In the United States, one in four people, or 61 million Americans, have some form of disability. This number goes up to one billion when you take a look at global statistics, but in truth, disability is part of being human: Most people are likely to experience at least a temporary disability at some point in their lives.
The problem is, people with disabilities still face stigma and discrimination in everyday life and, worryingly, when trying to access healthcare — a problem that has only worsened during the COVID-19 pandemic.
This type of prejudice is called ableism.
Ableism is defined as social prejudice or discrimination against those who have disabilities. Like racism or sexism, ableism is based on the unjust belief that an entire group of people is “less than” others — with the group in question being those that have some form of disability. It’s based on the assumption that disabled persons need to be “fixed,” and that a person’s identity is based on their disability.
Like other forms of prejudice, ableism can manifest as generalizations and stereotypes that help construct and maintain less than equitable hospital, school, and political systems.
But First, What Is a Disability?
In understanding ableism, a good first step is to have a clear understanding of what a disability is.
The Americans with Disabilities Act (ADA) legally defines it as “a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or being regarded as having such an impairment.”
This definition includes those who have a history of disability, even if they may not currently have a disability, as well as people who do not have a disability but are considered to have one.
The Centers for Disease Control and Prevention have categorized disabilities into six different “functional disability types,” which include:
- Mobility: a serious difficulty in walking or climbing stairs
- Cognition: trouble with concentration, memory, and decision-making
- Independent living: disabilities that make it hard to do errands alone
- Hearing: deafness or a serious difficulty in hearing
- Vision: blindness or a serious difficulty in seeing
- Self-care: disabilities that make it difficult to dress or bathe one’s self
But disability can also be better understood socially. The social model of disability highlights how aside from our legal and medical definitions of disability, our ideas of what a disability is and what it means to have one are socially constructed based on how we collectively understand what it means to be “normal.”
There is no single checklist of characteristics defining what it means to have a disability. However, people whose impairments tend to be more visible (like those who use wheelchairs) tend to have a different social experience of disability than those whose impairments may not be easily seen (like people who are hard of hearing or have depression), as well as those whose impairments have been so normalized that we don’t think of their impairments as disabilities (like people who wear glasses).
What we consider a disability is entirely dependent on social context. In a society that understands and celebrates neurodiversity, for example, the autism spectrum disorder (ASD) may not be considered a disorder or disability at all. (Unfortunately, we don’t currently live in that kind of world.)
Of course, the social model of disability doesn’t aim to deny the reality of physical or mental impairment, along with its impacts on individuals and communities.
What it does aim to do is to challenge how we understand disability, and how we might learn to think of it as a facet of human diversity that our physical and social environment just hasn’t adapted to well enough.
Under this model, we might understand it this way:
- Impairment: A medical condition, physical or mental, that leads to a disability.
- Disability: The result of an impairment, as well as a person’s experience of physical, attitudinal, and social barriers around them.
Thus, a person who uses a wheelchair isn’t prevented from going inside buildings because of their inability to walk — they can’t go inside a building because the building’s stairs aren’t accessible.
Disability is the result of a health condition experienced in the context of an environment that discriminates against them for having it, a form of oppression that encompasses negative attitudes, inaccessible infrastructure, and limited social support.
This shift in understanding is crucial in breaking down the ways ableism — or the idea that non-disabled people are the ideal — has seeped into our institutions, social interactions, and even our minds.
The Many Forms of Ableism
Ableism can be institutional, interpersonal, or internal. And though it is experienced by people with disabilities across race, ethnicity, gender, and class, it disproportionately affects the poor, women, and people of color — an issue that movements like #DisabilitySoWhite have sought to criticize.
Some of the common ways it’s experienced is through a lack of compliance with ADA and other disability rights laws, the segregation of students and workers with disabilities, and inaccessible websites, buildings, and other forms of infrastructure.
Ableism in Healthcare
Crucially, ableism most clearly rears its ugly head where it hurts people with disabilities the most: in healthcare. A recent survey of over 700 practicing doctors across different specialties reveals how 4 out of 5 physicians think that disability inevitably leads to a worse quality of life compared to non-disabled people — a belief that becomes a self-fulfilling prophecy.
In fact, only 56% of US doctors say they welcome people with disabilities as patients in healthcare institutions. This finding aligns with a 2013 experiment that yielded rather bleak findings: When researchers called doctors’ offices to make an appointment for a patient with obesity and a wheelchair, many offices said they couldn’t accommodate the patient. Good thing, then, that the patient in the study was fictional.
For the millions of real-life people with real disabilities, getting any form of medical attention is the first hurdle. The next hurdle is getting accurate diagnoses for ailments. Too often, when a patient with a disability goes to a doctor for an impairment unrelated to their disability, doctors tend to focus on the disability — which means that they tend to miss certain illnesses.
“This notion [of diagnostic overshadowing] started with intellectual disability and mental health conditions,” explains Dr. Lisa I. Iezzoni. “Doctors would say, ‘It’s all in your head,’ about any complaint that you have because they wouldn’t take seriously that a person with a disability might be able to sense things with their bodies that need to be evaluated.” Many people with disabilities also get less information about illness prevention and fewer screening tests.
Reports also reveal that doctors simply aren’t given enough training on how to deal with disabled people — a gap that has serious consequences for millions. Doctors might ignore lived experiences, mistake symptoms of worrisome diseases as part of a person’s disability, or as in the case of Michael Hickson, a 46-year-old disabled man who died of COVID-19 in 2020, deny patients life-saving care because they think disabled folks’ lives are of poor quality anyway.
COVID-19 and Disability
This disregard for disabled people’s lives goes beyond clinics and hospitals, too, especially in today’s pandemic. For example, there are people who refuse to wear masks despite knowing that this might get older adults and people with disabilities seriously sick.
It’s not just a problem among anti-maskers — it’s part of the CDC itself.
In a highly criticized interview earlier this month, the CDC’s Dr. Rochelle Walensky said, “The overwhelming number of deaths, over 75 per cent, occurred in people who had at least four comorbidities.” (Comorbidities tend to overlap with impairments we think of in relation to disability.) “So really these are people who were unwell to begin with and yes, really encouraging news in the context of Omicron.”
In other words, when faced with the fact that COVID-19 disproportionately affects people with existing illnesses, the CDC’s response is not that people with existing illnesses should be protected. The response, according to Dr. Walensky, is basically that that’s a relief.
Unfortunately, you don’t have to be the CDC director, a doctor, or an anti-masker to think or behave in ableist ways. Just as we might have internalized racism and internalized misogyny, we tend to learn about ableism, often unconsciously, from the world around us. And this is true even for the most progressive and egalitarian of us.
Study after study has found that we tend to have implicit biases against people with disabilities, and tend to favor non-disabled people.
Here are some ways we might experience ableism around us:
- When people with disabilities are mocked or used as a punchline;
- When media imagery frame disability only as either tragic or inspirational, instead of as a normal part of being human;
- When invisible disabilities are ignored or belittled;
- When people assume that those with invisible disabilities are simply not trying hard enough, like when teachers or parents punish children with dyslexia, instead of trying to adjust teaching styles or when bosses don’t think mental illness is a valid reason for requesting time off;
- When websites do not have text enlargement features, or videos lack of audio descriptions and closed captioning; and finally,
- When we use ableist language, like saying “dumb” or “lame” to describe someone as “stupid,” or “bad.”
So What Can We Do?
If you’ve come this far, then you’re taking the first step in fighting ableism: You’re learning more about it. Understanding the problem and thinking more critically about the ways it manifests in and around us is a good first step to promoting inclusivity for people with disabilities.
Learning can also come in the form of listening to those with disabilities. You can do that literally, through disability-focused podcasts, or figuratively, through books written by disabled writers and activists. Doing so can help us recognize ableism in everyday life more than this article could.
The language we use holds a certain power, too. Practicing more inclusive language can help us dismantle some of our implicit biases against people with disabilities.
It’s also important that we believe people who disclose their disabilities and listen when they request accommodation — especially because a lot of our world was built without them in mind. Don’t park in parking spaces meant for them, and avoid using accessible bathrooms so that people with disabilities can use them more.
You can also do what you can within your community. If you’re a manager or employer, hire more people with disabilities, or at the very least, review your company’s hiring and management policies and how these can be improved in practice for those with disabilities. When creating stories about disabled people, hiring disabled actors and consulting with disability organizations can also go a long way.
When talking to others who might be using ableist language or parroting ableist myths, gently call it out or correct them. You can also lessen the stigma by talking about disability with children, who may have lots of questions but are afraid to ask.
Ableism Affects Everyone
Ableism directly harms those with disabilities, which anyone can acquire or develop in their lifetime. But also, it affects society in ways that people who care more about the economy than about healthcare need to pay attention to, too. Ableism, after all, causes greater unemployment, poverty, and unnecessary institutionalization.
But at the core of it, ableism dehumanizes our brothers and sisters for things that they can’t help. And as with the fight for equality in terms of race and gender, the intersectional call is to recognize how ableism works in the everyday, and to challenge it where we can.
Just remember: Being a good ally is an active and continuous process.