Policy Analysis: Public Infrastructure and Accessibility in the City of Worcester, Massachusetts for Visually Impaired People
Kelly Morgese
MCPHS University
Problem statement
What actions should the City of Worcester take to improve public infrastructure and accessibility services for low vision and visually impaired people?
Background
Walking around the downtown area in the City of Worcester poses multiple problems for people with visual impairment. Not only is each individual crosswalk different in mode of operation, but different in crosswalk signal placement, sounds, lights, and tactile mat placement. Most importantly, the lack of uniformity creates multiple hazards to people with visual impairment and an unequal environment for accessibility to public buildings and services. Visually impaired persons face a distinct set of challenges and specific health inequalities that do not affect others to the same degree. The state of Massachusetts defines a person being legally blind under the General Law of Massachusetts, Chapter 6: section 133 as a person who after examination by a physician or by an optometrist whichever such person should select, has been determined to have not more than 20/200 central visual acuity in the better eye with correcting lenses or equally disabling loss of visual field as evidenced by a limitation to the field of vision in the better eye to such a degree that its widest diameter subtends an angle of no greater than twenty per cent. The American Optometric Association (2007) defined visual impairment as a functional limitation of the eyes or visual system, and can manifest as reduced visual acuity or contrast sensitivity, visual field loss, photophobia, diplopia, visual distortion, visual perceptual difficulties, or any combination of the above. A visual impairment can also cause disabilities by interfering with one’s ability to function independently, perform activities of daily living, and travel safely through the environment. The World Health Organization (WHO) defines disability as any restriction or lack (resulting from impairment) of ability to perform an activity in the manner or within the range considered normal for a human being, and a handicap as indicative of a person’s disadvantaged position in society, resulting from impairment and/or disabilities (WHO 1980).
According to the National Federation of the Blind (2016), many statistics in blindness are estimations, numbers are extrapolated from the entire population. This method of gathering data on visually impaired persons speaks loudly to the need to research accurate numbers of actual visual impairment within the American population. As gathered by statistical techniques from the Bureau of the Census, the National Center for Health Statistics, and the Bureau of Labor Statistics, estimations of non-institutionalized, male or female, with all education levels in the United States age 16-75 reporting visual disability in 2014 totaled 6.9 million people.
With 2.3 % of the overall population reporting visual impairment, 3.8 million are women, and 3.1 million are men. Age distribution of visual impairment between 18-64 years old is 3.8 million within the United States, and there are 3 million people aged 65 or older with a visual impairment. In Massachusetts, 130,300 individuals reported visual impairment.
Eliminating health disparities
Having a disability puts one at substantially higher risk for experiencing poor health status than the general population (Manduchi 2011). Policy changes must be put in place to address changes in access to public buildings, medical care, improve delivery of healthcare and remove environmental barriers in accessing these services (Drum 2005). Laws and public policy must advocate for people with visual impairment in order to eliminate health disparities. These disparities need to be addressed at the level of the person with the disability, the professionals who provide services and safeguarded against through the policies in place have the ability to impede or facilitate better access to health promotion (Drum 2005).
Studies suggest significant evidence of the association between socioeconomic status determinants and prevalence of visual impairment and blindness (Ruis 2012). Pending investigation, Ruis also postulated that the effect of an individual’s socioeconomic position on his or her health may be direct, but also may emerge from intermediate determinants of social stratification such as educational level or income. Multiple studies have found that ethnic or racial groups have a prevalence of visual impairment often due to specific eye diseases that are predisposed for genetically. Due to multifactorial variability between genetics and environment, it is difficult to know how much of this disparity was intrinsic to race, or ethnicity and how much was associated with socioeconomic position or the lack of eye care (Basbas, Konstantinidou, and Ribas 2010).
Quality of Life for Visually Impaired Persons
Drum (2005) defined health and wellness, which involves physical, emotional, social, spiritual, and other factors that enable individuals to maximize their potential and fully participate in their community. People with a variety of physical disabilities are more likely to experience early deaths, chronic conditions and potentially preventable secondary conditions. People with disabilities have some of the highest rates of oral disease and higher rates of diabetes than the general population. Differences are underscored by disparities in other areas of wellness including lower rates of high school completion, higher unemployment and fewer social activities. Lamoureux (2004) found that in people with visual impairment the greatest restriction of participation was associated with reading, outdoor mobility, participation in leisure activities and shopping. These activities are commonly thought of to be enjoyable amongst the population, thus decreasing the quality of life and range of pleasurable activities for visually impaired populations. Intervention for visually impaired persons aimed at improving quality of life may include strategies to improve not only vision rehabilitation but also mental and physical health.
The National Federation of the Blind reported that for working age adults reporting significant vision loss only 40.4% were employed in 2014, and for non-institutionalized persons age 21-64 years old 17% were without healthcare insurance. Overall health status is extremely important for experiencing quality of life, maintaining self-sufficiency and autonomy within daily life, and for full participation in society. By maintaining health and wellness, it is possible to reduce the impact of visual impairment on quality of life. Without full participation in society, people with visual impairment may experience increased rates of depression and isolation. By neglecting overall health and wellness, cardiovascular health may be at increased risk as well as rates of obesity. People with disabilities may be the largest underserved subpopulation demonstrating health status disparities that stem from preventable secondary conditions (Lamoureux 2004).
Mobility
People with vision impairment are able to walk without accompaniment of a sighted guide through the use of touching cues such as white canes and/or sighted guide dogs. Pedestrians that are visually impaired, similarly to sighted individuals, travel in unfamiliar places for work, education medical attention, recreation pleasure. This requires specific tasks to cross safely at signalized intersections, with an important need to recognize the boundary between the sidewalk and intersection with oncoming traffic (Bentzen, Barlow, and Franck 2000). In addition to these specific tasks before one crosses the intersection, the geometry of the intersection must be analyzed through auditory or tactile cues, including the angle of intersection, the width of the street, median and islands that can affect crossing strategies, and information from vehicle sounds. By stopping and observing for auditory cues, persons with visual impairment utilize the nature of traffic control, signal phases, and use these cues to localize a path to opposite corner of the intersection (Bentzen, Barlow, and Franck 2000). In Worcester, there are many lights, traffic signs, street furniture, trees and ramps that can mislead and misdirect visually impaired pedestrians and be potentially hazardous.
Manduchi (2011) stated vision loss increases the risk of unintentional injury, as research highlighted the correlation between type, severity, and frequency of injuries and the type and degree of vision loss. The mobility of pedestrians is influenced by wealth factors such as socioeconomic status and area infrastructure characteristics which may have poor safety for pedestrians, where traffic volume is high and crossing routes are unclear or unsafe. People who are visually impaired with higher socioeconomic status may have the option of hiring or having a driver transport them around areas of risk, where visually impaired persons with lower socioeconomic status may not have this luxury and rely on the public infrastructure to keep them safe. Especially important are route deviations such as areas under construction which can pose significant risk for visually impaired pedestrians on roads that are more often designed for sighted drivers. Visually impaired pedestrians are unaware of the blockade and being confronted with the construction can cause unnecessary safety risk in addition to closed connections and time and energy spent going around the blockade (Basbas, Konstantinidou, and Ribas 2010).
Barriers in pedestrian mobility and safety need to receive increased attention because people who are visually impaired rely on public crosswalks in order to maintain their independence and accomplish daily tasks of living. Transportation designed primarily for vehicles with little regard for visually impaired pedestrians needs to be prohibited in cities, especially when safety and quality of life are at risk. Pedestrian mobility is restrained by inadequate infrastructure such as pavement potholes, pedestrian crossings, ramps without special infrastructure for the disabled (Basbas, Konstantinidou, and Ribas 2010). In many cases, and in one notable area of downtown Worcester, vehicles are parked on the special surface on the pavement which is dedicated to the movement of blind and disabled people.
Steps taken in Worcester
The American Disability Act upholds the civil right for disabled pedestrians to access information provided to other pedestrians. To enforce the ADA, the city of Worcester must first address accessibility within the downtown area, modifications necessary to increase access to the community, and decrease barriers to access public buildings and resources. Under Massachusetts State law Chapter 6: section 145, the commission shall continuously study the problems relating to blindness and make investigations, demonstrations and reports, thereon, and shall establish and maintain contact with physicians and other qualified persons or facilities available to render competent services to the blind.
According to Worcester’s Commission on Disability meeting from September 2016, over the month of September 2016, the Department of Public Works repainted 652 Crosswalks, 18 miles of white skip lines, lane lines, and edge lines, 53 miles of double yellow center and edge lines, 451 stop bars, 236 legends and symbols. The city of Worcester will continue to work through the fall spending a total of $360,000 repainting streets this year to ensure roadways are clearly marked for drivers and pedestrians. While this amount of money will undoubtedly help the overall safety landscape for both drivers and pedestrians, this doesn’t truly address the accessibility of crosswalks for visually impaired individuals in Downtown Worcester. In order to address the problem and draft sidewalk improvement recommendations, there are two ways in order to suggest improvements to the city council. The first is when a street is resurfaced the sidewalks are also redone, and the second is a resident petition to city council. The 5 district city councilors are given a list of the street in the respective district and an estimate of available dollars, from the list a councilor will make their recommendation for sidewalk repair. The council will then vote on citywide recommendation (Commission on Disability 2016). This process sounds effective, yet, the overarching problem is that this is with the assumption all the crosswalks are accessible which is not the case. While the city council states all crosswalks are in compliance of the law, it is easy to observe by anyone walking through downtown Worcester, there is no consistency within this compliance and without the sense of sight, finding these crosswalks quickly turns into a dangerous guessing game. It is imperative there are accessible routes for visually impaired persons to access medical care facilities, libraries, courthouses, city hall, exercise clubs and supermarkets. Tactile signs and surface textures pointing into oncoming traffic or diagonally across an intersection is a safety risk to visually impaired pedestrians. By increasing uniformity of the walking routes downtown, it may be possible to increase participation in generic health promotion programs such as smoking cessation, weight management, and exercise routines that may increase overall health of visually impaired persons (Drum 2005).
Technology
The United States 21st Century Communications and Video Accessibility Act of 2010 ensures that people with disabilities are not left behind as technology changes and specifically mandates cellular phone companies to make web browsers, text messaging, and email on smart phones fully accessible for individuals with vision loss. This Act also provides $10 million dollars in funding each year for assistive technology for deaf-blind individuals (Massachusetts Office on Disability 2011). Currently, there are devices that can increase font size, contrast and read messages aloud with dictation. Scan squares, also known as Quick Response codes, throughout the city equipped with an audio locator may also be utilized by visually impaired persons with a smart phone to navigate and independently learn about the environment (Al-Khalifa 2008). To discuss accessibility in 2016, and not include the use of technology would be to ignore available resources. New possible resources to increase accessibility of the visually impaired, is an obstacle recognition system using radio frequency identification. This is in the form of smart cane technology utilizing differential global positioning system (DGPS) and/or radio frequency identification (RFID). At present, there are problems with the ability to recharge the cane, especially for people who do not have access to electricity. Another method to bypass this, is a system that could convert mechanical energy created by motion of the cane into electrical energy, making the charging of the battery a continuous process (Nassih, Cherradi, Maghous, Ouriaghli, and Salih-Alj 2012). By providing and utilizing technology such as this, managing a difficult landscape would be easier especially if the public infrastructure is not in place to enable accessibility of visually impaired persons.
Stakeholders
There are several stakeholders involved in this process in order to increase equality and accessibility to walking routes through Downtown Worcester for visually impaired persons. Stakeholders such as ADA Standards for Accessible Design, to ensure every public space is equally accessible to those with disabilities. The Worcester Health Department is a stakeholder in this as well, to promote safety and health across all socioeconomic statuses within the city of Worcester. Another stakeholder significantly invested in this issue is the Worcester Office on Disability and the town disability commission that functions to make the community a better place to thrive for visually impaired persons. The Massachusetts Commission for the Blind and Department of Developmental Services is responsible for advocating for the blind and disabled persons, to further the pursuits of visually impaired and increase quality of life. Congressman Jim McGovern, as well as Massachusetts Governor Charlie Baker, who essentially hold the power to make these changes and advocate for disabled and visually impaired persons equal access and thoughtful planning in city design. Businesses and organizations located in Downtown Worcester hold a stake in this, due to the fact with equal participation in society, the community will be enhanced with increased diversity, commerce and involvement. Lastly, visually impaired persons have the largest stake with perhaps the most to gain and the most to lose. With the increased use of public services, visually impaired persons are able to resume a safer, healthier, more active lifestyle participating in the community without the additional fear that public infrastructure is lacking.
Policy Options
Option 1: Audio Guidance and Technology Update for Visually Impaired Pedestrians
With this option, the city of Worcester would provide audio guidance and technology distribution to all visually impaired citizens. This would be through distribution of obstacle recognition systems for the blind using radio frequency identification (Nassih, Cherradi, Maghous, Ouriaghli, and Salih-Alj 2012). Advantages of this technology would be the progression of visually impaired persons utilizing technology, and perhaps through involving technical schools such as Worcester Polytechnic Institute and optometry schools such as MCPHS to monitor, study, and increase the progress of this technology. Another technological option would be installing scan pads throughout the city with an audio cue, which would be easily installed and inexpensive.
The disadvantage of this option would be the expense associated with outfitting the visually impaired citizens with a sustainable technology. In addition to this, providing this would not be truly solving the problem of inadequate infrastructure in the city, and disabled persons visiting Worcester would still have to use flawed crosswalks without technology. The disadvantage of scan squares or QR codes, is that people of lower socioeconomic status do not have cell phones, and to assume that would be ignorant, in addition to any difficulty of blind-deaf individuals locating the scan pad due to another disability unaccounted for in this technology.
Option 2: Incentives to Redesign Crossing Signals for Downtown Worcester
One large incentive to redesign crossing signals and create walking route uniformity is the Greater Worcester Community Health Improvement Plan (CHIP). The Worcester CHIP is a commitment to the long term well being of the vibrant and diverse community members with stakeholders such as City of Worcester Division of Public Health in partnership with Mass Memorial, Common Pathways and over 90 other community partners. The CHIP aims to improve the quality of life and prosperity of residents by identifying health related needs. The CHIP plans to accomplish this through promotion of healthy eating/active living, violence and injury prevention and health equity and health disparities. By improving the walking environment this will help to make Worcester not only ADA compliant but also ADA friendly. Through the CHIP program, Worcester can aim to become America’s healthiest city, revitalize downtown, attract more corporate interest, create a happier, healthy, and more successful city.
Challenges of this option, would be the expense required for these changes, and the increased effort, resources and time it would take to do so. Long term these disadvantages will be weighted and will minimize as time goes on and the benefits of the project are recognized.
Recommendation
While both options would better enable accessibility in Worcester, my strongest recommendation is appointed to option 2 which I believe holds the most significance and will highly increase the quality of life for visually impaired individuals and all stakeholders involved. Option 1 has many benefits, but also holds more limitations to visually impaired citizens and non-citizens navigating through Worcester. Option 2 holds the most weight, to alter the lives of the citizens living and working in Worcester, increasing access to public spaces for all. This policy will encourage and enable those who are visually impaired to access government buildings, public spaces, and participate in community events. By enacting this change, the city of Worcester will be reversing infrastructure discrimination inherently present in the flawed crosswalks and create a safe environment for the disabled.
Finally, by fulfilling the potential of the CHIP Worcester has an opportunity to become better, to make living in Worcester more equal for all and in doing so, this fulfills a responsibility the city has to create safe environment for all of its residents.
References
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