How Universal Design Creates a Better World for All

Living with chronic pain creates daily challenges both inside and outside of the home. Universal design, defined as the design of products, environments, programs and services to be usable by all people (Ostroff, 2010), is a set of principles for creating equal access to both able bodied persons and those living with disabilities. It is a powerful concept, because it enables those who live with disabilities, including chronic pain, to be fully functioning members of society.

Principles of universal design include the following

  • Equitable use: The same means of use for all users
  • Flexibility in use: Choices for users (adjustable desk).
  • Simple and intuitive use: Reducing complexity (pictograms in place of written words)
  • Perceptible information: Allows all persons to use a device, regardless of ability, experience or literacy
  • Tolerance for error: Minimizes hazards
  • Low physical effort
  • Size and space for approach and use: Navigable space and keeping controls within easy reach (, n.d.)

This movement is not new. In the United States, the first federal legislation in 1973 required all federally funded facilities be universally accessible. The later Fair Housing Amendments Act and Americans with Disabilities Act (1990) extended these requirements to much of the built environment. The United Nations’ Convention on the Rights of Persons with Disabilities (2009) was supported by three quarters of member countries, while a new World Health Organization classification system (2002) focuses on disability as an interaction of people with their environment, replacing the former medical model (Ostroff, 2010). You can access the WHO International Classification of Functioning, Disability and Health using this link.

Studies have shown that being a productive member of society is crucial to what occupational therapists describe as “living a meaningful life.” Modifying your approach to daily activities together with modifying the environment promotes safety and personal independence, enhancing one’s quality of life (Sauber, private conversation, March, 2023). The idea of universal design is particularly impactful for persons living with chronic back pain: the condition which continues to be the main reason why people are absent from work (Crawford, Berkovic et al., 2020). Returning to work after a back injury is a multifactorial process, involving both the patient and the workplace. The patient may need to engage in a process known as “work hardening,” as part of physical rehabilitation, to regain those specific skills necessary to do their job (Feinberg, Gatchel et al., 2015). Small changes in the work environment, such as ergonomically designed office furniture and flexible work hours during the transition back to work help the patient reintegrate back into their job.

A major barrier to universal design is that people continue to see it as a necessary evil as part of compliance. One reason is that poorly designed wheelchair ramps, wheelchair accessible bathrooms etc., are ugly. There is no reason for this. Good universal design should be beautiful, with such accommodations being invisible as opposed to looking like add-ons.

As the number of older adults increases globally, it will become more critical for the built environment to be safe and accessible. Although physical evaluation and functional exercise programs can reduce fall risks, the environment plays an equally important role. Simple changes within the home such as removing throw rugs, having railings adjacent to all staircases, and making sure that all areas of the house, including entry passages are well lit, make a big difference (Reis, Moro et al., 2012). Outside of the home, properly paved and well-lit pedestrian paths, traffic crossings with braille and audible signals that allow ample time for those who walk more slowly, and properly graded ramps make it possible those with sight, hearing and physical limitations to be in the world.

The world would be a poorer place were it not for the contributions of brilliant men and women who pursued their careers despite disabilities. A short list includes Stephen Hawking, Franklin Delano Roosevelt, John Forbes Nash Jr., Helen Keller and Christopher Reeve. When the world embraces all persons as equal, with equal access inside and outside of the home, everybody wins.


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