"Disability is both a cause and consequence of poverty. Eliminating world poverty is unlikely to be achieved unless the rights and needs of people with disabilities are taken into account." (DFID 2000)
What Is Disability
Disability is not something that a person possesses. A physical, intellectual, mental or sensory impairment can be more or less disabling depending on the context in which it occurs. Disability is not an ‘all-or-nothing’ matter. We often use one single word, ‘disability’, to cover many situations. Some disabilities can be highly visible, some are not; some are mild, others are more severe. Some forms of impairment or health conditions may result in temporary loss of function, while others are permanent in nature. Some disabilities are present at birth; other may occur at any time. During his/her life-cycle a person may experience any or all of these situations (CBM).
Consensus about the definition of 'disability' is critical for proper communication, research and educational purposes. Prior to 1980 the prevalent view regarding disability was that it was viewed as a disease/impairment focused model resulting in diagnostic and biomedical treatment. However, due to criticism of this model, changes have consistently occurred and in 1980 the World Health Organization (WHO) published the International Classification of Impairments, Disabilities and Handicaps (ICIDH). It stated:
- 'impairment' refers to a loss or abnormality of an anatomical structure or a psychological or physiological function (organ or organ system level)
- 'disability' refers to activity performance or behaviour (person level)
- 'handicap' refers to a disadvantage for a given individual that limits or prevents participation in society (society level)
This resulted in the development of 5 distinct definitions of disability including: the biomedical definition (medical model); the philanthropic definition (charity model); the sociological definition, the economic definition; and the socio-political definition. It is important to consider the implications of these definitions on how people with disabilities are viewed and treated as well as societal expectations (McColl and Bickenbach 1998).
Attitudes and Concepts on Disability
Compiled by Human Rights, Yes! in the paper Action and Advocacy on the Rights of Persons with Disabilities, the following highlights some of the negative and positive perspectives of disability.
Negative Models
- The Medical Model of Disability
One of the most damaging and widespread myths affecting human rights and disability is the notion that disability is a medical problem that needs to be solved or ‘cured’. It implies that a person is ‘broken’ and needs to be ‘fixed’. By defining “disability as the problem and medical intervention as the solution, individuals, societies, and governments avoid the responsibility of addressing the human rights obstacles that exist in the social and physical environment. Instead, they place the burden on the health profession to address the ‘problem’ in the person with the disability (Human Rights, Yes!, p.18).”
- The Charity Model of Disability
Another significant misperception is the idea that people with disabilities are helpless and need to be cared for, precluding that fixing something or offering pity and charity is easier than providing them with the tools or resources for them to do it by themselves. Thus people do not have to address the fear and/or discomfort they themselves feel when it comes to people with disabilities.
Though not limited to these two views or definitions of disability, they are the most prolific views held across society regarding disability. The result of such views strips people with disabilities of the power and responsibility for taking charge of their own lives and asserting their rights on an equal basis with others.
Positive Models
- Disability as a Natural Part of Human Diversity
Everyone is different in regards to their heritage, gender, ethnicity, size or age. A disability is no different. Though it may limit one’s ability to be mobile or limit their sensory functions, or affect the way a person thinks, feels or processes information, disability neither subtracts or adds from a person’s humanity, value or rights.
- Reasonable Accommodation
A person with disabilities may require a reasonable accommodation to accomplish a task. This is simply a “resource or a measure designed to promote full participation and access and to empower a person to act on his or her own behalf (Human Rights, Yes!, p.18).” This approach is not the same as trying to fix the person or assuming that the person is incapable of acting for him or herself as proposed in the Medical and Charity Models.
- The Social Model of Disability
The model focuses on “eliminating the barriers created by the social and physical environment that inhibit the ability of persons with disabilities to exercise their human rights. This includes promoting positive attitudes and perceptions, modifying the built environment, providing information in accessible formats, interacting with individuals with disabilities in appropriate ways, and making sure that laws and policies support the exercise of full participation and non-discrimination (Human Rights, Yes!, p.18-19).”
The most recent definition of persons with disabilities is from the UN Convention on the Rights of Persons with Disabilities states: ‘Persons with disabilities include those who have long-term physical, mental, intellectual, or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others’ (UN).
Contextual Factors Which Are Disabling Barriers (CBM)
- Physical Barriers: Inaccessible buildings, schools, clinics (high concrete platforms, steps, narrow entrances, slippery floors etc.), transport, roads and infrastructures.
- Institutional Barriers: Lack of consultation with persons with disabilities and their respective groups, legislation, policies and strategies that discriminate against persons with disabilities, (or absence of anti-discrimination legislation policies and strategies), disability seen as a “specialist” or welfare issue.
- Attitudes and social Barriers: Negative behaviour of family, community, authorities; prejudice, pity, overprotection; social stigma and discrimination against persons with disability and their families (e.g.: the whole family may be ostracised or isolated for having a family member with a disability).
Maya is 34 and lives in a rural area of India. In a road traffic accident she injured her back. She was taken to hospital and diagnosed as having a spinal cord injury (health condition or physical impairment). She cannot move her legs; she can sit up, but cannot walk (difficulty in functioning). Her family takes her home as they cannot afford further rehabilitation or hospital based care (her economic situation is a barrier) – there is no system in place to ensure her costs would be covered through social welfare, etc (the policy environment is a barrier). Maya is given a wheelchair but her home is on a hill, with steps leading up to it, so she cannot independently move around herself (the physical environment is a barrier). While she is physically able to sit up and can do many things, she often stays at home; the perception of her community is that she can no longer take part in many community activities (the attitudes in her environment/community are a barrier to her participation). Maya has a disability which is a combination of all these factors. An impairment or health condition can be more or less disabling depending on the context in which it occurs.
The Human Rights Approach to Disability
The social model of disability, which focuses on the responsibility of governments and society to ensure access, inclusion, and participation, sets the stage for the emergence of the Human Rights Approach to Disability, which focuses on the inherent human rights of persons with disabilities. This approach is outlined by the Human Rights, Yes! as follows:
- IDENTIFIES persons with disabilities as rights holders and subjects of human rights law on an equal basis with all people
- RECOGNIZES and respects a person’s disability as an element of national human diversity, on the same basis as race or gender, and addresses the disability-specific prejudices, attitudes, and other barriers to the enjoyment of human rights
- PLACES the responsibility on society and governments for ensuring that political, legal, social, and physical environments support the human rights and full inclusion and participation of people with disabilities
The UN Office of the High Commission for Human Rights (OHCHR) has summarized the rights-based approach as follows:
“A human rights approach asks what the long term or underlying reasons why a section of society is vulnerable, marginalized or experiences discrimination. A human rights approach then provides strategies based in international human rights law and standards which address these root causes of discrimination (OHCHR).”
In particular the OHCHR stresses the following ideas:
Empowerment – A human rights approach to disability aims to empower people with disabilities to make their own choices, advocate for themselves, and exercise control over their lives.
Enforceability and Remedies – A human rights approach to disability means that people with disabilities should be able to enforce their rights at the national and international levels.
Indivisibility – A rights-based approach to disabilities must protect both the civil and political rights as well as economic, social and cultural rights of people with disabilities.
Participation – A human rights approach to disabilities says that people with disabilities must be consulted and participate in the process of making decisions that affect their lives.
Barriers to exercising human rights can stem from attitudes, prejudice, a practical issue, a legal obstacle, or a combination of factors. But a disability itself does not affect or limit a person’s entitlement to human rights.