The effects of Neoliberal policies on access to healthcare for people with disabilities

Neoliberal reforms lead to deep changes in healthcare systems around the world, on account of their emphasis on free market rather than the right to health. People with disabilities can be particularly disadvantaged by such reforms, due to their increased healthcare needs and lower socioeconomic status. In this article, we analyse the impacts of neoliberal reforms on access to healthcare for disabled people. This article is based on a critical analytical review of the literature and on two case studies, Chile and Greece. Chile was among the first countries to introduce neoliberal reforms in the health sector, which led to health inequalities and stratification of healthcare services. Greece is one of the most recent examples of countries that have carried extensive changes in healthcare, which have resulted in deterioration of the quality of healthcare services. Through a review of the policies performed in these two countries, we propose that the pathways that affect access to healthcare for disabled people include: a) Policies directly or indirectly targeting healthcare, affecting the entire population, including disabled people; and b) Policies affecting socioeconomic determinants, directly or indirectly targeting disabled people, and indirectly impacting access to healthcare. The power differentials produced through neoliberal policies that focus on economic rather than human rights indicators, can lead to a category of disempowered people, whose health needs are subordinated to the markets. The effects of this range from catastrophic out-of-pocket payments to compromised access to healthcare. Neoliberal reforms can be seen as a form of structural violence, disproportionately affecting the most vulnerable parts of the population – such as people with disabilities – and curtailing access to basic rights, such as healthcare

Occupational therapy on the margins

This article discusses occupational therapy’s pursuit of social concerns through practice with marginalised groups or engaging with diversity. In this article we understand the term marginalisation as referring to people who are socially excluded from the rest of the society in which they live because of some economic, cultural, or social difference. We take the perspective that the experiences of marginalised people offer one means of assessing public health and social cohesion. We also explore the profession’s recent literature on social transformation. Occupational therapy’s narrow demographic profile and dominance of a Northern discourse are critically discussed in terms of engagement with how the problems of marginalisation, such as health inequality and poverty, impact on occupation. We address some of the problems which arise through professional and organisational power when working with marginalised people. The article concludes with an overview of the complexity of challenges in developing actions to meet diverse needs from a profession that is still growing

Healthcare access for refugee women with limited literacy: layers of disadvantage

Background Record numbers of people, across the world, are forced to be displaced because of conflict or other violations of their human rights, thus becoming refugees. Often, refugees not only have a higher burden of disease but also compromised access to healthcare, as they face many barriers, such as limited knowledge of the local language. However, there is very limited knowledge on the lived experiences of this population. Moreover, the strategies people might develop in their efforts to access healthcare have not been explored in depth, despite their value in establishing peer- support, community based programs. Methods In this article, we present the findings of a study aiming to explore the lived experiences of accessing healthcare in the greater Vancouver area for recently-arrived, government-assisted refugee women, who were non-literate and non-English-speaking when they arrived in the country. We carried out sixteen semi-structured interviews with eight refugee women, guided by descriptive phenomenology. Results The findings highlight the intersection of limited knowledge of the local language with low literacy, gender, and refugee status and how it impacts women’s access to healthcare, leading to added layers of disadvantage. We discuss three themes: (1) Dependence, often leading to compromised choice and lack of autonomy, (2) Isolation, manifesting as fear in navigating the healthcare system, rejection, or shame for a perceived inadequacy, and (3) Resourcefulness in finding ways to access healthcare. Discussion We propose that a greater understanding of the intersections of gender, low literacy, and refugee status can guide healthcare workers and policy makers in improving services for this population. Furthermore, It is important to enable seldom-heard, hard to reach populations and facilitate their participation in research in order to understand how vectors of disadvantage intersect

Barriers to accessing maternal care in low income countries in Africa: a systematic review

The new Sustainable Development Goals (SDGs) to 2030 aim to reduce maternal mortality and provide equitable access to maternal healthcare. Compromised access to maternal health facilities in low-income countries, and specifically in Africa, contribute to the increased prevalence of maternal mortality. We conducted a systematic review to investigate access barriers to maternal health in low-income countries in Africa since 2015, from the perspective of both community members and health providers. The findings show that the most important barriers to maternal health are transportation barriers to health facilities, economic factors, and cultural beliefs, in addition to lack of family support and poor quality of care. Further research is required to guide policymakers towards firm multi-sectoral action to ensure appropriate and equitable access to maternal health in line with the SDGs to 2030

The occupational therapist as a political being

In this article we argue for the development of an understanding of human occupation as being inherently political. Occupational therapy is broadly about the experience of ‘doing’ as the basis of social participation. This requires access to the means of participation: space, facilities and resources for different forms of human action, and occupational therapists need to develop an understanding of how access to these means is regulated. In this article we develop an argument for the development of a political occupational therapy. We do this by outlining the role of occupational therapists as activists as well as reflectors drawing on comparisons with cultural practice in community publishing; by discussing the development of a language that will enable the recognition and exploration of power differentials, and by delineating the importance of experiential knowledge

Depressive symptoms in people with disabilities; secondary analysis of cross-sectional data from the United Kingdom and Greece

Background: Evidence suggests there is an association between depressive symptoms and disability. Objective/Hypothesis: The objective of this study was to examine whether people with disabilities in the United Kingdom and Greece face more depressive symptoms than people without disabilities. The hypothesis was that people with disabilities in both countries are more likely to experience depressive symptoms. Methods: We used data from the 2014 European Health Interview Survey (wave 2). After performing principal-component factor analysis, we carried out logistic regressions, in order to investigate differences in depressive symptoms between people with and without disabilities, and examine the factors affecting depressive symptoms for people with disabilities. Results: People with disabilities in the UK were 2.8 times more likely to experience depressive symptoms compared to people without disabilities (95% C.I.: 2.51-3.05, p < 0.001), while in Greece, they were 2.2 times more likely to do so (95% C.I.: 1.90-2.64, p < 0.001). Our findings regarding people with disabilities showed that women, older people (in Greece), unemployed and inactive people (in Greece), and better-educated people (in the UK) were more likely to experience depressive symptoms. Married people, older people (in the UK), people living in densely-populated areas (in Greece), people who assessed their health as ‘average’ or ‘good’, and people who enjoyed social support (in Greece) were less likely to face depressive symptoms. Conclusions: Due to population-ageing and higher incidence of depressive symptoms in disabled people, it is important that policies are put in place to address the mental health needs of this population

Access to health care in an age of austerity: disabled people’s unmet needs in Greece

Since late 2009, Greece has been dealing with the effects of a debt crisis. The neoliberal principles embedded in the three structural adjustment programmes that the country accepted have required radical cuts in health care funding, which in turn have led to widening inequalities in health. This article focuses on access to health care for people with disabilities in Greece in the context of these structural adjustments. We investigate possible differences in unmet health care needs between people with and without disabilities, using de-identified cross-sectional data from the European Health Interview Survey. The sample included 5,400 community-dwelling men and women aged 15 years and over. The results of the logistic regressions showed that people with disabilities report higher unmet health care needs, with cost, transportation, and long waiting lists being significant barriers; experience of all barriers was positively associated with low socioeconomic status. These findings suggest that a section of the population who may have higher health care needs face greater barriers in accessing services. Austerity policies impact on access to health care in both direct and indirect ways, producing long-term disadvantage for disabled people. Social policies and comprehensive anti-discrimination legislation might help to address some of the barriers this population faces

Access to health care for men and women with disabilities in the UK: a secondary analysis of cross-sectional data

Objectives: The aim of this study was to investigate differences in access to health care between people with and without disabilities in the UK. The hypotheses were that: a) people with disabilities would be more likely to have unmet health care needs; and b) there would be gender differences, with women more likely to report unmet needs. Setting and Participants: We performed secondary analysis, using logistic regressions, of de-identified cross-sectional data from the European Health Interview Survey, Wave 2. The sample included 12,840 community-dwelling people over the age of 16 from across the UK, 5,236 of whom had a disability. The survey method involved face-to-face and telephone interviews. Outcome measures: Unmet need for health care due to long waiting lists, or distance or transportation problems; not being able to afford medical examination, treatment, mental health care, or prescribed medicines. All measures were self-reported. Results: Adjusting for age, sex, and other factors, people with a severe disability had higher odds of facing unmet needs. The largest gap was in ‘unmet need for mental health care due to cost’, where people with a severe disability were 4.5 times (CI 95%: 2.2-9.2) more likely to face a problem, as well as in ‘unmet need due to cost of prescribed medicine’, where people with a mild disability had 3.6 (CI 95%: 2.2-5.9) higher odds of facing a difficulty. Women with a disability were 7.2 times (CI 95%: 2.7-19.4) more likely to have unmet needs due to cost of care or medication, compared to men with no disability. Conclusions: People with disabilities reported worse access to health care, with transportation, cost, and long waiting lists being the main barriers. These findings are worrying as they illustrate that a section of the population, who may have higher health care needs, faces increased barriers in accessing services

Enacting varieties of subjectivity through practices of care: a story of living with Motor Neuron Disease

People living with disability or chronic illness often use practices of care to construct a version of life they are satisfied with. Drawing from a narrative-based study with people living with motor neuron disease, I show how one couple tried to be recognized as active agents in their life, while oscillating between positions of less and more power. Through an examination of the practices of care that the couple enacted, I illustrate how their positioning in relation to practices of care helped them create meaning in their life. In their efforts to create a way of living they were satisfied with they engaged in negotiations between varieties of subjectivity. Their subjectivity was not static, but was constructed as they shared power to carry out everyday self-care activities. The findings also underline the importance for healthcare practices of exploring the experiential knowledge of people living with MND

Home modifications and ways of living well

People living with a disability or illness and health care professionals often have different perspectives on what needs to be done, and why, in order to create a life they can recognize as good. Focusing on home modifications, I explore the enactment of diverging perspectives on the desired good. I show how one couple living with the effects of motor neuron disease in Wales tried to create a way of living. Drawing from a narrative-based study, I explore what happens when there is an interaction of different perspectives of what is considered to be a desirable outcome. I argue that the construction of some expectations as needs, and others as desires, serves to subjugate people to certain technologies. These technologies are those deemed necessary, following a neo-liberal language of cost-effectiveness where desires can be seen as liabilities