Introduction
Are you interested in climate change? Do you want to know about the connection between climate change, health and disability, and what role PM&R plays? Climate change is the biggest public health crisis we face and has major effects on our overall health. It also disproportionately affects people with disabilities. Physiatrists can play a role in mitigating the effects of climate change.
PAPA is so excited to introduce our first community collaboration with Sustain Our Abilities! We, as a nonprofit organization, are always looking for opportunities to show you different ways to impact the field of physiatry. This is an important topic for us to address as we see the extreme weather patterns affect so many different places across the globe, including the Philippines. In line with SCI Awareness Month blitz week, we have Alex Ghenis, Deputy Director of SOA writing about the importance of inclusive city design, the challenges and barriers that people with disabilities, especially spinal cord injury individuals, face and how this is all affected by our changing climate.
There are so many different ways to get involved. Read on to find out more!
What is Sustain Our Abilities?
Sustain Our Abilities is a US-based nonprofit focused on the intersection of climate change, health, and disability. SOA’s work is driven by a desire to have more inclusive climate mitigation and accessible, equitable climate adaptation for the disability community. Its efforts include research, policy development, and public education, plus supporting partner organizations and advocates on the SOA Advisory Board. Sustain Our Abilities is also co-hosting the upcoming Climate & Health 2023 conference, which will be held in New York and online October 21-22, 2023.
Who is Alex Ghenis?
Bio
Alex Ghenis is the Deputy Director of Sustain Our Abilities, a nonprofit focused on the intersection of climate change, health, and disability. Alex acquired a spinal cord injury in his teens and went on to receive a BA in Geography and MPP from UC Berkeley, where he learned about climate change and became ingrained in Berkeley’s disability rights community. He has built his career around disability climate justice, focusing on topics including disaster readiness, resilient and accessible urban design, equitable clean transportation, and disability
rights in climate migration. In addition to his work at SOA, Alex is a member of the cap equity Working Group for the Bay Area Climate Adaptation Program, a member of the Technical Advisory Committee for the California Governor’s Integrated Climate Adaptation and Resiliency Program, the disability SME for California’s Functional Assessment Service Teams, and a contributor to New Mobility Magazine.
Spinal Cord Injury and the Case for Urbanism: A Call for Inclusive City Design
By: Alex Ghenis, Deputy Director of Sustain our Abilities
As a person with a spinal cord injury (SCI) whose has lived in different suburban and urban environments, I’ve seen firsthand the connections between urban design, accessibility, and independent living. Given people with SCI grapple with difficult housing choices, transportation barriers, quality of life issues, and the ravages of climate change, it’s worth asking: what do we want our cities to look like and what goals do we want to achieve? After digging into things, I’ve concluded that urbanist and YIMBY (“Yes in My BackYard”) principles should be our starting point and we should embrace them, while also recommending extra accessibility features along the way. That will benefit us when it comes to housing choices, transportation options, independent living in general, and both limiting climate change and increasing our collective climate resilience.
Relevant Situations & Barriers Faced by People with SCI
People with SCI encounter many situations and barriers that can be addressed by good urbanist and housing policy. As you read through these, think about how a more vibrant urban fabric could benefit people with SCI. And in the next couple sections, I’ll lay out my thoughts on the matter.
Climate vulnerability: People with SCI, like all people with disabilities, are disproportionately affected by the impacts of climate change. Some of this is physiological, such as our limited thermoregulation leaving us especially exposed to extreme heat, while some of it is due to social inequities, like our lower average income leading us to live in housing with worse insulation and air conditioning (or leaving us without enough income to afford high AC bills). There are many other examples of climate inequities we face, whether that’s through navigating natural disasters or climate-related migration. Therefore, efforts to reduce warming or increase climate resilience especially benefit us. Opportunities to live in more climate-stable areas – e.g., away from fire zones and floodplains – are also valuable.
Transportation barriers: Transportation is a frequent headache for people with SCI, and many of us are transportation limited. People with disabilities, including people with SCI, have lower rates of car ownership than the able-bodied population and are more likely to use public transit and paratransit. Those of us with private vehicles need sometimes-expensive hand controls, expensive wheelchair-accessible minivans, or both, and many of us need someone else (like a friend, family member, or caregiver) to drive. Meanwhile, public transit and paratransit are often woefully inadequate to support independence and a good quality of life; even the best US cities don’t have the kind of coverage European cities do, some legacy transit systems have major accessibility issues (like in NYC, where fewer than 29% of stations were accessible in mid-2023), and paratransit is unreliable, with some systems requiring users to schedule rides multiple days in advance. More accessible public transit with better coverage and frequency will empower people with SCI to better navigate their own cities and to do so independently; this will also help us reduce our own carbon footprint.
Housing conundrums & insecurity: People with SCI need accessible housing to support independence and a decent quality of life. We also have much lower rates of employment and average incomes than our able-bodied peers, which limits our housing options and often leads us to qualify for subsidized affordable housing. Unfortunately, there’s a shortage of affordable housing and most is allocated by lottery to qualifying households – so even if we qualify, actually getting a spot is just luck of the draw. It’s also notable that apartments are generally more accessible than single-family homes, duplexes or townhomes, and newer apartments are more accessible than older ones. Even if they are not fully accessible (say, if they have a tub), they are easier to make fully accessible with modifications; the one trick is payment, since landlords are not legally required to pay for bathroom remodels and other reasonable accommodations (they can’t stop you from modifying your own apartment, but they can make you pay and also undo the modifications when you move out).
On sidewalks, crosswalks, and bike lanes: People with SCI deserve safe “pedestrian infrastructure” (sidewalks, crosswalks, and other walkways) so we can navigate our neighborhoods; to be accessible, this infrastructure should be unobstructed with well-designed curb cuts and smooth pathways. Unfortunately, rural and suburban areas usually have inadequate pedestrian infrastructure in general and poor accessibility on the infrastructure that exists, while cities have their own shortcomings that need to be fixed. In addition, those of us with power wheelchairs, power add-ons for manual chairs, or hand-powered tricycles often like to use bike lanes to get around (I especially like them because sidewalks are so bumpy). A good bike network can thus benefit people with SCI. Finally, people sitting in wheelchairs are harder for some drivers to see than pedestrians are (especially for drivers of SUVs and trucks), so good pedestrian and bicycle infrastructure should emphasize safety from vehicles.
Independence and quality of life: People with SCI deserve independence and a good quality of life, and the built environment can either support or harm both. The factors above, though, have combined to severely limit independence and quality of life. For example, the combination of living in sprawl and having bad transportation options contributes to people with SCI’s low employment rates: after all, it’s hard to land a job that you can do if there are limited jobs nearby and you can’t easily or reliably get to them. Sprawl and bad transportation options also make it harder to do errands independently, limit outings for entertainment, and contribute to social isolation and related psychological harms. On the flipside, a well-designed urban fabric can facilitate independence and boost quality of life, with everything that entails.
Urbanist Concepts and SCI
Now it’s time to dive into the intersections of urbanism and the SCI community. I’m going to list the principles of urbanism and the “Yes In My Backyard” (YIMBY) movement, and explain how each one connects to SCI. It seems clear that urbanism and the dense housing development advocated by YIMBYs will have a positive impact on people with SCI at many levels. It will support our independent living, improve our finances, expand job opportunities, grow our social circles, help us live more sustainably, and more. And by reducing carbon emissions, urbanism also limits of the climate change that does us disproportionate harm.
What is Urbanism?
At its core, urbanism focuses on the way cities are built, how they function, and how people interact within them. Urbanists advocate for the creation of cities that are “walkable,” sustainable, and culturally vibrant. (I like “stRollable” instead of “walkable” for inclusion’s sake). Here are some urbanist concepts and how they connect to SCI.
Density: Dense urban development involves building many homes, stores, offices, and other employment and entertainment opportunities close to each other. Good urban density also uses valuable “vertical space” by allowing tall buildings, thus taking advantage of limited land. In terms of housing, good density doesn’t have to be all skyscrapers: it can also involve medium-height towers, mid-rise apartment buildings, and even townhomes and rowhouses, depending on the neighborhood. This is good for people with SCI because it enables us to be closer to friends, family, attendants, medical services, jobs, shopping, entertainment, and pretty much everything else we need for robust lives. It’s even more important given our transportation barriers, since dense development supports good public transit and puts more of our destinations within wheelchair-rolling distance. And finally, dense development reduces carbon emissions because apartments are more energy-efficient than single-family homes are and because density reduces the need for using cars and trucks; this benefits all of society and disproportionally benefits people with SCI given our extra exposure to climate dangers.
Mixed-Use and Transit-Oriented Development: Mixed-use development patterns where buildings and spaces serve multiple purposes, such as apartments located above shops or offices, foster a sense of community and reduce transportation needs. They also improve quality of life by shortening commutes and time spent on errands. Urbanism advocates for these development patterns across cities, and especially near transit stations (called “transit-oriented development,” or TOD); nodes of TOD make it so people can get most needs met in their neighborhood or just hop on transit to another neighborhood, with no need for cars along the way. This kind of mixed-use development and TOD benefit people with SCI for many of the same reasons density does.
Public Transit: Efficient, accessible, and low-carbon transit systems like subways, streetcars, and buses decrease the reliance on private vehicles. A robust public transit system improves sustainability, decreases household transportation costs (cars are expensive to own and operate), and shortens travel times for people reliant on transit. By reducing the number of cars on the road, it also reduces automobile crash injuries and deaths (for context, car crashes are the 12th leading cause of death and the #1 cause of SCI in the US). This all supports people with SCI’s independence and quality of life, limits the climate change that disproportionately affects us, and helps our often-limited household finances. Of course, public transit should be made fully accessible – both in new construction and through retrofits of legacy systems.
Pedestrian and Bike Infrastructure: North American infrastructure has evolved to mainly serve cars while making biking, walking, and rolling in wheelchairs and scooters more difficult and unsafe than it should be. Streets that emphasize safe pedestrian and bike infrastructure with well-connected bike networks can save lives and prevent injuries from car crashes; make biking, walking, and chair-rolling more efficient and comfortable; and encourage more people to ditch their cars for less dangerous, less polluting forms of transportation. As mentioned above, many people with SCI can use bicycle infrastructure and will benefit from a robust bike network. And while good bike infrastructure should emphasize retaining accessible street parking, it’s worth noting that the inconvenience of fewer parking spots is a “push” factor that incentivizes people to ditch their personal vehicles. One key to good urbanism is thus providing other low-carbon, convenient transportation options for people with and without SCI to use instead of personal vehicles.
Public Spaces: Cities should provide plenty of parks, plazas, and other communal areas that offer recreational and social opportunities. Dense development also reduces the need for sprawl by allowing more people to live in cities, so they don’t move to newly-built suburbs instead – which saves farms, forests, and other natural lands from development. Protecting these green spaces is important for the environment and saves nature areas that people use for recreation. This access to green space is good for people with SCI, who get lifestyle and psychological benefits from parks, recreation, and socialization. A good urban fabric with lots of trees and parks also provides shade that can help people with SCI during heat waves.
On the YIMBY Movement, YIMBYism, and SCI
Housing shortages lead to skyrocketing rents, harm personal mobility when choosing a new home, and push people into sprawling suburbs and exurbs with large environmental footprints. (Please note that I use “homes” to refer to all kinds of housing, from single-family homes to apartments, since one’s residence is one’s home). Unfortunately, housing shortages in many urban areas have been made worse by ‘Not In My Backyard’ (NIMBY) efforts that push back against development, especially for apartments in more privileged neighborhoods and doubly so when they involve subsidized affordable housing. In response, the “Yes In My Backyard” (YIMBY) movement formed around a decade ago and has grown in the past several years. This movement pushes for housing abundance, especially within cities and in ways that support low-carbon lifestyles. It recognizes that supply and demand affect housing prices and that increasing the supply of homes lowers rents (this is backed up by growing evidence and studies, even showing that “luxury” apartments tame prices in other nearby properties). It also recognizes the housing crisis is especially acute for lower-income households, so most self-identified “YIMBYs” and YIMBY organizations support laws that expand subsidized below-market-rate (BMR) units. The movement in general advocates for: increasing housing supply, especially in amenity- and transit-rich neighborhoods; ensuring that businesses that want to build apartments are not blocked from doing so for arbitrary reasons; expanding BMR housing through government funding and by incentivizing private developers to set aside some portion of apartments as BMR (though not requiring they do so, as mandating set-asides slow down overall development); and providing reasonable renter protections without distorting the market in a way that harms certain renters.
I think YIMBYism is a critical movement and that abundant housing in cities supports many of the urbanist dynamics listed above, with all of the related benefits for people with SCI. First of all, taming rents by expanding the housing supply especially benefits people with SCI, who have disproportionately low income and assets. Subsidized units will help people with SCI who qualify for them. Building more apartments instead of single-family homes will provide more accessible housing options – and even though only a fraction of apartments will be fully wheelchair accessible (with easily navigable layouts, roll-in showers, etc.), almost all new apartments are accessible enough to visit friends or family, and plenty can be modified to be fully accessible. New larger apartment buildings also tend to have multiple elevators, which supports independence if one elevator is out of service. And although some new buildings willingly add accessibility features beyond the ADA – for example, I recently visited a new tower in Portland with a handful of fully accessible units, the nonprofit The Kelsey is building disability-inclusive apartment buildings in the Bay Area, and plenty of buildings have ground-level door openers even though it’s not required – more should be done to require or encourage developers to add fully accessible apartments and common areas.
Conclusion
The principles of urbanism and YIMBYism improve sustainability and quality of life for people of all stripes – and especially benefit people with SCI. The sustainability that comes from urban density and reducing automobile use especially benefits people who are disproportionately exposed to climate change, which includes the SCI community. Improved transportation for non-automobile-users reduces traffic risks for people with SCI, who are harder to see from cars and trucks; cuts back on the car accidents that contribute to SCI; heightens quality of life by making it easier to get around town; and supports financial independence by providing better access to jobs and cutting down on household transportation costs. Meanwhile, more apartments reduce housing costs, which is especially good for lower income groups, and any expansion of subsidized housing benefits people with SCI who qualify.
There is some resistance to more urbanism and apartments, largely from homeowners and people concerned about maintaining infrastructure for cars. Some folks with SCI that live in single-family-home neighborhoods and suburbs might oppose urbanism and apartments for their own reasons, and may not want to move into an apartment. I understand these concerns but also recognize that the climate and housing crises are massive and all but require us to prioritize urbanism and apartments going forward. I just ask that people try to see the larger picture and what a different world could look like, and to keep an open mind about the possibility of urban living. Speaking as someone who has lived in both suburbs and cities, I love city life and think it enhances my quality of life; my SCI makes it even more important.
Connect with us!
If you are curious about the connections between climate and disability, and how we can tackle the climate crisis while also supporting people with disabilities’ independence and quality of life, come visit Sustain Our Abilities at www.sustainourabilities.org. You can also reach out through the Contact Us section of our website, sign up to volunteer, or donate to our cause. Thank you for all you do!