1. International Classifications
World Health Organization Classification Assessment Surveys & Terminology Group
ICF
as the
New Member in the
WHO Family of
International Classifications
Greetings ,
I am happy to greet you on behalf of the World Health Organization and it is my pleasure to provide you with this introduction on the WHO Family of International Classifications (WHO- FIC)
We are now in an upgrading process and moving towards the a unified concept of integrated classification systems for health information.
In this presentation, I would like to address the following points:
What is the WHO Family of International Classifications ?
Why is there a need for the WHO FIC ?
What are the key concepts of WHO FIC And the underlying principles of family ?
How can we use the WHO FIC to improve people’s health?
For your information, a copy of the slides used in this presentation is available from WHO or over the INTERNET. The contact addresses are found at the end of this presentation.

2. Basic Messages ICF has been systematically revised in the last decade
large international and multidisciplinary participation
extensive field testing
guided by scientific principles
taxonomic guidelines: logic and terminology
practical utility: feasibility, ease of use, ethical guidelines
reliability, validity and comparability
When the rubber hits the road...
ICF can serve as a useful tool for Health Information Systems
evaluation: needs, outcomes, costs, quality, satisfaction
service provision, social policy
Application guidelines, training, tools are needed

3. استاديار دانشکده علوم توانبخشی ؛ دانشگاه علوم پزشکی ايران
دکتر محمد کمالی
استاديار دانشکده علوم توانبخشی ؛ دانشگاه علوم پزشکی ايران
صندوق پستي
دی ماه هشتاد ودو

4. [Keywords] ###[Narration] ###
World Health Assembly
Endorse and publish ICF
use the ICF in Member States in:
research
surveillance
reporting
Joint use with ICD
Operational subsets:
surveys
clinical encounters
Periodic revision
[Keywords] ###[Narration] ###

5. WHO Family of International Classifications
ICD-10
International Statistical Classification of Diseases & Related Health Problems
Interventions
procedures
Primary care adaptations
Reasons for encounter
ICF
International Classification of Functioning, Disability and Health
Speciality
adaptations
IND
Nomenclature of Diseases
[Keywords] context###[Narration] ###
Associated Products
Main Classifications
Adaptations

6. ICF Publications 1. Main volume with glossary - Full version 9999 cat.
- Short version 99 cat.
2. Clinical Descriptions
& Assessment Guidelines
3. Assessment Criteria
for Research
4. Other versions
- Specialty adaptations
Children and Youth
5. Dedicated
Assessment Tools
The International Classification of Impairment, Disabilities and Handicaps was developed as a tool for classifying the consequences of disease. The revised classification, ICF (see paragraph 9 in the main document above), aims to provide a unified and standard language and framework for the description of health states and is based on dimensions of functioning with categories, or domains, within each dimension. These dimensions are (1) body functions and structure, (2) activities at the individual level and (3) participation in society. It systematically groups different health domains and health-related domains (e.g. what a person can do or does do when he or she has a given health condition). It covers all possible health domains described at body, individual and society dimensions. In this way, the universe of ICIDH encompasses health and health-related outcomes (including non-fatal health outcomes – see Annex 3).

7. [Keywords] context###[Narration] ###
ICF Checklist
One component- One page
“at-a-glance”
Salient Categories (169 out of 1494)
Impairments with:
Body Functions
Body Structures
Activity and Participation
Environmental Factors
Other Contextual information
Available for:
Clinicians & providers
Consumers
[Keywords] context###[Narration] ###

8. Aims
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
time
to provide a systematic coding scheme for health information systems
[Keywords] context###[Narration] to provide a scientific basis for consequences of health conditions
to establish a common language for describing consequences of health conditions in order to improve communications between health care workers, other sectors and people with disabilities
to stimulate better care and services to improve the participation in society of people with disablements - this is central to improving quality of life and facilitating the autonomy of persons with disablements
to permit comparison of data across countries, health care disciplines, services and time - the need for such an international language has long been felt
to provide a systematic coding scheme for health information systems - international comparisons of epidemiological and other data has suffered from a lack of uniform systems
to stimulate research on the consequences of health conditions - this will facilitate the development of more effective interventions
to collect data on facilitators and inhibitors in society that affect the participation of people with disablements - this is crucial to influence policy change###

9. Foundations of ICF Human Functioning - not merely disability
Universal Model not a minority model
Integrative Model not merely medical or social
Interactive Model not linear progressive
Parity not etiological causality
Context - inclusive not person alone
Cultural applicability - not western concepts
Operational not theory driven alone
Life span coverage not adult driven
[Keywords] concept###[Narration] ###

10. Human Functioning not disability alone
Body functions vs impairments
Body Structures
Activities vs activity limitation
1980 disability
Participation vs handicap

11. Participation or Handicap?
neutral language
“politically correct”
correct use
intervention
opportunity
positive aspects
ICF does not only describe negative health experiences, but neutral health domains in which the state can be described as both positive and negative. For example: read slide

12. Universal Model vs. Minority Model
Everyone may have disability
Continuum
Multi-dimensional
Certain impairment groups
Categorical
Uni-dimensional
[Keywords] concept###[Narration] ICIDH applies to 100 %
disablement applies to nearly all###

13. Medical versus Social Model
PERSONAL problem vs SOCIAL problem
medical care vs social integration
individual treatment vs social action
professional help vs individual & collective responsibility
personal vs environmental adjustment manipulation
behaviour vs attitude
care vs human rights
health care policy vs politics
individual adaptation vs social change
The various models proposed to explain and classify disablements may be expressed in a dialectic of “medical model” versus “social model”. The medical model views the disablement phenomenon as a “personal” problem, directly caused by disease, trauma or health conditions, which requires medical care provided in the form of individual treatment by professionals. Management of disablement is aimed at the person’s better adjustment and behaviour change. Health care is viewed as the main issue and at the political level it is health care policy that needs to be modified. The social model of disablement, on the other hand, sees the issue mainly as a “societal” problem from the viewpoint of integration of persons with disabilities into society. Disablement is not an attribute of a person, but a complex collection of conditions many of which are created by the social environment. Hence the management of the problem requires social action and it is the collective responsibility of society to make the environmental modifications necessary for the full participation of people with disabilities into all areas of social life. The issue is, therefore, an attitudinal or ideological one which requires social change, while at political level it is a question of human rights. Hence the issue is highly political for all intents and purposes.

14. Sequence of Concepts ICIDH 1980
Disease or
disorder
Impairments
Disabilities
Handicaps

15. Interaction of Concepts
ICF 2001
Health Condition (disorder/disease)
Body function&structure (Impairment)
Activities
(Limitation)
Participation
(Restriction)
Environmental Factors
Personal Factors

16. Equity / Parity Loss of limb Missed days at usual activities Stigma
landmines = diabetes = thalidomide
Missed days at usual activities
flu = depression = back pain = angina
Stigma
leprosy = schizophrenia = epilepsy = HIV
[Keywords] concept###[Narration] ###

17. Contextual Factors Person Environment gender Products age Close milieu
other health conditions
coping style
social background
education
profession
past experience
character style
Environment
Products
Close milieu
Institutions
Social Norms
Culture
Built-environment
Political factors
Nature
[Keywords] structure###[Narration] ###

18. Cultural Applicability
[Keywords] concept###[Narration] ###
Conceptual and functional equivalence of Classification
Translatability
Usability
International Comparisons

19. Comparability: equivalence across cultures
Conceptual equivalence:
similar understanding /meaning of concepts
Functional equivalence:
similar domains
Metric equivalence:
similar measurement characteristics

20. ICF Field Testing 7 years 1994-2001 61 countries
ICF drafts translated into / tested in 27 languages
38 National Consensus Conferences
7 International Consensus Conf.
2000 Live Case evaluations
3500 Case Summary evaluations

21. Functioning and Disability
Structure
ICF
Classification
Part 1:
Functioning and Disability
Part 2:
Contextual Factors
Parts
Body Functions
and Structures
Activities and
Participation
Environmental
Factors
Personal
Factors
Components
Change in
Body
Functions
Change in
Body
Structures
Capacity
Performance
Facilitator/
Barrier
Constructs/
qualifiers
ICIDH categories are organized in a "nested" approach Broader Category  detailed subcategory
The classification has two parts, each with two components.
[An example may help to illustrate the point:
The universe of health and disability is being classified (this is the forest). Within that forest we classify the dimensions of Impairments, Activities and Participation (the trees). In the Activities dimension we have several chapters or domains ranging from simple to complex activities - from sensing and recognizing to interpersonal behaviors (the trunks). Within, for example, the chapter on Interpersonal Behaviors are included activities such as general interactive skills (the branch) and included in that broad category are behaviors such as initiating social contact, responding to cues and so on (the leaves).]
Item levels:
1st
2nd
3rd
4th
Item levels:
1st
2nd
3rd
4th
Item levels:
1st
2nd
3rd
4th
Item levels:
1st
2nd
3rd
4th
Item levels:
1st
2nd
3rd
4th
Domains and categories
at different levels

22. Body Functions and Structures
Mental functions
Structures of the nervous system
Sensory functions and pain
The eye, ear and related structures
Voice and speech functions
Structures involved in voice and speech
Functions of the cardiovascular, haematological, immunological and respiratory systems
Structures of the cardiovascular, immunological and respiratory systems
Functions of the digestive, metabolic and endocrine systems
Structures related to the digestive, metabolic and endocrine systems
Genitourinary and reproductive functions
Structures related to the genitourinary and reproductive systems
Neuromusculoskeletal and movement-related functions
Structures related to movement
Functions of the skin and related structures
Skin and related structures

23. Activities and Participation
1 Learning &Applying Knowledge
2 General Tasks and Demands
3 Communication
4 Movement
5 Self Care
6 Domestic Life Areas
7 Interpersonal Interactions
8 Major Life Areas
9 Community, Social & Civic Life

24. Environmental Factors
1. Products and technology
2. Natural environment and human-made changes to the environment
3. Support and relationships
4. Attitudes
5. Services, systems and policies

25. ICF Applications Health sector Social security Education sector
Labour sector
Economics & development sector
Legislation & law
Other ….
Though the ICIDH is a classification of disability's and functioning within a health context it is also intended that it will have a much wider applicability. The ICIDH could be used to inform the development of social security guidelines, special education facilities and policies and compensation in the labour sector. It could be used to identify investments into overall development and serve as the framework for developing national and international laws that address the area of disability in particular and discrimination in general.

26. ICF in health & disability statistics
Common Domains
Mobility - Cognition - Mood
Self Care - Usual Activities ...
link data from both health and disability
Multiple Components
overcomes the “impairment” focus
Environmental Factors
Comparability
Another principle that underlies ICIDH is that of parity. There is no distinction, at the level of impairment, activity limitation or participation restriction, between different health conditions (e.g. mental and physical). In other words, disablement is not differentiated by etiology.
ICIDH is etiologically neutral.

27. ICF in clinical practice & management
Needs assessment
Outcome assessment
Utilization patterns
Comparison of different interventions
Consumer satisfaction
Service performance
outcomes
cost-effectiveness
Electronic records
Clinical terminology
(Vorhersage des Inanspruchnahmeverhaltens & Länge der Hospitalisierung)

28. ICF in policy making assessment of population health
impact of disability
economic
social
evidence-base for policy makers on different policy interventions
responsiveness of services
efficiency
performance assessment
Gesundheitspolitik, Sozialpolitik, Behindertenpolitik and Menschenrechtspolitik (keine Entsprechung von Bedurfnisslagen, Problemlagen, Ressourcenvereilung)

29. ICF research applications
joint assessment of disease and functioning
description of association
intervention response & synchrony of change
explanatory power on:
utilization
needs
costs
outcomes
Cost-effectiveness of interventions
Unified approaches
Another principle that underlies ICIDH is that of parity. There is no distinction, at the level of impairment, activity limitation or participation restriction, between different health conditions (e.g. mental and physical). In other words, disablement is not differentiated by etiology.
ICIDH is etiologically neutral.

30. ICF Domains used in International WHO Surveys
Health Domains
Vision
Hearing
Speech
Digestion
Bodily excretion
Fertility
Sexual activity
Skin & disfigurement
Breathing
Pain
Affect
Sleep
Energy / vitality
Cognition
Communication
Mobility and Dexterity
Health Related Domains
Self-care: Including eating
Usual activities: household activities; work or school activities
Social functioning: interpersonal relations
Participation: societal participation including discrimination/stigma