1. Health Inequalities and Social Care

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

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

4. The Scale & Nature of the Issue o Consistent evidence from research of o Poorer physical health o Children and adults more likely to report poor general physical health o Health checks identify high levels of unmet health needs o Respiratory disease leading cause of death (46%-52%) o Coronary heart disease a common cause of death (14%-20%), and likely to be increasing o 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 o Consistent evidence from research of o Poorer physical health o Rates of epilepsy at least 20 times higher o One third have unhealthy teeth and gums o Around 8% reported with dysphagia o Increased rates of diabetes o Possible higher rates of osteoporosis o Higher rates of injuries and falls o More likely to have poor diet and low levels of exercise o More likely to be obese or underweight

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

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

8. What Does (or Should) Work? CausePotential Solution(s) Syndrome-specific risks Document and disseminate knowledge Targeted screening programmes & medical intervention Communication difficulties Help families and child care workers identify signs of ill- health Routine health checks

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

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

11. What Does (or Should) Work? CausePotential Solution(s) Poverty Targeted family support (e.g., welfare benefits, enabling parents to work) Build the resilience of children and adults with learning disabilities (and their families)

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

13. What Does (or Should) Work? CausePotential Solution(s) Discrimination in health care systems Ensuring compliance with relevant UN Conventions ‘Reasonable adjustments’ (e.g., more accessible information, longer appointment times) Discrimination in everyday life Anti-bullying strategies Building more inclusive communities

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

15. How Can Social Care Help? o Assessing risks and impact of general social care policy and practice on people with learning disabilities and doing something about it, e.g.: o Anti-discrimination o Poverty reduction and neighbourhood improvement o Leisure o Transport o Education and other services for children o 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