How can blind and partially sighted people break out of the ‘poverty cycle’?

Post date: 
Wednesday, 4 October 2017
David Allen

David Allen, Chief Executive at the Faculty of Public Health, is passionate about social inclusion for people with disabilities. In his blog, he offers some practical steps to ensure people with sight loss enjoy health in all aspects of life.

 

Background

 
“I started my career in the sight loss sector almost by accident. In 1990, I got a job at a local college researching employment support services for blind and partially sighted people. From there I went into regional and then national service management for RNIB and finally, went on to lead UK and European engagement on prevention of blindness initiatives.  
 
“When I first started out, blind and partially sighted people were still struggling to get bank statements in large print or braille, never mind having speech output on a smartphone or audio-access to an ATM. And if you don’t have control over your money, it’s a good bet that you may not have as much control over your general health and wellbeing as those who do.
 

What is health?

“In many ways, our health is shaped by our social and economic environment as well as our physical surroundings. The activities we get involved in; the communities we live in and also the local economy (transport links, housing, safety, parks and green spaces) all impact enormously on our health. 
 
“Before I go on, I want to define the issue in hand. What do I mean by ‘enjoying health’? 
 

“Compellingly, the World Health Organisation (WHO) defines health as ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’. Effectively, what WHO is saying is that it’s not enough just not to be ill: you need to be well.  

How do these determinants of health play out for disabled people?
  
“The story isn’t good at a population level. There are six million people in the UK with uncorrected refractive error and sight-threatening conditions and around 350,000 people who are registered as blind or partially sighted.  
 
“There is about an 82 per cent employment rate in the non-disabled population, which drops to 49 per cent amongst disabled people. And for blind and partially sighted people, this figure goes down to 25 per cent. In addition, the pay gap between disabled and non-disabled people widened by one-third between 2010 and 2014.
 
“In education, disabled people are three times more likely to have no formal qualifications as non-disabled populations. But disabled people are more likely to experience health problems – representing a third of all NHS users whilst only constituting 19 per cent of the population. Shockingly, 40 per cent of disabled children live in poverty. 
 

The 'poverty cycle'

 

“What we see here is what I have called a ‘poverty cycle’ - if you are poor, you are more likely to be disabled and either have or develop health conditions. If you become disabled, you are more likely to become poor (and more likely to develop health conditions subsequently). And, if you have a long-term health condition, you are more likely to be poor.

“In terms of sight loss, how does this pan out?  Well, we know sight loss ranks in the top ten causes of disability. It can cause falls and injuries, lead to social isolation and depression and decreases quality of life significantly.
 

“Unfortunately, none of this is news and we should not be surprised. It has been an obvious health inequality and social injustice for anyone working in the field for the last 30 years and more. It is outrageous, but society has become inured to it. 

So is it all bad news?  
 
“There have been many successes for blind and partially sighted people and those at risk of sight loss that have contributed to improved health and wellbeing.  
 
“Getting preventable sight loss as an indicator into the Public Health Outcomes Framework in 2012 was a major advance in two ways: it brought the sight loss community together in its call to government – and it put sight loss onto the public health community’s radar. 
 
There have been other steps in the right direction: 
  • developing clear commissioning guidance for sight loss services 
  • introducing clear health warnings on plain-packaged cigarette sales (including one warning of sight loss)
  • the introduction of free eye tests in Scotland 
  • the developing discipline of ophthalmic public health and the resultant mapping, research and trials 
  • medical innovations such as the introduction of “magnets” to better control the muscle flicker causing nystagmus 
  • other technical development such as talking buses, talking signs, inclusive streets 
  • visual-to-aural translation through glasses-mounted mini cameras. 
“But beyond this is the level of data available to the sight loss community: registers of blind and partially sighted people; Certificates of Visual Impairment; General Optical Service; Hospital Eye Service; and translatable tools such as the National Eye Health Epidemiological Model, the RNIB Sight Loss Data Tool and the Global Burden of Disease modelling.  
 

“There is a huge amount of data – what people with sight loss really need are champions to use this data, to talk about the implications of sight loss, to shout that 50 per cent of sight loss in the UK in preventable! 

So what practical steps do we need to take moving forward?

  1. Well, we could start by improving access to eye tests and eye health checks for high-risk groups - including consistent commissioning of vision screening in schools for kids aged four to five  
  2. We could make sure that eye health permeates other health messaging: smoking cessation, falls prevention, reducing loneliness, making every contact count  
  3. We could improve sight loss training for residential care staff by building it into core training programmes (given that one in nine people over 65 experience sight loss, rising to one third of the over 85’s)
  4. We could invest more in treatment and secondary prevention services - the NHS is creaking at the seams and we are already seeing waiting lists stretching further and further into the distance.  We need the ‘radical upgrade in prevention and public health’ that Simon Stevens, NHS England’s Chief Executive, called for in the Five Year Forward View.
  5. And, if we were feeling really adventurous, we may want to challenge the commercial model of sight testing that has developed: where high street opticians – passionate about saving and improving sight – feel obliged to operate a business model that relies on selling expensive frames and lenses to offset the cost of the test.  
“We need to make sure that there is sufficient workforce to deliver all this – and to grow adequately to keep pace with the demographic sight loss time-bomb that is drawing ever closer.
 

How do we end the 'poverty cycle'?

“These ideas are all well and good – but they won’t, in themselves, break the 'poverty cycle'. To do that we need:
  • decent employment opportunities for blind and partially sighted people, with adequate support services in place  
  • welfare support should enable people to live a healthy (WHO-defined) life 
  • sight loss in children needs identifying early on through screening 
  • children need access to decent education and training services – as do adults in need of retraining in later life. We might even consider legislation and regulation to make this happen – and find ways to better challenge discriminatory practice  
  • people with sight loss need the same, perhaps better, access to the health information and campaigns that encourage healthy lifestyles 
  • we need to develop digital and technical literacy from an early age and require accessible design as standard 

Final thoughts

“As a sector, we need to speak with one voice, not allow governments to resist progress by citing a disunited front, unclear on what it wants.  And together, we can find allies with common messages who can strengthen these calls – and find a narrative that appeals to the public.”

Disclaimer: The opinions expressed in this blog are the author's own and do not necessarily reflect the view of RNIB.

Further information

  • The Faculty of Public Health is the standard-setting body for specialists in public health in the UK. Find out more about the organisation and their work.
  • RNIB's Sight Loss Data Tool provides information about blind and partially sighted people, and those at risk of sight loss, at a local level throughout the UK.
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