Disability and Health Equity: Reflections on Causality and Disparities

Ari Ne'eman, Harvard University
Host: Johns Hopkins Department of Computer Science

Over the course of the last fifty years, American society has undergone a significant paradigm shift in how it approaches people with disabilities. Laws like the Americans with Disabilities Act and public investments in Home and Community-Based Services reflect a belief that the problems of disability are not inevitable results of biology, but instead reflect an interaction between impairment and a range of societal factors. Though public policy is increasingly acknowledging the role of systemic injustice in the gaps between disabled and non-disabled persons, more work is needed to adapt the frameworks of quantitative social science to reflect this more nuanced approach to causality.

These questions have concrete implications for public policy. As the health care system shifts away from fee-for-service, policymakers are increasingly tasked with measuring quality and holding health plans and providers accountable for outcomes. Disability is often an important input into risk-adjustment and quality measurement strategies in such contexts. Decisions regarding how to attribute causality for differences in outcomes between disabled and non-disabled persons may impact plan and provider behavior, incentivizing both positive and negative responses, depending on the choices made. In this talk, I will frame these challenges in the context of prior work addressing similar issues in the realm of racial disparities. When measuring differences in outcomes between disabled and non-disabled persons, what are appropriate and inappropriate control variables? To what should we attribute to systemic injustice as opposed to biological impairment? How do these decisions influence key policy choices regarding risk-adjustment and quality measurement in our health care system?

Speaker Biography

Ari Ne’eman is a PhD Candidate in Health Policy at Harvard University in the Political Analysis Track. He also serves as a Visiting Scholar at the Lurie Institute for Disability Policy at Brandeis. Ari previously served as executive director of the Autistic Self Advocacy Network from 2006 to 2016 and as one of President Obama’s appointees to the National Council on Disability from 2010 to 2015. He is presently writing a book on the history of American disability advocacy for Simon & Schuster, anticipated in 2023.