Disability Attitudes and Policy Perceptions in China and the United States: A Cross-National Survey

ABSTRACT

Prior research distinguishes between social and medical models of disability and outlines multilevel interventions (personal, organizational, and governmental) to reduce exclusion. This study compares public orientations toward these models in China and the United States and examines how disabled respondents assess the effectiveness of common policy interventions. Using online, self-administered surveys distributed via social media, this study fielded parallel Chinese and English questionnaires (28 items; Likert-type scales) to convenience/snowball samples in China (N=63; 6 disabled) and the United States (N=24). Two-sample t-tests suggest that Chinese respondents show slightly greater agreement that obstacles faced by people with disabilities arise from individual impairments than United States respondents, suggesting a comparatively stronger medical-model orientation in China. United States respondents express stronger support for equal employment and reported less discomfort and less tendency to curtail interactions with people with disabilities, whereas Chinese respondents more often endorse that assisting people with disabilities is personally rewarding. Among disabled respondents in China, inclusive education is rated the most effective awareness-raising strategy. Findings indicate cross-national differences consistent with relatively stronger social-model alignment in the United States and highlight inclusive education as a perceived priority lever for fostering inclusion.

INTRODUCTION.

Ensuring the full social inclusion of individuals with disabilities is a critical measure of a just and equitable society. Although disability rights have advanced globally, people with disabilities continue to encounter systemic exclusion—manifesting in persistent public prejudice, social isolation, and limited access to societal resources. A powerful lens for understanding this issue is the social model of disability, which posits that disability is not a result of an individual’s impairment, but rather a consequence of physical, attitudinal, and institutional barriers within society [1]. In contrast to the medical model, which locates the problem within the individual body or mind, the social model calls for structural transformation rather than personal adaptation.

This study builds on that framework by investigating the extent to which public attitudes align with either the social or medical model of disability, and how such alignment may contribute to the ongoing social exclusion of people with disabilities. Although various efforts—from government campaigns to local volunteer initiatives—aim to reduce exclusion and promote inclusion, there is limited knowledge about how the general public conceptualizes disability, and whether their views support or undermine inclusive practices. Equally understudied are the perspectives of disabled individuals regarding which policies or interventions they find most effective in countering social isolation and stigma. To address these gaps, this research compares attitudes and perceptions in the United States and China, two countries with divergent socio-political approaches to disability. Although prior studies have compared the difference in the public views on people with disabilities in the United States and China, most tend to focus on a specific a specific type of disability (e.g. autism) and measure attitudes in broad positive/negative terms, rather than examining perspectives grounded in the medical versus social models of disability [2]. Therefore, a cross-national comparison of general public views on disability in China and the United States—of the kind undertaken in this study—remains largely unexplored. Using survey data collected through social media platforms, the study explores: (1) the degree to which public opinion in each country reflects the assumptions of the social versus medical model of disability; and (2) how individuals with disabilities assess the effectiveness of current disability-related policies in reducing exclusion and fostering genuine inclusion.

This study argues that Chinese non-disabled public’s views of people with disabilities lean to agree more with the medical model of disability, while in the United States more with the social model of disability; and that the most effective awareness-raising strategy aiming to improve the inclusivity of people with disability perceived by people with disabilities themselves in the sample is inclusive education. The findings will suggest a direction for more future investigations on identifying the most effective promotion strategies to mitigate social exclusion for the disabled community.

Prior research identifies two primary theoretical frameworks for analyzing disability. One of them is the medical model of disability, which defines disability in terms of individual deficit and personal tragedy. The medical model focuses on the impairment of people with disabilities and considers it as the reason of the inadequate participation of disabled community in society. To alleviate the problems people with disabilities encounter, according to the medical model, cure and rehabilitation for the impairments of people with disabilities are the resolution. On the opposite side is the social model of disability, which is coined by Mike Oliver in 1983. The social model of disability defines disability as a social creation, or the restriction of activity of people with disabilities due to barriers in society. In other words, according to the social model of disability, the responsibility for change lies with the society, not the people with disabilities themselves. Rather than focusing on remedying the impairment of people with disabilities like the medical model, the social modal values the acceptance of those impairments and the removal of barriers in society [1].

One of the primary barriers in the society which the social model identifies is social exclusion, which differentiated itself from physical impairment [1]. Some major disadvantages related to social exclusion include social isolation and prejudice from the public, which adds on further hardship to other existing challenges people with disabilities are facing, such as physical impairments and daily inconvenience [3,4]. Such attitudes may be the results of misconceptions or a lack of awareness and can lead to outright vilification or indirect discrimination [5].

Given that negative attitudes and social exclusion are key barriers, the literature suggests that policy interventions are necessary to foster inclusion. These interventions can be organized into three reinforcing levels: personal, organizational, and governmental [6,7].

Personal-level policy: awareness raising and media portrayal.

Personal-level policies shape everyday interpretations of disability—whether people view exclusion as stemming from individual impairment (medical model) or from social barriers and discrimination (social model). In China, personal-level efforts often take a state-led form, such as National Disability Day (1990) and media content rules that prohibit discriminatory language. These measures can reduce explicit stigma, but when the emphasis is primarily on appropriate messaging and public sympathy, they may leave intact the assumption that disability is chiefly a personal limitation addressed through care or rehabilitation—an orientation consistent with the medical model.

In the United States, personal-level efforts more often highlight participation and rights, such as National Disability Employment Awareness Month (since 1988) and civil-society guidance that encourages respectful representation in arts and media. Because these approaches more directly cue equal opportunity, accommodations, and barriers to participation, they are more likely to reinforce social-model thinking. This contrast helps motivate the study’s first hypothesis: compared with U.S. respondents, Chinese respondents may be more likely to interpret disability through a medical-model lens, while U.S. respondents may more readily attribute disadvantage to discrimination and environmental barriers.

Organizational-level policy: inclusive education.

Inclusive education is analytically important because it changes daily interaction patterns: sustained contact in shared classrooms makes social barriers more visible and reduces the tendency to treat disability as “someone else’s problem.” Both countries have pursued inclusive education through different institutional channels (formal regulation in China; a broader support infrastructure in the U.S.). Because it operates through repeated, normalizing contact rather than one-time messaging, inclusive education is well positioned to be perceived by disabled respondents as the most effective strategy—directly linking policy design to the second hypothesis.

Governmental-level policy: policy trajectories.

Although both countries enacted major disability laws in 1990, their policy trajectories send different signals. China’s disability law initially leaned more toward protection/rehabilitation and later incorporated stronger social-model components (e.g., through later amendments), which may leave a more medicalized public “default” in how disability is interpreted. The U.S. Americans with Disabilities Act has been more consistently framed around rights and anti-discrimination, even while requiring medical definitions for eligibility in practice. These differences provide a macro-level basis for expecting stronger social-model endorsement in the U.S. and stronger medical-model endorsement in China.

Overall, U.S. policy cues disability as a participation-and-barriers issue, while China’s policy history has more strongly emphasized protection and rehabilitation. Therefore, this study hypothesizes that Chinese respondents’ view on people with disabilities will show a stronger tendency to assume a medical model, while the United State respondents will agree more with the social model. Taking account of the three levels of policy interventions, I also hypothesize that inclusive education would be perceived as the most effective awareness-raising strategy by people with disabilities.

MATERIALS AND METHODS.

The study adopts a comparative study survey design using an online, self-administered questionnaire to examine (1) how members of the public align with the social or medical model of disability and (2) to what extent are disability-related policies perceived as effective in addressing social exclusion and promoting inclusion for people with disabilities. Participants were recruited via social media platforms in each country using convenience and snowball sampling. For the Chinese participants, the questionnaire is distributed on social media platform Weibo, while on Reddit for the United States participants. Approximately, the data collection for the Chinese participants lasted about two weeks, while about a month for the United States participants. While this approach facilitated access to diverse respondents across regions, it is a nonprobability strategy that limits population generalizability. Moreover, it is important to consider the small sample sizes of this study: while 63 people in China with 6 people with disabilities completed the Chinese version of the survey, only 24 people with no people with disabilities in the United States completed the English version of the survey. The limited sample size causes limited statistical power and further makes the generalization of the results more difficult.

The survey questionnaire consisted of 28 close-ended questions. Parallel Chinese and English versions were fielded. Although formal back-translation was not used, translation aimed to preserve the meaning of full statements rather than word-by-word equivalence. The items included questions about basic sociodemographic information, such as their age, race, and whether they are disabled. It also evaluated respondents’ tendency towards either social or medical model respondents without disabilities only. Items captured agreement with statements indicative of medical-model logics (e.g., locating “problems” in individual impairment) versus social-model logics (e.g., emphasizing structural and attitudinal barriers). Items used Likert-type response options, enabling construction of mean scores and between-country comparisons. An example of a medical-model item is worded as “You believe the reason why people with disabilities encounter obstacles in their lives comes from their own disabilities” (1 = strongly disagree to 5 = strongly agree). An example of a social-model item is worded as “You believe that the government and society should improve the accessible environment and eliminate social and environmental barriers to alleviate the obstacles encountered by people with disabilities in their daily lives” (1 = strongly disagree to 5 = strongly agree). Lastly, the instrument included a set of questions on the perception of the effectiveness of the disability-related policies, which are only available for people with disabilities to answer. An example item on this is “Do you think inclusive education of people with disabilities can effectively help reduce prejudice and enhance social inclusiveness?” (1 = strongly disagree to 5 = strongly agree). Items are analyzed individually. Besides the questions on the perception of the effectiveness of the disability-related policies, people with disabilities did not answer the parts of the survey that were on the tendency of disability models, but only the basic sociodemographic information.

Only adults were eligible to participate. Participation was voluntary and uncompensated. The study minimized risk by collecting only anonymized responses and allowing participants to discontinue at any time. Although the project was not formally reviewed by an IRB, it was conducted as a supervised school-based research project. The questionnaire opened with an informed-consent notice describing confidentiality, the intended ethical use of responses, and requesting consent for using responses as research data.

After data collection, the study presents descriptive statistics and conducts hypothesis tests comparing outcomes across the two countries. For inference, it primarily relies on two-sample, two-tailed Welch’s t-tests, which do not assume equal variances. Because the sample size is small and normality may be questionable, all results are also re-estimated using the Wilcoxon rank-sum (Mann–Whitney) test, a nonparametric alternative to the two-sample t-test. The substantive conclusions are unchanged.

RESULTS.

Descriptive Statistics.

For the survey distributed on Chinese social media platforms, 63 people completed the survey. Among them, six identified as having a disability, with one of them experiencing vision disability, another intelligence disability, two experiencing physical disability, and the other two of them experiencing hearing disability. Among the respondents, 14 are male (22.22%) and 49 (77.78%) are female. The age profile skewed young, with 51 respondents, or 81.0 percent, between 18 and 35 years old.

For the survey distributed to the Americans, 24 people completed the survey, with 14 (58.33%) of them being female and 8 (33.33%) of them being male. Two respondents selected another category or did not report gender. Nineteen respondents, or 79.17% of the respondents, were between 18 to 35 years old. With respect to race and ethnicity, 12 respondents identified as White, and eight identified as Asian. The remaining four respondents, or 16.7 percent, reported other racial or ethnic identities. One respondent indicated disability but exited the survey after filling in her status of disability. Therefore, the data only allow the analysis of people with disabilities in China for the question on the effectiveness of disability-related policies perceived by people with disabilities. Other descriptive comparisons are presented for both countries.

Orientation towards Social and Medical Model.

When asked whether they believe the reason why people with disabilities encounter obstacles in their lives comes from their own disabilities, respondents rated their agreement on a matrix scale with higher values indicating stronger agreement. The country means diverged, with China averaging 3.40 and the United States averaging 3.09. According to the two-tailed Welch’s t-test, the difference is not significant at 95% confidence level. This insignificance, however, may be a result of small sample sizes in both countries. Although not statistically significant, the higher mean in China suggests a possible trend of the Chinese peoples’ relatively greater endorsement of an individual or impairment-centered explanation that reflects a possible tendency toward the medical model, whereas the lower mean value in the United States shows a possible emphasis on social and structural barriers associated with the social model.

Although not directly investigated in this study, my speculation of a possible factor that might have contributed to such difference is the distinct policy trajectories in the two countries. Although China passed the Law of the People’s Republic of China on the Protection of Persons with Disabilities in 1990, it experienced an amendment in 2008 in which new laws stipulating the quality of the establishment and reconstruction of accessible facilities and public services occurred for the first time. In contrast, the American with Disabilities Act of the United States has always been rooted on social model. Therefore, the later consolidation of accessibility and inclusion provisions in China relative to the ADA’s longstanding civil rights orientation in the United States may help contextualize the disparity between the mean values on a problem inferring the tendency toward the medical model.

Endorsement of Equal Opportunities.

When asked about whether equal employment opportunities should be available to disabled individuals, the disparity between the two countries is outstanding despite the relatively small sample size. Respondents also indicate their endorsement of equal opportunities on a scale with high values indicating stronger agreement. On this question, China has a mean value of 3.16, while the United States has a mean value of 4.48. This indicates that the Americans agree more with the equal employment between people with disabilities and non-disabled people than Chinese. The two-tailed Welch’s t-test without assuming unequal variance shows this difference is statistically significant at the 99.90% confidence level (p=0.000).

This pattern is consistent with the distinct historical and institutional trajectories surrounding disability and labor rights in the two settings. In the United States, the civil rights mobilizations of the late 1960s placed sustained attention on employment equality, and the Americans with Disabilities Act of 1990 subsequently codified a civil rights framework that foregrounds anti-discrimination in the workplace. Taking account of the emphasis of labor and employment during the civil right movement, it is reasonable for both the Americans and the American government to pay more attention on the matter of equal employment relative to their counterparts in China. However, such speculation is not vindicated in this study and requires further investigation in the future to test its credibility.

Tendency for Socializing with People with Disabilities.

Similarly, outstanding disparities occur on three questions centering around the socializing patterns with disabled people. All of them use scale questions with higher values indicating stronger agreement with the statement. When asked about whether they feel uncomfortable and find it hard to relax when people with disabilities are around, the mean value of responses from China is 2.51, while 1.57 from the United States. The two-tailed Welch’s t-test also shows that the difference is statistically significant at the 99.9% confidence level (p = 0.0002). It can be inferred that Americans feel more comfortable to stay in a place with people with disabilities around, though generally, the Chinese people also do not show a significant reluctance. A second question asks whether the respondent tends to keep contacts with people with disabilities brief and finish them as quickly as possible. China’s mean is 2.54, while the United States’ mean is 2.04. Two-tailed Welch’s t-test shows that the difference is not significant at the 95% confidence level, but one-tailed Welch’s t-test indicates a significant relationship at the 95% level (p = 0.044), which indicates that people in United States feel more comfortable when talking and making conversations with people with disabilities, while Chinese may feel more uneasy and are not used to treat those people with disabilities as how they treat anyone else. Finally, the third question asks whether people will consider it rewarding when they are able to help people with disabilities. The responses from China show a relatively high mean value of 4.30, while the responses from the United States show a mean value of 3.74. Two-tailed Welch’s t-test suggests that the difference is significant at the 95% confidence level (p = 0.022). This suggests greater endorsement among Chinese respondents of the idea that assisting people with disabilities is personally rewarding.

Taken together, these results point to an intriguing pattern. The reason why Chinese people show less willingness to stay in touch with people with disabilities and feel more uncomfortable beside them may be attributable to fewer accessible facilities established in China than in the United States, which leads to less routine contact with people with disabilities in public spaces overall. On the other hand, Chinese tend to feel more rewarding from providing assistances to people with disabilities than people from United States. This seemingly counterintuitive result may be also a result of less normalized encounters, which make acts of assistance feel more salient and gratifying. Similarly, such speculation is not backed by investigations in this study but is purely a possible factor that might have contributed to the trends of the results found though this study. Further investigations into this are required for the speculation to be taken into consideration.

Perception of disability-related policies’ effectiveness.

Because responses from disabled participants in the United States were insufficient, this analysis focuses on the Chinese sample. Four likert-scale questions in the survey are on the effectiveness of the awareness-raising strategies for people with disabilities. Respondents rate National Disability Day at a mean of 2.83, positive portrayal through media at 2.83, inclusive education at 3.67, and governmental policies at 3.17, where higher scores indicate stronger perceived effectiveness. Taken together, these results suggest that inclusive education is perceived as the most effective awareness-raising strategies of the four. Again, due to the small sample size — only 6 people with disabilities responded to the questionnaire, the results above are exploratory and not generalizable.

DISCUSSION.

This study examines how public opinion in each country aligns with the social versus medical model of disability and how individuals with disabilities perceive the effectiveness of current disability-related policies in reducing exclusion and raising public awareness. The results collectively suggest that in this sample, Chinese respondents tended to show greater endorsement of medical-model statements, while in the United States more with the social model. Among Chinese respondents with disabilities, inclusive education is perceived as the most effective awareness-raising strategies.

This study contributes to the existing literatures on the distinction between social and medical model of disability [1] and adds to the empirical understandings of public opinions in China and the United States based on this framework. This paper also relates the observed differences in both countries to the institutional history of disability rights protection, which provides more nuanced understandings and speculations for why the differences occur. Moreover, building on the existing literatures that emphasize the crucial role of policy to foster the inclusion of people with disabilities, this study contributes to this field from the perspective of people with disabilities themselves by showing that the Chinese people with disabilities in this sample perceive inclusive education as the most effective in awareness-raising and inclusion improvement.

The findings above point to the necessity of governmental policies in addressing the exclusion and marginalization experienced by the disabled communities. The perception of inclusive education as the most effective policy intervention by people with disabilities in this sample also points to a possible direction for future research — these preliminary findings suggest that inclusive education may be perceived as particularly impactful and warrants further investigation.

The biggest limitation of this study is the small sample size —especially the very limited number of United States respondents with disabilities—which prevented cross-national comparison for the second research question and confined that analysis to the Chinese data. Other limitations include a gender imbalance in the sample (majority female in both countries) and a racial imbalance in the United States sample (predominantly White and Asian), both of which limit representativeness. Using convenience and snowball sampling may have introduced additional selection bias, as recruitment through my social networks and the platforms I used likely underrepresented individuals who are less connected to me or harder for me to reach as the researcher. Additionally, as mentioned in the descriptive statistics, the respondents’ ages skewed young, which may limit the study’s ability to capture attitudes and experiences more common among older populations. As the surveys involved a considerable amount of attitude questions, potential social desirability bias should also be taken in consideration on the generalizability of the results. Some of the findings are also non-significant in the t-tests, which is also likely a result of insufficient number of respondents.

ACKNOWLEDGMENTS.

I would like to acknowledge to all those who have volunteered their time to participate in this research.

REFERENCES.

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Posted by buchanle on Friday, May 15, 2026 in May 2026.

Tags: disability models, People with disability, policy effectiveness, public opinion, social inclusion