Eric Emerson

Learning Disabilities Public Health Observatory

Three questions◦ Who are ‘people with intellectual disability’?◦ What do we know about international variation in

the health inequalities faced by people with intellectual disability?

◦ Why do these health inequalities exist? Future directions

The ‘hidden majority’

Little known◦ Poor health◦ High rates of

poverty & social exclusion

◦ Invisible to intellectual disability services (and policy)

Administrative Prevalence of Intellectual Disability in England

Mortality Morbidity

◦ Impairments◦ Physical health◦ Mental health

Health states & behaviours◦ Obesity◦ Inactivity◦ Smoking, drug use & sexual health?

Variation in need◦ incidence of intellectual disability (nearly all

preventable)◦ prevalence?◦ health status?

Variation in expenditure, policies and health care systems ◦ in general◦ for people with intellectual disabilities?

Syndrome-specific biological vulnerability◦ Down’s syndrome:

congenital heart defects, hearing loss, early onset dementia

Impact of intellectual disability ◦ Vulnerability to poorer

physical and mental health

◦ Self-identification of ‘ill health’

◦ Communication of health needs

◦ Understanding health promotion

Overt and institutional discrimination in health care systems

Social Determinants of Health: Social position and inequality are related to ...◦ Mortality◦ Morbidity

Impairments Physical health Mental health

◦ Health behaviours Obesity Inactivity Smoking, drug use & sexual health

People with intellectual disability are more likely than others to be exposed from infancy onwards to a wide range of material and psychosocial hazards◦ Poverty◦ Low social status◦ Low control◦ Victimisation & abuse

The poorer health of people with intellectual disability is (in part) due to their experience of deprivation and disadvantage (rather than their intellectual disability per se)

High rates of mental health problems among children with intellectual disability

Over 50% of children in the UK who have intellectual disability and a mental health problem are currently living in poverty

33%-50% of this increased risk is possibly due to increased exposure to poverty

Adversity Index

Prevalence of Diagnosable Mental Health Disorders

Better understanding of the health (and the determinants of health) of the ‘hidden majority’ of adults with intellectual disability

Better understanding of international variation in need and capacity

Combat discrimination in health care systems (and more generally)

Address the wider social determinants of health◦ Change the odds of exposure to adversity◦ Beat the odds when exposed (build resilience)

A public health approach to the health inequalities faced by people with intellectual disabilities

Improve daily living conditions

Tackle the inequitable distribution of power, money, and resources

Measure and understand the problem and assess the impact of action

eric.emerson@lancaster.ac.uk