Models of Disability HEAL 7112 Primary Health Praxis HEAL 6024 Nursing in the Community Aotearoa Assoc. Professor Dianne Roy 2015

Why is this important? Levels of impairment are increasing at epidemic levels People with impairment are living longer, many well into old age The 2013 NZ disability survey indicates a 24% prevalence of disability (Statistics NZ, 2014) – 15% globally (WHO, 2011) Nurses need a multi-level understanding of impairment and disability

Overview The challenges of language and definitions Models Personal tragedy/charity model Medical model Social model Capability approach

Challenges of language & definitions Historical variations – toolkit/disability-nz.html toolkit/disability-nz.html Context Location Culture Age Politics Theoretical perspective Challenging to get precise agreement

SourceDefinition - Disability ICIDH* - (WHO, 1980)^Any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being. (*International Classification of Impairments, Disabilities and Handicaps) Institute of Medicine (Pope & Tarlov, 1991)^ The inability or limitation in performing socially defined activities and roles expected of individuals within a social-cultural and physical environment. National Centre for Health Statistics (1992)^ The state of being limited in type or amount of activities a person is expected to perform because of a chronic mental or physical health condition. Institute of Medicine (Brandt & Pope, 1997)^ A limitation in performing certain roles and tasks that society expects of an individual the interaction of a person’s limitations with social and physical environmental factors. ICF* - WHO (2001)^ ^Cited Saleeby, (2007) An umbrella term for impairments, activity limitations or participation restrictions. (*International Classification of Functioning, Disability and Health) NZ Disability Strategy (MOH, 2001) Disability is not something individuals have. What individuals have are impairments. Disability is the process which happens when one group of people create barriers by designing a world only for their way of living, taking no account of the impairments other people have.

Models of disability - Personal tragedy/Charity model Underpins many historical perspectives Disability is viewed as a tragic or miserable existence and the only solution is to raise money or resources with the aim of somehow reducing the “suffering” Disabled people expected to passively and gratefully receive help. Charity providers decide what those with disabilities need. Focuses solely on “effects of impairment”

Models of disability - Medical Model Disability is located within the individual The answer to disability is to “cure” the person (which may not be possible or even desirable) Success is measured by achievement of “normalcy”. Disabled people are seen as passive recipients of “experienced” professionals

Models of disability - Social model Origins in the disability movement in the UK in the 1980s – particularly work of Michael Oliver. Distinguishes between the impairments that people have & the barriers to social participation that they experience. Problem not with individual but centred around the fact that society is organized to meet the needs of people without disabilities. Badly designed built environments, inaccessible transport, inaccessible information & discriminatory attitudes & practices lead to segregation Empowers disabled people

Models of disability - Capability or strengths approach Amartya Sen - Nobel Laureate in economics Shifts focus from person’s problems or deficits to their capabilities & strengths Interventions attempt to build on these Assesses what people are able to do in their real-life environments not just functional status Considers what is important in the person Does not ignore challenges faced

Summary The challenges of language and definitions Models Personal tragedy/charity model Medical model Social model Capability approach

References Leplege, A., Gzil, F., Cammelli, M., Lefeve, C., Pachoud, B., & Ville, I. (2007). Person- centredness: Conceptual and historical perspectives. Disability & Rehabilitation, 29(20/21), , doi: / Ministry of Health. (2001).The New Zealand Disability Strategy: Making a World of Difference - Whakanui Oranga. National Health Committee Report (2007) Meeting the Needs of People with Chronic Conditions. conditionshttp:// conditions Office for Disability Issues. (n.d.) Shifting beliefs about disability. perspective/shifting-beliefs.html perspective/shifting-beliefs.html Smart, J. F. (2009). The power of models of disability. Journal of Rehabilitation, 75(2), Link to Smart (2009) ?direct=true&db=s3h&AN= &site=ehost-live&scope=site ?direct=true&db=s3h&AN= &site=ehost-live&scope=site Statistics NZ (2014) Disability Survey – 2013: Key Facts. Retrieved from TP2013.aspx TP2013.aspx World Health Organisation (2011) World report on disability: Fact sheet.

Recommended reading: Chapters 1, 2, 8 and 10 in course text: Chang, E., & Johnson, A. (Eds.). (2014). Chronic illness and disability: Principles for nursing practice. Sydney: Elsevier Australia. Alleviating the burden of chronic conditions in NZ: The ABCC NZ workbook orkbook_Final.pdf orkbook_Final.pdf Wasserman, David, Asch, Adrienne, Blustein, Jeffrey and Putnam, Daniel, "Disability: Definitions, Models, Experience", The Stanford Encyclopedia of Philosophy (Winter 2011 Edition), Edward N. Zalta (ed.), URL =