What does disability mean – a framework

ISLAY: Historically disability has meant different things to different people and can be a tricky term to clearly define. In the last step, we heard an overview of attitudes towards disability and how these have changed over time. It’s really important that we have a clear, common understanding of what disability means and the population this refers to. 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.

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 charitable approach.

Another way that people have thought about disability in the past was to use a medical approach. With the medical model, someone is seen as being disabled because they have something, and I quote, ‘wrong’ with them due to a medical condition. An example of this is describing all people with visual impairments or hearing impairment 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. For example, imagine having a long-term ankle injury. This may force a Premier League footballer to retire early from a lucrative career.

In contrast, someone with a desk job may not experience as big an impact 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 a disability.

In the last step we were introduced to the social model approach, which was developed as a response to the medical model. This way of thinking 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 or she cannot walk, but because many offices are not set up to allow access for wheelchair users. As another example, a person with schizophrenia may be marginalised in lots of different ways because they make people feel uncomfortable or nervous and not because the condition stops them from 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. For instance, being in constant pain will limit a person’s quality of life, even if society is fully inclusive.

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 the removal of barriers as the social model would suggest and argues that full participation is a human right that can and should be claimed by everyone. The United Nations Convention on the Rights of Persons with Disabilities entered into force in 2006, reinforcing this framework.

Putting all these ideas together, a common way of viewing disability today is the International Classification of Functioning, Disability, and Health, otherwise known as the ICF, and launched by the World Health Organisation in 2001. Now this may look overwhelming, but let’s go through it together. According to the ICF, a health condition can lead to an impairment. For instance, glaucoma can lead to visual impairment. This can lead to reduced activities. For instance, visual impairment can lead to difficulties in walking. These limitations in activities can then restrict full participation in aspects of society like being able to go to work, and therefore result in a disability.

This model therefore recognises three levels at which disability is experienced– at the level of the body in terms of impairments, at the level of the person in terms of activity limitations, and at the level of society in terms of the participation restrictions. The model also shows us that the impact of the impairment on disability is not inevitable, but influenced by different factors. For example, environmental factors, such as access to assistive devices, and personal factors, such as training, can improve participation for a person with a visual impairment. Here’s another example. Dementia causes cognitive impairment, which can then lead to difficulties communicating. This may lead to difficulties in participating in social events.

However, other factors, such as a supportive environment, or personal factors such as the individual’s 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 that we will use throughout this course.