Image Description: A black screen with white text that reads the single word “Image.” This is what blind and deafblind people encounter when public health information is presented without accessibility, the word “image” where information should be.
Blog Excerpt
Imagine that behind that black screen with the word “Image” on it is important health information that could keep you safe, keep you healthy, or even save your life in an emergency—but you cannot access it. That is what it is like for millions of blind and disabled individuals who rely on alt text or image descriptions to understand the information being conveyed. In this case, that information is public health information—vital guidance that determines who stays safe, who gets care, and who is left behind.
A reflection on ableism, access, and accountability in public health. Public health cannot claim health literacy without accessibility. As a blind public health professional and sociologist living with retinitis pigmentosa, I share why alt text, image descriptions, captions, transcripts, and audio description must become non-negotiable standards across classrooms, departments, conferences, and accreditation. Equality and achievement begin with access.
To My Fellow Public Health Professionals
This message is for you: professors teaching the next generation, practitioners in local and state health departments, communications directors crafting public health campaigns, conference organizers showcasing our field’s best work, accrediting bodies setting our professional standards, and news outlets translating public health information for the public.
You entered this field because you care about reaching people. You believe in health equity. You understand that information can save lives, but only if people can access it.
Here’s what I need you to understand: right now, the health information you are creating is not reaching everyone. You are leaving out blind, deafblind, and disabled communities, people whose access needs should have been part of your design from the start. The people being excluded are not just members of the public; they include your colleagues. They include me, and it directly impacts my ability to do my job.
October is both Health Literacy Month and Blind Equality Achievement Month. These two observances share a fundamental truth: access is everything. Without it, there can be no understanding. Without understanding, there can be no informed decision-making. Without informed decision-making, there can be no health equity.
Health literacy is defined as the degree to which individuals can find, understand, and use information and services to make informed health decisions. But here’s the question we rarely ask: what happens when the information itself is designed in ways that make it impossible for entire populations to find it in the first place?
That’s not a literacy problem. That’s an access problem. And it’s a problem we created.
Understanding Ableism and Its Role in Public Health
Before we talk about accessibility, we have to talk about ableism.
Ableism is a system of discrimination and exclusion that devalues people with disabilities by assuming that non-disabled ways of moving, seeing, hearing, and thinking are the norm. It’s the idea that disability is something to be fixed, pitied, or overcome instead of a natural part of human diversity.
In public health, ableism manifests when we design materials that can’t be read by screen readers, when we post videos without captions or transcripts, when we rely on infographics that aren’t described, or when we teach health literacy without ever mentioning accessibility.
Ableism isn’t always intentional, but it is always harmful. It creates inequity through omission. It tells disabled people that their access is secondary to everyone else’s convenience. And it undermines everything our field claims to stand for.
If we truly believe in cultural humility, equity, and justice, then we must also believe in confronting ableism wherever it exists, including in ourselves and in our institutions.
The National Federation of the Blind and the Roots of Dignity
The National Federation of the Blind (NFB) is the oldest and largest civil rights organization led by blind people in the United States. For more than eighty years, the NFB has fought to dismantle ableism and the structural barriers that prevent blind people from living full, independent, and successful lives.
The NFB is not a charity or service agency. It is a movement, a community of blind people working together to change what it means to be blind in this society. The organization’s philosophy is grounded in the social model of disability, which teaches that disability is not caused by our bodies but by inaccessible environments, systems, and attitudes.
This model changed my life.
I am proud to be a graduate of the Colorado Center for the Blind, one of the NFB’s national training centers. The Colorado Center offers intensive training in the alternative techniques of blindness such as Braille literacy, cane travel, technology, and home management, but more importantly, it teaches confidence and self-advocacy. It challenges the stereotypes and low expectations that ableism has placed on us and replaces them with competence, community, and pride.
This is health literacy at its most human and most practical. The National Federation of the Blind recognizes that the medical model has its place in treating the health of the eye and in advancing care that can preserve or protect vision. But it also teaches that health literacy cannot stop there. Understanding how systems distribute power, define ability, and shape access is equally essential. Learning to navigate, advocate, and lead as blind people is both personal liberation and public health in action, a living example of informed choice, collective care, and equity made real.
Today, I serve on the state board of the National Federation of the Blind of California, my local San Francisco chapter, and cochair our local chapter’s Outreach and Education Committee. This piece is written as part of those collective efforts to mark both Blind Equality Achievement Month and Health Literacy Month, two observances that share a common goal: access, understanding, and equity.
The NFB taught me that equality and achievement are not about overcoming blindness; they are about removing barriers. They taught me that I am not broken; the systems around me are. That lesson is one public health urgently needs to learn.
My Journey Through Blindness and Public Health
When I entered the public health field, I had just learned that I was blind with a condition called retinitis pigmentosa, a rare genetic condition that causes gradual loss of peripheral vision and eventual loss of central vision.
I earned degrees in Public Health and Human Sexuality, a sociology-based discipline, but I have no memory of anyone in those programs mentioning image descriptions, alt text, or audio descriptions. Accessibility wasn’t just missing from the materials; it was missing from the conversation entirely.
At the time, I still had some usable vision. I could strain to read a chart or enlarge a graph and thought that was enough. I didn’t yet understand what accessibility really meant or how deeply ableism was embedded in our field.
Now, twenty-one years into my blindness journey, I have only a small amount of residual sight. I rely on image descriptions every single day. They help me interpret what I’m seeing, confirm what I’m perceiving, and access the details my remaining vision can’t capture. Image descriptions, alt text, and audio descriptions are not “extra features.” They are bridges to participation, understanding, and dignity.
As I lost more vision, I also gained perspective. I found community. I learned that accessibility is not an accommodation; it is a matter of health equity. It is the foundation of inclusion in every aspect of our field.
Understanding the Tools of Access
Let me define the tools that make information accessible, because understanding these is fundamental to public health practice.
Screen readers are software programs that blind people use to access digital content. They read aloud the text on a screen, including alt text for images. Common screen readers include JAWS, NVDA, and VoiceOver (Apple’s built-in screen reader).
Braille displays are refreshable electronic devices that translate on-screen text into Braille, essential for people who are deafblind and cannot access information through audio alone.
Alt text (alternative text) is concise text embedded within an image’s code, allowing screen readers to convey the essential meaning of a visual.
Image descriptions are longer explanations of complex images like charts, graphs, infographics, or maps. They provide the relationships, context, and data that alt text alone cannot convey.
Audio descriptions are narrated explanations of visual elements in videos, describing what is happening on screen for blind or low vision viewers.
Captions provide text versions of spoken dialogue and important sounds in videos, essential for people who are deaf or hard of hearing.
Transcripts provide complete text versions of audio and video content, essential for people who are deaf, deafblind, or have auditory processing differences. They also help people with cognitive disabilities, non-native speakers, and anyone who needs to reference content in text form.
All of these accommodations are essential. None should be optional in public health communication.
When Crisis Information Isn’t Accessible
When public health information is designed for sighted people only, blind and deafblind communities are forced to build our own systems of access. We crowdsource updates, describe what others can see, and piece together fragments of information that should have been available to everyone from the start. This is what resilience looks like when accessibility fails.
In March 2020, just days after the first stay-at-home orders were announced, members of the blind community in the Bay Area began organizing daily support calls. Around March 17 or 18, we gathered to make sense of what was happening, sorting through an overwhelming mix of information, misinformation, and memes—all of it largely inaccessible and all of it requiring a great deal of health literacy to decipher. What began as a collective effort to understand the pandemic soon became an act of public health in itself. We were reading, interpreting, and translating the inaccessible materials that government agencies and media outlets were releasing without thought for nonvisual access.
As someone with a Master of Public Health and a Master of Arts in Human Sexuality, a sociology-based degree, I was witnessing in real time both the gaps in our public health systems and the extraordinary community response that filled them. The calls were exclusively blind-led and blind-run. Each one became a space of collective care and shared problem-solving: people reading aloud local health orders, explaining visual signage like six-foot distancing markers and floor stickers, and helping each other navigate grocery delivery, testing sites, and shifting safety protocols.
As the months went on, these calls evolved. Once the immediate shock of the pandemic settled, they naturally grew into something broader, rooted in community, connection, and joy. We began hosting more informal calls, talking about cooking, travel, technology, and advocacy. Many lasted six, seven, sometimes even eight hours. The first hour might focus on practical updates, but what followed was deep conversation about blindness, identity, and philosophy. Together, we unpacked harmful narratives and discovered the social model of disability in practice. It was through those calls that I decided to attend the Colorado Center for the Blind, a decision that changed my life.
Then, by the summer of 2020, California began to burn. The wildfires layered one crisis atop another, and our calls once again shifted back into emergency mode. The network we had built to survive the pandemic became the infrastructure that helped us survive the fires. Evacuation maps, fire perimeters, and safety alerts were shared across county websites and social media, but all were visual and nearly all were inaccessible. Blind people in evacuation zones, myself included, scrambled to access life-saving information. Some relied on family or friends to interpret maps; others used visual interpreter services or called 211, a free, confidential helpline operated by the United Way that connects callers 24/7 to local community resources for essential needs like food, housing, healthcare, mental health support, and disaster relief.
It was exhausting. The constant work of finding, translating, and validating inaccessible information took a toll on our mental health as individuals and as a community. But it was also revealing. As a sociologist, I could see clearly that ableism itself operates as a social determinant of health. It shapes who gets timely information, who experiences prolonged uncertainty, and who shoulders the cognitive and emotional burden of navigating systems that were never designed for us.
Those months taught us that health literacy is not just about individual capacity; it is about whether the systems we rely on make information accessible in the first place. The blind community modeled health literacy in action, even as we were denied access to the very materials that public health claimed were inclusive.
Public health cannot claim health literacy without accessibility. Accessibility is not the afterthought of health literacy; it is its foundation.
When Public Health Professionals Cannot Access Public Health
Years later, I encountered exclusion of a different kind.
A public health organization hosted an infographics competition, an event meant to celebrate creativity and data storytelling in our field. I was eager to engage, to learn from my peers’ work, to see the innovative ways they visualized data.
As I opened the gallery, my screen reader began to speak:
“Image.”
Next.
“Image.”
Next.
“Image.”
Again.
“Image.”
Over two hundred submissions. Not one included alt text or an image description.
Every “Image” was a reminder that someone had designed something to communicate important public health information and had never imagined that a blind colleague might want, or need, to engage with it.
This was a celebration of communication that excluded communicators. A showcase of public health work that was inaccessible to public health professionals.
We understand social determinants. We talk about structural inequities. But we forget to apply those same principles to disability. We create campaigns about inclusion that are inaccessible to the very people they are meant to reach.
We should never graduate students who can analyze data but cannot describe it accessibly.
We should never produce “health literacy” professionals who exclude entire populations through omission.
We should never allow our field to call something “inclusive” when it leaves disabled people behind.
Accessibility is not a favor. It is not charity. It is a professional standard. It is a public health competency.
During Health Literacy Month, if we are not making our materials accessible to all, we are failing as a field.
Cultural Humility and Continuous Learning
Like so many of us, I am still learning. Cultural humility is a lifelong practice; it means recognizing that we will never arrive at complete understanding, but that we have a responsibility to keep showing up, listening, and growing.
While this post focuses significantly on the needs of blind and low vision individuals, accessibility must go far beyond vision. Our work must reach people who are deaf, deafblind, hard of hearing, neurodivergent, or who have mobility, cognitive, or communication disabilities.
Accessibility is not a checklist. It is a mindset, a commitment to ensure that every person can engage with and act on the information we share.
We can only create equitable systems when accessibility and cultural humility are embedded in everything we do, from our classrooms to our crisis communications.
Achieving Equality Through Access
Blind Equality Achievement Month reminds us that blind and deafblind people can achieve anything when barriers are removed, not despite blindness or deafblindness, but because of the access and community that allow us to thrive.
The National Federation of the Blind’s philosophy, that blindness is not the problem, inaccessibility is, belongs at the heart of public health. This philosophy is a form of health literacy in action. It empowers individuals to understand the systems around them, navigate them with skill, and advocate for themselves and others.
Equality and achievement are not abstract ideals. They are daily practices. They are what happens when we make sure everyone can access the information they need to live, learn, and lead.
We use the language of equity often in public health, but equity only exists when access does. Health literacy is how we turn our values into action.
If we truly believe in health equity, we must make accessibility a public health priority.
A Call to the Field I Love
To my colleagues in public health, from practitioners and professors to department leaders, communications directors, news editors, and accrediting bodies, this message is for you.
Let’s make Health Literacy Month 2025 the year we mean it.
Describe your images. Caption your videos. Transcribe your podcasts. Make accessibility a habit, a policy, and a culture.
Because when the next emergency strikes, when California burns again, or another public health crisis unfolds, blind, deafblind, and disabled people deserve access to the same information, at the same time, with the same ability to act.
That is not a special accommodation. That is equity. That is health literacy. That is public health.
Our profession needs blind epidemiologists, deafblind educators, deaf health communicators, wheelchair-using program directors, neurodivergent researchers, all of us. But we can only contribute if we are invited in through access.
I love this field. I believe in its mission. And I know you do too.
Let’s rebuild it together, through accessibility, humility, and action.
This October, commit to alt text, image descriptions, captions, and transcripts. It is not an add-on. It is health literacy. It is equity. It is public health.
To learn more about my work and the advocacy I do to advance accessibility and disability inclusion in public health, please visit my website at www.lauramillar.com or follow me on my new Patreon.
Author’s Note
This post was written and compiled with the support of artificial intelligence. While AI assisted with organization, formatting, and editing, the heart of this piece comes from a much deeper collective source. These words are my own, but the wisdom within them is shared, drawn from generations of disabled advocates, organizers, and disability justice leaders whose work and lived experience have shaped the language of access, equity, and liberation. They have been an integral part of my personal and professional journey. I write from their shoulders, carrying forward what they have taught us: that access is love, and that justice begins with the courage to listen, learn, and act.