Rethinking Disability

Abstract

Disability as a health outcome deserves more attention than it has so far received. With people living longer and the epidemiological transition from infectious to noncommunicable diseases as the major cause of health burden, we need to focus attention on disability – the non-fatal impact of heath conditions – over and above our concern for causes of mortality.With the first Global Burden of Disease study, WHO provided a metric that enabled the comparison of the impact of diseases, drawing on a model of disability that focused on decrements of health. This model has since been elaborated in the International Classification of Functioning, Disability and Health as being either a feature of the individual or arising out of the interaction between the individual’s health condition and contextual factors. The basis of WHO’s ongoing work is a set of principles: that disability is a universal human experience; that disability is not determined solely by the underlying health condition or predicated merely on the presence of specific health conditions; and finally, that disability lies on a continuum from no to complete disability. To determine whether interventions at individual or population levels are effective, an approach to disability measurement that allows for an appropriate and fair comparison across health conditions is needed. WHO has designed the Model Disability Survey (MDS) to collect information relevant to understand the lived experience of disability, including the person’s capacity to perform tasks actions in daily life, their actual performance, the barriers and facilitators in the environment they experience, and their health conditions. As disability gains prominence within the development agenda in the United Nations Sustainable Development Goals, and the implementation of the United Nations Convention on the Rights of Persons with Disabilities, the MDS will provide the data to monitor the progress of countries on meeting their obligations.The lesson learned from WHO’s activities is that disability is a universal human experience, in the sense that everyone can be placed on a continuum of functioning and either currently experiences or is vulnerable to experiencing disability over the course of their lives. This understanding of disability is the key to mainstreaming disability within the public discourse.

Operacionalização da Classificação Internacional de Funcionalidade, Incapacidade e Saúde, CIF, em um Centro Especializado em Reabilitação

“…The findings corroborate models implemented in other countries that show that, after the ICF training, health professionals have conditions to operationalize the Classification in their routine, and to structure their interventions with more focus on participation and environment (5,(11)(12)(13) .…”

“…Data systematization, possibility of generating indicators and their contribution to qualify the healthcare, was a recurring topic highlighted by the professionals. National and international initiatives corroborating this finding were also identified (12)(13)(14)(15)(16) .…”

“…To underpin and discuss the results, the experiences in healthcare services and systems in the literature were taken into consideration, especially those in Italy, England and Germany, and also successful experiences in Brazil, such as the case of the Evaluation for Granting the Continuous Benefit for Disabled Person, and of the experience in the municipality of Barueri (5,(11)(12)(13)(14)(15)22,23) .…”

“…To that end, the use of this Classification in healthcare services demands the development of appropriate tools for its implementation in the clinical-therapeutic practice. Tools comprising the core ICF sets, in combination with the use of qualifiers brought by the classification, allow the description of user's functionality experience, to define therapeutic goals and appropriate interventions, allowing an overlook of the resources needed to improve specific functionality aspects, as well as to monitor post-assistance changes (12)(13)(14)(15)(16) .…”

The World Health Organization Disability Assessment Schedule 2 (WHODAS 2.0): remarks on the need to revise the WHODAS

“…Strategies of functioning information collection in health surveys are also laid down in the literature 18 . Some tools as the Model Disability Survey -MDS 19 and the World Health Organization Disability Assessment Schedule -WHODAS can be used 20 . Reinforcing the functioning role in the public health field, the 11 th International Classification of Disease -ICD-11 (https://icd.who.int/browse11/l-m/en) came up with a new section, "V Supplementary section for functioning assessment" in order to "…allow creating functioning profiles and overall functioning scores for the individuals, which are suitable to describe and quantify the level of functioning associated with health conditions.…”