Health Conditions in People with Disability

Disability is primarily the difficulties encountered by a person in body-functioning, executing activities or participation in any area of life. Persons with disabilities include those who have long-term physical, mental, intellectual, or sensory impairments.(1) Disability arises from the interaction of any of these conditions with environmental and personal barriers that may hinder person’s full and effective participation in society on an equal basis with others.(2) There are various types of disability: Visual impairment, hearing disability, physical disability and intellectual disability, for instance, are among others.

Nowadays, nearly one billion people in the world live with some form of disability. (2) Eighty percent people with disabilities live in developing countries where their right to participate fully in society is almost nonexistent.(3, 4) Moreover, they are heavily suffered by the deprivation of basic health services, education, transportation and employment opportunities, leading poor health outcomes, low education achievements and high rate of poverty than people without disabilities.(2, 4) The high prevalence of disability among female, old age, people living in rural areas and the poorest wealth quintile group has exacerbated the inequalities beyond the threshold. (3)

In the midst of numerous difficulties, people with disability are now facing the burden of new health problems. With worldwide explosion of incidence of chronic diseases, they are more prone to develop obesity, diabetes and cardiovascular disorders. New research reports have shown that they are also vulnerable to be suffered from sexual and reproductive, and mental health problems as well. (3)

Starting with obesity, adults with disability are highly prone to develop it. According to Behavioral Risk Factors Surveillance system (USA), obesity rate found to be almost 57 % higher in adult with disability.(5) They are less likely to involve in moderate physical activities. Similarly, lack of healthy food and lack of accessible environment also attribute to obesity. Obesity itself is a risk factor for various conditions. It acts as a precursor for diabetes and cardiovascular disorders.

In the same way, tobacco consumption, another cardiovascular risk factor also found to be highly prevalent among the adult with disability. It is the leading preventable cause of death. In a study, it is showed that smoking contributes for long term persistency of problem in a person with musculoskeletal disability.(6) Tobacco consumption may sometimes relate to stress and other psychological conditions that found abundantly in people with disability.

Apart from various minor mental disorders, people with disability may experience the symptoms of depression 2 to 10 times more than others.(7) The causes are none other than limited mobility, inaccessible services, unemployment, social barrier and isolation. More importantly, people with intellectual disability have high risk of developing other mental health problems.(2)  Sometimes, some sexual and reproductive health (SRH) problems may also associate with psychological conditions.(3)

Moreover, currently the SRH need itself is largely unmet among the people with disability.(3) As a result, they are more likely to become infected with HIV and other sexually transmitted infections. They have been subjected to forced sterilization and abortions.  For instance, according to United Nation fact sheet, 6 percent of women with disabilities had been forcibly sterilized in India.(8) So are the situations of physical, mental and sexual abuse among female with disability. (8) Furthermore, some may face the mechanical and psychological difficulties in sexual relationships. Prejudicious attitudes of people, social stigma and lack of disability related support create the psychological barriers in terms of sexuality among people with disability.(3, 4)

But, million dolor questions are how we can reduce the risk of development of these diseases in people with disability. What might be the appropriate strategies for initiating healthy behavior? Can we adjust disability focused issues in existing health program? How we can bring the substantial changes in environmental and physical factors that are creating obstacles for people with disability to access the services. The answers are as follows.

Firstly, regular physical activity can prevent the obesity and cardiovascular disorders in people with disability.  For that, community based program can motivate them to incorporate physical activity in daily life.  Physical education will be equally helpful for making people with disability aware about its health benefit.  Availability of appropriate environment like a trail for wheel chair is also important to be physically active. Support from health care providers, families and friends can facilitate the process of promoting physical activities in people with disability even more.

Similarly, we can utilize existing comprehensive tobacco control program for disseminating smoking cessation message in people with disability. It can reduce the smoking, which ultimately lowers the development of cardiovascular disorders and death.(9)  However, in case of psychological co-morbidity like depression and SRH related psychological problems, because of presence of factorial causation, it requires multilevel approaches. Social and personal barriers first need to be addressed. Then, cognitive and behavior therapy will be useful.

For promoting sexual and reproductive health (SRH), inclusion of disability perspective in SRH related policies and programs is a prerequisite. It can address the disability specific issues of SRH rights, family planning, HIV/AIDS and gender based violence. The disability specific programs can raise the awareness and ensure the equal access of SRH related services and information to people with disability. In addition to this, establishing partnership with organization of people with disabilities is equally important for planning and implementation of policies and programs. (3)

To sum up, people with disabilities are more susceptible to develop various health disorders. That can exert an unmanageable economical burden to a person with disability and his/her family, and ultimately to nation. A series of concurrent programs for addressing the education, transportation and unemployment problems along with specific disease prevention programs can substantially bring a positive change in their lives.

References:

1.          Convention on the Rights of Persons with Disabilities, Article 1.

2.         WHO and World Bank. World Report on Disability; 2011.

3.          WHO/UNFPA. Promoting sexual and reproductive health for persons with disabilities; 2009.

4.         United Nations. Fact sheet on Persons with Disabilities. 2013 [updated 2013; cited 2013 06/10]; Available from: http://www.un.org/disabilities/default.asp?id=18.

5.         Centers for Disease Control and Prevention. Disability and Obesity.  [cited 2013 10/06]; Available from: http://www.cdc.gov/ncbddd/disabilityandhealth/obesity.html.

6.         Lincoln AE, Smith GS, Amoroso PJ, Bell NS. The effect of cigarette smoking on musculoskeletal-related disability. Am J Ind Med 2003 Apr;43(4):337-49.

7.         Thompson K. Depression and Disability. The North  Carolina Office on Disability and Health; 2002.

8.         UNFPA. Sexual and Reproductive Health of Persons with Disability.

9.          Centers for Disease Control and Prevention. Disability and Health.  [cited 2013 10/06]; Available from: http://www.cdc.gov/ncbddd/disabilityandhealth/smoking-in-adults.html.

 


My education includes training in medicine, public health, clinical research, biostatistics and health response in complex emergency. I have more than seven years of experiences in health research (Survey, Case control studies, Randomised Controlled Trials (RCT), Health Policy and Systems Research). My areas of expertise also include the project management particularly in health sector. I have also experience and interest to work in health emergency in large population in disaster setting.

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