The usability of the built environment for people with disabilities is dependent on the level of barrier-free access provided. Unfortunately, it is common for the built environment to be planned, designed and constructed without consideration for the needs of all users. This is usually unintentional and due to a lack of awareness. The list of barriers in our society is endless and includes attitudinal barriers that prevent full community participation by people with disabilities. It is important to acknowledge that it is a combination of physical, attitudinal, communication and systematic barriers that prevent people with disabilities from leading active and independent lives.
This feature is designed to raise awareness about the major types of disabilities, the common barriers and the benefits of universal design for reducing the discrimination and stigma that is currently faced by the more than 3.6 million Canadians with disabilities. (1) I hope this discussion will encourage health professionals to think about ways in which they can contribute to increasing accessibility.
II. Types of Disabilities
Knowledge of the basic characteristics of different disabilities is critical to understanding how to reduce barriers (an entire feature article could be dedicated to discussing definitions and terminology related to disability; here, I am only presenting common disability categories and their definitions).
1. Physical disabilitie involve restricted mobility (e.g., limited ability to walk, move about, stand for long periods or to carry objects) or restricted agility (e.g., limited ability to bend, dress, feed oneself or to manipulate objects).
2. Auditory disabilities involve having partial or no hearing (e.g., persons who are deaf, deafened or hard of hearing). For some individuals, the loudness of the sound will determine whether it is heard. For others, it depends on the type of sound (e.g., consonants versus vowels or intonation). In other situations, individuals may become confused by certain sounds due to excessive background noises.
3. Visual disabilities involve complete blindness, limited or residual sight. They may involve a loss of visual clarity/acuity or a decrease in the size of the visual field.
4. With intellectual and learning disabilities, cognitive impairment can vary widely, from severe intellectual disabilities to the inability to remember to the absence or impairment of specific cognitive functions (e.g., language).
5. Emotional disabilities may be hidden or apparent (e.g., depression). In many cases, they have little or no effect on learning. They may appear in actions of indifference or other types of mood swings. The causes of emotional disabilities are wide ranging, but common forms are evident in individuals experiencing depression, anxiety or stress.
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III Common Barriers
In 1999, as part of a strategy to identify barriers faced by Toronto's disability community, I conducted one-on-one interviews with individuals experiencing some form of disability, representatives from community organizations, disability advocates and a variety of planning and design professionals. Following are some of the findings from that consultation.
Some of the common barriers for people with mobility and agility problems included
* environments inaccessible to people who use wheelchairs or motorized scooters (no curb cuts at intersections or ramps adjacent to stairs);
* steep grades and slopes;
* lack of grab bars, handrails and resting areas inside and outside public facilities;
* soft or unstable surfaces;
* narrow widths of sidewalks and paths due to the placement of street furniture (e.g. benches, and trash receptacles;
* heavy entrance doors; and
* lack of barrier-free public transportation.
Some of the common barriers for people who are deaf, deafened or hard of hearing included
* lack of interpreter/intervenor services;
* lack of accessible public telephones (e.g., no volume controls), TTY's and other adapted devices (e.g., adaptive media, FM and InfraRed systems in public facilities);
* verbal instruction;
* information/instructions written without the use of plain and clear language;
* emergency bells, sirens and audible signals;
* background noise and poor acoustics in indoor environments; poor lighting can also be a problem for some people relying on speech reading or sign language;
* lack of enhanced listening systems; and
* insufficient sensitivity training.
Some of the common barriers for people with impaired vision included
* insufficient use of contrasting colours, raised letters and characters on most signage;
* poor indoor lighting;
* excessive background noise can be a barrier for individuals who are relying primarily on hearing for sensory input;
* lack of textural surfaces in indoor and outdoor environments (e.g., no tactile markers warning pedestrians of potential objects in the path of travel on streetscapes);
* protruding objects that overhang the path of travel (e.g., wall-mounted light fixtures);
* lack of barrier-free streetscapes and street crossings;
* inaccessible building and room layouts; and
* availability of public documents in alternative formats (e.g., Braille, large print, raised print, diskette, tape or readable colour contrasts).
Some of the common barriers for people with cognitive/language disabilities included
* lack of access to information and special services and difficulties in problem solving (language impairments can cause difficulty in comprehension and/or expression of written and/or spoken language);
* hi-tech environments that place pressure upon individuals or have high performance expectations that do not allow users to operate at their own comfortable levels;
* overly bright environments that confuse and affect concentration; and
* internal and external environments with signage that is difficult to read or understand.
Some of the common barriers for people with emotional disabilities included
* safety concerns (people with emotional problems feel at greater risk for criminal activity such as assaults, robberies, harassment);
* negative attitudes and expectations;
* prejudice, labeling and stigma; and
* lack of sensitivity to individual needs.
What this consultation demonstrated was clear--we have failed to address the needs of persons with disabilities. One new approach that continues to evolve is known as universal design--the "design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design."(3) As discussed below, the value of this approach lies in the fact that its principles extend beyond the design of the built environment into the design of policies, programs and services. This approach makes the point that there is no average person and that greater flexibility and creativity is required throughout the environmental design process.
This consultation resulted in a policy report that was used to guide the development of a new accessibility policy for the City of Toronto. The policy includes a series of planning principles geared towards addressing barriers at a variety of levels, including housing, transportation, recreation and communication.
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IV The Concept of Universal Design
The overall intent of the universal design approach is to simplify life for everyone by making policies, products, communication and the built environment more usable by as many people as possible at little or no extra cost. Universal design principles include
* Principle 1: Equitable Use--The design is useful and marketable to any group of users.
* Principle 2: Flexibility in Use--The design accommodates a wide range of individual preferences and abilities.
* Principle 3: Simple and Intuitive Use--Use of the design is easy to understand, regardless of the user's experience, knowledge, language skills or current concentration level.
* Principle 4: Perceptible Information--The design communicates necessary information effectively to the user, regardless of ambient conditions or the user's sensory abilities.
* Principle 5: Tolerance for Error--The design minimizes hazards and the adverse consequences of accidental or unintended actions.
* Principle 6: Low Physical Effort--The design can be used efficiently and comfortably and with a minimum of fatigue.
* Principle 7: Size and Space for Approach and Use--Appropriate size and space is provided for approach, reach, manipulation and use regardless of user's body size, posture or mobility.(4)
These principles in no way comprise all criteria for good design (e.g., additional building code regulations, other access guidelines and standards), only those for universally-usable design. Certainly, other factors are important, such as aesthetics, cost, safety, gender and cultural appropriateness.
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V Lessons Learned
Negative attitudes continue to be one of the greatest barriers towards achieving barrier-free environments. Without an attitudinal shift and increased efforts by all professions to become more aware of disability issues, improved health and quality of life for persons with disabilities will not be achieved. Communities, policies, programs and services are supposed to be designed to address the needs of everyone, but the reality is that many people are still excluded. Barriers faced by persons with disabilities also have a negative impact on their families, friends, caregivers and colleagues.
Experiences in the USA, UK and Australia have demonstrated that a combination of a universal approach to design, along with improved building codes and mandatory disability legislation, is necessary to meet our social responsibility. In 2001, the Province of Ontario passed the Ontarians with Disabilities Act (ODA), to "improve opportunities for persons with disabilities and to involve them in the identification, removal and prevention of barriers to establish full participation in the life of the province of Ontario." (5) Unfortunately, disability advocates and the community recognize that the ODA, as it stands, has no teeth: its provisions are voluntary with no mandatory requirements to improve access, no implementation deadlines and no effective enforcement tools. Furthermore, the ODA is primarily geared to the public sector, even though barriers are frequently a result of private-sector activities. As one member of the City of Toronto's Community Advisory Committee on Disability Issues has described it, the ODA "is an empty truck: the task is to fill it with boxes if it is to have any meaning." (6) This is where planners, designers, architects and health promoters can step in, collaborate, learn from each other's experiences and become engaged in pursuing a universal approach to environmental design. Improved design will ultimately improve health and quality of life by making independent and active lives possible.
1. Updated statistics regarding persons with disabilities in Canada and Ontario can be found in the following reports:
A. Statistics Canada (2001). A profile of disability in Canada in 2001--Participation and Activity Limitation Survey (PALS). Available online at http://www.statcan.ca/english/IPS/Data/89-577-XIE.htm#abstract.
B. Human Resources Development Canada (2002). Advancing the Inclusion of Persons with Disabilities. Available online at http://www.hrdc-drhc.gc.ca/hrib/sdd-dds/odi/documents/AIPD/.
C. Accessibility Ontario (No Date). Ontarians with Disabilities Act, 2001: A Guide to the Act. Available online at http://www.gov.on.ca/citizenship/accessibility/english/guide.htm.
2. Further details on this consultation and the issues that arose can be found in the research report "Planning A Barrier Free City of Toronto: A Statement of Planning Principles, " available online at http://www.sph-planning-consulting.ca/publications.htm.
3. As identified on the Centre for Universal Design website, located at http://www.design.ncsu.edu:8120/cud/.
4. The Principles of Universal Design (1995). The Center for Universal Design, NC State University.
5. See (1) C, Ontarians with Disabilities Act.
6. City of Toronto Community Advisory Committee on Disability Issues (December 2001). Submission to the Legislative Assembly Standing Committee on Financial and Economic Affairs Bill 125 The Ontarians with Disabilities Act. Available on-line at http://www.toronto.ca/diversity/reports.htm.