Article: Disabilities

Disabilities are limitations in activity and/or functioning that are attributable to permanent medical conditions in physical, mental, emotional, and/or sensory domains and, significantly, are also due to societal responses to those limitations. Disabilities, then, denote more atomized perspectives on the phenomenon than does "disability" or "impairment". Those latter terms focus upon conditions within the individual. The term disabilities, by contrast, recognizes that people with disabilities live in communities. The lives they lead are enabled and/or circumscribed not only by their conditions but also by the circumstances in which they find themselves from day to day.

Defining Disabilities

Defining disabilities is challenging. There is a social model (UK primarily), a civil rights model (US), a medical model, and a moral model that professionals and consumers alike use to approach the definition (Bowe, 1978).

The Americans with Disabilities Act adopts a three-prong definition first used in section 504: (A) a physical or mental impairment that substantially limits one or more of the major life activities of such individual; (B) a record of such an impairment; or (C) being regarded as having such an impairment. This is known as the "civil rights definition" of disability. Note that under the second (B) prong, an individual may currently have no impairment at all. The ADA protects this person from unjust discrimination on the grounds that there once was an impairment. Consider, for example, a man aged 50 who had a heart attack at age 44. He has since recovered, thanks to conscientious rehabilitation. It is possible that an employer, considering him as a potential worker, might deny him a job based on that history ("He had a heart attack; he may have another one"). That would be unfair. The civil-rights nature of the definition becomes even clearer with the third (C) prong, which envisions instances in which there is no current impairment and actually never was one. Suppose, to illustrate, that someone has many prominent pimples on his face. A prospective employer might erroneously think "he has AIDS" and deny him employment.

The Social Security Administration defines disability in terms of inability to perform substantial gainful activity (SGA), by which it means “work paying minimum wage or better”. The agency pairs SGA with a "listing" of medical conditions that qualify individuals for benefits. With respect to one program, Supplemental Security Income (SSI), the "listing" runs hundreds of pages of single-spaced type. It makes the SSA definition a medical-model one.

A third approach to "definition" is the ages-old moral one. As memorably characterized by Alan Toy, a professional actor with a disability: "There is a really terrible reason you are like you are -- too terrible to fathom". In different words, the moral model says that people have disabilities because they, or their parents, did something bad and the disability is the punishment that gods levy upon them. One example, from 1700s-era America, is the Salem witches. They may actually have had epilepsy. People may laugh about this today, but in many parts of the world, especially in developing nations, disability continus to be feared as possibly having supernatural causes.

Demographics

The demography of disability is treacherous territory. Take the seemingly simple matter of definition. What do we mean by “disability”? The answer varies from survey to survey. It even varies within survey, from year to year. Counting persons with disabilities, it turns out, is far more challenging than is counting males, say, or 16-to-24 year-olds. That is because disability is not a status condition, entirely contained within the individual. Rather, it is an interaction between medical status (say, having low vision or being blind) and the environment. To continue with the example involving visual disabilities, for someone sitting in the audience while an orchestra is playing Beethoven's Fifth Symphony, there is no real limitation. The same individual experiences real restrictions, by contrast, when sitting in the same chair while a silent film is being displayed on a screen. Someone who is deaf will experience the two situations in opposite ways: shut out of the symphony but enjoying the silent film. The 504/ADA definition presents even thornier issues for demographers. It is not a definition that is useable for purposes of counting people.

For all of these reasons, estimates of worldwide and country-wide numbers of individuals with disabilities are problematic. The varying approaches taken to defining disability notwithstanding, demographers agree that the world population of individuals with disabilities is very large. In the United States, for example, Americans with disabilities constitute the third-largest minority (after persons of Hispanic origin and African Americans); all three of those minority groups number in the 30-some millions in America. According to the U.S. Bureau of the Census, as of 2004, there were some 32 million adults (aged 18 or over) in the United States, plus another 5 million children and youth (under age 18). If one were to look at impairments, Census estimates put the figure at 51 million.

There is also widespread agreement among experts in the field that disability is more common in developing than in developed nations. The World Health Organization, for example, estimates that there are as many as 600 million persons with disabilities.

Eligibility for Social Programs and Entitlements

Making matters worse is that "disabilities" are defined, and eligibility criteria set, differently for different social purposes. In the U.S., for example, there is one definition for PreK-12 education and a very different one for welfare-like benefits. Eligibility for special education is limited to children and youth who satisfy the "child with a disability" definition. That definition refers to a dozen disability categories (e.g., specific learning disability) and adds that, to be eligible, students must require both special education (modified instruction) and related services (supports such as speech and language pathology). For the definition, and related information, see Individuals with Disabilities Education Act.

Eligibility for SSI, a major entitlement program in the U.S., calls for people to show that they are unable to engage in "substantial gainful activity" (SGA; in plain English, working for minimum wage) in any job anywhere in the country. That is a high standard. They also must show that they are poor (in that they have few or no assets).

Disabilities Today and Tomorrow

A human rights based approach has been adopted by many organisations of and for people with disabilities. In 1976, the United Nations launched its International Year for Disabled Persons (1981), later re-named (thanks to U.S. Representative Frank Bowe), to the International Year of Disabled Persons. More than one word change was involved. Bowe noted that the 1975 International Year of Women had "of" in it, whereas the 1976 declaration that there be a Year on disability adopted the more patronizing "for". In 2000, the United Nations Assembly decided to start working on a comprehensive convention for the rights of people with disabilities. Since 2002 the "UN Ad-Hoc meeting" has gathered every six months to discuss the content of this UN convention. These meetings are open for Non-Governmental Organisations and Disabled Peoples' Organisations.

Meanwhile, a number of nations have followed the U.S. lead by adopting national laws patterned after the Americans with Disabilities Act. While there is undeniable progress being made, many advocates are concerned that the greatest need is in developing nations -- where the vast bulk of the estimated 600 million persons with disabilities reside. A great deal of work -- from basic physical accessibility through education to self-empowerment and self-supporting employment -- remains ahead.