The Living Conditions of Working Age Adults with a Disability: Poverty and Low Socio-economic Position

Living in poverty has long been known to be associated with increased risk of mortality and morbidity (e.g. Krieger, 2011; Marmot et al., 2008; World Health Organization and Calouste Gulbenkian Foundation, 2014; World Health Organization Regional Office for Europe, 2014). In addition, studies undertaken in high-income countries have consistently reported that working age adults with disabilities are significantly more likely to be living in poverty than their non-disabled peers (e.g. Brucker & Houtenville, 2015; Emerson et al., 2018; Heslop & Emerson, 2017). The link between poverty and disability is also evident in low- and middle-income countries (Banks et al., 2017). Despite these strong associations, surprisingly few studies have investigated the association between poverty and health among working age adults with disabilities. The scant evidence that does exist suggests that exposure to poverty among people with disabilities is associated with poorer self-rated health (e.g. Emerson & Hatton, 2008; Emerson, Hatton, Baines, & Robertson, 2016).

Working age adults with disabilities are more likely to live in poverty than their peers.

• • In Australia in 2016, 38% of working age adults with disabilities experienced one or more financial stressor, compared with 18% of non-disabled working age adults (Emerson et al., 2018)
• • In the United Kingdom in 2012, 30% of working age adults with disabilities were living in poverty compared with 13% of non-disabled working age adults (Heslop & Emerson, 2017)
• • In the United States in 2017, 26% of working age adults with disabilities were living in poverty compared with 11% of non-disabled working age adults (Fontenot et al., 2018)

The association between poverty and health appears to be mediated, in part, by the association between poverty and the probability of engaging in some riskier health behaviours (e.g. smoking, physical inactivity). Given the association between poverty and disability, it is not surprising that smoking rates are higher among people with disabilities than among their non-disabled peers (Australian Institute of Health and Welfare, 2016; Courtney-Long, Stevens, Caraballo, Ramon, & Armour, 2014; Emerson, 2018), and that people with disabilities are more likely to be physically inactive (Australian Institute of Health and Welfare, 2016).

Employment

Employment is an important social determinant of health, with a well-established evidence-base demonstrating negative effects of unemployment, employment insecurity, and poor psychosocial job quality on physical and mental health (Marmot et al., 2008).

Working age adults with disabilities are more likely to be unemployed or not in the labour force than those without disabilities.

• • In Australia in 2016, 41% of working age adults with disabilities were not in the labour force compared to 16% of non-disabled working age adults; of those in the labour force, 13% of adults with disabilities were unemployed compared with 5% of non-disabled adults (Emerson et al., 2018)
• • In the United Kingdom in 2012, 51% of working age adults with disabilities were not in the labour force compared with 17% of non-disabled working age adults; of those in the labour force 9% of adults with disabilities were unemployed compared with 7% of non-disabled adults (Heslop & Emerson, 2017)
• • In the United States in 2017, 58% of working age adults with disabilities were not in the labour force compared with 19% of non-disabled working age adults; of those in the labour force 12% adults with disabilities were unemployed compared with 5% of non-disabled adults (Fontenot et al., 2018)

A comparison of countries in the Organization for Economic Co-operation and Development using data from 2003 to 2006 demonstrated large inter-country variation in employment rates between people with and without disability, ranging from 70% lower for people with disability in South Africa and 62% in Japan, to only 8% lower in Malawi and 19% in Switzerland (World Health Organization and the World Bank, 2011). There is also evidence that people with disabilities are less likely to enjoy optimal working conditions (Milner, Krnjacki, Butterworth, Kavanagh, & LaMontagne, 2015) and more likely to be underemployed (Milner et al., 2017) and underpaid (Hogan, Kyaw-Myint, Harris, & Denronden, 2012).

There is some evidence that poor employment outcomes impact on the health of people with disabilities. The negative mental health effects of becoming unemployed, economically inactive or underemployed have been found to be greater tor people with a disability compared to those without (Milner et al., 2017; Milner et al., 2014). For young people who acquired a disability, one of the determinants of poor mental health trajectories was unemployment (Kariuki, Honey, Emerson, & Llewellyn, 2011). Finally, a study examining the association between disability acquisition and mental health found evidence that the deterioration in mental health was predominantly explained by material socioeconomic factors including employment (Aitken, Simpson, Gurrin, Bentley, & Kavanagh, 2018). These findings highlight the importance of employment tor the health of people with disabilities.