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A quilt with 'Our say, our rights' sewed on the front.
Quilt from the Our Say, Our Rights project (Keating and Sheeran, 2013)

Overcoming health disparity

As you have learned from this week’s videos, people with intellectual disability experience more health inequalities and inequities than their non-disabled peers. How can we, as healthcare professionals, help people with an intellectual disability overcome these healthcare disparities? We will explore some of the barriers they face, and how we can begin to address them in our professional practices.

The World Health Organisation identifies barriers for people with disabilities as:

Factors in a person’s environment that, through their absence or presence, limit functioning and create disability.

These barriers can exist on many levels, including:

  • The environment,
  • People’s social ability,
  • Communication and language skills,
  • Education level,
  • Personal challenges that impact on the person’s ability to interact such as their mental health,
  • Intellectual impairment,
  • Undetected health issues, visual or auditory impairment,
  • The attitudes of others,
  • Policies,
  • Lack of information / health promotion,
  • Transportation.

These barriers frequently occur together and can impact hugely on how the person functions in society and on their quality of life. More than ever, there is a great opportunity to examine how health services can address and overcome inequalities and barriers to meet the diversity of ageing experiences.

We will return to some of the bigger issues at the end of Week 3 but, for now, let’s consider some of the issues that all healthcare staff can address.

Recognising the need

Firstly, we need to recognise the existence of health disparities and barriers for people with an intellectual disability; we must remain conscious that disparities do exist. During this course, you can see and hear various examples of inequality, from failure of the built environment to meet the access needs of a person, to failure to address the health needs of the person themselves, resulting in harm.

Addressing attitudes

As we have seen from previous steps, the community integration of people with intellectual disability has increased. Attitudes, however, continue to be a barrier to people’s full integration and equal rights. The attitudes the health professional brings to the health encounter will help or hinder relationship building and shared decision making.

Trying to change attitudes is a complex job. For this reason, improving care for people with intellectual disabilities ought to be a key priority for all primary, secondary and tertiary healthcare providers. This will inevitably contribute towards overcoming not only health disparity but other inequalities as well.

Support of key experts

Historically, most countries trained a number of healthcare professionals to work specifically with people with an intellectual disability. These professionals then played a major role in delivering and supporting healthcare for people with intellectual disability. These professionals are now often promoting a relationship-based model of care, which we will discuss in Week 3.

There are now, however, a diverse group of healthcare professionals involved in the lives of people with intellectual disability. It makes sense that all healthcare workers support one another. Nowadays, even if you do not have access to a professional with expertise in intellectual disability, there are many online resources that you can access to provide support (explore the “see also” section within each step for more details).

Nothing about me without me: valuing people

This is a core message from people with intellectual disabilities that any decision-making about their lives should be made in partnership and collaboration with them. It emphasises the point that people with intellectual disabilities want to be heard, and that carers and service providers can learn from them.

Fundamentally, people are saying see me as a person, not as my disability.

Some suggested strategies to overcome barriers include:

  • Do not make assumptions, especially around people’s disability, because all disabilities are not visible or obvious.
  • Providing person-centred care which emphasises respect for the person’s preferences, needs and values.
  • Focusing on the person’s aspirations, goals and abilities.
  • Not having pre-conceived ideas about what is important to people.
  • Developing robust communication standards with a commitment from all staff.
  • Building all of these points into policy and standard operating procedures.

Reflection

  • Think about disparities that exist for other marginalised groups within health services in your country (e.g. low-income groups, sensory impairment).
  • What has been done for them in the areas of recognising need, changing attitudes, providing support for healthcare workers, and inclusion?
  • What can this teach us about what needs to be done to include people with intellectual disabilities in the health services?

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This article is from the free online course:

Improving Health Assessments for People with an Intellectual Disability

Trinity College Dublin

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