Biomedical Engineering Reference
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any case, the need for updated estimates on the worldwide prevalence of disability has
led the World Health Organization (WHO) and the World Bank to jointly produce the
first ever World Report on Disability (2011). This report is based on two large data sources:
the WHO World Health Survey of 2002-2004 (WHO 2002-2004; Üstün et al. 2003b), from
59 countries, and the WHO Global Burden of Disease study, 2004 update (WHO 2008). The
first is the largest multinational health and disability survey ever using a single set of
questions and consistent methods to collect comparable health data from across coun-
tries; the second is an overall assessment of the health of the world's population, pro-
viding exhaustive estimates of premature mortality, disability, and loss of health from
different diseases, injuries, and risk factors, drawing on available WHO data sources
and on information provided by member states.
The World Health Survey and Global Burden of Disease “based on very different
measurement approaches and assumptions, give global prevalence estimates among the
adult population of 15.6% and 19.4% respectively” (WHO and World Bank 2011, p. 29).
The World Report on Disability makes some recommendations to improve the availability
and quality of data on disability: (1) adopt the ICF “as a universal framework for disabil-
ity data collection” (WHO and World Bank 2011, p. 45); (2) improve national disability
statistics; (3) improve the comparability of data; and (4) develop appropriate tools and fill
research gaps, with particular suggestions for developing “better measures of the envi-
ronment and its impact on the different aspects of disability” (WHO and World Bank
2011, p. 46) and for coupling the evaluation of disability experience with the measure-
ment of the “well-being and quality of life of people with disabilities” (WHO and World
Bank 2011, p. 47).
Moreover, in the field of measurement, the crucial point is not to find the right answer but
to answer the right question, and, as Zola conveyed (1993), any attempt to identify standard
measures on disability reflects, more than anything else, the effort to consider disability as
a fixed and dichotomous entity and not, as the universal model of disability states, a fluid
and continuous experience. Indeed, only in a purely theoretical manner might one find in
an individual either a full disability or a full ability. In the biopsychosocial model, disability
is no longer considered, as medical and social models do, as an identity that defines people
or social classes. In the medical model, disability is a negative characteristic belonging to
an individual that defines the gap between them and normal standard health. Conversely,
the social model identifies disability as a social class of individuals in whom the majority
recognizes a stigmatized status of minority (Goffman 1963; Hahn 1985). In the medical
model people have a disability because an illness or an impairment is attributed to them
and they are called “people with disability” or, much easier, they are wholly identified
with the illness (e.g., Down syndrome, deaf, blind); in the social model, people are disabled
because they are stigmatized by prejudices of society and one may talk about them as
disabled people (not “with disability”) or oppressed (not “with oppression”) (Oliver and
Barnes 1998). The biopsychosocial model moves from the person to his or her function-
ing, overcoming a causal inference of disability as a result of both the impact of disease
or other health conditions (WHO 2001) and a social disadvantage. According to this view,
disability is just a way of functioning, expressed by positive wording as the “ability to do”
in specific contexts and health conditions.
Individual functioning is also related to the interrelation between a specific environment,
personal features, and health conditions: “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). Disability is not a set of immutable characteristics that define a person over
another, nor is it predictable by a medical diagnosis because it is not a direct consequence
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