Case Synopsis

Following years of advocacy work, Christina Peterson, foundational standards specialist at Public Health Sudbury & Districts (PHSD) and co-chair of the Evidence-Informed Practice Working Group (EIPWG), facilitated the formation of the People with Disabilities Working Group in early 2015. People with disabilities (PWD) faced significant health inequities compared to people without disabilities. The People with Disabilities Working Group had established three long-term outcomes from their logic model:

  1. Programs and services at PHSD are fully accessible and inclusive, particularly for people with disabilities (especially for unseen disabilities).
  2. Staff at PHSD have the ability to recognize, understand, and apply attitudes and practices that are sensitive to and appropriate for people with disabilities.
  3. Staff have the knowledge, attitudes, and skills to ensure programs and services are fully accessible and inclusive for people with disabilities.

Oftentimes, public health programs, services, infrastructure, and policies are not designed with people with disabilities in mind. Healthcare professionals often focus on disabilities alone, rather than the needs of the whole person. PHSD recently developed ten promising local public health practices to reduce social inequities in a health framework. The PWD working group had made some progress towards their long-term goals, such as a board-approved motion for a personcentred language statement within PHSD. However, Christina knew that there was very little done that was based on the health equity framework they had established, especially for those with unseen disabilities. There was a need to go “beyond the wheel chair ramp”.

The goal of this case is for students to understand the definition of health equity and recognize its importance when planning, delivering, and evaluating public health programs, services, infrastructure, and policies within agencies. Based on a modern public health issue, students will have the opportunity to apply promising evidence-based public health practices to reduce social inequities in health and devise other programs when dealing with a marginalized population.

The backdrop of the case, which depicts Christina’s fight to create change within an organization, will highlight the social-ecological model of behaviour change typically applied in health promotion strategies.

Case Objectives

  1. Define health equity.
  2. Describe the importance of using a health equity framework when planning, implementing, and evaluating programs, services, infrastructure, and policies within public health agencies.
  3. Assess various complex, multi-faceted, and common issues in public health related to health equity and devise recommendations for improvement.
  4. Define and apply the social-ecological model when advocating for change within an organization.

Case Study Questions

  1. What were some of the barriers Christina and the PWD team faced in advocating for the health outcomes for people with disabilities?
  2. What are some other practices that PHSD can perform, which can reduce the social inequities for people with disabilities?
  3. What are some of the benefits of using a health-equity framework when planning, delivering, and evaluating programs within PHSD?
  4. Christina was an outstanding leader in this process. What are some of the qualities she possessed that helped create change?


health equity, people with disabilities, unseen disabilities, universal design, surveillance, community engagement, social-ecological model of behaviour change

Additional Author Information

Akshay Varghese, BSc, MPH

Laurel O’Gorman, MA, formerly Health Promoter

Joelle Martel, Health Promoter

Groulx, RN, BScN, MPH, Manager Professional Practice and Development, Knowledge and Strategic Services

Mark Speechley, PhD, Professor



Recommended Citation

Varghese, A., et al. (2018). Going Beyond the Wheel Chair Ramp: Public Health Sudbury & Districts’ Plan to Become Accessible to All. in: McKinley, G. & Sibbald, S.L. [eds] Western Public Health Casebook 2018. London, ON: Public Health Casebook Publishing.