis. TNCs have had mixed success enforcing arbitration clauses contained in service agreements with their drivers under the Federal Arbitration Act (FAA). As for passengers, TNCs have been increasingly litigating disability-based discrimination claims brought against them and/or their drivers pursuant to the Americans with Disabilities Act (ADA). These claims have largely arisen in two situations.

Genetic and Disability Discrimination During COVID-19.

Genetic and Disability Discrimination During COVID-19.

Disability, Doctors and Dollars: Distinguishing the Three Faces of Reasonable Accommodation

Despite a decade of litigation, there is no consistent understanding of the reasonable accommodation requirement of Title I of the Americans with Disabilities Act of 1990 (the 'ADA'). Indeed, there are three inconsistent distributive outcomes that appear to comport with the reasonable accommodation requirement: cost-shifting, cost-sharing, and cost-avoidance. One reason for such inconsistent outcomes is a failure to develop a coherent and consistent theory of disability. Because disability has been and continues to be medicalized, this Article takes a fresh look at the medical literature on health, illness, and disability. It recommends the use of the experiential health model over the currently accepted functional health model to understand disability in the context of the ADA because it captures the contextual, socially-constructed, and political nature of disability. A second, related reason for inconsistent outcomes is an ambivalent attitude toward the costs of antidiscrimination law, often expressed as a tension between efficiency and rights. This Article examines disability-based discrimination in the workplace in this context, revealing the underlying tension between disability discrimination as a civil rights issue, and the view of disability discrimination as a social safety net issue. Using a theory of disability informed by an experiential definition of health and the distributive analysis to evaluate the three distributive outcomes demonstrates that, although flawed, cost-shifting is the best outcome because it embodies a social-experiential model of disability and the potential for both socioeconomic and political reconstruction.

Pathways of disability-based discrimination in cancer care

ABSTRACT Disabled people often report poorer health outcomes and increased barriers to accessing healthcare, compared to the general population. Our aim was to foreground lived experiences of disability-based discrimination, often indirect, and identify pathways through which this operates. We used a case study approach to explore the experiences of people with physical impairment accessing cancer services in England and Wales, from screening to therapy and follow-up, and investigated the complex and interacting nature of factors that affect their experiences. Participants described how they had to navigate a healthcare system that often was not responsive to their needs, leading to poor experiences of care. The barriers experienced by the participants operated at different levels. We identify three specific pathways through which discrimination is embodied: normativity expectations, lack of disability-awareness, and discontinuity of care. Our study is of particular importance to health professionals and policy makers, since there is limited evidence available on how people with physical impairment in the United Kingdom experience access to cancer care services. We argue that in order to advance the conversation on healthcare access for disabled people, it is important to reconceptualise the observed barriers as disability-based discrimination, reflective of broader structural processes, and to analyse in depth the pathways through which this discrimination operates.

Development of Law on Protection from Disability-Based Discrimination in Russia

Development of Law on Protection from Disability-Based Discrimination in Russia

Rethinking the Americans with Disabilities Act’s Insurance Safe Harbor

Despite the importance of access to healthcare for the disabled, the Americans with Disabilities Act (ADA) has made little inroads in reducing disability-based discrimination by health insurers in the United States. One reason is undoubtedly the ADA’s insurance safe harbor, which explicitly permits insurers to discriminate on the basis of disability in health insurance so long as the differential treatment is supported by actuarial data and is not just intended to disadvantage the disabled. While the safe harbor’s harms are somewhat limited by the advent of the Affordable Care Act (ACA), they are not entirely neutralized. This article argues that there are both practical and principled reasons for amending the ADA to remove the insurance safe harbor. Practically speaking, the ADA could prove a useful tool to challenge aspects of the ACA that place the disabled at a disadvantage, but the insurance safe harbor limits this reach in meaningful ways. From a more principled or philosophical lens, the insurance safe harbor is a law that perpetuates stigma against the disabled and that no longer reflects the views of American society. For these reasons, and many others, a rethinking of the ADA’s insurance safe harbor is necessary and timely.

Disability, perceived discrimination and political participation

Disability affects the lives of hundreds of millions across the world. People with disabilities often experience discrimination and unequal treatment. Sometimes the mere categorization of people into groups, that is, ‘healthy’ vs. ‘disabled’, is enough to trigger discriminatory behaviour against people with disabilities. Previous studies show that in general disabilities depress political participation. However, the effect of disability-based discrimination on participation has received little scholarly attention. We study how perceptions of discrimination affect three forms of political participation: voting; contacting politicians; and participating in demonstrations. Results show that disability decreases voting, especially when associated with perceptions of discrimination. The analysis points in the opposite direction when the other two forms of political participation are analysed. People with disabilities are more likely to partake in demonstrations and contact politicians than non-disabled. Thus, disability-based discrimination is not always a hindrance to participation. It sometimes further motivates people with disabilities to participate.

Discrimination and sleep quality among older US adults: the mediating role of psychological distress

ObjectiveTo examine the association between everyday discrimination and sleep quality and identify mediating pathways between discrimination and sleep quality. DesignLongitudinal. SettingHealth and Retirement Study (HRS). ParticipantsParticipants (N = 9223, mean age 66.7 years, 12.8 years of education; 85% White, 12% African American, and 3% another race or ethnicity) who participated in 2006, 2008, 2010, and 2012. MeasurementsAt each assessment, participants completed measures of everyday discrimination, lifetime discrimination, attributions of discrimination, depressive symptoms, anxiety symptoms, sleep quality, and non-restfulness. ResultsMore experiences with everyday discrimination were associated with worse sleep quality (β = 0.048, SE = 0.009, P < .01). When psychological distress was added to this model, the direct effect was lower in both magnitude and significance (β = 0.029, SE = 0.011, P < .05), which indicated partial mediation. Psychological distress also fully mediated the relation between everyday discrimination and non-restfulness (direct effect: β = −0.003, SE = 0.010, ns). Individuals who experienced physical disability-based discrimination had worse sleep quality than those who did not experience this form of discrimination (β = 0.114, SE = 0.029, P < .01); psychological distress fully mediated this relation (direct effect: β = −0.025, SE = 0.031, ns). Among individuals with obesity, psychological distress fully mediated the relation between weight discrimination and sleep quality (direct effect: β = 0.036, SE = 0.025, ns), and partially mediated the relation between weight discrimination and non-restfulness (direct effect: β = 0.049, SE = 0.025, P < .05). ConclusionsEveryday discrimination and discrimination based specifically on weight or a physical disability were associated with worse sleep quality. The findings suggest that psychological distress may be one pathway through which these experiences are associated with worse sleep.

Sexual and reproductive health services for women with disability: a qualitative study with service providers in the Philippines.

BackgroundThe Philippines has ratified the United Nations Convention on the Rights of Persons with Disabilities and recently passed domestic legislation protecting the sexual and reproductive rights of people with disability. However women in the Philippines continue to report barriers to sexual and reproductive health services, and there is limited empirical evidence available to inform policy makers’ efforts to respond. This study aims to contribute to the available evidence by examining service providers’ perceptions of disability and their experiences providing sexual and reproductive health services to women with disability.MethodsThe study was conducted as part of a larger three-year program of participatory action research that aims to improve the sexual and reproductive health of women with disabilities in the Philippines. Fourteen in-depth interviews and two focus group discussions were conducted with a total of thirty-two sexual and reproductive health service providers in Quezon City and Ligao. Qualitative data were analysed to identify key themes in participants’ discussion of service provision to women with disability.ResultsAnalysis of service providers’ accounts suggests a range of factors undermine provision of high quality sexual and reproductive health services to women with disability. Service providers often have limited awareness of the sexual and reproductive health needs of women with disability and inadequate understanding of their rights. Service providers have had very little training in relation to disability, and limited access to the resources that would enable them to provide a disability inclusive service. Some service providers hold prejudiced attitudes towards women with disability seeking sexual and reproductive health services, resulting in disability-based discrimination. Service providers are also often unaware of specific factors undermining the health of women with disability, such as violence and abuse.ConclusionRecent legislative change in the Philippines opens a window of opportunity to strengthen sexual and reproductive health service provision across the country. However the development of services that are disability-inclusive will require substantial efforts to address supply-side barriers such as prejudiced service provider attitudes and limited capacity. Disability inclusion must be prioritised for the national goal of responsible parenthood and reproductive health to be realised for all.

Querying the Call to Introduce Mental Capacity Testing to Mental Health Law: Does the Doctrine of Necessity Provide an Alternative?

Trends in international human rights law have challenged States globally to rethink involuntary mental health interventions from a non-discrimination perspective. The United Nations Convention on the Rights of Persons with Disabilities (CRPD) in particular prohibits laws that discriminate on the basis of disability. However, a key criterion for compulsory mental health treatment under typical mental health legislation is a psychiatric diagnosis (in conjunction with risk of harm and other criteria). Hence, for people with mental health disabilities, rights to liberty and consent in healthcare are held to a different standard compared to other citizens. A prominent law reform option being explored by some governments and commentators for achieving non-discrimination is to replace the diagnostic criterion for triggering involuntary intervention with an assessment of mental capacity. After all, every citizen is subject to restrictions on autonomy where they are deemed to lack mental capacity, such as where concussion necessitates emergency service. However, the use of mental capacity “testing” is seen by diverse commentators as wanting in key respects. A prominent criticism comes from the United Nations Committee on the Rights of Persons with Disabilities, which considers mental capacity assessments a form of disability-based discrimination. This article queries the call to replace the diagnostic criterion in mental health law with an assessment of mental capacity in the light of jurisprudence on equality and non-discrimination in international human rights law. Instead, we examine the doctrine of necessity as an area of law, which might help identify specific thresholds for overriding autonomy in emergency circumstances that can be codified in a non-discriminatory way. We also consider the need for deliberative law reform processes to identify such measures, and we suggest interim, short-term measures for creating a “supported decision-making regime” in the mental health context. The article focuses in particular on the Australian context of mental health law reform, though the analysis can be generalised to international trends in mental health law.