Disability and Ableism 101

What are we talking about when we talk about disability and ableism? 

Disability: The World Health Organization defines disability as the interaction between someone’s state of health and their environment. They note that most people experience some form of disability in the course of their life [1]. This definition largely aligns with the popular social model of disability, which defines disability as a social failure to include those who are considered disabled [2]. 

Ableism: Ableism refers to the “stereotyping, prejudice, discrimination, and social oppression toward people with disabilities” [3]. Put differently, ableism views able-bodiedness and neurotypicality as the norm, and deviations from this norm as deficits that should be overcome [4]. Ableism is embedded in language. Scroll down to find resources on avoiding language that perpetuates disability bias.

Why do disability and ableism matter in healthcare?

Around 20-30% of Americans qualify as disabled [4,5]. However, ableism remains a pressing issue in health care. Throughout the literature, patients with disabilities report feeling discriminated against and dehumanized by health care professionals [4]. A study of lived experiences of ableism found that one of the main themes discussed by participants was negative experiences in health care–for example, having symptoms minimized or dismissed by health care providers. Ableism can also manifest as paternalism, or as an intolerance for treating patients with disabilities. Furthermore, patients with disabilities as well as other commonly stigmatized identities–including identities based on their gender, race, or body weight–report feeling the combined effects of these stigmas in health care [6].

Studies have found many health care professionals hold ableist beliefs. A 2021 survey of 714 U.S. physicians found that over 80% reported thinking people with significant disabilities have a lower quality of life than those without disabilities. In contrast, when asked, over half of people with significant disabilities report having a good or excellent quality of life [7]. Medical professionals’ bias can lead them to provide people with disabilities limited treatment options. They may also fail to recognize the impact of ableism. Less than half of physicians felt able to provide the same quality of care to disabled patients as to nondisabled patients. Simultaneously, the overwhelming plurality of physicians did not strongly agree that the health care system treats people with disabilities unfairly, revealing a lack of awareness that ableism is a pervasive issue [8]. Stigma surrounding disability, and a lack of awareness of ableism, creates negative health care experiences for people with disabilities. These negative experiences are reflected in many tangible health disparities that people with disabilities face, including less access to health services, less screening for preventable diseases, and worse outcomes in cases of cancer diagnoses [5].

What do we know about disability and ableism in medical and health professions education?

Medical and health professions education often neglects discussion of disability and reinforces ableism. One way that this ableism manifests is through messaging in curricula, such as the guidance to “sit less” to be healthy, when seated exercise is both possible and necessary for many people [9]. Authors have noted that DEI efforts in these educational settings tend to neglect disability; they have called for the integration of perspectives of disability into medical school curricula [5,6]. It’s also important to note that some ways of teaching about disability may in fact be harmful; for example, common activities like “disability simulations” can actually increase negative attitudes toward disability, distort the reality of living with disability, and ignore structural factors that influence experiences of disability. Other methods of teaching about ableism and barriers to care have been more effective at improving medical students’ understanding of disability [4]. 

Beyond ableism in the curriculum, students with disabilities are underrepresented in medical schools, with a 2019 study finding that only 4.6% of medical students identified as disabled. This underrepresentation is partly a result of the admissions process: some educational institutions have policies that prevent students from using accommodations when they apply [11]. Even when students with disabilities are admitted, they may face continuing challenges. A study of residents with disabilities found that many of them were scared to ask for accommodations, or had no clear guidelines for doing so [12]. Medical spaces can also be physically inaccessible, another barrier to inclusion for students with disabilities [5].

How does the Bias Checklist address disability and ableism in health professions education content?

The Bias Checklist first asks: 

  • “Does the content include any mention of disability, including physical or cognitive/intellectual disability?”

Mental health, substance use, and aging are addressed in separate domains, although these topics overlap and intersect with discussions of disability and you may choose to include them when responding to the questions in this domain.

If you answer no, you will be prompted to consider whether your content should mention disability and ableism. Like several of the domains, disability bias is in part promoted through omission: disability, although representing a wide slice of the human experience and affecting many people seeking healthcare, is often neglected in health professions education. As noted above, the fact many mental health concerns, as well as the experience of aging, involve disability is often ignored in our teaching. Furthermore, teaching about disability tends to focus solely on the disability and related health consequences, omitting discussion of preventive healthcare and sexual and reproductive health, and encouraging learners to assume that 

The Bias Checklist asks the following disability-related questions about content:

  • “Does the content include positive representations of disability (e.g., as typical human variation or diversity)?”

Below are some examples of common ways in which bias, shame, stereotype and stigma toward disability can manifest in health professions education content:

  • Failing to recognize that most people with disabilities regard their quality of life as comparable to those without disabilities, or assuming that people with disabilities' quality of life is not comparable to those without disabilities

  • Neglecting preventive health in patients with disabilities, perhaps because of assumptions that patients with disabilities are “already sick” and therefore prevention is less important

  • Omitting any discussion of sexual and reproductive health when teaching about disability

  • Using "us" and "them" language when talking about patients with disabilities (failing to recognize that many learners and colleagues may be disabled)

  • Using language that diminishes patients’ autonomy and individuality and forces a negative lens on their experience of disability (e.g., “wheelchair-bound

  • The use of negative simile and metaphor based upon disability (e.g., “He was blind to his own faults.”) 

  • Any comment about this subject that is meant to elicit laughter, including the use of cartoons

Last, the Checklist asks: 

  • “Could the content be perceived as promoting stereotypes, bias, shame or stigma?”

A note about language:

Person-first language: Many disabled people and disability rights advocates do not use person-first language. That said, we recognize that there are nuances, and we generally suggest person-first language when there is uncertainty. 

The following resources can provide guidance on using disability inclusive language:

  • Andrews E.E., Powell R.M. and Ayers K. The evolution of disability language: Choosing terms to describe disability. Disability and Health Journal. 2022 Jul;5(3):101328. Available online at: https://doi.org/10.1016/j.dhjo.2022.101328 →

What can we do to address this problem?

Where can I go to learn more? 

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Need a consultation?

The following people have identified themselves as experts in disability and health professions education and are willing to be contacted with questions regarding your content.

  • Margaret Turk, MD, Vice-Chair of Physical Medicine and Rehabilitation and SUNY Distinguished Service Professor, SUNY Upstate Medical University (email: turkm@upstate.edu)

  • Rebecca Garden, PhD, Associate Professor of Public Health and Preventive Medicine, SUNY Upstate Medical University (email: gardenr@upstate.edu)

  • Elizabeth Bowen, PhD, Assistant Professor of Bioethics and Humanities, SUNY Upstate Medical University (email: bowenel@upstate.edu)

Have something to add? 

Email us at biaschecklist@gmail.com with any of the following:

  • Recommendations for additional important content to include above, or suggested corrections or clarifications → use the subject header “Disability and Ableism 101 - Correction”

  • Suggestions for additional questions to add to the Bias Checklist → use the subject header “Disability and Ableism 101 - Checklist Question”

  • Suggestions for additional resources for learning more → use the subject header “Disability and Ableism 101 - Learn More”

  • Examples of curricular bias, including before and after versions of content → use the subject header “Disability and Ableism 101 - Example”

  • Your name, credentials, affiliation, area(s) of expertise, and brief biography or summary of qualifications if you are willing to serve as an expert consultant → use the subject header “Disability and Ableism 101 - Consultant”

References

  1. World Health Organization. (2023, March 7). Disability. Accessed September 14, 2023, from https://www.who.int/news-room/fact-sheets/detail/disability-and-health

  2. Beaudry, Jonas-Sébastien. (2016). Beyond (Models of) Disability. Journal of Medicine and Philosophy, 41(2), 210-228. https://doi.org/10.1093/jmp/jhv063

  3. Bogart, Kathleen, & Dunn, Dana S. (2019). Ableism Special Issue Introduction. Journal of Social Issues, 75(3), 650-664. https://doi.org/10.1111/josi.12354

  4. Borowsky, Hannah, et al. (2021). Disability and Ableism in Medicine. MedEdPORTAL, 17. https://doi.org/10.15766/mep_2374-8265.11073 

  5. Kaundinya, Trisha, & Schroth, Samantha. (2022). Dismantle Ableism, Accept Disability. Journal of Medical Education and Curricular Development, 9. https://doi.org/10.1177/238212052210766 

  6. Feldner, Heather A., et al. (2022). Infusing disability equity within rehabilitation education and practice. Frontiers in Rehabilitation Sciences, 3. https://doi.org/10.3389/fresc.2022.947592  

  7. Roy-O’Reilly, Meaghan. (2023). Stigma Associated With Requesting Accommodations–the High Cost of Ableism in Medicine. JAMA Network Open, 6(5). 10.1001/jamanetworkopen.2023.12131 

  8. Iezzoni, Lisa I., et al. (2021). Physicians’ Perceptions of People With Disability And Their Health Care. Health Affairs, 40(2), 297-306. https://doi.org/10.1377/hlthaff.2020.01452

  9. Faught, Emma, et al. (2022). Five ways to counter ableist messaging in medical education in the context of promoting healthy movement behaviors. Canadian Medical Education Journal, 13(5), 81-86. https://doi.org/10.36834/cmej.74119

  10. Janz, Heidi L. (2019). Ableism: the undiagnosed malady afflicting medicine. Canadian Medical Association Journal, 191(17), E478-E479. https://doi.org/10.1503/cmaj.180903 

  11. Meeks, Lisa, & Moreland, Christopher. (2021). How Should We Build Disability-Inclusive Medical School Admissions? Medicine and Society, 23(12), E987-E994. 10.1001/amajethics.2021.987

  12. Roy-O’Reilly, Meaghan, et al. (2023). Stigma Associated With Requesting Accommodations–the High Cost of Ableism in Medicine. JAMA Network Open, 6(5). 10.1001/jamanetworkopen.2023.12131 

Contributing writer(s)

Sophie Pollack-Milgate, BA

Margaret Turk, MD

Amy Caruso Brown, MD, MSc, MSCS

last updated January 29, 2024