Classification of Disability

C. Classification of Disability

72. Central to disability reform is the development of a universally acceptable classification system to facilitate planning, decision making, and evaluation that describes the capacities and restrictions from the individual to the macro policy level. The challenge is to collect information that profiles the complexity of disability in a manageable way—which is highly situational and context specific. This is no easy task because what would be a barrier in one community is not necessarily a barrier in another. For example, roads that are paved and on flat terrain are not barriers for school children who require a wheelchair for mobility. When this is the case, wheelchairs function effectively. However, wheelchairs are of little value to children with mobility challenges who want to go to school in communities where the roads are rocky, sandy, and on hilly terrain.

http://www.apcdproject.org

Figure II.2: APCD Social Model

Full Participation and Equality of People with Disabilities in Society

Barrier-free society

Empowerment

Synergistic effects

Freedom from barriers in community Organizing self-help groups and advocacy

Removal of barriers

Barriers of

in existing

thoughts and

Actions for

organizations

physical information

regulations

attitudes of

and system

people

barriers in society

communication Participatory/centered

Independent Living

problem-solving

Movement

methods/process in community

Physically/visually

Exclusion and

Intellectually/mentally

disabled people, etc.

Visually/hearing

Severely/multiple

impaired people, etc.

disabled children

People with disabilities, being socially disadvantaged and

vulnerable

APCD = Asia-Pacific Development Center on Disability Source: http://www.apcdproject.or/about/index.html

73. Further, a danger of classification systems is that they may shape citizens’ expectations and perceptions of people with disabilities. Great sensitivity needs to be taken when considering approaches to classification systems.

74. Various attempts have been made to classify disability. Each approach developed reflects one of the models of disability and is a good example of the way a prevailing model of disability influenced the global response to disability planning and programming (McColl and Bickenbach 1998). It is important to note that people with disabilities have been very critical of these classification systems, which do not yet truly represent their realities.

75. The current development paradigm promotes citizenship through a rights-based and inclusive model. Recognizing that people with disabilities have complex and distinct health, environmental, and social requirements, a necessary condition for development is a support system that is culturally and regionally diverse. In this model, the priority is to profile the full spectrum of people with disabilities. It aims to capture the disability category, the functional limitations, and barriers to access and participation in a quantifiable and descriptive manner.

76. The International Classification of Functioning, Disability, and Health (ICF), published by WHO in 2001, reflects some of the core ideas of the citizenship model.

ICF is based on an integration of these two opposing models. In order to capture the integration of the various perspectives….ICF attempts to achieve synthesis, in order to provide a coherent view of different perspectives of health from a biological, individual and social perspective. (WHO 2001, p. 20)

77. The purpose of this classification system is to standardize the language and provide a unified framework for description and quantification of disability. A central tenet has been to combine the need by health services and development agencies for information on health and functioning (as it relates to the medical model) to the need to describe the magnitude of disability in terms of how the environment is a positive or

limiting factor (social model). This new version of ICF is available online. 10

78. ICF defines disability as an umbrella term for impairment, activity limitations, and participation restriction. It is viewed as a complex collection of culturally and context- specific conditions, many but not all of which are created by the social environment (WHO 2001). This places disability in its wider societal context, which in turn becomes responsible for environmental, attitudinal, and ideological modifications. These are viewed as necessary to ensure full participation of people in all aspects of life with disabilities. However, although a step forward from the previous classification system, it is argued that the ICF fails to identify disability as a social process or set of social relationships. The ICF continues to be viewed by some as an extension of the medical model that defines individuals rather than social processes as “the problem.”

79. ICF is a tool that can be used to describe and compare the health of populations in an international context. The new classification aims to promote a universal

http://www3.who.int/icf/icftemplate.cfm

orientation, neutral terminology, and recognition of the importance of environmental factors. In addition it aims to address the role of impairment in the lives of people with disabilities by providing a comprehensive framework for understanding health, functioning, and disability. It recognizes and quantifies the reality that disability and functioning are outcomes of complex, dynamic, and multidirectional interactions between health conditions and contextual factors. The IFC also promotes the need for a continuum of services and support systems to be accessible to all citizens with disabilities and their communities. Within this continuum, users “theoretically” can make the appropriate choices according to their needs, local context, and resource capacities, and development practitioners can collect information to reflect the needs and patterns of usage and their impact. This, however, will depend in the first instance on the extent to which services are accessible, a situation not yet a reality for the majority of people with disabilities in the region.

80. The ICF offers development practitioners information that describes the factors affecting the ability of people with disabilities to step out of the disability-poverty cycle. These factors are related to environmental and sociocultural barriers and disadvantages preventing people with disabilities from accessing resources and participating in activities and initiatives that would make them and their families visible, productive, and integral members of the community. Of crucial importance is the investigation and analysis of the factors that restrict accessibility due to physical and attitudinal barriers to go to school, to go to work, to help out in the home, and to enable family members to participate in these endeavors. What is also needed is an appreciation of what kinds of social services and support systems, such as appropriate technology, knowledge, and skills are available and required to help people with disabilities and their families to lead an independent and productive family life.