The measurement of disability has important implications for law and policy. There is no universally accepted definition for disability. There are, however, a number of conceptual models that guide measurement. No model can encompass all the dimensions of disability, but different models serve different purposes and provide useful perspectives on disability in a given context (Palmer & Harley, 2012). Disability represents a complex process and is not a single, static state. It refers to the outcome of the interaction of a person and his/her environment (physical, social, cultural or legislative) and represents a measure of the negative impact of environmental factors on one’s ability to participate. The complexity of the concept has resulted in the proliferation of statistics on disability that are neither comparable nor easy to interpret (Madans, Loeb & Altman, 2011) and that demand definitions that are flexible but able to capture disability in various manifestations (Loeb, Eide, & Mont, 2008).
With the burgeoning interest in disability studies, civil society groups, disability organisations, and researchers - both social and medical scientists, have contested the concept itself. The contestations arise from the complex, multidimensional and dynamic nature of the concept. However, the discussion converges at two broad perspectives about disability - its social and medical domains, thus the awareness that disability portends both social and physical barriers. To that extent, the Washington Group on Disability Statistics (2010) argued that disability should not be framed within the political, social and medical sciences’ discourses but rather within the realms of scientific balance. In the introduction to the CRPD, it was also pointed out that disability is an evolving concept, and was further surmised that,
“disability results from the interaction between persons with impairments and attitudinal and environmental barriers that hinder their and effective participation in society on an equal basis with others” (p. 56).
According to a WHO (1980) mode1, disability is “any restriction or lack of ability to perform an activity in the way or within the range considered normal for a human being”. Examples include walking disability, dressing disability or shopping disability. Disability is to be distinguished from handicap, the latter being defined as a “disadvantage for a given individual, resulting from impairment or a disability that limits or prevents the fulfilment of a role that is normal for that individual” (p. 291).
Nagi (1991) defined disability as “inability or limitation in performing socially defined roles and tasks expected of an individual within a sociocultural and physical environment” (p. 3151). Limitations in performing various tasks commonly referred to as activities of daily living, such as dressing, shopping or driving, are “part of the set of expectations inherent in family, vocational and a variety of other roles” (p. 3171) and, therefore, are components of the concept of disability.
Disability is perceived to be caused by physical impairments resulting from disease, injury or health conditions (Barnes & Mercer, 2003). Impairment leads directly to the loss of bodily
The International Classification of Disability and Handicaps framework conceptualizes disability in the following domains - impairment, disability and handicap. The International Classification of Functioning, Disability and Health (ICF) define disability as an umbrella concept that embraces impairments, activity limitations, and participation restrictions.
· Impairment: any loss or abnormality of psychological, physiological or anatomical structure or function. This could include blindness or deafness, loss of limb.
· Disability: any functional restriction or lack (resulting from an impairment) of ability to perform an activity within the range considered normal for a human being. This could include walking, stretching, lifting, feeding and so on.
· Handicap: this is the relationship between impaired and/or disabled people and their surroundings affecting their ability to participate normally in a given activity and which puts them at a disadvantage.
The social model presents disability as societal construction as opposed to individual interpretation. Social changes are therefore required in reframing who is disabled and who is not. This view discounts the importance of impairment. Impairment is seen to occur depending on structural arrangements that either impede or promote the functioning of individuals in societies. One of the influential proponents of the social model, Michael Oliver argued that, ‘disablement has nothing to do with the body’, and ‘impairment is in fact nothing less than a description of the physical body’ (Hughes & Paterson, 1997). One of the motivations of social reconstructing is to challenge the medical view that unconsciously presents the disabled people as “other”. The social model has served as the basis for political organisations and demands for empowerment of people with disability (PWD). The social model however, does not preclude impairments entirely except that its advocates insist that disability is contingent on social conditions (Thomas, 2004; Reindal, 2009). For instance, Allotey et al., (2003) found that paraplegia patients in Cameroon and Australia reported different disabling experiences largely due to the social context – the later country being much supportive of PWD.
Although useful, serving both political and empowerment interests, the social model proponents have been criticized for neglecting the centrality of impairment – real experience of disabled people. One of the key critics, Bury (2000) contended:
I do not believe that the ‘social model’ has really engaged with the real issues facing the vast majority of disabled people, and, despite its rhetoric and undoubted attractions for some, it has not produced a cogent approach which can serve the real practical needs of disabled people, or indeed the research community (p.1075).
Despite the criticisms against the social model, its importance lies in an outlook to reduce the burdens and barriers to PWD.
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