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Addressing Health Disparities Through Promoting Equity for Individuals with Intellectual Disability

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Abstract

Intellectual disabilities (ID) are conditions originating before the age of 18 that result in significant limitations in intellectual functioning and conceptual, social and practical adaptive skills. IDs affect 1 to 3% of the population. Persons with ID are more likely to have physical disabilities, mental health problems, hearing impairments, vision impairments and communication disorders. These co-existing disabilities, combined with the limitations in intellectual functioning and in adaptive behaviours, make this group of Canadians particularly vulnerable to health disparities. The purpose of this synthesis article is to explore potential contributory factors to health vulnerabilities faced by persons with ID, reveal the extent and nature of health disparities in this population, and examine initiatives to address such differences. The review indicates that persons with ID fare worse than the general population on a number of key health indicators. The factors leading to vulnerability are numerous and complex. They include the way society has viewed ID, the etiology of ID, health damaging behaviours, exposure to unhealthy environments, health-related mobility and inadequate access to essential health and other basic services. For persons with ID there are important disparities in access to care that are difficult to disentangle from discriminatory values and practice. Policy-makers in the United States, England and Scotland have recently begun to address these issues. It is recommended that a clear vision for health policy and strategies be created to address health disparities faced by persons with ID in Canada.

Résumé

Les déficiences intellectuelles (DI) sont des affections qui apparaissent avant l’âge de 18 ans et dont la conséquence est une limitation significative du fonctionnement intellectuel ainsi que des capacités conceptuelles, sociales et d’adaptation. Les DI touchent entre 1 et 3 % de la population. Les personnes atteintes présentent généralement des déficiences physiques, des problèmes de santé mentale, des troubles de l’audition ou de la vue, et des problèmes de communication. Ces incapacités concomitantes, combinées aux limitations du fonctionnement intellectuel et du comportement adaptatif, rendent ce groupe d’individus particulièrement vulnérable à des disparités sur le plan de la santé. Le but de cet article de synthèse était d’examiner les facteurs qui contribuent éventuellement à rendre vulnérables sur le plan de la santé les individus atteints de DI, de préciser l’ampleur et la nature des disparités auxquelles est en butte cette population et d’analyser les initiatives qui permettraient de s’attaquer à ces différences. Selon cette revue, les personnes atteintes de DI s’en tirent moins bien que la population en général sous l’angle de certains indicateurs clés de la santé. Parmi les facteurs de vulnérabilité, nombreux et complexes, mentionnons l’attitude de la société devant les DI, l’étiologie de ces déficiences, les comportements dommageables sur le plan de la santé, l’exposition à des environnements malsains, les problèmes médicaux de mobilité, et l’accès inadéquat aux services essentiels de santé et autres services de base. Dans le cas des personnes atteintes de DI, on note d’importantes disparités quant à l’accès aux soins de santé, disparités qu’il est difficile de distinguer des valeurs et des pratiques discriminatoires. Aux États-Unis, en Angleterre et en Écosse, les décideurs ont récemment commencé à se pencher sur ces questions. On recommande de se doter d’une vision claire en matière de politique et de stratégies sur le plan de la santé afin de s’attaquer aux disparités que subissent les personnes atteintes de DI au Canada.

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Authors and Affiliations

  1. Department of Community Health & Epidemiology, Queen’s University, 191 Portsmouth Ave., Kingston, ON K7M 8A6, Canada

    Hélène Ouellette-Kuntz MSc

  2. Department of Psychiatry, Queen’s University & PREM-TGC, Canada

    Nathalie Garcin PhD

  3. Department of Medical Genetics, UBC and BC Children’s and Women’s Hospital, Canada

    M. E. Suzanne Lewis MD

  4. Departments of Psychology & Psychiatry, Queen’s University, Canada

    Patricia Minnes PhD

  5. Department of Otolaryngology, Queen’s University, Canada

    Carol Martin MA

  6. Departments of Psychiatry & Physiology, Queen’s University, Canada

    Jeanette J. A. Holden PhD

Authors
  1. Hélène Ouellette-Kuntz MSc
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  2. Patricia Minnes PhD
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  3. Nathalie Garcin PhD
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  4. Carol Martin MA
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  5. M. E. Suzanne Lewis MD
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  6. Jeanette J. A. Holden PhD
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Correspondence to Hélène Ouellette-Kuntz MSc.

Additional information

Acknowledgments, Sources of Support and Disclaimer: The original paper that forms the basis of this manuscript was commissioned by the Canadian Institutes of Health Research for the International Think Tank on Reducing Health Disparities and Promoting Equity for Vulnerable Populations held in Ottawa, Canada (September 21–23, 2003). The authors first prepared a draft paper for discussion at the Think Tank. The paper was then revised and finalized by incorporating many of the comments and suggestions made during the Think Tank discussions. While individuals with other disabilities (physical, sensory, mental/emotional) also face significant health disparities, the authors and the Think Tank Disability Discussion Group deemed it desirable to retain the original focus of the paper on intellectual disabilities (ID). Many parallels can be drawn from the focus on ID to other disability groups. However, the issues faced by Canadians with ID, including a history of institutionalization, the lifelong nature of the disability, the effects of cognitive and other deficits through the developmental years and the multiple medical disorders seen across syndromes associated with ID present distinct and extensive vulnerabilities in this population.

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Ouellette-Kuntz, H., Minnes, P., Garcin, N. et al. Addressing Health Disparities Through Promoting Equity for Individuals with Intellectual Disability. Can J Public Health 96 (Suppl 2), S8–S22 (2005). https://doi.org/10.1007/BF03403699

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