Health Equity and Health Inequity of Disabled People: A Scoping Review

Abstract

Health equity is an important aspect of wellbeing and is impacted by many social determinants. The UN Convention on the Rights of Persons with Disabilities (CRPD) is a testament to the lack of health equity and the many health inequity issues based on social determinants experienced by disabled people. The health equity/health inequity situation of disabled people is even worse if their identities intersect with those of other marginalized groups. Many societal developments and discussions including discussions around the different sustainability pillars can influence the health equity/health inequity of disabled people. The general aim of this study was to better understand the academic engagement with the health equity and health inequity of disabled people beyond access to healthcare. To fulfill our aim, we performed a scoping review of academic abstracts using a hit count manifest coding and content analysis approach to abstracts obtained from SCOPUS, the 70 databases of EBSCO-HOST, Web of Science, and PubMed. Health equity and health inequity abstracts rarely cover disabled people as a group, less with many specific groups of disabled people, and even less or not at all with the intersectionality of disabled people belonging to other marginalized groups. Many social determinants that can influence the health equity and health inequity of disabled people were not present. Ability-based concepts beyond the term ableism, intersectionality-based concepts, and non-health based occupational concepts were not present in the abstracts. Our qualitative content analysis of the 162 abstracts containing health equity and disability terms and 177 containing health inequity and disability terms found 65 relevant abstracts that covered problems with health equity disabled people face, 17 abstracts covered factors of health inequity, and 21 abstracts covered actions needed to deal with health inequity. Our findings suggest a need as well as many opportunities for academic fields and academic, policy, and community discussions to close the gaps in the coverage of health equity and health inequity of disabled people.

1. Introduction

“Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, powerlessness, and their consequences—including lack of access to good jobs with fair pay, safe environments, and quality education, housing, and health care. For the purposes of measurement, health equity means reducing and ultimately eliminating disparities in health and its determinants that adversely affect excluded or marginalized groups” [1] (p. 593).

Braveman further clarified their definition stating: “achieving health equity requires removing obstacles to health such as poverty, discrimination (encompassing racism and other forms of discrimination), powerlessness, and their consequences; and by specifically naming what some of those consequences may be, for example, “lack of access to good jobs with fair pay, safe environments, and quality education, housing, and health care” [1] (p. 593).

Fitting with the definition of Braveman, it is argued that actions on all social determinants of health and indicators of wellbeing are needed to achieve health equity [1,2,3,4,5,6,7].

The UN Convention on the Rights of Persons with Disabilities (CRPD) [8] is a testament to the lack of health equity, the many health inequity issues experienced by disabled people, and the actions needed to fix the issues.

Furthermore, it is argued that academic literature increasingly engages with the concept of health equity. For example, it is highlighted that in PubMed, the number of articles with health equity in the title or abstract increased from five in the year 2000 to 1639 in the year 2021 [1]. However, to our knowledge, no review exists that looks at the state of academic inquiry into health equity and health inequity among disabled people. As such, the overall aim of our study was to better understand the engagement of health equity and health inequity-focused academic literature with disabled people. We see this as important given the far-reaching effects of health inequities on disabled people. By providing data on the state of coverage, one can better inform policies and interventions that address the complex health equity and health inequality challenges faced by disabled people. As such, in the first research question, we asked: (1) How often are terms depicting disabled people mentioned in abstracts focusing on health equity or health inequity, and in which context?

There are many societal developments, disciplines, and discussions that can influence the health equity/health inequity of disabled people, such as law, sustainability, climate change, emergency and disaster planning, preparedness and management, environmental issues, wellbeing, activism, equity, diversity and inclusion, and science and technology governance. International documents, in addition to the CRPD [8] and other international normative documents covering marginalized groups, and international policy documents such as the “Global Report on Health Equity for Persons with Disabilities” [9] and the “UN Flagship Report On Disability and development” [10], also offer policy direction in relation to disabled people. Law in general is seen as an important aspect of fighting for health equity due to its interplay with the social determinants of health [11]. Therefore, we asked: (2) How often are keywords linked to societal developments and discussions and inter-national normative policy documents present in the literature?

Then there are many theoretical concepts one could use to discuss the health equity/health inequity of disabled people. For the purposes of this study, we focused on three sets of concepts (ability judgment-based, intersectionality-based, and occupational rights-based concepts) that we see as useful to discuss three issues impacting the health equity/health inequity problems disabled people face.

Intersectionality, a term coined by Kimberly Crenshaw [12] to capture and elaborate “on the precise nature of discrimination that occurs when there are multiple axes of identity vulnerable to oppression” [13] (p. 30), is seen as an important aspect of health equity and health inequity discussions [14]. The intersectionality of disabled people with other identities is recognized to add intersectionality-related problems to the problems disabled people already experience [15,16,17,18,19,20,21,22], and many intersectional concepts are used to further the intersectional analysis [23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64].

Many ability judgment-focused concepts [65,66,67,68,69,70,71,72,73,74,75,76,77,78] have been developed within the disability rights movement [79] and the fields of disability studies [80,81] and ability-based studies [68,82,83,84,85,86,87] to analyze ability-based expectations, judgments, norms and conflicts. Ability norms, judgments, and conflicts are often one factor in the health equity/health inequity problems disabled people face. As such, these ability-judgment-based concepts are useful to discuss these problems. Many occupational rights-focused concepts [88] are used to discuss social problems people, including disabled people, experience in being occupied in the first place and their barriers to occupational quality, which in turn impact their health equity. All these occupational concepts could be used to discuss the impact of health inequity on being occupied and the impact of experiencing problems in obtaining an occupation on health equity. As research question three, we asked: (3) How often are ability-based, intersectionality-based, and occupational rights-based concepts employed to discuss health equity or health inequity problems disabled people face?

1.1. Health Equity/Health Inequity and Disabled People

In 2022, the World Health Organization published the “Global report on health equity for persons with disabilities”, in which they argued that health equity for disabled people has to be a global health priority, that evidence on existing health equities is needed, and within which they gave recommendations for action [9]. The report also lists many factors that contribute to the health inequities of disabled people, such as structural issues within the social, economic, or political context, problems with social determinants of health, and barriers in the health system [9]. In addition to this report, there are other sources that mention barriers to health equity that disabled people experience [89,90,91,92,93,94]. EquiFrame is an analytical tool for examining the extent to which health policy documents address health equity for vulnerable groups, including disabled people [95,96]. The Bias Free framework (“Building an Integrative Analytical System For Recognizing and Eliminating InEquities”) focuses on unmasking social hierarchies that are seen to “contribute to the persistence of global social, economic and health inequities” [97] (p. 50), (BIAS FREE Framework also covered in [98]. In the forward to [97], one reads, “One important group of biases that arise in health research is associated with social hierarchies, including those based on ability, class or caste, gender, race or ethnicity, religion and sexual orientation. The existence of such biases may result, in the health research field, in research that is not only flawed but that perpetuates and reinforces health inequities” [97]. Many societal developments and discussions can influence the health equity/health inequity reality of disabled people, which is evident in the many health inequity factors mentioned in the literature.

1.2. Societal Developments and Discussions Influencing Health Equity/Health Inequity of Disabled People

The CRPD [8] mentions many social issues one could classify as health inequities issues disabled people experience, such as and outlines many needed actions that could decrease health inequities and increase health equity for disabled people. To give some examples of societal developments and discussions that we think influence the health equity situation of disabled people. Environmental issues are frequently cited as one source of health inequity/health equity (for non-academic sources, see, for example, [99], and there are determinants of health related to climate change [99]). There are environmental determinants of health [100] and ecological determinants linked to health equity [101,102,103,104]. Terms such as “environmental health equity” and “environmental health inequities” are used widely [105]. At the same time, it is noted that disabled people are disproportionally and differently impacted by environmental issues [106,107,108,109,110,111,112,113] but are often ignored [113].

Actions on sustainability are seen to benefit health equity [114,115] including action on social sustainability [116,117,118,119,120]. It is reported that municipalities that include “social sustainability” are more successful in “implementing health equity across policy sectors” [121] (p. 62). In an EU policy brief, it is stated, “We recommend above all a shift of narrative for 2020–2030 to be integrated within the EU strategic objectives including the European Semester. It is a new narrative for an economy of wellbeing, for social sustainability, for social rights, for public health and health equity” [122] (p. 24).

Social sustainability is an important concept for disabled people [123] and linking it to health equity and health inequity could be a useful tool to engage with the health equity and health inequity of disabled people beyond access to health care.

Various tools exist to analyze the social aspects of health and well-being and, with that, health equity/health inequity [124]. The four composite measures (“The social determinants of health (SDH), the Canadian Index of Wellbeing (CIWB), the OECD Better Life Index, and the Community-based Rehabilitation (CBR) matrix) by themselves contain over 111 indicators one could see as health equity indicators [124], whereby the UN Convention on the Rights of People with Disabilities [8] highlights problems disabled people have in conjunction with many of these 111 indicators.

Not being employed or being employed badly has health equity consequences. Many equity, diversity, and inclusion (EDI)-related phrases and EDI policy frameworks are used to flag and improve the negative workplace situation of marginalized people, including disabled people [125]. However, it is noted that problems exist in how disabled people are engaged with in EDI discussions [125].

Numerous academic articles cover advancements in science and technology, together with “health equity” and “health inequity”. For example, there are 505 abstracts in Scopus that contain the terms “health equit*” and “technolog*” and 297 that contain the terms “health inequit*” and “technolog*”. Disabled people are extensively mentioned in the science and technology literature. For example, there are 4124 abstracts in Scopus that contain the terms “disabled people” or “people with disabilities” and “technolog*”. Many science and technology governance concepts and technology-focused ethics fields exist with the purpose of preventing or decreasing potential negative and increasing potential positive effects of science and technology on society [126], which means discussions taking place under these terms should engage with health equity and health inequity in order to prevent science and technology-caused health inequity issues in general and for disabled people in particular.

1.3. Health Equity/Health Inequity and Ability, Occupational Rights, and Intersectionality-Based Concepts

There are many concepts that could be used to discuss very specific health inequity issues that disabled people and others face. Ability-based concepts, occupational rights, and intersectionality-based concepts are three areas of challenges to health equity that could be used to discuss in a differentiated way the problems disabled people face.

Being occupied is essential to human well-being [127,128,129,130,131,132,133,134,135]. The UN CRPD [8] outlines many problems and barriers disabled people face to being occupied, whether it is paid work or other forms of occupation. Barriers to being occupied are one barrier to health equity. There are many occupational rights and occupational quality-focused concepts [88] that are used to discuss social problems people, including disabled people, experience in being occupied (e.g., occupational rights, occupational injustice, occupational justice, occupational alienation, occupational deprivation, occupational apartheid, occupational marginalization, occupational engagement, occupational identity, occupational satisfaction, occupational dysfunction, and occupational imbalance). All these occupational concepts could be used to discuss problems and barriers disabled people experience in being occupied [88], to discuss the impact of health inequity on being occupied, and to discuss the impact of experiencing problems in being occupied on health equity.

As to intersectionality, a concept coined by Kimberly Crenshaw [12] to capture and elaborate “on the precise nature of discrimination that occurs when there are multiple axes of identity vulnerable to oppression” [13] (p. 30), the inclusion of the intersectionality of disabled people is essential to highlight health inequities that occur to disabled people who also belong to other marginalized groups. Disabled people are constantly in danger of experiencing intersectionality-specific problems such as intersectional invisibility, which is the dynamic that people with more than one marginalized identity feel more invisible than individuals who have one or zero marginalized identities [27,34]. For the intersectional invisibility disabled women face, see, for example, the work of disability studies and feminist scholar Anita Ghai [21,136]. Intersectional conflict, which is about different views of intersecting identities and lived realities by individuals and other social actors [23,137], is a problem for disabled people as their “disability” identity is often judged as more negative than the other identities, and there is also a conflict if one has different “disabilities” that are judged differently in society. Multiple intersectionality concepts (e.g., “intersectional conflict”, “Intersectional self”, “Intersectional hostility”, “intersectional struggle”, “intersectional adjustment”, “intersectional solidarity”, “Intersectional consciousness”, “intersectional oppression”, “intersectional privilege”, “Intersectional invisibilit”, “intersectional (dis)empowerment”, “intersectional fairness”, “intersectional bias”, “intersectional microaggression”, “intersectional stigma”, “Intersectional discrimination*”, “intersectional inequity”, “intersectional inequality” and “intersectional justice”) [23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64] have been developed to enhance the intersectional analysis, all of which could be used to enhance the intersectionality discussions of health equity and health inequity in relation to disabled people.

Ability-based judgments, norms, and conflicts impact the ability expectations of humans, which in turn can impact one’s danger of experiencing health inequity. Many ability judgment-focused concepts (ableism, disablism, internalized ableism, internalized disablism, ability security, ability insecurity, ability equity, ability inequity, ability equality, ability inequality”, ability privilege, ability discrimination, ability oppression”, ability apartheid, ability obsolescence, ability consumerism, ability commodification, ableism foresight, ability governance, ableism governance, and techno-ableism [65,66,67,68,69,70,71,72,73,74,75,76,77,78]) have been developed within the disability rights movement [79] and the fields of disability studies [80,81] and ability-based studies [68,82,83,84,85,86,87] to analyze ability-based expectations, judgments, norms, and conflicts. All these concepts could enrich the discussions around the impact of ability norms, judgments, and conflicts on experiencing health equity or health inequity. Indeed, the capability approach is about abilities to be and to be able to act on for a good life [138], which can be seen to be impacted by the level of health equity or health inequity one experiences.

To conclude, given the far-reaching effects of health inequities on disabled people, it is essential to engage with health equity and health inequality in all their facets. By doing so, one can better inform policies and interventions that address the complex health equity and health inequality challenges faced by disabled people, other marginalized groups, and society at large. We performed a study aimed at better understanding academic engagement with health equity and health inequity in relation to disabled people, asking three research questions covering three different areas (Figure 1).

2. Materials and Methods

2.1. Study Design

Scoping studies are used to investigate the state of research on a given topic [139,140]. Our scoping study focuses on the extent of academic research that has been conducted on the interface of health equity and health inequity and disabled people and health equity or health inequity in relation to sustainability, climate change, emergency and disaster planning, preparedness and management, environmental issues, well-being, concepts linked to a good life, intersectionality, activism, occupational rights concepts, equity, diversity and inclusion, science and technology governance, and ability-based concepts.

Our study followed a modified version of a scoping review outlined by [141]. We fulfilled all the requirements of the Prisma chart for scoping reviews [142], with the exception that we use instead of a flow chart a table under methods to highlight how we generated our sources for analysis (Appendix A).

2.2. Theoretical Frameworks and Lenses

We interpret our findings through the lens of the field of disability studies, which investigates the lived experience of disabled people [80,81], and the field of ability-based studies (the three strands of ability-based studies: ability expectation and ableism studies [68,82], studies in ableism [83,84,85], and critical studies of ableism [86,87]), which focus on the investigation of ability-based expectations, judgments, norms, and conflicts [67].

2.3. Identification of Research Questions

This study aimed to better understand academic engagement with health equity and health inequity in conjunction with disabled people. In relation to the visibility of disabled people, our focus was (a) on the general visibility of disabled people, (b) which disabilities were present, and (c) which social factors of experiencing health inequity were present. We did not focus on the health equity topic of access to healthcare and health services (for one study doing so, see [143], and we did not look at the impact of socio-environmental factors (i.e., social, physical, or attitudinal) on the health outcomes of disabled people (see [144] for one study). We also did not cover content where the “disability” as a health condition was seen to be caused by health inequity, such as air pollution causing a medical condition/disability [145].

Given that societal developments and discussions can influence the state of health inequity of disabled people, we also analyzed the linkage of the academic literature focused on health equity and health inequity to discussions around sustainability, climate change, emergency and disaster planning, preparedness and management, environmental issues, well-being, the 111 indicators of four wellbeing measures (Canadian Index of Well-Being, Social Determinants of Health, OECD Better Life Index, and the Community Based Rehabilitation Matrix), activism, international normative documents, science and technology governance, and equity, diversity, and inclusion in conjunction with disabled people. Finally, we looked at the presence of occupational rights concepts, intersectionality-based concepts, and ability judgment-based concepts in conjunction with disabled people.

2.4. Data Sources and Data Collection Strategy and Inclusion/Exclusion Criteria

Between 28 February and 27 April 2024, we searched the 70 academic databases of EBSCO-HOST, the academic database Scopus, which includes Medline, and the databases Web of Science and PubMed, with no time restrictions to obtain content relevant to answer our research questions. The databases contain many journals with the terms “disability” or “disability studies” in the title and cover many journals covering health equity and the other topics we focused on. As to inclusion criteria, scholarly peer-reviewed journals were included in the EBSCO-HOST search, and reviews, peer-reviewed articles, conference papers, and editorials in Scopus and the Web of Science search were set to all document types. For all these databases, we searched the abstracts. For PubMed, we did not screen out anything, but an abstract-only search was not available, so we did a title/abstract, which, without saying so, also included keywords, which led to many false positives in our qualitative analysis, where health equity, for example, was a keyword but did not show up in the abstract. As to exclusion criteria, data not fitting the search strategies, research questions, and data not being in English were excluded. In

Table 1. Search strategies used and abstract selected.

Strategy	Sources	Search Terms	Hits	Results in Tables
Strategy 1	Scopus/EBSCO-HOST/Web of Science	ABS “Health equity” or “health equities” AND ABS (“Disabled” OR “Disabled people” OR “disabled person*” OR “Disabled women” OR “disabled woman” OR “women with disabilities” OR “Women with a disability” OR “Woman with a disability” OR “Disabled activis*” OR “activist* with disabilit*” OR “Disabled artist*” OR “artist* with disabilities” OR “with disabilities” OR “people with disabilities” OR “person* with disabilities” OR “learning disabilit*” OR “Dyslexia” OR “visually impair*” Or “visual impair*” OR “hearing impair*” OR “physically impair*” OR “physical impair*” Or “cognitive impair*” OR “Deaf” OR “Adhd” OR “autism” OR “attention deficit” OR “Autistic women” OR “women with autism” OR “Autistic woman” OR “woman with autism” OR “neurodiver*” OR Wheelchair OR “Indigenous disabled” OR “disabled Indigenous” OR “Indigenous person with disabilit*” OR “Indigenous people with disabilit*” OR “Black disabled” OR “disabled Black” OR “Black person with disabilit*” OR “Black people with disabilit*” OR “Ableism” OR “Disablism” OR “disableism” OR “Ableist” OR “Disableist” OR “disablist” OR “Disability studies” OR “Disability minorit*” OR “Ability minority”)	133/103/93 = 329-dup = 162 (downloaded)	Abstract search results in Table A1, Table A2, Table A3, Table A4, Table A5 and Table A6, and Section 3.1.1 and Section 3.2)
Strategy 2	Scopus/EBSCO-HOST/Web of Science	ABS “Health inequity” or “health inequities” AND ABS of disability terms from strategy 1	421-dup = 135 EBSCO Scopus125 WebofScience 101 =361-dup = 177 (downloaded)	Abstract search results in Table A1, Table A2, Table A3, Table A4, Table A5 and Table A6, Appendix B and Section 3.1.1 and Section 3.2)
Strategy 3a	Scopus	Health Equity	7183 (downloaded)	Abstract search (results in Table A1, Appendix B)
Strategy 3b	EBSCO-HOST	Health equity	17,861 (not downloaded)	NOT Downloaded but online search in combination with other search terms (results in Table A1, Appendix B)
Strategy 3c	Web of Science	Health equity	6135 downloaded	Abstract search (results in Table A1, Appendix B)
Strategy 3d	PubMed (one can only search Title/Abstract together)	Title/ABS “Health equity” AND Title/ABS of disability terms from strategy 1	173 (downloaded)	Title/Abstract search (results in Section 3.1.1 Timeline)
Strategy 3e	PubMed (one can only search Title/Abstract together)	Title/ABS “Health equity”	11,647 (downloaded)	Abstract search (results in Table A1, Appendix B and Section 3.1.1, Timeline)
Strategy 4a	Scopus	Health Inequity	5393 (downloaded)	Abstract search (results in Table A1, Appendix B)
Strategy 4b	EBSCO-HOST	Health Inequity	12,866 (not downloaded)	NOT Downloaded but online search in combination with other search terms (results in Table A1, Appendix B)
Strategy 4c	Web of Science	Health Inequity	4446 (downloaded)	Abstract search (results in Table A1, Appendix B)
Strategy 4d	PubMed (one can only search Title/Abstract together)	Title/ABS “Health inequit*” AND ABS of disability terms from strategy 1	111 (downloaded)	Title/Abstract search (results in Section 3.1.1, Timeline)
Strategy 4e	PubMed (one can only search Title/Abstract together)	Title/ABS “Health inequit*”	5838 (downloaded)	Title/Abstract search (results in Table A1, Appendix B and Section 3.1.1, Timeline)

, we outline our search strategies, the original hit numbers, and the numbers of abstracts downloaded after eliminating duplicates of abstracts if we downloaded the abstracts.

We obtained abstracts to download for the terms “health equit*” and health inequit*” in conjunction with disability terms to answer RQ1–3.

For the online quantitative search, no duplicates were eliminated, and the record results reflected the three numbers obtained for the three databases for each search term. They also included duplicates within the 70 databases searched within EBSCO-Host.

Depending on the database, hit counts, and ease of downloading procedures, we downloaded some set of abstracts.

For that, we used the citation export function of the databases we searched and the import function of Endnote 9 software. As for the initial sets of abstracts downloaded, we used the Endnote 9 software to eliminate duplicates due to abstracts being present in more than one database. The final number of abstracts was exported as one WORD Office file from the Endnote 9 software and transformed into one PDF file. The PDFs were used for the quantitative and qualitative analyses.

2.5. Data Analysis

To answer the research questions, we used two approaches. We used manifest coding and a qualitative content analysis approach to answer the research questions.

For the manifest coding and quantitative analysis, both authors of this study independently generated hit counts for keywords in the abstracts using the online search function of the databases accessed through the university and generated hit counts for the keyword searches in the downloaded abstracts using the advanced search function in Adobe Acrobat Pro Software 2024.002.20991 version to determine how many abstracts contained the various terms linked to the terms in the tables. The two authors then compared the numbers for each keyword (peer debriefing). No differences were found between the authors.

For the qualitative analysis, we decided to perform a content analysis on abstracts containing health equity or health inequity and the disability terms we used. For the terms chosen, both authors of the study used the comment function in Adobe Acrobat Software for the coding procedure to independently ascertain relevant abstracts first and then analyze how disabled people were mentioned in conjunction with the social barriers to health equity. Peer debriefing between the study’s two authors was performed to compare the themes.

2.6. Trustworthiness Measures

Trustworthiness measures include confirmability, credibility, dependability, and transferability [146,147,148]. Peer debriefing was employed between the two authors of this study. As for transferability, this study offers all the details needed so others can decide whether to apply our search approaches to other data sources, whether to use other search terms or disability terms, and whether to perform a more in-depth analysis of terms based on the hit counts.

2.7. Limitation

The search was limited to specific academic databases, English language literature, and abstracts. As such, the findings are not to be generalized to the whole academic literature, non-academic literature, or non-English literature. We also did not use every possible disability term. However, our findings allow conclusions to be drawn within the parameters of the searches. We also did not use PubMed for the results beyond

Table A1. An online search of health equity and health inequity-focused abstracts and desktop search of downloaded abstracts containing health equity or health inequity (columns 2 and 3) abstracts that contained “health equit*” or “health inequit*” as terms and the disability terms from strategy 1 (columns 3 and 4) for (a) disability terms; (b) intersectional phrases depicting disabled people that also belong to another marginalized group; (c) disability-related terms mostly seen within a medical framework; (d) negative isms linked to disabled people; (e) other ability judgment based concepts; and (f) technology-related terms including technology-focused ability judgment terms.

Terms	“Health Equit*” Scopus/Web of Science/PubMed Downloaded Abstracts (PubMed Could Only Be Searched as Title/Abstract Search) /EBSCO-ALL Online Search 7183/17,816/6135/11,674 = 42,808 = 100%	“Health Inequit*” Scopus/Web of Science/PubMed Downloaded Abstracts (PubMed Could Only Be Searched as Title/Abstract Search) /EBSCO-ALL Online Search 5393/12,866/4446/5838 = 28,543 = 100%	“Health Equit*” and Disability” Terms, 162 Abstracts from Web of Science, EBSCO All and Scopus Abstracts. NOT PubMed as That Could Only Be Searched as Title/Abstract)	“Health Inequit*” and Disability Terms, 177 Abstracts from Web of Science, EBSCO All and Scopus Abstracts. NOT PubMed as that Could Only Be Searched as Title/Abstract)
Disability Terms
“disability minorit*”	0	0	0	0
“ability minority*”	0	0	0	0
“disabled”	170	208	21	31
“disabled people” or “disabled person*”	40	34	6	10
“disabled activis*” or “activist* with disabilit*”	0	0	0	0
“disabled artist*” or artist* with disabilities	0	0	0	0
“with disabilities”	638 (but 181 from EBSCO which does not search the phrase as it ignores “with”) so the actual number for the phrase is lower	655 (but 270 from EBSCO which does not search the phrase as it ignores “with”) so the actual number for the phrase is lower	49	61
“people with disabilities” or “person* with disabilities”	233 (but 25 from EBSCO which does not search the phrase as it ignores “with”) so the actual number for the phrase is lower	280 (but 103 from EBSCO which does not search the phrase as it ignores “with”) so the actual number for the phrase is lower	24	38
“learning disabilit*”	3	8	0	4
dyslexia	4	0	1	0
“impair*”	468	371	29	25
“visually impair*” or “visual impair*”	87	74	9	7
“hearing impair*”	9	8	2	2
“physically impair*” or “physical impair*”	3	2	0	0
“cognitive impair*”	69	43	11	8
deaf	91	87	6	9
“adhd” or “autism” or “attention deficit”	229	125	4/11/8	3/11/3
“neurodiver*”	2	0	1	0
wheelchair	5	7	1	2
“disability studies”	19	3	4	2
Intersectional phrases containing disability terms with some other marginalized group
“intersectionality”	1389	819	4 (here also searched “intersec*” 13 abstract hits)	8 (here also searched “intersec*” 23 abstract hits)
“disabled women” or “disabled woman” or “women with disabilities” or “women with a disability” or “woman with a disability”	37	62	5	4
“indigenous disabled” or “disabled indigenous” or “indigenous person with disabilit*” or “indigenous people with disabilit*” or “aboriginal disabled” or “disabled aboriginal” or “aboriginal person with a disability” or “aboriginal people with disability*”	0	0	0	0
“black disabled” or “disabled black” or “black person with disabilit*” or “black people with disabilit*”	2	0	1	0
“disabled women of color” or “women of color with disabilities”	0	0	0	0
“autistic women” or “women with autism” or “autistic woman” or “woman with autism”	0	0	0	0
Disability related terms mostly seen within a medical framework
“patient*”	23,791	16,036	39	34
“mental health”	14,153	5265	15	18
“mental illness”	352	332	3	1
Negative isms linked to disabled people
“ableism”	48	26	12	8
“disablism” or “disableism”	0	1	0	1
“ableist”	13	13	4	3
“disableist” or “disablist”	0	0	0	0
Other Ability judgment-based concepts
“ability”	1335	1052	5	12
“internalized ableism”	0	0	0	0
“internalized disablism” or “internalized disableism”	0	0	0	0
“ability security” or “ability insecurity” or “ableism security” or “ableism insecurity”	0	0	0	0
“ability equity” or “ability inequity” or “ability equality” or “ability inequality” or “ableism inequity” or “ableism equity” or “ableism equality” or “ableism inequality”	0	0	0	0
“ability privilege”	0	0	0	0
“ability discrimination” or “ableism discrimination”	0	0	0	0
“ability oppression” or “ableism oppression”	0	0	0	0
“ability apartheid” or “ableism apartheid”	0	0	0	0
ability obsolescence or ableism obsolescence	0	0	0	0
“ability consumerism” or “ableism consumerism” or “ability commodification” or “ableism commodification”	0	0	0	0
“ability foresight” or “ableism foresight”	0	0	0	0
“ability governance” or “ableism governance”	0	0	0	0
Technology and human enhancement related terms and technology linked ability-judgment terms
“technolog*”	1787	1047	14	10
“assistive technolo*”	8	24	3	4
“assistive device*”	1	1	1	1
“human enhancement”	0	0	0	0
“human enhancement technolog*”	0	0	0	0
“performance enhancement”	0	0	0	0
“posthuman”	0	0	0	0
“supercrip”	0	0	0	0
“superhuman”	0	0	0	0
“technoableism” or “techno-ableism”	0	0	0	0
“techno-disablism” or “techno-disableism”	0	0	0	0
“technodoping” or “techno-doping”	0	0	0	0
“techno-poor”	0	0	0	0
“techno-supercrip”	0	0	0	0
“technowashing” or “techno-washing”	0	0	0	0
“transhuman*”	0	0	0	0

, Appendix B, and Section 3.1.1 Timeline, as PubMed could not be searched for abstracts only but had to be searched for “Table/abstract”.

3. Results

Within Section 3.1 (Quantitative Data), we report on the online and desktop search results of abstracts containing the terms health equity or health inequity by themselves and in conjunction with disabled people.

We first report under 3.1.1 (Timeline) on the publication hits according to year.

In Section 3.1.2 Summary Results for RQ1 and RQ3 covering the ability judgment-based terms, we report the results shown in Table A1,

Table A2. The number of abstracts not hit counts, that contained terms we selected from the literature to cover various areas we identified as important to be discussed around health equity and health inequity and disabled people that were not part of the 111 indicators linked to the four composite well-being measures (see Table A3, Table A4, Table A5 and Table A6).

Terms	“Health Equit*” and Disability Terms, (162 Abstracts from Web of Science, EBSCO and Scopus = 100%, Pub Med Not Used); Number of Abstracts, Not Hit counts	“Health Inequit*” and Disability Terms (177 Abstracts from Web of Science, EBSCO and Scopus = 100%, Pub Med Not Used); Number of Abstracts, Not Hit counts
“activis*”	2	3
“ally” or “allies” or “allyship”	0	0
“autonomy”	1	0
“burnout”	1	0
“democrac*”	3	1
“global south”	0	0
“good life”	0	0
“interdependen*”	2	0
“justice”	19	18
“self-determination”	3	1
“social good”	0	0
“solidarity”	4	3
“stereotype*”	0	3
“stigma*”	15	23
“stressor*”	0	4

,

Table A3. Presence of Community Based Rehabilitation Matrix [315,316,317] indicators in downloaded abstracts containing the terms “health equit*” or “health inequit*” and disability terms (hit counts, not number of abstracts).

Terms	Secondary Indicator	“Health Equit*” and Disability Terms, (162 Abstracts from Web of Science, EBSCO and Scopus = 100%, Pub Med Not Used). Hit Counts Not Abstract Counts. Therefore, the Actual Abstract Numbers Might Often Be Lower Due to That a Possible Term is Present More than Once in a Given Abstract.	“Health Inequit*” and Disability Terms (177 Abstracts from Web of Science, EBSCO and Scopus = 100%, Pub Med Not Used). Hit Counts Not Abstract Counts. Therefore, the Actual Abstract Numbers Might Often Be Lower Due to That a Possible Term is Present More than Once in a Given Abstract.
health		ND	ND
	“healthcare” or “health care”	226	221
	“assistive technolo*”	5	11
	“assistive device”	1	1
	“health prevention”	0	0
	“rehabilitation”	40	22
“education”		68	69
	“childhood education”	0	0
	“primary education”	0	0
	“secondary education”	0	1
	“non-formal education”	0	0
	“life-long learning”	0	0
“livelihood”		0	0
	“skills development”	0	0
	self-employment	0	0
	“financial services”	0	0
	“wage employment”	0	0
	“social protection”	0	3
“social”		190	211
	“social media” (added by us)	7	0
	“social relationship*”	0	0
	“family”	54	33
	“personal assistan*”	0	0
	“culture”	8	6
	“recreation” or “leisure” or “sport*”	0/2/5	0/0/10
	“access to justice”	0	0
“empower*”		9	7
	“communication”	32	41
	“social mobilization”	0	0
	“political participation”	0	0
	“self-help groups”	0	0
	“disabled people’s organizations”	0	0

Table A3, Table A4, Table A5 and Table A6 show a very uneven coverage of the 111 indicators.

,

Table A4. Presence of the Canadian Index of Wellbeing [318,319], indicators in downloaded abstracts containing the terms “health equit*” or “health inequit*” and disability terms (hit counts not number of abstracts).

Terms	Secondary Indicator	“Health Equit*” and Disability Terms, (162 Abstracts from Web of Science, EBSCO and Scopus = 100%, Pub Med Not Used). Hit Counts Not Abstract Counts. Therefore, the Actual Abstract Numbers Might Often Be Lower Due to That a Possible Term is Present More than Once in a Given Abstract.	“Health Inequit*” and Disability Terms (177 Abstracts from Web of Science, EBSCO and Scopus = 100%, Pub Med Not Used). Hit Counts Not Abstract Counts. Therefore, the Actual Abstract Numbers Might Often Be Lower Due to That a Possible Term is Present More than Once in a Given Abstract.
social relationship*		0	0
	“social engagement”	0	0
	“social support”	14	8
	“community safety”	0	0
“social norm*”		1	1
	“attitudes toward others”	0	0
“democratic engagement”		0	0
	participation	24	27
	communication	32	41
	leadership	17	8
“education”		68	69
	competenc*	10	18
	knowledge	25	40
	skill*	8	10
“environment”		14	17
	air	ND	ND
	energy	ND	ND
	freshwater/water	ND	ND
	“nonrenewable material”	ND	ND
	“biotic resources”	ND	ND
“healthy population*”		0	0
	“personal well*”	0	0
	“physical health”	4	9
	“life expectancy”	6	6
	“mental health”	50	62
	“functional health”	0	0
	“lifestyle”	3	12
	“public health”	55	56
	“healthcare” or “health care”	226	221
“culture”		8	6
“living standard”		0	0
	“income”	44	60
	“economic security”	0	0
“time”		ND	ND

Table A3, Table A4, Table A5 and Table A6 show a very uneven coverage of the 111 indicators.

,

Table A5. Presence of Better Life Index [320] indicators in downloaded abstracts containing the terms “health equit*” or “health inequit*” and disability terms (hit counts, not number of abstracts).

Terms	“Health Equit*” and Disability Terms, (162 Abstracts from Web of Science, EBSCO and Scopus = 100%, Pub Med Not Used). Hit Counts Not Abstract Counts. Therefore, the Actual Abstract Numbers Might Often Be Lower Due to That a Possible Term is Present More than Once in a Given Abstract.	“Health Inequit*” and Disability Terms (177 Abstracts from Web of Science, EBSCO and Scopus = 100%, Pub Med Not Used). Hit Counts Not Abstract Counts. Therefore, the Actual Abstract Numbers Might Often Be Lower Due to That a Possible Term is Present More than Once in a Given Abstract.
“housing”	11	14
“income”	44	60
“jobs”	0	0
“communit*”	170	106
“education”	68	69
“environment”	14	17
“physical environment*”	0	3
accessibility (added by us)	15	8
“civic engagement”	0	0
“health	ND	ND
“life satisfaction”	0	0
“safety”	9	31
“work life balance”	0	0

Table A3, Table A4, Table A5 and Table A6 show a very uneven coverage of the 111 indicators.

and

Table A6. Presence of the Social Determinants of Health (SDH) [14,321,322,323,324,325,326] indicators in downloaded abstracts containing the terms “health equit*” or “health inequit*” and disability terms (hit counts, not number of abstracts).

Terms	“Health Equit*” and Disability Terms, (162 Abstracts from Web of Science, EBSCO and Scopus = 100%, Pub Med Not Used). Hit Counts Not Abstract Counts. Therefore, the Actual Abstract Numbers Might Often Be Lower Due to That a Possible Term is Present More than Once in a Given Abstract.	“Health Inequit*” and Disability Terms (177 Abstracts from Web of Science, EBSCO and Scopus = 100%, Pub Med Not Used). Hit Counts Not Abstract Counts. Therefore, the Actual Abstract Numbers Might Often Be Lower Due to That a Possible Term is Present More than Once in a Given Abstract.
“income”	44	60
“education”	68	69
“unemployment”	0	7
“job security”	0	0
“employment“	11	12
“early childhood development”	0	0
“food security” or “food insecurity”	2	3
“housing”	11	14
“social exclusion”	1	1
“social safety network”	0	0
“health services”	20	35
immigration	3	1
globalization	1	0
coping	2	1
resilience	5	3
adapt*	27	17
discrimination	26	55
genetic*	2	1
transportation	14	25
“vocational training”	0	0
“social integration”	0	0
advocacy	5	17
literacy	19	4
walkability	0	0
“social engagement”	0	0
“social status”	1	1
“socioeconomic status”	9	9
poverty	7	17

Table A3, Table A4, Table A5 and Table A6 show a very uneven coverage of the 111 indicators.

 Appendix B, which covered our desktop and online searches of abstracts in EBSCO-HOST, Scopus, and Web of Science (and title/abstracts for PubMed) containing (a) disability terms; (b) intersectional phrases depicting disabled people that also belong to another marginalized group; (c) disability-related terms mostly seen within a medical framework; (d) negative isms linked to disabled people; (e) other ability judgment-based concepts; and (f) technology and human enhancement-related terms and technology-linked ability-judgment terms.

Section 3.1.3 Results for RQ2, we give the first results that we did not add into Tables in Appendix B covering well-being terms, the mentioning of composite measures of well-being, environmental issues-related terms, international conventions and declarations covering social groups covered within EDI, science and technology governance terms, and technology-focused ethics terms.

Then we summarize the results of (a) terms we selected from the literature to cover various areas we identified as important to be discussed around health equity and health inequity that were not part of the 111 indicators linked to the four composite well-being measures (Table A2, Appendix B) and (b) the results for the 111 indicators of the four composite wellbeing measures (Appendix B: Table A3, Table A4, Table A5 and Table A6).

In Section 3.2 Qualitative Analysis RQ1–RQ3, we provide the results of the qualitative content analysis covering health equity (Section 3.2.1) and health inequity (Section 3.2.2); areas of needed actions and problems identified in relation to disabled people to answer RQ1–RQ3.

3.1. Quantitative Data

3.1.1. Timeline of Abstracts Mentioning Health Equity or Health Inequity

To first report the numbers for how many abstracts in the 162/177 downloaded abstracts (strategy 1 and 2) were published in what year. The first number for any given year reflects the result for the 162 abstracts covering “health equit*” and the second number gives the numbers for the 177 abstracts covering ”health inequit*”:2024 = 24/14; 2023 = 42/42; 2022 = 33/31; 2021 = 15/27; 2020 = 16/20; 2019 = 5/7; 2018 = 6/6; 2017 = 6/7; 2016 = 5/1; 2015 = 3/4; 2014 = 3/3; 2013 = 3/2; 2012 = 1/3; 2011 = 0/4; 2010 = 0/3; 2009 = 0/0; 2008 = 0/0; 2007 = 1/0; 2006 = 0/0; 2005 = 0/2; 2004 = 0/0; 2003 = 0/0; 2002 = 0/0; 2001 = 0/0 (stopped at 2001 to search for a year).

For a visual, see Figure 2.

As to PubMed, searching title/abstract in PubMed, the yearly numbers for “health equit*” (first number) and “health inequit*” (second number) were: 2024 = 1191/507; 2023 = 2784/1197; 2022 = 2250/1193; 2021 = 1495/891; 2020 = 918/518; 2019 = 707/327; 2018 = 487/280; 2017 = 393/248; 2016 = 282/178; 2015 = 228/177; 2014 = 182/140; 2013 = 139/126; 2012 = 120/105; 2011 = 98/75; 2010 = 67/61; 2009 = 45/46; 2008 = 35/47; 2007 = 34/26; 2006 = 29/21; 2005 = 12/20; 2004 = 5/10; 2003 = 18/8; 2002 = 11/11; 2001 = 15/4 (stopped at 2001 to search for a year).

For a visual, see Figure 3.

Adding the disability terms from strategy 1 as search terms, the yearly numbers for “health equit*” (first number) and “health inequit*” (second number) in the title/abstract were: 2024 = 29/12; 2023 = 50/33; 2022 = 46/25; 2021 = 25/17; 2020 = 19/10; 2019 = 11/7; 2018 = 4/7; 2017 = 8/5; 2016 = 1/0; 2015 = 2/0; 2014 = 2/2; 2013 = 0/0; 2012 = 0/1; 2011 = 0/2; 2010 = 1/1 (stopped at 2010 to search for a year).

For a visual, see Figure 4.

Using the term “patient*” instead of the disability terms, the yearly numbers for “health equit*” (first number) and “health inequit* (second number) in the title or abstract were: 2024 = 435/168; 2023 = 910/332; 2022 = 681/249; 2021 = 438/176; 2020 = 209/98; 2019 = 159/55; 2018 = 105/45; 2017 = 79/34; 2016 = 47/26; 2015 = 34/23; 2014 = 22/18; 2013 = 15/15; 2012 = 12/8; 2011 = 13/5; 2010 = 5/3; 2009 = 4/1; 2008 = 4/4; 2007 = 2/1; 2006 = 5/1 (stopped at 2006 to search for a year).

For a visual, see Figure 5.

3.1.2. Summary of Results for RQ1 and RQ3 Covering the Ability Judgment-Based Terms Listed in Appendix B

We found that health equity and health inequity abstracts rarely engaged with disabled people as a group, less with many specific groups of disabled people and rarely or not at all with the intersectionality of disabled people, belonging to other marginalized groups. Negative isms linked to disabled people were rarely or not at all mentioned, as was the case for the other ability-based concepts. Technolog* as a term was mentioned quite a bit, but the other technology-linked terms, the human enhancement-related terms, and the technology-linked ability judgment terms were rarely or not mentioned. Table A1 (columns 4 and 5) also covered the desktop search of downloaded abstracts that covered health equity or health inequity together with the disability terms from strategy 1 (the 162/177 abstracts from strategies 1 and 2). The results, trend-wise, were the same.

3.1.3. Results for RQ2

As to the RQ 2 results not shown in the tables in Appendix B:

As to the hit count results for the 162 abstracts covering health equity and disability terms and the 177 abstracts covering health inequity and disability terms, of the 21 well-being measures we searched for in the abstracts, only the phrases “determinants of health” 12/19 (health equity hits/health inequity hits) and “social determinants of health 8/15 generated hits. The other 19 terms (“Community based rehabilitation”, “Community based rehabilitation matrix”, “Community rehabilitation”, “Meaning in Life”, “Well-being index”, “Satisfaction with life scale”, “Capability approach”, “Perceived Life Satisfaction”, Aqol, “Better life index”, “Brief Inventory of Thriving”, “Calvert-Henderson Quality of Life”, “Canadian Index of well-being”, “Community based rehabilitation matrix”, “Comprehensive Inventory of Thriving”, “Flourishing Scale”, “Index of well-being”, “Scale of Positive and Negative Experience”, “The Disability and Wellbeing Monitoring Framework and Indicators,, “The Quality of Being Scale” generated no hits.

The term, “well-being” and variations, “well being” and “wellbeing” had 6/19 (health equity hits/health inequity hits) abstracts and “social well-being” with variations, “social well being” and “social wellbeing” was mentioned in 2 of the 162 abstracts on health equity and 0 in the 177 abstracts on health inequity. The remaining terms searched, “environmental wellbeing”, “environmental well-being”, “environmental well being”, “subjective wellbeing”, “subjective well-being”, “subjective well being”, “societal wellbeing”, “societal well-being”, “societal well being”, “psychological wellbeing”, “psychological well-being”, “psychological well being”, “emotional wellbeing”, “emotional well-being”, “emotional well being”, “economic wellbeing”, “economic well-being”, and “economic well being” generated no hits.

As to environment-based concepts, we found a few hits with sustainability (2/2) (health equity hits/health inequity hits) and climate change (3/1). Emergency management and emergency preparedness both had (0/1) hits. Emergency planning, disaster management, disaster planning, disaster preparedness, and environmental activism generated no hits.

As to the science and technology governance terms (“Technology governance”, “Science and technology governance”, “Anticipatory governance”, “Democratizing science and technology”, “Parliamentary technology assessment”, “Participatory technology assessment”, “Responsible innovation”, “Responsible research and innovation”, “Technology assessment”, “Transformative vision assessment”, “Upstream engagement”), only “technology assessment was present in the 177 health inequity abstracts. Ethics as a generic term was mentioned in 6/11 (health equity hits/health inequity hits) abstracts, and bioethics in 10/0 abstracts. “AI-ethics”, “Computer science ethics”, “Information technology ethics”, “Nanoethics”, “Neuroethics”, “Quantum ethics”, “Robo-ethics”, and “Environmental ethics” generated no hits.

As to the RQ 2 results shown in the tables in Appendix B:

Table A2 covers a number of abstracts for terms we selected from the literature to cover various areas we identified as important to be discussed around health equity and health inequity that were not part of the 111 indicators linked to the four composite well-being measures. “Justice” and “stigma” were the terms with the most hits. Most terms generated few hits, such as the terms “good life” and “social good”. Burnout, allyship, and activism also did not have many hits, or none at all. The term “global south” generated no hits.

Table A3, Table A4, Table A5 and Table A6 cover the 111 indicators of the community-based rehabilitation matrix, the Canadian Index of Well-Being, the Better Live Index, and the social determinants of health and show a very uneven presence of indicator terms. Most terms with significant hits covered very broad concepts such as social, health, education, culture, communication, or participation, to just list a few, but many more specific terms that impact health equity/health inequity were rarely or not at all present.

3.2. Qualitative Analysis (RQ1–RQ3)

In this section, we cover themes that relate to social aspects of health equity linked to disabled people, social aspects leading to the health inequity of disabled people, and actions flagged as needed to decrease the health inequity of disabled people. We do not cover in detail the topic of lack of access to health care. However, within the 162 abstracts obtained with “health equit*” and the disability terms, the term “access*” was mentioned over 190 times, and within the 177 abstracts obtained with “health inequit*” and the disability terms, the term “access*” was mentioned over 182 times. The numbers for “access to healthcare” were 13 for the health equity abstracts and 14 times for the health inequity abstracts. Accessibility of medical or healthcare-related physical environments and procedures, see for example [149], and tools such as the acquisition of disability-accessible medical diagnostics, see for example [150], were mentioned 17 and 10 times, respectively. We also did not look at the theme of social issues of health equity or health inequity generating a “disability” in the medical sense; see, for example, [145].

The following sections report on the results of the qualitative content analysis covering health equity (Section 3.2.1) and health inequity (Section 3.2.2) in relation to disabled people.

3.2.1. Health Equity

As to the relevant abstracts, the following topics were found in relation to health equity and disabled people and are shown in

Table 2. Summary table of topics in relation to health equity and disabled people.

Topic (Number of Abstracts)	Sub Topics
Ableism (n = 11), disablism (n = 1), (other ability focused concepts 0)	Ableism is noted as a key barrier towards achieving health equity for disabled people.
Health Communication (n = 11)	Need for streamlined health communication that addresses barriers in place for disabled people, including technologies, and language/translation for deaf people.
Education and/or lack of advocacy and/or lack of knowledge (n = 9)	Need for further education, advocacy and knowledge by medical workers when working with disabled people.
Intersectionality (n = 7);	The importance to acknowledge an intersectional approach to health equity that also includes disabled people. As to intersectional concept.
Intersectionality-based concepts (n = 2);	intersectional identity and intersectional experience each found once; no other intersectionality-based concept found.
Need for representation on staff level (n = 6)	Need for further representation for disabled people at the frontline and staffing level.
COVID (n = 5)	Lasting effects of the COVID-19 pandemic need to be addressed as they relate to disabled people and health equity.
Importance of health equity for disabled people (n = 4)	Positive developments; disabled people often ignored; have to be mainstreamed into health equity discussions; attention to social determinants of health needed.
Digital/Online Technologies (n = 4)	Innovation of digital/onling technologies should consider disabled people with a health equity approach.
Lack of Data/Need for Participation (n = 3)	Lack of data around disabled people, and the need for further participation in knoweldge generation, as well as in the medical field to address health equity.
Built Environment and Transportation (n = 3)	Need to address build barriers such as transporation needs, and the physical environment that hinder equitable access.
Equity, Diversity and Inclusion (EDI) (n = 2)	Approching the participation of disabled people in higher education utilizing a EDI approach.
Disabiliy Studies (n = 2)	The academic field of disability studies and the approach to health equity needs for disabled people.
International normative document: CRPD (n = 1), World Health Organisation Global Report on Health Equity for Persons With Disabilities (n = 1);	Use of the CRPD and another international document in addressing health equity needs.
Tool to audit health equity (n = 1)	Development of an auditing tool for health equity.
Culture of disability (n = 1)	Need for a culture of disability surrounding health equity.
occupational rights and occupational quality related concepts	No relevant content
no content covering the other normative legal documents (“Convention on the Rights of the Child”(CRC); “Convention on the Elimination of All Forms of Discrimination Against Women”; “Universal Declaration of Human Rights”; “Declaration on the Rights of Indigenous Peoples”; “International Convention on the Elimination of All the Forms of Racial Discrimination”; “UN Framework Convention on Climate Change” and “UN Flagship Report On Disability And Development”.	No relevant content

.

Ableism (n = 11)

Ableism was mentioned in conjunction with health promotion and competency training [151], as a structural issue [152], that ableist discourses and realities have to be challenged [153], and that the Canadian health care and medical system is systemically exhibiting many isms, such as ableism, and that these systemic issues were increased during the COVID pandemic [154]. In one abstract, it was argued that how our reaction to COVID played itself out must change how we think about health equity, that it is important to engage intersectionality, and that “discrimination (e.g., sexism, ableism, racism, classism, etc.) within our social institutions intersect to withhold resources needed for health from people who themselves have intersecting identities that make them vulnerable to the effects of discrimination” [155] (p. 585). Ableism was also noted as one factor in in-group health disparities and as a cause of conflict within communities that impacts in a negative way health equity [156], and the impact of ableism on health ranging from medical care to addressing the social determinants of equity was highlighted [157]. One noted that an evaluation of health service needs “…should be grounded in health equity, address systemic racism and ableism, and emphasize the life course and journey of those with such needs and their families” [158] (p. 1). One stated, “Nurses must recognize how racism, sexism, transphobia, ableism, and all forms of structural discrimination impact their work, and embrace intersectionality identity theory’s role in producing disparate outcomes” [159]. The capability approach was noted as a useful tool to tackle health equity-related social justice problems for disabled people [160]. In one abstract, it was argued that disability-based discrimination and health inequities in Europe are systemic and that “EU social policies should aim to reduce the impact of these social determinants on health equity” [161] (p. 1). Disablism or other ability- and judgment-based concepts were not found.

Health Communication (n = 11)

One article by Manganello [162] outlined the importance of health-related communication around disability, such as “…health information, misinformation, health literacy, interpersonal communication, media campaigns, media representation, digital health, communication technologies”. A further article by Morisod [163] also outlined the lack of health information. Further articles highlighted the barriers deaf people face in health-related communications, arguing that these barriers must be addressed to increase the health equity of the deaf/hard-of-hearing population [164,165]. Another abstract mentioned the use of the “…social model of disability into the social marketing framework” to increase health equity and inclusiveness” [166]. In another abstract, it is argued that making written medication information accessible for patients with visual impairment is an action item for generating health equity [167]. To achieve health equity for the deaf community in healthcare settings, it is argued that one has to train and credential interpreters [168]. Technological supports for communication, such as eHealth platforms to communicate with health care, were seen as a potential solution if done right [165]; see also [169]. The problems of artificial intelligence algorithms in telemedicine and mental health related to disabled people were acknowledged [170]. Inclusive access to health equity was noted as having to include broadband internet access in order to be able to take part in telehealth and telecommunications services [171].

Education and/or Advocacy and/or Lack of Knowledge (n = 9)

Using disability studies and work from other scholars of marginalized backgrounds was seen as useful to teach the history of nursing and healthcare in nursing education “to advocate for greater health equity and social justice during their nursing careers” [172] (p. 469). In one abstract, it was stated that their “article uses an intersectional lens to discuss the scope, magnitude, and determinants of health inequities that people with disabilities experience and the ways in which theoretical models of disability used in nursing education can further contribute to inequities” [173]. In one abstract, it is argued that training in the lived experience of disability is not always included in medical education [174]. To include community members with intersection identities, including disabled people, in medical education was highlighted as a useful strategy to make implicit biases visible [175], and in another abstract, it was argued that health professionals need disability training to counter implicit and explicit bias against disabled people [176]. It was furthermore argued that nurses must recognize how racism, sexism, transphobia, ableism, and all forms of structural discrimination impact their work and that they have to embrace the intersectionality identity lens in order to decrease the negative outcomes [159]. In one abstract, it was noted that over 90% of physicians stated that they lack the knowledge and skills to deal with intellectual and developmental disabilities [177]. For lack of knowledge, see also [178,179].

Intersectionality (n = 7)

The intersectionality of the disability identity with the identities of other marginalized identities, such as being a black disabled person or a woman with a disability, is engaged within two abstracts [180,181]. It is noted that the focus is often on individual patient barriers over systemic and relational barriers such as intersectional identities [182], intersecting experiences of stigma using “intersecting social positions (i.e., sexual orientation identity; gender identity/modality; race/ethnicity; physical disabilities/chronic illness; mental health/behavioral/emotional problems)” [183] (p. 608) and one study looked at “disability prevalence in the US and present evidence of differences in prevalence by race, ethnicity, and sexual orientation; health disparities by disability status and type of disability; and health disparities for people whose disability intersects with other forms of marginalization. We suggest policy changes to advance equity, reduce disparities, and enhance the health and well-being of all Americans with disabilities” [184] (p. 1379). Ray argued that health equity discussions have to be intersectional, whereby Ray used the intersectionality-based health equity problems that appeared during the COVID pandemic as an example, and Ray argued “that discrimination (e.g., sexism, ableism, racism, classism, etc.)” intersected to increase the COVID health equity problems [155] (p. 585). It was argued that “nurses must recognize how racism, sexism, transphobia, ableism, and all forms of structural discrimination impact their work, and embrace intersectionality identity theory’s role in producing disparate outcomes” [159] (p. S10). Intersectional identity, and intersectional experience listed above were the only intersectional concepts mentioned in the relevant abstracts.

Need for Representation on Staff Level (n = 6)

It was flagged in various abstracts that it is essential for health equity that disabled people are present on the staff level, such as doctors with disabilities [185], disabled staff [186], disabled nursing staff [187,188], disabled medical staff [189]; see also [190].

COVID (n = 5)

It was noted that the “COVID-19 pandemic has disproportionately impacted disabled people, especially those who are members of marginalized communities that were already denied access to the resources and opportunities necessary to ensure health equity before the pandemic. Participants reporting a disabled household member were more likely to report challenges accessing basic needs, such as food, housing, healthcare, transportation, medication, and stable income during the pandemic” [191] (p. 1); see also [192]. In one abstract, it was argued that “…disability-a chronic omission in health equity that must be central to Canada’s post-pandemic recovery” [193]. Urban health policy, planning, and practice were seen to have a negative effect on disabled people during the COVID pandemic and on being inclusive and healthy cities for all [194]. In one abstract [195], it was argued that the health rights of people with disabilities and their health equity were neglected during the pandemic.

Importance of Health Equity (n = 4)

In one abstract, the concept of health equity is mentioned in relation to looking at positive developments around health equity/health inequity for disabled people, mentioning the documents “World Health Organisation Global Report on Health Equity for Persons With Disabilities”, “the United States National Council on Disability’s Health Equity Framework”, and “the Joint Commission’s Sentinel Event Alert” [196].

In another abstract, it is argued that the health and wellbeing of disabled people have to be a main focus of health equity and that the voices of disabled people have to be involved in health equity strategies, but that disabled people are often ignored in health equity discussions [160].

In a third, it is stated, “Health equity demands attention to social determinants of health (SDOH), particularly for people with disabilities who often have poorer outcomes and face more health inequities than nondisabled peers” [197] (p. 11); see also [198] from the same author.

Digital/Online Technologies (n = 4)

Digital health equity was a concern mentioned in relation to disabled people [199], and the problem of the usability of new and novel technologies was flagged as a health equity problem [200]. Digital and online technologies, if done right, were suggested as useful to increase health equity, whereby the technologies covered were around access to services [201,202]. However, of the science and technology governance terms and the technology-based ethics terms, none at all were found in conjunction with health equity and disabled people.

Lack of Data/Need for Participation (n = 3)

In one abstract, it was highlighted that adults with intellectual/developmental disabilities “provided their priorities for health equity data, surveys, and information dissemination by U.S. federal agencies” [203] (p. 368) in another that “community-based participatory research (CBPR) can generate knowledge and support actions to tackle the many social, environmental, and system-level factors causing health disparities of disabled people and in particular women with disabilities and to promote health equity” [204] (p. 370). To involve intellectually and developmentally disabled people to generate data on health equity was flagged [205].

Transportation and the Built Environment (n = 3)

Two abstracts classified problems with access to transportation as a health equity problem [206,207]. The lack of research on the impact of the built environment on the wellbeing of older people with disabilities was seen as another health equity problem [179].

Equity, Diversity, and Inclusion (EDI) (n = 2)

In relation to EDI, one abstract argued for EDI-ing admission processes to medical school [189]. Health equity impact assessments (HEIA) were seen as a way “…to ground this program on principles of equity, inclusion, and diversity with a focus on the marginalized groups” it aims to serve [208].

Disability Studies (n = 2)

The academic field of disability studies was mentioned in one abstract as needed to engage with racialized understanding of chronic pain to increase literacy to increase health equity to the Long COVID community [209] and another abstract focusing on nursing noted that disability studies is essential for looking at political determinants of health [210].

Convention on the Rights of Persons with Disabilities (CRPD) and Other International Normative Documents (n = 1)

One abstract mentioned the CRPD ratification of the 2006 United Nations Convention on the Rights of Persons with Disabilities to reinvigorate US efforts to maximize the health and dignity of disabled Americans and support their full participation in the community [211]. But strictly speaking, this was not linked to health equity as a concept in the abstract. We found no content covering the other normative legal documents: (“Convention on the Rights of the Child” (CRC); “Convention on the Elimination of All Forms of Discrimination Against Women”; “Universal Declaration of Human Rights”; “Declaration on the Rights of Indigenous Peoples”; “International Convention on the Elimination of All the Forms of Racial Discrimination”; “UN Framework Convention on Climate Change”, and “UN Flagship Report On Disability And Development”.

Health Equity Audit Tool (n = 1)

One article by O’Donovan introduced EquiFrame, an analytical tool for examining the extent to which health policy documents address health equity for vulnerable groups [91].

Culture (n = 1)

The culture around disability was mentioned in relation to the Ukrainian healthcare system [212]. This article outlined the consequences of limited dialog around disability, such as a lack of resources and health equity for disabled people.

3.2.2. Health Inequity Not Already Covered under Health Equity

This section outlines the literature on health inequity that we did not already cover in the health equity section.

As outlined by Mishra, the “WHO/Europe developed the ‘WHO European framework for action to achieve the highest attainable standard of health for persons with disabilities 2022–2030’, in close cooperation with organisations of persons with disabilities…The Framework is aligned with the core priorities of the WHO European Programme of Work 2020–2025, that is, achieving universal health coverage, protecting against health emergencies, and promoting health and well-being. It consists of four objectives, 13 targets, and 20 indicators that act as measures of progress and success, and as drivers for policy action and a roadmap for Member States towards a disability-inclusive health sector… Inclusive health sectors will aid towards the achievement of the Sustainable Development Goals, the protection of the human rights of persons with disabilities, and the promotion of their health” [213] (p. 1).

Factors in the Health Inequities of Disabled People Mentioned

The following

Table 3. Factors in health inequity problems for disabled people mentioned.

Factors in Health Inequity Problems Mentioned	Number of Abstracts
Topics only mentioned once (at the end)	18
Attitudinal and other barriers	15
Technologies	9
Lack of knowledge about and lack engagement with disabled people	8
Lack of engagement with intersectionality in relation to disabled people	5
Sexual health inequity	4
Disability discrimination (disablism)	4
Violence	3
Youth with Disabilities	3
Transportation	2
Science and technology governance terms and ethics	0
Specific intersectionality concepts	0
Occupation and the rights and quality of occupation focused concepts	0

lists the factors and total number of abstracts mentioned in the literature that were flagged to contribute to the health inequity problems disabled people face.

It is noted that no relevant abstract contained any occupational rights and quality related concepts.

Attitudinal and Other Barriers (n = 15)

Attitudinal and other barriers were mentioned in 15 abstracts such as social, physical and attitudinal factors [144], physical, attitudinal, communication, and structural barriers [214,215], prevalence of the ableist medical model of disability being [216], consequences of ableist messaging for persons living with disabilities, particularly in the context of promoting healthy movement behaviors [217], structural ableism [218,219], stigmatization [220,221,222], stereotypes [223], biases [223], systemic and individual health professional biases [224], “…socioeconomic, political, involve social determinants of health, include higher risk factors, and display a wide spectrum of health system barriers” [225] (p. 121), built environment [223], environmental level barriers to a healthy lifestyle [226], and physical, psychosocial, environmental, and economic barriers [227].

Technologies (n = 9)

Technologies were seen as a factor in health inequity in nine abstracts, such as lack of access to assistive technology (AT) [228,229,230], digital transformation of society, including jobs [231,232,233,234], and technical and financial challenges [214,215]. However, of the science and technology governance terms and the technology-based ethics terms, none at all were found in conjunction with health inequity and disabled people.

Lack of Knowledge about and Lack of Engagement with Disabled People (n = 8)

Lack of knowledge about and lack of engagement with disabled people showed up in various ways in eight abstracts, such as lack of knowledge [223,235], lack of awareness of and about homeless youth with intellectual disabilities [236], “low literacy on systemic biases that exist within multiple social determinants and how these perpetuate health inequities for disabled people” [224] (p. 131), lack of knowledge of health care professionals [222], failure to include and consider the impact decisions will have for disabled people [237], and lack of prioritization of disability issues [214,215].

Lack of Engagement with Intersectionality in Relation to Disabled People (n = 5)

Lack of engagement with intersectionality in relation to disabled people was seen as a problem regarding health inequity in two abstracts [216,238]. Various intersectionalities were seen to increase health inequities and, as such, are in need of attention, such as adverse pregnancy and birth outcomes for black, deaf, and hard-of-hearing women [239]. See also “Blind and deaf individuals comprise large populations that often experience health disparities, with those from marginalized gender, racial, ethnic and low-socioeconomic communities commonly experiencing compounded health inequities” [240] (p. 1), chronic pain, and “…gender, ethnicity, socioeconomic and migration status” [241] (p. 479). Specific intersectionality-based concepts were not found to justify health inequity actions related to disabled people.

Disability Discrimination (n = 4)

Disability-specific discrimination (disablism) as a health inequity problem was mentioned in four abstracts [242,243,244,245]. For example, it was highlighted that nearly 14% of Australians with disabilities reported disability-based discrimination in the previous year [245]. And in another abstract, it was stated, “In the UK (i) adults with disabilities were over three times more likely than their peers to be exposed to discrimination, (ii) the two most common sources of discrimination were strangers in the street and health staff and (iii) discrimination was more likely to be reported by participants who were younger, more highly educated, who were unemployed or economically inactive, who reported financial stress or material hardship and who had impairments associated with hearing, memory/speaking, dexterity, behavioural/mental health, intellectual/learning difficulties and breathing” [243] (p. e16).

Sexual Health-Related (n = 4)

Sexual health-related factors were mentioned four times [246], sexual health inequities [247,248], and higher rates of sexually transmitted infections (STI) [249].

Violence (n = 3)

Violence was mentioned in three abstracts, such as obesity, partner violence, and suicide (focusing on deaf people [250,251], forced sterilizations of women and girls with disabilities [252], and sexual violence against disabled people [252].

Youth with Disabilities (n = 3)

Youth with disabilities were mentioned in three abstracts, such as paternalist attitudes and infantilization of young people with intellectual disabilities [253], not enough sport programs to accommodate college matriculation of disabled students [254], and “…school-to-prison pipeline disproportionately impacts African Americans, Latinos, Native Americans, and youth with disabilities, who also experience health inequities” [255] (p. 269).

Transportation-Related (n = 2)

Transportation was flagged as a problem twice: as a disparity in social determinants of health [256] and “…lack of transportation, housing instability, low income, and most importantly, lack of health insurance” [257] (p. 1).

Other Factors (Only Mentioned Once Each)

Other factors mentioned were: having to rely on crowdfunding [258], individual- and neighborhood-level factors (specific ones not mentioned) [259], problems with employment and education [242], personalization schemes [260], loneliness [261], inequities in opportunities for healthy living, health care, and health outcomes [238], de-prioritization during COVID [220], and a lack of person-centered support [262], social and economic disadvantage [144], health and housing policies [91], paternalistic beneficence versus idealized autonomy [222], and a focus on equality, not equity [224]. The term occupation and the rights and quality of occupation-focused concepts were not found to engage with the health inequity of disabled people.

Actions Needed and Performed Actions

In this section we provide

Table 4. Actions are needed to address the health inequities mentioned.

Action Needed and Performed Action	Number of Abstracts
Action Needed: cover intersectionality	6
Action Needed: To include disabled people	4
Actions needed: Existing knowledge has to be applied (solutions are known)	4
Action Needed: Education	3
Actions needed and performed in relation to intellectually/developmentally disabled people	2
Action Needed: Distrust	2
Action needed: To recognize ableism	1
Action Needed: Lack of access to assistive technology	1
Action Needed: Social Stressor	1
Action Needed: Generation of data	1

with the list of themes found and detailed findings of our analysis.

Actions Needed

In the literature on health inequities, there were various calls to action in order to address existing health inequities related to disabled people. For example, “Actions that affect the main factors associated with disability, such as reducing health inequities through policies, strategies, and activities, can contribute significantly to the well-being and quality of life of Colombian older adults” [263] (p. 1).

Action Needed: To Cover Intersectionality (n = 6)

Intersectionalities are covered as an action item in six abstracts [144,173,216,238,241,264]. One, for example, mentioned the following intersectionalities: “disability intersects with characteristics such as race and ethnicity, sexual orientation and gender identity, and rural residence” [238] (p. 91). One argued that an intersectional social justice approach is needed in nursing education to decrease the health inequity caused by nursing education due to the disability models they use in nursing education [173]. Sometimes it is not about intersecting identities but the negative impact of intersecting factors on disabled people who are in need of action. “People with disabilities are often subject to intersecting layers of social and economic disadvantage and other barriers that drive health inequity” [144] (p. 1254).

Action Needed: To Include Disabled People (n = 4)

To include disabled people was seen as needed in four abstracts in service design [144], awareness-raising [144], and as health professional students and teachers [224], and it was stated that including disabled people in research decreases health inequity [265] and that disabled nursing faculty are needed [266].

Actions Needed: Existing Knowledge Has to Be Applied (n = 4)

Four abstracts noted that solutions are known but have to be applied [214,215], for example, the universal design of the physical environment [267], and preconditions that allow people to engage in society [267]. Disability studies literature was seen as useful to engage with the health inequity of disabled people [266].

Action Needed: Education (n = 3)

Education, including the content of curricula, was mentioned as an action item in three abstracts [221,224,253], including in medical education [221].

Actions Needed and Performed in Relation to Intellectual/Developmental Disabled People (n = 2)

Two abstracts covered actions needed and performed in relation to intellectually/developmentally disabled people, including children [246], including empowering intellectually/developmentally disabled people, including children [267].

Action Needed: Distrust (n = 2)

Mistrust between deaf patients and hearing staff in healthcare settings was mentioned twice [268,269].

Action Needed: To Recognize Ableism (n = 1)

It was argued in one abstract that the medical community has a responsibility to acknowledge the reality of ableism and take meaningful action [217], and Faught proposed five strategies to counter ableist messaging in medical education: “(1) increase knowledge and confidence among physicians and trainees to optimize movement behaviours in persons living with disabilities, (2) perform personal and institutional language audits to ensure terminology related to disability is inclusive and avoids causing unintended harm, (3) challenge ableist messages effectively, (4) address the unmet healthcare needs of persons living with disabilities, and (5) engage in efforts to reform medical curricula so that persons living with disabilities are represented and treated equitably. As mentioned in the article, physicians and trainees are well-positioned to deliver competent and inclusive care, making medical education an opportune setting to address health inequities related to disability” [217] (p. 82).

Action Needed: Lack of Access to Assistive Technology (n = 1)

Lack of access to assistive technology during the COVID-19 pandemic was seen as an action item [270].

Action Needed: Social Stressor (n = 1)

Social stressors were mentioned as an action item once, stating that “addressing social stressors related to lifetime adversity may be important to increasing engagement in pain self-management. Lack of attention to these factors may increase health inequity among those most disabled by chronic pain [271] (p. 267).

Action Needed: Generation of Data (n = 1)

The generation of data was flagged as an action item [272], and the Patient Protection and Affordable Care Act of the USA was seen to provide powerful tools to generate such data [272].

4. Discussion

Our results (Table A1, Appendix B) suggest that “health equity” and “health inequity” are rarely covered in conjunction with disabled people. Although the numbers increased in recent years in both cases (the 162 and 177 abstracts we found and used were predominantly from 2021 to 2024). They are still very low. For example, the term “patient*” generated 23,791 abstracts (Table A1, Appendix B, column 2) with “health equit*” versus all our disability terms, which generated 162 abstracts (strategy 1) and 16,036 abstracts with “health inequit*” (Table A1, Appendix B, column 3) versus 177 abstracts with all our disability terms (strategy 2). And the numbers are even lower or are 0 if one looks for certain disability terms. The intersectional identities we selected as examples between disability and another marginalized identity did not generate any hits (Table A1, Appendix B,). And intersectional identities were also not found much in our qualitative analysis.

Many keywords we covered in our study showed few or no hits in the abstracts covering disabled people, such as the EDI phrases sustainability, climate change, burnout, allyship, or activism. Many of the 111 indicators of wellbeing, all of which could be seen to impact “health equity” and “health inequity” of disabled people were not visible for example “physical environment*”, “social exclusion”, “social safety network”, “social norm*”, “social relationship*”, or “personal assistan*” to name a few.

Finally, ability judgment-based concepts, with the exception of the term ableism, occupation-based concepts (non-health focused), and intersectionality-based concepts were not used to enrich the health equity” and “health inequity” of disabled people discussions.

4.1. Health Equity and Health Inequity: Visibility of Disabled People

Our results suggest that “health equity” and “health inequity” were rarely covered in conjunction with disabled people and often not at all if one looks at specific disability terms. In three of the abstracts covering health equity, it is argued that disabled people should be the main focus of health equity agendas [160,197,198], which our data suggest is not the case, and in six other abstracts, the need for data, lack of knowledge, and the ability of disabled people to generate the data are highlighted [177,178,179,203,204,205]. Lack of knowledge and data and the need to involve disabled people in many different areas was also a theme in the health inequity abstracts [144,214,215,222,223,224,235,236,237,265,266,272], as was the fact that existing knowledge on the health inequity problems of disabled people needs to be applied [214,215,266,267]. Linked to lack of knowledge was the need for education [172,173], including medical education [174,175] and training of health professionals [159,176] in the health equity abstracts, and education, including the content of curricula, was mentioned as an action item in three abstracts covering health inequity [221,224,253], including in medical education [221]. Linked to visibility It was flagged in various abstracts that it is essential for health equity that disabled people are present on the staff level, such as doctors with disabilities [185], disabled staff [186], disabled nursing staff [187,188], and disabled medical staff [189,190].

In the “Global report on health equity for persons with disabilities” [9] it is stated: “The overarching aim of this report is to make health equity for persons with disabilities a global health priority” [9] (p. 2). However, the very report only generated one hit in our abstracts. Not part of our sample but the hits were 12 if the name of the report was searched in the full text of documents that had “health equit*” or “health inequit*” in the abstract in the databases we used. That the report is hardly cited even in the full text of articles suggests some problems with the use of the report to trigger this goal.

Given that many disabled people belong also to other marginalized groups its is especially problematic that “intersectionality”/“intersec*” showed up only in 15 relevant abstracts in our qualitative content analysis. Within these 15 abstracts, six indicate that intersectionality of disabled people needs to be an action of health inequity [144,173,216,238,241,264], that there is a lack of engagement with intersectionality in relation to disabled people and health inequity [216,238,239,240,241] and the same problems are flagged in conjunction with health equity [155,159,180,181,182,183,184]. The abstracts covering intersectionality show that there are many different intersectionalities that shape the health equity/health inequity reality of disabled people and all these intersectionalities generate a diversity of health equity/health inequity problems and the need for different approaches to health equity/health inequity. Given the few abstracts covering intersectionality it is no surprise that two aspects of intersectionality of disabled people were not present. One being that we tend to treat “disability” as a homogenous group when mentioned in intersectionality whereby different disabled people have different intersectionality-based health equity/health inequity problems. The second being that a disabled person can have two different “disabilities” with totally different impact on health equity and health inequity and intersectionality. These two “disabilities” could lead to inter-sectional conflict but also intra-sectional conflict between the two “disabilities”.

Attitudinal and other barriers were covered in 15 abstracts, and the barriers were the main theme within the factors leading to health inequity [144,214,215,216,217,218,219,220,221,222,223,224,225,226,227] suggesting that there has to be a system wide change in how one deals with and relates to disabled people within the health equity/health in equity discussions. Interestingly, the recent Accessibility Canada Act [273] lists five main areas of accessibility barriers: (a) attitudinal, (b) systemic, (c) architectural, and physical, (d) informational and communicational, and (e) technological. All these barriers were mentioned as factors in health inequity and preventing health equity. That the term “patient” was at least 100 times or more mentioned in the health equity and health inequity abstracts than individual disability terms (Table A1, Appendix B, columns 2 and 3) might suggest a certain mindset that disability is mostly looked at in the health equity discussions within a medical lens, and that might suggest a reason why so little of the lived reality of disabled people is covered within health equity and health inequity.

In the “Global report on health equity for persons with disabilities” [9], it is stated that one goal of the report is to “document evidence on health inequities and country experiences on approaches in advancing health equity in the context of disability” [9] (p. 2). Our data suggest that the evidence on the social causes of health inequity and how to decrease these social causes of health inequities for disabled people is not generated as needed and even less or not at all on a differentiated level based on different disabilities and the intersectionality of disabled people with other marginalized identities. As such, the data needed to “make recommendations that stimulate country-level action” [9] (p. 2) is not generated.

4.2. Societal Developments and Discussions Influencing Health Equity/Health Inequity of Disabled People

Our study adhered to a broad understanding of health equity that moved beyond access to healthcare and health services [274] to include that health equity is impacted by one’s lived reality as reflected by many social determinants [2,3,4,5,6,7,275], which fits the understanding in the “Global report on health equity for persons with disabilities” [9]. As such, there were many opportunities to engage with disabled people.

Many keywords we looked at in our study (during manifest coding and qualitative content analysis) that cover social aspects and fit with [9] showed few or no hits in the abstracts covering disabled people, such as the EDI phrases, sustainability and climate change. Many of the 111 indicators of wellbeing, all of which can be seen to impact “health equity” and “health inequity”, were not visible in relation to disabled people, for example “physical environment*”, “social exclusion”, “social safety network”, “social norm*”, “social relationship*”, or “personal assistan*”, to list a few. The broad interpretation of health equity and health inequity demands an interaction with all of the keywords that had low hits.

To give another example, there were 1787 abstracts for “technolog*” and “health equit*” and 1047 abstracts with “technolog*” and “health inequit*” in the three databases (Table A1, columns 2 and 3) indicating the importance of technologies to health equity and health inequity. But we found only 14 abstracts within the 162 abstracts (column 4, Table A1) and 10 abstracts within the 177 abstracts (Table A1, column 4) containing technolog*. At the same time, our qualitative content analysis showed the importance of technologies; for example, digital and online technologies were seen as potentially useful to increase health equity for disabled people if done right [201,202], but at the same time, the usability of new and novel technologies was flagged as a health equity problem for disabled people [200]. The terms “assistive technolog*” and “assistive device*” had even fewer hits in the non-disability abstracts (Table A1, columns 2 and 3) and the disability-covering abstracts (Table A1, columns 4 and 5), whereby the qualitative content analysis revealed that there are accessibility problems with assistive technologies [228,229,230]. Given the importance of technologies in general and assistive technologies in particular for disabled people to be able to experience health equity, it is essential that technologies, especially assistive technologies, are much more engaged with in conjunction with disabled people. There are many academic and policy communities that focus on how to govern science and technology using various governance terms [126]. And there are technology-focused ethics fields such as AI ethics, bioethics, computer science ethics, information technology ethics, nanoethics, neuroethics, and robo-ethics that exist with the purpose of preventing or decreasing potential negative and increasing potential positive effects of science and technology on society. However, we found none of the phrases during our qualitative content analysis, which suggests a lack of engagement with the health equity/health inequity concepts in conjunction with disabled people within the science and technology governance discussions. This is a problem for disabled people given the multifaceted impacts of scientific and technological advancements on disabled people, such as employment, and many other social issues impacting health equity and health inequity. People within these fields could also fill the gap we found around technologies, especially assistive technologies, health equity/health inequity, and disabled people.

Terms such as “poverty” and “socioeconomic status” are other examples of terms rarely used around disabled people. These terms deserve much more coverage given that disabled people are disproportionally represented among people living below the poverty line [276], and poverty is linked to health equity/health inequity [9]. Indeed, the quote from [149] (p. 1) we used at the end of our qualitative analysis clearly shows the importance of engaging more with the health equity/health inequity of disabled people within the poverty discussions.

It is argued that to achieve health equity, one has to remove disadvantages based on one’s social position [6,7] and any other socially defined circumstance [6] that especially impact in a negative way socially marginalized groups [4], such as poverty, discrimination, lack of power, and lack of access to meaningful jobs, education, housing, safe environments, and health care [2]. This would require engaging much more with disabled people, not only as a group but also with the different disabilities and the intersectionality of disabled people’s lived realities, given their low social positioning in many places and that they are disproportionally represented among the people living in poverty [276].

Given the problematic lived reality of disabled people and their low positioning, disabled people are in high danger/already experience life burnout due to the disablism, the systemic discrimination they experience, [277], and specific groups of disabled people face specific burnout causes such as autistic burnout, which is linked to masking who one is in order to avoid negative treatment [277].

To quote Gill, a former director of the first disability studies program in the USA, “…Understandably these facts of disability oppression can take a toll on the morale of persons with disabilities. 37 After struggling with employment bias, poverty, blocked access to the community and its resources, unaccommodating and selective health services, lack of accessible and affordable housing, penalizing welfare policies, and lack of accessible transportation, some may experience what is known in the disability community as “disability burn-out.” This term refers to emotional despair engendered by thwarted opportunities and blocked goals. It is aggravated and intensified by years of exposure to disability prejudice and devaluation. In fact, a frequently repeated theme in research interviews with persons with disabilities and illnesses is, “I can live with my physical condition but I’m tired of struggling against the way I’m treated”38” [278] (p. 180).

However, burnout had few hits in Table A2, and no relevant abstract covering burnout was found during the qualitative content analysis.

Environmental issues are frequently cited as one source of health inequity/health equity [99]. There are environmental determinants of health [100] and ecological determinants linked to health equity [101,102,103,104]. There are determinants of health related to climate change [99]. Terms such as “environmental health equity” and “environmental health inequities” are used widely [105]. Actions on sustainability are linked to health equity [114,115]. Social sustainability is also linked to health equity. For example, it is stated, “In order to achieve community wellbeing, the social environment must also support health equity by advancing economic, environmental and social sustainability, and fostering belonging, inclusivity, and diversity” [119].

However, we found no linkage between the three pillars of sustainability and the health equity/health inequity of disabled people. This disconnect is problematic because disabled people’s health equity and health inequity are impacted by how the SDG goals (for example, SDG1 focuses on poverty, which is a known problem for disabled people [279]) and the three pillars of sustainability are discussed and implemented. Indeed, all indicators of social sustainability can be seen as social determinants impacting health equity/health inequity, and social sustainability as a concept could be employed to improve the health equity/health inequity of disabled people. We also found no relevant abstract covering climate change or any other environmental issue or emergency and disaster management, planning, and preparedness, although it is argued that extreme weather events are increasing [280] and the many problems noted for disabled people in relation to sustainability, climate change, environmental issues, and environmental and disaster planning, preparedness, and management [105,113,281,282,283,284,285,286,287,288,289,290,291,292,293,294,295].

Environmental activism is aiming to change how we live as a society [105], and environmental activism is expected [296]. As such, it has the potential to impact many aspects of health equity and health inequity. However, no connection to health equity/health inequity among disabled people was found and the qualitative content analysis), although disabled people face many challenges in relation to environmental activism (as activists and as a consequence of activism), including activist burnout [105,297,298,299,300,301]. The many problems disabled people face in their lived reality and as activists also suggest that disabled people need allies, and that disabled people have to be able to be allies to others [302]. However, we found no engagement with the topic of allyship, which deserves more coverage, as it is not simple to be an ally of disabled people and, as disabled people, to be an ally to others [302].

Interestingly, the “Convention on the Rights of Persons with Disabilities” (CRPD), which is a testament to the many health inequities disabled people encounter, is not used to make a case for the health equity of disabled people, as well as the Convention on the Rights of the Child (CRC), the Convention on the Elimination of All Forms of Discrimination Against Women, the Universal Declaration of Human Rights, the Declaration on the Rights of Indigenous Peoples, the International Convention on the Elimination of All Forms of Racial Discrimination, and the UN Framework Convention on Climate Change. As such, one wonders why international normative documents are not used to shape discussions around health equity/health inequity, and disabled people.

In the “Global report on health equity for persons with disabilities” [9], it is stated to “bring health equity for persons with disability to the attention of decision-makers in the health sector” [83] (p. 2). If the health sector is the only group seen to have to deal with the health equity of disabled people, it might explain our results, which saw most societal developments and discussions not directly linked to health not being discussed in relation to health equity/health inequity among disabled people. We suggest that this is a problem, as health equity beyond the medical health and access to healthcare angle has to be brought to the attention of decision-makers and others beyond the health sector.

4.3. Health Equity and Health Inequity and Ability-Judgment Focused Concepts, Non-Health-Focused Occupational Concepts, and Intersectionality Concepts

Finally, ability-judgment-focused concepts, non-health-focused occupational concepts, and intersectionality concepts were not used to enrich the “health equity” and “health inequity” discussions.

4.3.1. Ability Based Concepts

The term “abilit*” had many hits in the non-disability abstracts (Table A1, columns 2 and 3), which makes sense as health equity is about the ability to access many social determinants. But the term had very few hits in the disability terms containing abstracts (Table A1, columns 4 and 5). Ableism was flagged only in eleven of the 162 health equity abstracts in our qualitative analysis, whereby it was framed, for example, as a structural problem (structural ableism [152]), needed to be part of the intersectionality lens [155], the cause of conflict between social actors [156], and to impact all aspects of health equity, from access to health services and health care to all social determinants of health [157]. The content of the eleven abstracts suggests that more data and studies are warranted. Furthermore, ableist/disableist and disablism were mentioned rarely, and the other ability-based theoretical concepts [65,67,68,69,70,71,72,73,74,75,76,82] were not present in the disabled people-focused abstracts (Table A1, Appendix B, columns 4 and 5). In general, ability-based concepts, with the exception of “ableism” and “ability”, also were not present in the abstracts, not focusing on disabled people (Table A1, Appendix B, columns 2 and 3). All of these terms could be used to critically analyze ability-based expectations, judgments, norms, and conflicts [67] and disablism, the systemic discrimination based on not measuring up to irrelevant ability norms [79], that influence social, political, and environmental factors in health equity and health inequity.

To note, we use ableism and disablism as general cultural realities that impact not only disabled people but also humans–human relationships in general and how humans interact with nature [82]. We also use ableism, but not with a negative connotation. Everyone has ability expectations and sees certain abilities as essential (ableism) [68,82]. However, ability judgments are used often to disable others. Ability judgments are used to support various negative isms such as racism and sexism [82,303] and have been used to justify colonialism [304]. In one study, students indicated that different social groups have different ability expectations [105], which means that there are ability-based conflicts, and with that, the question arises as to who can push through their ability expectations and what this means for marginalized groups in general and disabled people. All these ability judgments influence the abilities of especially marginalized groups, including disabled people, to move toward health equity.

To engage with some of the ability judgment-based terms. Ability privileges, defined as having one ability opening the doors to experience other abilities [67], can be seen to be an underlying dynamic within health inequity. If one does not fit a given ability norm, one has decreased access to other abilities such as employment, education, or transport, which in turn increases the danger of health inequity. People are often not aware of their ability privileges, a reality one could link to the fact that they internalize ableism [66] and disablism [69,70,71,72].

Adaptation is a main word in the health equity discussions linked to climate change [305,306,307]. The question is, what does adaptation mean for disabled people and other marginalized groups already experiencing health inequity? What can disabled people adapt to? Ability inequity is “…a normative term denoting an unjust or unfair distribution of access to and protection from abilities generated through human interventions”, and ability inequality is “a descriptive term denoting an uneven access to and protection from abilities generated through human interventions” [297] (p. 16). Ability inequity could be used to discuss that disabled people and other marginalized groups are unequally impacted in their ability to adapt to actions needed due to certain human interventions and to question why they must adapt instead of eliminating the cause of the problem.

Desmond Tutu used the term “adaptation apartheid” to question that the people who cause climate change related issues do expect others to adapt to the problems they did not cause, which they often can not do [308]. In essence, what Desmond Tutu describes is ability inequity.

Ability obsolescence, defined as that one’s set of abilities is seen as obsolete [68,78], impacts disabled people and others in many ways. Having cherished abilities is one factor in staying out of poverty, and that is an essential factor in obtaining and maintaining health equity. And which abilities become obsolete constantly changes. Within Table A1, we list the results for various terms linked to modifying the human body to change abilities and ability-linked terms that cover certain problematic aspects of that. None of these terms received many hits, if any. This is problematic as these changes in ability expectations made possible by technologies that are added to the body, implanted into the body, or used by the body pose constant new health equity challenges, such as employability for disabled people, but also for non-disabled people and deserve much more coverage. For example, what will artificial technologies (to use the latest technology discussed extensively) do to ability obsolescence, who will be hit the hardest, and what will this mean for health equity?

In the way we perceive ableism, ableism is not a negative by default. It just says that certain abilities are seen as essential. Ableism can be deployed to disable but also to enable [68]. For example, having the ability to experience the seven areas of human security: economic security, food security, health security, environmental security, personal security, community security, and political security [309] could be seen as an enabling use of ability expectations/ableism that benefits health equity. EDI/DEI would be another positive example of a positive use, as in being enabled to experience an equitable, diverse, and inclusive society, and could have a positive effect on health equity. Health equity is, in essence, about the ability to have a good life and is another potential positive example of an ability expectation. The capability approach is about the ability to have a good life [310,311,312], and health inequities such as poverty deprive a person of their “capability to lead a “good life” [313] (p. 102). In the end, the different ability judgment-based concepts can be deployed to engage and analyze different problems for health equity. Indeed, if different groups cherish different abilities, these could lead to ability-based conflicts between groups, which impact the implementation of health equity, especially for marginalized groups whose ability expectations are marginalized.

4.3.2. Occupational Rights-Based Concepts

The occupational concepts we looked at [88] were not found at all in our qualitative content analysis. Indeed, the very term occupation was not found in even one relevant abstract. However, the occupational terms could be used to strengthen the questioning of occupation-related health inequities. For disabled people, the usefulness of these terms is evident. For example, “Occupational injustice” is heavily influenced by one’s social position [71,72,73]. “Barriers to engagement in meaningful occupation are considered injustices” [88] (p. 3). Social positioning is one factor in health inequity [6,7], and the UN Convention on the Rights of Persons with Disabilities [8] reveals that disabled people are in a low social position. Therefore, one can make a linkage between occupational injustice, disabled people, and health inequity. Many of the non-health-focused occupational concepts could enrich the health equity/health inequity discussions.

4.3.3. Intersectionality Theoretical Concepts

Many intersectional concepts are used to further the intersectional analysis [23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64]. All of them could be used to enrich the health inequity and health equity discussions in relation to the intersectionality of disabled people. This intersectionality includes an area often forgotten, namely where one has two different “disabilities” (intra-sectionality). This type of intersectionality deserves much more coverage, as different “disabilities” could reflect totally different cultures and judgments, and with that, a different positionality of the person for the different disabilities. For example, one could have a “disability” where the “disability” is not seen as a medical one (deaf culture), but the other “disability” could be linked to a medical culture.

To apply some of the concepts to disabled people. Our findings of a lack of engagement with the intersectionality of disabled people could be categorized as intersectional invisibility (the dynamic that people with more than one marginalized identity often feel more invisible than individuals who have one or zero marginalized identities [27,34]). Given the intersectional invisibility, no data are generated on the intersectional self of disabled people, so how does one see intersectionality? [24,25] No data are generated on intersectional oppression [26,27,28,29], intersectional bias [40,41,42,43,44,45,46], intersectional activism [63], and intersectional self-advocacy [64], to name a few intersectionality concepts. Disabled people face many intersectionality conflicts (intersectional conflict is about different views of intersecting identities and lived realities by individuals and other social actors, which in turn can lead to conflicts due to different views about any of the given intersecting identities, including that identity categories can compete with each other [23,137]) if they also belong to other marginalized groups. The intersectional conflict plays itself out differently in different settings and cultures. Anita Ghai and others [21,136], for example, flagged not only the intersectional invisibility disabled women face but also intersectional conflict and a lack of intersectional solidarity (although they did not use the terms). All of the intersectionality concepts could be used to make visible the increased problems disabled people face if their identity intersects with other marginalized identities. The intersectional concepts could be used to analyze the impact of ability-based judgments, norms and conflicts on the health equity/health inequity realities of intersecting identities.

5. Conclusions

Our results suggest that the “health equity” and “health inequity” focused academic literature are not the theoretical and data engine to change the lived reality of disabled people for the better given the low academic coverage of disabled people in conjunction with health equity” and “health inequity” in general and even lower or not at all in conjunction with sustainability, climate change, emergency and disaster planning, preparedness and management, environmental issues, wellbeing, the 111 indicators of four of the wellbeing composite measure (“The Social Determinants of Health (SDH), The Canadian Index of Wellbeing (CIWB), the OECD Better Life Index and the Community-based rehabilitation (CBR) matrix), activism, equity, diversity and inclusion, science and technology governance and technology-focused ethics fields, and international normative documents. Finally, ability-judgment-based concepts, occupation-based concepts, and intersectionality-based concepts were not used to enrich the health equity” and “health inequity” discussions.

In the Global Report on Health Equity for Persons with Disabilities [9], it is stated that one goal of the report is to “document evidence on health inequities and country experiences on approaches in advancing health equity in the context of disability”. Our data suggest that the evidence on the social causes of health inequity related to disabled people and what to do about it is hardly generated. And as such, the data needed to “make recommendations that stimulate country-level action” [9] (p. 2) is not generated.

5.1. Implication for Research

Given the results of our study, further research projects could and should be carried out to fill the gaps. All the causes of health inequity and action items noted to generate health equity demand data to inform best practices. The causes and action items also demand the involvement of non-medical health researchers with non-medical health, health equity focus to generate data and best practices to decrease health inequity. It in particular demands researchers engage with the numerous intersectionalities of disabled people with other identities and situations and the involvement of disabled people with intersecting identities. EDI-ing research questions could help with that, as could EDI-ing the workplace.

5.2. Implication for Education

In one abstract, it is stated that “significant gaps have been identified in the integration of health equity and social justice into health professions education programs in Canada across all educational levels” [314] (p. 2). Given our results, the data are not there to integrate disability justice [20] and health equity into any educational program. Indeed, the need for education was a theme in our qualitative analysis. However, the need for education goes beyond medical health. Indeed, one wonders why various areas focusing on social determinants of wellbeing do not link to health equity and health inequity for disabled people and whether this disconnect is due to how health equity/health inequity are understood in conjunction with disabled people.

5.3. Implications for Decision Makers

The lack of data suggests that decision-makers do not have health equity and health inequality data focusing on disabled people, and with that, cannot generate evidence-based policies on the topic. When it is stated in the Global Report on Health Equity for Persons with Disabilities, “bring health equity for persons with disability to the attention of decision-makers in the health sector” [83] (p. 2), this suggests a siloing of health equity, at least in relation to disabled people, to a very narrow group of people. Why would the topic not be brought to the attention of decision makers in the sustainability sector, emergency preparedness sector, or employment sector, and what data would be needed? Would data on the social aspects of health equity, which goes beyond access to healthcare and the danger of developing diseases and impairments, be wanted? Such language seems to support siloing disabled people into the medical realm and making them invisible in the social wellbeing area of health equity. It might also hinder people who work on the negative lived reality of disabled people from using or engaging with health equity as a concept.