NDA

Submission to the National Steering Committee on the Development of a Men’s Health Policy

Introduction

The National Disability Authority was established in 2000 to advise the Minister for Justice, Equality and Law Reform on issues relating to people with disabilities. The NDA has produced a number of research reports, policy documents, guidelines and standards relevant to men’s health and welcomes this opportunity to inform the development of a national men’s health policy.

The 2002 Census recorded 152,000 men with disabilities in Ireland, or 7.8% of the male population. Rates of disability increase with age, and as people age, they are more likely to experience multiple disabilities. For example, almost one in five men aged 65-69 (18.3%) has a disability, while at age 85 or over, three out of five men (59.2%) have a disability. Given Ireland’s ageing population, this suggests that men with disabilities are a significant target group for men’s health policy. The 2006 Census and the post-Census National Disability Study in 2006 will provide substantial data on demographics of disability and people with disabilities’ experiences of the social determinants of health such as housing, employment, education and transport.

People with disabilities should have an equal opportunity to achieve positive health outcomes. The UN Standard Rules on the Equalization of the Opportunities for Persons with Disabilities (1993) state that:

States should ensure that persons with disabilities…. are provided with the same level of medical care within the same system as other members of society.

The NDA welcomes the Government’s understanding of the significance of the social determinants of health as well as the importance of quality, equitable, person-centred and accountable health provision as articulated in Quality and Fairness: A Health System for You National Health Strategy (2001). The NDA considers that health is of fundamental importance to the inclusion of men with disabilities in Irish society. This potential participation and contribution is compromised by:

  • negative experiences of a range of social determinants of health,
  • the health impacts of disability and
  • inequalities in access to general health services
  • poor access to health-promoting activities such as physical activity.

Determinants of health

Men with disabilities experience a high rate of poverty and social exclusion. People with disabilities are at double the risk of poverty of the non-disabled population. In turn, poverty is a key predictor of poor health.

In its recent publication ‘How far towards equality? Measuring how equally people with disabilities are included in Irish society’ (2005), the NDA undertook a secondary analysis of existing datasets and highlighted that, compared to non-disabled people, people with disabilities with regard to:

  • education, are much more likely to leave school early and less likely to have achieved any qualifications
  • employment, are two and a half times less likely to have a job
  • income, earn less in a job and are twice as likely to be at risk of poverty
  • social relationships, are more restricted in socialising outside the home, be less likely to marry and more likely to be separated or divorced
  • transport, are more likely to have difficulty with public transport
  • housing, are less likely to live in a private household, more likely to live in care and more likely to live with their parents into adulthood
  • healthstatus, are more likely to experience poor health
  • health-related behaviours, are twice as likely to take no exercise.

The NDA’s publication ‘The Experience of People with Disabilities in Accessing Health Services in Ireland: Do inequalities exist?’ (2005) highlighted the substantial and wide-ranging health impacts of disability. These include:

  • Greater risk as a consequence of having a reduced income due to exclusion from the labour force and being caught in the ‘benefits trap’;
  • The additional costs of being disabled;
  • Increased incidence of other disabling conditions and illnesses;
  • Lack of access to acute, rehabilitative and population health services;
  • Experience of a range of barriers to accessing care (financial, physical, organisational, transport, communication, attitudinal and informational including the inadequate knowledge of health care providers);
  • Experience of un-coordinated and fragmented provision, exacerbated by the involvement of multiple health and social providers and;
  • Limited provision due to the focus of health services being on the individual’s impairment rather than the health issue or condition or their holistic health needs.

People with disabilities frequently experience physical, attitudinal, communication and information barriers to availing of mainstream health services. As men are less likely in general to avail of heath services, disabled men are likely to be additionally disadvantaged in relation to general and specialist health care.

Men at particular risk

The NDA would like to draw particular attention to areas where men’s health status is at particular risk.

Accidents

Men are at higher risk of road traffic injuries (and associated disability). For example in 2002, 4,800 men were injured in road accidents compared to 3,300 women. Risks are particularly high for young male drivers, and for male motorcyclists. Men are also at greater risk of injury at work, and of sporting injuries. This underlines the importance of prevention programmes aimed at reducing risky behaviours, which specifically target men at high risk.

Suicide

Men are at higher risk of suicide. This can often be associated with mental health difficulties. Addressing this issue should be a high priority for a men’s health strategy

Homelessness

Men constitute roughly two thirds of homeless people, and both their physical and mental health is often seriously compromised. It is estimated that about 40% of homeless men have mental health difficulties. Prevention of homelessness among those at risk, including men with mental health difficulties is of vital importance, as well as the delivery of appropriate health services to men who are homeless.

Health risks for men with disabilities

People with disabilities experience a higher incidence of poor health than the general population. About 90% of non-disabled people describe their health as good or very good, a proportion which falls to just over 50% among people with disabilities (How far towards equality? NDA 2005 Table 2.2).

People with certain conditions or impairments experience specific risks and disadvantage. People with Down’s Syndrome have a much higher risk of developing epilepsy and dementia as they age. Men with mental health difficulties who are prescribed anti-psychotic medications have a higher risk of obesity, diabetes and heart attacks. Men with mental health difficulties are also at significantly higher risk of suicide.

Using physical activity as an exemplar, people with disabilities are less likely to have access to health promoting and health protecting activity. Men with disabilities are less likely to take exercise, which puts them at higher risk of illness. A recent study carried out in the East Coast Area Health Board showed that only one sixth of people with a learning disability and only one third of people with a physical or sensory disability had participated in physical activity in the previous week. Only 2% of people with a physical or sensory disability participated in sports on a weekly basis.[1] The NDA’s report ‘Promoting the Participation of People with Disabilities in Physical Activity in Ireland’ (2005) recommends developing a ‘national framework for inclusive physical exercise and sport’ to ensure inclusion of people with disabilities in these activities. The NDA notes that the 2004 review of the National Health Promotion Strategy 2000-2005 highlighted the absence of strategic and significant action on health promotion and disability.

Disabled men are not a homogenous group. It is important that any action on the health of men with disabilities takes account of men from different social classes and men who are members of populations covered by equality legislation including men from ethnic minorities, the Traveller community and gay and bisexual men.

Recommendations for Men’s Health Policy

  • Ensure health service facilities and information are accessible to people with disabilities, in accordance with the Disability Act 2005.
  • Ensure that disabled men who live in residential and institutional care are included in health programmes for the general population, e.g.preventive health checks, dental care, and health promotion programmes
  • Men at are particular risk of injury through motor accidents, and of suicide. Preventive programmes would be of particular importance in these areas.
  • Increased research on health issues for men with disabilities, to include health statistics which can be analysed by gender and disability status
  • Support men with disabilities to understand and articulate their health needs.
  • Programmes to increase the engagement of men with disabilities in physical exercise, including programmes operated through disability services, and promotion of sporting activities
  • Ways of sharing best practice on delivering health care and population health for men with disabilities should be developed

The NDA welcomes any further opportunities to contribute to the work of the Department of Health and Children and agencies under its auspices regarding the health of men with disabilities.

Page 1 of 4

[1] Boland, M. (2005) Health Promotion and Health Promotion Needs Assessment of people attending disability services in the HSE, East Coast Area. Doctorate of Medicine, University College Dublin (under consideration).