A project by the Centre for Disability Research at Lancaster University aimed to find out how neighbourhoods and community participation are linked to the health of people with learning disabilities. Chris Hatton and colleagues report on their findings.
Study title: Perceptions of neighbourhood quality, social and civic partnership and the self-rated health of British adults with intellectual disability: cross sectional study – http://www.biomedcentral.com/1471-2458/14/1252
Aims: To examine the relationship between the social connections and community participation of people with learning disabilities and their health.
Methods: Secondary analysis from Understanding Society, a new longitudinal study focusing on the life experiences of UK citizens, focusing on the experiences of a sample of people aged 16-49 with learning disabilities.
Research has shown that people with learning disabilities die significantly earlier and have more health problems than the rest of the population. Emerson & Hatton, 2014 (1). This, combined with failings in health services and increased attention to the human rights of disabled people, has led regulatory bodies and governments to stress the importance of reducing the health inequalities experienced by people with learning disabilities. Department of Health, 2007; Parliamentary and Health Service Ombudsman and Local Government Ombudsman, 2009 (2).
Despite some research looking at poverty, hardship or adversity to account for the poorer health of people with learning disabilities, few studies have looked at the relationship between either neighbourhood quality or social networks and people’s health. This is odd because we know from general population studies that people with closer and more extensive social networks, and people who report feeling more connected to their local community and/or live in more supportive neighbourhoods tend to have better health. Murayama, Fujiwara and Kawachi, 2012 (3). There is also evidence that people with learning disabilities often have restricted social networks and live in less supportive neighbourhoods, e.g Amado et al, 2013 (4).
The literature on the social networks of people with learning disabilities has reported positive associations between better health and more contact with friends with learning disabilities, being in paid employment, and greater participation in community activities. Emerson & Hatton, 2008 (5).
The aims of this study were: to describe people’s experiences of neighbourhood quality, and their social and civic participation; to estimate the strength of the relationship between these experiences and self-rated health among British adults with and without learning disabilities; and to take account of any potential effects due to socio-economic disadvantage, perceived neighbourhood quality and civic participation.
After adjusting statistical results to take account of group differences in age, gender, having children and socio economic disadvantage, it was found that people with learning disabilities were less likely than non-disabled people to report living in positive neighbourhoods, and of feeling closely engaged in the life of their communities. Reasons they gave for not going out socially tended to relate to a health condition, illness, impairment or disability, or because they had nobody to go out with. More positive perceived neighbourhood characteristics and higher reported levels of social and civic participation (except for membership of community organisations) were associated with more positive self-rated health for both people with learning disabilities and the general population. For people with learning disabilities, more positive self-rated health was found to be associated with younger age, socio-economic advantage, being employed for 16 hours or more each week, and feeling safe outside in the dark. There was also a strong association between being able to access community services and self-rated health scores.
Despite its limitations, the study results indicate a number of important things:
(1) British adults with learning disabilities have less favourable perceptions of important neighbourhood characteristics and lower levels of social and civic participation than their non-disabled peers;
(2) favourable perceptions of important neighbourhood characteristics and higher levels of social and civic participation are associated with more positive self-rated health for adults with and without learning disabilities;
(3) for adults with learning disabilities this is particularly the case with regard to employment and social contact with friends. These findings support previous studies showing the potential importance of contact with friends and paid employment to their health.
In addition to socio-economic factors, this study concludes that social exclusion has a significant impact on the health of people with learning disabilities, especially those with less severe learning disabilities. People with learning disabilities living in neighbourhoods where they do not feel safe and/or they feel excluded, and where there are few opportunities for community participation, may suffer poorer health. References
1. Emerson E, Hatton C: Health Inequalities and People with Intellectual Disabilities. Cambridge: Cambridge University Press; 2014.
2. Parliamentary and Health Service Ombudsman and Local Government Ombudsman: Six lives: the provision of public services to people with learning disabilities. London: Parliamentary and Health Service Ombudsman and Local Government Ombudsman; 2009.
3. Murayama H, Fujiwara Y, Kawachi I: Social Capital and Health: A Review of Prospective Multilevel Studies. J Epidemiol 2012, 22:179–187.
4. Amado AN, Stancliffe RJ, McCarron M, McCallion P: Social Inclusion and Community Participation of Individuals with Intellectual/Developmental Disabilities. Intellect Development Disabilities 2013, 51:360-375.
5. Emerson E, Hatton C: Socioeconomic disadvantage, social participation and networks and the self-rated health of English men and women with mild and moderate intellectual disabilities: Cross sectional survey. Eur J Pub Health 2008, 18:31-37.
Department of Health: Promoting Equality: Response from Department of Health to the Disability Rights Commission Report, “Equal Treatment: Closing the Gap”. London: Department of Health; 2007.
• Poorer health amongst adults with learning disabilities may in part be due to where they live and to lower levels of social and civic participation.
• Living in neighbourhoods that exclude people and offer little opportunity to engage in the life of their community, is linked to people with learning disabilities suffering poorer health.
• The study highlights the potential importance of contact with friends and paid employment to the health of adults with learning disabilities