Health Inequalities and Social Care

1. Health Inequalities and Social Care

2. This morning • What do we know about: • The scale and nature of the health inequalities experienced by people with learning disabilities? • The causes of the health inequalities experienced by people with learning disabilities? • What works in resolving the health inequalities experienced by people with learning disabilities? • How can social care help in reducing health inequalities?

3. The Scale & Nature of the Issue • Consistent evidence from researchof: • Shorter life expectancy • All-cause mortality 3 times higher for people with moderate to severe learning disabilities • Mortality particularly high for young adults, women, and people with Down’s syndrome • More sensory & physical impairments • 8-200 times more likely to have a visual impairment • 40% with hearing impairment • 14 times more likely to have musculo-skeletal impairment

4. The Scale & Nature of the Issue • Consistent evidence from research of • Poorer physical health • Children and adults more likely to report poor general physical health • Health checks identify high levels of unmet health needs • Respiratory disease leading cause of death (46%-52%) • Coronary heart disease a common cause of death (14%-20%), and likely to be increasing • Currently lower rates of cancer, but proportion of gastro-intestinal cancer higher and pattern/scale of cancer changing with increased longevity

5. The Scale & Nature of the Issue • Consistent evidence from research of • Poorer physical health • Rates of epilepsy at least 20 times higher • One third have unhealthy teeth and gums • Around 8% reported with dysphagia • Increased rates of diabetes • Possible higher rates of osteoporosis • Higher rates of injuries and falls • More likely to have poor diet and low levels of exercise • More likely to be obese or underweight

6. The Scale & Nature of the Issue • Consistent evidence from research of • Poorer mental health • Psychiatric disorders 4.5 times higher for children with learning disabilities • Rates of psychosis, anxiety, depression likely to be higher for adults with learning disabilities • Higher rates of dementia and more likely early onset (especially for people with Down’s syndrome) • Challenging behaviour • 10%-15% show some form of challenging behaviour

7. The Causes of Poorer Health 1 • Causes related to the nature of learning disability • Syndrome-specific risks (e.g.,hypothyroidism in Down syndrome, overeating in Prader-Willi syndrome) • Communication difficulties resulting in the failure to (or delay in) identifying illness and/or accessing health care

8. What Does (or Should) Work?

9. Health Checks • Robust evidence that health checks are effective in identifying unknown illness • DES Feb 2009 • Poor uptake (49% in 2010/11) • Unknown impact on health status

10. The Causes of Poorer Health 2 • Poverty and material disadvantage • Poverty causes poorer health • Poverty is a cause of (especially mild) learning disability • Learning disability may increase the risk of poverty

11. What Does (or Should) Work?

12. The Causes of Poorer Health 3 • Discrimination • People with learning disability face discrimination (systemic and at times overt) in health care systems • People with learning disability face discrimination in their daily lives

13. What Does (or Should) Work?

14. How Can Social Care Help? • Awareness of health issues and working with health services • Awareness of health needs amongst people with learning disabilities using (and not using) learning disability services • Supporting healthy lifestyles (exercise, diet, employment, friendships and relationships) • Demanding and supporting health checks and follow-up screening/interventions from health services • Working with health services and families to ensure effective health care (‘reasonable adjustments’)

15. How Can Social Care Help? • Assessing risks and impact of general social care policy and practice on people with learning disabilities and doing something about it, e.g.: • Anti-discrimination • Poverty reduction and neighbourhood improvement • Leisure • Transport • Education and other services for children • Ensuring public health (to be located in local authorities) is responsive to the health needs of people with learning disabilities

16. http://www.improvinghealthandlives.org.uk/ chris.hatton@lancaster.ac.uk