Disabilities, Chronic Illness, and Relationship Functioning

The Growing Presence of Illness and Disability in Human Relationships

The gift of longevity has guaranteed a prominent place for chronic illness now and into the future. In the past, people lived shorter lives due to poor public health, infectious disease, accidents, and wars. There was also a high mortality rate from cardiovascular disease, respiratory conditions, and other illnesses.

Chronic illness is currently the main cause of both death and disability worldwide. Of the 58 million deaths that occurred in 2005, approximately 35 million, or 60 percent, were due to chronic, disabling health problems, primarily cardiovascular disease, diabetes, cancer, and respiratory conditions. People are living longer, but they are living longer with health problems and disabilities.

The extent of people worldwide living with chronic conditions is significant; for example, the number of people over age 80 in Western Europe has quadrupled in the past 60 years. Of the 17 million people currently living with long-term conditions in Britain, up to 80 percent need support for self-care.

A substantial proportion of care is provided within the context of family and intimate relationships. It is important to note that those in the most disadvantaged socioeconomic groups experience the highest prevalence, mortality, and morbidity (ongoing health issues and disability), and the gap in health inequalities across the globe has been widening. Furthermore, those in disadvantaged groups are less likely to experience equality of access to services and support in regard to their health and social care needs. This circumstance can increase stress and burden of care for disadvan-taged individuals and their families and can contribute to social isolation. Physical inaccessibility of housing and lack of transportation are some of the practical issues faced in sustaining relationships.

There are numerous relevant themes to consider in examining the interface between illness and relationships: the impact of illness and disability on relationships, how people adapt relationships in the context of illness, relationship theory, and specific relationship functioning (couples, parent-child, health professional), the impact of relationships on coping with illness, and approaches (policies and Disabilities, Chronic Illness, and Relationship Functioning [Page 421]practices) to improve relationship quality. In many instances, researchers are expanding beyond middle class, Western relationships to study these themes as they are experienced in different cultures, geographies, and socioeconomic contexts—for example, families coping with AIDS in Africa, inner-city couples dealing with a spinal cord injury as a result of violence, serious health problems in uninsured immigrant families, and so on.

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