The Case for 'Health Related Impairments and Disabilities'
Simon Harper, Julia Mueller, Alan Davies, Hugo Nicolau, Sukru Eraslan, Yeliz Yesilada · 2020 · Proceedings of the 17th International Web for All Conference (W4A) · doi:10.1145/3371300.3383335
Summary
This position paper argues for recognizing a distinct category of impairments called Health-Related Impairments and Disabilities (HIIDs) that are fundamentally different from traditionally defined disabilities and therefore require different accessibility approaches. Drawing on the authors' experience across research in blind accessibility, aging, autism, lung cancer, Parkinson's Disease, and neurodegenerative disease, the paper contends that health conditions — both chronic and acute — produce disability-like impairments affecting mobility, cognition, and perception that are pernicious because they are difficult to isolate, vary in intensity over time, and are under-investigated. The concept originated from Nicolau and Jorge's work circa 2012/13 on a disability continuum. The authors define four key characteristics that distinguish HIIDs from traditional disabilities and present three case studies (a COPD self-management app, musculoskeletal issues from Facioscapulohumeral muscular dystrophy, and web use for lung cancer symptom appraisal) to illustrate these characteristics. The central argument is that addressing the disability caused by the underlying illness is often ineffective; instead, addressing the illness directly will in turn address the disability through their transitory relationship.
Key findings
The paper identifies four defining characteristics of HIIDs. First, combinatorial impairments: multiple low-intensity impairments that individually seem minor but in combination create significant accessibility barriers — exemplified by COPD patients who simultaneously experienced reduced manual dexterity, visual impairments, low technology familiarity, and low health literacy, with these impairments interacting and exacerbating each other. Second, dynamic impairments varying in magnitude and extent: conditions like intermittent claudication or angina where pain and functional limitation fluctuate rapidly based on exertion, medication timing, stress, and other factors, making it impossible to design for a stable state. Third, impairments as comorbidity: the disability is secondary to a primary health condition, meaning addressing the underlying condition (e.g., managing asthma) may relieve the associated mobility impairment more effectively than traditional accessibility solutions. Fourth, socio-technical impairments: eleven barriers including low income, low literacy, fear of technology, reluctance to seek support, inadequate healthcare resources, and poor communication between health professionals that compound the functional impairments. The paper also discusses how affective computing could help detect dynamic HIIDs but notes significant challenges in applying emotional recognition technologies to people whose conditions may prevent typical facial expressions.
Relevance
This paper challenges a fundamental assumption in accessibility practice: that disabilities are relatively stable conditions that can be addressed with consistent accommodations. For practitioners, it raises the question of whether designing for static accessibility profiles is sufficient when many users experience fluctuating, combinatorial impairments driven by underlying health conditions. The HIID framework is particularly relevant to aging populations and anyone with chronic illness, which represents a large and growing user base. The socio-technical barriers identified (fear of technology, low income, low literacy) remind practitioners that accessibility extends beyond interface design to encompass the full context of technology adoption. As a position paper, it does not provide empirical evidence or solutions, but rather defines a problem space and calls for new approaches — including adaptive systems that can respond to changing impairment states and interdisciplinary "team science" combining healthcare professionals, psychologists, and computer scientists.
Tags: health-related impairment · comorbidity · chronic illness · dynamic disability · COPD · accessibility theory · combinatorial impairment · position paper
Standards referenced: ICF