1. Eric Emerson Learning Disabilities Public Health Observatory

2.  Three questions ◦ Who are ‘people with intellectual disability’? ◦ What do we know about international variation in the health inequalities faced by people with intellectual disability? ◦ Why do these health inequalities exist?  Future directions

3.  The ‘hidden majority’  Little known ◦ Poor health ◦ High rates of poverty & social exclusion ◦ Invisible to intellectual disability services (and policy) Administrative Prevalence of Intellectual Disability in England

4.  Mortality  Morbidity ◦ Impairments ◦ Physical health ◦ Mental health  Health states & behaviours ◦ Obesity ◦ Inactivity ◦ Smoking, drug use & sexual health?

5.  Variation in need ◦ incidence of intellectual disability (nearly all preventable) ◦ prevalence? ◦ health status?  Variation in expenditure, policies and health care systems ◦ in general ◦ for people with intellectual disabilities?

6.  Syndrome-specific biological vulnerability ◦ Down’s syndrome: congenital heart defects, hearing loss, early onset dementia  Impact of intellectual disability ◦ Vulnerability to poorer physical and mental health ◦ Self-identification of ‘ill health’ ◦ Communication of health needs ◦ Understanding health promotion

7.  Overt and institutional discrimination in health care systems

8.  Social Determinants of Health: Social position and inequality are related to... ◦ Mortality ◦ Morbidity  Impairments  Physical health  Mental health ◦ Health behaviours  Obesity  Inactivity  Smoking, drug use & sexual health

9.  People with intellectual disability are more likely than others to be exposed from infancy onwards to a wide range of material and psychosocial hazards ◦ Poverty ◦ Low social status ◦ Low control ◦ Victimisation & abuse  The poorer health of people with intellectual disability is (in part) due to their experience of deprivation and disadvantage (rather than their intellectual disability per se)

10.  High rates of mental health problems among children with intellectual disability  Over 50% of children in the UK who have intellectual disability and a mental health problem are currently living in poverty  33%-50% of this increased risk is possibly due to increased exposure to poverty Adversity Index Prevalence of Diagnosable Mental Health Disorders

11.  Better understanding of the health (and the determinants of health) of the ‘hidden majority’ of adults with intellectual disability  Better understanding of international variation in need and capacity  Combat discrimination in health care systems (and more generally)  Address the wider social determinants of health ◦ Change the odds of exposure to adversity ◦ Beat the odds when exposed (build resilience)  A public health approach to the health inequalities faced by people with intellectual disabilities

12.  Improve daily living conditions  Tackle the inequitable distribution of power, money, and resources  Measure and understand the problem and assess the impact of action

13. eric.emerson@lancaster.ac.uk