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The health inequalities experienced by women with intellectual disabilities: A need for more research.

  • Apr 06 / 2021
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Current Affairs, Sophie Westrop

The health inequalities experienced by women with intellectual disabilities: A need for more research.

I was asked to contribute to the IHAWKES special on “Women” as my PhD relates to gender differences in the physical activity and sedentary behaviour of adults with intellectual disabilities. However, I want to take this special as an opportunity to raise awareness of the health inequalities experienced by women with intellectual disabilities and express a need for more researchers to address this issue.

Intellectual disabilities occur before adulthood, and are associated with impairments in intellectual functioning, characterised by an IQ < 70, and impairments in adaptive skills which are needed for daily living [1]. A person’s level of intellectual disabilities can range from mild (IQ between 50 – 70), where a person can live relatively independently, to profound intellectual disabilities (IQ < 20), where an individual requires daily care and support [2]. It is estimated that approximately 1% of the population have intellectual disabilities, with a greater prevalence among males [3].

It is important to emphasise that compared to the general population, all people with intellectual disabilities experience increased risk of health inequalities [4]. This includes reduced life expectancy, increased risk of numerous diseases that cannot be transmitted, such as coronary heart disease, and increased prevalence of being underweight or obese [4]. Many factors contribute to these health inequalities, as people with intellectual disabilities may experience of poverty, social exclusion, discrimination, reduced access to health care and potentially engage in unhealthy lifestyles, such as physical inactivity [4]. For example, as little as 9% of adults meet the recommended physical activity levels needed to protect against poor health [5], versus roughly 72% of the general population [6]. Even when considering these individual contributory factors, such as physical inactivity, there are multiple complex barriers to participation in a healthy lifestyle, such as a greater reliance on social support, resulting in physical activity impacted by support staffing levels, work routines, and expertise of support staff relating to physical activity [7].

Research in the general population has also identified marginalised women, including women with disabilities, as having greatest risk of health inequalities [8]. It has been argued that multiple forms of disadvantage intersect, such as being a woman and having a disability, to increase risk of health inequalities [8]. This is reflected in the growing evidence that women with intellectual disabilities are at greater risk of poor health.  

Women with intellectual disabilities experience poorer health than men with intellectual disabilities [9] and are at greater risk of obesity, which itself is associated with many negative health outcomes [10]. However, most concerningly, women with intellectual disabilities are at greater risk of reduced life expectancy [11] [12]. An exploration of premature deaths among people with intellectual disabilities in the UK, reported a 13-year reduction in life expectancy among men with intellectual disabilities, and an alarming 20-year reduction for women with intellectual disabilities compared to the general population [11]. This increased risk among women was also supported in a systematic review of death rates among people with intellectual disabilities; however, at present the cause for this is unknown [12].

Experts in intellectual disabilities research were consulted following a review of the literature relating to gender and mortality among people with intellectual disabilities [13]. The research experts agreed that women with intellectual disabilities experience greater inequalities in life-expectancy than men with intellectual disabilities.  However, it was highlighted that there is major lack of understanding about why these inequalities occur, inhibiting the ability to understand and address these inequalities [13].

Research with the goal of understanding and promoting the health and wellbeing of people with intellectual disabilities is essential. People with intellectual disabilities experience numerous social inequalities and barriers to improved health and wellbeing, however it is unknown what contributes to the increased health inequalities of women with intellectual disabilities. Very limited research has considered differences between men and women in the pathways to poor health or explored whether any of these contribute to the health inequalities experienced by women. This is very concerning, and more attention is needed to explore this area so that actions can be made to improve the health and wellbeing of people with intellectual disabilities.

References

1. AAIDD. (2010). Intellectual Disability: Definition, Classification, and Systems of Supports (12th Editi). Washington DC: AAIDD. Retrieved from http://aaidd.org/intellectualdisability/definition

2. Boat, T. F., Wu, J. T., & National Academies of Sciences, Engineering, and Medicine. (2015). Clinical characteristics of intellectual disabilities. In Mental disorders and disabilities among low-income children. National Academies Press (US).

3. Maulik, P. K., Mascarenhas, M. N., Mathers, C. D., Dua, T., & Saxena, S. (2011). Prevalence of intellectual disability: A meta-analysis of population-based studies. Research in Developmental Disabilities, 32(2), 419–436. https://doi.org/10.1016/j.ridd.2010.12.018

4. Emerson, E. & Hatton, C. (2014) Health inequalities and people with intellectual disabilities. Cambridge University Press

5. Dairo, Y. M., Collett, J., Dawes, H., & Oskrochi, G. R. (2016). Physical activity levels in adults with intellectual disabilities: A systematic review. Preventive Medicine Reports, 4, 209–219. https://doi.org/10.1016/j.pmedr.2016.06.008

6. World Health Organisaiton (2020) Physical Activity. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/physical-activity

7. Bossink, L. W. M., van der Putten, A. A., & Vlaskamp, C. (2017). Understanding low levels of physical activity in people with intellectual disabilities: A systematic review to identify barriers and facilitators. Research in Developmental Disabilities, 68(February), 95–110. https://doi.org/10.1016/j.ridd.2017.06.008

8. Heise, L., Greene, M. E., Opper, N., Stavropoulou, M., Harper, C., Nascimento, M., Zewdie, D., Darmstadt, G. L., Greene, M. E., Hawkes, S., Henry, S., Heymann, J., Klugman, J., Levine, R., Raj, A., & Rao Gupta, G. (2019). Gender inequality and restrictive gender norms: framing the challenges to health. The Lancet, 393(10189), 2440–2454. https://doi.org/10.1016/S0140-6736(19)30652-X

9. Hughes-McCormack, L. A., Rydzewska, E., Henderson, A., MacIntyre, C., Rintoul, J., & Cooper, S. A. (2018). Prevalence and general health status of people with intellectual disabilities in Scotland: A total population study. Journal of Epidemiology and Community Health, 72(1), 78–85. https://doi.org/10.1136/jech-2017-209748

10. Ranjan, S., Nasser, J. A., & Fisher, K. (2018). Prevalence and potential factors associated with overweight and obesity status in adults with intellectual developmental disorders. Journal of Applied Research in Intellectual Disabilities, 31(April), 29–38. https://doi.org/10.1111/jar.12370

11. Heslop, P., Blair, P. S., Fleming, P., Hoghton, M., Marriott, A., & Russ, L. (2014). The Confidential Inquiry into premature deaths of people with intellectual disabilities in the UK: A population-based study. The Lancet, 383(9920), 889–895. https://doi.org/10.1016/S0140-6736(13)62026-7

12. O’Leary, L., Cooper, S. A., & Hughes-McCormack, L. (2018). Early death and causes of death of people with intellectual disabilities: A systematic review. Journal of Applied Research in Intellectual Disabilities, 31(3), 325–342. https://doi.org/10.1111/jar.12417

13. Robertson, J., Heslop, P., Lauer, E., Taggart, L., & Hatton, C. (2020). Gender and the Premature Deaths of People with Intellectual Disabilities: An International Expert Consultation. Journal of Policy and Practice in Intellectual Disabilities. https://doi.org/10.1111/jppi.12360

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