Disability, Rehabilitation, Socioeconomics and Health

Original Editor - Oyemi Sillo uploaded for Adrian Palmer

Top Contributors - Oyemi Sillo and Kim Jackson  

Introduction[edit | edit source]

Engaging in rehabilitation has been associated with improved health outcomes and as healthcare advances rehabilitation is currently seen as a critical aspect of the future of health promotion.[1][2] However, not much discussion has been done to highlight the importance of rehabilitation in sustaining family finances and economics, which can play a part in maintaining health. This would present rehabilitation as an indirect health strategy.

Global Need for Rehabilitation[edit | edit source]

Approximately 1 in 3 persons throughout the course of a disease or injury will need rehabilitation services, this translates to 2.41 billion persons (which may also be an underreported number); it is also important to note that musculoskeletal conditions are the largest contributors to need for rehabilitation services, with over 1.7 billion people globally affected by musculoskeletal conditions and 1 billion having injuries.[3]

Personal/Domestic Financial Impact of Poor Access to Rehabilitation[edit | edit source]

According to the WHO musculoskeletal skeletal conditions are the leading contributors to disability worldwide and not only do they reduce participation in society but they can also lead to early retirement, reduced ability to work, affect younger folks during their peak income earning years, they lead to work absenteeism and loss of productivity.[4] This underscores the importance of access to rehabilitation to maintain productivity and economic stability.

Early retirement and inability to work will typically mean less income and financial resources for a person, and their family especially in a breadwinner’s circumstance. This will definitely impact personal and household health, because it is known that lower socioeconomic status is associated with poorer health related quality of life, and this seen in various countries with even different health systems.[5]

Poverty will definitely result in reduced quality of healthcare and reduce access to healthcare. A systematic review done by Banks, Kuper and Polack in 2018 indicated that there is a strong positive association between poverty and disability in low and middle income countries, and this association was strong for the working age adults.[6] Poverty and disability were also said to feed each other. Rehabilitation can be a critical component to break this cycle and help these persons especially those in the working age to be more productive and earn more money.

According to another systematic review done by Bright, Wallace and Kuper in 2018 it states that disability is linked to poverty and poverty is linked to disability in a cyclic manner, and poverty is linked to poor health.[7] They also found that rehabilitation coverage is low in low and middle-income countries. This would indicate that persons with disabilities, would be more inclined to experiencing poverty and consequently poorer health. This underscores the importance of including rehabilitation in universal health coverage.

Effects of Disability[edit | edit source]

Economic[edit | edit source]

The National Bureau of Economic Research commenting on a study that was done, stated the following economic impacts of disability:[8]

  • Limits or prevents persons from working, more so common in men above 50 years old.
  • After 10 years since onset of chronic and severe disability persons experience a decline of up to seventy nine percent (79%) in earnings and twenty two percent (22%) in food consumption.
  • Assistance and monetary aids such as insurance, savings, family support, etc. only partially fill the deficit in consumption.
  • One in six (1/6) of families in which the head of that family has become severely and chronically disabled ends up falling below the poverty line.

There are economic gains to be made if the talents of persons with disabilities are also utilized, listen to the International Labour Organization comments on this matter:


Health[edit | edit source]

Krahn, et al., describes the disability population as an unrecognized health disparity group. They have reported that disabled persons have more chronic diseases and earlier onset compared to others, less access to healthcare and human services.[10]

PP Disability Images.jpg

The Centers for Disease Control and Prevention reports that persons with disabilities are more likely to have poorer overall health, less access to healthcare and they are more likely to smoke and be physically inactive (which is known to be a major risk factor for non-communicable diseases and premature death).[11]

The Centers for Disease Control and Prevention also reports that persons with disabilities are at risk for secondary conditions which are largely preventable, these include:

  • Bladder and bowel dysfunctions for example persons with neurological conditions such spinal cord injuries.
  • Fatigue
  • Injuries (inclusive of suicide and homicide )
  • Mental health, people with disabilities were said to report higher rates of stress and depression
  • Disabled persons are more likely to have unhealthy weights (overweight/obese), and it is known that overweight and obesity are associated with other health issues.
  • Pain is said to be a frequent problem reported by persons with disabilities and this affects daily functions.
  • Pressure sores/ulcers can be a serious health concern for persons with disabilities that causes them to be bed ridden or wheelchair bound.  
  • Others such as oral health (poor dexterity to brush), violence/abuse.

Watch this video as disabled persons around the world share the challenges they face in accessing healthcare


Effects of Poverty on Health[edit | edit source]

There are quite few factors related to poverty that will negatively affects one’s health. Healthy People highlights the following negative consequences of poverty on people’s health:[13]

  • Poorer communities are said to be at an increased risk of mental health disorders, chronic diseases (such as diabetes, heart disease, obesity), higher death rates and decreased life expectancy.
  • Poorer older adults are at increased risk of disability and death.
  • Certain racial groups living in poverty are at higher risk for certain diseases for example, African American men and women are more likely to die from prostate cancer and ail from breast & cervical cancers, respectively.
  • Poorer children are more likely to have cavities, and less likely to receive dental care.

Carolyn Shimmin, who is the Public and Patient Engagement Lead at the George and Fay Yee Centre for Healthcare Innovation, Canada, highlighted several health issues related to poverty:[14]

  • Cancers: The incidence as well as the death rates of several cancers (e.g. breast, lung, prostate, colorectal) are higher amongst lower income earning Canadians. Shimmin explained that recent studies indicated that throughout the continuum of cancer care, lower income earners are falling behind.
  • Cardiovascular Diseases: Prevalence of risk factors associated with cardiovascular diseases and mortality rates are higher amongst lower income earners in Canada, despite the rate of cardiovascular  diseases falling in Canada over the past ten (10) years.
  • Diabetes: Lower income earners have higher prevalence of risk factors, higher incidence, higher levels of mortality and morbidity, higher hospitalizations and less likely to receive the recommended care.
  • Mental Disorders: The lowest income earners in Canada are more likely to report some sort of mental health issue, and more likely to develop high psychological distress levels.
  • Child Health: Poorer children in Canada were said to be more likely to have a low birth weight, type 2 diabetes, asthma, malnutrition and poor oral health. Children in poverty were also said to have higher rates of unintentional injuries, which would increase their risk of death as well.

The arguments presented by Shimmin were supported by earlier research done by Gupta, de Wit and McKeown.[15]

Health Consequences of Job loss [edit | edit source]

There are persons who have become disabled and experienced job loss, due to various labour market barriers, and during the COVID19 pandemic, disabled persons had higher rates of job loss, and were amongst the first set of persons to be laid off (temporarily or permanently).[16]

Stephanie Pappas of the American Psychological Association, explains that job loss has been associated with depression, anxiety and  loss of life satisfaction, and other negative outcomes such as increased distress and decreased satisfaction with their marriages and families.[17] Job loss is shown to be associated with decreased use of healthcare services and has the potential of increasing the risk of mortality.[18] These facts would indicate that losing a job due to a disability could have other mental and physical impacts on the person's health.

Listen to the following discussion on the potential impact of job loss on health:


Health Benefits of Rehabilitation[edit | edit source]

The World Health Organization lists the following health-related benefits of rehabilitation:[20]

  • Improves a variety of conditions such as acute & chronic conditions,, injuries and illnesses.
  • Supplements other medical and surgical interventions, to improve patients' outcomes.
  • Impede the rate of disabling effects of chronic diseases.
  • Empowers patients with self-management skills, assistive tools/devices, etc.
  • Decreases cost or need for more costly or increasing cost of other medical interventions.

Other health related benefits of rehabilitation include:[21]

  • Physical: improvements in physical capacity, musculoskeletal health, aerobic capacity, neuromuscular development, and prevention of deformities and limb issues.
  • Psychological: enhanced self-confidence, improved independence, return to pre-injury mental well-being.
  • Lifestyle: return to activities such as exercise, sports and others that improve overall wellbeing and general health.

Conclusion[edit | edit source]

Rehabilitation is indeed an effective health strategy, there are direct health related benefits from participating or engaging patients in rehabilitation. There are indirect health benefits as well, when persons becomes disabled, if they receive the necessary rehabilitation this could assist them to remain employed, or employable, this would further assist in preventing poverty which is associated with several health related issues. Job loss is also associated with other health related issues. Therefore, improving access to rehabilitation will make it an excellent direct and also indirect health strategy, and play a part in minimizing poverty and further health inequalities.

References[edit | edit source]

  1. Graham J, Middleton A, Bettger J, Malison T, Roberts P. Health services research in rehabilitation and disability - the time is now. Archives of Physical Medicine & Rehabilitation 2019;99(1):198-203.
  2. Frontera W, Bean J, Damiano D, Ehrilch-Jones L, Fried-Oken M, Jette A, Jung R, Leibier R, Malec J, Mueller M, Ottenbacher K, Tansey K, Thompson A. Rehabilitation research at the National Institutes of Health: moving the field forward (executive summary). Physical Therapy 2017;97(4):393-403.
  3. Cieza A, Causey K, Kamenov K, Wulf Hanson S, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the global burden of disease study 2019: a systematic analysis for the global burden of disease study 2019. The Lancet 2020;396(10267):2006-2017.
  4. World Health Organization (WHO), Musculoskeletal conditions. 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions [Accessed: 12 October 2021].
  5. McMaughan M, Oloruntoba O, Lee Smith M. Socioeconomic status and access to healthcare: interrelated drivers for healthy ageing. Frontiers in Public Health 2020;8:231.
  6. Banks L, Kuper H, Polack S. Poverty and disability in low and middle-income countries: a systematic review. PLOS ONE 2018;13(9):e0204881.
  7. Bright T, Wallace S, Kuper H. A systematic review of access to rehabilitation for people with disabilities in low and middle-income countries. International Journal of Environmental Research and Public Health 2018;15(10):2165.
  8. National Bureau of Economic Research, The prevalence and economic consequences of disability. 2013. Available from: https://www.nber.org/bah/2013no1/prevalence-and-economic-consequences-disability [Accessed: 14 October 2021].
  9. International Labour Organization. Not tapping into the potential of persons with disabilities is an economic mistake. Available from: https://www.youtube.com/watch?v=MS-xhqUzVDw [last accessed 30/10/2021]
  10. Krahn G, Walker D, Correa-De-Araujo R. Persons with disabilities an unrecognized health disparity population. American Journal of Public Health 2015;105(2):S198-S206.
  11. Centers for Disease Control and Prevention. Disability & health related conditions. Available from: https://www.cdc.gov/ncbddd/disabilityandhealth/relatedconditions.html (Accessed: 14 October 2021).
  12. World Health Organization. Persons with disabilities share their experiences of accessing health services. Available from: https://www.youtube.com/watch?v=TKzgi5jmgQM [last accessed 30/10/2021]
  13. Healthy People 2020. Poverty. Available from: www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/poverty (Accessed: 17 October 2021).
  14. Carolyn S. Backgrounder: The impact of poverty on health. Available from: http://evidencenetwork.ca/backgrounder-the-impact-of-poverty-on-health/ (Accessed: 18 October 2021).
  15. Gupta R, de Wit M, McKeown D. The impact of poverty on the current and future health status of children. Paediatrics Child Health 2007;12(8):667-672.
  16. Maroto M, Pettinicchio D, Lukk M. Working differently or not at all: COVID-19’s effects on employment among people with disabilities and chronic health conditions. Sociological Perspectives 2021;0(0):1-22.
  17. Pappas, S. The toll of job loss. 2020. Available from: www.apa.org/monitor/2020/10/toll-job-loss (Accessed: 18 October 2021).
  18. Michaud P, Crimmins E, Hurd M. The effect of job loss on health: evidence from biomarkers. Labour Economics 2016;41:194-203.
  19. The New York Times. National: Job Loss Can Lead to Health Problems - nytimes.com/video. Available from: https://www.youtube.com/watch?v=YBS3oP5k7RU [last accessed 30/10/2021]
  20. World Health Organization (WHO), Rehabilitation. 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/rehabilitation [Accessed: 18 October 2021].
  21. Sivan M, Phillips M, Baguley I, Nott M. Oxford Handbook of Rehabilitation Medicine. Oxford: Oxford University Press, 2019.