Championing good health for people with disabilities

Abstract

Dec 3, 2011, marks the International Day of Persons with Disabilities—a time to celebrate the diversity and contribution that people with disabilities make to society and to draw attention to their unmet needs. Globally, disability affects more than 1 billion people. The prevalence of disability is increasing concurrently with an ageing population and rising rates of chronic diseases. Disability is heterogeneous, and many individuals affected have suboptimum health and wellbeing. There has been a move away from the medical model of disability towards the social model; with the spotlight on how societal barriers disable individuals, the health of disabled people has received insufficient attention and investment. People with disabilities are often more vulnerable than the general population to developing ill health. There is often a clustering of health conditions, reflecting a narrower margin for health. There can be increased susceptibility to development of secondary conditions (linked to the cause of disability) and comorbid conditions (unrelated to the primary cause). Additionally, disabled people have general (unrelated to their disability) and specialist health-care needs. In older people, the higher prevalence of disability represents a lifetime's accumulation of risk factors. Comorbid disorders—often overlooked when health-care professionals do not look beyond the disability—are an important cause of morbidity and mortality. The UK Disability Rights Commission reported that people with long-term mental health conditions had more chronic health diseases than the general population. In the USA, more than half of adults with disabilities have multiple chronic conditions; of those with limitations on daily life, over 30% have four or more chronic diseases. While disability can lead to chronic ill health, the latter can also lead to disability. In the USA, of adults with arthritis and an additional chronic disease, around 60% reported having a disability as well, and in low-income and middle-income countries, dementia is a major cause of disability in elderly people. Despite neuropsychiatric disorders and unintentional injuries being the main causes of disability in young people worldwide, these remain neglected by policy makers. Sadly, people with disabilities often do not receive the health care that they deserve. Economics plays its part, with half of disabled people unable to afford health care compared with a third of people without a disability, but attitudinal barriers also pose a major hurdle. In developing countries, disabled people are less likely to receive health care compared with their counterparts in developed nations. Results from the WHO Mental Health Surveys showed that 35–50% of people with a serious mental health disorder in developed countries received no treatment in the year preceding the study; this situation was worse in developing countries, where 76–85% did not receive treatment. Paradoxically, although people with disabilities seek health care services more often, they are three-times less likely to receive it compared with people without a disability. There are also inequalities in health promotion. For example, in the USA, women who have major difficulties in walking are 40% less likely to be screened for cervical cancer and 30% less likely to have a mammogram for breast cancer screening compared with other women. The interaction between disability and health is complex, with each having an effect on the other. It is time to dismantle professional barriers and galvanise health-care providers and the disability community into action. Attitudes towards the health of disabled people must change, to enable equitable access to health-care services. Doctors should tackle comorbidities head on, instead of focusing on the disability during consultations. Education—of undergraduates and in continuing professional development—can go some way to tackle the low expectations towards the health of disabled people. Using the concept of universal design, physical barriers to accessing health-care facilities can be eased. Appropriate support should be provided during health-care interactions—for example, a sign language interpreter for an individual with hearing impairment. Providing care with respect and dignity throughout is paramount. Disability, its impact on health, and vice versa, are often difficult to define and quantify, making it imperative that high quality, comparable data for the causes, global burden, and outcomes are obtained. An integrated approach is required, considering chronic disease, disability, and ageing as overlapping conditions. People with disabilities face many challenges on a daily basis; the right to achieve the highest standard of health—without discrimination—should not be one of them. For The Lancet themed issue on disability see http://www.thelancet.com/themed-disability For The Lancet themed issue on disability see http://www.thelancet.com/themed-disability