Having a disability is not synonymous with having a health problem: many persons with disabilities live healthy lives. People with disabilities often have a diverse range of health needs (WHO & World Bank, 2011).
However, there is some evidence that, collectively, they experience poorer levels of health and require more healthcare than the general population (WHO & World Bank, 2011, p. 57; Morgon Banks & Polack, 2014, p. 50). Increasing evidence also indicates that exclusion from care and treatment for both general and disability-specific health needs leads to poorer health outcomes among people with disabilities (WHO & World Bank, 2011, p. 57; Morgon Banks & Polack, 2014, p. 48). Mortality rates for children with disabilities are estimated to be as high as 80 per cent in countries where under-five mortality as a whole has decreased to below 20 per cent – this cannot solely be ascribed to genetic or bio-medical factors (Inclusion Intl., 2006, p. 39).
People with disabilities may face inequities in access, quality and delivery of care in mainstream health services, leading to poorer overall treatment outcomes (Morgon Banks & Polack, 2014, p. 47). Health facilities are often inaccessible; information is often not communicated appropriately; transport is often not accessible or affordable; health services are often not affordable; misconceptions and stigma around disability may prevent families seeking healthcare; and discrimination by healthcare providers may limit provision of appropriate services (Morgon Banks & Polack, 2014, pp. 48-49; Fembek et al., 2013, p. 81; WHO & World Bank, 2011, pp. 62-63, 70-72, 77; Burns et al., 2014, p. 34). For example, the incorrect but common assumption that people with disabilities are sexually inactive limits provision of sexual and reproductive healthcare, and women with disabilities may experience ‘forced and/or coerced sterilisation, forced contraception and/or limited or no contraceptive choices, a focus on menstrual and sexual suppression, poorly managed pregnancy and birth, [and] forced or coerced abortion’ (Frohmader & Ortoleva, 2013, p. 2; Morgon Banks & Polack, 2014, p. 49; Ortoleva & Lewis, 2012, p. 41; HRW, 2012, p. 9).
In addition, healthcare workers are often unfamiliar with people with disabilities. They hesitate to take on routine care in the mistaken belief that specialist care is always needed (Groce & Kett, 2014, p. 6; WHO & World Bank, 2011, p. 77).
Healthcare costs and poverty
A study in Vietnam found that the economic burden of healthcare, especially in relation to medication and travel costs, was greatest for people with disabilities, around 12 per cent of whom experience catastrophic expenditure (40 per cent non-food expenditure) (Palmer, 2014, p. 389, 392). Such high out-of-pocket medical costs for people with disabilities can exacerbate poverty (Morgon Banks & Polack, 2014, pp. 49-51).
Lack of access to, or delay in appropriate healthcare may lead to higher medical and productivity costs in the long term as a result of continuously poor or worsening levels of functioning, with associated costs for wider society (Morgon Banks & Polack, 2014, p. 51).
Public health campaigns
Failure to include people with disabilities in public heath interventions may impede the effectiveness and efficiency of these programmes (Morgon Banks & Polack, 2014, pp. iv, 48, 52; WHO & World Bank, 2011, pp. 60-61). There is increasing evidence that people with disabilities, especially women, are at increased risk of contracting HIV. This is partly because of sexual violence due to the persistence of the myth that sex with a virgin can cure AIDS (Morgon Banks & Polack, 2014, p. 52; Ortoleva & Lewis, 2012, p. 14; HRW, 2012, pp. 8-9). However, they are frequently overlooked in preventative measures, which could lead to very high individual and societal costs (Morgon Banks & Polack, 2014, p. 52; HRW, 2012, p. 8). Many children with disabilities are not included in immunisation efforts, although they are at the same risk of childhood diseases (UNICEF, 2013, p. 23). A growing body of research indicates that young people with disabilities are at equal or greater risk for smoking, alcohol consumption and unsafe sex, yet public heath campaigns are often inaccessible to them (Groce & Kett, 2014, p. 6, 11; UNICEF, 2013, p. 26).
The nutritional needs of children and adults with disabilities are rarely addressed, as a result of:
- less access to health and social services;
- lack of awareness and ineffective communication on the part of health and development professionals; and
- public health campaigns that do not consider the special needs of people with disabilities (Groce et al., 2013, p. e180).
People with disabilities are sometimes deliberately omitted from nutrition outreach efforts as their lives are less valued (Groce et al., 2013, p. e180). Poor knowledge and stigma among caregivers can result in some children and adults with disabilities, such as severe cerebral palsy, suffering from undernutrition and failure to thrive as a result of inadequate feeding (Groce et al., 2013, p. e180-e181; UNICEF, 2013, p. 25). People with disabilities can be denied food or offered less food than other household members (Groce et al., 2013, p. e181).
- Burns, D., Oswald, K., & the ‘we can also make change’ team. (2014). ‘We can also make change’: Piloting participatory research with persons with disabilities and older people in Bangladesh. Sightsavers, HelpAge International, ADD International, Alzheimer’s Disease International, & Institute of Development Studies. See document online
- Fembek, M., Butcher, T. H., Heindorf, I., & Wallner-Mikl, C. (2013). Zero Project report 2013: Employment. Klosterneuburg: Essl Foundation. See document online
- Frohmader, C., & Ortoleva, S. (2013). The sexual and reproductive rights of women and girls with disabilities (Issues Paper). ICPD Beyond 2014. See document online
- Groce, N., & Kett, M. (2014). Youth with disabilities (Working Paper Series: No. 23). London: Leonard Cheshire Disability and Inclusive Development Centre. See document online
- Groce, N. E., Kerac, M., Farkas, A., Schultink, W., & Berman Bieler, R. (2013). Inclusive nutrition for children and adults with disabilities. The Lancet Global Health, 1(4), e180–e181. See document online
- Human Rights Watch. (2012). Human rights for women and children with disabilities. New York: Human Rights Watch. See document online
- Inclusion International. (2006). Hear our voices: A global report: People with an intellectual disability and their families speak out on poverty and exclusion. London: Inclusion International. See document online
- Morgon Banks, L., & Polack, S. (2014). The economic costs of exclusion and gains of inclusion of people with disabilities: Evidence from low and middle income countries. CBM, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine. See document online
- Ortoleva, S., & Lewis, H. (2012). Forgotten sisters – A report on violence against women with disabilities: an overview of its nature, scope, causes and consequences (Northeastern public law and theory faculty research papers series no. 104-2012). Northeastern University. See document online
- Palmer, M. G. (2014). Inequalities in universal health coverage: Evidence from Vietnam. World Development, 64, 384–394. See document online
- UNICEF. (2013). The state of the world’s children 2013: Children with disabilities. New York: UNICEF. See document online
- WHO & the World Bank. (2011). World report on disability. Geneva: WHO. See document online