Differences in health outcomes are an important and well-documented dimension of inequality.
As discussed in Case and Kraftman (2022), there are marked differences in life expectancy and mortality by regions, gender, education groups, and measures of deprivation. In this commentary, we supplement that analysis by looking at differences and inequalities in the prevalence of disability and the degree to which health limits functional capabilities in the UK. This commentary studies differences in the prevalence of disability between education groups, regions, date of birth cohorts and genders. While there are a number of ways in which disability may affect outcomes, this commentary focuses particularly on employment as an outcome.
Disability is closely related to health conditions, but is not exactly the same. Some disabilities stem from health conditions directly, either from lifelong conditions which affect people since childhood, or from conditions, such as arthritis, that occur as people age. But some health conditions, for example high blood pressure or diabetes (which are two of the most prevalent conditions), can be managed by medication in a way that prevents them from causing functional limitations. Alternatively, older or obese individuals can become (more) disabled over time without any new diagnoses of health conditions. Because of this nuanced distinction between disability and health conditions, it is important to document the patterns of disability over the life course, and its causes and consequences. Disability relates more directly than health to the activities that individuals are able to do and whether they feel included by, and able to participate in, society. Thus inequalities in disability matter independently of inequalities in health.
When defining disability, we can think of it sitting somewhere in the middle of a spectrum going from specific health conditions over to subjective well-being. An analysis of disability, and inequalities in disability, gets closer to an analysis of subjective well-being than does an analysis of inequalities in health because it characterises individuals in part in terms of their subjective feelings about how limited and included they are, given the environments that they live in. These are precisely the kind of dimensions that have been shown to drive individual well-being.
In addition, issues around disability are related to some of the most pressing social and economic policy concerns of contemporary Britain, namely the impending huge burden of social care for the older aged population, the issue of rising labour market inactivity at older working ages particularly since the COVID-19 pandemic, the rapidly rising rate of disability benefit receipt across all age groups, and the staggering rise in mental health conditions for younger cohorts of working-age adults, young adults and children.
Disability is a protected characteristic in UK law under the Equality Act (2010), meaning that disabled individuals have a right not to be treated less favourably, or subjected to an unfair disadvantage, by reason of that characteristic. This right includes protection from discrimination at work, in education, as a consumer, and when accessing public services. Data on protected characteristics are required to be collected by organisations working in these areas, and such data then need to be treated differently than other data that are collected. The Equality Act protects characteristics such as disability precisely because they can be margins of frequent and systematic discrimination. Yet it is striking that there is significantly less large-scale systematic documentation and quantitative evidence on inequalities in disability, than on other protected characteristics such as gender, ethnicity and age. As a case in point to illustrate this, the first analysis of the effect of the COVID-19 pandemic on disabled workers (Jones, 2022) emerged well after the worst phases of the pandemic. In this work, the author points out that evidence on how the pandemic was affecting the disabled population was not prioritised during the pandemic itself, unlike the other three characteristics.
The relative lack of systematic evidence on inequalities in the prevalence of disability may be partly because disability itself is a highly complex issue. While some disabled individuals are easy to classify – for example, wheelchair users, the visually impaired or deaf communities, or those born with Down’s syndrome, cerebral palsy or other lifelong disabling medical conditions – others are less so. Physical and mental disabilities vary significantly, can be difficult to observe, are often a joint product of a person and their environment, and are reported by people’s ‘subjective’ evaluation of the degree of their functional limitations in the tasks they try to carry out. As such, defining disability in a way that covers all such cases can be complex. But analytical complexity should not be a bar to empirical analysis however, quite the opposite in fact.
In addition, it is important to note that, even for individuals where disability can be considered more ‘subjective’, this does not make it less worthy of analysis or study. People’s subjective evaluation of their ability to carry out activities and tasks of everyday life will matter for their own assessments of their material quality of life, but will also directly feed into their behaviour – the choices they and their families make – and hence the outcomes that they experience in the future. As discussed later on in this commentary, those choices, such as young people seeking more help with mental health conditions, can also lead to very real consequences on provision of public services and cannot be dismissed.
In this commentary, we give some summary, high-level evidence on the prevalence of disabilities and inequalities in disability over age, socio-economic status and region. We also focus on the interaction between disability and labour market participation. Our analysis is far from exhaustive but does provide a glimpse into how important, and how large, these inequalities are, how they steadily accumulate from early adulthood onwards, and how these patterns have been changing over time. There is a strong need for more work in the area, in particular work that can bring issues of inequalities in, and by, disabilities of different types more to the fore in the mainstream of empirical analysis of inequality.
We will show that inequalities in the prevalence of disability, defined across educational qualifications, are large. As with health inequalities, they emerge steadily across all ages of the life cycle, although this emergence is patterned somewhat differently for physical versus mental disabilities. These inequalities are highly consequential by the time a generation has reached older working age, being strongly related to both labour market participation and to quality of life. As a result, they will also have important consequences for inequalities in well-being in retirement as well as for future social care needs.
We document the emergence of large inequalities in mental health disabilities at younger ages for recent birth cohorts. This is likely to have consequences for future inequalities in broader disability and for the physical health of those cohorts in the future, 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 Kraftman (2022) chapter for the IFS Deaton Review.
Cite this as:
Banks, J., Karjalainen, H. and Waters, T. (2023), ‘Inequalities in disability’, IFS Deaton Review of Inequalities, https://ifs.org.uk/inequality/inequalities-in-disability