POVERTY AND INTELLECTUAL DISABILITY

by Sheila Nevin, Psychologist in Clinical Training

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As part of its Public Lecture Series 2004, the UCD Centre for Disability Studies, with the Department of Social Policy and Social Work, hosted a lecture on ‘poverty and intellectual disability’ by Professor Eric Emerson of Lancaster University, UK, on 22 January 2004.

‘In policy making, we ignore poverty at our peril.’

Professor Emerson began the lecture with a brief focus on absolute poverty, which has been defined in terms of ‘severe deprivation’ (e.g. Gordon et al., 2003) which ‘puts health and life in danger’. We learned that these types of severe deprivation are related to intellectual disability in the developing world. In Chad, for example, nearly half of all children experience ‘significant failure to thrive’. As a result of this, one may expect a high incidence of intellectual disability. Professor Emerson explained that the poverty issue for our richer countries (e.g. USA, UK, Ireland) is one of ‘relative poverty’. He asked us to remember that ‘the concerns of richer countries on this topic pale into insignificance when one considers the situation in the developing world where they experience absolute poverty. However, Professor Emerson’s focus in the lecture was primarily concerned with the relative poverty of richer nations of the developed world, and on ‘what we know about the extent of poverty and the impact of poverty’.

UNICEF (2000) identified the challenge of child poverty, and the fact that a significant proportion of children are living in poverty, as one of the most important and critical factors that richer countries need to face. A common definition of poverty is that it is less than half of the national median household income. From the league table of child poverty, as recorded in the mid-1990s, it could be seen that 1 in 5 children in the UK live in poverty. Professor Emerson made the point that this need not be the case; in many of the Nordic countries relative poverty is minimal. Worryingly, the figures show a steady rise in child poverty from the 1970s to the present (e.g. Darton and Strelitz, 2003), with a rise of from 15% (1978) to 30% (late 1990s) in the UK, and from 15% (1973) to 30% (1994), in Ireland. These figures show that up to one in three children live in relative poverty in the UK and Ireland.

The impact of socio-economic status on health and development.

Professor Emerson said that there is clear evidence that social inequalities and relative poverty are bad for people’s health: ‘the jury is not out on this one!’ He explained that the research evidence is clear, using key health indicators, for example low birth weight. It was shown that in the USA, where there is the highest rate of relative poverty, there are also the lowest birth weights. This ‘social inequality’ exists within the US healthcare system where the greatest amount of money is spent—and the most unequal distribution to the population being served.

In an examination of ‘household income and child health’, Professor Emerson quoted his own recent research which found that the prevalence of intellectual disability almost doubled within the poorest families, compared with the richest families. The next point he made was in relation the ‘goodness-of-fit’ between policy makers and service providers (who mainly tend to come from middle class families) and the families they serve. The importance of trying to understand the actual conditions within which poorer families live needs to be taken into account: ‘In policy making, we ignore poverty at our peril.’ Professor Emerson also made the point that professionals working in the field may tend to consider parents as ‘reckless’ or non-compliant when they don’t seem to cooperate in a suggested treatment/behavioural programme for their child. He stressed that the importance of poverty in the lives of such families needs to be taken into account when considering appropriate programmes or interventions. This understanding also needs to be emphasised in the training programmes for those working in the field.

In ‘linking poverty to health’, the Professor spoke of a ‘sensitive period’ for intellectual development, which has been well documented in the literature on early intervention and prevention. He also noted the utmost importance of the cumulative life-course pathways of risk that can exist in the lives of certain individuals, especially those who find themselves living under conditions of relative poverty.

In terms of ‘intellectual disability policy’, there is a need to look more closely at ‘resilience’, and a need to ask why it is that some children manage to survive, regardless of early difficulties, and to develop strategies to help increase resilience in children with intellectual disability. This is of importance for those involved in service provision in order to counter the cumulative adversity with which children with intellectual disability are often faced.

‘Poverty as an explanatory construct’

Professor Emerson gave some examples of existing well-accepted findings within the intellectual disability literature and how this research might be re-formulated taking poverty into the equation. He instanced research on the relationship between maternal distress and children with difficult behaviour. Almost no studies have examined the hypothesis that the experience of maternal distress may be moderated by poverty. So, for example, a mother with a child with difficult behaviour may experience more distress if she and her family are living in conditions of relative poverty. Another question to consider is why the emotional and behavioural needs of children with intellectual disability are greater than for children without intellectual disability. Professor Emerson said that many of the findings in the literature tend to explain the difference by putting it down to the ‘intellectual disability’. However, he encouraged us to consider a wider conceptualisation that could embrace such outside factors as relative poverty. ‘There is a need to disentangle how much of the construct is about the intellectual disability, and how much is about poverty’. Professor Emerson wondered if the increased emotional and behavioural needs of children with disability, as opposed to their non-disabled peers, could be related to ‘poor health’, which is related to poverty and intellectual disability.

Professor Emerson concluded his lecture with a powerfully appropriate quote from Mahatma Gandhi: ‘Poverty is the worst form of violence.’ A number of questions were then addressed to Professor Emerson, including how best professionals and policy makers might move forward? He emphasised the need to create connections between disability policy and poverty policy. ‘Both exist but they are not connected’, he said, ‘and we cannot safely assume that the work on poverty reduction will automatically reach the children with intellectual disability.’ Another area of critical importance, according to Professor Emerson, is the area of intensive early-intervention services to diminish the higher developmental risk of children with intellectual disability who live in relative poverty.

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