Differences in health status are an important and well-documented aspect of inequality.
As discussed in Case and Kraftman (2022), there are notable differences in life expectancy and mortality across regions, sexes, education groups and measures of deprivation. This commentary complements that analysis by looking at differences and inequalities in the prevalence of disability in the UK and the extent to which health limits functional ability. This commentary studies differences in the prevalence of disability across education groups, regions, birth cohorts and sex. There are many ways in which disability can affect outcomes, but this commentary focuses specifically on employment as an outcome.
Disability is closely related to, but not exactly the same as, health conditions. Some disabilities result directly from health conditions, either from lifelong conditions that affect people from childhood onwards, or from conditions such as arthritis that develop as a person ages. However, some health conditions, such as high blood pressure and diabetes (the two most common conditions), can be managed with medication so that they do not cause functional limitations. On the other hand, older people and people who are obese may become (more) disabled over time, even without a new diagnosis of a health condition. Because of these subtle differences between disability and health conditions, it is important to document patterns of disability over the lifespan, and their causes and consequences. Disability, more so than health, is directly related to the activities individuals can perform and whether they feel accepted and able to participate in society. Disability inequalities are therefore important independently of health inequalities.
In defining disability, we can think of it as lying somewhere in the middle of a spectrum that goes from a particular health condition to subjective well-being. An analysis of disability, and of disability inequalities, is closer to an analysis of subjective well-being than an analysis of health inequalities, because it characterizes individuals in terms of their subjective feelings of how limited and accepted they are, given the environment in which they live. These are exactly the kinds of aspects that are known to determine an individual’s well-being.
Furthermore, issues around disability are linked to some of the most pressing socio-economic policy concerns in contemporary Britain: the imminent and enormous social welfare burden on the ageing population, the problem of labour market inactivity among older working age people which has increased particularly since the COVID-19 pandemic, the sharp rise in disability benefit receipt across all age groups, and the alarming increase in mental health conditions among working age adults, young adults and young children.
Disability is a protected characteristic in UK law under the Equality Act (2010) and disabled individuals have the right not to be treated less favourably or unfairly disadvantaged because of that characteristic. This right includes protection from discrimination in the workplace, in education, as consumers and in access to public services. Data on protected characteristics must be collected by organisations operating in these areas and such data must be treated differently from other data collected. The Equality Act protects characteristics such as disability precisely because they may be borders on frequent and systematic discrimination. However, it is striking that there is significantly less extensive and systematic documentation and quantitative evidence on inequalities with respect to disability than there is for other protected characteristics such as gender, ethnicity and age. As a case in point, the first analysis of the impact of the COVID-19 pandemic on disabled workers (Jones, 2022) appeared long after the worst of the pandemic had passed. In this study, the authors point out that evidence on how the pandemic is affecting disabled populations was not prioritised over the pandemic itself, unlike the other three characteristics.
The relative lack of systematic evidence on inequalities in the prevalence of disability may be because disability itself is a very complex issue. Some disabled people are easy to classify – for example, wheelchair users, blind or deaf people, people born with Down syndrome, cerebral palsy, or other medical conditions with lifelong disabilities – while others are not. Physical and mental disabilities vary widely, can be difficult to observe, are often a co-product of the individual and his or her environment, and are reported by people’s “subjective” assessment of the degree of functional limitation in the tasks they are trying to perform. Defining disability in a way that covers all such cases can therefore be complicated. However, analytical complexity should not be an obstacle to empirical analysis, but rather the opposite.
Moreover, it is important to bear in mind that even in the case of individuals whose disabilities may be considered more “subjective”, this does not make them any less valuable for analysis and research. People’s subjective assessments of their ability to carry out activities and tasks of daily life relate to their assessment of their own material quality of life, but also directly influence their behaviour – the choices they and their families make – and therefore the outcomes they will experience in the future. As we will explain later in this commentary, choices such as young people seeking more help for their mental illness can have very real consequences for public service provision and cannot be ignored.
In this commentary, we present some summary, high-level evidence on the prevalence and inequalities of disability by age, socio-economic status and region. We also focus on the interplay between disability and labour market participation. Our analysis is not exhaustive, but it provides a glimpse into how important and large these inequalities are, how they steadily accumulate from early adulthood, and how these patterns have changed over time. There is a strong need for research in this field, particularly that can bring the issue of inequalities across and by different types of disability more to the fore in mainstream empirical analysis of inequalities.
We show that inequalities in the prevalence of disability as defined by educational qualifications are large. Like health inequalities, these inequalities are manifested steadily across all ages of the life cycle, although they are manifested somewhat differently for physical and mental disabilities. These inequalities are strongly related to both labour market participation and quality of life, with significant implications for generations as they reach older working age. As a result, they also have important implications for inequalities in retirement well-being and future social welfare needs.
We document large inequalities in mental disability among young people in recent birth cohorts. This may have implications for wider disability inequalities and the future physical health of these cohorts, particularly given the links between mental health and health behaviours and social participation, each of which are risk factors for future physical health and longevity, as pointed out by Fancourt and Steptoe (2022) in their commentary on the Case and Craftsman (2022) chapter in the IFS Deaton Review.
To quote:
Banks, J., Karjalainen, H. and Waters, T. (2023), “Inequalities in Disability”, IFS Deaton Inequality Review, https://ifs.org.uk/inequality/inequalities-in-disability