Biomedical Engineering Reference
In-Depth Information
Moreover, disability belongs to the human condition not only on a biological level but
also on a cultural one because “across the world, people with disabilities have poorer
health outcomes, lower education achievements, less economic participation and higher
rates of poverty than people without” (WHO and World Bank 2011, p. xi). According to
the recent
World Report on Disability
, it estimates that between 110 and 190 million people
(from 2.2 to 3.8%) have very significant difficulties in functioning (WHO and World Bank
2011, p. 44).
1.2 Classification, Declaration, and International
Definitions of Functioning and Disability
In the International Classification of Functioning, Disability, and Health (ICF; WHO 2001),
conceptually founded on the biopsychosocial or universal model, an interactive model
(holistic) is proposed. In this model, a person's functioning and disability are considered
to be the product of the dynamic interaction between health conditions and contextual
factors, which include personal factors as well as environmental ones. In the ICF, concepts
such as “functioning” and “disability” are defined in reference to the relation between an
individual and his or her context, or rather the complex interaction between personal and
environmental factors: “A person's functioning and disability is conceived as a dynamic
interaction between health conditions (diseases, disorders, injuries, traumas, etc.) and con-
textual factors” (WHO 2001, p. 8).
Actually, it is impossible to talk about a person's functioning and disability as if he or
she lived in a social, cultural, political, and economic vacuum. This vacuum is filled by
the introduction of the contextual factors in the ICF's biopsychosocial inter-relational
model of disability. The multidimensionality of the ICF is guaranteed by the fact that
contextual factors are a basic and integral component of the human functioning model
based on the classification, body functions and structures, and activity and partici-
pation. The positive aspects of the relationship between an individual and his or her
context are defined by the umbrella term “functioning,” by which we mean all nonprob-
lematic or positive aspects of health and health-related individual conditions. On the
other hand, all negative aspects that characterize the relationship between an individual
and his or her context are defined by the umbrella term “disability.” Both terms have in
the classification a neutral meaning (or rather are meant as traced back to their original
semantic value) beyond any possible social-cultural encrustation that justifies their use
as “umbrella” terms.
Overall, the ICF individuates four components related to human functioning and its
restrictions: the functioning and disability components, subdivided into i) body func-
tions and structures and ii) activities and participation, and the contextual factor com-
ponents, which encompass iii) personal and iv) environmental factors. Each component
consists of different constructs or qualifiers and is subdivided into domains and cat-
egories at different levels. Health and health-related states may be classified using an
alphanumeric code system:
b
= body functions,
s
= body structures,
d
= activities and
participation, and
e
= environmental factors. Separated by a dot, on the right of the
alphanumeric codes, the ICF requires the use of one or more qualifiers, which denote, for
example, the magnitude of the level of health or severity of the problem at issue (WHO
2001, Annex 2).
