Are “all men (and women) created equal?”

AMERICAN ACADEMY OF DEVELOPMENTAL MEDICINE & DENTISTRY

BY H. BARRY WALDMAN DDS, MPH, PHD, STEVEN P. PERLMAN DDS, MSCD, DHL (HON) AND MATTHEW COOKE, DDS, MD, MPH

Advances have been made in the United States and other countries, but we have a long way to go to reach any semblance of equality between individuals with disabilities and the general public.

“…Abraham Lincoln asked his listeners why the Declaration of Independence asserted that ‘all men are created equal.’ Not because the founders believe that all men had already attained equality, Lincoln said. That was an ‘obvious untruth.’ The founders’ point, Lincoln declared, was that equality for all was a goal that should be ‘constantly looked to, constantly labored for, an even though never perfectly attained, constantly approximated.’” 1

TOWARD EQUALITY
The Americans with Disabilities Act (ADA) became law in 1990. The ADA is a civil rights law that prohibits discrimination against individuals with disabilities in all areas of public life, including jobs, schools, transportation, and all public and private places that are open to the general public. “The purpose of the law is to make sure that people with disabilities have the same rights and opportunities as everyone else.”2 This is not just an issue in the U.S.

DOES DISCRIMINATION (I.E. INEQUALITY) STILL EXIST FOR PEOPLE WITH DISABILITIES?
United Nations: Over 650 million people around the world live with disabilities. They have little hope of going to school, getting a job, having their own home, creating a family and raising their children, socializing or voting. “Persons with disabilities make up the world’s largest and most disadvantaged minority.”3 98% of children with disabilities in developing countries do not attend school, around a third of the world’s street children live with disabilities, and the literacy rate for adults with disabilities is as low as 3%, and 1% for women with disabilities in some countries.4

UNICEF: Relatively little data exist on children with disabilities and what evidence does exist is based on a smaller set of studies than available for most other groups of children.
• Children who are poor are more likely to become disabled through inadequate healthcare, malnutrition, lack of access to clean water and basic sanitation, dangerous living and working conditions. Once disabled, they are more likely to be denied basic resources that would mitigate or prevent deepening poverty.
• A significant proportion of children with disabilities are denied access to basic services including education and health care.
• Children with disabilities are disproportionately vulnerable to violence, exploitation and abuse.
• Cultural, legal and institutional barriers render girls and young women with disabilities the victims of two-fold discrimination: as a consequence of both their gender and their disability.4

SPECIFICALLY, BY COUNTRY
Great Britain: “Almost a quarter of disabled people are still regularly suffering from discrimination, a charity said today… half working age people (with disabilities) are still unable to access employment in this country… We found a remarkable level of discrimination and inaccessibility in shops and services, particularly given the Disability and Discrimination Act first came into force 15 years ago. ”5 (emphasis added).
• 23% of people with disabilities reported they had been discriminated against while trying to access goods and services in the past year.
• Under the Disability Discrimination Act providers must make adjustments where it is unreasonably difficult for a disabled person to access a service.5

India: Between 4% and 8% of the population have one of more disabilities. One in every 10 children is born with or acquires a physical, mental or sensory disability. “This translates into 40-90 million children’s with one or more disabilities. Only 35% of all people living with disabilities have access to
schools.” 6
• Despite improvement in the health care system in the country, “…the situation of differently abled children remains deplorable, particularly in rural areas and among the lower socio-economic population.
• Differently abled children in India are subject to multiple deprivations and limited opportunities in several dimensions of their lives. Some of these include, not being enrolled in schools, lower employment rates, limited awareness of entitlements and services available and lack of social welfare support.” 6

Women and girls with disabilities in India are forced into mental hospitals and institutions, where they face unsanitary conditions, risk physical and sexual violence, and experience involuntary treatment, including electroshock therapy. As one woman put it, they are “treated worse than animals.”7.

Russia: “The Convention on the Rights of Persons with Disabilities (CRPD), which Russia ratified in 2012, requires providing people with disabilities access to local, quality inclusive primary and secondary education, as well as higher education, vocational training, and adult education on an equal basis with others.”8 Nevertheless:
• Children with disabilities in Russia face serious obstacles to accessing quality education,
• The tens of thousands of children with disabilities living in state orphanages often receive poor quality or little education, and many receive no education at all.8

Australia: In late 2008, the Australian government released a discussion paper asking the community to respond to a series of questions about their and their families’ experience of disability.

The following table summarizes the more than 750 responses.


Area where barriers experienced                         Percentage of submissions 9
Social inclusion & community participation                                         56
Disability services                                                                                        56
Rights, justice & legislation                                                                       39
Income support & the cost of disability                                                  37
Employment                                                                                                 34
Accommodation                                                                                           32
Families & carers                                                                                         30
Education                                                                                                      29
Transport                                                                                                      29
Health & wellbeing                                                                                     29
Built environment                                                                                       27
Disability services—workforce issues                                                      21
Aids, equipment & assistive technologies                                              20


United States: In the more than 25 years since the enactment of The Americans with Disabilities Act (ADA) there has been an increase in the awareness and understanding, support, education mainstreaming, employment and countless opportunities for individuals with disabilities.

BUT as to equality, for example:
Education:
“Section 504 of the Rehabilitation Act of 1973 (as amended) is designed to protect the rights of individuals with disabilities in programs and activities that receive Federal financial assistance from the U.S. Department of Education (ED). “No otherwise qualified individual with a disability in the United States .

. . shall, solely by reason of her or his disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.” 10

1. Despite the passage of the ADA, the Rehabilitation Act and the Individuals with Disabilities Education Act (IDEA) (to ensure that a free appropriate public education is made available to eligible students with disabilities) students with special needs are still punished at disproportionate rates. A report by UCLA’s Civil Rights Project found that just over 5% of elementary-school children with disabilities were suspended during the 2011-12 school year, more than double the overall suspension rate. Among secondary-school students, 18% of youngsters with disabilities were suspended, versus 10% overall. Even more striking, a third of all K-12 children with emotional disabilities, such as anxiety or obsessive compulsive disorder, were suspended at least once. 11

2. Only 10 U.S. studies have been conducted on the connection between bullying and developmental disabilities, but all of these studies found that children with disabilities were two to three times more likely to be bullied than their nondisabled peers. “One study shows that 60% of students with disabilities report being bullied regularly compared with 25% of all students.” 12

3. In the years following Hurricane Katrina, the New Orleans public school system had been transformed to include charter schools, schools operated by the state and others by the Orleans Parish School Board. A complaint to the Louisiana Department of Education described how in 30 schools, students had been either completely denied enrollment as a result of their disability or forced to attend schools ill-equipped or entirely lacking the resources necessary to serve them. “The complaint trigger(ed) a formal administrative process during which the parties will attempt to negotiate a settlement.” 13

Employment: In both 1991 and 2010, a far smaller proportion of US residents with disabilities, than their non-disabled counterparts, were employed.14 In addition, 44% of workers with disabilities reported they have experienced discrimination or unfair treatment in the workplace, according to a nationwide survey. 15

LESSONS TO BE LEARNED
1. Advances have been made in the United States and other countries, but we have a long way to go to reach any semblance of equality between individuals with disabilities and the general public.

2. One must be careful with pronouncements that seem all too simple for the satisfactory explanation and elimination of complex problems.

For example, consider the popular story circulating about a physician who decided to explain the causes of heart disease in the following manner:
• “The Japanese eat very little fat and suffer fewer heart attacks than the British or Americans.
• The French eat a lot of fat and also suffer fewer heart attacks than the British or Americans.
• The Chinese drink very little red wine and suffer fewer heart attacks than the British or Americans.
• The Italians drink excessive amount of red wines and also suffer fewer heart attacks than the British or Americans.
• The Germans drink a lot of beer and eat lots of sausages and fats and suffer fewer heart attacks than the British or Americans.
• His conclusion: Eat and drink what you like. It’s obvious that speaking English is what kills you!” 16

“Many people in the community believe disability is someone else’s problem. They do not believe disability will touch their lives, and give little thought to the experience of living with disability, or caring for someone with a disability. Without first-hand experience, they hold on to the belief that at least things are better than they used to be.” 9 •

ABOUT THE AUTHORS:
H. Barry Waldman, DDS, MPH, PhD – Distinguished Teaching Professor, Department of General Dentistry at Stony Brook University, NY; E-mail: h.waldman@stonybrook.edu
Steven P. Perlman, DDS, MScD, DHL (Hon) is Global Clinical Director, Special Olympics, Special Smiles and Clinical Professor of Pediatric Dentistry, The Boston University Goldman School of Dental Medicine, Private pediatric dentistry practice – Lynn MA.
Matthew Cooke, DDS, MD, MPH is Associate Professor, Departments of Anesthesiology & Pediatric Dentistry University of Pittsburgh School of Dental Medicine Pittsburgh PA; Assistant Clinical Professor, Departments of Oral & Maxillofacial Surgery and Pediatric Dentistry Virginia Commonwealth University School of Dentistry, Richmond, VA.


References
1. Dolnick E. The Clockwork Universe: Isaac Newton, the Royal Society, and the Birth of the Modern World. New York: Harper Collins, 2011.
2. ADA National Network. What is the Americans with Disabilities Act (ADA). Available from: https://adata.org/learn-about-ada Accessed December 1, 2015.
3. United Nations Human Rights Human Rights Day. Combating Discrimination against Persons with Disabilities. Available from: http://www.ohchr.org/EN/AboutUs/Pages/DiscriminationAgainstPersonsWithDisabilities.aspx Accessed December 1, 2015
4. UNICEF. Children and Young People with Disabilities Fact Sheet May 2013. Available from:
http://www.unicef.org/disabilities/files/Factsheet_A5__Web_NEW.pdf Accessed November 30, 2015.
5. Daily Mail reporter. Disabled people enduring ‘shockingly high’ levels of discrimination. April 14, 2010. Available from: http://www.dailymail.co.uk/news/article-1265858/Disabled-people-enduring-shockingly-high-levels-discrimination.html Accessed December 1, 2015.
6. Janardhana N, Muralidhar D, Naidu DM, et al. Discrimination against differently abled children among rural communities in India: Need for action. Journal of Natural Science, Biology and Medicine, 2015;6(1):7–11.
7. Human Rights Watch. India: Women with disabilities locked away and abused. December 2014 Available from: https://www.hrw.org/news/2014/12/03/india-women-disabilities-locked-away-and-abused Accessed December 1, 2015.
8. Human Rights Watch. Russia: Children with disabilities face discrimination Available from: https://
www.hrw.org/news/2015/09/01/russia-children-disabilities-face-discrimination Accessed December 1, 2015.
9. Australian Government Department of Social Services. SHUT OUT: The experience of people with disabilities and their families in Australia. Available from: https://www.dss.gov.au/our-responsibilities/disability-and-carers/publications-articles/policy-research/shut-out-the-experience-of-people-with-disabilities-and-their-families-in-australia?HTML Accessed December 3, 2015.
10. U.S. Department of Education. Protecting students with disabilities. Available from:
http://www2.ed.gov/about/offices/list/ocr/504faq.html Accessed December 4, 2015.
11. The Atlantic. Why schools over-discipline children with disabilities. Available from:
http://www.theatlantic.com/education/archive/2015/07/school-discipline-children-disabilities/399563/ Accessed December 4, 2015.
12. National Bulling Prevention Center. Bullying and harassment of students with disabilities. Available from: http://www.pacer.org/bullying/resources/students-with-disabilities Accessed December 4, 2015.
13. Southern Poverty Law Center. Children with disabilities face discrimination in New Orleans schools. Available from: https://www.splcenter.org/news/2010/07/28/children-disabilities-face-discrimination-new-orleans-schools Accessed December 4, 2015.
14. Discrimination Against the Disabled Statistics. Images for discrimination against the disabled statistics. Available from: https://www.google.com/search?q=discrimination+against+the+disabled+statistics Accessed December 4, 2015.
15. Career Builder. Four-in-ten workers with disabilities have experienced discrimination or unfair treatment at work. Available from: http://www.careerbuilder.com/share/aboutus/pressreleasesdetail.aspx?id=pr379&sd=6%2F19%2F2007&ed=12%2F31%2F2007 Accessed December 3, 2015.
16. Costa RD. The Watchman’s Rattle. Vanguard Press, Philadelphia, PA, 2010.

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