Population Outcome: Disabled people in Suffolk and North East Essex have Health Equality
People in Suffolk and North East Essex should have the same opportunity of good health and wellbeing, dignity and respect regardless of their circumstances, and this should include people with disabilities, who currently have twice the risk of developing a number of health conditions, and inaccessible health facilities are up to 6 times more difficult for persons with disabilities.
People with a disability
The 2021 Census asked people: “Do you have any physical or mental health conditions or illnesses lasting or expected to last 12 months or more?”. If they answered yes, a further question “Do any of your conditions or illnesses reduce your ability to carry out day-to-day activities?”
The Story Behind the Outcome
Range of inequalities
The government’s Women’s Health Strategy 2022 highlights:
- Women with disabilities cannot always access face to face services, and are less comfortable talking to professionals about some topics e.g. contraception and pregnancy
- Women who have served in the armed forces may have specific physical or mental health needs as a result of their experience of service or injuries.
- Autism in women and girls is under-recognised and therefore under-diagnosed.
- Most carers are women and the burden of caring can impact on their ability to meet their own mental and physical health as well as progress in their careers.
Among people with disabilities, excess weight is 11 percentage points higher than among those without disabilities.
Oral health – people with learning disabilities
- compared to the general population, people with learning disabilities have:
- higher levels of gum (periodontal) disease
- greater gingival inflammation
- higher numbers of missing teeth
- increased rates of edentulism (toothlessness)
- higher plaque levels
- greater unmet oral health needs
- higher levels of untreated tooth decay
- poorer access to dental services and less preventative dentistry
Inequalities – maternity
- Some medications can impact the unborn child, though there is a lack of robust evidence.
- Stopping medication could lead to relapse.
Research into discontinuation of antipsychotic medications shows those who are younger (under 35) and those who have been taking their medications for less than a year are more likely to cease their medications in pregnancy.
Research into depression during pregnancy found that women who discontinued medication relapsed significantly more frequently over the course of their pregnancy compared with women who maintained their medication.
New parents can experience a range of emotional and mental health issues:
- Difficulty concentrating, poor memory, difficulties sleeping
- Practical and financial worries about coping with a new baby
- Unwanted and upsetting thoughts, heightened emotions
- Depression, anxiety and panic attacks, Perinatal Obsessive Compulsive Disorder
- Post partum psychosis
- Impacts of birth trauma
Inequalities - children and young people
Abuse, neglect or family dysfunction – can lead to ill-health and disabilities in later life.
In a 2014 UK study on ACEs, 47% of people experienced at least one ACE with 9% of the population having 4+ ACES
Relationship between number of ACEs experienced by a child increases and risk of poor outcomes
Risks of alcohol use, smoking, drug use, violence and mental illness outcomes were increased in individuals with any level of ACEs. Risks of high BMI, heart disease and respiratory disease were increased in individuals with ≥2 ACEs, and risks of type 2 diabetes, cancer and stroke in those with ≥4 ACEs only.
Impact of disability on children and young people’s mental health
Royal College of Psychiatrists’ report in 2017 Good mental health services for young people highlights some young people are at a much higher risk of developing a mental disorder and should be prioritised when developing mental health services:
- Young people with an intellectual disability – 6.5-fold increased risk of mental health problems.
- Young people with special educational needs – increased risk of conduct disorder.
- Young people with physical illness – increased risk of emotional and conduct disorder.
Common Mental Health Disorders
People with more than four physical health conditions are nearly seven times more likely to experience mental ill health than people in good physical health.
The Health Foundation highlights that for people with depression and/or anxiety:
- Almost three quarters have at least one other physical or mental health-related long-term condition; almost a third have 3 or more other long-term conditions.
- Chronic pain, hypertension and irritable bowel syndrome are particularly prevalent.
Inequalities - Severe Mental Illness (SMI)
Inequalities – people with learning disabilities
- Digestive Issues & constipation
- prevalence of diabetes is estimated to be twice as high
- Dental health outcomes are significantly worse
- prevalence of dementia is significantly higher than the general population
- Inactivity levels are higher
The number of people with LD living with obesity is higher
Cancer is the third most common cause of death of people with LD in England. – 1 in 10 chance of dying from the cancer, as opposed to a 1 in 36 chance in the general population. Tumours more often diagnosed at a late stage
Reasons for these health inequalities are often multifactorial. This includes genetic factors, poor access to services and poorer socio-economic outcomes. Housing, educational attainment, employment and social inclusion determine their health and wellbeing
Learning Disabilities Mortality Review (LeDeR) found almost half (46%) of adults had 7 to 10 long term health conditions when they died
People with learning disabilities and/or autism – life expectancy
Learning from lives and deaths – People with a learning disability and autistic people (LeDer) data from 2021 shows:
- The average age at death for people with a learning disability
is 23 years younger for men, and 27 years younger for women
than the wider population.
- People of Black, Black British, Caribbean or African, mixed
ethnic group and Asian or Asian British ethnicity died at a
younger age in comparison to those of white ethnicity.
- Avoidable deaths (ie those considered preventable and treatable
causes of death of people who died at younger than 75 years old)
are significantly higher for people with a learning disability.
People with autism – barriers in accessing healthcare
- far less likely to say that they could describe how their symptoms feel in their body, describe their pain levels, and explain their symptoms.
- less likely to know what is expected of them when they go to see their healthcare professional.
- less likely to feel they are provided with appropriate support after receiving a diagnosis.
- over 7 times more likely to report that their senses frequently overwhelm them so that they have trouble focusing on conversations with healthcare professionals.
- over 3 times more likely to say they frequently leave their healthcare professional’s office feeling as though they did not receive any help at all.
- 4 times more likely to report experiencing shutdowns or meltdowns due to a common healthcare scenario (e.g., setting up an appointment to see a healthcare professional).
The study found high rates of chronic physical and mental health conditions, including arthritis, breathing concerns, neurological conditions, anorexia, anxiety, ADHD, bipolar disorder, depression, insomnia, OCD, panic disorders, personality disorders, PTSD, SAD, and self-harm.
Long term conditions and inequality
- Frailty is linked to long-term conditions in middle-aged and older adults.
- Deprived communities, coastal communities, rural communities, and people from minority ethnic communities face some of the biggest health inequalities
- People who live in more deprived areas are up to six times more likely to die from alcohol-related liver disease than those who live in wealthier areas
- Lung disease continues to be a major factor in health inequalities. Someone from the most deprived section of society is two-and-a-half times more likely to have COPD
- Type 2 diabetes is 2-4 times more likely among people of South Asian, African-Caribbean and Black African descent
- People from some ethnic minority groups, especially Pakistani and Bangladeshi groups, are more likely than White British to report long-term illness and poor health. But on some measures Black Caribbean and Black African communities report better outcomes
than their white peers.
- People from ethnic minority groups are more likely to live in deprived
Inequalities – Older people with disabilities
Impact of inequalities on carers
- Research shows carers are at increased risk of illness, and specifically musculoskeletal conditions, cardiovascular disease, generalised cognitive deterioration and function, and poor sleep.
- Carers are 16% more likely than non-carers to live with 2 or more long-term health conditions – Among carers living with 2 or more long-term conditions, arthritis and high blood pressure are the most common conditions.
- There is some evidence that indicates that mental health outcomes may be worse for carers compared to the general population
- Premature death, higher levels of disease and neglect of their own health care needs are known to be common amongst carers
- Impact of social isolation and lack of leisure time on mental and physical wellbeing
References & Further Reading
What we know matters to people and why
|I have my disabilities recognised and recorded||Recording and using information on my disabilities and health conditions means that my risks of ill-health, can be identified early, and may be prevented.|
|I have equality of access to health and care||Information on my rights and options for care and support, shared in the right way for me, means I can make the right decisions and know what to expect from my care.|
Understanding the impacts of disability discrimination on my health, and actively tackling the barriers I face, means I have access to the right care at the right time.
Full access to interpreters and translated materials mean I can be a full partner in my care.
|I receive high quality care||High quality, culturally competent, compassionate and sensitive trauma informed care, enables me to have better outcomes for my health and wellbeing.|
Support to access my family, friends, work and community means I can live a full, independent life.
Understanding my identity, and the adjustments I need for my disability, means my care needs and choices are met.
|I am seen and heard||Being treated with respect, not experiencing stereotypes, assumptions, bias, prejudice or discrimination, means I can have trust in the professionals who provide my treatment, care and support.|
Actively listening and responding to my concerns, feelings and experiences, and giving me choice and control, means my care, and my care for others, is safe and effective.
How will things be different in Suffolk and North East Essex
|We wIll remove barriers to screening, diagnosis, treatment||We will integrate services and teams|
|We will implement new technologies||We will personalise care with patients as equal partners|
|We will enable people to seek help early||We will enable access to care records|
|We will think of cancer as a long term condition||We will integrate advocacy|
|We will focus on survivorship|
Case Studies – how we are making progress across Suffolk & North East Essex
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Publish your case study here
Publish your case study here
Publish your case study here
Publish your case study here