Health Inequity and Children with Intellectual Disabilities

The limited evidence that is available indicates that children with intellectual disabilities are at increased risk of exposure to all of the major categories of social determinants of poorer physical and mental health. They are more likely to live in households characterized by low socioeconomic position (SEP) and poverty, and to be exposed to recurrent poverty. Over time they are more likely to become poor and less likely to escape from poverty. They are more likely to be exposed to a wide range of material and psychosocial hazards that are detrimental to their health, including inadequate nutrition; poor housing conditions; exposure to environmental toxins; family, peer, and community violence; poor parenting; and family instability. They are also less likely to have access to the resources necessary to build resilience in the face of adversity. However, the published literature in this area is highly variable in its scope and quality. In order to better identify and understand health inequities in this particularly vulnerable group of children, we suggest the following priorities for future research: (1) longitudinal studies using the extensive network of cohort studies in high-income countries to elucidate pathways and mechanisms in the association of low family SEP with childhood intellectual disability and to strengthen the evidence base on the combined impact of SEP and intellectual disability on health and well-being across the life course; (2) cross-sectional and longitudinal studies in different country settings to strengthen the evidence base in areas where it is weak; (3) controlled interventions designed to test approaches to reducing discrimination and strengthening resilience at both an individual and societal level.