Deaf Sign Language Users, Health Inequities, and Public Health: Opportunity for Social Justice

Deaf sign language users, health inequities, and public health: opportunity for social justice. Introduction Inequities in health and health care have increasingly become an area for concern and action for public health professionals, clinicians, policy makers, and communities. Research has documented inequities in the prevalence of chronic diseases of subpopulations defined by education , income, race and ethnicity, and English proficiency. Justice, a cornerstone of medical ethics, calls for corrective actions (1). We contend that all communities contain a minority group whose health needs are understudied and underserved. This group is the sign language–using deaf population. Most sign language users have been deaf since birth or early childhood (2-7). Sign language is not global nor is it based on a local spoken language. For example, British Sign Language (BSL) and American Sign Language (ASL) are distinct languages with little in common with the English language or each other. In the United States, an estimated 100,000 to 1 million people use ASL as their primary language. We describe 4 issues that underlie health inequities experienced by deaf sign language users and propose 6 public health approaches to address these health and health care inequities to promote health and prevent chronic diseases. Data on the health of deaf persons are lacking. In Healthy People 2010, the absence of health indicator data on groups with disabilities is recurrently cited (8). In the United States, telephone surveys exclude deaf persons, and questionnaires distributed by mail often use written English, a second language for many deaf ASL users (9). Written English surveys may also be inadequate because many people deaf since birth or during childhood have low English literacy (10). The sparse health data that do exist show that adults who have been deaf since birth or early childhood report poorer health than adults in the general US population (11). The lack of the most rudimentary health statistics from deaf populations thwarts efforts to engage deaf communities in setting priorities for health improvement and chronic disease prevention programs. Many adults deaf since birth or early childhood have low health literacy. This low health literacy results from a lifetime of limited access to information that is often considered common knowledge among hearing persons (12). For example, many adults deaf since birth or early childhood do not know their own family medical history, having never overheard their hearing parents discussing this with their doctor (13). Family history …