The ICF Best of both worlds or the medical model in disguise? David Webb

1. The ICF Best 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 ...

2. The ICF Health Condition (disorder or disease) Body Functions Activities Participation And Structures Environmental Factors Personal Factors

3. The ICF Medical diagnosis Health Condition (disorder or disease) Body Functions Activities Participation And Structures Environmental Factors Personal Factors

4. The ICF Medical diagnosis Health Condition (disorder or disease) Impairment Body Functions Activities Participation And Structures Environmental Factors Personal Factors

5. The ICF Medical diagnosis Health Condition (disorder or disease) Impairment Body Functions Activities Participation And Structures Environmental Factors (Physical, Social, Attitudinal) Personal Factors

6. The ICF Medical diagnosis Health Condition (disorder or disease) Impairment Body Functions Activities Participation And Structures Environmental Factors (Physical, Social, Attitudinal) Personal Factors Empty

7. The ICF Medical diagnosis Health Condition (disorder or disease) Impairment Body Functions Activities Participation And Structures Disability Environmental Factors (Physical, Social, Attitudinal) Personal Factors Empty

8. Social Model of Disability Person Disability arises through the interaction of a person with the society they live in – i.e. it is not an attribute of the person. Disability Society

9. Social Model of Disability Person More precisely, disability is social discrimination against a person with an “impairment” ... Impairment Disability Society

10. Social Model of Disability Person More precisely, disability is social discrimination against a person with an “impairment” ... Impairment Disability Which makes disability a human rights issue ... Society

11. Social Model of Disability Person More precisely, disability is social discrimination against a person with an “impairment” ... Impairment Disability Which makes disability a human rights issue ... Which has now led to the CRPD! Society

12. 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.

13. Medical diagnosis ICF - revisited Health Condition (disorder or disease) Impairment Body Functions Activities Participation And Structures Disability Environmental Factors (Physical, Social, Attitudinal) Personal Factors Empty

14. Medical diagnosis ICF - revisited Health Condition (disorder or disease) Impairment Body Functions Activities Participation And Structures Disability Environmental Factors (Physical, Social, Attitudinal)

15. Medical diagnosis ICF - revisited Person Health Condition (disorder or disease) Impairment Body Functions Activities Participation And Structures Disability Environmental Factors (Physical, Social, Attitudinal)

16. 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

17. 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 ...

18. 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

19. Social Model of Disability - revisited Person Impairment Disability Society

20. Social Model of Disability - revisited Person (Imputed) Impairment Disability Society

21. Social Model of Disability - revisited Person (Imputed) Impairment Activity limitations Participation restrictions Functional disability Disability Society

22. Social Model of Disability - revisited Person (Imputed) Impairment Activity limitations Physical Social Attitudinal Participation restrictions Functional disability Disability Barriers or Facilitators Environment

23. Social Model of Disability - revisited Person (Imputed) Impairment Activity limitations Physical Social – incl. medical Attitudinal – incl. medical Participation restrictions Functional disability Disability Environment

24. 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