Perry lecturer calls for radical change in preventing disabilities

Alan Jette believes radical change in how the United States discusses and approaches preventing disabilities is needed if there’s to be any improvement to disturbing recent trends.

As the 35th J. Warren Perry lecturer, Jette — a 1973 alumnus of UB’s physical therapy program — focused on disability and its impacts on the world.

It’s a lifelong passion he’s focused on changing.

He harkened back to 1961, when as a boy, he said, he learned an important lesson.

“I learned that I couldn’t fly,” Jette said, flashing a slide of a picture of him laid up in a hospital bed. “So, I fractured my femur, broke both of my arms and I ended up in … (what is) now Erie County Medical Center for an extended visit.”

Since then, he’s been professionally obsessed with disability, its causes, prevention and understanding. It’s a pursuit that led him to co-publish a paper seeking to better define disability, which has been cited more than 40,000 times since publication 30 years ago.

In a three-pronged lecture approach, Jette touched on the epidemiology of disability, highlighted some disturbing trends and advocated for expanding further into the public health sphere for prevention.

The biggest challenge? There’s no set definition, he said. It’s a secret what constitutes a disability in the United States.

“Definitions matter,” he said. “Definitions implicitly will indicate suggested potential solutions and targets for action.”

Despite how prevalent disability is, Jette said, it has taken a long time for public health to recognize the issue. While the Americans with Disabilities Act of 1990 sought to address many concerns, it has taken until this year for the National Institutes of Health to recognize persons with disabilities as a population with health disparities.

Luckily, he said, the National Health and Aging Trends Study, started in 2011, is using consistent measures for comparison across multiple decades taken from previous studies. It’s a tactic Jette called “very smart.”

These studies, Jette said, point to increasing prevalence, percentage wise, for both men and women. Categorized across three different severities, trends show the rate of disability decreased between 1982 and 2004, then increased again by 2011.

A 2021 update showed some more positive trends, Jette said, like how a greater percentage of individuals with disabilities are accommodating their disabilities with devices meant to ease their burden. And, he added, the use of Hospice care for end-of-life services has also increased, itself a great sign.

Still, he said, compared to white people, Hispanic and Black populations are less likely to successfully accommodate and more likely to require assistance, resulting in a higher likelihood of experiencing an unmet need.

Jette argued a more population-centered approach would do greater good in addressing the overall concern caused by disability.

Similar to how public health officials targeted smoking 30 years ago, he said changing the public perception of disabilities through positive messaging, increasing ease of access to amenities like public transit and bicycle lanes on roads, promoting physical activity, decreasing price points for non-car travel and providing new opportunities for those who suffer, could all help address the hidden pandemic.

A population-centered approach addresses one of the key barriers hampering the most influential models used today: reversion.

“As soon as you pull back on the intervention,” he said, “the patient reverts back to baseline. It happens all the time.”

Combined with humanity’s poor ability to predict who is at high risk of disability, there’s likely to be little to no impact under clinical interventions, he said.

In other words, things will just continue along unless different tactics come into play.

“I think we need to be much more radical,” he said.