Disability and Inequality

Jeremy Ney
6 min readOct 14, 2022


Americans with disabilities lack work, pay, and healthcare, especially in the Rust Belt — Here’s what you can do to help populations in need

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Explore the data

Americans with disabilities face some of the greatest inequalities in this country. They struggle to find work, access affordable healthcare, and graduate high school or college. Americans with disabilities have a 3x higher unemployment rate, are 2x more likely to live in poverty, are 3x less likely to have internet access as compared their peers without disabilities.

Disability can cause cycles of poverty, and this is much more common in certain parts of America, like the Rust Belt.

Ability and Disability

The Census started collecting data on disability beginning in 1990 for people 15 years or older and on people 5 years or older after 2000. This article uses US census data and the following definitions of disability to understand the inequalities that this population faces. The language and understanding around disability has grown dramatically in recent years, which has also not only help individuals receive care, but it has also helped data scientists capture important information.

Younger people tend to have cognitive and independence disabilities, while elderly people struggle with movement and hearing. Physical disability is the most common amongst workers in America. Source — US Census

Disability legislation is civil rights legislation

The Americans with Disabilities Act (ADA) was signed 30 years ago, transforming America both physically and ideologically. The ADA required offices and schools to have ramps, elevators, and designated parking spots for individuals with disabilities. In addition to requiring cities to introduce curb cutouts, the law required accommodations for people with a range of disabilities, including those who are blind or deaf. The ADA also provided wording that 180 other countries adopted for disability legislation.

The ADA improved lives for millions of Americans. 84% of respondents to a University of Texas study said the ADA improved their quality of life, and 57% said the ADA improved their access ​​to public resources.

Yet disability-related complaints remain the largest category of complaints filed with fair housing and employment agencies.

Kentucky & West Virginia are the epicenter of disability

When it comes to specific counties, Breathitt County, Kentucky right across the West Virginia border has the nation’s highest disability rate per capita. 1 in 3 people in Breathitt have a disability — the county is 98% White and has a median income ofis $29,513, less than half the national median.

In 2013, The Washington Post wrote an article about healthcare in Breathitt describing it as “a county that is one of the poorest and unhealthiest in the country.”

West Virginia is the state with the highest share rate of disability per capita in the country. 1 in 5 West Virginians has a disability. This is largely the result of high rates of obesity, smoking, and lack of exercise. West Virginia has the highest rate of diabetes and one of the highest rates of cardiovascular disease in the country.

Donna Jean with her two dogs in her home which is the size of a one-car garage — Source: The Washington Post

Donna Jean lives in West Virginia and knows how challenging it can be to get by as a person with disabilities. Donna Jean started receiving disability benefits at 22 for mental and cognitive challenges. “I’m not that smart, buddy. Kids made fun of me.” she says.

Her Social Security Disability Insurance is her primary income, but only provides her with $735/month. That money disappears by half though at the first of the month, she explains. $304.17 for her house, $20 to the Dollar Store for minutes on a phone with a cracked screen that she rarely uses, and then $50 for utilities despite her house having no running water.

She explains that her disability makes it really hard to find a job and in turn she works illegally finding spices and roots that she sells to distributors.

Janitors and rural counties

The most common occupations for people with a disability are janitors and building cleaners, where about 300,000 workers with disabilities find employment. They make up 11% of janitors country wide and make less than $30K per year on average in these roles.

Explore the data

The CDC found that 1 in 3 people in rural communities lives with a disability. One reason for the higher rates of disability in rural regions is lack of access to healthcare. The National Association of City and County Health Officials points to adults living in rural areas may rely on services that are more informal and less specialized. They must travel farther and pay more for those services, yet still tend to receive worse care than they would have in urban areas.

Race based differences in employment for people with disabilities also persists — Source: Brookings

In the 100 largest metro areas, Black people with disabilities have among the lowest employment rates. But the gaps for both White and Black people with disabilities compared to their peers without disabilities is equally as large.

The Path Forward

Disability in America does not have to be a barrier to opportunity. We can provide better care in the workforce, support those in their moments of need, and create systems that don’t denigrate individuals and instead help give them the tools to succeed.

  • Disability inclusivity in the workplace — I looked at the work that more than 50 companies were doing to promote disability inclusion in the workforce and found several leading examples. Live-captioning for virtual meetings and events is incredibly helpful for people with hearing disabilities. Pre-install KNFB reader (an award winning app developed by the National Federation of the Blind) on work phones to help blind or low-vision employees convert text to speech. Create community groups for people with disabilities to share their experiences and for those without to read reports on inclusive design. Lastly, consider hiring from disability job-boards like the Holland Bloorview Ready to Work program.
  • Protect parents with disabilities — Parents with disabilities are much more likely to be wrongfully reported to Child Protective Services (CPS), sometimes while the parents are even still in the hospital after having just given birth. A study from Brandeis University looked at 516,849 cases across 8 states when parents with disabilities were referred to CPS. The researchers found that in 73% of cases the parents were wrongfully accused. Social workers can be better trained in understanding when disabilities may actually challenge a child’s home life as well as be trained in bias reduction against parents with disabilities. This training and awareness can ensure that inequality in treatment of Americans with disabilities will stop breaking up homes.
  • Keep people with disabilities out of prison40% of people in state and federal prisons have at least one disability. As I’ve previously said, prisons are America’s largest mental health facilities. Deaf people walking towards cops are often killed or arrested for failure to comply through no fault of their own. Organizations like the Black Disability Collective have a proven track record of helping at-risk groups with disabilities get the support they need and stay out of prison.

People with disabilities are one of the largest constituencies in the country — 61 million Americans if we include those living in institutional care. Federal, state, and local agencies (as well as businesses) have done a tremendous amount to improve care, access, and opportunity for Americans with disabilities but much work remains, particularly in rural counties and the Rust Belt. The policy suggestions and actions discussed here outline the steps we can take to make a difference.

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Jeremy Ney

Former Federal Reserve policymaker, currently at Google, now writing about inequality at AmericanInequality.substack.com