The Intersection of Race and Disability: A View from Ohio
By: Rose Frech, Guest Author
Key Highlights
- The inequities and discrimination experienced by people with disabilities are often exacerbated for those individuals who are also people of color.
- Racial disparities are well-documented for people with disabilities in the areas of healthcare, education, financial security, community safety, and more. This includes inequities in access to services within the developmental disabilities system itself, including home and community-based services.
- Ohioans with disabilities who are people of color report worse outcomes in the areas of transportation, health, and are more likely to report feeling left out. Black students with disabilities in Ohio experience disparate treatment in the classroom, including facing more severe discipline.
- Most systems and institutions are not well-equipped to embrace an intersectional lens when it comes to supporting people with disabilities, and training among educators and health care providers can be lacking. This is compounded by internalized personal stereotypes and harmful beliefs about the abilities and worth of people of color, and people with disabilities.
- Reforms are needed in multiple areas to ensure equitable access to services and opportunities for people of color with disabilities. Centering people with disabilities in decision-making will be essential to achieving meaningful progress.
The troubling interaction between racism and ableism
When analyzing the impact of state and federal policies designed to address the needs of people with disabilities, it is essential to examine the racial disparities that are embedded within these systems and institutions. The troubling interaction of racism and ableism has deep historical roots. As a result, reform by policymakers and other community leaders is crucial to improve quality of life and equalize access to services for people of color with disabilities.
According to the Centers for Disease Control and Prevention, 3 in 10 American Indian/Alaskan Native people have a disability, 1 in 4 Black people, 1 in 4 White people, 1 in 6 Hispanic people, and 1 in 10 Asian people.[1] Opportunities for Ohioans with Disabilities produced the following graphic illustrating the race of people with disabilities in Ohio; this aligns closely with the overall makeup of the state. [2]
As definitions of “developmental disability” and “intellectual disability” vary, capturing specific data on race/ethnicity for this population can be a challenge. Among those served by the Ohio Department of Developmental Disabilities, 58,611 are White (58 percent), 13,368 are Black or African American (13 percent), 1,080 are Asian (1 percent), 3,488 are “other,” (3 percent) and 24,978 are “unknown/no answer” (25 percent).[3] The high percentage of “unknown/no answer” individuals suggest a notable gap in reporting that makes it difficult to draw conclusions around overall racial/ethnic composition. A 2016 analysis showed that relative to their numbers in the general population in Ohio, adult African Americans and those who identify as Hispanic were overrepresented in the developmental disability community. [4]
There is ample evidence that among children of color a diagnosis of a developmental or intellectual disability is more common.
There is ample evidence that among children of color a diagnosis of a developmental or intellectual disability is more common. According to Child Trends, Black students are twice as likely as their White peers to be identified as having an intellectual disability. [5] This overrepresentation goes back over 50 years and has been attributed by researchers to testing bias, as well as a lack of diversity training for school faculty and administrators, the unequal distribution of early childhood resources, higher rates of poverty among people of color, and other bias that exists within educational systems.
People of color with disabilities often face additional barriers to care, resources, and supports
According to the Center for Disability Rights, “Ableism is a set of beliefs or practices that devalue and discriminate against people with physical, intellectual, or psychiatric disabilities and often rests on the assumption that disabled people need to be ‘fixed’ in one form or the other. Ableism is intertwined in our culture, due to many limiting beliefs about what disability does or does not mean, how able-bodied people learn to treat people with disabilities and how we are often not included at the table for key decisions.” [6] The inequities and discrimination experienced by people with disabilities are often exacerbated, or compounded, for those individuals who are also people of color. This is a result of institutional racism and ableism within our health and social care systems, but also internalized personal stereotypes and harmful beliefs about the abilities and worth of people of color, and people with disabilities. As a result, people of color with disabilities often face additional barriers to accessing care, resources, and supports to meet their needs.
The inequities and discrimination experienced by people with disabilities are often exacerbated, or compounded, for those individuals who are also people of color.
Multiple data points illustrate the disparities that exist among different racial groups of people with disabilities. This is particularly pronounced and troubling regarding healthcare outcomes and access. Overall, people of color with disabilities are more likely to report poor health[7]. A 2016 study concluded that “Latino and Black adults with IDD had worse health outcomes compared to White adults with IDD, and Latino and Black adults with IDD had worse health outcomes than nondisabled adults from the same racial and ethnic group.” [8] While the cause of this disparity is multi-faceted, factors such as implicit bias within the healthcare system, as well as upstream indicators including higher rates of socioeconomic disadvantage among people of color and people with disabilities, are likely contributors.
The experiences of children of color within the school system also illustrates disparate treatment and access to services. According to a 2021 report issued by the Ohio Department of Education:[9]
Ohio educators are two times as likely to…
- Identify Black students as having an intellectual disability
- Place Black students with disabilities in more restrictive settings
- Remove Black students with disabilities from the classroom for disciplinary reasons
Ohio educators are three times as likely to…
- Identify Black students as having an emotional disturbance
- Discipline Black students with disabilities through expulsion”
People of color with disabilities face added barriers to financial security
The implication of this is far-reaching and extends to the opportunities and resources available to these students as they approach adulthood. In fact, people of color with disabilities face added barriers to financial security. According to US Census Bureau data, the poverty rate for Black people with disabilities is at 36 percent. The relationship between race, disability, and poverty is multi-faceted. As described in a report by the National Disability Institute, poverty can cause increased likelihood for disability, as people in poverty have greater exposure to harmful environmental toxins (including early lead exposure), are more likely to work and live in dangerous environments and have less access to early identification programs that can lead to early intervention and treatment. Disability often also causes poverty, as people with disabilities face challenges in finding and sustaining employment, have high medical expenses, and/or must survive on minimal safety net resources, such as Supplemental Security Income (SSI) (In 2021, the average monthly payment in Ohio was about $590).[10] Racial disparities are linked to both disability and poverty; people of color are more likely to struggle financially and are more likely to experience health issues and disabilities. [11]
50% of adults with disabilities reported experiencing violence in the past year, while children with disabilities are more than three times as likely to experience abuse.
The safety of people of color with disabilities is another area where we see inconsistencies in outcomes. Across all races/ethnic groups, people with disabilities face a significantly higher risk for victimization. Researchers with the Ohio Disability and Health Program write “rates of violence against people with disabilities are staggering: 50% of adults with disabilities reported experiencing violence in the past year, while children with disabilities are more than three times as likely to experience abuse and youth aged 12-19 experience violent crime victimization at a rate nearly 3 times higher than their peers without disabilities.”[12] Disproportionate rates of violence and victimization among people of color are well-documented. This “double burden” results in a serious safety risk for people with disabilities who are people of color, and interactions with the criminal justice system can end poorly. According to a Disability Rights Ohio Report on Policing and Racial Justice “30-50% of individuals subject to use of force or killed by police have a disability. This risk cumulatively increases based on the person’s race, class, gender, and LGBTQ+ status.” [13] Further, they are disproportionally more likely to be arrested and incarcerated, and are less likely to receive appropriate, intersectional care within correctional facilities. [14] The Disability Rights report also calls out the enhanced risk for violence and police brutality experienced by children of color with disabilities within school systems.
Broader structural inequalities contribute to unequal access
While there is robust evidence to demonstrate the negative health and social outcomes too often experienced by people with disabilities who are people of color, less data is available to illustrate their experiences within the disabilities system. It is clear, however, that broader structural inequalities contribute to unequal access. As a report issued by the Autistic Self-Advocacy Network describes, states with a high percentage of people of color were less likely to expand access to Medicaid,[15] and states with more people of color tend to rely more on institutional care and spend less on Medicaid Home and Community-Based Services (HCBS).[16] This has serious implications for people with disabilities seeking services that allow them to live as independently as possible.
Other research points to racial disparities in access to HCBS. In 2018, researchers sought to examine racial disparities in HCBS utilization and expenditures, specifically for people with multiple sclerosis. Black people were less likely to receive case management, equipment, technology and modification services, and nursing services compared to White people. “Additionally, Black men had the lowest Medicaid HCBS expenditures, while White men had the highest.” [17] Furthermore, according to a 2016 study examining service utilization of people with intellectual and developmental disabilities in California, racial and ethnic minorities were less likely than Whites to receive the services they needed. [18] Additional research, especially at the state level, would be valuable to illuminate this topic further.
In considering how these issues manifest in Ohio, a 2022 study from the Ohio Disability and Health Partnership highlighted several key areas where people with disabilities who identify as Black, Indigenous, People of Color (BIPOC) described worse outcomes compared to those who are White. BIPOC respondents were more likely to report: [19]
- Feeling left out
- Fair or poor health
- Delaying or avoiding care due to transportation challenges
- More frequent visits to the emergency room
This data makes clear that more work is needed in Ohio to build truly inclusive systems and communities for people of color with disabilities.
Highlighting representation and intersectionality in education
To gain additional perspective on this issue, we spoke with two individuals with lived experience who agreed to share their thoughts. This included Saphire Murphy, who is a biracial woman with multiple disabilities. She is currently a student at the University of Toledo, pursuing a graduate degree in Sociology, and is a passionate advocate within the disability community. Saphire shared that she has often found that our systems and institutions are not well-equipped to embrace an intersectional lens when it comes to supporting people with disabilities. This, coupled with the shame that many people with disabilities carry, can result in lost opportunity, isolation, and a lack of support.
A lack of representation in schools and communities can make it especially difficult for young people to find role models and mentors, and to see the range of opportunities that may exist for their futures. According to Saphire, this lack of representation manifests in multiple ways, including a lack of attention to the history of the disability rights movement within K-12 education, where the topic is rarely covered with much depth, if at all. In addition, she noted, rarely are the disabilities of key figures in history revealed and discussed. As an example, Saphire shared, Harriet Tubman is often recognized in the classroom for her work as an activist and abolitionist. Few people know that she also had disability (a seizure disorder, the effects of a traumatic brain injury suffered as young person). Similarly, while some may know about Franklin Roosevelt’s use of a wheelchair, this is too often an afterthought in the discussions of the man and his life. As a result, children miss out on concrete examples of people who have accomplished remarkable things, who also are people with disabilities. Or worse, children with disabilities may implicitly receive the message that their disability is something to be hidden or ashamed of.
In addition, Saphire has observed that few people who work within the Special Education field themselves have disabilities. If more schools employed people with disabilities (and Special Ed training programs actively welcomed people with disabilities), more students with disabilities would see those who relate to their experiences. Students without disabilities would benefit from the exposure to people who are differently abled, which could help to decrease ableist beliefs that are prevalent in our society.
We also had the opportunity to discuss experiences in navigating healthcare environments. Saphire shared that, too often, she must make the impossible choice between prioritizing a provider who is a woman, or a provider who is a person of color, or a provider with expertise in her specific health care need. Rarely, if ever, is she able to find a provider who is all three. Too often, providers lack experience in working with people with disabilities, or the curiosity to learn more about their specific disability. This can result in an unfortunate dynamic where Saphire must herself become the educator for the provider.
Too often, providers lack experience in working with people with disabilities, or the curiosity to learn more about their specific disability.
We also spoke about Saphire’s work as an advocate. Based on her experience, the mainstream disability rights movement is often lacking in diversity, and there is room for improvement in bringing more perspectives to these spaces. Smaller, grassroots groups have emerged, however, to give voice to the intersectional identities of people of color. She also called out the work of the Disability EmpowHer Network, which is focused on the needs and resources of girls and woman with disabilities, providing mentoring, skill-building, and a space for a shared community. These groups have built meaningful connections and a unique voice that strengthens the disability rights movement as a whole. Overall, as an advocate, Saphire sees areas of disability law that could benefit from modernization, as the primary pieces of legislation that provide protections, including the Americans with Disabilities Act, are more than 25 years old, and our society has changed significantly in this time. She was encouraged, however, by the recent updates to Section 504, which heightened standards that prohibit discrimination in health care and social service settings.[20]
We also had the chance to speak with Lisa Hunt, a Board member with the Cuyahoga County Board of Developmental Disabilities (CCBDD), and the Family Engagement Specialist with the Cleveland Heights-University Heights (CH-UH) City School District. Lisa is also the parent of two children, one of whom has a disability.
Lisa’s experience as a parent of a child with a disability has deeply informed her professional interests and work as an advocate. When seeking school services for her child within the public school system, she often encountered inadequate support, uninformed school representatives, and a system that was designed around “pity” for those with disabilities, rather than empowerment and integration. She found she had to extensively educate herself on her rights, and responsibilities of the district, to ensure that her child received the appropriate services, adapted to his specific abilities and needs. Even with this fierce advocacy, services still fell short at times. Due to her experience, she helped to found the district’s Exceptional Children’s Advocacy Group, made up of parents of children with disabilities, and designed to provide support and advocacy. The group has helped to champion change within the system, including securing a new role for a Parent Mentor. However, while the group has made important strides, it continues to lack diversity, and places a heavy burden on families already struggling with parenting and service navigation to lead system reform. It is important, Lisa emphasized, to not take for granted the mental burden families carry when trying to do what is best for their child, while up against powerful systems that may be slow to change or address their needs. Advocates should consider this when developing strategies, assigning responsibility, and dividing tasks.
Lisa also spoke to the challenges families of color may face when encountering the prospect of “adding another label,” in the form of a disability diagnosis. Speaking to the prevalent negative racial stereotypes that exist in our society, Lisa shared “if you’re Black, the last thing you want is another label,” and that this “additional identify” may seem like an “extra burden” to overcome for some individuals and families. Like Sapphire, Lisa believes that there is a need to reclaim the disability label, and to move away from the common idea that “disability is less.” Rather, children should receive messages that emphasize their unique abilities and the characteristics that make them exceptional. This could shift the lens, for some, from seeing disability as an extra burden to another factor that makes them special. Related, representation within school systems should not be overlooked, Lisa implored. In the CH-UH district, while 78 percent of the families are Black, 79 percent of the teachers are White. This is a similar trend to many other predominately Black districts across the country, Lisa shared, and speaks to the need to build more opportunity and access for Black educators nationally, and pathways for post-secondary education. This should also be extended to educators who are people with disabilities.
“Representation matters,” Lisa says, and can make a significant difference in the lives of young people.
Lisa also spoke about the safety concerns she has had for her child, who is a person of color with a disability. She said that unequal access to resources like community recreation can exacerbate this issue and should be explored. Furthermore, she spoke highly of the work of CCBDD to engage police, especially around working to ensure that they have greater awareness of who is in their community and who may need additional support (via a social worker or similar) in the instance of a crisis.
Overall, the work to build truly inclusive school and community environments, Lisa believes, will be ongoing, and requires “fearless honesty,” from all parties involved to explore not only personal bias and stereotypes, but also to acknowledge systemic and historic discrimination within our institutions. The CH-UH district, for example, is currently in the midst of an intensive DEI training process, as a part of their broader equity strategy. The goal is not to just shift individual perceptions and behaviors but also to introduce the notion that we need to “rethink education,” overall, in order to address historic inequities. “The world we live in is built by us,” she says, and if we all work collaboratively with equity in mind, change is possible.
Reforms: education, access to care, and elevating the experiences of people of color
Reforms at multiple levels and across multiple systems are necessary to begin to address the inequities described in this paper. This includes starting early, by addressing issues of racial discrimination in schools and early childhood settings, and by ensuring that early intervention and identification programs and services are easily accessible and well-funded. Parents and families can benefit from accessing the range of services and support that are available within the community (including programs like Help Me Grow Early Intervention) and should be encouraged to do so. However, information should be easy to find and navigate, especially, as Lisa reminds us, given the mental strain families face when navigating a new diagnosis or developmental concern. As shared by Saphire, education reforms must also include better efforts to integrate the stories and experiences of people with disabilities into the school curriculum, to increase visibility and representation. And, as previously discussed, diversifying staff and faculty to include more people with disabilities is essential.
Expanding outreach and education within high school and community settings to highlight these opportunities, and the accommodations available, would be valuable.
At the state level, continuing to emphasize opportunities for higher education for people with disabilities, in addition to vocational opportunities, is essential. Too often, people with disabilities feel like higher education is out of reach, and this may be especially heightened for people of color who have been historically disenfranchised in college access. Saphire shared that “a lot of people with learning disabilities feel like college isn’t achievable…with the right accommodations and the right help, it is possible.” Expanding outreach and education within high school and community settings to highlight these opportunities, and the accommodations available, would be valuable.
We must also seek to build more inclusive environments in both healthcare and the social services, including implicit provider bias and a lack of sufficient training on intersectionality, and identify strategies to rebuild trust within the community. More training for providers on best practices in caring for people with disabilities, across specialties, would be a crucial step. In addition, making it easier for all people with disabilities to identify providers who embrace an intersectional lens, and who embrace working with people with disabilities, would make it easier to find a good provider fit more quickly.
There is a need to improve access to race/ethnicity data on disability indicators to better define and quantify disparate access to services or other institutional biases.
Furthermore, there is a need to improve access to race/ethnicity data on disability indicators to better define and quantify disparate access to services or other institutional biases. In Ohio, it is difficult to find publicly available data on key indicators broken down by race/ethnicity, including employment outcomes and waiver access. This should be explored.
Finally, we must elevate the experiences of people of color with disabilities in programmatic and policymaking decisions, to ensure that their perspective is central to the decisions that impact their lives. Without this representation, we risk the likelihood of making false assumptions about the needs of this group, or worse, allowing our own biases to influence decision-making.
[1] CDC. 2019. “Infographic: Adults with Disabilities: Ethnicity and Race.” Centers for Disease Control and Prevention. October 25, 2019. https://www.cdc.gov/ncbddd/disabilityandhealth/materials/infographic-disabilities-ethnicity-race.html
[2] Opportunities for Ohioans with Disabilities, “2021 VR Comprehensive Statewide Needs Assessment”
https://ood.ohio.gov/about-us/statistics2/2021-comprehensive-statewide-needs-assessment#SectionIVDisabilityDemographicsandEmploymentStatus
[3] The Ohio Department of Developmental Disabilities, “Data Dashboard, General Demographics,”
https://data.ohio.gov/wps/portal/gov/data/view/dodd-general-demographics
[4] Emily A. Yang, Susan M. Havercamp, PhD, & Rebecca Andridge, PhD, “Ohio Adults with Developmental Disabilities and Special Health Care Needs: 2015 OMAS Health and Health Care Findings,” https://grc.osu.edu/sites/default/files/inline-files/AdultDDBriefFINAL.pdf
[5] Harper, Kristen. 2017. “5 Things to Know about Racial and Ethnic Disparities in Special Education – Child Trends.” Child Trends. 2017. https://www.childtrends.org/publications/5-things-to-know-about-racial-and-ethnic-disparities-in-special-education
[6]Smith, Leah. n.d. “#Ableism – Center for Disability Rights.” Cdrnys.org. https://cdrnys.org/blog/uncategorized/ableism/
[7]Li, Henan, Susan L. Parish, Sandra Magaña, and Miguel A. Morales. 2021. “Racial and Ethnic Disparities in Perceived Barriers to Health Care among U.S. Adults with Intellectual and Developmental Disabilities.” Intellectual and Developmental Disabilities 59 (1): 84–94. https://doi.org/10.1352/1934-9556-59.1.84
[8]Magaña S, Parish S, Morales MA, Li H, Fujiura G. Racial and Ethnic Health Disparities Among People with Intellectual and Developmental Disabilities. Intellect Dev Disabil. 2016 Jun;54(3):161-72. doi: 10.1352/1934-9556-54.3.161. PMID: 27268472.
[9]Boughton, Heather, and Eben Dowell. 2021. Ohio Department of Education. “Data on Ohio’s Black Students.” https://education.ohio.gov/getattachment/Topics/Equity-in-Education/Task-Force-on-Best-Practice-Models-for-Black-Stude/TaskForce-DataPresentationPDF-May2021.pdf.aspx?lang=en-US
[10]“Average Monthly Payment for SSI Beneficiaries.” n.d. KFF. Accessed September 22, 2023. https://www.kff.org/medicaid/state-indicator/average-monthly-payment-for-ssi-beneficiaries/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22
[11] Goodman, Nanette, Michael Morris, Kelvin Boston, and Donna Walton. 2019. “FINANCIAL INEQUALITY: Disability, Race and Poverty in America.” https://www.nationaldisabilityinstitute.org/wp-content/uploads/2019/02/disability-race-poverty-in-america.pdf.
[12] Blick R.N., Franklin M.D., Ellsworth D.W., Havercamp S.M., Kornblau, B.L. (2015). The Double Burden: Health Disparities Among People of Color Living with Disabilities. Ohio Disability and Health Program
“Policing and Racial Injustice: A Disability Rights Perspective” 2020. Disability Rights Ohio. https://www.disabilityrightsohio.org/assets/documents/policing–racial-injustices-a-disability-rights-perspective_11.10.2020_new_format.pdf
[14] “The Criminal Legal System Fails to Address Black Disabled People’s Intersectional Identities.” 2022. Urban Institute. August 29, 2022. https://www.urban.org/urban-wire/criminal-legal-system-fails-address-black-disabled-peoples-intersectional-identities
[15] Brown, Elizabeth, “Southern States Lag in Medicaid Expansion. Racial Justice Demands They Catch Up.” 2023.US News, https://www.usnews.com/news/health-news/articles/2023-06-07/racial-justice-demands-medicaid-expansion-in-the-south
[16] “Crisis in Our Communities: Racial Disparities in Community Living – Autistic Self Advocacy Network.” 2022. Https://Autisticadvocacy.org/. February 3, 2022. https://autisticadvocacy.org/policy/toolkits/disparities/
[17] Fabius CD, Thomas KS, Zhang T, Ogarek J, Shireman TI. Racial disparities in Medicaid home and community-based service utilization and expenditures among persons with multiple sclerosis. BMC Health Serv Res. 2018 Oct 12;18(1):773. doi: 10.1186/s12913-018-3584-x. PMID: 30314479; PMCID: PMC6186063.
[18] Charlene Harrington, Taewoon Kang; Disparities in Service Use and Expenditures for People with Intellectual and Developmental Disabilities in California in 2005 and 2013. Intellect Dev Disabil 1 February 2016; 54 (1): 1–18. doi: https://doi.org/10.1352/1934-9556-54.1.1
[19] “DIFFERENCES by DISABILITY and RACE Key Facts from the 2022 ODHP Statewide Needs Assessment of Ohio Adults with Disabilities Why Did We Do the Needs Assessment?” n.d. Accessed September 22, 2023. https://nisonger.osu.edu/wp-content/uploads/2023/04/ODHP-Race-Differences-in-Health_FINAL.pdf.
[20] Rajkumar, Shruti, “Department of Health and Human Services to Bolster Disability Protection in Federal Law.” 2023. HuffPost. September 8, 2023. https://www.huffpost.com/entry/section-504-rehabilitation-act-rule-proposed-disability-protection_n_64fa6319e4b08f0f4ebd6cfc