The intersection of disability and healthcare disparities: a conceptual framework

Meade, Michelle A.; Mahmoudi, Elham; Lee, Shoou-Yih

doi:10.3109/09638288.2014.938176

Cited by 106 publications

(85 citation statements)

References 48 publications

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“…The prevalence of disability is expected to grow, due to population ageing and to the so-called epidemic of survival [2], as medical advances are turning life-threatening conditions into disabling ones [1, 3, 4]. Disability is increasingly a public health concern [5, 6], not only by its growing prevalence but also due the health disparities people with disabilities face on a daily basis [1, 7–9]. …”

Section: Introductionmentioning

confidence: 99%

Human resources for health (and rehabilitation): Six Rehab-Workforce Challenges for the century

et al. 2017

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BackgroundPeople with disabilities face challenges accessing basic rehabilitation health care. In 2006, the United Nations Convention on the Rights of Persons with Disabilities (CRPD) outlined the global necessity to meet the rehabilitation needs of people with disabilities, but this goal is often challenged by the undersupply and inequitable distribution of rehabilitation workers. While the aggregate study and monitoring of the physical rehabilitation workforce has been mostly ignored by researchers or policy-makers, this paper aims to present the ‘challenges and opportunities’ for guiding further long-term research and policies on developing the relatively neglected, highly heterogeneous physical rehabilitation workforce.MethodsThe challenges were identified through a two-phased investigation. Phase 1: critical review of the rehabilitation workforce literature, organized by the availability, accessibility, acceptability and quality (AAAQ) framework. Phase 2: integrate reviewed data into a SWOT framework to identify the strengths and opportunities to be maximized and the weaknesses and threats to be overcome.ResultsThe critical review and SWOT analysis have identified the following global situation: (i) needs-based shortages and lack of access to rehabilitation workers, particularly in lower income countries and in rural/remote areas; (ii) deficiencies in the data sources and monitoring structures; and (iii) few exemplary innovations, of both national and international scope, that may help reduce supply-side shortages in underserved areas.DiscussionBased on the results, we have prioritized the following ‘Six Rehab-Workforce Challenges’: (1) monitoring supply requirements: accounting for rehabilitation needs and demand; (2) supply data sources: the need for structural improvements; (3) ensuring the study of a whole rehabilitation workforce (i.e. not focused on single professions), including across service levels; (4) staffing underserved locations: the rising of education, attractiveness and tele-service; (5) adapt policy options to different contexts (e.g. rural vs urban), even within a country; and (6) develop international solutions, within an interdependent world.ConclusionsConcrete examples of feasible local, global and research action toward meeting the Six Rehab-Workforce Challenges are provided. Altogether, these may help advance a policy and research agenda for ensuring that an adequate rehabilitation workforce can meet the current and future rehabilitation health needs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12960-017-0182-7) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Human resources for health (and rehabilitation): Six Rehab-Workforce Challenges for the century

et al. 2017

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“…But the more general point is worth underscoring. National policy initiatives need to intersect with local decision‐making and to take account of service history and cultures (Meade, Mahmoudi, & Lee, ). Providing evidence of the variations across areas should stimulate the discussions that are needed to bring about culture shifts in services (McConkey & Keogh, ).…”

Section: Discussionmentioning

confidence: 99%

A case-study of policy change in residential service provision for adult persons with intellectual disability in Ireland

Kelly

McConkey

Craig

2019

Health Soc Care Community

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In Europe, many people with intellectual disabilities continue to live in congregated settings. In 2012, Ireland formally introduced a resettlement policy with people moving to live in more personalised arrangements. This longitudinal country case‐study aimed to monitor the implementation of this policy and the intra‐country variations that arose using the records maintained in the National Intellectual Disability Database. Details of over 4,000 people living in congregated settings were examined in 2007 and again in 2012 and 2017. In addition, people who moved from such settings from 2007 onwards were tracked and the number of new admissions to them was estimated over the 10‐year period. Overall there was nearly a 30% drop in the numbers of people in congregated settings but the reductions varied markedly across the country and by 2017 the disparity was greater than in 2007. Also by 2017 persons aged over 55 years were eight times more likely to be accommodated in congregated settings. The case‐study illustrates the value of a longitudinal dataset for monitoring policy implementation across a diversity of provider organisations and administrative areas.

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“…According to a theoretical model by the Institute of Medicine’s Committee on Monitoring Access to Personal Health Care Services, personal factors, such as income and education, financial factors, such as public support and insurance coverage, and structural factors, such as availability and transportation, all contribute to service utilization, which correlates with health status [24, 25]. Empirical observational studies have also shown that these three types of factor are associated with service utilization [9, 15, 18, 26] and health status [27, 28].…”

Section: Discussionmentioning

confidence: 99%

Impact of geographic accessibility on utilization of the annual health check-ups by income level in Japan: A multilevel analysis

et al. 2017

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Although both geographic accessibility and socioeconomic status have been indicated as being important factors for the utilization of health care services, their combined effect has not been evaluated. The aim of this study was to reveal whether an income-dependent difference in the impact of geographic accessibility on the utilization of government-led annual health check-ups exists. Existing data collected and provided by Chiba City Hall were employed and analyzed as a retrospective cohort study. The subjects were 166,966 beneficiaries of National Health Insurance in Chiba City, Japan, aged 40 to 74 years. Of all subjects, 54,748 (32.8%) had an annual health check-up in fiscal year 2012. As an optimal index of geographic accessibility has not been established, five measures were calculated: travel time to the nearest health care facility, density of health care facilities (number facilities within a 30-min walking distance from the district of residence), and three indices based on the two-step floating catchment area method. Three-level logistic regression modeling with random intercepts for household and district of residence was performed. Of the five measures, density of health care facilities was the most compatible according to Akaike’s information criterion. Both low density and low income were associated with decreased utilization of the health check-ups. Furthermore, a linear relationship was observed between the density of facilities and utilization of the health check-ups in all income groups and its slope was significantly steeper among subjects with an equivalent income of 0.00 yen than among those with equivalent income of 1.01–2.00 million yen (p = 0.028) or 2.01 million yen or more (p = 0.040). This result indicated that subjects with lower incomes were more susceptible to the effects of geographic accessibility than were those with higher incomes. Thus, better geographic accessibility could increase the health check-up utilization and also decrease the income-related disparity of utilization.

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The intersection of disability and healthcare disparities: a conceptual framework

Cited by 106 publications

References 48 publications

Human resources for health (and rehabilitation): Six Rehab-Workforce Challenges for the century

Human resources for health (and rehabilitation): Six Rehab-Workforce Challenges for the century

A case-study of policy change in residential service provision for adult persons with intellectual disability in Ireland

Impact of geographic accessibility on utilization of the annual health check-ups by income level in Japan: A multilevel analysis

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