Do Area-Level Environmental Factors Influence Employment for People with Disability? A Scoping Review

Employment is an important social determinant of health and wellbeing. People with disability experience labour market disadvantage and have low labour force participation rates, high unemployment rates, and poor work conditions. Environmental factors are crucial as facilitators of or barriers to participation for people with disability. Understanding how the physical, social, and economic characteristics of local areas influence employment for people with disability can potentially inform interventions to reduce employment inequalities. We conducted a scoping review of research investigating associations between area-level environmental factors and employment for people with disability. Eighteen articles published between 2000 and 2020 met the inclusion criteria, and data were extracted to map the current evidence. Area-level factors were categorised into six domains relating to different aspects of environmental context: socioeconomic environment, services, physical environment, social environment, governance, and urbanicity. The urbanicity and socioeconomic environment domains were the most frequently represented (15 and 8 studies, respectively). The studies were heterogeneous in terms of methods and data sources, scale and type of geographic units used for analysis, disability study population, and examined employment outcomes. We conclude that the current evidence base is insufficient to inform the design of interventions. Priorities for future research are identified, which include further theorising the mechanisms by which area-level factors may influence employment outcomes, quantifying the contribution of specific factors, and interrogating specific factors underlying the association between urbanicity and employment outcomes for people with disability

Governing risk and older age during COVID-19 : contextualizing ageism and COVID-19 outbreaks in Australian aged care facilities during 2020

The infectious spread of the novel coronavirus (COVID-19) has generated numerous media and political responses that bring together health, risk, and age. Within these responses, older people have been cast as "the vulnerable elderly" who are less socially worthy and valuable than younger people, in poor health, and considered to be automatically at risk of COVID-19 due to their age. This simplistic connection between older age, frailty, and ill-health reduces older age to a medical and health problem, which perpetuates and deepens ageism. The implied connection has been particularly evident during the coronavirus pandemic through the imposition on older people, who are living in aged and long-term care facilities, of severe lockdown restrictions enforced through the processes of risk governmentality and authoritative control. These socio-political and institutional regulations have heightened the isolation from society that older people living in such environments already face, ironically further threatening their health and wellbeing. Drawing on Australian media reports and specific institutional responses imposed on or emerging from residential aged care that occurred during 2020, our theoretical examination reveals how ageism, risk discourses, and risk governance during the coronavirus pandemic jeopardized older Australian's health, wellbeing, and dignity of risk, while also reinforcing barriers to social inclusion. We conclude with suggestions for dealing with ageism including challenging the medicalisation of older age, promoting and supporting older people's dignity of risk, and radically changing our attitudes towards, and language regarding, ageing

Ageism and risk during the coronavirus pandemic

The sudden risk and spread of the coronavirus, which was declared a global pandemic by the World Health Organization (2020) on 11 March 2020, has indelibly etched itself into social and public consciousness. Faced with the threat of COVID-19 infections and deaths, and the potential for the pandemic to place increasing burdens on healthcare systems, many countries have ‘staged’ precautionary safety measures to slow or contain the spread of the coronavirus. These measures included closing territorial borders, enforcing temporary closures on trading, hospitality and recreational venues, and introducing new policing and legal powers, including strict ‘stay at home’ measures and increased surveillance of social lives (Fernandes, 2020). These risk management or risk migration strategies regulate the activities of individuals, populations and economic systems. They involve risk discourses or frames that can cause ‘othering’ of specific behaviours or populations, which help shape public thinking about risk and vulnerability (McCormick and Whitney, 2013). Such discourses also fuel a range of discriminatory attitudes and actions towards certain individuals and populations (IFRC, UNICEF and World Health Organization, 2020), including stigma based on age. In this chapter, we explore how the topic of COVID and age was framed or ‘staged’ in political and media discourses. Drawing on examples from Australian online media sources published in the early phase of the crisis (between March and April 2020), we shed light on how these risk discourses problematise and homogenise younger and older age groups as ‘risky’ and ‘at risk’, while also presenting confusing risk messages. To begin this discussion, we first explore some sociological perspectives on risk

Patients' perspectives of healthcare-associated infection: ‘you don't know what impacts it will have on your life’

Background: Healthcare-associated infections (HAIs) are not present on admission but are contracted while a patient is undergoing hospital treatment. While the prevalence of HAIs, and their causes and treatments have been researched in various contexts to date, patients' perspectives of contracting and living with the consequences of an HAI remain under-researched. Objective: To explore patients' experiences of having an HAI. Methods: A qualitative phenomenological study that drew on data from semi-structured interviews was conducted in order to explore the lived experiences of patients who had recently contracted an HAI while in hospital. Participants were recruited from two Australian hospitals in 2019 and 2021. Telephone interviews were conducted with 10 participants by two research team members, and transcripts from these interviews were analysed qualitatively using a thematic coding process to identify the patients' perspectives of contracting an HAI. Results: The participants had a range of different HAIs. The participants described how the experience of having an HAI can be very isolating and distressing from the patient's perspective, with life-long implications. This contributes to understanding of the way in which patients are impacted emotionally and mentally as a result of contracting an HAI. Conclusion: There is a need for improved, person-centred communication about the source, treatment and prognosis of HAIs. The findings from this study indicate the importance of considering patients' voices in their own health care

Adults with intellectual disability : choice and control in the context of family

This chapter about the experience of choice and control by adults with intellectual disability in the family context is offered against the background of the tripartite ecological theory of self-determination (Abery and Stancliffe, A tripartite-ecological theory of self-determination. In Wehmeyer et al. (Eds.), Theory in self-determination: Foundations for educational practice (pp. 43–78). Springfield, IL: Charles C. Thomas, 2003). The challenges in determining readiness for adult decision-making are discussed, as are the experiences of adults with intellectual disability when exercising choice and control within the family context. How families, including parents and siblings, influence decision-making by their family member with intellectual disability is summarized. The critical role of the family in supporting independent choice-making is also highlighted. The chapter ends with a call for research about skills and resources for families to become effective, knowledgeable, and confident supporters of their member with intellectual disability in the quest for adult self-determination