The Disability sector - Are we addressing the barriers for disabled people accessing healthcare in New Zealand?
Written by Tom Varghese
Disabled people make up 15% of the world’s population. In NZ, 24% of the population considered themselves disabled according to the 2013 NZ Disability survey. Internationally, disability is more prevalent in known marginalized populations such as women, children, and indigenous populations. This is also true in NZ where the NZ Disability Survey (2013) showed Māori have a higher (age-adjusted) prevalence (32%) of disability compared to people who identify as European (24%) and Asian (17%).
Disability is not about having a specific medical condition, it is about living with activity limitations or functional difficulties that affect everyday life, and older people are more likely than younger people to be affected. Disabled people experience health inequities due to barriers existing within multiple social determinants of health such as education, employment, housing, as well as bias within the health systems (e.g., access to quality health services).
The New Zealand Health Strategy highlights some of the poor outcomes facing disabled people, including a shorter lifespan (learning / intellectually disabled people live on average 18-23 years less than the non-disabled population), and a significantly higher reporting rate of health being fair or poor (29% for disabled people, vs 4% for non-disabled people), as compared with the non-disabled population. The New Zealand Disability Strategy (2016) furthermore notes that “disabled people remain worse off than non-disabled people across all social and economic outcomes”.
Fragmentation of services also remains a key barrier to equity for disabled people. These services include Work and Income, the DHB’s, disability support providers, GPs, other medical specialists related to impairment, and specialists in equipment and home modification. Each service has its own eligibility criteria, communication system and way of working, and must be navigated by the disabled person and their whānau in order to access support. Compounding this issue is the lack of disability training provided to medical professionals.
There is also a significant lack of data related to disability in NZ. Without this baseline data, is it nearly impossible to assess levels of employment and access to health services for this group, and it is similarly challenging to assess whether improvements are being made. A significant increase in investment in disability research, particularly research which is not based on a medicalised understanding of disability is also required.
To improve outcomes for disabled people, the health system will need to improve its understanding of different population groups, involve people in designing services and provide a range of services that are appropriate for the people who use them.