WikiDoc Resources for
Evidence Based Medicine
Guidelines / Policies / Govt
Patient Resources / Community
Healthcare Provider Resources
Continuing Medical Education (CME)
Experimental / Informatics
A disability is a condition or function judged to be significantly impaired relative to the usual standard of an individual or their group. The term is often used to refer to individual functioning, including physical impairment, sensory impairment, cognitive impairment, intellectual impairment mental illness, and various types of chronic disease. This usage is associated with a medical model of disability. The human rights or social model focuses on functioning as an interaction between a person and their environment, highlighting the role of a society in labelling, causing or maintaining disability within that society, including through attitudes or accessibility favoring the majority. Disabilities may come to people during their life or people may be born disabled.
On December 13, 2006, the United Nations formally agreed on the Convention on the Rights of Persons with Disabilities, the first human rights treaty of the 21st century, to protect and enhance the rights and opportunities of the world's estimated 650 million disabled people. Countries that sign up to the convention will be required to adopt national laws, and remove old ones, so that persons with disabilities would, for example, have equal rights to education, employment, and cultural life; the right to own and inherit property; not be discriminated against in marriage, children, etc; not be unwilling subjects in medical experiments.
In 1976, the United Nations launched its International Year for Disabled Persons (1981), later re-named the International Year of Disabled Persons. The UN Decade of Disabled Persons (1983-1993) featured a World Programme of Action Concerning Disabled Persons. In 1979, Frank Bowe was the only person with a disability representing any country in the planning of IYDP-1981. Today, many countries have named representatives who are themselves individuals with disabilities. The decade was closed in an address before the General Assembly by Robert Davila. Both Bowe and Davila are deaf. In 1984, UNESCO accepted sign language for use in education of deaf children and youth.
The Disability rights movement
The Disability rights movement, led by individuals with disabilities, began in the 1970s. This Self-advocacy is often seen as largely responsible for the shift toward independent living and accessibility. The term "Independent Living" was taken from 1959 California legislation that enabled people who had acquired a disability due to polio to leave hospital wards and move back into the community with the help of cash benefits for the purchase of personal assistance with the activities of daily living. With its origins in the US civil rights and consumer movements of the late 1960s, the movement and its philosophy have since spread to other continents influencing people's self-perception, their ways of organizing themselves and their countries' social policy.
In 2006, the Extremity Games was formed for people with physical disabilities, specifically limb loss or limb difference, to be able to compete in extreme sports. The College Park Industries, a manufacturer of prosthetic feet, organized this event to give disabled athletes a venue to compete in this increasingly popular sports genere also referred to as action sports. This annual event held in the summer in Orlando, FL includes competitions in skateboarding, wakeboarding, rock climbing, mountain biking, surfing, moto-x and kayaking.
Current issues and debates surrounding 'disability' include social and political rights, social inclusion and citizenship. In developed countries the debate has moved beyond a concern about the perceived cost of maintaining dependent people with a disability to the struggle to find effective ways of ensuring people with a disability can participate in and contribute to society in all spheres of life. Many are concerned, however, that the greatest need is in developing nations -- where the vast bulk of the estimated 650 million persons with disabilities reside. A great deal of work -- from basic physical accessibility through education to self-empowerment and self-supporting employment -- is needed. In the past few years, disability rights activists have also focused on obtaining full sexual citizenship for the disabled.
Definitions and Models
The International Classification of Functioning, Disability and Health (ICF), produced by the World Health Organization, distinguishes between body functions (physiological or psychological, e.g. vision) and body structures (anatomical parts, e.g. the eye and related structures). Impairment in bodily structure or function is defined as involving an anomaly, defect, loss or other significant deviation from certain generally accepted population standards, which may fluctuate over time. Activity is defined as the execution of a task or action. The ICF lists 9 broad domains of functioning which can be affected:
- Learning and applying knowledge
- General tasks and demands
- Domestic life
- Interpersonal interactions and relationships
- Major life areas
- Community, social and civic life.
(see also List of mental disorders)
The introduction to the ICF states that a variety of conceptual models has been proposed to understand and explain disability and functioning, which it seeks to integrate:
The medical model
The Medical Model of Disability The medical model of disability sees the disabled person as the problem. We are to be adapted to fit into the world as it is. If this is not possible, then we are shut away in some specialised institution or isolated at home, where only our most basic needs are met. © Self Direction Community Project 2000 - 2001
The medical model views disability as a problem of the person, directly caused by disease, trauma, or other health condition which therefore requires sustained medical care provided in the form of individual treatment by professionals. In the medical model, management of the disability is aimed at "cure", or the individual’s adjustment and behavioral change that would lead to an "almost-cure" or effective cure. In the medical model, medical care is viewed as the main issue, and at the political level, the principal response is that of modifying or reforming healthcare policy.
Impairment and chronic illness exist and they sometimes pose real difficulties for us. The disability movement comprises those disabled people and supporters who understand that we are, regardless of our particular impairment, subjected to a common oppression by the non-disabled world. We are of the view that the position of disabled people and the discrimination against us are socially created. This has little to do with our impairments. As disabled people we are often made to feel it's our own fault that we are different. The difference is that some part, or parts, of our body or mind are limited in their functioning. This is an impairment. © Self Direction Community Project 2000 - 2001
The social model of disability sees the issue of "disability" mainly as a socially created problem, and basically as a matter of the full integration of individuals into society (see Inclusion (disability rights)). In this model disability is not an attribute of an individual, but rather a complex collection of conditions, many of which are created by the social environment. Hence, in this model, the management of the problem requires social action, and thus, it is the collective responsibility of society at large to make the environmental modifications necessary for the full participation of people with disabilities in all areas of social life. The issue is both cultural and ideological, requiring individual, community, and large-scale social change. Viewed from this perspective equal access for people with impairment/disability is a human rights issue of major concern.
Impairment, Culture, Language, & Labeling
The American Psychological Association style guide states that, when identifying a person with an impairment, the person's name or pronoun should come first, and descriptions of the impairment/disability should be used so that the impairment is identified, but is not modifying the person. Improper examples would be "A Borderline, a "Blind Person." For instance: people with/who have Down syndrome, a man with/who has schizophrenia (instead of a Schizophrenic man), and a girl with paraplegia/who is paraplegic. (This applies only to English, possibly other, prepositional languages, not postpositional languages.) It also states that a person's adaptive equipment should be described functionally as something that assists a person, not as something that limits a person (e.g., "A woman who uses a wheelchair" rather than "in" it or "confined" to it. Many books on disability and disability rights point out that 'disabled' is an identity that one is not necessarily born with, as disabilities are more often acquired than congenital. Some disability rights activists use an acronym TAB, Temporarily Able-Bodied, as a reminder that many people will develop disabilities at some point in their lives, due to accidents, illness (physical, mental or emotional), or late-emerging effects of genetics.
The late Prime Minister Olof Palme of Sweden, speaking at the Stanford University Law School in the 1970s, summed up the divergence between U.S. and Swedish attitudes towards people with disabilities:
- Americans regard the able-bodied and the disabled as, effectively, actively or not, consciously or subconsciously, two separate species, whereas,
- Swedes regard them as humans in different life stages: all babies are helpless, cared for by parents; sick people are cared by those who are well; elderly people are cared by those younger and healthier, etc. Able-bodied people are able to help those who need it, without pity, because they know their turn at not being able-bodied will come.
Palme maintained that if it cost the country $US 40,000 per year to enable a person with a disability to work at a job that paid $40,000, the society gained a net benefit, because the society benefited by allowing this worker to participate cooperatively, rather than to be a drain on other people's time and money.
- The moral model (Bowe, 1978) refers to the attitude that people are morally responsible for their own disability, including, at one extreme, as a result of bad actions of parents if congenital, or as a result of practicing witchcraft if not. This attitude can be seen as a religious fundamentalist offshoot of the original animal roots of human beings, back when humans killed any baby that could not survive on its own in the wild (see Darwinism).
- The Expert/Professional Model has provided a traditional response to disability issues and can be seen as an offshoot of the Medical Model. Within its framework, professionals follow a process of identifying the impairment and its limitations (using the Medical Model), and taking the necessary action to improve the position of the disabled person. This has tended to produce a system in which an authoritarian, over-active service provider prescribes and acts for a passive client.
- The Tragedy/Charity Model depicts disabled people as victims of circumstance, deserving of pity. This and Medical Model are probably the ones most used by non-disabled people to define and explain disability. To counter this trend, disabled activists are fond of the slogan "PISS ON PITY".
- Social Adapted Model
- Economic Model
- Empowering Model
Government policies and support
Under the Disability Discrimination Act (1995, extended in 2005), it is unlawful for organisations to discriminate (treat a disabled person less favourably, for reasons related to the person's disability, without justification) in employment; access to goods, facilities, services; managing, buying or renting land or property; education. Businesses must make "reasonable adjustments" to their policies or practices, or physical aspects of their premises, to avoid indirect discrimination.
A number of financial and care support services are available, including Incapacity Benefit and Disability Living Allowance.
Discrimination in employment
The US Rehabilitation Act of 1973 requires all organizations that receive government funding to provide accessiblity programs and services. A more recent law, the 1990 Americans with Disabilities Act (ADA), which came in to effect in 1992, prohibits private employers, state and local governments and employment agencies and labor unions from discriminating against qualified individuals with disabilities in job application procedures, hiring, firing, advancement, compensation, job training, or in the terms, conditions and privileges of employment. This includes organizations like retail businesses, movie theaters, and restaurants. They must make "reasonable accommodation" to people with different needs. Protection is extended to anyone with (A) a physical or mental impairment that substantially limits one or more of the major life activities of an individual (B) a record of such an impairment or (C) being regarded as having such an impairment. The second and third critiera are seen as ensuring protection from unjust discrimination based on a perception of risk, just because someone has a record of impairment or appears to have a disability or illness (e.g. features which may be erroneously taken as signs of an illness).
African Americans and Disability
According to the 2000 U.S. Census, the African American community has the highest rate of disability at 24.3 percent. Although people have come to better understand and accept different types of disability, there still remains a stigma attached to the disabled community. African Americans with a disability are subject to not only this stigma but also to the additional forces of race discrimination. African American women who have a disibility face tremendous discrimination due to their condition, race, and gender. Doctor Eddie Glenn of Howard University describes this situation as the "triple jeopardy" syndrome.
The US Social Security Administration defines disability in terms of inability to perform substantial gainful activity (SGA), by which it means “work paying minimum wage or better”. The agency pairs SGA with a "listing" of medical conditions that qualify individuals for benefits.
Under the Individuals with Disabilities Education Act, special educational support is limited to children and youth falling in to one of a dozen disability categories (e.g., specific learning disability) and adds that, to be eligible, students must require both special education (modified instruction) and related services (supports such as speech and language pathology).
Difficulties in measuring
The demography of disability is difficult. Counting persons with disabilities is far more challenging than is counting males. That is because disability is not just a status condition, entirely contained within the individual. Rather, it is an interaction between medical status (say, having low vision or being blind) and the environment.
Estimates of worldwide and country-wide numbers of individuals with disabilities are problematic. The varying approaches taken to defining disability notwithstanding, demographers agree that the world population of individuals with disabilities is very large. The World Health Organization, for example, estimates that there are as many as 600 million persons with disabilities. The United Nations estimate is 650 million. In the United States, for example, Americans with disabilities constitute the third-largest minority (after persons of Hispanic origin and African Americans); all three of those minority groups number in the 30-some millions in America. According to the U.S. Bureau of the Census, as of 2004, there were some 32 million adults (aged 18 or over) in the United States, plus another 5 million children and youth (under age 18). If one were to add impairments -- or limitations that fall short of being disabilities -- Census estimates put the figure at 51 million.
There is also widespread agreement among experts in the field that disability is more common in developing than in developed nations.
Disability insurance—nationalized and private
Disability benefit, or disability pension, is the largest kind of disability insurance, and is provided by government agencies to people who are unable to work due to a disability, temporarily or permanently. In the U.S., disability benefit is provided within the category of Supplemental Security Income, and in Canada, within the Canada Pension Plan. In other countries, disability benefit may be provided under Social Security system.
Costs of disability pensions are steadily growing in Western countries, mainly European and the United States. It was reported that in the UK, expenditure on disability pensions accounted for 0.9% of Gross Domestic Product (GDP) in 1980, but two decades later had reached 2.6% of GDP. Several studies have reported a link between increased sickness absence and elevated risk of future disability pension. A study by Denmark researchers suggests that information on self-reported days of sickness absence can be used to effectively identify future potential groups for disability pension.  These studies may provide useful information for policy makers, case managing authorities, employers, and physicians responsible for interventions aiming at reducing the cost and work disability.
Private, for-profit disability insurance plays a role in providing incomes to disabled people, but the nationalized programs are the safety net that catches most claimants.
Assistive Technology (AT) is a generic term for devices and modifications (for a person or within a society) that help overcome or remove a disability. The first recorded example of the use of a prosthesis dates to at least 1800 BC. A more recent notable example is the wheelchair, dating from the 17th Century. The curb cut is a related structural innovation. Other modern examples are standing frames, text telephones, accessible keyboards, large print, Braille, & speech recognition Computer software. Individuals with disabilities often develop personal or community adaptations, such as strategies to suppress tics in public (for example in Tourette's syndrome), or sign language in deaf communities. Assistive technology or interventions are sometimes controversial or rejected, for example in the controversy over cochlear implants for children. A number of symbols are in use to indicate whether certain accessibility adaptations have been made.
As the personal computer has become more ubiquitous, various organisations have been founded which develop software and hardware which make a computer more accessible for people with disabilities. Some software and hardware, such as SmartboxAT's The Grid, and Freedom Scientific's JAWS has been specifically designed for people with disabilities; other pieces of software and hardware, such as Nuance's Dragon NaturallySpeaking, was not developed specifically for people with disabilities, but can be used to increase accessibility.
Further organisations, such as AbilityNet and U Can Do IT, have been established to provide assessment services which determine which assistive technologies would best assist an individual client, and also to train people with disabilities in how to use computer-based assistive technology.
- ↑ ENABLE website UN section on disability
- ↑ Disability NOW Time To Talk Sex at Disability NOW
- ↑ OECD. Transforming disability into ability: Policies to promote work and income security for disabled people. Paris: OECD Publication Offices. 2003
- ↑ Labriola M, Lund T. Self-reported sickness absence as a risk marker of future disability pension. Prospective findings from the DWECS/DREAM study 1990-2004. Int J Med Sci 2007; 4:153-158. http://www.medsci.org/v04p0153.htm
- ↑ Virtanen M, Kivimaki M, Vahtera J, Elovainio M, Sund R, Virtanen P, Ferrie JE. Sickness absence as a risk factor for job termination, unemployment, and disability pension among temporary and permanent employees. Occup Environ Med. 2006;63(3):212-7
- ↑ Disability Social History Project
- Frank Bowe, Handicapping America:Barriers to disabled people, Harper & Row, 1978 ISBN 0-06-010422-8
- Encyclopedia of disability, general ed. Gary L. Albrecht, Thousand Oaks, Calif. [u.a.] : SAGE Publ., 2005
- David Johnstone, An Introduction to Disability Studies, 2001, 2nd edition, ISBN 1-85346-726-X
- Michael Oliver, The Politics of Disablement, St. Martin's Press 1997, ISBN 0-333-43293-2
- Tom Shakespeare, Genetic Politics: from Eugenics to Genome, with Anne Kerr , New Clarion Press, 1999, ISBN 1-873797-25-7
- Kaushik, R.,1999, " Access Denied: Can we overcome disabling attitudes ," Museum International (UNESCO) , Vol. 51, No. 3, p. 48-52.
- Disability Now
- Glenn, Eddie. March 20, 1997. "African American Women with Disabilities: An Overview."
- Directgov disabled people - UK Government information site
- Disabilities Online Database
- Disability 247: Information and resources for disabled people in the United Kingdom
- PDRater.com: Online Calculator for Worker's Compensation Benefits in California
- Sadie's Shack – An online community for people with disabilities
- Disapedia – A Wiki for everything disability related
- People with disabilities, EU-OSHA
- Integration and retention of people with disabilities, EU-OSHA
- Disability Help Site – A disability resource site
- Disability Now
- Enable America - a disability resource site
- Disability, Pregnancy & Parenthood International
- American Association of People with Disabilities
- The Disability Social History Project
- Independent Living Institute
- UN Enable
- National Association of the Deaf (United States)
- Source - International Information Support Centre
- International Disability and Development Consortium
- The British Council of Disabled People (BCODP)
- UN International Day of Disabled Persons
- World Health Organization pages on disability
- Social Security Administration page on disability
- National Association to Stop Guardian Abuse (NASGA) USA
- Gibraltar Local Disability Movement (G.L.D.M.)
- Parents with Disabilities Online
- Applying for disability
- Through the Looking Glass
- Applying for Bipolar Disability
There is no pharmaceutical or device industry support for this site and we need your viewer supported Donations | Editorial Board | Governance | Licensing | Disclaimers | Avoid Plagiarism | Policies