It is tempting to treat disability history and racial history as parallel lines. In public administration they were the same line. The institution, the school board, the county relief office, the court and the clinic were often the same set of officials applying the same discretion, and that discretion was shaped by race, language, income and immigration status as much as by any clinical judgment.
The consequences compounded rather than added. A label of incapacity attached to a person who was also poor, also not a native English speaker, or also from a community the agency did not know, produced a different outcome from the same label attached to a person with a family that could argue, a lawyer, and a shared language with the official. Which children were sent away and which were kept home, which parents were believed about their own child, which families got a service and which got a case file, which adults were offered work and which were supervised: these were not decided by diagnosis alone.
Where this history involves Tribal Nations and Native American communities, this program defers to the Office of Indian Affairs and to the DHS offices that handle tribal matters. That history is theirs to tell and to lead on, and Module 20 in this area is where those responsibilities belong.
The administrative point is straightforward. If your program measures disability alone, you inherit the old distribution and report it as an average. The compounding is only visible when you look at more than one thing at once, which is what makes this a data and design question rather than a matter of belief.
