Desde otros puntos de vista: The Lancet y las discapacidades para el aprendizaje

Más de siglo y medio al servicio del conocimiento de las ciencias médicas desde la Gran Bretaña, la revista The Lancet no es una revista sólo para internistas.

Este es el Editorial de la semana pasada, sobre la influencia de la demografía en las discapacidades:

Demography still dictates destiny for children with disabilities

“Give me a child until he is seven and I will show you the man.” The idea that the early years of life are crucial to a person’s physical, cognitive, social, and emotional development is not new. Two reports published in the past week highlight the extent to which circumstances around a child can affect their future health, wellbeing, and lifecourse—and build a compelling case for governments to prioritise the interests of children in a climate of austerity.

About one in 50 people in England have a learning disability, a significant general impairment in intellectual functioning acquired during childhood. People with learning disabilities have worse health and increased age-adjusted mortality than their peers. The Learning Disabilities Public Health Observatory (Improving Health and Lives), part of Public Health England, collates current research and new analyses from the UK’s Millennium Cohort Study (MCS) in their report The determinants of health inequities experienced by children with learning disabilities. Focusing not on those health differences that are to some extent unavoidable (eg, congenital abnormalities associated with syndromes such as Down’s and Prader-Willi) nor factors that affect adults with learning disabilities (such as transition between children’s and adults’ care, or limited opportunities within the workforce), the report finds that children with learning disabilities are at increased risk of exposure to all major categories of social determinants that adversely affect health.

Children with learning disabilities are more likely to live in poor housing and to be exposed to tobacco smoke and environmental toxins than their non-disabled peers. They are less likely to have adequate nutrition or to have been breastfed. They have increased risk of exposure to family, peer, and community violence—including physical, sexual, or emotional abuse, bullying, and neglect. Parents of children with learning disabilities are at increased risk of mental health problems compared with other parents; children with learning disabilities are less likely to have a close relationship with their parents, and more likely to be exposed to inconsistent or harsh parenting and to grow up in chaotic family environments. Children with learning disabilities are not just at increased risk of exposure to material and psychosocial hazards to their health; they are also less likely than their peers to be resilient in the face of these threats—partly due to difficulties in executive functioning, self-regulation, and problem-solving, and partly because they have less access to protective factors such as wealth, social connections, and timely access to health and welfare services.

The association between a family’s socioeconomic position and their child’s learning disability is no coincidence. People with learning disabilities are more likely to become poor, remain poor, and experience longer periods of poverty than their peers, and are less likely to escape from poverty. Analysis of data from the MCS showed that exposure to income poverty on two or more occasions was associated with increased risk of poor health for six of 13 indicators of general health and for all six indicators for mental health in children with learning disabilities in England.

In the same week, four studies from the Social Policy in a Cold Climate programme at the Centre for Analysis of Social Exclusion (CASE) published their findings on social mobility and educational attainment. Downward mobility, opportunity hoarding and the ‘glass’ floor used data from the 1970 British Cohort Study (BCS70) to assess factors that contribute to children from privileged backgrounds achieving better-paid employment in later life, an association which holds across the distribution of cognitive skills attained in childhood. This study showed that the social gradient is caused mostly by education, and by childhood social and emotional skills such as self-esteem and locus of control—just those non-cognitive skills that are often challenged in children with learning difficulties born into less advantaged families.

The conclusions from both reports are clear. If policy-makers are serious about their expressed desires to improve the lives of children and the health and wellbeing of future adults, they must focus not only on reducing child poverty, but also on reducing exposure to specific hazards that affect children born to poor families disproportionately, and on building resilience through action on health and social inequities. If politicians truly want to be able to say to their own children “This generation did the right thing”, challenging health and social inequities in childhood is the place to start.

Muy bueno para la reflexión.

X. Allué (Editor)

(Nota: Quien precise una traducción al español o al catalán , sólo tiene que pedírnosla.)