Including people with intellectual disability in health policy

As we have seen in the previous steps, despite much progress, health differences exist between people with an intellectual disability and the general population. Thinking about these differences, we can all appreciate that there is a policy and political context to the attention that people with intellectual disabilities receive from the health services.

Health policy at a national level, however, is often framed within a broader context.

• Some health policies tend to focus on the responsibility of the individual to take ownership of their own health.
• Other policies put the focus on the infrastructure of health services with a lot of the attention going into building hospitals and training medical staff.

So, where do people with an intellectual disability fit within health policy?

Case Study: Healthy Ireland Policy

The overlapping rings in the model illustrate how factors at one level influence factors at another level.

The model also suggests that in order to instigate health promotion, it is necessary to work across all levels of the model at the same time. This type of approach is more likely to sustain health promotion efforts over time.

Differences in the lives of people with an intellectual disability

As we have already seen, however, the lives of people with intellectual disabilities can be very different from their non-disabled peers. And so, the social determinants are often very different in many countries:

• They often have lower levels of access to education, to employment and to income.
• Their living environments may also be very different; they may be living in an institution or in a group home with other people with intellectual disabilities.
• They may have trouble using public transport.
• They may have no key to their own front door and so are not free to come and go as they please, or others have deemed it unsafe for them to do so.
• In some cases, they may have someone else deciding what they eat, where they go, what time they get up or go to bed.

Challenges with public health promotion

People with an intellectual disability can also be forgotten or overlooked in public health campaigns and in health promotion (we will be exploring this in more detail in Week 2).

• Often the materials are not available in formats that are helpful to them.
• They are not visible in the campaigns and so believe that it does not affect them.
• The health service through which they might avail of, for example, a vaccination or a health check, does not treat them in a welcoming or considerate way.

Policies specifically for people with an intellectual disability

Many countries developed health strategies which specifically address the needs of people with intellectual disability. Over a short number of years, between 1990 and 2000, a number of governments developed policies to comprehensively improve the health and wellbeing of people with intellectual disability:

• 1990: Ireland published Needs and Abilities: A Policy for the Intellectually Disabled
• 2001: The United Kingdom published Valuing People: A New Strategy for Learning Disability for the 21st Century
• 2002: The US Surgeon General published Closing the Gap: A National Blueprint to Improve the Health of Persons with Mental Retardation;
• 2002: Scotland published Promoting Health, Supporting Inclusion
• 2003: New South Wales, Australia published Health and People with Intellectual Disability;
• 2004: Canada published Addressing Health Disparities through Promoting Equity for Individuals with Intellectual Disability

These policies raised awareness of the health disparities faced by people with intellectual disability. They also provided guidance on addressing those disparities. Many of those policies were enhanced and developed by further policy in this area (see the See Also section for more details).

Even if your country does not have a specific policy on health services for people with intellectual disabilities, most countries have now ratified the United Nations Convention on the Rights of People with Disabilities (UNCRPD), which has an article relating to health (Article 25) and one relating to habilitation and rehabilitation (Article 26).

Take a moment to read Article 25: Health and Article 26: Habilitation and Rehabilitation of the UNCRPD to see what people with intellectual disabilities should expect from your country’s health service.

Post your thoughts in the comment section

• Are you aware of your country’s health services policy for people with an intellectual disability?
• Using a web search engine, find a health policy from your country that addresses people with an intellectual disability. Share it with other learners in the comment section below.
• Do you think the policy successfully addresses the UNCRPD?