智力残疾者健康方面的不平等和不公平现象

E. Emerson
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引用次数: 2

摘要

智力残疾的儿童和成人健康状况较差,比非智力残疾的同龄人更有可能早死。越来越多的证据表明,卫生方面的一些不平等是可以避免的、不公正的和不公平的,因为这些不平等是由智力残疾者接触健康状况不佳的既定社会决定因素的比例较高造成的。与同龄人相比,智力残疾者更有可能生活在贫困中,没有工作(或者在不稳定的条件下工作),遭受歧视和暴力,在获得有效的卫生保健方面面临重大障碍,并且在面临逆境时抵抗力较差。换句话说,它们是卫生不公平现象的例子,这些不公平现象源于“人们出生、成长、生活、工作和衰老所处的社会条件”,被称为健康的社会决定因素。这些包括早年经历、教育、经济地位、就业和体面工作、住房和环境,以及预防和治疗疾病的有效制度”(世界卫生组织)。未来的研究需要解决三个关键问题。首先,大多数现有证据都是基于世界高收入国家智力残疾者的经历。相比之下,世界上绝大多数人口生活在中低收入国家。现有的有限证据表明,在中低收入国家长大的智力残疾儿童比同龄人更有可能在贫困中长大,并更有可能接触到与贫困有关的健康状况较差的具体社会决定因素,如营养不良、卫生条件差、父母刺激程度低、父母暴力管教和危险形式的童工。其次,很少有研究关注两个重要智力残疾者群体之间的健康不平等和不平等:少数民族社区的智力残疾者和轻度智力残疾者。第三,很少有研究试图检验智力残疾者在接触健康的社会决定因素时可能比同龄人更有或更少的适应力这一命题。虽然关于智力残疾者面临的不平等和不公平现象仍有许多有待了解的地方,但现有的知识足以指导和推动政策和实践的变革,从而减少智力残疾者面临的健康不平等现象。这些措施包括:提高智力残疾者在地方、国家和国际卫生监测系统中的可见度;为卫生保健系统的运作提供“合理便利”(例如,在初级保健服务中引入年度健康检查,提供“易于阅读”的材料,在急症医院雇用智障联络护士),以确保智障人士不遭受系统性歧视;确保将智力残疾者(以及所有其他残疾人)纳入地方和国家战略,并使其平等受益,以降低人口接触健康状况不佳的既定社会决定因素的程度。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Inequalities and Inequities in the Health of People With Intellectual Disabilities
Children and adults with intellectual disabilities have poorer health and are more likely to die sooner than their non–intellectually disabled peers. There is growing evidence that some of these inequalities in health are avoidable, unjust, and unfair, given that they are driven by the higher rates of exposure of people with intellectual disabilities to well-established social determinants of poor health. People with intellectual disabilities are more likely than their peers to: live in poverty, not be employed (or if employed to work under precarious conditions), be exposed to discrimination and violence, face significant barriers in accessing effective health care, and be less resilient when exposed to adversities. In other words, they are examples of health inequities that arise from “the societal conditions in which people are born, grow, live, work and age, referred to as social determinants of health. These include early years’ experiences, education, economic status, employment and decent work, housing and environment, and effective systems of preventing and treating ill health” (World Health Organization). Future research needs to address three key issues. First, most of the existing evidence is based on the experiences of people with intellectual disabilities in the world’s high-income countries. In contrast, the vast majority of the world’s population live in middle- and low-income countries. The limited evidence available suggests that children with intellectual disabilities growing up in middle- and low-income countries are much more likely than their peers to be growing up in poverty and to be exposed to specific social determinants of poorer health associated with poverty such as undernutrition, poor sanitation, low levels of parental stimulation, violent parental discipline, and hazardous forms of child labor. Second, little research has focused on health inequalities and inequities among two important groups of people with intellectual disabilities: people with intellectual disabilities from minority ethnic communities and people with mild intellectual disabilities. Third, very little research has attempted to test the proposition that people with intellectual disabilities may be more or less resilient than their peers when exposed to social determinants of health. While much remains to be learned about the inequalities and inequities faced by people with intellectual disabilities, the existing knowledge is sufficient to guide and drive changes in policy and practice that could reduce the health inequities faced by people with intellectual disabilities. These include: improving the visibility of people with intellectual disabilities in local, national, and international health surveillance systems; making “reasonable accommodations” to the operation of health care systems (e.g., introducing annual health checks into primary care services, making “easy read” materials available, employing intellectual disabilities liaison nurses in acute hospitals) to ensure that people with intellectual disabilities are not exposed to systemic discrimination; and ensuring that people with intellectual disabilities (along with all other 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 poor health.
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