Inequalities and challenges experienced by disabled people in Scotland: evidence review

Health

This chapter aims to highlight the importance of context and type of disability when exploring disabled people’s experiences of health.

As disability and health are interlinked, this chapter discusses evidence focusing on two examples of health and wellbeing of disabled people in Scotland: the impact of COVID-19 on disabled people’s mental health, and health outcomes and experiences when examining particular disabilities^[106].

Mental Health and COVID-19

It is clear from Scotland’s Census 2022 data, and across other evidence in this review, that mental health difficulties are common in the disabled population and can be a cause of disability for many people in Scotland. The research presented in this chapter explores the mental health of disabled people during COVID-19.

Evidence suggests that the COVID-19 Pandemic had a negative impact on disabled people’s mental health. The Office of National Statistics surveyed people in the UK aged 16 and over and found that in February 2021, 46% of disabled people said the pandemic had a negative impact on their mental health in comparison to 28% of non-disabled people^[107]. Despite the easing of restrictions by December 2021, disabled people were still more likely to report worse mental health compared to non-disabled people, at 50% and 31% respectively. It should be noted that these surveys had low sample sizes for Scotland and may not be representative of the Scottish population as a whole. ^[108].

Glasgow Disability Alliance (GDA) investigated the mental health of disabled people through focus groups with 37 disabled members after the pandemic restrictions eased in 2022^[109]. This study also found that the pandemic had negatively impacted participant’s mental health due to increased isolation and fear for their safety^[110]. Participants in this research reflected that they did not feel they were taken seriously when they tried to access mental health support specifically due to a lack of understanding of comorbidity between mental and physical conditions from service providers^[111]. Participants also reflected that they received inappropriate suggestions from health professionals when in mental health crisis and were often dismissed without support^[112].

Health Outcomes and Experiences for Intellectual Conditions

Disabled people may experience differing health outcomes and experiences based on different conditions which can influence their experiences of health inequality^[113]. This section discusses the role that intellectual conditions, as an example of disability based on existing evidence, can have on health outcomes and experiences. As mentioned previously, the language used here matches the language used in the research discussed.

For context, Scotland’s 2022 Census found that the percentage of people reporting a learning difficulty increased from 2.0% in 2011 to 3.3% in 2022, with younger people being more likely to report a learning difficulty than older people. The percentage of people reporting a developmental disorder increased from 0.6% in 2011 to 2.2% in 2022. In relation to intersectional disabilities, Kinnear et al. also demonstrates that people with intellectual disabilities and autism are more likely to report mental health conditions than people without these disabilities^[114].

People with intellectual conditions have a lower reported median age at death and higher rate of avoidable deaths. According to a study by Rydzewska et al using the 2011 Scotland Census, the median age at death among Scottish adults aged 25 and older with intellectual disabilities is 65 years compared to 80 years for adults without an intellectual disability^[115]. There is also a higher proportion of avoidable deaths for adults with an intellectual disability with 31.7% versus 18.2% for adults without an intellectual disability. Avoidable deaths include those were treatable or preventable^[116]. Rydzewska et al investigated Census 2011 data to create comparative cohorts of adults with and without intellectual disabilities. This could be replicated to investigate the Census 2022 data for more up to date understanding of mortality for disabled people. This study urges greater investigation into the role that health inequalities play on mortality for people with intellectual disabilities in Scotland.

Ward et al^[117] used Scotland’s 2011 Census to identify intellectual disabilities and linked these to records in Scottish Cancer Registry and death certificate data (March 2011-December 2019). The control cohort without intellectual disabilities and/or autism were used for indirect standardisation and calculation of crude incident rates/crude mortality rates, and age-sex standardised incident rate ratios/standardised mortality ratios (SIR/SMR). This study found that adults with intellectual disabilities were more likely to die of cancer than the general population. Adults with intellectual disabilities were less likely to be diagnosed with cancer and were disproportionately more likely to die from cancer^[118]. The higher instance of death may be due to later presentation and diagnosis and poorer treatment compliance. This study recommends that more accessible public health approaches are required to help people with intellectual disabilities and healthcare professionals identify cancer in this population. Similar to above, this study used data from the Scotland’s 2011 Census, so the results may be different if looking at the most recent census (2022).

Research suggests that there are intersectional challenges faced by women with intellectual disabilities in Scotland. Wiseman and Ferrie^[119] asked 21 women who self-identified as having an intellectual disability to complete a questionnaire and 12 took part in focus groups. The participants in this study reflected that they did not receive sex education and were removed from sex education classes which left them feeling infantilised and unequal to their peers. The participants also reported that when they did receive educational material about reproduction, they were inaccessible. Participants also noted that they received limited education about menstrual health and were not given information or choices about contraception with an overwhelming focus on avoiding pregnancy. The authors suggested that most women in the focus groups reported that they had been given hormonal contraception without discussion and were not informed about non-hormonal contraceptive methods. Participants had limited understanding about Sexually Transmitted Infections with some believing the hormonal contraception they were on would also protect them from venereal disease, which is not the case. Lastly, participants reported a lack of information about reproductive health including smear tests, breast screening and menopause, particularly among older participants.

This section has highlighted that disabled people’s experiences of health can be impacted by contexts, such as COVID-19, and highlights the importance of understanding how specific disabilities may impact outcomes and health experiences, which may also be compounded by other intersectional characteristics. It may be useful for future research to investigate specific conditions in relation to health in particular contexts and the impacts of different intersectional characteristics on these experiences, such as ethnicity, age and gender, in more detail, as well as exploring the impact of other policy topics discussed across this report on health experiences.