State Plan to Address Health Promotion and
Disease Prevention in Populations with
Disabilities
By
The Disability and Public Health Planning Group
May 2013
1
Table of Contents
The Disability and Public Health Planning Group………………….…………………3
Executive Summary ……………………………………………………………………………….4
I.
Introduction ………………………………………………………………………………..6
II.
Methods ……………………………………………………………………………………..9
III.
Priority Areas and Recommendations ………………………..……………….10
1. Access to Care ………………………………………………………..…………10
2. Environments Where We Live, Learn, Work and Play ………..12
3. Awareness and Promotion of Health Equity ………………………14
4. Data …………………………………………………………………………….…..16
5. Emergency Planning and Response…………..……………………….18
IV.
Next Steps for Health Equity in New Hampshire……………..…………..20
Appendix A: Strategies and Activities…………………………………………………..21
2
The Disability and Public Health Planning Group
This publication was supported by Grant / Cooperative Agreement Number 1U59DD000954-01
from the Centers for Disease Control and Prevention (CDC). Its contents are solely the
responsibility of the authors and do not necessarily represent the views of CDC.
The New Hampshire Disability and Public Health project (DPH) is a collaboration between the
New Hampshire Division of Public Health Services and the Institute on Disability at the
University of New Hampshire. The overarching goal of the collaboration is to promote and
maximize health, prevent chronic disease, improve emergency preparedness, and increase the
quality of life among people with disabilities.
DPH is led by Charles Drum, MPA, JD, PhD, Director of the UNH Institute on Disability and José
Their Montero, MD, Director of the NH Division of Public Health Services. The NH Disability
Community Planning Group, the project’s advisory board, provides input on methods for
achieving program goals, objectives, and activities, and assists in leveraging resources and
partnerships within the state.
Disability Community Planning Group Members
Richard Cohen, NH Disability Rights Center
Diana Dorsey, Special Medical Services
Bonnie Dunham, Parent Information Center
Debbie Krider, Granite State Independent Living
Martha-Jean Madison, NH Family Voices
Kris McCracken, Manchester Community Health Center
Jo Moncher, Military Community Programs
John Richards, NH Governor’s Commission on Disability
Julie Smith, IOD Consumer Advisory Council
Carol Stamatakis, NH Council on Developmental Disabilities
Trinidad Tellez, Office of Minority Health & Refugee Affairs
Allyssa Thompson, National Multiple Sclerosis Society, New England Chapter
Gloria Fulmer, Easter Seals NH Disability Services
3
State Plan to Address Health Promotion and Disease Prevention
in Populations with Disabilities
Executive Summary
In 2012, the Institute on Disability at the University of New Hampshire and the Division of Public
Health Services entered a cooperative agreement with funding from the Centers for Disease
Control and Prevention to promote and maximize health, prevent chronic disease, improve
emergency preparedness and increase the quality of life among people with disabilities. With
the aim to infuse disability components into existing public health programs and activities, the
new public-private partnership identified the need for a clear plan to guide its work in the state
of NH (small “s”).
The State Plan to Address Health Promotion and Disease Prevention in Populations with
Disabilities outlines strategic priorities for this partnership. The scope and implementation of
the plan is not limited by the resources of State Government, nor by the capacity of a single
person, agency or organization. This plan is a call to action for organizations and community
members to join the NH Disability and Public Health Planning Group to implement this agenda
across multiple sectors. Five priority areas have been identified, and summary
recommendations from each area are as follows:
Access to Care
 Expand access to high quality and affordable healthcare.
 Promote an integrated, whole person approach.
 Develop community members’ health literacy and capacity to navigate the healthcare
system.
 Support efforts to improve providers’ capacity to serve populations with disabilities.
 Improve the education that providers receive on patient-centered, culturally responsive
care.
 Ensure access to ASL interpreters, AAC, and medical information in alternate formats.
 Advocate for funding streams tied to appropriate care.
Environments Where We Live, Learn, Work and Play
 Increase access to physical activity and recreation, access to healthy foods, and safety in
neighborhoods in which populations with disabilities live, learn, work and play.
 Expand accessible transportation alternatives and improve use of existing options.
 Support initiatives that encourage populations with disabilities to build networks.
 Improve early childhood development and school-based programs’ cultural
effectiveness.
 Expand accessibility and effectiveness of education and training opportunities for
people with disabilities.
 Encourage employers to recruit, train, and retain people with disabilities for staff and
leadership positions.
4
Awareness and Promotion of Health Equity
 Educate and involve partners outside the health sector who impact where we live, learn,
work and play in improving health for populations with disabilities.
 Incorporate concepts of civic and social responsibility in health and equity discourse.
 Identify and pursue funding opportunities to support the priorities of this plan.
 Encourage public, private, and nonprofit organizations to prioritize and budget for
health equity.
 Build and maintain a collaborative public-private partnership structure to implement the
plan.
 Influence and create public policy that supports health and equity.
Data






Establish NH DHHS guidelines and policy for the collection of data on disabilities as a
model for other agencies and organizations.
Dedicate resources for electronic data system improvements and quality assurance.
Train collectors and submitters of data to use NH DHHS policy.
Educate the public about the collection of disabilities related data.
Work with data stewards to stratify their data to identify disparities on populations with
disabilities.
Monitor and report on health care utilization and the health status of people with
disabilities.
Emergency Preparedness and Response
 Provide technical assistance and model plans to local emergency management directors;
regional public health emergency planners to facilitate complementary planning in
accordance with the ADA.
 Ensure the State of NH Emergency Operations Plan respects the equal liberty, autonomy
and dignity of all persons across all Emergency Support Functions as appropriate.
 Provide technical assistance and model plans, including Continuity of Operations Plans,
to private agencies and businesses supporting individuals with disabilities.
 Foster engagement of individuals with disabilities in local, regional, and state-level
emergency planning and exercises.
 Increase the number of individuals and families that are personally prepared for
emergencies to the greatest extent possible.
 Improve the ability to share information between state and local emergency responders
about the location and needs of individuals with disabilities.
 Activate health, medical and shelter facilities during emergencies that meet ADA
requirements and are staffed by well-trained staff and volunteers who can address the
needs of individuals with disabilities.
 Integrate disabilities service providers into local and regional systems that provide
situational awareness during emergencies.
 Support disabilities service providers capacity to continue to provide services during
emergencies
5
I. Introduction
In 2012, funding from the Centers for Disease Control and Prevention (CDC) established the
Disability and Public Health project (DPH), collaboration among CDC, the Institute on Disability
at the University of New Hampshire, and the Hew Hampshire Division for Public Health
Services. The overarching goal of the collaboration is to promote and maximize health, prevent
chronic disease, improve emergency preparedness, and increase the quality of life among
people with disabilities.
One of the initial actions of DPHS was to convene a board of advisors into the Disability
Community Planning Group. The Group includes experts, advocates, and representatives from
both public health and disability.
The work group developed this plan using a collaborative planning process involving diverse
public, private and nonprofit stakeholders and using as a template the State Plan to Address
Health Disparities and Promote Health Equity in New Hampshire. The goal of this plan is to
define statewide priorities and prepare recommendations to advance health equity for NH
residents with disabilities. The scope and implementation of the plan is not limited by the
resources of State Government, nor by the capacity of a single person, agency or organization.
What are Health Disparities?
Not everyone in the United States enjoys the same health opportunities. Studies show that
certain populations, including racial, ethnic, and linguistic minorities and people with
disabilities, often experience poorer than average health and health outcomes. In 2005 the
Surgeon General’s Call to Action to Improve the Health and Wellness of Persons with
Disabilities reminded the nation that “Health and wellness are not the same as the presence or
absence of a disability; they are broader concepts that directly affect the quality of a person’s
life experience.”1
Health disparities among people with disabilities have been well documented at the national
and state level. Data from the CDC’s Behavioral Risk Factor Surveillance System (BRFSS)
presented in the 2012 New Hampshire Disability and Public Health Needs Assessment show
that people with disabilities are more likely to be smokers, more likely to be obese, and less
likely to receive certain clinical preventive services and screenings than people without
disabilities.2
What Factors Influence Health?
Barriers in access to health care and differences in the quality of care received contribute to
health disparities. Overcoming cultural, linguistic, and environmental barriers, especially, are
6
critical to accessing high quality health care. However, health is not merely the result of medical
or clinical care but the sum of what we do as a society to create the conditions in which people
can be healthy.3 Other factors are now recognized as being equally, if not more important in
determining one’s health and health status including income and poverty status, education,
employment and working conditions, housing quality, and environmental features including
access to healthy food choices, walkable or wheelable streets, and safe neighborhoods. This
complex array of social, cultural, and environmental factors that impact one’s quality of life are
called social determinants of health, and they contribute significantly to health disparities.
Figure 1 illustrates these diverse factors, or social determinants, that impact health. It is the
combined differential experiences in access to health care, quality of healthcare, individual
health behaviors, and social determinants that result in inequalities in health for racial, ethnic,
and linguistic minority populations and for people with disabilities.
FIGURE 1. Factors that Determine Health 1
1
Dahlgren G, Whitehead M. Policies and strategies to promote social equity in health. Stockholm: Institute for
Future Studies; 1991.
7
Why Does NH Need this Plan?
NH residents with disabilities share concerns for health, housing, education, employment, and
quality of life. Some populations struggle because they do not have adequate opportunities to
maintain optimum health. We succeed as a state when we ensure opportunity for all, including
the opportunity for health and well-being. By applying our ingenuity, we can make better use
of our limited resources, progress towards solving health disparities affecting the NH disabled
population and develop programs and services that are fairly distributed and improve their
access to health promotion and disease prevention services accessible across all communities.
Developing a State Plan to Address Health Promotion and Disease Prevention in Populations
with Disabilities will focus our collective efforts to promote initiatives and policies that can help
make our communities healthier places to live, learn, work and play for all.
A State Plan will serve as a guiding document for a variety of organizations and coalitions, some
of whom have been working to eliminate health disparities on disease promotion and disease
prevention for the population with disabilities in NH for years. While much has already been
accomplished, continued collaboration will be critical to achieve systemic change. Now is the
time to focus the energy of these groups by improving collaboration. The State Plan also clearly
presents these issues for a wide audience, including new leaders and stakeholders who have
not worked on these issues in the past. This plan will help to engage new partners as issues of
health and equity gain momentum and importance in NH.
8
II. Methods
The State Plan to Address Health Promotion and Disease Prevention in Populations with
Disparities in New Hampshire was developed through a collaborative, participatory process
during the summer/fall of 2013. The planning process included two phases.
Phase I
During the late spring early summer of 2013 a small group took as template the Disparities plan
and reviewed the results of the disabilities assessment and the objectives and goals of the grant
(insert appropriate names)
Phase II
Phase II was the review by the Disability Community Planning Group.
Phase III
Phase III will offer an opportunity for interested partners and community members to become more
engaged as the State Plan is implemented. As a living document, this State Plan will guide the work of
the NH taskforce for at least 5 years, and progress towards the objectives will be monitored by the
steering committee.
9
III. Priority Areas and Recommendations
1. Access to Care
NH’s growing identification of populations with disabilities challenges the healthcare system to
adapt to meet a broad spectrum of new, often unrecognized or unknown needs. The patientcentered care each healthcare organization strives to offer requires a high level of sensitivity
and responsiveness. At the same time, requirements to provide appropriate care have
increased. Given the high cost of U.S. healthcare, providers face real challenges in their efforts
to provide high quality healthcare to the state’s entire population. At the same time, NH is
home to a complex healthcare system. Even when individuals are insured, they often have to
advocate for themselves or follow complicated directions to navigate the system, receive test
results, locate specialists, or care for all aspects of their mind and body. In this context,
achieving high quality health poses unique and complex challenges for populations with
disabilities and providers.
Key Points
 Access to affordable and quality health promotion and disease
prevention services disproportionately affects populations with
disabilities.
 Integrated care is essential for ensuring healthy individuals. This will
require changes across the system.
 Federal regulations require that healthcare providers ensure
effective communication with their patients, but there is limited
funding available to support providers in this effort.
 Culturally responsive care and improved health literacy can greatly
improve health outcomes and well-being for populations with
disabilities.
10
Recommendations
Healthcare Access
 Expand access to high quality and affordable health promotion and disease
prevention healthcare.
o Expand access to health insurance coverage and maximize opportunities
presented by the implementation of the Affordable Care Act (health care
reform).
o Develop high quality patient centered medical homes for all.
 Promote an integrated health perspective to include the whole individual.
 Develop community members’ health literacy and capacity to navigate the healthcare
system.
Cultural Competence
 Support efforts to improve providers’ capacity to serve populations with disabilities.
o Require training on cultural competence on populations with disabilities and
on all forms of discrimination as part of training, licensure, and continued
credentialing of all health professionals.
o Promote culture change within healthcare organizations to improve the
delivery of culturally responsive care.
 Improve the education that providers receive on establishing patient-centered,
culturally responsive practices.
Communication
 Ensure and/or expand access to ASL interpreters, augmentative and alternative
communication, and medical information in alternate formats.
 Advocate for funding streams tied to appropriate preventive healthcare for
populations with disabilities.
o Support efforts to improve organizations’ capacity to serve this population.
11
2. Environments Where We Live, Learn, Work and Play
The economic, social and environmental conditions individuals experience on a day-to-day basis
play a significant role in shaping their health and quality of life. Factors related to individual
and community health status that challenge most NH residents—finding a job or housing in
troubled economic times, finding transportation options—also affect populations with
disabilities, often to a greater extent. It is the combination of factors related to where we live,
learn, work and play that set the stage for health and well-being.
Key Points
 The neighborhoods we live in, and the context of daily living, directly
influence our health and well-being. This includes housing, education,
employment, safety and other factors.
 Accessible, affordable transportation is of crucial importance to ensure
equality of opportunity for health care, education, housing, employment,
and other essentials of daily life.
 Academic success and educational attainment are directly linked to an
individual’s ability to achieve socio-economic success and well-being.
 Populations with disabilities face significant social and cultural barriers in
school that limit their chances for success.
 Populations with disabilities often face greater challenges in living healthy
lifestyles due to social, cultural and environmental factors including
discrimination and social isolation.
12
Recommendations
Built Environment
 Increase access to physical activity and recreation, access to healthy foods, and safety in
neighborhoods in which populations with disabilities live, learn, work and play.
o Assist residents with disabilities in securing housing in safe and accessible
neighborhoods.
 Expand accessible transportation alternatives and improve use of existing options.
Social Inclusion
 Support initiatives that encourage populations with disabilities to build networks.
o Encourage networking and community building for individuals with disabilities to
address issues of isolation.
o Encourage networking and community building between individuals with
disabilities and the general population to foster integration.
Education and Workforce Development
 Improve early childhood development and school-based programs’ cultural
effectiveness.
o Integrate culturally competent programming into early childhood development
and school-based programs to improve integration for populations with
disabilities and their families.
 Expand accessibility and effectiveness of education and training opportunities for
people with disabilities.
o Reach out to and include residents with disabilities in education and training
opportunities including post-secondary education and vocational training
programs.
 Encourage employers and labor unions to dedicate resources to recruitment, training
and retention of people with disabilities for staff and leadership positions.
13
3. Awareness of Health Promotion and Disease Prevention as a Health
Equity Issue
In 2012, America’s Health Rankings rated NH the third healthiest state overall in the United
States.2 But given the results of the reports and qualitative inputs examined for this State Plan,
the question is: for whom? It is clear that the benefits of our healthy environment and our
healthcare system are not equally distributed across the NH population. Populations with
disabilities face a range of challenges in seeking a healthy lifestyle. This directly impacts their
health and ability to achieve well-being. The importance of raising awareness of issues unique
to these populations is increasing in urgency as diagnosis and early identification of disabilities
increases and as these disparities persist.
Key Points
 NH is considered the third healthiest state in the U.S., but not all
residents experience this healthy status.
 Many health care providers and other organizations are unaware of
the challenges populations with disabilities face when accessing
health promotion and disease prevention services.
 Many public, nonprofit, and private sector organizations within and
outside the health sector lack appropriate policies, systems, and
processes, to address program and policy issues relating to
disabilities.
 Promoting health promotion and disease prevention that meets the
needs of NH’s population with disabilities requires funding; possible
approaches include exploring new multi-sectorial approaches,
redirecting budgets, and seeking new grants and funding streams.
2
America’s Health Rankings, New Hampshire (2010), Available online at
http://www.americashealthrankings.org/yearcompare/2009/2010/NH.aspx. Accessed December 2010.
14
Recommendations
Education and Outreach
 Educate and involve partners outside the health sector who impact where we live,
learn, work and play in improving health promotion and disease prevention for
populations with disabilities.
o Develop materials and approaches to educate professionals, leaders and
decision-makers about the social determinants of health, health equity, cultural
competence and disabilities.
o Encourage collaborations with new partners who influence community-level
factors and systems that impact health.
 Incorporate concepts of civic and social responsibility in health and equity discourse.
Funding
 Identify and pursue funding opportunities to support the priorities of this plan.
o Coordinate funding initiatives across sectors to focus efforts and avoid
duplication, and to address health promotion and disease prevention inequities
for population with disabilities, as well as social determinants system-wide.
 Encourage public, private and nonprofit organizations to prioritize and budget for
health equity.
o Examine current operations and budgets to seek ways to promote health equity
within existing, routine activities.
o When distributing funding throughout the state, require applicants to
demonstrate their commitment to health and equity in their response to RFPs.
Infrastructure and Policy
 Build and maintain a collaborative public-private partnership structure to implement the
plan.
 Influence and create public policy that supports health and equity.
15
4. Data
As NH diversifies, it becomes increasingly important to understand and address how
populations with disabilities experience health disparities. This necessitates an understanding
of differences in health and in factors that affect health including health care, social
determinants, and individual behavior. In order to understand and address these variations, we
must be able to measure them. This requires common standards for what information is
collected, how it is collected, training of data collectors, and how data is utilized. At the same
time, public education and engagement is necessary so that populations with disabilities
understand the importance of data collection and feel comfortable with supplying the
information.
Key Points
 Improving collection of data on disabilities is a priority for
identifying, tracking and monitoring health disparities and
improvements in health equity.
 Health and human service organizations in NH vary in their
collection, reporting and utilization of disabilities related data.
 NH public health data stewards indicated that they would like
guidance and more extensive training on the implementation of
standards for the collection of disabilities related data.
 There may be some procedural challenges to implementing the
collection of disability data in the public health data sets. Different
data sets might require changes in contract language, policy,
administrative rules or legislation.
 There are certain limitations on the capacity to collect data because
of small sample sizes. Overcoming these limitations may require
additional resources to capture information about subgroups.
16
Recommendations
Guidelines and Systems
 Establish NH DHHS guidelines and policy for the collection of disability related data as a
model for other organizations and state agencies.
o Collaborate with stakeholders to define a list of relevant data fields for the state
and develop a system for periodic updates.
 Dedicate resources for electronic data system improvements and quality assurance.
Training and Education
 Train collectors and submitters of disabilities related data to use NH DHHS policy.
o Create a forum for providers and data stewards to communicate and
understand the importance of disabilities data collection.
 Educate the public about the collection of disabilities related data.
Data Use
 Work with data stewards to stratify their data to identify health disparities experienced
by people with disabilities.
 Monitor and report on health care utilization and the health status of people with
disabilities.
17
Emergency Planning and Response
Engaging individuals with disabilities in emergency planning and meeting their needs during
emergency events is a high priority at all levels of government, as well as for the private
individuals and agencies who support them. In addition to ensuring a strong and sustainable
response capacity, strengthening community resilience is a key factor with respect to mitigating
the impact from emergencies as well as restoring community-based systems of care to their
pre-disaster capacity. While in many instances individual entities and individuals have a clear
view of their role and responsibilities in preparing, responding and recovering from
emergencies a more significant challenge is developing a comprehensive, systems-based
approach to improve community resiliency.
Key Points
 Individual units of local, county and state governments have clear
mandates and responsibilities to prepare for, respond to, and recover
from emergencies.
 There are a large number of private agencies and businesses in NH
that support individuals with disabilities that are at different levels of
preparedness.
 NH’s experience during recent emergencies has highlighted an higher
level of vulnerability among some individuals with disabilities.
 Many times individuals with disabilities are not effectively engaged in
local and state emergency planning efforts.
 Individuals and families who are personally prepared to the greatest
extent possible increases personal and community resilience.
18
Recommendations
Planning
 Provide technical assistance and model plans to local emergency management
directors; regional public health emergency planners to facilitate complementary
planning in accordance with the ADA.
 Ensure the State of NH Emergency Operations Plan respects the equal liberty,
autonomy and dignity of all persons across all Emergency Support Functions as
appropriate.
 Provide technical assistance and model plans, including Continuity of Operations
Plans, to private agencies and businesses supporting individuals with disabilities.
 Foster engagement of individuals with disabilities in local, regional, and state-level
emergency planning and exercises.
 Increase the number of individuals and families that are personally prepared for
emergencies to the greatest extent possible.
Response
 Improve the ability to share information between state and local emergency
responders about the location and needs of individuals with disabilities.
 Activate health, medical and shelter facilities during emergencies that meet ADA
requirements and are staffed by well-trained staff and volunteers who can address the
needs of individuals with disabilities.
 Integrate disabilities service providers into local and regional systems that provide
situational awareness during emergencies.
 Support disabilities service providers’ capacity to continue to provide services during
emergencies.
Recovery
 Ensure access among individuals with disabilities and their services providers to federal
and state recovery programs, including financial assistance, following emergencies.
 Ensure that disabilities services providers are included in local and statewide recovery
planning to restore services, facilities, and infrastructure within the public health, health
care delivery, and human services sectors.
19
IV. Next Steps for Health Equity in New Hampshire
The NH Disability Community Planning Group developed this State Plan to Address Health
promotion and disease prevention in populations with disabilities, including recommendations
to improve health and access to health care for NH’s populations with disabilities.
This plan is a call to action for agencies, organizations and individuals across the public, private
and nonprofit sectors of the state. Many of these recommendations are directed to
stakeholders in the health and health care sectors. However, to truly implement the plan and
its vision for health equity for populations with disabilities, NH will need a broad based
community effort that reaches beyond the traditional “health” domain and approaches it from
a multi-sectoral perspective that addresses the social determinants of health: education,
housing, employment, and the context and environment of daily living for populations with
disabilities.
DPHS and the Disability Community Planning Group invite stakeholders throughout New
Hampshire to play their part in bringing this vision to reality.
20
Appendix A: Strategies and Activities
Access to Care
Healthcare Access
 Expand access to high quality and affordable health promotion and disease
prevention healthcare.
o Expand access to health insurance coverage and maximize opportunities
presented by the implementation of the Affordable Care Act (health care
reform).
o Develop high quality patient centered medical homes for all.
 Promote an integrated health perspective to include the whole individual.
 Develop community members’ health literacy and capacity to navigate the healthcare
system.







Research patient activation strategies and utilize findings in creation of health
promotion materials.
Create interactive obesity prevention program for youth with disabilities and their
parents. Disseminate via IOD website and NH Family Voices online training center.
Create and disseminate inclusion tips and facts for tobacco cessation and prevention
programs and providers.
Assist state public health programs and initiatives (including obesity prevention, tobacco
cessation, emergency management, breast & cervical cancer screening) to develop
strategies and protocols to target and include people with disabilities.
Distribute CDC Right to Know (breast cancer screening) campaign materials to all
partners in Let No Woman Be Overlooked program.
Conduct accessibility assessments of built environment at Community Health Centers
and provide customized feedback and offers of technical assistance.
Advertise on the project website which centers have participated in the assessment
process.
21
Cultural Competence
 Support efforts to improve providers’ capacity to serve populations with disabilities.
o Require training on cultural competence on populations with disabilities and
on all forms of discrimination as part of training, licensure, and continued
credentialing of all health professionals.
o Promote culture change within healthcare organizations to improve the
delivery of culturally responsive care.
 Improve the education that providers receive on establishing patient-centered,
culturally responsive practices.


Develop curriculum and deliver Responsive Practice train-the-trainer model to
Community Health Care centers across the state.
Develop curriculum and deliver training to mammography technicians in responsive
practice techniques for different types of disability.
Communication
 Ensure and/or expand access to ASL interpreters, augmentative and alternative
communication, and medical information in alternate formats.
 Advocate for funding streams tied to appropriate preventive healthcare for
populations with disabilities.
o Support efforts to improve organizations’ capacity to serve this population.
22
Environments Where We Live, Learn, Work and Play
Built Environment
 Increase access to physical activity and recreation, access to healthy foods, and safety in
neighborhoods in which populations with disabilities live, learn, work and play.
o Assist residents with disabilities in securing housing in safe and accessible
neighborhoods.
 Expand accessible transportation alternatives and improve use of existing options.
Social Inclusion
 Support initiatives that encourage populations with disabilities to build networks.
o Encourage networking and community building for individuals with disabilities to
address issues of isolation.
o Encourage networking and community building between individuals with
disabilities and the general population to foster integration.
Education and Workforce Development
 Improve early childhood development and school-based programs’ cultural
effectiveness.
o Integrate culturally competent programming into early childhood development
and school-based programs to improve integration for populations with
disabilities and their families.
 Expand accessibility and effectiveness of education and training opportunities for
people with disabilities.
o Reach out to and include residents with disabilities in education and training
opportunities including post-secondary education and vocational training
programs.
 Encourage employers and labor unions to dedicate resources to recruitment, training
and retention of people with disabilities for staff and leadership positions.
23
Awareness and Promotion of Health Equity
Education and Outreach
 Educate and involve partners outside the health sector who impact where we live,
learn, work and play in improving health promotion and disease prevention for
populations with disabilities.
o Develop materials and approaches to educate professionals, leaders and
decision-makers about the social determinants of health, health equity, cultural
competence and disabilities.
o Encourage collaborations with new partners who influence community-level
factors and systems that impact health.
 Incorporate concepts of civic and social responsibility in health and equity discourse.

Create Policy Surveillance System with Michelle Winchester to monitor legislative
sessions and produce timely fact sheets and educative policy briefs. Disseminate to
targeted audiences within legislature and make available electronically to the public.
24
Funding
 Identify and pursue funding opportunities to support the priorities of this plan.
o Coordinate funding initiatives across sectors to focus efforts and avoid
duplication, and to address health promotion and disease prevention inequities
for population with disabilities, as well as social determinants system-wide.
 Annually
assess
standing
health committees
for inclusion
of people
with for
Encourage
public,
privatepublic
and nonprofit
organizations
to prioritize
and budget
disabilities.
health equity.
o Examine current operations and budgets to seek ways to promote health equity
within existing, routine activities.
o When distributing funding throughout the state, require applicants to
demonstrate their commitment to health and equity in their response to RFPs.
Infrastructure and Policy
 Build and maintain a collaborative public-private partnership structure to implement the
plan.
 Influence and create public policy that supports health and equity.
25
Data
Guidelines and Systems
 Establish NH DHHS guidelines and policy for the collection of disability related data as a
model for other organizations and state agencies.
o Collaborate with stakeholders to define a list of relevant data fields for the state
and develop a system for periodic updates.
 Dedicate resources for electronic data system improvements and quality assurance.
Training and Education
 Train collectors and submitters of disabilities related data to use NH DHHS policy.
o Create a forum for providers and data stewards to communicate and
understand the importance of disabilities data collection.
 Educate the public about the collection of disabilities related data.
Data Use
 Work with data stewards to stratify their data to identify health disparities experienced
by people with disabilities.
 Monitor and report on health care utilization and the health status of people with
disabilities.
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Conduct statewide needs assessment / annual disability and health report. Disseminate
widely to stakeholders, including legislators and policymakers, and the public.
Identify data sources for inclusion in statewide disability and health reports.
Promote inclusion of disability identifiers on strategic sources of public health data
(state-level surveillance, administrative forms, etc).
Annually report rates of preventive services and screenings among people with
disabilities.
Conduct sessions at the annual AHEC conference (or other statewide events) to educate
on disability and public health data.
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Emergency Planning and Response
Planning
 Provide technical assistance and model plans to local emergency management
directors; regional public health emergency planners to facilitate complementary
planning in accordance with the ADA.
 Ensure the State of NH Emergency Operations Plan respects the equal liberty,
autonomy and dignity of all persons across all Emergency Support Functions as
appropriate.
 Provide technical assistance and model plans, including Continuity of Operations
Plans, to private agencies and businesses supporting individuals with disabilities.
 Foster engagement of individuals with disabilities in local, regional, and state-level
emergency planning and exercises.
 Increase the number of individuals and families that are personally prepared for
emergencies to the greatest extent possible.
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DCPG will review state’s Emergency Ops Plan, Functional Needs and Support Services
Annex to ensure that it is appropriate for people with a broad range of disabilities.
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Resources are available on project website and via IOD statewide trainings re planning and
making EP kits for people with disabilities.
Train-the-trainer curriculum is being developed for Emergency Response personnel to acquire
cultural competence with disability, so they can train populations with disabilities about the
importance EP plans and kits and how to develop them.
Present sessions at the annual NH EP Conference about project activities and information for
planners.
Work with Public Health Networks to ensure a disability contact for each region to help
recruit and include people with disabilities for exercises, trainings, and workshops.
Help to determine baseline levels of people with disabilities and their caregivers who
have EP kits and plans or know of tools to create them.
Provide technical assistance to Public Health Network coordinators about inclusion of
people with disabilities in EP messaging and communication.
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Response
 Improve the ability to share information between state and local emergency
responders about the location and needs of individuals with disabilities.
 Activate health, medical and shelter facilities during emergencies that meet ADA
requirements and are staffed by well-trained staff and volunteers who can address the
needs of individuals with disabilities.
 Integrate disabilities service providers into local and regional systems that provide
situational awareness during emergencies.
 Support disabilities service providers’ capacity to continue to provide services during
emergencies.
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Provide feedback to state re volunteer assessments of emergency shelter facilities. Offer
technical assistance with next steps.
Provide technical assistance to Public Health Network coordinators re results of a needs
assessment to determine their readiness to respond to the needs of people with
disabilities in the event of an emergency.
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Recovery
 Ensure access among individuals with disabilities and their services providers to federal
and state recovery programs, including financial assistance, following emergencies.
 Ensure that disabilities services providers are included in local and statewide recovery
planning to restore services, facilities, and infrastructure within the public health, health
care delivery, and human services sectors.
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