October 01, 2024
Disability justice is key to the pursuit of economic justice; the latter requires commitment to the former. Economic justice and disability justice are deeply intertwined because the economic inequalities that disabled people1 face are rooted in the same systems of oppression that marginalize them socially and politically. Disability justice demands a comprehensive understanding of how these systems intersect to deny disabled individuals economic security, independence, and dignity.
The intent of this chartbook is to provide a broad overview of the relationship between disability and economic (in)justice in the United States, particularly among adults of working age. The chartbook includes tables and figures covering prevalence, employment, income levels, access to essential services, and other barriers to prosperity as they relate to disabled people. The chartbook also highlights the intersection between disability and other characteristics such as race, ethnicity, gender, age, and geography. This chartbook is designed to illuminate these intersections and provide a data-driven foundation for addressing the economic challenges facing disabled US adults. The chartbook is meant as both an educational resource for the general public and a starting point for policymakers, advocates, and researchers to apply a disability lens to economic justice issues.
The 2024 chartbook updates portions of a 2022 chartbook authored by Hayley Brown, Julie Yixia Cai, and Shawn Fremstad, and a report from that same year by Rebecca Vallas, Kimberly Knackstedt, Hayley Brown, Julie Yixia Cai, Shawn Fremstad, and Andrew Stettner.
Disability is a complex and multifaceted concept that can be defined and measured in different ways. The two most well-known conceptual models of disability are the medical model and the social model. The medical model conceives of disability as a problem located within the individual requiring treatment, rehabilitation, or cure. This model tends to emphasize physical limitations or impairments, and frames disability as a medical condition to be managed, treated, or cured. The social model focuses primarily on the societal barriers that disable individuals. This model maintains that disability results from social, environmental, and attitudinal barriers that prevent individuals from fully participating in society. By characterizing disability as a social rather than an individual problem, it positions systemic and social change as the primary remedies. Figure 1.1 compares and contrasts the medical and social models, highlighting areas of overlap and how they contribute to our understanding of disability.
Figure 1.1
There are also alternate and hybrid models of disability. The human rights model situates disability within the context of human rights and emphasizes equality, non-discrimination, and the inherent dignity of all individuals. It overlaps with the universal model, which posits that nearly everyone will experience some form of disability at some point throughout their life. They focus on the empowerment and self-determination of individuals with disabilities, ensuring they are fully integrated into society and can exercise agency in their lives. Like the social model, the human rights and universal models advocate for the removal of societal barriers and the provision of support to ensure full and equal participation in all aspects of life.
Definitions of disability vary substantially by context and may reflect characteristics of various conceptual models. The definition that the Social Security Administration employs to determine who qualifies for benefits is different than the one established by the Americans with Disabilities Act (ADA), and both of these differ from definitions used in various surveys. Even across US government surveys, the definition of disability is far from settled, and the questions used to assess disability vary (see Appendix Table 1). As a result, there can be big differences in the estimated size of the disabled population between surveys and even within surveys, depending on the definition used.
As Table 1 shows, depending on the survey, the question set, and the way the questions are interpreted, annual government surveys produce estimates of disability prevalence among US adults that range from less than 10 percent to over 40 percent. Many national surveys in the US use the Standard Short Set from the Department of Health and Human Services (HHS), which consists of six “yes” or “no” questions about different types of difficulty. Other surveys use a different set of questions referred to as the Washington Group Short Set (WG-SS), which includes six questions about type and degree of difficulty. This set of questions can yield different prevalence estimates depending on what degree of difficulty one sets as the threshold for disability.
Table 1
The first two columns in Table 1 reflect different potential definitions of disability within the National Health Interview Survey (NHIS). The NHIS uses the WG-SS; because this question set allows for more than one possible estimate of disability prevalence, two of these potential estimates are shown in the figure. The first column (NHIS 1) includes only those who reported "a lot of difficulty" or "can't do at all," while the second column (NHIS 2) additionally includes those who said they had “some difficulty.” For the remaining surveys — the Behavioral Risk Factor Surveillance System (BRSFF), the American Community Survey (ACS), and the Current Population Survey Annual Social and Economic Supplement (CPS ASEC) — determination of disability is based on answers to the Standard Short Set. The Standard Short Set is also used in the CPS Basic Monthly survey, while the biweekly Household Pulse Survey uses the WG-SS.
For disability overall, the NHIS yielded both the highest and the lowest prevalence depending on the definition used. However, it’s also worth noting the variability in prevalence among the three surveys that use the same set of questions. This suggests that other aspects of survey design may significantly influence the extent to which surveys include disabled people and accurately report disability status among those they include. Research indicates that both the Standard Short Set and the WG-SS fail to capture large swathes of the disabled population compared to other, more comprehensive sets of questions, with the more restrictive interpretation of the WG-SS missing the most.
Various datasets are used throughout this chartbook, selected based on their suitability for a particular topic or geography. Some figures are based on analysis of the annual surveys shown in Table 1, while others reflect data from monthly surveys like the Basic Monthly Current Population Survey, or the Current Population Survey Outgoing Rotation Group, or the biweekly the Household Pulse Survey. For datasets like the NHIS that use the WG-SS questions, we use the definition of disability that encompasses those with any activity limitation, including those who said they had “some difficulty” (NHIS 2 in Table 1).
A thorough accounting of disability prevalence also requires an intersectional approach that takes into account other demographic characteristics. Figure 1.2 shows the share of adults with a disability, defined as any activity limitation, by age group and gender. Women were more likely to report a disability earlier in life, but the gender gap in disability narrowed in older age groups.
Figure 1.2
Race and ethnicity also intersect considerably with disability prevalence. Structural inequalities contribute to differences in disability rates among racial and ethnic groups. Figure 1.3a shows disability prevalence by age group and race/ethnicity among adult men, while Figure 1.3b shows disability prevalence by age group and race/ethnicity among adult women. Among men, disability rates were consistently higher among those who identified as American Indian or Alaska Native, though the magnitude of the disparity was smaller among adults aged 65 or older. Among women, racial and ethnic gaps in disability rates narrowed considerably within older age groups.
Figure 1.3a
Figure 1.3b
Disability rates vary appreciably by geography. Figure 1.4a shows the share of US adults under age 65 with a disability in each US state, the District of Columbia, and Puerto Rico; Figure 1.4b shows the same among US adults aged 65 or older. Puerto Rico had the highest share of US adults with disabilities in both age groups. Among working-age adults, Puerto Rico was followed by Kentucky and West Virginia. Disability prevalence among working-age US adults was lowest in New Jersey, followed by California and the District of Columbia. Disability prevalence among seniors was higher in parts of the southern US. Over half of seniors in Puerto Rico had a disability, compared to less than a third in Vermont.
Figure 1.4a
Figure 1.4b
Employment plays a critical role in economic security, yet individuals with disabilities face significant barriers to participation. Employment rates for working-age disabled individuals are considerably lower than for their non-disabled counterparts. However, disability is not a monolith, and levels of both employment and labor force participation vary substantially by type of difficulty. Figure 2.1a shows the share of those ages 16 to 64 who were employed, unemployed, and not in the labor force by disability status and type of difficulty. Just over a third (34.6 percent) of those with a disability were employed, compared to nearly three-quarters (74.1 percent) of those without a disability. Among those with disabilities, the employed share also varied appreciably by type of difficulty. Over half of those who experienced hearing difficulty were employed, compared to only 11.8 percent of those who reported difficulty with personal care, such as dressing or bathing
Figure 2.1a
The number of types of disability also plays a role. Figure 2.1b shows the share of those ages 16 to 64 who were employed, unemployed, and not in the labor force by disability status, and whether those with disabilities experienced only one type of difficulty or multiple types of difficulty. Less than 20 percent (17.8 percent) of those with multiple types of difficulty were employed, compared to 47 percent of those with only one type of disability.
Figure 2.1b
Lower levels of employment among working-age people with disabilities is not a new phenomenon. Figure 2.2 shows employment levels and labor force participation among working-age people with disabilities over time. While the number of employed disabled people aged 16 to 64 increased substantially in 2023, the number without jobs (which includes both the unemployed and those not in the labor force) has been largely steady since 2018. As has been previously noted, this may mean that recent increases in employment among disabled people of working age reflect an overall increase in the number of disabled working-age people, rather than an increase in employment or labor force participation among disabled people who were previously not employed. This increase in disability among working-age people may reflect the impact of the ongoing COVID-19 pandemic and, in particular, of Long COVID.
Figure 2.2
People with disabilities face numerous barriers to employment. Figure 2.3 shows the share of disabled US adults ages 18 to 64 who said they faced a given employment barrier (the options are not mutually exclusive, meaning respondents could say they faced more than one type of barrier). The most commonly cited barrier was the disability itself, followed by a lack of education or training. While this may seem like a clear rebuke of the social model of disability, it may also reflect the ubiquity of systemic obstacles within a capitalist structure. That said, it is also true that not everyone with a disability will be able to participate in the labor force. The just course requires supporting disabled individuals in paid employment to the fullest extent, without depriving those whose disabilities are not compatible with paid work of economic security and dignity.
Figure 2.3
While the ADA requires that employers subject to the law make reasonable accommodations for workers with disabilities, employers and employees may not see eye-to-eye on what is reasonable, and employers frequently fail to meet disabled employees’ accommodation needs. Figure 2.4 shows that over a quarter of disabled workers’ requests for accommodations were not fully honored. Employers partially fulfilled just over 10 percent of requests, and 16 percent of requests were denied altogether. The share of disabled workers who said they requested an accommodation at all was relatively small, suggesting that either their workplaces are already sufficiently accessible to meet their needs or that they are reluctant to request an accommodation, even if they would benefit from having one. While ideally more workplaces would shift to a universal design framework rather than relying primarily on accommodations, these results suggest that the accommodations framework as currently implemented is failing to meet the accommodation needs of a considerable portion of disabled workers.
Figure 2.4
People with disabilities must contend with discrimination both in and out of the workplace. This includes but is not limited to employers’ refusal to reasonably accommodate disabilities in the workplace. Figure 2.5 shows the number of discrimination claims made to the US Equal Employment Opportunity Commission by basis or issue. Disability was the most commonly cited non-retaliatory basis for discrimination, with over 29,000 reports in fiscal year 2023. This likely represents an undercount, as it excludes charges filed with state or local Fair Employment Practices Agencies. Moreover, many incidents of discrimination never result in a formal filing, because most disabled Americans simply do not have the time, money, and physical energy required to see through a years-long legal process to sue employers. These violations also, by nature, only include individual instances of discrimination covered by civil rights laws like the ADA. As Marta Russell notes, such laws do not address or remedy more systemic forms of discrimination against people with disabilities, as these structural barriers often derive from entrenched capitalist power relationships.
Figure 2.5
Even among those who are employed, there is a substantial pay gap between those with and without disabilities. As Figure 3.1 shows, disabled workers earned just 80 cents for every dollar earned by their peers without disabilities. Among full-time workers, those with disabilities made only 83 cents per every dollar made by their non-disabled peers.
Figure 3.1
Disability intersects with race and ethnicity such that disabled Black and Hispanic workers face especially large earnings disadvantages (Figure 3.2). These disparities also persist even among full-time workers.
Figure 3.2
Unions offer one potential remedy for increasing earnings for disabled workers. Even after controlling for other factors, union representation is associated with a wage premium of nearly 18 percent for workers with disabilities. As Figure 3.3a shows, the union wage premium holds across all types of difficulty. Those with personal care difficulty receive the biggest dollar boost, followed by those with hearing difficulty.
Figure 3.3a
Figure 3.3b shows that despite the advantages of unionization, the share of workers represented by a union has declined among workers with and without disabilities. Declines in union coverage mean that the union advantage is enjoyed by a dwindling minority of workers, both disabled and non-disabled. The contraction frustrates the labor movement's efforts to promote economic justice by building worker power. Rebuilding the labor movement should be considered a key part of the fight for economic justice for those with disabilities, and the rebuilding must be done in a way that includes and lifts up disabled people.
Figure 3.3b
Employed adults with disabilities are overrepresented among those with low or very low incomes, regardless of whether they work full-time or part-time. Figure 3.4 shows the share of working adults with and without disabilities in each income category, among both full-time and part-time workers. Income categories are determined using the Supplemental Poverty Measure (SPM), which improves on the Official Poverty Measure by more thoroughly accounting for government in-kind benefits, taxes, and other forms of income and non-discretionary expenses. A larger proportion of workers with disabilities fell into low- and very low-income categories compared to workers without disabilities, even among those who worked full-time hours. This reinforces the idea that simply raising the employment rate for disabled individuals is not a cure-all for achieving economic justice for people with disabilities.
Figure 3.4
Among adults of working age, those with disabilities are much more likely to experience poverty than their non-disabled peers. Figure 3.5a shows the percentage of people ages 18 to 64 who were living in poverty (defined using the SPM), broken down by disability status and type of difficulty. The poverty rate for disabled working-age adults was more than double the rate for those without disabilities. The highest rates of poverty were observed among those who reported ambulatory difficulty (difficulty walking or climbing stairs) or personal care difficulty (difficulty dressing or bathing).
Figure 3.5a
Disability also intersects with race and ethnicity, manifesting in consistently higher poverty rates among Black and Hispanic adults with disabilities relative to their white counterparts (Figure 3.5b). Despite a general decline in poverty rates among working-age adults with disabilities since the start of the COVID-19 pandemic, considerable racial and ethnic disparities remained. Such disparities highlight the compounded economic challenges faced by Black and Hispanic adults with disabilities, emphasizing the need to address intersecting forms of marginalization when working toward economic justice for disabled people.
Figure 3.5b
Disabled individuals are more likely to experience economic insecurity and often struggle to access vital services. Disabled people are systematically denied access to affordable housing and healthcare, reliable transportation, and paid sick leave, among others. These barriers are compounded by discriminatory policies, underinvestment in public services, and punitive systems like incarceration that entrench economic hardship.
Among working-age adults, those with disabilities were disproportionately affected by economic hardship, and those from marginalized racial and ethnic groups were particularly impacted. As Figure 4.1 shows, disabled adults under age 65 were much more likely to experience both food insecurity and difficulty with expenses compared to their non-disabled peers. Hispanic and Black adults with disabilities were more likely than their white or Asian counterparts to report these hardships.
Figure 4.1
Disabled adults reported higher rates of housing insecurity (Figure 4.2), defined as needing to defer or miss a housing payment in the last month. Disabled renters were more likely to be housing insecure than homeowners, and non-white renters with disabilities were especially affected.
Figure 4.2
Disabled individuals are also overrepresented in the criminal justice system, a cruel reality that experts attribute to a lack of community-based services following widespread deinstitutionalization. Figure 4.3a illustrates disability rates among state and federal prisoners, while Figure 4.3b breaks down the percentage of prisoners with disabilities by sex and disability type. These figures show that the US criminal justice disproportionately locked up those with disabilities and that incarcerated women were especially likely to be disabled. Nearly half of incarcerated women reported at least one type of difficulty, and over a third reported cognitive difficulty. This points to a need for comprehensive services support for disabled individuals, rather than punitive measures that compound hardship for an already marginalized population.
Figure 4.3a
Figure 4.3b
Economic justice for people with disabilities is tied to the idea of mobility justice, which a report from the UK-based Cross River Partnership defines as “the principle that all people should have the same opportunity to move around and access public spaces.” Access to reliable and secure transportation is crucial for economic participation and independence. Disabled adults are more likely than those without disabilities to contend with transportation insecurity. Transportation insecurity limits one’s ability to access employment, healthcare, and other essential services, and to fully participate in one’s community. As shown in Figure 4.4, disabled adults are twice as likely as their non-disabled peers to lack secure access to transportation. Achieving economic and mobility justice for disabled individuals requires dismantling systemic barriers to transportation access, ensuring that disabled people can move freely and participate fully in society. It also requires discarding the notion of a “transportation-limiting disability,” instead placing the onus on transportation systems to be accessible and inclusive.
Figure 4.4
Disabled individuals in the US are also disproportionately burdened by healthcare costs. Figure 4.5a shows the share of working-age US adults with health insurance by disability status and source of insurance, while Figure 4.5b highlights the share who were unable to see a doctor due to cost in the past 12 months. Working-age people with disabilities are more likely to rely on public health insurance. While those with disabilities were slightly less likely to report not having insurance at all, they were much more likely to report having foregone medical care due to cost. This suggests that insurance may be insufficient to render health care affordable for those who need it. Cost barriers to accessing health care worsen health outcomes and reinforce cycles of poverty among those with disabilities. This underscores the critical need for universal healthcare policies like Medicare for All to make health services accessible and affordable for people with disabilities, who are more likely to require medical care and tend to have greater health-related expenses despite lower average incomes.
Figure 4.5a
Figure 4.5b
The US is the only wealthy industrialized nation that does not guarantee workers any paid sick leave. Figure 4.6 shows that disabled workers, whether part-time or full-time, were less likely than their non-disabled peers to say they had paid sick leave. Among full-time workers, more than a quarter of those with disabilities and just over a fifth of those without disabilities lacked paid sick leave. The situation is more concerning for part-time workers, among whom two-thirds of those with disabilities and three-fifths of those without disabilities did not have paid sick leave. Without paid sick leave, workers are forced to make impossible choices between their health and their livelihoods. Lack of paid sick leave serves to intensify existing financial strain and jeopardize workers’ financial security, especially for disabled workers who already face higher expenses. Ensuring access to this benefit is critical to dismantling structures that perpetuate economic injustice.
Figure 4.6
Disabled people who can become pregnant face additional challenges, particularly in states with restrictive abortion laws. Figure 4.7 shows the share of disabled women of reproductive age 2 (ages 15 to 49) who live in states with abortion bans, restrictions, and protections, broken down by income level. The data highlight how low-income disabled women of reproductive age are disproportionately subject to restrictive reproductive policies, limiting their autonomy and access to healthcare. People with disabilities already face greater economic burdens during pregnancy and are more likely to experience unintended and unplanned pregnancies.
Figure 4.7
The threat of climate change and the ongoing COVID-19 pandemic have drawn attention to the need for crisis management and disaster preparedness. In times of disaster or emergency, disabled individuals often face heightened risks due to preparedness and response barriers. Evacuations can be especially challenging for those with disabilities who require specific types of support to survive, and who may face additional accessibility challenges if they are forced to relocate quickly. Research suggests that preparedness can mitigate the negative consequences of disasters and contribute to resilience. Figure 4.8 presents the adjusted self-assessed level of preparedness for large-scale disasters or emergencies by disability status. Disabled people were less likely to feel prepared for such events and more likely than those without disabilities to report that they were not prepared at all. These findings emphasize the need for inclusive disaster planning and support systems that take into account the unique needs of disabled populations during emergencies. This need has only become more pressing given the increased frequency and severity of natural disasters due to climate change.
Figure 4.8
Appendix Table 1
The authors would like to thank John Schmitt for his helpful feedback. They would also like to acknowledge Shawn Fremstad for his work on the previous release of this chartbook, as well as Rebecca Vallas, Kimberly Knackstadt, and Andrew Stettner for their work on the report related to that version.
