Concept of Disability,Social benefits and support from government
for persons with Disability
variety in the
Disability is a multidimensional concept making it difficult to define. Due to the extensive
nearly
nature of the problem a global definition of disability that fits all circumstances, is in reality
impossible (Salter et.al, 1974). Attempts have been made to define disability with simple statements,
theoretical models, classification schemes and different forms of measurement. When trying to make
sense ofa variety of ideas and forms it is necessary to take into consideration the structure, orientation
relationship
and source of definitions as well as single purpose definition, theoretical models that map the
schemes and other forms of
of conceptual clements scen as part of the definition and classification
of health
translating the concepts into empirical measures. Duckworth (1984) noted that in the context
care there is a need for consistent terminology relating to disease consequences or "disablement', a term
used to express the process of becoming disabled. Definitions that have developed for clinical purposes
and administrative implementation are those, which have greatest influence on our understanding of the
phenomenon.
Definitions
a) Pragmatic definition:
The administrative definition suggests an emphasis on the individual and the categorization of the
individual as a member or non member of the disabled category (Altman, 1986). For instance, the
definition of disability given by the United States Social Security -
"Disability is the inability to engage in any substantial gainful activity by reason of any medically
determinable physical or mental impairment which can be expected to result in death or has lasted
or can be expected to last for a continuous period of not less than 12 months." [U.S dept. of
Health and Human Services, 1990]
These definitions further specify whowill receive the benefits provided by the welfare or health
policy legislation or who is subject to the civil rights protection that the laws provide.
b) Public Health
More recently, governments have also been taking an interest inbeing able to predict the size and
nature of the population with disabilities, as well as the cpidemiology, to further refine or change
benefit programs and understand the disablement process from a public health standpoint.
Definition of disability is associated with selected diagnosed chronic conditions or injuries and
the accompanying limitations in function as well as elucidation of social limitations which
contributes to disability. These definitions are based on survey or census data of the national
population.Organizations such as World health Organization (WHO) and the World Bank having
recognized the burden of disability in tlhe world - particularly developing countries and the
implications this has on economie development and human rights, have played an active role in
developing ways to measure this problem (Albrecht and Verbrugge, 2000).
and participation
"Disability is an umbrella term, covering impairments, activity limitations,
limitation is a
restrictions. Impairment is a problem in body function or structure; an activity
while aparticipation
difficulty encountered by an individual in executing a task or action;
in life situations. Disability
restriction is a problem experienced by an individual in involvement
reflecting the interaction between
is thus not just a health problem. It is a complex phenomenon,
he or she lives" WHO
features ofaperson 's body and features of the society in which
Impairment, Disability and Handicap
Researchers have attempted to distinguish between certain terms while explaining the
process of Disability. These terms are - impairment, disability and handicap. In early attempt,
a
Hamilton (1950) described disability as a "condition of impairment", distinguishing it from
handicap, or "the cumulative result of the obstacles which disability interposes between the
individual and his maximum functional level". Others have distinguished among three terms
terms of defective
impairment, disability and handicap. Sussman (1969) defined impairment in
faculties; disability as limitations in activities experienced by impaired persons; and handicap as
the largely socially created disadvantages imposed on an individual's "pattern of psychological,
physical, vocational and community activities" by an impairment or disability.
In its comprehensive needs study, the Urban Institute (1975) conceptualized impairment
as the residual effects of defect, disease or injury; disability as an inability to perform tasks and
functions: and handicap as the disadvantage associated with personal and environmental factors.
Nagi (1965, 1976) delineated four concepts regarding disability:
Pathology-Organism's response to disease or injury
Impairment - Symptoms, abnormalities or losses
Limitations in functioning of the organism defined in terms of cognitive, emotional and
physical performance.
Disability - limitations in performance of major social roles, such as work and
independent living.
Despite the differences in terminology, these and similar conceptualizations have several features
in common:
Recognition of the imperfect relationship between a diagnosed impairing condition and
extent of functional limitations.
A distinction between discrete human capabilities (e.g. hearing) and broad human
adjustment phenomenon (e.g. vocational success).
An understanding that not only functional limitations but also environmental factors
affect adaptation in major social roles, such as work.
Classification of Disabilities
Census of India 2001 defined five types of disabilities:
Seeing- A person who cannot see at all (has no perception of light) or has blurred vision even
with the help of spectacles.
Speech- A person who is dumb or whose speech is not understood by a listener of normal
comprehension and hearing was considered to have speech disability. Persons who stammer but
whose speech is comprehensible were not classified as disabled by speech.
Hearing- A person who cannot hear at all (deaf), or can hear only loud sounds was considered
to have hearing disability. A person who is able to hear using hearing aid, was not considered as
disabled under this category. If a person cannot hear through one ear but her/his other ear is
functioning normally, she/ he was still considered to have hearing disability
Movement- A person, who lacks limbs or is unable to use the limbs normally, was considered
to have movement disability. Absence of a part of a limb like a finger or a toe was not considered
as disability.
Mental- A person who lacks comprehension appropriate to her/his age was categorised as
mentally disabled. This would not mean, however, that if a person is not able to comprehend
her/his studies appropriate to her/his age and is failing to qualify her/his examination, she/ he
was considered mentally disabled
Prevalence of Disability
The analysis of the Global Burden of Disease 2004 data for this Report estimates that 15.3% of
the world population (some 978 million people of the estimated 6.4 billion in 2004) had
"moderate or severe disability", while 2.9% or about 185 million experienced severe disability".
Among those aged 0-14 years, the figures were 5.1%o and 0.7%, or 93 million and 13 million
children, respectively. Among those 15 years and older, the figures were 19.4% and 3.8%, or 892
million and 175 million, respectively.
Models of Disability
The prevailing wisdom about the causes of disability has changed in the last several decades. In
the 1950s, impairment of a given severity was viewed as sufficient to result in disability in all
circumstances; in contrast, the absence of impairment of that severity was thought to be sufficient grounds
to deny disability benefits. Thus, the American Medical Association's Committee on Medical Rating of
Physical Impairments stated that "competent evaluation of permanent impairment requires adequate and
complete medical examination, accurate objective measure of function, and avoidance of subjective
impressions and nonmedical factors such as the patient's age, sex and occupation" (American Medical
Association, Committee on Medical Rating of Physical Impairment, 1958). Thus, understanding the
different concepts of disability is important not just for people directly involved with a child or adult with
adisability but also for everyone in society in order to build positive attitudes and a better understanding.
1. Biomedical Model: The medical model is a traditional approach to disability which takes the
presumed biological reality of impairment as its fundamental starting point. This biological
reality is taken to be the foundation of allforms of illness and impairment, whether "mental" or
"physical'". Although ill health may arise from sources in the environment surrounding the
person, it is the individual body within which illness is situated. The relation to the rehabilitation
of disabled people, the focus is on the functional limitations that an individual has, the effect of
these on activities of daily living and attempts to find ways of preventing, curing or caring for
disabled people" (Marks, 1997). The role of persons with disability is to accept the care
determined by and imposed by health professionals who are considered the experts.
Limitations:
> This approach to disability has been rejected by many researchers because it does not cover the
Social limitations contributing to disability.
> Further, it ignores the ability of many individuals to live successful lives and to be independent.
It also ignores the impact of a disability on access to health care, and the need to modify how
care is delivered because of a disability.
> The medical model reinforces the view that physicians, nurses and other health care professionals
are best qualified to make key decisions about health issues.
Social Model:
The origins of the approach can be traced to the 1960s; the term was coined by Mike Oliver
(1983). A fundamental aspect of the social model concerns equality. The struggle for equality is
often compared to the struggles of other socially marginalized groups. The 'social model of
disability" is a reaction to the dominant medical model of disability which in itself is a functional
analysis of the body as machine to be fixed in order to conform to normative values.
The model identifies systemic barriers, negative attitudes and exclusion by society (purposely or
inadvertently) that mean society is the main contributory factor in disabling people. While
physical, sensory, intellectual, or psychological variations may cause individual functional
limitation or impairments, these do not have to lead to disability unless society fails to take
account of and include people regardless of their individual differences. Thus, disability is
thought to result from stigma and social oppression ahd disabled people are perceived as
collective victims of an uncaring and discriminatory society (Oliver, 1990).
Stigma is an adverse reaction to the perception of a negatively evaluated difference
(Susman, 1994). It resides in the interactions between the person with the difference and the others
whoevaluate that diference in negative terms (Goffman, 1963). Link and Phelan (2001) describe
5 components of stigma
Labeling: Labeling is the recognition f differences and the assignment of social salience to those
differences.
Stereotyping: Stereotyping is the assigning of negative attributes to socially salient differences.
Separation: Separation is the reaction of others to the differences which leads to a sense of
otherness.
Status Loss and Discrimination: Status loss and discrimination occurs when stigma interferes with
an individual's ability to participate fully in social and economic life of his or her community.
When individuals lose status and are discriminated against bccause of their negatively enacted
difference they experience "enacted stigma". Link and Phelan go on to argue that stigma can only
be enacted upon when there is a power differential between those with the trait and those without.
Stigmatization will not occur if those with the difference have a greater power than those without
the difference.
The social model of disability focuses on changes required in society/ These might be in terms of:
Attitudes- Attitudinal Bariers are behaviours, perceptions and assumptions that discriminate
against people with disabilities. These barriers average from a lack of understanding which can
lead people toignore, judge or have misconceptions about people with adisability. For example a
more positive attitude toward certain mental traits or behaviors, or not underestimating the
potential quality of life of those with impairments.
Social support- for example help dealing with barriers; resources, aids or positive discrimination
to overcome them, for example providing a buddy to explain work culture for an employee with
autism.
Information- Information and Communication barriers occur when sensory disabilities such as
hearing, seeing or learning disabilities occur. Those barriers relate to both sending and receiving
of information. For example using suitable formats (e.g. Braille) or levels (e.g. simplicity of
language) or coverage (e.g. explaining issues others may take for granted).
Physical structures-Architecturalor physical barriers are elementsof buildings or outdoor spaces
that create barriers to persons with disabilities. For example buildings with sloped access and
elevators, or
Organizational or systemic barriers- These are policies, procedures or practices that unfairly
discriminate and can prevent individuals from participating fully in a situation. For example,
flexible work hours for people with circadian rhythm sleep disorders, experience anxiety/panic
attacks in rush hour traffic.
Limitations:
> This model has been criticized because it ignores or dismisses disease or injury as part of the
picture, although such factors and their consequences may have a major role in the life of a
person with a disability and may require intervention by health care providers at times.
People with disabilities are encouraged to see any problems they encounter as emerging from
barriers and negative attitudes of others in their social environment.
process by which a pathology
Nagi Symbolic Model: By the mid-1970s, Nagi (1976) outlined a
range of motion in a joint), which may
(e.g., arthritis) gave rise to an impairment (e.g., a limited
which, finally, may result in a
then result in a limitation in function (e.g., an inability to type),
would seem to move from
disability (inability to work). Nagi's nodel outlined a process that
accommodated limitations largely
pathology to disability. But extent to which the environment
medical condition.
determined whether disability would result fron the onset of a
pathology, which refers to
Nagi (1965) begins his model of disability with a discussion of active
associated with infection,
the state of mobilization of the body's defenses against a condition
pathology
traumatic injury or some other etiology. In all his discussions (Nagi 1965, 1977, 1991),
attempts to restore that
represents an interruption in normal body processes while the body
etiologies.
normal state. It's associated with disease as well as traumatic injury and other
in the initial
Impairment is defined as anatomical or physiological abnormalities and losses,
also be reflections
Nagi (1965) formulation. While he acknowledged that such abnormalities can
abnormalities and losses
of an active pathology, he made a distinction by also including
active
associated with residuals of pathology, that is, abnormalities and losses that remain after an
pathology has been arrested or eliminated. In this way, he accounted for paralysis remaining after
a disease such as polio has been neutralized or organ deficiencies that remain after multiple flare
ups of lupus have damaged such organs. In further elaboration of his model, Nagi,
(1977, 1991)
specifically included abnormalities, such as congenital deformities, which are not necessarily
associated with apathology
The concept of functional limitations as a separate element is not common to all conceptual
models of disability. Nagi (1965) initially identified functional limitations as the restrictions that
impairments set on the individual's ability to perform the tasks and obligations of his or her usual
roles and normal daily activities. These include tasks associated with family roles, such as taking
care of a child; work roles, such as holding down ajob; community roles, such as participation in
church or club activities and roles in other interactional settings as well as activities or tasks
associated with self - care. Later in 1977, Nagi clarified the concept of the nature of limitation.
He referred to functional limitations as the most direct way impairments contribute to disability
and grouped it into four categories: physical, emotional, intellectual and sensory. Ths, this
conceptualization considers functioning as something common across roles. So a person will only
be disabled if he fails toperform his daily life activities or roles.
Nagi (1965) saw disability as a pattern of behaviour that evolves in situationof long term or
continucd impairments that are associated with functional limitations.
Limitation: Although the Nagi model included the environment, it was limited in how it
conceived of the environment. In his model, the environment impinges on individuals only when
activity limitation interacts with the demands placed on those individuals; the process that gives
rise to disability is still inherently a function of the characteristics of medical conditions and
attendant impairments.
Rehabilitation Model: The foundation of all developments in rehabilitation is based on the
medical model. The rehabilitation model is based on the belief that with adequate effort on the
part of the person, the disability can be overcome. The model identifies the person with
impairment or functional limitation as having a potentially disabling condition (Brandt and Pope,
1997). The model assesses the person with disability. In the context of his social environment and
tries to find out the degree of functionality of the individual which is the disabling process. This
enabling an disabling process finally helps in determining the intensity of disability and the
rehabilitation intervention.
One of the most renowned rehabilitation models of disability is the IOM (Institute of medicine)
modelof disability. The fist IOM model addressed issues of preventing the disabling conditions
(both physical and environmental) which could lead to disability and reducing the effects of such
conditions on an individual's productivity and quality of life (Pope and Tarlov, 1991). The first
model also examined risk factors that could take the form of pathology. The conceptualization of
the term pathology was similar to the Nagi model (Pope, 1991). The second IOM model was
developed at the request of the U.S. Congress, In response to the request the model focused on
current knowledge base in rehabilitation science, evaluated current rehabilitation models,
recommended ways to transfer scientific findings to promote health care facilities for disabled
individuals (Brandt and Pope, 1997).
1 IOM MODEL:
The IOM (Institute of medicine) model, 1994, is one of the rehabilitation models of disability.
The first IOM model addressed
issues of preventing the disabling conditions (both physical and environmental) which could
lead to disability
and reducing the effects of such conditions on an individual's productivity and quality of life
(Pope and Tarlov, 1991).
It also examined risk fuctors that could take the form of pathology.
So it focused mainly on primary and secondary intervention.
The second IOM model focused on -
current knowledge base in rehabilitation science,
evaluated current rehabilitation models,
recommended ways to transfer scientific findings to promote health care facilities for disabled
individuals (Brandt and Pope, 1997).
Along with primary and secondary intervention this model also focused on tertiary intervention.
