Disparities in access to health and support services for people with disability in Australia: a scoping review of the structural social determinants

Abstract

Background Systemic inequities in health and social services exacerbate barriers for disadvantaged groups within the disability community, leading to poorer health outcomes and diminished quality of life. We aimed to evaluate how structural determinants function to shape disparities in access to health and support services for people with disability. Methods We followed Arksey and O’Malley’s methodological framework. A comprehensive search strategy was implemented across five major databases—Medline, Embase, CINAHL, PsycINFO, and Scopus—focusing on four key concepts: social determinants, disability, services (both support and health services), and Australia. Articles published after 2013 were included in the review. Results After screening 2,506 records, 54 studies were included in the review. These studies identified key drivers of inequities in access to health and social support services. Structural determinants, such as policy gaps, geographic disparities, service integration challenges, cultural misalignment, and socioeconomic marginalisation, significantly hinder equitable access. Additionally, social determinants—including household income, educational attainment, employment status, and gender — shaped individuals’ ability to engage with systems and services. Low-income individuals, those with limited education, and other disadvantaged communities, such as Indigenous and culturally diverse groups, face compounded barriers when seeking support. Conclusions People with disability face significant structural barriers to access health and support services, especially those from disadvantaged backgrounds. The implementation of interventions and efforts to improve the health and well-being of this population should be primarily viewed through the lens of those facing intersectional disadvantage. Future research should focus on generating disaggregated evidence to support policy efforts aimed at better targeting disadvantaged groups. Keywords Disability, Social determinants of health, Inequity, Socioeconomic factors, NDIS, Health services, Australia