James H. Rimmer, Ph.D., Director

As the Presidential debates enter their peak season, a key issue that affects all of us is rising health care costs. Almost every mailbox in America this year will contain one or more medical bills. For the less fortunate, bills from hospitals, insurance companies, or collection agencies will appear weekly. It is unimaginable how we can have such a disappointing health care system in a society that prides itself on being the most affluent country in the world.

Issues such as who will pay and how much they will pay, as well as what type of payment the government should subsidize are hotly contested issues in this campaign. Except for the wealthiest people in the U.S., this is one of the most stressful issues for millions of Americans, and in particular, for people with disabilities, older adults, and others with chronic conditions such as diabetes, arthritis and heart disease. Many Americans who fall into one of these three groups live under an umbrella of rising medical costs that threaten their quality of life and force them into taking large loans to pay for their health care or that of their children, or to default on loans and end up with poor credit for many years. Some have to work extra hours or take part-time evening jobs to pay for medical bills resulting from a family member's illness. Millions are constantly called by collection agencies demanding payment. Many say it's a life filled with stress and anguish, often worsening other medical conditions such as heart disease, high blood pressure, and depression. A recent article in the American Public Health Association's newspaper, The Nation's Health, describes how a family struggles with the financial costs associated with treatment for their daughter's obsessive-compulsive disorder. The author of the story writes: "Meghann's seven-year struggle with obsessive-compulsive disorder and the treatment for her illness has put the family tens of thousands of dollars in debt - a debt that probably wouldn't exist if employer-provided health plans were required to cover mental health care on the same level as medical care."

It is difficult to think about answers to the health care crisis when you're caught in the middle of a rising creek with no paddle in sight. Yet something must be done this election year to make the candidates aware that universal health care must include health promotion for people with disabilities and chronic health conditions. While no one would argue that medication is not an important part of treatment, health promotion programs should be an equally important part of our health care delivery system.

There are viable ways for people with disabilities to improve their health and perhaps reduce their dependency on other treatments. For example, exercise is mentioned in almost every study related to good health, but among people with physical and cognitive disabilities, it's not as simple as going for a walk. Streets and sidewalks are often hazardous for someone using a wheelchair, and poor weather or safety creates hazards for many individuals who have difficulty with balance or are concerned with crime in their neighborhoods.

In several recent studies, exercise was found to improve cognition in people with multiple sclerosis, reduce pain in people with spinal cord injury, reduce depression in people with major depression disorder, and improve functional independence in people with cerebral palsy, stroke, and Parkinson's disease. Yet, the vast majority of people with disabilities are not involved in an exercise program. Efforts to reach this underserved population require subsidizing health promotion programs - no different than providing life-sustaining medications - that build upon good health and give individuals with disabilities opportunities to improve and manage their own health. A critical part of this is plan is to build it into a structure that exposes physicians and health care providers to valued health promotion programs tailored to the needs of people with disabilities, and who can link their patients or clients to the appropriate programs in their communities.

In every debate on health care, the words "health promotion" should be at the front and center of the discussion. People with disabilities want to manage their own health, but this will only happen when they are encouraged, informed, and educated on how and where to do so. It doesn't come naturally when you've been discouraged and discriminated against by many in the industry.