You’re at a clinic with a friend who uses a wheelchair. The nurse looks at you and asks how he’s been feeling. Not at him. At you. He answers anyway, and she writes it down while still facing you.
Then the exam. The table is fixed at one height, and it isn’t his height, so he gets examined sitting in his chair. Parts of the exam don’t happen. Nobody weighs him, because the scale has a step. His chart will record that his weight wasn’t obtained. It will probably say the same thing next year.
Nothing in that appointment was caused by his spinal cord injury. All of it was caused by the furniture, the equipment, and a habit the nurse almost certainly doesn’t know she has.
More than a quarter of American adults have a disability. That’s a quarter of the people you work with, serve, treat and live next to, and most of what makes their day harder can be fixed by somebody who decides to fix it.
More than 1 in 4 adults, and no single population
The Centers for Disease Control and Prevention states it plainly: “More than 1 in 4 adults (28.7%) in the United States have some type of disability.”
CDC defines a disability as any condition of the body or mind that makes it harder to do certain activities and to interact with the world. That definition comes out of a World Health Organization model with three parts, and the parts are worth separating, because people collapse them constantly.
Impairment is something about how a body structure or a mental function works. A spinal cord that stops transmitting signals below a certain point. A retina that doesn’t process light.
Activity limitation is the difficulty that follows: trouble seeing, hearing, walking, or working through a problem.
Participation restriction is the part people skip. It’s being shut out of ordinary life: holding a job, seeing friends, getting health care. That third dimension is the one the environment controls almost entirely.
The shape of this population isn’t what most people picture, either. Run CDC’s figures for U.S. adults and the largest single category is cognition, at 13.9 percent, ahead of mobility at 12.2 percent. The two sensory categories are smaller than people assume: hearing at 6.2 percent, vision at 5.5 percent. Two more categories describe consequences rather than functions, which is a useful distinction to hold onto. Difficulty living independently affects 7.7 percent of adults, and difficulty with self-care affects 3.6 percent. The mental image most people hold, a wheelchair, is real and common, and it isn’t the largest category. Most disability is invisible to a stranger in a hallway.
Disability also arrives by many routes. CDC describes conditions present at birth, conditions that become apparent during childhood, injuries such as traumatic brain or spinal cord injury, and long-standing conditions like diabetes that can cost someone vision, nerve function or a limb. It can be progressive, static or intermittent. That last word carries weight. Some people need a cane on Tuesday and not on Friday, and get accused of faking on both days.
CDC itself makes the point this whole article rests on: “Two people with the same type of disability can be affected in very different ways.” Same diagnosis, different income, different housing, different employer, different transit system, different family, and the result is a different life. Treating people with disabilities as one group with one set of needs is the first mistake, and it’s the one that produces accommodations nobody asked for while the useful ones go unbuilt.
The medical model and the social model, without the jargon
Two explanations for why life is harder have been arguing with each other for decades, and you can understand both in a paragraph each.
The medical model locates the problem inside the person. A body doesn’t work the way bodies typically work, and the response is treatment, correction, therapy, cure. Under this view, disability is a health condition and the expert is the clinician.
The social model locates the problem in the fit. A body exists. A world was built assuming a narrow range of bodies. The difficulty lives in the gap between the two. Under this view, stairs disable a wheelchair user and a ramp stops disabling them, and the expert is the person living it.
Arguments between the two camps are less interesting than they sound, because both describe something real. Pain is real, and treating it helps. Progressive conditions are real, and medicine changes their course. At the same time, a ramp does more for someone’s Tuesday than another round of therapy, and no amount of therapy turns a 1940s staircase into something a wheelchair can use. The honest position is that bodies and buildings both matter, and that American public life has spent far more effort on the first than the second.
The World Health Organization’s framework holds both. Its International Classification of Functioning, Disability and Health, endorsed by 191 member states in May 2001, includes a list of environmental factors precisely because functioning happens somewhere rather than in the abstract.
CDC says something similar when it describes what shapes whether people take part in daily life: social, political and cultural expectations, the built and natural surroundings, whether assistive technology is available, and whether family and community show up. Three of those four are controlled by other people.
Access is a design decision, and it helps far more people than it was built for
The most underrated fact about accessibility is that it leaks.
Curb cuts were fought for by wheelchair users. Now they’re used by anyone pushing a stroller, pulling a suitcase, delivering a keg, riding a scooter, or walking on a sprained ankle. Nobody counts that, because convenience goes invisible once it exists.
Captions were built for deaf and hard-of-hearing viewers. They’re now used by people in noisy bars, people in quiet offices without headphones, people learning English, and people who simply retain more when they read along.
Plain-language documents were pushed by advocates for people with intellectual and cognitive disabilities. They’re easier for everyone, especially at 11 p.m. after a long day, or in the second language you happen to speak at the doctor’s office.
Flexible scheduling started as a disability accommodation. It now keeps shift workers, parents, people with migraine, people recovering from surgery and people with long-term illness attached to their jobs.
This has a practical use. If you run a meeting, a shop, a clinic or a website, every accessibility decision you make serves a larger group than the one that prompted it. The business case and the civil rights case point the same direction, which is unusual enough to be worth using when you’re asking someone to spend money.
Accessible health information is a subject with its own standards and its own article in this library, so treat this as a pointer rather than a full treatment.
Health care is where the gap gets concrete
This is the sharpest example, and it’s well documented.
Start with attitudes. In 2021, Lisa Iezzoni and colleagues published a survey of 714 practicing U.S. physicians in Health Affairs. 82.4 percent reported believing that people with significant disability have a worse quality of life than people without disability. Only 40.7 percent said they were very confident they could deliver the same quality of care to a patient with a disability. Just 56.5 percent strongly agreed that they welcomed such patients into their practices. And only 18.1 percent strongly agreed that the health care system often treats these patients unfairly.
Hold the first and last findings next to each other. Most physicians surveyed thought these patients’ lives were worse, and fewer than one in five thought the system treats them unfairly. That combination has consequences in exam rooms.
Then the equipment. In a 2019 study in Archives of Physical Medicine and Rehabilitation, Nicole Agaronnik and colleagues interviewed 20 physicians across five specialties in Massachusetts. Fourteen of their practices had a height-adjustable exam table. Seven had a wheelchair-accessible weight scale. Some physicians who did have the accessible table still examined patients seated in their wheelchairs, because a transfer takes time and staff and the schedule doesn’t allow for it. The authors say clearly that 20 physicians in one state can’t speak for the country. The pattern will still be familiar to anyone who has lived it.
This is the mechanism that surprises people. The U.S. Access Board, working with the Food and Drug Administration, issued accessibility standards for medical diagnostic equipment in January 2017, covering exam tables and chairs, weight scales, and radiological and mammography equipment, with specifications for things like transfer surfaces, support rails and armrests. A further final rule in July 2024 dealt with low transfer heights. But the Board’s standards aren’t themselves binding on providers or manufacturers. They only become enforceable when another agency adopts them. That’s why the Department of Health and Human Services matters here. Its Office for Civil Rights issued a final rule on May 1, 2024, under Section 504 of the Rehabilitation Act, adding enforceable standards for accessible medical diagnostic equipment in programs that receive HHS funding, along with provisions on discrimination in medical treatment and on accessible websites and mobile apps.
Time is the third gap. CDC tells providers to plan for extra time during an examination when it’s needed, and to take the time a patient’s care requires. Scheduling software rarely agrees. A fifteen-minute slot built around a patient who can undress, climb onto a table and dress again is not fifteen minutes for everyone, and the person who runs over is the one who gets rushed.
Then there’s the habit from the top of this article. CDC instructs providers to communicate clearly and directly with the patient. The reflex to address the companion instead is common, unconscious and corrosive, and it teaches patients that their own appointment is a conversation about them rather than with them.
The Americans with Disabilities Act has concrete rules here too. Under the guidance published at ADA.gov, covered entities can’t require someone to bring their own interpreter. A companion may interpret only in narrow situations: in an emergency when no qualified interpreter is available, or in a non-emergency when the person asks for it and the accompanying adult agrees. Minor children may not interpret in non-emergencies at all. And a companion can’t interpret when their impartiality is in doubt, which is a polite way of describing a family member with strong opinions about the treatment.
Language, and why people disagree about it
Two conventions exist. Both are correct.
People-first language says “a person with a disability.” It was adopted to put the human ahead of the condition, and it’s standard in most medical, government and educational settings.
Identity-first language says “a disabled person,” “an autistic person,” “a Deaf person.” Many autistic people, many Deaf people, and many blind and physically disabled advocates prefer it, on the grounds that a disability isn’t a detachable accessory and that tiptoeing around the word implies the word is shameful.
Communities differ on this. Individuals inside those communities differ too. Neither convention is a trap, and nobody reading this needs a lecture about which one wins. If you know what a person uses, use it. If you don’t, use what they use about themselves, or ask once, briefly, and then get on with the conversation.
A few terms have fallen out of use, and it’s more useful to know why than to memorize a list. “Wheelchair-bound” and “confined to a wheelchair” describe a wheelchair as a cage, when for the person using it the chair is the thing that ends confinement. “Special needs” was coined as a kindness and names nothing in particular: a ramp isn’t a special need, it’s a door. “Differently abled” is a euphemism that wasn’t requested by the people it describes, and reaching for a euphemism implies there was something to soften.
Two more habits are worth dropping. Nobody is their diagnosis. A person has epilepsy. A person is not an epileptic case, a bed number, or “the stroke in room four.”
And skip the inspiration framing. Going to work, raising kids, finishing a degree and buying groceries are not feats of heroism when a disabled person does them. Calling ordinary life “overcoming” tells the person you expected less of them, and it reassigns a structural problem to individual grit. The ramp wasn’t inspiring. Somebody just built it.
How to be useful, in practice
Six habits cover most situations.
Ask before you help. A wheelchair is part of someone’s body in motion. Grabbing the handles of a moving chair is closer to grabbing an arm than to holding a door. The same goes for taking someone’s elbow, moving a cane, or reorganizing a desk you think is laid out wrong.
Ask how, not whether to guess. If help is wanted, the person knows the method, and the method is often not the obvious one. “How do you want to do this?” takes three seconds and prevents the particular awkwardness of being helped badly.
Accept no. A declined offer isn’t stubbornness and doesn’t need a second attempt. People refuse help because they’ve got a system, because your method would hurt, or because they’d rather take four minutes than explain themselves. All of those are complete answers.
Talk to the person. If someone has a companion, an aide or an interpreter, keep your eyes and your questions on the person you’re talking to. This is the single most common error, and it’s the easiest to stop making.
Don’t audit a disability you can’t see. Fatigue, pain, cognitive and sensory conditions, and anything intermittent all generate suspicion from strangers. You aren’t the verification office. A person who parks in an accessible space and walks away from the car may simply not be able to walk the extra two hundred feet.
Fix the thing instead of apologizing for it. “Sorry, we’re not really set up for that” is where most access conversations die. The alternative is to ask what would work, write it down, and change it before the next person arrives.
When something needs a clinician rather than an adjustment
Access problems and medical problems get confused with each other, which is why some genuinely urgent things get filed as inconveniences. These are reasons to call rather than wait.
- A change in function that arrives over days or weeks rather than years. New weakness, new numbness, a change in speech, vision or balance. Sudden one-sided weakness or sudden trouble speaking is a 911 call, not an appointment.
- Redness or broken skin over a bony area in someone who sits or lies in one position for long stretches. That’s a wound, not a bruise, and the early stage is the cheap one to treat.
- New pain or sores coming from a device: a wheelchair cushion, a prosthesis, a brace, a hearing aid. Fitting problems have people whose job is fitting.
- Mood. Adults with disabilities face real barriers to mental health care, and a low mood often gets waved through as understandable. Persistent hopelessness is a reason to be seen, not a reasonable reaction to be endured. CDC suggests asking a primary care clinician for a referral to a psychologist, social worker or counselor, and points people toward Centers for Independent Living and disability organizations for peer support. For a mental health crisis, call or text 988 (the 988 Suicide and Crisis Lifeline). For an emergency, call 911.
There’s also a non-clinical version. If you ask a clinic in writing for an accommodation and get refused or ignored, that’s a civil rights question rather than a customer service one. The Office for Civil Rights at HHS enforces Section 504 for programs that receive HHS funding.
Where to start
Ask, then do what you’re told.
That’s the entire protocol for one person dealing with another. The person in front of you is the expert on their own body, their own equipment and their own day, and the most common failure is a confident guess made with good intentions.
If you control something, change the something. A clinic can buy one height-adjustable table and one roll-on scale. A manager can put “we can be flexible on scheduling” in a job posting. A website owner can turn on captions this month. A receptionist can look at the patient instead of the person standing behind them. None of this requires a committee, and each change removes a barrier for far more people than the one who prompted it.
Home modification for aging, cultural and language access, and the readability of health documents each belong to their own articles here. This one was about the two things that do most of the damage: the building, and the assumption.
Sources
- Centers for Disease Control and Prevention. “Disability and Health Overview.” cdc.gov
- Centers for Disease Control and Prevention. “Disability Impacts All of Us (infographic).” cdc.gov
- Centers for Disease Control and Prevention. “Disability and Health Information for Health Care Providers.” cdc.gov
- Centers for Disease Control and Prevention. “Information for People with Disabilities.” cdc.gov
- Centers for Disease Control and Prevention. “Disability Inclusion.” cdc.gov
- U.S. Department of Justice, ADA.gov. “ADA Requirements: Effective Communication.” ada.gov
- U.S. Access Board. “Medical Diagnostic Equipment Accessibility Standards.” access-board.gov
- U.S. Department of Health and Human Services, Office for Civil Rights. “Section 504 of the Rehabilitation Act of 1973.” hhs.gov
- World Health Organization. “International Classification of Functioning, Disability and Health (ICF).” who.int
- Health Affairs (PubMed). “Iezzoni LI et al. "Physicians' Perceptions Of People With Disability And Their Health Care." 2021. PubMed. DOI: 10.1377/hlthaff.2020.01452.” doi.org
- Archives of Physical Medicine and Rehabilitation (PubMed). “Agaronnik N et al. "Accessibility of Medical Diagnostic Equipment for Patients With Disability: Observations From Physicians." 2019. PubMed. DOI: 10.1016/j.apmr.2019.02.007.” doi.org