Physical barriers can come from the natural environment or also from human-made changes within the natural environment. The natural environmental barriers can be as diverse as the terrain and climate to human-made changes including things such as walkways and other things built into the environment. Able-bodied people give little thought to these barriers but it becomes a problem in people with disabilities when trying to navigate with a walker or a wheel-chair. These barriers also vary depending on if the person with a disability lives in cities or in rural areas. Environmental barriers affect rural respondents more than their city-living counterparts (Visagle et al. 2017).
The United States has made significant strides in improving the lives of people with disabilities in regards to environmental barriers. Reasonable accommodation is ensured with the establishment of the American with Disabilities Act 19. A research agenda, “New Paradigm of Disability” was established by the National Institute on Disability and Rehabilitation Research (NIDRR) to help improve lives of people with disability.
The Institute of Medicine has established disability as the basis of its research agenda, and they have placed importance on environmental barriers in people with disabilities as addressed in their report, Enabling America, 21. Also, there is a growing international interest in disability issues and the importance of environmental factors. This is not just a United States problem but a global problem. The United Nations (UN) has also focused attention on disability and established the Disability Year 25 and Disability Decade.
There are many different disabilities but a group looked at barriers seen in people with spinal cord injuries and found there were five main barriers in this disabled population. These top barriers in descending order include environment, transportation, help at home, health care, and governmental policies (Whiteneck et al. 2004). Quality of life is likely adversely impacted as well due to the environmental factors, however, the authors did not perform a systematic review of that effect. The environment is a major barrier with people living with traumatic brain injury and includes physical barriers such as stairs, hills, roads, and buildings (Whiteneck et al. 2004).
These physical barriers are more of a substantial problem in older adults than with younger adults but affects all populations to some degree (Brainline). The older population has problems with finding transportation either lack of transportation or limited access to transportation. There are also barriers in their surroundings that affect life such as poor lighting, too much noise, crowds, cold temperature, too much rain, steep hills, etc. (Brainline). Although these barriers were specifically addressed in people living with spinal cord injuries or traumatic brain injuries, they may have an effect on anyone living with a disability.
Many of these environmental barriers can be mitigated by providing adequate transportation. It is also important to design and layout buildings keeping in mind the needs to accommodate people with disabilities. The natural environment is not as easily manipulated or changed as temperature, terrain, and climate are more stationary or unadjustable. Lighting and noise can be managed or adjusted to help accommodate these individuals. Many of these adaptations can easily be made to improve the environment for individuals with disabilities.
The environment can create barriers for participation and inclusion. These barriers include things as simple as not having accessible building which could be lack of an elevator for someone with a walking disability or who is in a wheel chair. People living in poverty may not have access to drinkable water or sanitation which provides an added barrier to someone with a disability. Policy changes need to be enacted to help improve conditions and provide proper buildings and building layouts, technology including Braille or hearing-impaired services, signage, and opportunities for people with disabilities.
Can disability be prevented? There are preventative measures that can be taken to help reduce the potential for disability. These measures include providing education and adequate nutrition, preventing diseases, providing safe water and sanitation, improving safety on the roads and in the workplace (Caulfield et al. 2006). These preventative measures fall under the realm of public health and have three different prevention approaches.
The first is primary prevention which provides education to help promote health, an example would be educating people about HIV (Maart and Jelsma 2010). The secondary prevention detects a problem early on and provide a cure or reduces long-term effects, an example would be to provide screening for breast cancer in women with disabilities (McIlfatric et al. 2011). Finally, the tertiary prevention reduces disease-related complications, an example would be rehabilitation for someone with a musculoskeletal system impairment where they might receive physical or occupational therapy services (Atijosan et al. 2009).