“Large and Heterogeneous”: Disability, Health Disparities, and the Politics of Public Health Recognition

Abstract Context: In 2023, the National Institute on Minority Health and Health Disparities (NIMHD) denied people with disabilities a health disparities population designation. The decision occurred amid growing recognition of ableism as a health determinant and calls to reorient disability research toward health equity. Although reversed, the rejection represents a key episode for understanding how disability is studied in public health. Methods: This article presents a discourse analysis of texts related to the NIMHD rejection. Drawing on meeting materials and reports, the analysis examines discursive strategies used in deliberations, which were synthesized into three themes. Findings: Three themes structured NIMHD's decision-making process: 1) (bio)medical models undermined the recognition of disability as a social position; 2) health disparities were framed as corruptible, both conceptually and administratively vulnerable to the inclusion of disabled people; and 3) characterizing disability as “large and heterogeneous” transformed diversity into institutional risk, justifying the segregation of disabled people from health equity projects. Conclusions: Overall, this case illustrates how ostensibly neutral and scientific reasoning can reproduce ableism and narrow the scope of health disparities research, underscoring the need for equity frameworks that treat disability as a legitimate axis of social inequality not an exception or burden.