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Social Focus on Disability 2004

chapter six: Health and Care

'Improving Scotland's health is central to the welfare of our society. Our poor health record is well known. New initiatives are required to create a step change in improving health.'

A Partnership for A Better Scotland: Partnership Agreement

Ensuring good health of all members of our society is extremely important and NHS Scotland are working to ensure every person in Scotland benefits from their services, irrespective of their ethnic origin, sexuality or whether they have a disability. Work is already progressing in this area through initiatives such as Fair for all and The Same as You?.

How does the health of disabled people compare with non-disabled people? Are they more or less likely to visit their GP? Do they smoke more? What type of adaptations to their home do they have or require in order to ensure that they can live an independent life? How much help and care do disabled people receive and from whom?

This chapter presents information on the health and care of adults living within Scotland. The data is taken primarily from the Scottish Household Survey (SHS). Other sources used in this chapter include Scottish Community Care Statistics, 'The Same as You?' Annual Survey, and the Royal National Institute for Deaf People (RNID).

The results show that:

• Over 50 per cent of adults with a disability or long-term illness rated their health over the last year as 'not good' compared with 5 per cent of non-disabled people.
• Nearly one-third of adults with a disability have visited their GP on more than 10 occasions last year, compared with 5 per cent of non-disabled adults.
• Disabled adults and those with a long-term illness are more likely to smoke (32 per cent and 35 per cent respectively) compared to non-disabled adults (27 per cent).
• The most common type of disability reported in the SHS is problems relating to hands or feet (55 per cent of disabled adults).
• In 2001, it was estimated that over 30,000 people were admitted to hospital with a mental health illness.
• In 2003, there were 38,000 registered blind or partially sighted people in Scotland.
• There was estimated to be 758,000 deaf or hard of hearing people in Scotland in 2003.
• Forty-four per cent of disabled adults require regular help and care.

Self-assessed health

Respondents in the SHS are asked to rate their state of health over the past 12 months. The results, displayed in Table 6.1, show that over half of adults with a disability or long-term illness consider their health to be 'not good'. In contrast, only 5 per cent of adults without a disability or long-term illness view themselves in poor health.

There are only marginal differences between men and women in terms of the proportions describing their health as 'not good' (52 per cent of men and 54 per cent of women with a disability consider their health to be 'not good').

Adults' perception of their health varies considerably by age as shown in Chart 6.1.

S ource: Scottish Household Survey
Note: The data on which the percentages for the 16-24 age group would be calculated is less than 100 and is thus judged to be insufficiently reliable for publication.

We expect adults to report poorer health as they become older and this finding does hold for those adults without a disability or long-term illness. However, it is interesting to note that the proportion of disabled adults reporting poor health increases until the age of 59, and then starts to fall as they become older.

Visits to General Practitioners (GPs)

Virtually all adults in Scotland, whether disabled or not, are registered with a General Practitioner or Health Centre (99 per cent).

Disabled adults are significantly more likely to have visited their GP in the past 12 months. Only 6 per cent of adults with a disability did not see a GP or family doctor about their own health during the previous year. In comparison, a quarter (25 per cent) of adults without a disability or long-term illness have not seen their GP in the past 12 months. Nearly a third of adults with a disability (29 per cent) have visited their GP on more than 10 occasions in the last year compared with only 5 per cent of adults without a disability or long-term illness.

Source: Scottish Household Survey

The SHS asks those respondents who have seen their GP in the last 12 months, how many of the visits were home visits. The results are displayed in Table 6.2. Adults with a disability or long-term illness are more likely to receive a home visit from their GP than those without a disability/long-term illness. During the previous year, 30 per cent of disabled adults had seen their GP during a home visit, while only 6 per cent of adults without a disability or long-term illness received a home visit.

Table 6.3 shows that nearly all adults who rate their health as 'not good' will have visited their GP in the last 12 months (97 per cent). Adults in poor health are significantly more likely to see their GP during the year, than those in good health.

Of those adults who have visited their GP or family doctor on at least one occasion during the past year, nearly all (92 per cent) have been satisfied with their last visit. This finding holds across the disabled and non-disabled population with only one or two percentage point differences.

Smoking

Adults with a disability and/or a long-term illness are significantly more likely to smoke as shown in Table 6.4. There are 32 per cent of disabled adults and 35 per cent of adults with a disability and a long-term illness who smoke compared to 27 per cent of adults without a disability or long-term illness smoking.

Analysis shows that there are no significant differences between the proportion of men and women smoking, but there are differences by age. Specifically, younger people are more likely to smoke than older ones. Those most likely to smoke are aged between 25 and 34 years. Table 6.5 provides details of those smoking by age.

Type of disability or ill-health

Information is available from the SHS on the type of ill-health or impairment type for those adults with a disability or long-term illness. Table 6.6 shows that there are significant differences between disabled adults and adults with a long-term illness in terms of the type of illness or impairment type. Please note, the results in Table 6.6 are not comparable with the results from Chapter Five (Labour Market). Table 5.3 shows the main health problem affecting the respondent, thus only one response is permitted. In contrast, the SHS allows respondents to give as many reasons as they wish.

Disabled adults are more likely to experience physical problems (legs, arms, and back); 55 per cent of disabled adults have problems related to their legs or feet. The comparable figure for adults with a long-term illness is 22 per cent. However there are a higher proportion of adults with a long-term illness suffering from heart problems, chest or breathing problems and mental health problems.

Table 6.7 shows that the type of ill-health of disabled adults will influence their perception of their own health. For example, of those disabled adults or adults with a long-term illness who rate their health as good or fairly good, there are 38 per cent who have problems or disabilities related to their legs or feet. This increases to 45 per cent for those disabled/long-term ill adults who consider themselves to be in poor health. There are, however, some types of ill-health that do not influence self assessed health. For example, there are a similar proportion of adults in good/fairly good health and adults in poor health with diabetes.

Activities found difficult

The SHS asks respondents whether they find certain activities difficult to manage on their own. The results are presented in Table 6.8. [Note: for all of the tables on activities found difficult and for aids and adaptations, the comparisons made are between people with a disability, those with a long-term illness and those with both a disability and long-term illness]

Disabled adults are more likely to find each of the listed activities more difficult than adults with a long-term illness. Furthermore, the proportions finding the activities difficult are even higher if adults have both a disability and a long-term illness.

The activity found most difficult (out of those listed in the SHS) is climbing stairs; 59 per cent of disabled adults and 45 per cent of adults with a long-term illness have difficulty carrying out this activity and over 70 per cent of those adults with both a disability and a long-term illness consider themselves to have difficulties climbing stairs. Other common difficulties are walking and standing for more than 10 minutes and doing housework.

The SHS allows respondents to record as many activities as they find difficult. Table 6.9 shows that over 80 per cent of disabled adults and over 60 per cent of adults with a long-term illness find at least one or more activity difficult to manage on their own.

Over a quarter (27 per cent) of disabled adults find more than 5 of the activities difficult compared to 13 per cent of adults with a long-term illness.

Adaptations and equipment currently held

Disabled adults are more likely to have special equipment or adaptations to their home to help them to manage independently (47 per cent) than adults with a long-term illness (23 per cent).

There are considerable differences by sex and age in terms of the proportions having special equipment or adaptations to their home. Overall, there are 42 per cent of women (with a long-term illness, health problem or disability) who have special equipment or adaptations, compared with 33 per cent of men. Not surprisingly, those in older age groups are more likely to have special equipment/adaptations than their younger counterparts.

Tables 6.11 and 6.12 show the results by sex and age for those disabled, long-term ill and both disabled and long-term ill.

Information is available on the different types of adaptations and special equipment held by those disabled adults and adults with a long-term illness responding that they do currently possess such in their home. Table 6.13 shows that the most common form of adaptation within the home is a handrail with 52 per cent of disabled adults and 48 per cent of adults with a long-term illness having a handrail.

Adaptations and equipment needed

The SHS also asks respondents whether there are any adaptations or special equipment that they do not currently have, which would make it easier for them to manage independently. The results are shown in Table 6.14:

Nearly one in five adults with a disability and/or long-term illness could benefit from an adaptation or piece of special equipment to make things easier. For those who have both a disability and long-term illness the figure is 28 per cent.

It was noted earlier that women are more likely to have special equipment or adaptations to their home. Results also show that, when asked, women are also more likely to respond that they need special equipment/adaptations to help them to manage independently, compared to men. Table 6.15 shows that 22 per cent of women with a disability and/or long-term illness say they need special equipment/adaptations, compared to 16 per cent of men.

In general, the older adults are the more likely they are to need special equipment or adaptations to their home (Table 6.16). Twelve per cent of adults aged between 16 and 24 with a disability and/or long-term illness need some form of equipment or adaptation to their home. This figure increases to 23 per cent for adults aged 75 years and over with a disability and/or long-term illness.

The actual special equipment and adaptations needed by the disabled/ long-term ill population is provided in Table 6.17.

The special equipment and adaptations needed most are handrails and bath/shower seats with 24 per cent and 20 per cent of adults with a disability and/or long-term illness responding that they need these to manage independently.

Mental health

Mental health is central to the Scottish Executive's targets for health improve-ment in Scotland. The commitment to improving mental health is emphasised in all recent relevant policy documents and through the extensive work of the National Programme for Improving Mental Health and Well-being. Since its launch in October 2001, the National Programme has been working nationally and locally to raise the profile of, and to support further action in, mental health improvement (promotion and prevention), to address the stigma of mental ill-health and to prevent suicide in Scotland.

The number of men and women in each age group admitted to mental illness specialties during the year ending 31 March 2001 is shown in Table 6.18.

It was estimated that just over 30,000 people were admitted to hospital with a mental health illness in 2001, of which 52 per cent of admissions were men and 48 per cent were women. People aged 25 to 44 are most likely to be admitted with a mental health illness; 41 per cent of all admissions were in this age group.

Additional statistics on mental health illness within Scotland can be found on the website of ISD Scotland. ¹⁴

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