BARRIERS TO ACCESSING HEALTH CARE
المؤلف:
DEBRA FEARNS, JACKIE KELLY, PAUL MALORET, MALCOLM McIVER AND TRACEY-JO SIMPSON
المصدر:
Caring for People with Learning Disabilities
الجزء والصفحة:
P108-C7
2025-10-17
259
BARRIERS TO ACCESSING HEALTH CARE
In spite of recent legislation and advances in the provision of care, the evidence suggests that the healthcare needs of adults with learning disabilities are still not being fully met:
• Adults with learning disabilities are much more likely to be obese than the general population.
• Less than 10 per cent of adults with learning disabilities eat a balanced diet, with an insufficient intake of fruit and vegetables and a lack of knowledge and choice about healthy eating.
• Less than 20 per cent of adults with learning disabilities engage in physical activity at or above the minimum level recommended by the Department of Health, as opposed to 36 per cent of the general population (Robertson et al. 2000).
‘70% of people with learning disabilities visit their GP four or less times a year. The average for the general population is five times a year’.
(Band 1998)
Adults with learning disabilities are less likely to receive regular health checks (Whitfi eld et al. 1996), and are 58 times more likely to die before the age of 50 years than those without a learning disability, often from preventable conditions such as respiratory illness (Hollins et al. 1998). It is little wonder that the Disability Rights Commission felt moved to say:
‘. . . there is compelling evidence of inequalities in health outcomes between disabled and non-disabled people; and evidence of significant problems in access, staff attitudes and quality of service.’
(Disability Rights Commission 2004)
That adults with learning disabilities die younger than non-disabled people is an established fact, yet learning disability in itself is not a cause of premature death. Adults with learning disabilities are more likely to die young because of deprivation, lifestyle and barriers to accessing health promotion, assessment, screening and treatment. For example, whilst 77 per cent of women in the general population routinely undergo cervical smears, for women with a learning disability, that figure is only 19 per cent (Djuretic et al. 1999). Similarly, they are much less likely to engage in breast cancer examinations, and receive far fewer (33 per cent) invites to mammography than women without a learning disability (Davies & Duff 2001).
So what are the barriers that prevent adults with learning disabilities accessing the health services that they need? Ironically, the answer appears to be the very professionals who are supposed to be helping them.
Despite the fact that 75 per cent of GPs have had no training in treating adults with learning disabilities, 90 per cent of them believe that a learning disability makes diagnosis harder. Mencap (2004) report that many families of people with learning disabilities state that some doctors look at their son or daughter and – consciously or unconsciously – believe that his/her health problem is a result of the learning disability and that not much can be done about it. As a consequence, there is a low reporting of illnesses and symptoms among adults with learning disabilities, with the subsequent risk of misdiagnosis and inappropriate treatment, or no treatment at all (Beange et al. 1999).
A lack of accessible information further adds to the barriers that adults with learning disabilities face. Despite the fact that all but the smallest of GP practices are likely to have upwards of 40 patients with learning disabilities (NHSE 1999), 70 per cent do not provide any accessible information (Mencap 2004). With little understanding of their needs and no access to understand able information, it is not surprising that 20 per cent of disabled people find it difficult or impossible to access health care. One in seven could not collect prescriptions and 20 per cent had deferred treatment, compared with just 7 per cent of the general population (Leonard Cheshire 2003).
Some adults with learning disabilities lead unhealthy lifestyles which hinder attempts to live a healthy life. This can be partly explained by the fact that many adults with learning disabilities rely on carers and family members to shop, cook and provide meals and to help them undertake activities. Often, this results in adults with learning disabilities leading a sedentary lifestyle (Mencap 2004). Despite government initiatives, adults with learning disabilities are poorly served by primary and secondary healthcare provision. There has been a tendency for specialist NHS services to develop their own inclusive services. However, this model of provision continues to segregate adults with learning disabilities from mainstream services and has ‘allowed’ the NHS to continue to ignore their needs (Department of Health 2001a).
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