ASTHO, in collaboration with CDC, provided full-time disability and preparedness specialists to 17 jurisdictions to better meet the needs of people with disabilities. In this brief, specialists share their thoughts on why people living with disabilities may be hesitant to get the COVID-19 vaccine and some approaches public health officials can take to address vaccine hesitancy in people living with disabilities.
People who use electricity-dependent durable medical equipment (DME) at home—such as ventilators and oxygen concentrators—can face life-threatening consequences during a power outage. HHS reports that 2.7 million Medicare beneficiaries rely on electricity-dependent DME to live independently. This ASTHOBrief details the significant challenges that individuals who rely on electricity-dependent DME face during power outages and discuss recent efforts to increase support for this population.
Web Accessibility Content Review Guides Guides to Review for Digital Accessibility Emily Lapayowker These actionable guides help you prepare accessible web and digital content. Digital accessibility is an important process that makes websites, files like Word documents or PDFs, and other digital products accessible to people with disabilities, as well as making these products more user-friendly overall. There are many criteria to meet when making your digital content accessible. The guides on this page serve as checklists for ensuring that web content and digital products are accessible, as laid out in the 2024 ADA Title II Web Rule, and meet the current standard of WCAG 2.1. Neither will address the web development needs laid out in WCAG, but they are useful for most digital content creation. The two checklists represent two different approaches to meeting accessibility standards: standards-driven and content-driven. It is important to remember that many of the techniques contained in each are not exclusive to websites, emails, or Microsoft Office products; they can be used for all forms of digital content. Guide for Meeting WCAG Web Accessibility Standards The structure of this checklist template roughly corresponds with the Preliminary Easy Checks Checklist by W3C. Each section contains a list of relevant WCAG links that detail the criteria and conformance levels covered in that section. It also indicates which checks are manual and which can be done by an automated checker, like the applet ANDI. Get the Checklist for Meeting WCAG Accessibility Standards (automatic Word download) Special Thanks - Resource - Guide for Meeting WCAG Web Accessibility Standards Padding Block - Large Padding Block - Small Guide to Reviewing Digital Content for Accessibility This checklist has a content-first focus and is less technical than the Guide for Meeting WCAG Web Accessibility Standards. Sections are organized to keep like-topics together. Overarching sections include document content, document structure, and multimedia. Get the Guide to Reviewing Digital Content for Accessibility (automatic Word download) Padding Block - Medium OE22-2203 PHIG article yes
According to the federal government, a homebased individual is someone who requires the help of another person or supportive device to leave the home, someone who is advised against leaving the home by a physician, and/or someone for whom it is extremely taxing to leave the home. Compared to non-homebased adults, homebased people are more likely to be older, have lower income, and belong to racial minority groups—as well as live with disabilities, chronic health conditions, and comorbidities. Individuals who are homebased therefore tend to be at increased risk for COVID-19 morbidity and mortality.
To promote health equity for people with disabilities, public health planning efforts should be intentional and inclusive. ASTHO has identified health equity as a strategic priority and supports its members in their quest to increase disability inclusion through capacity building, partnerships, workforce development, and data collection.
For many individuals living with disabilities, inaccessible vaccination websites have been a significant barrier to receiving the COVID-19 vaccine. Recent studies have found that many vaccination websites do not reliably meet accessibility standards. This brief discusses how several disability rights laws apply to COVID-19 vaccine registration websites and offers considerations for state and territorial health agencies as they work to improve website accessibility for people living with disabilities.
FAQ for Preparing for CBRNE Emergencies at Mass Gatherings FAQ for Preparing for CBRNE Emergencies at Mass Gatherings Kelsey Tillema, Adrianna Evans Learn how to prepare for Chemical, Biological, Radiological, Nuclear, and Explosive events with this handy FAQ. As the United States prepares to host multiple high-profile or international mass gathering events in the coming years, preparedness professionals should revisit and strengthen plans to address complex and high-impact threats. Among the most critical are Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) hazards — a grouping of high-consequence threats with potential to significantly impact public safety and health: Chemical agents (toxic chemicals, nerve agents). Biological agents (harmful bacteria, viruses). Radiological materials (accidental or intentional dispersion of radioactive material, including from nuclear power plants). Nuclear incidents (nuclear detonations). Explosives (intentional or accidental blasts). Human health could be greatly impacted, with the potential for the following consequences: Acute injuries (burns, trauma, poisoning, radiation sickness) and mortality, along with other long-term conditions (cancer, organ damage, etc.). Psychological impacts such as PTSD, anxiety, and depression, among other long term mental health impacts. Strain on health care and public health systems, including disruptions to hospital services and the supply chain. As jurisdictions prepare for the 2026 FIFA World Cup and future mass gathering events, this resource serves as a broad overview of the roles and responsibilities of public health in relation to a CBRNE incident. This information is not comprehensive but is intended to provide consideration and further resources for planning efforts. article yes
Pennsylvania introduced innovative processes to help individuals with intellectual and developmental disabilities access COVID-19 vaccines and other critical care.
With Omicron surges pushing jurisdictions to activate protocols for providing healthcare during crisis, it is important to incorporate disability inclusion into these crisis standards of care.
Episode 620: Prepping for a Wave of Seniors, Listeria Response Relies on Communication website yes
Episode 495: Power Outage Toolkit, Alpha-Gal Syndrome Explained website yes
Accessibility Pillars in Web and Design Learn the core principles of accessible web and document design in public health, aligned with ADA guidelines, to ensure resources are usable by all communities. Accessibility in web and document design ensures that digital content is usable by everyone. This presentation introduces the core principles of accessibility, aligned with Americans with Disabilities Act (ADA) guidelines, and empowers you to recognize and implement accessible design practices. By the end of this webinar, participants will be able to: Identify visual elements in a document as accessible or inaccessible without external guidance. Understand the importance of inclusive design and its impact on users with disabilities. Apply accessibility principles to everyday digital products and workflows. Recognize the legal and ethical standards required for compliance. Resource Slide Deck (PDF) Speakers Emily Lapayowker, Assistant Director, Web Content, ASTHO Christopher Preheim, Manager, Graphic Design, ASTHO Heidi Satter, Director, Web & Data Solutions, ASTHO Transcript - Video - Accessibility Pillars in Web and Design OE22-2203 PHIG article yes
Advanced Accessibility Training Advanced Digital Accessibility Training Take a deeper dive into digital accessibility with members of ASTHO's Graphic Design and Web teams. This session will build on skills from the October 2025 training by covering the legal requirements and landscape, basic document remediation strategies, and the overlap between web and document accessibility. After this session, attendees should be able to: Understand the ADA Title II Web Rule requirements. How to communicate the importance of embracing accessibility. Be familiar with common document remediation strategies. Understand the commonalities between website and document accessibility. Speakers Emily Lapayowker, Assistant Director, Web Content, ASTHO Christopher Preheim, Manager, Graphic Design, ASTHO Heidi Satter, Director, Web & Data Solutions, ASTHO Resources Slide Deck (PDF) Fact Sheet: New Rule on the Accessibility of Web Content and Mobile Apps Provided by State and Local Governments Transcript - Video - Advanced Accessibility Training article yes
Each video in this series focuses on a unique topic and features stories from ASTHO’s disability and preparedness specialists in the field. The videos demonstrate how they work to ensure information, testing, and COVID-19 vaccination sites are accessible for people living with disabilities
This article in the Journal of Public Health Management and Practice assesses the impact of COVID-19 on health service utilization of adults with intellectual and developmental disabilities through an analysis of Medicaid claims data..
Basic PDF Accessibility Remediation Demonstration How to Remediate a PDF for Accessibility This video is a demonstration of basic PDF remediation techniques using Adobe Acrobat Pro. The methods in the video address some of the most common fixes needed to make a PDF converted from Microsoft Word accessible. This includes: How to access document properties, and which fields you should fill out. How to run the accessibility checker and why it is always necessary to check the checker’s results. The difference between tag structure and logical reading order. How to create new sections in a PDF. How to move and change tags. Speaker Emily Lapayowker, Assistant Director, Web Content, ASTHO Transcript - Video - Basic PDF Remediation Demonstration Adobe Remediation Cheat Sheet This section serves as a quick reference for the skills included in the demonstration. Note that both the demonstration and this resource use a mouse to navigate Adobe Acrobat Pro. The processes will be different for those using keyboard navigation. Document Properties Menu Document Properties (toward the bottom of the Menu) Description Tab: Title Author (optional) Subject & Keywords – These fields make it easier for screen reader users to search for and identify your document. Advanced Tab: Language (in the Reading Options section) - Make sure the language selected matches the language in which your document is written. This is how screen readers know what language to use. Save changes by selecting the OK button on the Document Properties dialog box. Accessibility Checker The Adobe Acrobat Pro version used in this demonstration is 2026.001.21529. Other versions may have a different layout, but the functionality for all recent versions should be roughly the same. Click on All Tools in the header menu. From the All Tools menu pane, choose “Prepare for Accessibility.” Note that it may be necessary to select “View More” on the menu pane if Prepare for Accessibility is not immediately visible. In the Prepare for Accessibility menu, choose “Check for Accessibility.” A dialog box of Accessibility Checker Options will open. Set the desired parameters and click the “Start Checking” button. An Accessibility Checker pane will appear on the opposite side of the window. It will catalog all of the accessibility issues it detects. Open each item to get more information. Some items must be manually approved. These include Logical Reading Order and Color Contrast. The checker cannot check these for you. To manually pass something, right-click on the item and choose “Pass” from the context menu (i.e., the right-click menu). It is vital to check the checker. All checkers start with the assumption that the document or page in question has been created already using best practices and cannot check some elements as thoroughly as a human can. They are a great starting place, but should not be considered the final word. Tags Tags are the structure of a PDF. They should be the first stop when remediating a document. To open the tags, check the far side of the Accessibility Checker pane. There will be a button with an icon shaped like a gift tag. Click on the icon and the Accessibility Tags will replace the checker results in the pane. All tags should be listed under a top-level Tags item with the PDF icon next to it. Under that will be a Document tag — in almost every instance, the rest of a PDF’s tags will live under the Document tag as well. Tips Clicking on a tag in the structure will highlight the corresponding section in the document. The relevant area will be enclosed in a purple box. Make sure the document structure is correct. This means: Headings are used in order, none are skipped. In almost every case, there will be only one H1 per PDF. H2s should be used as section headings, H3s as subsections, and so on, down to H6. Empty tags can and should be deleted. Right-click on an empty tag and select Delete Tag from the context menu. The context menu has an option to Delete Empty Tags. This is faster, but it is important to check the results. Creating New Tags in the Tags Pane All page content should have a corresponding tag. If a tag is missing, create a new one. Click on a tag near where the new one should go. Click the three dots in the upper right corner of the Tags pane. Select “New Tag” from the context menu. Set the correct tag type by using the dropdown field. In the demonstration video, it is Section. The empty Sect tag will appear in the Tags pane. If it is not in the right place, click on the tag and drag it to the correct location. Add content to the new tag by clicking on the relevant content and dragging it into the new tag. If this is done correctly, the content will appear under and slightly to the right of the new tag (much like a subitem in a list). Nested Tags: Lists Lists are an example of when to use nested tags. The top-level tag in a list should be List, which shows up in the tag order as an L. Under that, each list item should be labeled LI. Within each LI should be two sub-tags: Lbl (or label — a bullet or a number) and LBody, which will contain the text for that list item. Create new tags, change tag type, and/or drag-and-drop content to correct any tagging errors. Nested Tags: Tables Tables are another common type of nested tag. When evaluating tables: Make sure everything is nested under a Table tag. The top row of content should always be nested under a heading tag (THead). Though the sub-tag for the row will be a normal TR, the individual header cells in the row should be tagged as TH. The rest of the table content should be nested under a TBody tag. These will be split up by row (TR). Individual cells should be tagged as TD. Note that if the first column should also be treated as a heading, the tags will still be nested under TBody and inside a TR tag, but the first cell in the row will be a TH. Only use tables for data, not for styling. Try to avoid empty and merged cells. Screen readers go through tables top-to-bottom, left-to-right, one cell at a time. Changing Tag Types Incorrectly categorized tags can be changed (e.g., the title is tagged as a regular paragraph when it should be an H1). Right-click on the existing tag and choose Properties from the context menu to open the Object Properties dialog box. Use the dropdown menu in the Type field to select the correct tag type. Note that tag types are listed alphabetically. Select the “Close” button to save the changes. Reading Order Reading order should be adjusted after the Tags. Typically, it will mirror what you see in the Tag pane, but not always. As the name implies, it is the order in which a screen reader will read the document. To access the Reading Order pane, look at the far end of the Tags pane and there should be an icon that looks a bit like a Z — that is the Reading Order button. Click on it and Reading Order will replace the Tags. The Reading Order content is divided up by page, which makes it easier to stay on track. Removing Items from the Reading Order In the demonstration example, there are three decorative lines inserted in the content to help visually break up the content. Each is marked as a Figure and each generated a flag from the accessibility checker because there was no associated alt text. No alt text is needed for these lines because they are decorative (meaning they do not give the reader any additional information). The best way to remove them from the reading order is to mark them as “background/artifact.” Right-click the decorative item in the Reading Order pane. Choose “tag as background/artifact” from the context menu. The item will disappear from the reading order, but the decorative line will remain visible on the page. Note that sometimes this does not work and you end up with empty or erroneous items in the reading order. Known Conversion Errors It is possible to create a completely accessible document in Microsoft Word and still have errors when it is converted to a PDF. Some of these problem areas may be the result of known conversion errors, such as: Images (or figures) moving to the bottom of the reading order, regardless of where they are placed on the page. Empty P tags where the author has used the Enter/Return key to move to a new line. Unfortunately, these are not preventable issues. Any fixes have to be done by Adobe, so it is important to watch out for them when remediating a document. article yes
Discover how improving public health data infrastructure can create more robust care for people with disabilities in this blog post.
Learn about engaging partners in a virtual space, with actionable steps, examples, and resources.
On the 32nd anniversary of the ADA, this blog post explores state legislation around the country that supports people living with disabilities.
Learn how health agencies are prioritizing children’s health as they develop public health emergency preparedness planning in this blog.