Health inequalities: death by political means
BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m755 (Published 27 February 2020) Cite this as: BMJ 2020;368:m755
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Dear Editor,
The health of people with intellectual disabilities has been of long-standing concern.
Inequalities and inequities in health and healthcare have been identified for people with intellectual disabilities(ID). Equality and equity are related concepts since inequities arise when care of an equal quality is not provided. Not all differences in health status are inequities but that where differences are unnecessary, avoidable, unfair and unjust then inequity exists.
Across every indicator of health inequality, adults with ID are disadvantaged. Thematic analysis has revealed how low income and reduced employment had a negative impact on the physical and psychological health of men with ID. Other findings show how living in deprived areas exposed men with ID to constant threats to their safety with an adverse effect on their health.
There is an increased prevalence of a number of health conditions and impairments among children with ID and evidence that these health inequalities are associated with several preventable environmental determinants.
Promoting equal and equitable access to healthcare for people with intellectual disabilities requires a range of responses at a number of different levels involving a number of key stakeholders. If people with ID are valued then they should be provided with the opportunity to access healthcare of a quality comparable to the rest of the population.
Research has shown that many people with ID, who can make decisions about their everyday life, aren’t given clear information about their medication. As a result, they often don’t understand the drugs prescribed for them or their potential side effects. People with ID have identified that using simpler language, as well as pictures and videos may help them understand their medicines. Healthcare professionals such as pharmacists and doctors will have to spend longer explaining their medication, use different resources, and explain things in simpler language.
Healthcare staff including doctors, pharmacists, nurses, physiotherapists, occupational therapists, speech and language therapists, clinic support staff, administrative staff, etc., need to be aware of the health problems more prevalent amongst people with intellectual disabilities so that a proactive approach may be taken: even if individuals are unable to make others aware of their health needs staff can be alert to possible increased risk and monitor accordingly, hopefully leading to earlier detection and treatment.
Strategies to reduce inequalities and inequities include use of data to educate decision makers including doctors and pharmacists, attention to social determinants and a life-course model and emphasis on leveraging inclusion in mainstream services where possible.
Bibliography
Health inequalities experienced by children and young people with intellectual disabilities: A review of literature from the United Kingdom. Lindsay A. Allerton, Vicki Welch, Eric Emerson First Published November 30, 2011 https://doi.org/10.1177/1744629511430772
Volume: 15 issue: 4, page(s): 269-278. Article first published online: November 30, 2011; Issue published: December 1, 2011
Northway, Ruth. Equality and Equity of Access to Healthcare for People with Intellectual Disabilities, UH http://www.intellectualdisability.info/changing-values/articles/equality...
Martin Bollard, Eileen Mcleod & Alan Dolan (2018) Exploring the impact of health inequalities on the health of adults with intellectual disability from their perspective, Disability & Society, 33:6, 831-848, DOI: 10.1080/09687599.2018.1459476
Smith, MVA, Adams, D, Carr, C, Mengoni, SE. Do people with intellectual disabilities understand their prescription medication? A scoping review. J Appl Res Intellect Disabil. 2019; 32: 1375– 1388. https://doi.org/10.1111/jar.12643
Krahn, G.L. and Fox, M.H. (2014), Health Disparities of Adults with Intellectual Disabilities: What Do We Know? What Do We Do?. J Appl Res Intellect Disabil, 27: 431-446. doi:10.1111/jar.12067
Competing interests: No competing interests
Dear Editor,
I am not sure that the government is ready to accept that austerity has a negative impact on health and equity of access to health judging by the comments of a government minister on question time yesterday.
Competing interests: No competing interests
Socioeconomic gradient in health and the COVID-19 outbreak
Dear Editor,
Up to the day of this writing, the Coronavirus Disease 2019 (COVID-19), first discovered in Wuhan, Hubei, China, has led to 114,452 confirmed cases and 4,026 deaths(1). While the epidemic has been under better control in China partially due to national mobilization of healthcare resources (including medical professionals and equipment) into Hubei, shortage of medical resources is of grave concern in other, especially those underdeveloped, countries recently affected by the COVID-19, underscoring the implication and potential consequences of health inequalities at a global level.
Many countries are currently employing a household-based prevention model, which usually includes mandatory self-quarantine of people who traveled to high-risk places. However, this model can be very fragile and limited, especially for those socially disadvantaged people who are poor, socially isolated and undereducated. Also, well-being of family members of the patients can be compromised indirectly even if they did not contract the disease. In the rural area of Hubei, a 17-year-old boy with cerebral palsy from a single parent family, whose father was placed in a quarantine facility for possible COVID-19 infection, was found dead after six days of being left alone at home (2).
Moreover, the socioeconomic gradient in health can be observed even among people in relatively higher socioeconomic groups. In Hong Kong, during the earlier stage of the outbreak, there was inadequate government support for healthcare professionals – a specialist claimed that he had been paying out-of-pocket to rent a hotel room in order not to affect his family members; however, healthcare personnel of lower ranking and less earning may not be able to do so (3). We need to be cautious of similar situations happening in other countries where the COVID-19 recently becomes rampant.
In conclusion, the socioeconomic gradient in health extends beyond individuals in relatively lower socioeconomic groups, and applies to their family members and those in higher socioeconomic position. Therefore, attention should not be just focused on high-risk individuals with the disease, but the whole population health prevention strategy that promotes good public hygiene practices and disease-specific health literacy is also essential.
References:
1. Johns Hopkins Center for Systems Science and Engineering. 2019-nCoV Global Cases. https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594... (last updated March 10, 2020), accessed March 10, 2020.
2. Disabled teenager in China dies at home alone after relatives quarantined, The Guardian. https://www.theguardian.com/world/2020/jan/30/disabled-teenager-in-china... (Jan 30, 2020), accessed Feb 3, 2020.
3. No Quarantine Arrangement at the Queen Mary Hospital. After Receiving Confirmed Case, Doctor Rented Hotel Room for Self-Quarantine. [瑪麗無隔離安排 醫生昨接確診個案：自租酒店隔離], HK01. https://www.hk01.com/article/427950 (Jan 30, 2020), access Feb 3, 2020.
Competing interests: No competing interests