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Michael Hatzakis, Jr, MD

JAMA. 1999;281:762.

In ancient Greece, the agora was a central marketplace where products and services were traded and people met to vote, hear lectures, and gather with friends and neighbors. Improved transportation has replaced the classic agora with scattered malls and business complexes. However, a new agora is being created on the Internet.

For most people, the Internet provides a convenient way to access a variety of goods and services. But for those with even minor disabilities, access to education, employment, goods and services, assembly with peers, or contact with physicians over electronic media may provide a lifeline.

As physicians, we are not always taught about the impact acute and chronically disabling diseases will have on various aspects of the impaired patient's quality of life such as employment, education, shopping, contact with loved ones, or even contact with their physicians. Of the 35 million US citizens with a disability, 38% have mobility limitations, 32% have respiratory or circulatory disease, cancer, or diabetes, and 15% have sensory and intellectual limitations.¹ Computer and Internet technology are now powerful enough to offer people with impairment access to others with similar medical conditions, as well as to medical information, education and training, goods and services, and employment.

Employment is vital to the individual with chronic disease, and studies have shown that it is high on the list of factors that contribute to how people perceive their quality of life.^2-3 Yet, only 26.1% of those with significant disabilities are employed.⁴ At the same time, telecommuting is growing rapidly; nearly 10% of US workers now telecommute, and that number has grown more than 15% a year for the last several years.⁵ This trend, combined with improvements in assistive devices, as well as cheaper access and new telecommuting technology, will make reputable online educational and employment resources a great asset to a person with a disability.

Legislators, recognizing the potential of Internet resources for those with disabilities, have introduced legislation that supports electronic resources for employment. President Clinton recently unveiled an initiative that includes the Work Incentives Improvement Act, intended to protect Medicare coverage for those returning to work, provide a $1000 tax credit to cover work-related costs, and funding for cost-effective access to information and telecommunications technologies.

Access to employment gives a person with a disability not only the potential for financial independence, but also greater self-esteem and more control over his or her health care. Access to loved ones and peers allows people to better adapt to their illnesses; greater access to health care and medical information permits more effective disease prevention. Many of us in medicine recognize that this new agora of services the Internet provides will benefit the health care industry; but those with a disability stand to benefit far more than any of us.

Resident, Department of
Rehabilitation Medicine
Thomas Jefferson University Hospital
Philadelphia, Pa

REFERENCES
1. National Center for Medical Rehabilitation Research. NCMRR Research Plan: The scope of disability. Available at: http://silk.nih.gov/silk/NCMRR/Archive/RPlan/PlSco.htm. Accessed November 8, 1998. 2. Clayton KS, Chubon RA. Factors associated with the quality of life of long-term spinal cord injured persons. Arch Phys Med Rehabil. 1994;75:633-638. FULL TEXT | WEB OF SCIENCE | PUBMED 3. Felce D. Defining and applying the concept of quality of life. J lntellect Disabil Res. 1997;41(pt 2):126-135. 4. US Census Bureau. Employment rate of persons with disabilities. Available at: http://www.census.gov:80/hhes/www/disable/sipp/emprate.html. Accessed January 26, 1999. 5. US Department of Commerce. The emerging digital economy. Available at: http://www.doc.gov/ecommerce/emerging.htm. Accessed January 26, 1999.

Prepared by Ashish Bajaj, Department of Resident and Fellow Services, American Medical Association.

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