Health

May 7 11, 2012 Washington, D.C.

People with disabilities have ordinary health needs and require access to mainstream health care.

Outline
Understanding disability and health
Language and terms Increased risk factors Needs and unmet needs

Identifying barriers to health care provision What works in overcoming barriers

Perceptions of Disability

In general, higher poverty, lower employment, less education, unequal health care access In general, poorer levels of health, narrower margins of health

Understanding Health
TERMINOLOGY Primary condition DEFINITION Cause/Diagnosis leading to impairment, activity, participation; examples less to more complex; relates to onset, type, progressive vs. static, aging

Associated condition Additional impairments noted at onset or shortly thereafter; often examiners must seek; Cerebral Palsy - seizures, cognitive impairments; Spinal Cord Injury neurogenic bladder/bowel, insensate skin Secondary condition Co-morbidity Later onset health condition, related to primary; Depression, Pain, Osteoporosis Unrelated (seemingly) additional condition; some studies, higher hypertension, diabetes in Intellectual Disability and Schizophrenia

Understanding Health
TERMINOLOGY General health care Specialist health care Health Health promotion DEFINITION Typical care (Prevention, Health Promotion, Treatment, Referrals); Primary plus specialist care often needed; Access Multiple needs Primary care plus treatment for multiple primary, secondary, co-morbid conditions; multiple systems involved and complexity requires expertise Complete physical, mental, and social well-being and not merely the absence of disease or infirmity Process of enabling people to increase control over, and to improve their health

Understanding Health
Infant born with blindness: Special health needs?

An adolescent with spinal cord injury: Acute needs, ongoing needs?

Chronic conditions: Cerebral palsy in a child or adult, ongoing health needs?

Understanding Health
RISK
Secondary conditions

DESCRIPTORS
Pain and fatigue(Most common), depression-like symptoms (isolation, Central Nervous System involvement), osteoporosis (immobility) Can be cause of disability (diabetes cause for vision change, neuropathy); obesity and cardiovascular disease, diabetes; Intellectual Disability and mental health risks Earlier onset (Dementia with Down Syndrome/Intellectual Disability), greater impact typical aging change with smaller performance capacity

Co-morbid conditions

Age-related changes

Understanding Health
RISK
Unhealthy behaviors Violence exposure Unintentional injury Premature death

DESCRIPTORS
Smoking, inactivity, alcohol, obesity Reported rate increase, especially sexual; not rigorous science Greater risk children; greater with age (falls, motor vehicle crashes); Wheelchair accidents Mental Health (cardiovascular diseases, hypertension, diabetes, obesity); Spinal Cord Injury >2yrs post injury no change mortality; Traumatic Brain Injury shorter lifespan

Understanding Health
Higher usage health care for those with disabilities; > women; more seeking in high income, with aging.

All ages, both genders did not receive care.

Survey question*
Sought inpatient care Sought outpatient care Needed, did not get

* * * (low)

* * * (high)

* * * (low)

* * * (low)

60 & >
* (high) * * * WHS 2002-04

Femal e

18-49

Estimates weighted and age-standardized * Suggested significant difference from not disabled at 5% low = low income countries more significant high = high income countries more significant

50-59

Male

Understanding Health
NEEDS/UNMET NEEDS
Health promotion/prevention

DESCRIPTORS
Immunization often offered US Not exercise/activity (not therapy) Rare counseling for nutrition, stress, selfmanagement Limited examinations and prevention screening procedures - accessibility Education, family planning, contraception; sexually transmitted diseases (HIV/AIDS); screening Accessibility, behavioral issues WHS: 35-50% developed and 76-85% developing receive no care; schizophrenia, mood and anxiety disorders, substance abuse/dependence

Reproductive health

Dental care Mental health services

Barriers Problems with service delivery Negative attitudes Lack of provision of services Costs Inadequate policies and standards

Building blocks for change

1. Service delivery including technologies 2. Workforce 3. Financing 4. Policy, legislation and regulatory mechanisms 5. Information and evidence

Service delivery

Mother's love Natalie Behring-Chisholm

Workforce

Financing

Policy

Information and evidence

Summary of solutions
Reform policy and legislation. Financing: health insurance, targeted funding, income support, reducing fees, incentives to providers, conditional cash transfers. Service delivery: reasonable accommodations including accessible information, targeted interventions, coordination. Human resources: education and training. CBR: to promote access to healthcare. Research: include PWD; produce disaggregated data.