Structural ableism in public health and healthcare: a definition and conceptual framework

Elsevier, Lancet Regional Health - Americas, Volume 30, February 2024
Lundberg D.J., Chen J.A.

Structural ableism has received limited attention in the public health and health services literature as a determinant of health outcomes and disparities. This is notable for several reasons.

First, disabled people represent an estimated 16% of the world's population, and a sizable portion of the healthcare system exists to provide services to disabled people. For example, in the United States (U.S.), 36% of healthcare expenditures are related to disability.

Second, interpersonal disability-based discrimination remains prevalent. In the healthcare system, explicit and implicit biases toward disability are pervasive, suggesting this is an important sector to examine the effects of structural ableism.

 Third, significant health inequities exist for and among disabled people which relate at least in part to discrimination, inaccessibility, and other barriers that disabled people experience throughout health systems and society.

 To-date, structural ableism has received greater attention in other fields, such as in prior literature by disability studies and disability justice scholars.  In this viewpoint, we offer a definition and conceptual framework for examining structural ableism in public health and healthcare and suggest potential pathways by which structural ableism may influence health. We also propose a series of principles to guide researchers in studying structural ableism and health. Throughout this article, we use identify-first (i.e., disabled person) rather than person-first language (i.e., person with a disability). We discuss our language choices in Section A of the Supplementary Material. Describing the effects of structural ableism on health greatly exceeds the scope of a single publication. For this reason, our broader goal is to inspire dialogue about why structural ableism has often been ignored in the public health and health services literature and the ways that these fields have been complicit in perpetuating and legitimizing ableism. This exploration is particularly timely given the National Institutes of Health (NIH)'s designation in September 2023 that people with disabilities are a population with health disparities and related calls for research on ableism.