Disability Definitions, Christopher J. Rossiter ©

Disability Definitions, Christopher J. Rossiter ©


Disability: Definitions and ModelsWorkshop objectives

• Develop an understanding of the differences between definitions of disability

• Understand the appropriate use and context of different definitions of disability

• How do these definitions shape our understanding of disability


Disability: Prevalence and Trends

Why is it important to understand disability?

• The World Health Organization and World Bank (2011) suggests that more than one billion people, or 15%, of the world’s population live with some form of impairment

• Disability prevalence increases with age. The average age in Western societies is ageing because of lower birth rates and greater longevity

• Less than 50% of working age adults with a disability are employed, compared to over 80% of people without disabilities. This figure has largely remain the same for twenty years.


Disability: Prevalence and Trends

Why is it important to understand disability?

Prevalence as reported in national disability surveys and population estimates by nation-state

Nation Population (in millions) % of people with disability

UK 62.3 27.2

France 64.8 24.6

Indonesia 239.8 21.3

Australia 22.3 20.0

Denmark 5.5 19.9

USA 308.7 14.9

Japan 127.4 5.0

Brazil 194.9 1.8


What is a disability?

A



What is a disability?

A

Disability type

The case of poor mental health

Poor mental health affects a substantial number of people.

1 in 6 workers will experience mental ill health at some point in their working life.

Employees with poor mental health face significant difficulties in the workplace. 40% of employers view workers with mental health conditions as a ‘significant risk’.

In addition research suggest that those employees with disabilities which are psychological, cognitive or intelligence based are viewed as less reliable, less safe, more likely to have poor attendance, judge them to have lower levels of productivity and performance and are more reluctant to giving them responsibility for fear of over burdening them.

Those with physical disabilities are consistently judged as more qualified, competent and have higher positive affect.

Medical Model - prevalence

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> 1 Billion people> 15% of the world’s population> 50 million EU citizens> 11 million UK citizens


Definitions of Disability

International Classification of Functioning:a) Body Functions are physiological functions of body systems (including psychological functions).

b) Body Structures are anatomical parts of the body such as organs, limbs and their components.

c) Impairments are problems in body function or structure such as a significant deviation or loss.

d) Activity is the execution of a task or action by an individual. Participation is involvement in a life situation.

e) Activity Limitations are difficulties an individual may have in executing activities.

f) Participation Restrictions are problems an individual may experience in involvement in life situations.

g) Environmental Factors make up the physical, social and attitudinal environment in which people live and conduct their lives.

Agents: The ICF is used by medical professionals to assess the extent of impairment and determine appropriate treatment. The ICF is also used by public and private agencies (e.g. health services, governments and insurers) and INGOs (e.g. UN, WHO, WB).

Disability is measured and assessed using statistical thresholds. National and global surveys of disability, such as the Global Burden of Disease and the World Health Survey, use varying

thresholds to judge an individuals ‘functional limitations’.

Example: WHS estimates severe disability prevalence in women at 60%. GBD estimates this figure to be 71%.

10Disability Definitions, Christopher J. Rossiter ©


Definition of Disability – legal definitions

UK Equality Act (2010): A person has a disability if:

• They have a physical or mental impairment• The impairment has a substantial and long-term adverse effect on their ability to perform normal day-to-day activities

Examples: HIV/Aids, poor Mental Health, Dyslexia and Specific Learning Difficulties, Diabetes, Cancer.

United Nations Convention on the Rights of People with Disabilities:‘Persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others.’

The first global convention to address the inequalities of disabled people, ratified by 153 signatories (September, 2012)


Definition of DisabilityAdministrative Definitions

Administrative systems for the provision of welfare segregate individuals according to their ability to perform specific every day activities. These may include personal care needs, cooking and working.

The recent changes to Work Capability Assessments have been highlighted in the media. Essentially these assessments look at an individual’s capacity to carry out specific tasks, to identify functional limitations.

Functional limitations:

Introduced by Nagi (1965), the concept of functional limitation relates to one’s ability to perform everyday activities. This is a central theme within ‘official’ understandings of disability (Political-Social policy, Welfare provision etc.), which forms a basis for many legislative codes, including the UK’s Equality Act and Germany’s BGG.

Examples of specific abilities or functions include: listening, speaking, reading, writing, reasoning, motor control and coordination, social skills, working memory, and processing speed.

The problem with functional limitations is that they are very specific and relate to binary classifications, i.e. can you walk 100m, Yes/No. However capability is not the same as ability; psychological factors, pain and discomfort or the effects of medication should also be considered.

Assessments of functional limitations segregate people in to ‘disabled’ and ‘non-disabled’ by default.


Definition of Disability

Administrative Definitions

Example: William70 year old male with an incurable and progressive disease affecting his ability to walk, talk, feed himself or undertake personal care needs. William’s condition may result in severe disability and possible death.

William has almost complete functional limitation and is dependent upon the assistance of others (medical professionals, carers, family etc.)

•Does William have any independence?

•Is William ‘dependent’?

•Can William take action?

A


Definition of DisabilityAdministrative Definitions

Prof. Stephen W. Hawking,

• Stephen William Hawking has Motor Neurone Disease (MND)

• Diagnosed aged 21, Stephen was given two-three years to live

• Stephen has received 14 different honours for his work in astro-physics including:

• Commander of the Most Excellent Order of the British Empire (CBE)• Order of the Companions of Honour• Fellow of the Royal Society • Presidential Medal of Freedom

• One of the best scientific minds

Dependent, with severe functional limitations. But not without the power to act.


Definition of DisabilityThe Subjective Approach

• When does one go from abled to disabled?

• What does being ‘disabled’ mean to me?

• Can I have an impairment and not be disabled?

• Is disability a dichotomous position?

Disability discourse:

Disability ‘talk’ often centres on two binary characters:

The saint: someone who has overcome great adversity and will help anyone

The embittered: Depressed, withdrawn, socially isolated and positioned outside of the mainstream

Media portrayals:

- Feckless, work-shy, faking it, scrounger, needy

+ courageous, saint, brave, super-human


The Social Model‘Disability is the disadvantage or restriction caused by society, which takes no account of people with impairments’ Oliver (1990).

Led by disabled activists of the 1970s, the social perspective of disability argues that people with impairments whether physical, sensory or cognitive and labelled 'disabled' experience a range of environmental and social barriers that inhibits their active participation in economic, political and cultural spheres. It is also widely acknowledged that this exclusion is manifest in the design and construction of physical and cultural infrastructures.

Barriers: In essence the social model points to barriers in society that prevent the full participation of disabled people. These barriers could include:

• Structural; accessibility of the built environment, policy and procedural• Social; attitudes, stereotypes, organisational culture

The social model points to the environment as being exclusive and oppressive to disabled people, rather than seeing the individual as deficient. The social model approach is widely cited as being empowering and more positive for people with disabilities.

A


Social Model p.2

A

Can you think of any specific examples of barriers in your organisation?

‣ The built environment

‣ Organisational policy and procedures

‣ Products and services and the systems and processes of delivering these

‣ Attitudes, Culture and Leadership


Definition SummariesModel Criteria Purpose Stakeholders

Medical A loss or abnormality of bodily structure or function which prevents or restricts participation in everyday activitiesInternational Classification of Functioning, Health and Disability

• Medical treatment, diagnosis and research• Rehabilitation and therapy• Statistical analyses for public surveys/ census

•Medical professionals•Public agencies•INGOs (UN, WHO, WB)

Legal / Administrative

Emphasise medical basis of disability in terms of functioningSpecific to jurisdiction or nation state

Categorisation of those in need or eligible for:• Support by the Welfare State, e.g. non-medical support, housing, social care, financial payments• Ascertain legal rights and responsibilities for both disabled people and agents•Distribute resources as above•Assess capacity to work

• Judiciary, legal professionals and institutions• Government departments• Human Resources


Definition Summaries (contd.)

Model Criteria Purpose Stakeholders

Subjective Self acceptance of the disabled label, identity or role, regardless of impairment and or severity

•To understand and construct a ‘disabled’ identity•Elucidate embodied experience•Identification of disability status in surveys etc.

•Disabled people•Disability organisations•Academics•Counsellors and therapists

Social Physical, structural and attitudinal barriers imposed by society, that oppress disabled people

To shift the focus away from people with ‘problems’ or deficits to highlight discriminatory practicesChallenges the power and control of medical professionals over disabled people

•Disabled people•Disability organisations and advocates

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Disability at micro, meso, macro levels

Figure 1: Social ecological systems, presented as spheres of influence between macro, meso and micro levels


Organisational language abstractions of disability

A

Disability

Culture

Attitude

Leadership

Policy


Disability and diversity

Insert org. diversity policy. If policy contains disability specific info cut and paste this here. Do not include details of branding or name

Discuss policy text in light of your own organisation’s approach to disabled employees.


Summary

• We’ve explored your own disability concepts

• We’ve discussed the theoretical underpinnings of disability and how they shape the way we understand disabled people

• We have looked at the key role language plays in the above


Questions?

Documents

Disability Definitions, Christopher J. Rossiter ©