The small volume of literature on health promotion for people with physical and cognitive disabilities has left a substantial gap in our understanding of how to improve health and reduce secondary conditions in this population. In the government report entitled, Healthy People 2000: National Health Promotion and Disease Prevention Objectives, an expert panel wrote: "A clear opportunity exists for health promotion and disease prevention efforts to improve the health prospects and functional independence of people with disabilities. Gaps, overlaps, inconsistencies, and inequities in existing programs require the effective coordination of existing services if the health of people with disabilities is to be promoted (p. 41)." Within the last decade, there has been a slow but steady increase in the visibility and importance of health promotion for people with disabilities.

In 1994, the Centers for Disease Control and Prevention, in conjunction with the Spina Bifida Association of America and the United Cerebral Palsy Associations and several other federal agencies, hosted a conference to discuss the health-related needs of persons with cerebral palsy and spina bifida. The major emphasis of this conference was to address issues related to secondary conditions among people with cerebral palsy and spina bifida. The term, secondary conditions, was defined as "...those physical, medical, cognitive, emotional, or psychosocial consequences to which persons with disabilities are more susceptible by virtue of an underlying impairment, including adverse outcomes in health, wellness, participation and quality of life." The conference and published proceedings served as a benchmark for recognizing the importance of health promotion for people with disabilities and emphasized the importance of reducing secondary conditions in this population.

A primary focus of health promotion for people with disabilities is on the prevention or reduction of secondary conditions associated with the primary impairment. Ravesloot et al. noted that the impact of secondary conditions on the lives of people with physical disabilities has resulted in an increase in the severity of disability and has eroded participation in community activities. Innovative strategies for improving health, preventing complications associated with the disabling condition, and adequately preparing individuals with physical or cognitive disabilities to understand and monitor their own health, has emerged as an important public health priority.

The agency that has taken the initiative in supporting projects in the area of health promotion for people with disabilities is the Disability and Health Branch of the Centers for Disease Control and Prevention. Concerning this paradigm shift from disability prevention to prevention of secondary conditions, Hough eloquently wrote: "On the premise that among persons with existing disabilities the prospect of primary prevention of their disability is no longer a viable option, it is within the environment that the negative effects of secondary conditions could be ameliorated and even prevented. This premise generates the conclusion that, although primary prevention of disabilities remains a high priority for public health agencies and intervention specialists, secondary prevention of the secondary conditions of disabilities must be elevated to an equally high priority, so as to accommodate not only the needs of persons currently living with a disability but also to prepare for the needs of the enormously larger number of persons who will experience a disability within their lifetime, regardless of etiology of such disabilities" (p. 187-188).

Progress is being made towards improving the health of people with physical and cognitive disabilities. For the first time since the federal government started tracking the health of Americans over 20 years ago, the Healthy People 2010 report targets people with disabilities as a subgroup of the population. A chapter entitled, Disability and Secondary Conditions, has been added to the document to reflect the growing needs of people with disabilities. This document will serve as an important benchmark for supporting the development of health promotion initiatives for people with physical and cognitive disabilities.

Additionally, the recently published 2008 Physical Activity Guidelines for Americans describe the types and amounts of physical activity that offer substantial health benefits to all Americans, including those with disabilities. These science-based guidelines were designed to help individuals with disabilities aged 6 and older improve their health through appropriate physical activity.