Structural Ableism,Health,and Functioning among People with Disabilities: An Extension of the Social Determinants of Health Framework

Abstract

This study examined how structural ableism, conceptualized through the social determinants of health framework, impacts health outcomes among people with disabilities. Using multilevel regression analysis with data from the 2020 National Survey on Health and Disability (N = 2,175) paired with state-level indicators from the 2019 American Community Survey, it investigated associations between state-level disparities (in educational attainment, income, health insurance coverage, housing accessibility, and public transportation access) and self-rated health and functional limitation. Results demonstrated that structural ableism operates through distinct pathways for each health outcome. Income, health insurance, and transportation gaps by disability status at the state level significantly predicted self-rated health, and health insurance and housing gaps were the strongest predictors of functional limitation. The findings provide empirical evidence that state-level arrangements create systematic patterns of health advantage or disadvantage that transcend individual experiences, emphasizing the need to address structural barriers associated with disability.