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The ICFBest of both worlds or the medical model in
disguise?
David Webb
DSARC Conference, Sydney, June 2009
ICF = International Classification of Functioning, Disability and Health (WHO 2001)
• aims to be an “operational” model of disability
• supersedes (medical model) ICIDH
• claims to be a marriage of social and medical models, giving the best of both worlds
• has many fine elements to it ... but ...
Health Condition(disorder or disease)
Body Functions Activities ParticipationAnd Structures
Environmental Factors
Personal Factors
The ICF
Health Condition(disorder or disease)
Body Functions Activities ParticipationAnd Structures
Environmental Factors
Personal Factors
Medical diagnosisThe ICF
Health Condition(disorder or disease)
Body Functions Activities ParticipationAnd Structures
Environmental Factors
Personal Factors
Impairment
Medical diagnosisThe ICF
Body Functions Activities ParticipationAnd Structures
Personal Factors
Impairment
Health Condition(disorder or disease)
Medical diagnosis
Environmental Factors(Physical, Social,
Attitudinal)
The ICF
Body Functions Activities ParticipationAnd Structures
Impairment
Health Condition(disorder or disease)
Medical diagnosis
Personal Factors
Empty
Environmental Factors(Physical, Social,
Attitudinal)
The ICF
Body Functions Activities ParticipationAnd Structures
Impairment
Health Condition(disorder or disease)
Medical diagnosis
Personal Factors
Empty
Environmental Factors(Physical, Social,
Attitudinal)
Disability
The ICF
Social Model of Disability
Person
Disability
Society
Disability arises through the interaction of a person with the society they live in – i.e. it is not an attribute of the person.
Social Model of Disability
Person
Disability
Society
Impairment
More precisely, disability is social discrimination against a person with an “impairment” ...
Social Model of Disability
Person
Disability
Society
Impairment
More precisely, disability is social discrimination against a person with an “impairment” ...
Which makes disability a human rights issue ...
Social Model of Disability
Person
Disability
Society
More precisely, disability is social discrimination against a person with an “impairment” ...
Impairment
Which makes disability a human rights issue ...
Which has now led to the CRPD!
Strong and weak versions of social model
Strong• disability is entirely due to environment• i.e. without social discrimination,
“impairment” is just a health issue
Weak• recognises social factors ... but also ...• impairment contributes to experience of
disability
Very weak version accuses strong model of denying the (biological) reality of impairment – e.g. Tom Shakespeare.
Body Functions Activities ParticipationAnd Structures
ICF - revisited
Impairment
Health Condition(disorder or disease)
Medical diagnosis
Personal Factors
Empty
Environmental Factors(Physical, Social,
Attitudinal)
Disability
Body Functions Activities ParticipationAnd Structures
Impairment
Health Condition(disorder or disease)
Medical diagnosis
Environmental Factors(Physical, Social,
Attitudinal)
Disability
ICF - revisited
Body Functions Activities ParticipationAnd Structures
Disability
Impairment
Health Condition(disorder or disease)
Medical diagnosis
Environmental Factors(Physical, Social,
Attitudinal)
PersonICF - revisited
Problems
• the person – and their personhood – is absent
• “health condition” (medical diagnosis) is the defining characteristic, which many PWD reject
• impairment is physiological, anatomical
(medical)
• impairment is “deviation or loss”
• disability is abnormality rather than diversity
Beware – the “health” in WHO
• WHO defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
• but frequently the usage of “health” in WHO documents could only mean “medical health”
• e.g. “health condition”
• which in turn is then defined in narrow, biological, physiological, anatomical terms – i.e. medical
• e.g. “impairment”
• “including psychological functions” ... leading to ...
Special problems for psychosocial disability
• not recognised without a psychiatric diagnosis
• but science of psychiatric diagnosis is
contested • psychological distress reduced to biological
impairment of the brain
• psychiatric diagnosis as discrimination:
• environmental factor contributing to
stigma
• foundation of psychiatric force
Person
Disability
Society
Activity limitations
Participation restrictions
Functionaldisability
Social Model of Disability - revisited
(Imputed) Impairment
Person
Disability
Environment
Activity limitations
Physical
Social
Attitudinal
Barriersor
Facilitators
Participation restrictions
Functionaldisability
Social Model of Disability - revisited
(Imputed) Impairment
Person
Disability
Environment
(Imputed) Impairment
Activity limitations
Physical
Social – incl. medical
Attitudinal – incl. medical
Participation restrictions
Functionaldisability
Social Model of Disability - revisited
Conclusions
• the ICF has many strengths and uses and is not going to go away any time soon
• but at its core (i.e. health condition) the ICF is still ultimately a medical model of disability
• it is not an alternative to the social model of disability with its emphasis on human rights
• medicalisation of disability remains a negative environmental factor
• as CRPD notes, concept of disability is evolving
• social model can accommodate ICF strengths rather better than vice versa