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.

Defining Disability

Defining disability 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 Actadopts 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.

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. There is also widespread agreement among experts in the field that disability is more common in developing than in developed nations.

Eligibility for Social Programs and Entitlements

Making matters worse is that "disabilities" are defined differently for differnt social purposes. In the U.S., for example, there is one definition for education and a very different one for welfare-like benefits.

References

Bowe, F. (1978). Handicapping America. New York: Harper & Row