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What do we mean by disability?

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Disability has historically meant different things to different people, and can be a tricky term to clearly define. It’s really important that we have a clear, common understanding of what disability means and the population this refers to. We need this to support the full inclusion of people with disabilities and to monitor progress towards this. So now, we’re going to look at some different frameworks for describing disability that have been commonly used. This will include the charity model, the medical model, the social model, the human rights model, and finally, the International Classification of Functioning, Disability, and Health, otherwise known as the ICF.
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An early way that people understood disability was through the so-called charity model. This model encourages charitable support towards people with disabilities, but does not focus on their rights or their capabilities. For example, a programme that donates clothes or other goods to a person with a disability, but does not try to support him or her in finding a job and being financially independent, would be defined as a charity model approach.
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Another way that people have thought about disability in the past was to use a medical approach. With this model, someone is seen as being disabled because they have something wrong with them due to a medical condition. An example of this is describing all people with vision impairments or hearing impairments as disabled. The primary concern with this approach is that people with the same impairment may have very different experiences as to how this impacts on their lives.
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Having a long-term ankle injury may force a Premier League footballer to retire early from a lucrative job. In contrast, someone with a desk job may not experience as big of an effect on their livelihood if they fail to recover fully from a broken ankle. The medical model, therefore, doesn’t recognise the role of the environment or external factors in excluding a person with disability.
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The social model approach, which was developed as a response to the medical model, views disability as being due to society’s failure to respond to the needs of people with impairments. Someone may have limited employment opportunities not because he cannot walk, but because offices are not set up to allow access to wheelchairs. A person with schizophrenia may be marginalised in lots of different ways because she makes people feel uncomfortable or nervous, and not because the condition stops her being able to do everyday activities. However, this model is also not without criticism. Through a focus only on societal barriers, the model does not give enough attention to the role of the individual’s impairment in their disability.
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For instance, being in constant pain will limit a person’s quality of life, even when society is fully inclusive.
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The human rights model of disability is a different way of thinking about disability. At its core is the slogan “nothing about us without us.” It calls for inclusion of people with disabilities and for them to take control over their own fate. It goes beyond mere removal of barriers as the social model would suggest, but argues that full participation is a human right that can and should be claimed by everybody. The United Nations Convention on the Rights of Persons with Disabilities, the UNCRPD, entered into force in 2006, reinforcing this framework.
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Putting all these ideas together, a common way of viewing disability today is as the International Classification of Functioning, Disability, and Health, otherwise known as the ICF, launched by the World Health Organisation in 2001. According to the ICF model, a health condition can lead to an impairment. For instance, glaucoma can lead to a visual impairment. This can lead to reduced activities. For instance, visual impairment can lead to difficulties in walking. These limitations in activities can restrict full participation in aspects of society, like being able to go to work, and so result in disability. This model, therefore, recognises three levels at which disability is experienced– the body, the person, and the society.
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The impact of the impairment on disability is not inevitable, but it is influenced by different factors. environmental factors, such as access to assistive devices, and personal factors, for instance, training, can improve participation for a person with visual impairment. Here’s another example. Dementia causes cognitive impairment, which can then lead to difficulties communicating. This may lead to difficulties participating in social events. However, other factors, such as a supportive environment, or personal factors, such as attitude, can help alleviate disability in relation to dementia. The ICF, therefore, combines aspects of the human rights, medical, and social models, and is the prevailing model of disability used globally, and that we will use throughout this course.

Disability is quite a complex term that many people describe in different ways.

In this step, Dr. Tess Bright (LSHTM) provides an overview of past and prevailing frameworks for understanding and describing disability. This includes the charity model, the medical model, the social model, the human-rights model, and finally the International Classification of Functioning, Disability and Health, otherwise known as the ICF.

It is also important to consider attitudes to disability, and this video from Professor Tom Shakespeare (also available in the See Also section below) describes how attitudes to disability have changed over time. In particular, he highlights the social model of disability, which was developed in the 1970s, marking a turning point in the disability movement. These two videos in combination help to build a picture of the complexity of disability, and the different ways it is understood.

When considering the ICF model, what environmental factors might influence the lives of people with disability in your setting? What are the attitudes towards disability in your setting?

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Global Disability: Research and Evidence

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