What’s driving health inequalities for Australians with disability?

Mellissa Kavenagh, Zoe Aitken and Alexandra Devine are researchers in the Centre of Research Excellence in Disability and Health (CRE-DH).

Health inequalities are not a necessary result of disability, write Mellissa Kave nagh , Zoe Aitken and Alexandra Devine.

I was a bit disappointed in that the things that I asked for and I think are really important to me and I really needed … they just sort of brushed it off… I was asking if I could get a housing support worker … I would love to have a part-time job. I just wish that I eventually find one that really suits me and it makes me happy and I make lovely friends there and I go there and I don’t feel scared. I would love one that I can actually maintain but I don’t know if it can happen right now, but it will happen, it might anyway.

Natalie, research participant for the Improving Disability Employment Study

Victorians are living in changing times. For people with disability whose lives are already precariously balanced, these currents are even more turbulent and deep, coming amid the roll-out of the NDIS, mental health systems in transition and employment services reform.

People with disability experience significant health inequalities compared to those without disability. They have poorer self-reported physical and mental health, higher rates of chronic conditions including diabetes and heart disease and poorer access to health services.

Some of these health inequalities are related to people’s disabilities, but there’s also increasing evidence that some of them are socially driven, unrelated to health conditions or impairments. Inequality often stems from the disadvantages experienced by people with disability in areas such as education, employment, housing and social inclusion. These are social determinants of health influenced by underlying political, economic and cultural factors.

When you live somewhere and you know that you can be there for the foreseeable future … you are more grounded to be able to make better choices, to actually want to go and find a job …

This quote is from research exploring sustainable and meaningful employment outcomes for people with disability. Natalie’s story highlights her hope for future work and the positive change it can bring. It also highlights her frustration about not having the choice and control within her NDIS plan to get help in addressing what she considers the major barrier to gaining employment: her lack of appropriate housing.

This is supported by broader research on the social determinants of mental health for people with disability. Research led by the Centre of Research Excellence in Disability and Health has shown that people with disability are particularly disadvantaged when it comes to finding secure, accessible and affordable housing, and that housing disadvantage increases mental health inequalities.

People with disability also experience poor employment outcomes. They are more likely to be unemployed or underemployed and less likely to have good working conditions, which is damaging to their mental health, wellbeing and social participation.

These kinds of inequalities can be addressed, but taking meaningful action on the social determinants of health means properly considering the underlying structural factors that disadvantage people with disability.

We have an important window of opportunity at the moment, with various enquiries taking place that might help us understand and respond to these structural causes of disadvantage. At the federal level, there is the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability and the Productivity Commission inquiry into the Social and Economic Benefits of Improving Mental Health. At state level there is the Royal Commission into Victoria’s Mental Health System. We need to use this opportunity to gain a better understanding of how different federal and state policies and systems interact with each other and affect people’s lives.

We also have promising initiatives already in place that we can draw on. Australia’s Primary Health Networks (PHNs), for example, bring together local stakeholders like GPs, hospitals and the general community to collaboratively identify healthcare gaps and plan for better integrated local health services.

The next challenge is to ensure that these networks understand the needs and priorities of people with disability and their families – people like the study participant Natalie, whose mental health is impacted by lack of good housing and employment and the social connections these benefits provide. PHNs need to be able to build partnerships with sectors outside of health – including housing, education, employment and community inclusion – so they can help develop context-specific solutions for people like Natalie.

We know that access to work, education and affordable housing has a greater impact on our health than access to healthcare. When these issues aren’t addressed for people with disability, they result in health inequalities. Looked at like this it’s a simple proposition: the real-life context in which people with disability live, work and participate needs to guide decision-making and policy reform. Once fundamental structural inequities are reduced, mental health outcomes will improve.