Opinion | How Every City Can Promote Health Equity for People With Autism

April is Autism Awareness Month, a time to take action to address the fact that there is inadequate healthcare and support services for individuals with autism across the U.S. Those with autism have poorer access to healthcare than non-autistic people and higher rates of chronic disease. Rural and low-income areas are particular service deserts for those with autism. Those from racial and ethnic minority groups with autism face challenges in receiving early, continuous, coordinated, and specialty care, and have poorer quality of interactions with providers. More globally, those with autism from childhood through adulthood experience isolation and have difficulty finding the kind of belonging and connectedness that is so critical to health and wellbeing.

Here in Laredo, Texas, where I serve as Health Director, we sought to address these concerns with our recently passed “All Kinds of Minds” plan, focusing on improving access to services, financing for services, health equity, and overall quality of life and well-being for community members with autism and other disabilities. The project kicked off with a survey that showed the overall quality of services in Laredo for persons on the autism spectrum was rated at a score of only 2.24 out of 5.

With that sobering starting point, we developed our plan around a series of town halls, which provided input from parents, disability advocates, educators, local government leaders, health department staff, and the business community. We took a broad approach that emphasizes family-centered care, comprehensive services, effective transition, quality healthcare, and quality data collection.

The final “master plan” is aimed at improving the delivery of healthcare and services for persons with disabilities (PWD) in our community within a defined period of time and includes a number of elements intended to make the effort meaningful, rigorous, and sustainable. The plan is based on the “Blueprint for Change,” a national framework developed by the Maternal and Child Health Bureau. We instituted a staged process that is transparent to the community. In the first phase 1 (years 1-2), we’ll assess gaps in access to care and services, and take steps to fill those gaps with community partnerships and technical assistance and training. In phase 2 (years 3-5), we’ll implement and scale the pilot work developed in phase 1 and grow, improve, and sustain our programs. The plan also emphasizes robust data collection for evaluation and continuous program improvement, means of recognizing and celebrating stakeholder engagement and support of the program, and sustainability over the long term.

If this all seems fairly straightforward, that’s exactly right: the novelty is in the doing. While the outcomes from this initiative remain to be seen, simply by entering into this process and developing a concrete structured plan on a timeline, Laredo is ahead of the curve. As we started the initiative, I reached out to the Texas Association of City and County Health Officials (TACCHO) to inquire about any plans to improve communities for those with autism or other disabilities that may have been implemented in other jurisdictions. No other city or county in the state had drafted anything like what we envisioned. Around the country, municipal governments generally fail to demonstrate commitment to a higher standard of living for persons living with disabilities or make specific efforts to do so.

The good news is that what we’re doing in Laredo is feasible and reproducible. Our development process and plan for implementation and sustainability are available online in the master plan. And we love to share more about this work and its early impact on our city with other community leaders around the country. I’ve received inquiries about our program from as far away as New York state, speaking to the early reach of this effort.

That’s not to say it’s not a challenge. The fact that so many people and groups around Laredo wanted to invest in this work is unusual, fortunate, and necessary: this work requires a collective effort from government agencies, community organizations, healthcare providers, and individuals. We must work together to identify and address the systemic barriers that prevent individuals with disabilities from fully participating in all aspects of society. We must invest in accessible infrastructure, promote disability rights and advocacy, and provide comprehensive healthcare services that meet the unique needs of individuals with disabilities.

Those with disabilities are used to molding their lives around the way the cities are built. Here in Laredo, we decided to see what would happen if we mold our city to better meet the needs of those with disabilities. By embracing this challenge wholeheartedly, we hope to create a more inclusive and equitable society, where every person has the opportunity to thrive.

Richard Chamberlain, DrPH, MPH, is director of health in Laredo, Texas, and senior advisor on Border Health for the Wellness Equity Alliance.