1. Understanding disability
Introduction to disability

2. Introduction to disability
Individual models:
Medical or charity view point
Problem = the individual
Social exclusion considered as resulting from the limitations imposed by impairments
Social model:
« It is the society that disables us, not our impairments »
Disability is part of life
Exclusion is created by external and environmental barriers
Individual models of disability
Disability has long been considered an individual problem to be addressed only from a medical or charitable viewpoint. The charity model looks at persons with disabilities with pity and calls for generosity to help them, while the medical model seeks medical/ rehabilitation systems alone and special services to ‘repair the broken’ or ‘restore normal functioning’. Although these two models differ in spirit and proposed response, they both have a common root: the individual with impairment is seen as the problem to be solved and responsibility for disability lies with the person who must be ‘fixed’. This view equates disability with impairment, and “within this paradigm social exclusion is seen essentially as the result of limitations imposed by ‘disabilities’”.
Social model of disability: “it is society that disables us, not our impairments”
The social model of disability is born from the critique of the above-mentioned interpretations, which emerged in the 1970’s in the UK and the US. It proposes an interpretation that is radically different by asserting that persons with disabilities are disadvantaged not because of their individual characteristics but as a result of limitations imposed on them by environmental and external barriers. Disability is thus a result of how society is organised. According to this formulation, disability is about discrimination and social exclusion. This model implicitly recognises that impairment is part of life and calls for different responses and priorities: while acknowledging and including the necessary medical interventions, the focus is placed on the removal of disabling barriers (cf. examples of barriers in box (a) below) that prevent the full participation of persons with disabilities and make it impossible for them to take control of their own lives.

3. How do people in your country consider persons with disabilities?
Question: can you provide examples of the way disability is perceived in your country or in the country where you work ?

4. « Handicapped people are poor and helpless
« Handicapped people are poor and helpless. Somebody needs to spare a penny and help them. They are a real burden to society.» How do communities generally respond? SG
© P. Geiser pour Handicap International
Question: how would you characterize the model of disability conveyed by this statement?
Charity model
This statement reflects the « charity model of disability ».
Perception: disabled people are objects of charity with need of protection.
The « disabled » are a burden to society. They live mainly on charity and have a lower social status. They have to be « protected »
Many workers respond through acts of charity and basic medical care.
The low social position and existing prejudices are rarely challenged.
Examples :
disabled people are often beggars, their suffering makes them « pure »
disabled people are fed and clothed in charity hospitals or shelters
Hospitals, clinics or shelters run by faith-based groups
Community response:
Cash handouts to persons with disabilities who are poor. This might provide enough to buy food for a limited period of time, but it does not supply people with a sustainable income.
Isolating people with disabilities to protect them
© International rehabilitation for African disabled

5. « We see a growing number of amputees due to traffic accidents
« We see a growing number of amputees due to traffic accidents. It’s a terrible problem because we don’t have enough prosthetics to go around!» How do communities generally respond?
© P. Geiser pour Handicap International
Medical model
This statement reflects the « medical model of disability » which summarizes the disability as a physical/medical problem. There is no consideration of the physical and social environments that might facilite or prevent participation. (not holisic toward the person in their environment).
Perception: Disability as an individual pathology*:
The problem is in the individual : the disability is the direct result of the person’s impairment
Disability is only a health (thus medical) issue.
Solutions are designed by « experts » on the basis of a diagnosis.
Focus : elimination or cure of disability ; normalisation
(*Adapted from Rioux, Cité par Interactif déc Understanding disability : look, then act)
Community response:
Taking disabled children to traditional healers or healthcare professionals with expectations that they will “fix” the disability.
Distribution of wheelchairs without a holistic assessment to find out if the wheelchairs are actually appropriate. A large majority of these chairs remain unused due to size not being correct, or terrain not being appropriate.
Sanatoriums for leprosy or tuberculosis.
Note: In many societies, this perception is often linked with special treatment of war victims who are considered to be « heroes » ; whereas for most other disabled people in the community, no rehabilitation or other services are accessible.

6. How do communities generally respond?
«  Yesterday my neighbor went to register her child for primary school. She was frustrated that the school director only handed her printed material (my neighbor is blind) instead of explaining the important information to her. »
Social model
This statement reflects the « social model of disability ». There is a focus on community and society creating a disability (e.g. being deaf is not a problem, the fact the shop keeper can not understand me is).
Perception: The social model is a holistic model that
Acknowledges an impairment that a person might have
How that impairment has created a disability
How this impacts the person in their environment.
Important remark: the social model is an interactive model, it does not deny personal factors adds the perspective of the environment. We need to distinguish between acknowledging individual factors and impairments and the medical model who sees only the impairment and understands disability as an individual pathology. The social model entails both individual and environmental factors, therefore we don’t need to combine the medical + social model. We refer to the social model only that entails both.
Disability as a human rights issue
The human rights approach to disability is in line with the social model.
It is comprehensive and holistic (see CRPD)
Everyone has the same rights
Focuses on equalisation of opportunities and social participation through access to full citizenship.
Keywords: equality, non-discrimination
The whole community is involved in enabling disabled people to fully participate in society
Persons with disabilities and their representatives claim their rights and fight to have them implemented.
Examples :
International level : promotion of PWD rights
National level: disability policies focused on equalisation of opportunities and self-representation
Inclusive Actions
How do communities generally respond?
© Olivier Asselin pour Handicap international

7. Suresh’s story
My name is Suresh. My back broke when I fell down a cliff whilst cutting grass to feed my cattle. I am now unable to walk due to problems with my legs. I am a teacher and the school where I work has 15 steps between the road and the classroom.
Exercise: take 5 min to exchange with your neighbour on possible solutions using different understanding/ models of disability
Examples
Medical Model approach:
Problem: Spinal Cord Injury resulting in patient not able to move legs properly.
Goal: For patient to move independently in a wheelchair in 1 month
Intervention: Wheelchair provision
Social Model approach
Problem: Due to Suresh's new physical status, he is unable to teach because he can not access the classroom.
Goal: For Suresh to return to work as a teacher within 2 months.
Intervention: Provide wheelchair and environmental modifications to the school where he works. Raise awareness in the education sector (public and private) on PWDs rights (to work…) and ability to teach.

8. Disability Creation Process (DCP)
The DCP is based on a human development model which considers that:
Human development results from an interaction between different personal and environmental factors
The purpose is social participation

9. Quizz on terminology
For each situation, identify what is: 1 - A cause 2 - An organic impairment 3 – A functional impairment 4 - An obstacle 5 - A disabling situation
Distribute the exercise
5 to 10 minutes A B C D E

10. Life Habit Risk factor Disability Creation Process (RIPPH, 1996)
Cause
Disability Creation Process
(RIPPH, 1996)
Personal Factors
Environmental Factors
Organic
systems
Systèmes organiques
Aptitudes
Integrity Impairment
Capacity Inability
Facilitator Obstacle
Interaction
Life Habit
Social participation Disabling situation

11. Defining disability
“A disabling situation corresponds to the partial or non-realisation of life habits”. 
Article 1, CRPD :
«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”. 
Defining disability
The social model of disability highlights the fact that disability is a contextual and evolving concept. In this perspective, the Disability Creation Process defines a disabling situation as follows: “A disabling situation corresponds to the partial or non-realisation of life habits”. 
The UN Convention on the Rights of Persons with Disabilities states in its 1st article: “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”. 
These definitions focus on what creates a disabling situation and do not provide strict and universal criteria to determine who people with disabilities are. The choice of a disability definition strongly impacts people with disabilities’ identification and the disability prevalence rate in a given country. Defining disability is at the core of important public policies’ stakes: indeed, criteria and levels of disability decided by a State to define disability are strongly influenced by its capacity or will to address the demands of the identified population through appropriate social policies.

12. What terminology should be used?
DCP
people in a « disabling situation »
CDPH
persons with disabilities
DPOs (different views)
disabled people
What terminology should be used?
The vocabulary that is use dis often a reflection of how disability is understood. The Disability Creation Process (DCP) uses the expression « disabling situation», to emphasize the fact that the person is not to be equated with the person. On the contrary, disability is a relative notion that results from a situation in which personal factors interact negatively with the environment.
The Convention on the Rights of Persons with Disabilities refers to « persons with disabilities », which is a more common expression that emphasizes the person first. In everyday language, “people with disabilities” is more commonly used. Some groups argue that “disabled people” is preferable as it highlights the fact that the person is ‘rendered disabled’ by the society. Expressions such as “the disabled” should definitely be proscribed.

13. Key messages
Disability should not be considered as a personal attribute and limited to impairment, but as a situation which results from the interaction between the person and his/her environment.
To reduce situations of disability, it is essential to reduce external and environmental barriers which prevent participation of people with disabilities on an equal basis with others.
Disability is a relative concept; hence there is no strict definition.
The English preferred terminology is “person with a disability” or “disabled person”.

14. Categories of impairments
Psychological disability
Visual disability
Hearing disability
Intellectual disability
Disabling diseases
Physical disability

15. Disability movement
1970s: in the US and UK, individuals with disabilities started carrying out self-advocacy against discrimination and inequality and claimed for independent living and accessibility
Creation of numerous Disabled People’s Organisations (DPOs)
1981: ‘Disabled Peoples’ International’ (DPI) founded as the first international advocacy organization of this ‘new generation of DPOs’ emerging out of the social model of disability
In their function of representatives of persons with disabilities, DPOs mostly see their role as raising awareness in society and advocating for equal rights as citizens.

16. « Nothing about us without us »
For historical reasons linked to the fact that people with disabilities have for long been considered unable to decide for themselves, DPOs pay a particular importance to the notion of participation, reflected in their international motto: « nothing about us without us ».
« Nothing about us without us »