Social and Environmental Determinants of Health Among People With Disabilities

There is extensive evidence that people with disabilities experience significantly poorer health than their nondisabled peers. These are, in part, health inequities (differences in health status that are avoidable, unjust, and unfair) resulting from increased rates of exposure of people with disabilities to a range of well-established social (and environmental) determinants of poor health, including poverty, reduced access to effective education, lack of employment or employment under hazardous or precarious conditions, social disconnectedness, violence, discrimination, and poor healthcare. They also include environmental determinants of poor health that are a direct result of human activity (e.g., outdoor air pollution resulting from industrial processes and transportation). In addition, people with disabilities are often less likely than their peers to have access to many of the resources (power, wealth, social support, problem-solving skills) that have been linked to increased resilience in the face of adversity. As such, it would appear reasonable to expect that the health of people with disabilities is as likely, if not more so, to deteriorate, when exposed to social determinants, than the health of their nondisabled peers. Future research needs to focus on two key issues. First, given that most of the current evidence has been generated in high-income countries, it is critical for future research to focus on the situation of people with disabilities living in middle- and low-income countries. Second, more needs to be known about the determinants of the resilience and/or vulnerability of people with disabilities. Some significant limitations remain in the current evidence base, but it is clear that existing knowledge is sufficient to drive and guide changes in policy and practice that could reduce the health inequities faced by people with disabilities. These include (a) improving the visibility of people with disabilities in local, national, and international health surveillance systems; (b) making “reasonable accommodations” to the operation of healthcare systems to ensure that people with disabilities are not exposed to systemic discrimination in access to and the quality of healthcare; and (c) ensuring that people with disabilities are included in and benefit equally from local and national strategies to reduce population levels of exposure to well-established social determinants of health.