Scottish Government Equality Outcomes: Disability Evidence Review

12 Health and access to health services

12.1 This section addresses health outcomes, health behaviours, and disabled people's experiences of health services. It draws on the Scottish Household Survey (2010)^[88], the Scottish Health Survey^[89] (2012), and the Inpatient Experience Survey (2010)^[90].

Health outcomes

12.2 The Scottish Household Survey (2010) found that:

• 32% of people who had a disability or long term limiting illness assessed their health as good or very good, compared to 88% of those with no disability.
• There is a disabled person or a person with a long-term condition living in 33% of households in Scotland.

12.3 The remaining discussion on health outcomes refers to the Scottish Health Survey (2012).

12.4 The association between self-assessed health and disability was very strong, as might be expected. Only 39% of respondents with a limiting long-term condition reported being in good or very good heath compared to 81% of those with a non-limiting condition and 92% of those without any condition.

12.5 Respondents with a limiting long-term condition also had significantly poorer mental wellbeing: measured on the WEMWBS scale (where lower scores indicate less good wellbeing), they had a mean score of only 45.8, compared with 50.6 for those with non-limiting conditions and 51.5 for those with no condition. Respondents with a limiting long-term condition were significantly more likely to display mental ill-health by means of a high GHQ12 score (where higher scores indicate ill-health): 30% with a limiting long-term condition had a low score compared with 11% of those with a non-limiting condition, and 9% of those with no condition. Overall, the evidence suggests that disabled respondents have notably poorer general health and mental wellbeing. However, the association may be partly artefactual as limiting long-term conditions recorded in the survey include incidences of diagnosed psychiatric disorders.

12.6 Poor dental health was associated with disability. Only 65% of people with a limiting long-term condition had 20 or more natural teeth, compared with 75% of those with no longstanding condition. Disability was also associated with the experience of toothache: 19% of respondents with a limiting long-term condition reported having experienced toothache in the last month compared to 11% of those without a condition.

12.7 The prevalence of obesity was significantly associated with disability: 34% of respondents with a limiting, long-term condition were obese, compared to 30% of those with a non-limiting condition, and 24% of those without a condition. There was no difference in the prevalence of overweight including obesity, between those with a limiting and non-limiting condition (both 68%). This was, however, significantly higher than the prevalence of overweight including obesity among those with no long-term condition (63%). It is possible that respondents with physical impairments may become overweight as they are less capable of being physically active. It is also possible that those who are overweight and obese develop debilitating and longstanding conditions as a consequence of their unhealthy weight. The point has been made, however, that whether obesity is the cause or the result of having a disability, the association presents a major challenge to public health.

12.8 As would be expected, there was a significant association between cardio-vascular disease and disability: 24% of individuals with a limiting long-term condition had cardio-vascular disease, compared with 14% with a non-limiting condition and 9% with no condition. Respondents with any kind of long-term condition were significantly more likely to be diabetic, although there was no difference in diabetes prevalence between those with a limiting and non-limiting condition (both 9%).

Health behaviours

12.9 The Scottish Household Survey (2010) found that adults who most commonly smoke are:

• those unable to work due to short-term ill health (60%),
• those unemployed and seeking work (52%), and
• those who are permanently sick or disabled (47%).

12.10 The remaining discussion on health behaviours refers to the Scottish Health Survey (2012).

12.11 Respondents who reported a disability were less likely to drink excessively than those who did not: 19% of respondents with a limiting long-term condition drank at hazardous or harmful levels, compared with 24% of those without a long-term condition. They were also significantly less likely to exceed daily limits, at 31% compared to 41%. There was no difference in alcohol consumption between those with a non-limiting condition and those without a condition.

12.12 Respondents who reported a disability were significantly more likely to smoke than those who did not: 34% of those with a limiting long-term condition smoked, compared with only 23% and 22% of those with a non-limiting condition or with no condition. Those with a limiting long-term condition also smoked more on average (15.2 cigarettes per day) than those with a non-limiting condition (14.2) and those with no condition (13.7). Disability was not significantly associated with the age of starting smoking.

12.13 There was some variation in diet between disability groups. Fewer adults with a limiting long-term condition (19%) ate five portions of fruit and vegetables a day than those without a condition (23%). On average, respondents with a limiting longstanding condition ate 3.0 portions of fruit and vegetables a day compared with 3.3 for those with a non-limiting condition and 3.4 for those with no condition.

Experience of health services

12.14 Regarding communication support needs, the (then) Scottish Executive (2007)^[91] reported that "People with communication disabilities often report that they find it particularly difficult getting their needs met in primary care". This is attributed to the training, awareness or attitudes of healthcare professionals, to the requirement for the patient to express his needs, and to the time constraints on consultations. The report's recommendations include training healthcare professionals in involving patients with communication support needs in the decision making process as a means of removing barriers to healthcare service.

12.15 The remaining discussion on experiences refers to the Inpatient Experience Survey (2010). The findings of the survey were analysed by the following types of disability:

• Deafness or severe hearing impairment
• Blindness or severe vision impairment
• A physical disability
• A learning disability (such as Down's Syndrome)
• A learning difficulty (such as dyslexia)
• A mental health condition (such as depression or schizophrenia)
• A long term condition (such as diabetes, cancer, HIV, heart disease or epilepsy)
• Other

12.16 The survey report examines the variations in the self-reported experiences of Scottish inpatients from different equality groupings including by gender, age, ethnicity, religion, sexuality, health status, day-to-day activity limiting illnesses, interpretation needs, and a variety of conditions.

12.17 Of the 30,880 survey respondents, 14% were deaf or had a severe hearing impairment. Patients with deafness or a severe hearing impairment were less likely to report a positive experience of their time in Accident and Emergency: being told what was happening in a way they could understand was reported as a problem.

12.18 Five percent of the survey respondents were blind or had a severe visual impairment. These patients had similar experiences to others i.e. those that did not have that disability, although they were less likely to know how and when to take their medicines and they were less confident of being able to look after themselves when they got home.

12.19 The 21% of respondents with a physical disability were more likely to report a positive experience for four questions, and for six questions they were less likely to. There does not appear to be a pattern in the areas where the differences were found. As might be expected, patients with a physical disability were more likely to report that they were given help with eating and drinking, and arranging transport.

12.20 Just 143 (~0%) of the survey respondents had a learning disability. The only difference was that they were less likely to answer positively about being involved in decisions about their care. This difference may be because family and hospital staff are likely to be more involved in these decisions.

12.21 One percent of respondents had a learning difficulty. They were less likely to report a positive experience compared to others for 12 questions, and were never more likely to report a positive experience. The areas where they were less likely to report a positive experience included their time in Accident and Emergency, and interactions with doctors.

12.22 The 7% of respondents who had a mental health condition were generally less positive than others. They were less likely to report a positive experience for 33 questions, and were never more likely to report a positive experience. The areas where they were less likely to report a positive experience are spread throughout all sections of the survey.

12.23 Seventeen percent of respondents had a long term condition, they were more likely to report a positive experience for 21 questions and were never less likely to report a positive experience. Patients with long term conditions are more likely to have poorer health status and to report that their day-to-day activities are limited: both of these factors were shown earlier in the survey report to have a negative impact on the likelihood of a patient reporting a positive experience. The survey report suggests that the patient's experience depends a lot more on the severity, rather than the existence, of a long term condition.