What is intellectual disability?
The tenth revision of the World Health Organization (WHO) states that, intellectual disability (ID) is a disorder, which is defined by the prevalence of arrested or incomplete mental development. These disabilities are principally characterized by deterioration or loss of concrete mental functions during the developmental stages and contribute to the overall intelligence level (15). The higher mental faculties such as language comprehension, cognitive skills and motor or socialization functions get severely affected. This in turn affects the adaptation to the environment.
Clinical signs and adaptive behaviour are used to determine the intellectual development scores for people with this disability. These disabilities originate before 18 years of age (7). Every individual who is has been diagnosed with mental retardation is eligible for an intellectual disability diagnosis. Moreover, the rates of ID prevalence differ according to socio-economic status and income standards. Intellectual disability manifests principally in the form of developmental delay in the intellectual functioning. Moreover, deficits are also observed in social adaptive functioning. The IQ ranges from 50-70 in mild conditions, 35-50 in moderate, 20-35 in severe and less than 20 in profound disabilities. It has been chosen based on prevalence of intellectual disabilities among people in Australia. Thus, the report will address the health of people with intellectual disability.
Holistic Health: Physical, Mental, Social, Spiritual
The Red Lotus Health Promotion Model will be used to determine the philosophical, technical and ethical principles related to intellectual disabilities. It will identify the health paradigm, needs of the target population and the inequalities faced by them.
Individual Determinants of Health
Biological
- Age- Intellectual disabilities originate before 18 years of age. It showed a 10% among people aged 75 years or more. Health disparities exist among older people related to lack of access to healthcare (16).
- Gender- Males are more likely to get affected. Social exclusion, stigma and discriminatory practices occur when people with ID do not conform to gender norms (14).
- Ethnicity- People with ID belonging to linguistically and culturally diverse are more likely to experience discrimination throughout their lives Studies have proved that Aboriginal and Torres Strait Islander people are 1.5 times more likely to get affected than nonindigenous people.
- Genetics- Inheritance of abnormal genesfrom parents may also lead to these conditions. Most prevalent genetic conditions that lead to ID are Klinefelter syndrome, Down syndrome, neurofibromatosis, Prader-Willi syndrome and Fragile-X syndrome.
Socio-Economic Status
- Low income for people with intellectual disabilities undermines their hope, reduces opportunities for progress and limits their choices. Thus, their health status gets threatened.
- Lack of education is one of the most consistent predictors for health disparities. It is closely associated with access to healthcare experiences and benefits. Thus, it plays an important role in the lives of the impoverished. Educational attainment is related to better health outcomes (8).
- It is absolutely essential for abolishing health inequalities. Unemployment and poor working conditions expose a person to hazardous environment. Intellectually disabled workers face noticeable gaps in their compensation and pay (11).
- Globalisation increases increasing internationalization of health risks. It is an interaction of political, economic, social and environmental factors.
Cognitive Factors
- People have limited understanding of intellectual disabilities. A lack of awareness is linked to stigmatising attitudes and negative beliefs (10).
- Cultural beliefs that ID is due to possession of spirits or are occur due to past sins greatly contribute to the disparities.
- Such discriminatory behaviours and attitudes arise due to low awareness and widely held negative attitude.
- Extreme hostility and prejudices among small minorities also act as determinants.
Behaviours
- Individuals with ID are at a high mortality risk from respiratory disease like pneumonia, chronic obstructive pulmonary disease, aspiration and sinusitis. Cardiovascular diseases, malnutrition and peptic ulcer are common.
- People are thrice more likely to get affected with psychiatric disorders than the general population. The common mental illnesses observed in the population are depression, bipolar disorder, anxiety and schizophrenia (16).
- Profound intellectual disabilities have often been associated with ambiguous spiritual states. Spirituality has often been linked to organised religious practices. Spirituality can be represented as the sum total of their life experiences.
- Lack of empathy, inability to recognise specific needs of the population and discriminatory attitudes also lead to disparities.
- The natural environment creates a major impact on intellectual limitations or disabilities (18). An environment where there is absence of mold or ragweed growth can prevent events that trigger the incidence of severe allergic reactions like asthma. , The physical conditions are disabling in one environment and enhancing in other. Conversely, a person with limited walking ability in severe ID will experience less disability in a flat geographical location like Port Douglas, than on a hilly region such as Adelaide hills. Moreover, changes in climatic conditions also affect disabilities. A person feels more disabled in winter. Thus, the topography and climate affects the degree a functional limitations.
- The built environment includes homes, workplaces, schools, roads and recreation areas. They play a huge impact on the indoor and outdoor physical activities. People with ID are often unable to access facilities and building like others (12). Such people often have to encounter built environments that do not cater to their physical needs. Built objects such as computers and dishwashers contain the potential to either create barriers or enhance human performance. Modifications in the built environment such as, the use of assistive technology (corrective lenses for visual impairment or TDD for hearing loss) can improve functional capabilities of a person with ID.
- Social determinants- People with ID often live in accommodation that isolates them from their community and family. These environments provide either excess or little activity scopes (1). They are more likely to be subjected to trauma, abuse, harassment and exploitation. Low expectations from others lower their confidence. Protective family members lead to over-dependence. Display of empathy, effective communication and non-judgemental behaviour greatly improve these disabilities. Disparities in education are another major factor (2).
- Economic- Poverty is a major health determinant. Disabilities are characterised by low socio-economic status and unequal economic distribution. Paid employment and adequate income enhance the social status and improve self-esteem. This makes the participation of disabled people in community life and enhances their opportunities for regular activity. Unemployment is often detrimental to mental and physical health. Unemployment rates increase for intellectually disabled people (17).
- Political- Designing of public policies can impact the extent to which the impairments cause disabilities among individuals. Legal policies, for the intellectually disabled people increase social awareness and tolerance for all such people (9). This in turn improves their quality of life.
- Social justice can be defined as equal distribution of opportunities and resources to all people. It is a broad term and encompasses concepts of human equality and rights. I consider social justice to be central to public health mission. It signifies a fair disbursement of advantages and sharing of burdens (5). It captures the twin moral impulses that animate public health: to advance human well-being by among all people. I intend to improve the health of the intellectually disabled people by focusing on their needs. One of the biggest obstacles is misconstruing access for health equity (18).
- The future implications would include formulating public health policies, developing personal skills, strengthening community actions and building supportive environment for the target population (3). The existing policies and services related to disabilities will be assessed. The priority areas will be identified. These priority areas would basically target ensuring physical accessibility, creating awareness on disabilities and providing adequate training to healthcare and community workers that will help them to recognise and meet the demands of the people.
- Health care standards will be established related to the care of the specific population. These policies would make access to healthcare services easy for all sections of the society. Strengthening the workforce will bring about improvements in healthcare and will better address the poor health of people with ID. Community services will be strengthened to enhance social support and self-help (4). Future strategies involve development of flexible systems that will increase public participation. Mass-reach health interventions will increase awareness among people.
- Conducting community wide campaigns will also lead to modification of outdoor recreational facilities and will enhance the access to places for physical activities. Teaching social and personal skills to people with intellectual disability will help them take significant steps towards their independence (6). Establishing skills training at homes or schools will teach them how to cope with their disabilities and will further prepare them for the surrounding environment.
- Designing a cordial and supportive environment will help to meet the impairment needs of the disabled people. A supportive environment will allow individuals with moderate intellectual disabilities to master vocational and self-help skills with the assistance of trained personnel (13). I wish to collaborate with other healthcare professionals for bringing about these changes.
- This is how my discipline will help me reduce health inequalities for this vulnerable population. Thus, my future plans for promoting social justice among the intellectually disabled people abide by the health promotion strategies of Ottawa Charter.
- I will seek help from my colleagues to bring about some changes in future to assist the people with intellectual disabilities. I would promote emergency preparedness among the target population to safeguard their health and lives. During calamities, disasters or at times of emergency, people with intellectual disabilities are least likely to get evacuated. They become especially vulnerable to the situations and can suffer to a great extent.
- My plan for emergency preparedness would include planning for the various phases of multiple disasters that could be man-made or natural. It would involve a system-level responsiveness, which would assure that people with intellectual disabilities and their family or support systems are always included in every stage of the training. Training would be conducted on their preparedness, evacuation and recovery within community settings. It would also focus on teaching adaptive strategies for shelter accommodations on a large community scale. It would also require planning and training at the individual level during such disastrous events.
- Explicit planning and coordinated efforts across all healthcare agencies would better address the needs of people with intellectual limitations. Most often, people with ID are excluded from participating in mainstream public health services and programs. This occurs due to historical isolation and segregation, discomfort in working with such people, and not recognising their cognitive limitations (20). Inclusion of such people into effective mainstream healthcare practices would act as a powerful tool and would improve their health status. Ethnic and health disparities would get abolished. People suffering from intellectual disabilities are often paid inadequate attention in health surveillance programmes. Their health needs are given low priority in disability research. Therefore, my future practice would include application of stringent evidence based practices that would impact the several environmental factors and life-style habits (21).
- Utilising evidence-based research would help to administer interventions that would create health outcomes and reduce gaps (22). I will collaborate with other health professionals and liaise between specialist teams or tertiary specialists belonging to departments such as dementia, gerontology, neurology, or cardiovascular departments.
- My future practice strategies also aim to introduce telehealth services. It would prevent unnecessary delay in providing care to the disabled people and would improve access to specialists and rehabilitation services (19). Use of telehealth services will show enhanced independence among participants.
- Thus, these future implications are in accordance with Ottawa Charter strategies of health promotion because the basic aim of the future practices is to improve health outcomes of the target population.
Conclusion
Thus, from the above discussion I conclude that intellectual disability is a condition of incomplete or arrested development of the mind. It is specifically characterized by impairment of skills that are manifested during developmental period. These skills contribute to the level of intelligence. The term encompasses cognitive, motor, language and social skills. Epidemiological reports suggest that its incidence is higher among men especially those belonging to the adolescent or old age group. I realised that there are several genetic, environmental and socio-cultural factors that contribute to the occurrence of these disabilities.
A detailed analysis of the contribution of these factors provided the idea that though, scientific progress has enhanced our ability to improve health, there is still widespread deprivation in health. I intend to promote social justice and eliminate all health disparities among the intellectually disabled people. My future task would be to seek help form colleagues and work towards building an environment where all people will be able to achieve optimal health status, without any distinction based on ethnicity, race, religion, nationality, language, gender, age, socioeconomic resources, geography or political affiliations. I would accomplish this goal by establishing contextually relevant public health policies, increasing access to health services, promoting supportive environment and community settings. Thus, these strategies would help in meeting social justice for the people with ID.
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