A cascade of disparities: Health and health care access for people with intellectual disabilities
Abstract
People with ID represent approximately 2% of the population and, as a group, experience poorer health than the general population. This article presents recent conceptualizations that begin to disentangle health from disability, summarizes the literature from 1999 to 2005 in terms of the cascade of disparities, reviews intervention issues and promising practices, and provides recommendations for future action and research. The reconceptualization of health and disability examines health disparity in terms of the determinants of health (genetic, social circumstances, environment, individual behaviors, health care access) and types of health conditions (associated, comorbid, secondary). The literature is summarized in terms of a cascade of disparities experienced by people with ID, including a higher prevalence of adverse conditions, inadequate attention to care needs, inadequate focus on health promotion, and inadequate access to quality health care services. Promising practices are reviewed from the perspective of persons with ID, providers of care and services, and policies that influence systems of care. Recommendations across multiple countries and organizations are synthesized as guidelines to direct future action. They call for promoting principles of early identification, inclusion, and self‐determination of people with ID; reducing the occurrence and impact of associated, comorbid, and secondary conditions; empowering caregivers and family members; promoting healthy behaviors in people with ID; and ensuring equitable access to quality health care by people with ID. Their broadscale implementations would begin to reduce the health disparity experienced by people with ID. MRDD Research Reviews 2006;12:70–82. © 2006 Wiley‐Liss, Inc.
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Previous reviews have investigated healthcare-access issues for people with intellectual disability.
“While previous reviews have investigated healthcare-access issues for people with intellectual disability,9,10”
From Barriers and facilitators to primary health care for people with intellectual disabilities and/or autism: an integrative review (2020) · cites this paper as [10]
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Health advocacy: a vital step in attaining human rights for adults with intellectual disability
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Hatton, C., & Emerson, E. (2015) · International Review of Research in Developmental Disabilities · doi:10.1016/bs.irrdd.2015.04.001 · Cited by 27 · see citing works
Goldschmidt, J. (2017) · Qualitative Health Research · doi:10.1177/1049732316644415 · Cited by 18 · see citing works
- Authors
- Krahn, G. L., Hammond, L., & Turner, A.
- Affiliations
- Oregon Health & Science University (US)
- Corresponding author
- Krahn, Gloria L.
- Venue
- Mental Retardation and Developmental Disabilities Research Reviews
- Publisher
- Wiley
- Published
- 2006-01
- Volume
- 12
- Issue
- 1
- Pages
- 70-82
- ISSN
- 1080-4013 (ISSN-L)
- 1098-2779
- OpenAlex
- W2044631678
- Cited by
- 775
- References
- 110
- Citations by year
- 2026: 27 · 2025: 38 · 2024: 51 · 2023: 45 · 2022: 43 · 2021: 44 · 2020: 50 · 2019: 48 · 2018: 54 · 2017: 58 · 2016: 44 · 2015: 49 · 2014: 45 · 2013: 49 · 2012: 43
- FWCI
- 9.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Mental Retardation and Developmental Disabilities Research Reviews (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Münchner Zentrum für Gesundheitswissenschaften
- National Institute on Disability and Rehabilitation Research
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Down syndrome and intellectual disability research
- Social Sciences › Safety Research › Disability Rights and Representation
- Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
- Keywords
- intellectual disability, health disparities, health care access, health promotion, comorbidities, secondary conditions, associated conditions, health determinants, health equity, caregiver empowerment, family involvement, self-determination, early detection, inclusion, health policy, quality of care
- MeSH terms
- Cross-Cultural Comparison, Health Services Accessibility, Health Services Needs and Demand, Health Status, Humans, Intellectual Disability, Reference Values, Social Justice
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