Biomedical Engineering Reference
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between an independent variable and a dependent variable. On the contrary, we claim an
approach that examines the interrelations among many variables, some of them unknown,
and takes into consideration the organicistic characters of life and considers concepts such
as order, organization, differentiation, and orientation to a purpose. As a result, human
beings are also seen as systems ecologically plunged into multiple systems (Gray et al.
1969). In the biopsychosocial model, the definition of the state of health or illness is there-
fore the outcome of the interaction of processes that operate at the macro level (e.g., the
existence of social support for depression) and the processes that operate at the micro level
(e.g., biological or biochemical derangements).
Thus, it is impossible from this perspective to isolate disability from the functioning of
an individual and vice versa, or rather hypothesize one without the other, not only at the
level of social organization but also at the level of a single individual. Disability implies
functioning and vice versa. When I. K. Zola in “Toward the Necessary Universalizing of
a Disability Policy” (1989) expresses hope for the demystification of the “specialness” of
disability and the admission that “people with a disability have long been treated as an
oppressed minority” (p. 19), he assumes a conception of disability that is fluid and con-
textual: “Disability is not a human attribute that demarks one portion of humanity from
another (as gender does, and race sometimes does); it is an infinitely various but universal
feature of the human condition” (Bickenbach et al. 1999, p. 1182). The issue of disability for
individuals “is not whether but when, not so much which one, but how many and in what
combination” (Zola 1993, p. 18).
There is not, according to Zola's approach that is close to the biopsychosocial model, a
dichotomy between ability and disability, but rather a continuum in which complete abil-
ity or complete disability represent nothing but a borderline case possible only in theory.
The unique borders to delineate on this continuum should have political and economic
purposes and produce functional distinctions to redistribute resources within society.
Evidently, we are talking about boundaries that could be criticized and modifiable in the
course of time. According to Zola, developing “universal policies” is a matter of urgency
that recognizes an indisputable fact: the entire population is “at risk” because of the
extraordinary concomitance of chronic illnesses and disability (1989, p. 1). Beyond a uni-
versal perspective, we seriously risk creating and perpetuating a model of segregated and
separated society, which is also characterized by a progressive accentuation of inequalities:
Only when we acknowledge the near universality of disability and that all its dimen-
sions (including the biomedical) are part of the social process by which the meanings of
disability are negotiated will it be possible fully to appreciate how general public policy
can affect this issue. (Zola 1989, p. 20)
The rapid aging of the world population, now more than ever before, confirms what Zola
claimed. In most of the World Health Organization's (WHO) recent documents, the spread
of disability as a condition correlates with the progressive aging of the population is dra-
matically shown:
Life expectancy is increasing in most countries in the Region and the populations are
therefore ageing rapidly. In 2050, one third of the population is projected to be 60 years
and older. […] Whereas much of old age is a healthy period, there may be ill health,
which leads to disability and dependence, especially in late old age (WHO 2011, p. viii);
Global ageing has a major influence on disability trends. The relationship here is
straightforward: there is higher risk of disability at older ages, and national populations
are ageing at unprecedented rates (WHO and World Bank 2011, p. 35).
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