1. The International Classification of Functioning, Disability and Health (ICF) Section 1 Els R. Nieuwenhuijsen, PhD, MPH, OTR

2. Section 1. Health and Disability Progress: Definition of health Health-related classifications and measurement instruments Evidence-based treatment outcomes Challenges: Prevalence of Disability is increasing – also by age Disability measurements Complexity of disability experience Overview

3. Section 2. Functioning and Disability Uniform terminology and classification Concepts Models Section 3. The ICF ICF Applications Value and Utility Potential new applications Overview

4. 1. What is the essential meaning of disability? 2.What do you thing are the benefits/draw backs of using the Classification of Functioning? Two Questions for you

5. Progress Definition of Health Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" (WHO, 1946). In more recent years, this statement has been modified to include the ability to lead a "socially and economically productive life."

6. Health-related classifications and measurements Diagnostic-related classifications: ICD – International Classification of Disease DSM – Diagnostic and Statistical Manuel Blood pressure (blood pressure monitor) Heart rate (heart rate monitor) Temperature (thermometer) Weight (scale) Number of steps a day (pedometer) Any other? Progress

7. Examples of evidence-based treatment outcomes  Increased life expectancies, e.g. first half of 20 th century a person with a SCI could survive 14 months – at the end of the 20 th century this person could survive 46 years  Decreased mortality rates and hospitalization among rare chronic genetic disorders (e.g. 40% less among hemophilia patients in 2000) (Source: AJPH 2005)

8. Challenges  In 2000: about 54 million Americans lived with a disability. In 2010: about 70 million Americans live with a disability  About 17% of children in the USA have a developmental disability  Prevalence of hearing and visual impairments at age 80 and over is about 17%  Depression – high incidence among people with disability  Injuries  Cost (est. 1996 cost $260 billion)

9. Challenges - disability prevalence by age Source: U.S. Census Bureau, Census 2000 Summary File 3 (adapted from Panko Reis et al 2004)

10. Challenges People with disability  are at higher risk developing secondary health problems  may encounter barriers in regard to health promotion, wellness and well-being  may face barriers regarding access to care, annual medical check-up  People with disability are twice as likely to be physically inactive compared to people who have no disability

11. Surgeon General Call for Action – 2005 page 18

12. Disability - challenges Disability measurements No uniform definition of disability No clearly defined conceptualization of disability Measurement scales are uncoordinated.. No systematic review of previous instruments No cumulative understanding of the concept of disability (Adapted from: Measuring health : a guide to rating scales and questionnaires Ian McDowell. Oxford: Oxford University Press, 1996)

13. Disability challenges

14. BRFSS: Behavioral Risk factor Surveillance System

15. Challenges “At any time, each of us is at risk acquiring a disability” (Surgeon General, 2005) “Disability is an issue that effects every individual, community, neighborhood, and family in the US. It is more than a medical issues: it is a costly, public health and moral issue” (Pope and Tarlov, 1991).

16. The end of the first section of this presentation What is your opinion about the essence, the real meaning of disability?

17. References Measuring health : a guide to rating scales and questionnaires. Ian McDowell. Oxford: Oxford University Press, 1996 American Journal of Public Health: November 2005 Challenges of Disability Surgeon General's Call to Action to Improve the Health and Wellness of Persons with Disabilities http://www.surgeongeneral.gov/library/disabilities Pope A.M., Tarlov A. Disability in America Towards a National Agenda for Prevention. Washington DC: National Academy Press; 1991.