Disability-related Disability-related models and models and

classifications classifications Evolution and Evolution and applicationsapplications

Aida Hakimi Osmanbegovic , Handicap International

The WHO ClassificationsThe WHO Classifications

International classifications

• Evaluating the state of health in populationsEvaluating the state of health in populations

• Providing Providing a a scientific basisscientific basis for consequences of health for consequences of health conditionsconditions

• Creating tools for describing and collecting data about the Creating tools for describing and collecting data about the health of populations :health of populations :– establishing aestablishing a common languagecommon language to improve communications to improve communications– permitting permitting comparison of datacomparison of data across:across:

countries countries health care disciplines health care disciplines services services timetime

- to provide ato provide a systematic coding schemesystematic coding scheme for health information systems for health information systems

Moving from a classification ofMoving from a classification ofthe causes of death to the causes of death to

a classification of illnesses a classification of illnesses (1893-1948) (1893-1948)

• 1893 : Bertillon classification: international nomenclature of the causes of death

• 1946 : ICD (1010thth revision on 1990): revision on 1990): IInternational Statistical Classification of nternational Statistical Classification of DiseasesDiseases & Related Health Problems& Related Health Problems– Death statistics– Illness statistics

Moving from a classification of Moving from a classification of illnesses to a classification of illnesses to a classification of

disabilitiesdisabilities(1948 – 1980)(1948 – 1980)

1950 : epidemiological transition in industrial countries

The medicinal improvements: • Reanimation • Neonatology• Surgery• Rehabilitation• Pharmacology

The effects of this:- Decrease in infectious diseases- Increase in chronic diseases and problems- Ageing populations

First classification of handicaps (WHO First classification of handicaps (WHO 1980): ICIDH1980): ICIDH

Proposition of Philip Wood (1970-1980) adopted by WHO for an experimental trial

3 levels in the development of handicaps

Disease ordisorder

Impairments

Disabilities Handicaps

Critiques of ICIDHCritiques of ICIDH

• Classification founded on the “medical model” :– Linear causality from impairment to

handicap– Description of handicaps: insufficient – Absence of an environmental dimension

• Handicaps are described in a negative way

International conceptual evolution International conceptual evolution in the field of disabilitiesin the field of disabilities

1. Evolution of international norms- Before 1975: UN recommendations based on rehabilitation- Since 1980: a shift from rehabilitation to human rights

- International year of Persons with Disabilities (1982)- Decade of Persons with disabilities- World program actions for Persons with Disabilities- Standard rules for equal opportunities for Persons with disabilities- Convention on the Rights of Persons with Disabilities (13th of December, 2006)

2. Evolution of practices and social representation of disabilitiesa- Emergence of the Independent Living Movement (USA 1960)b- Diffusion of the model and extension of the ILM in the worldc- Development of a theory of the social model of disabilities

3. Evolution of the political representation of people with disabilities- 1993: Creation of the European Forum of persons with disability- Lobbying: UN, WHO, European Council, European Parliament:

- Nothing about us without us- Consultative status of Persons with disabilities NGOs

Models of Disability:Models of Disability:

1- Individual ModelDisability as an individual pathology

2 variants

Biomedical approach:- Prevention: intervention, prenatal diagnosis,eradication of the causal disease- Treatment: recovery by medical or technologicalMeans,- Society’s responsibility: recovery of

Handicappedperson

Functional approach:Prevention: early diagnosis and reeducation

Treatment: means of functional rehabilitation

Society’s responsibility: To improve the daily livesof persons with disabilities by means ofcompensation.

2- Social ModelDisability as a social pathology

“It is society that disables us, not our impairments.”

2 variants

Environmental approach:- The handicap is a consequence of the absence

ofenvironmental planning- Treatment: make the environment accessible- Society's responsibility: identification andelimination of the architectural, economic, socialand psychological barriers

Approach based on human rights:- The handicap results from social organizationproblems and connection problems between thesociety and the individual- Treatment: Reformulation of the political,

economic and social “rules”- Society's responsibility : Reducing theinequalities in rights and permitting, ensuringaccess to full citizen rights

Systemic Model of DisabilitySystemic Model of Disability((P.Fougeyrollas.Fougeyrollas RIPPH/SCCIDIH, Canada, 1998 , J.Sanchez CTNERHI 1989, 2002), J.Sanchez CTNERHI 1989, 2002)

An independent life in an accessible society = Environmental

+ Individual approach + Human Rights

- TRT: individual and collective

- Society's responsibilities: identifying and eliminating individual difficulties and social and psychological barriers

Interaction of ConceptsInteraction of Concepts- 1998: DCP = Explanatory model of the causes and consequences of

disease, trauma and other disruptions to a person’s integrity or development based on the anthropological model of human developpement

Patrick Fougeyrollas and Co (RIPPH, Quebec)

- 2001: ICF as the New Member in the WHO Family of international Classifications

- to provide a scientific basis for consequences of health conditions

- to establish a common language to improve communications

• to permit comparison of data across countries, health care disciplines, services

• to provide a systematic coding scheme for health information systems

A comprehensive modelA comprehensive model

• The DCP is a global approach which considers disability not as a fixed “state” but as a process which limits the person’s activities.

• In this model, the “disability” is differentiated from the “handicap” by the social variable that separates the two.

• The “handicap” is considered as a disturbance in a person’s life habits as a result of interaction between personal factors (impairment or disability) and environmental factors (obstacles). It’s a relative “situation” which varies according to the context and the environment, but which can also be modified by reducing impairment (medical care) and develops capabilities (rehabilitation) as well as adapting the environment (policies, elimination of physical obstacles).

DCP: based on the Model of DCP: based on the Model of human developmenthuman development

Personal factors (PF)(intrinsic)

Environment Factors (EF) (extrinsic)

Social participation

Interaction

Every human being develops himself in an interactive model

Illustration of the dynamic of the interactive process between PF and EF that determines the performance of habits life realization depending on the age, gender, socio-cultural identity of the individual

Disability Creation Process

Envrionmental Factors

Life Habits

Interaction

Risk factors

Cause

Personal FactorsOrganic systems Capabilities

Integrity ImpairmentFacilitator Obstacle

capacity incapacity

Participation handicap Situation

The disability is not considered as a fixed state but an unsatisfying process that places the person in a situation of handicap

The HS is the partial or non-achievement of life habits resulting from the interaction between personal factors and environmental factors.

« A life habit is a daily activity or a social role promoted by the person or his socio-cultural context according to his/her characteristics (age, sex, cultural identity).

Health Condition Health Condition ((disorder/diseasedisorder/disease))

Interaction of ConceptsInteraction of ConceptsICF 2001ICF 2001

Environmental Environmental FactorsFactors

Personal Personal FactorsFactors

Body Body function&structurefunction&structure

(Impairment(Impairment))

ActivitiesActivities(Limitation)(Limitation)

ParticipationParticipation(Restriction)(Restriction)

SynthesisSynthesis

Risk Factors

Cause

Personal factors

Organic system Capabilities

Health Condition Health Condition (disorder/disease)(disorder/disease)

Body function & Body function & structurestructure (Impairment(Impairment))

ActivitiesActivitiesLimitationLimitation

ParticipationParticipation(Restriction)(Restriction)

Environmental Environmental FactorsFactors

Personal Personal FactorsFactors

Environmental Factors

Interaction

Life habits

Participation Handicap Situation

Facilitator Obstacle

DCP ICF

DCP Application:DCP Application:Individual plan of interventionIndividual plan of intervention

To extract the information to select the USEFUL information

Risk factors

ImpairmentCapabilities/Disabilities

Request,expectation,

desires

Life habits

Environment

Surveys Syntheses and formulation of the handicap situation

INDIVIDUAL PLAN OF

INTERVENTIONSynthesis document)

Coordination of goals to reach

The plan of the team Intervention

• Assessment of population health

• Impact of disability– economic– social

• Evidence-base for policy makers on different policy

interventions– responsiveness of services– efficiency – performance assessment

ICF APPLICATIONS IN POLICY ICF APPLICATIONS IN POLICY MAKINGMAKING

ICF-based toolsICF-based tools

In France: the new disability policy defined by the law n°2005-102 is partially based on the ICF concepts. The law attempts to reduce the activities limitations or the restriction of participation by:- A better accessibility- Collective and individual compensations

A multidisciplinary team assesses the compensation needs for a person with disability on the basis of:

- His or her life objectives (life project)- Defining references by the law

Using the GEVA (guide for multidimensional assessment of compensation needs of person with disability) for:

- Assessment the different dimensions of the disability of the person- Analysis compensation needs- Elaborating a compensation plan

the team proposes a personalized plan of compensation of the disability