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

Defining Disability

The Equality Act 2010 states that a person has a disability if they have a physical or mental impairment and the impairment has a substantial, long-term adverse effect on their ability to carry out normal day-to-day activities. Most current disability definitions are based on this definition, and this is often used to measure disability in quantitative research.

However, disability is complex and therefore, there are many differing definitions of disability and ways of measuring it. These different ways of understanding and measuring disability are found throughout the evidence presented in this review. The research mentioned in this review focuses on different kinds of disability such as intellectual conditions, mental health conditions or physical disabilities. Some evidence examines disability more generally, using the Equality Act definition, and does not focus on specific illnesses or impairments. It is clear that disabled people are not a homogenous group and will have different lived experiences depending on various intersecting factors that impact their lives.

There are two main understandings of disability that are used to measure and define disability in the literature sources identified for this review:

• The medical model of disability focuses on an impairment within the individual and on diagnosis and treatment.
• The social model of disability understands that people are disabled by the way that society is organised and there are societal barriers that restrict life choices for disabled people.

The Scottish Government is aligned with the social model of disability, and the Disability Equality Plan reflects this. In keeping with the social model of disability the term “disabled people” will be used throughout this evidence review^[2]. Therefore, this evidence review is structured to focus primarily on the structural and societal influence on the lives of disabled people in Scotland rather than the impact of impairments or conditions. However, many of the sources in this evidence review use language about conditions and impairments that are aligned to the medical model which is reflected in the way this review discusses this evidence to maintain consistency with the original source.

Measurement of Disability

In 2021, the Scottish Government, Office for National Statistics (ONS) and Office for Disability Issues worked on a harmonised suite of questions on disability, guided by the Equality Act 2010, to allow for reliable comparison between national censuses. The guidance currently uses two questions^[3]:

Do you have any physical or mental health conditions or illnesses lasting or expected to last for 12 months or more?

1. Yes

2. No

Does your condition or illness/do any of your conditions or illnesses reduce your ability to carry out day-to-day activities?

1. Yes, a lot

2. Yes, a little

3. Not at all

A person is counted as disabled if they answer “yes” to both the above questions^[4]. There is an optional additional question, used in the Scottish Census for example, that collects more information about the nature of the health condition or long-term illness:

Do any of these conditions or illnesses affect you in any of the following areas?

1. Vision (for example blindness or partial sight)

2. Hearing (for example deafness or partial hearing)

3. Mobility (for example walking short distances or climbing stairs)

4. Dexterity (for example lifting or carrying objects, using a keyboard)

5. Learning or understanding or concentrating

6. Memory

7. Mental health

8. Stamina or breathing or fatigue

9. Socially or behaviourally (for example associated with autism spectrum disorder (ASD) which includes Asperger's, or attention deficit hyperactivity disorder (ADHD))

10. Other (please specify)

The Scottish Surveys Core Questions (which uses a range of Scottish Government data, including the Scottish Household Survey and other data sources referenced in this review) uses this as a way of measuring disability in the population. However, Scotland’s Census 2022 disability question is slightly different to maintain consistency with the 2011 Census^[5].

School Education statistics also use a different method to measure disability in school pupils using administration data. This data set counts the number of school pupils who have been assessed as having a disability by a qualified professional or declared having a disability themselves or by their parent/carer. Pupils may be recorded as both assessed and declared. This administrative data also records the reasons pupils receive additional support, such as having a Co-ordinated Support Plan, an Individualised Educational Programme, a disability, or another identified need. These examples show that while there is guidance on harmonised standards for collecting disability data, the extent to which this is applied is not always consistent due to specific research or population needs.

A review of the current harmonised measure of disability is currently underway by the ONS^[6]. The ONS highlighted weaknesses in using these questions as they are. For example, they identified that there is complexity around answering the questions for people without diagnoses, for those whose condition is managed by medication or with conditions which fluctuate, or only sometimes impact day-to-day activities. These findings demonstrate the current challenges of measuring a heterogenous group of people with different types of disability, conditions and experiences. The ONS also notes that while the harmonised standard is in line with the Equality Act 2010, it could also be argued that it aligns with the medical model of disability as it focuses on impairment and the way a person is restricted by their condition, instead of examining the ways in which social inequality inhibits a disabled person.

In 2024, the Welsh Government commissioned NatCen^[7] to gather insights to inform the development of survey questions to align more with the social model of disability. This study identified strong support from data users and disabled people for developing new questions that focus on societal barriers faced by disabled people such as discrimination and accessibility. This work is the first attempt to develop a standardised measure that is in line with the social model of disability, however was not published at the time of writing this review.