Disability

A disability (or lack of a given ability, as the "dis" qualifier denotes) in humans may be physical, cognitive/mental, sensory, emotional, developmental or some combination of these.

An impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations. Thus disability is a complex phenomenon, reflecting an interaction between features of a person’s body and features of the society in which he or she lives."

An individual may also qualify as disabled if he/she has had an impairment in the past or is seen as disabled based on a personal or group standard or norm. Such impairments may include physical, sensory, and cognitive or developmental disabilities. Mental disorders (also known as psychiatric or psychosocial disability) and various types of chronic disease may also qualify as disabilities.

Some advocates object to describing certain conditions (notably deafness and autism) as "disabilities", arguing that it is more appropriate to consider them developmental differences that have been unfairly stigmatized by society.

A disability may occur during a person's lifetime or may be present from birth.

Types of disability
Disability is caused by impairments to various subsystems of the body - these can be broadly sorted into the following categories.

Physical disability
Any impairment which limits the physical function of limbs or fine or gross motor ability is a physical disability. Other physical disabilities include impairments which limit other facets of daily living, such as severe sleep apnea.

Sensory disability
Sensory disabilities relate mainly to sight and hearing. The inability to smell or taste is relatively rarer and is not always considerered to be a disability. Other sensory impairments such as of the skin senses, the sensing of touch, heat, cold or pain also exist and are commonly associated with physical disabilities involving paralysis.

Visual impairment
Visual impairment (or vision impairment) is vision loss (of a person) to such a degree as to qualify as an additional support need through a significant limitation of visual capability resulting from either disease, trauma, or congenital or degenerative conditions that cannot be corrected by conventional means, such as refractive correction, medication, or surgery. This functional loss of vision is typically defined to manifest with
 * 1) best corrected visual acuity of less than 20/60, or significant central field defect,
 * 2) significant peripheral field defect including homonymous or heteronymous bilateral visual, field defect or generalized contraction or constriction of field, or
 * 3) reduced peak contrast sensitivity with either of the above conditions.

Hearing impairment
Hearing impairment or hard of hearing or deafness refers to conditions in which individuals are fully or partially unable to detect or perceive at least some frequencies of sound which can typically be heard by most people. Mild hearing loss may sometimes not be considered a disability.

Olfactory and gustatory impairment
Impairment of the sense of smell and taste are commonly associated with aging but can also occur in younger people due to a wide variety of causes.

There are a wide variety of olfactory disorders:
 * Anosmia – inability to smell
 * Dysosmia – things smell different than they should
 * Hyperosmia – an abnormally acute sense of smell.
 * Hyposmia – decreased ability to smell
 * Olfactory Reference Syndrome – psychological disorder which causes the patient to imagine he has strong body odor
 * Parosmia – things smell worse than they should
 * Phantosmia – "hallucinated smell," often unpleasant in nature

Complete loss of the sense of taste is known as ageusia, while dysgeusia is persistent abnormal sense of taste,

Somatosensory impairment
Insensitivity to stimuli such as touch, heat, cold, and pain are often an adjunct to a more general physical impairment involving neural pathways and is very commonly associated with paralysis (in which the motor neural circuits are also affected).

Balance disorder
A balance disorder is a disturbance that causes an individual to feel unsteady, for example when standing or walking. It may be accompanied by symptoms of being giddy, woozy, or have a sensation of movement, spinning, or floating. Balance is the result of several body systems working together. The eyes (visual system), ears (vestibular system) and the body's sense of where it is in space (proprioception) need to be intact. The brain, which compiles this information, needs to be functioning effectively.

Intellectual disability
Intellectual disability is a broad concept that ranges from mental retardation to cognitive deficits too mild or too specific (as in specific learning disability) to qualify as mental retardation. Intellectual disabilities may appear at any age. Mental retardation is a subtype of intellectual disability, and the term intellectual disability is now preferred by many advocates in most English-speaking countries as a euphemism for mental retardation.

Mental health and emotional disabilities
A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which are not a part of normal development or culture. The recognition and understanding of mental health conditions has changed over time and across cultures, and there are still variations in the definition, assessment, and classification of mental disorders, although standard guideline criteria are widely accepted.

Developmental disability
Developmental disability is any disability that results in problems with growth and development. Although the term is often used as a synonym or euphemism for intellectual disability, the term also encompasses many congenital medical conditions that have no mental or intellectual components, for example spina bifida.

"Handicap"
Some people with disabilities do not like the term "handicap" because of a belief that it originally meant someone who could not work and went begging with their cap in hand. This, however is not the true origin of the word. It originated in a lottery game known as hand-in-cap in the 17th century which involved players placing money in a cap. It moved later into horse racing where it meant bringing the strongest competitors back to the field by giving them extra weight to carry. In golf, it became the number of strokes a player could subtract from his score to give him a chance against better players, so a bigger handicap is actually an advantage in golf. Only in 1915 did it become a term to describe disabled people, when it was used to describe crippled children.

People-first language
The American Psychological Association style guide states that, when identifying a person with an impairment, the person's name or pronoun should come first, and descriptions of the impairment/disability should be used so that the impairment is identified, but is not modifying the person. Improper examples are "a borderline", "a blind person", or "an autistic boy"; more acceptable terminology includes "a woman with Down syndrome" or "a man who has schizophrenia". It also states that a person's adaptive equipment should be described functionally as something that assists a person, not as something that limits a person, e.g. "a woman who uses a wheelchair" rather than "a woman in/confined to a wheelchair."

A similar kind of "people-first" terminology is also used in the UK, but more often in the form "people with impairments" (e.g. "people with visual impairments"). However, in the UK, the term "disabled people" is generally preferred to "people with disabilities". It is argued under the social model that while someone's impairment (e.g. having a spinal cord injury) is an individual property, "disability" is something created by external societal factors such as a lack of wheelchair access to the workplace. This distinction between the individual property of impairment and the social property of disability is central to the social model. The term "disabled people" as a political construction is also widely used by international organisations of disabled people, such as Disabled Peoples' International (DPI).

Literature
Many books on disability and disability rights point out that "disabled" is an identity that one is not necessarily born with, as disabilities are more often acquired than congenital. Some disability rights activists use an acronym TAB, "Temporarily Able-Bodied", as a reminder that many people will develop disabilities at some point in their lives due to accidents, illness (physical, mental or emotional), or late-emerging effects of genetics.

Masculinity
According to author Daniel J. Wilson, the characteristics of masculinity include strength, activeness, speed, endurance, and courage. These characteristics are often challenged when faced with a disability and the boy or man must reshape what it means to be masculine. For example, rather than define "being a man" through what one can physically do, one must re-define it by how one faces the world with a disability and all the obstacles and stereotypes that come with the disability.

In Leonard Kriegel's book, Flying Solo, he describes his fight with poliomyelitis and the process of accepting his disability in a world that values able-bodiedness. He writes, "I had to learn to be my own hero, my own role model – which is another way of saying that I had to learn to live with neither heroes nor role models" (pg. 40).

Femininity
Some note that women who are disabled face what is called a "double disability", meaning they must not only deal with the stereotypes and challenges posed by femininity, but they must also deal with those posed by being disabled. Culture also tends to view women as fragile and weaker than men, stereotypes which are only heightened when a woman has a disability.

According to the "Survey of Income and Program Participation", as described in the book Gendering Disability, 74 percent of women participants and 90 percent of men participants without disabilities were employed. In comparison, of those with a form of disability, 41 percent of women and 51 percent of men were employed. Furthermore, the nondisabled women participants were paid approximately $4.00 less per hour than the nondisabled men participants. With a disability, women were paid approximately $1.00 less than the nondisabled women participants and the men were paid approximately $2.00 less than the nondisabled men participants. As these results suggest, women without disabilities face societal hardships as compared to men, but disability added to the equation increases the hardships.

Theory
The International Classification of Functioning, Disability and Health (ICF), produced by the World Health Organization, distinguishes between body functions (physiological or psychological, e.g. vision) and body structures (anatomical parts, e.g. the eye and related structures). Impairment in bodily structure or function is defined as involving an anomaly, defect, loss or other significant deviation from certain generally accepted population standards, which may fluctuate over time. Activity is defined as the execution of a task or action. The ICF lists 9 broad domains of functioning which can be affected:


 * Learning and applying knowledge
 * General tasks and demands
 * Communication
 * Basic physical mobility, Domestic life, and Self-care (i.e., activities of daily living)
 * Interpersonal interactions and relationships
 * Community, social and civic life, including employment
 * Other major life areas

In concert with disability scholars, the introduction to the ICF states that a variety of conceptual models has been proposed to understand and explain disability and functioning, which it seeks to integrate. These models include the following:

The medical model
The medical model is presented as viewing disability as a problem of the person, directly caused by disease, trauma, or other health condition which therefore requires sustained medical care provided in the form of individual treatment by professionals. In the medical model, management of the disability is aimed at a "cure," or the individual’s adjustment and behavioral change that would lead to an "almost-cure" or effective cure. In the medical model, medical care is viewed as the main issue, and at the political level, the principal response is that of modifying or reforming healthcare policy.

The social model
The social model of disability sees the issue of "disability" as a socially created problem and a matter of the full integration of individuals into society (see Inclusion (disability rights)). In this model, disability is not an attribute of an individual, but rather a complex collection of conditions, many of which are created by the social environment. Hence, the management of the problem requires social action and it is the collective responsibility of society at large to make the environmental modifications necessary for the full participation of people with disabilities in all areas of social life. The issue is both cultural and ideological, requiring individual, community, and large-scale social change. From this perspective, equal access for someone with an impairment/disability is a human rights issue of major concern.

Other models

 * The spectrum model refers to the range of visibility, audibility and sensibility under which mankind functions. The model asserts that disability does not necessarily mean reduced spectrum of operations.
 * The moral model refers to the attitude that people are morally responsible for their own disability. For example disability may be seen as a result of bad actions of parents if congenital, or as a result of practising witchcraft if not. This attitude may also be viewed as a religious fundamentalist offshoot of the original animal roots of human beings when humans killed any baby that could not survive on its own in the wild. Echoes of this can be seen in the doctrine of karma in Indian religions.
 * The expert/professional model has provided a traditional response to disability issues and can be seen as an offshoot of the medical model. Within its framework, professionals follow a process of identifying the impairment and its limitations (using the medical model), and taking the necessary action to improve the position of the disabled person. This has tended to produce a system in which an authoritarian, over-active service provider prescribes and acts for a passive client.
 * The tragedy/charity model depicts disabled people as victims of circumstance who are deserving of pity. This, along with the medical model, are the models most used by non-disabled people to define and explain disability.
 * The legitimacy model views disability as a value-based determination about which explanations for the atypical are legitimate for membership in the disability category. This viewpoint allows for multiple explanations and models to be considered as purposive and viable.
 * The social adapted model states although a person’s disability poses some limitations in an able-bodied society, oftentimes the surrounding society and environment are more limiting than the disability itself.
 * The economic model defines disability by a person’s inability to participate in work. It also assesses the degree to which impairment affects an individual’s productivity and the economic consequences for the individual, employer and the state. Such consequences include loss of earnings for and payment for assistance by the individual; lower profit margins for the employer; and state welfare payments. This model is directly related to the charity/tragedy model.
 * The empowering model allows for the person with a disability and his/her family to decide the course of their treatment and what services they wish to benefit from. This, in turn, turns the professional into a service provider whose role is to offer guidance and carry out the client’s decisions. This model “empowers” the individual to pursue his/her own goals.
 * The market model of disability is minority rights and consumerist model of disability that recognizing people with disabilities and their stakeholders as representing a large group of consumers, employees and voters. This model looks to personal identity to define disability and empowers people to chart their own destiny in everyday life, with a particular focus on economic empowerment.  By this model, based on US Census data, there are 1.2 billion people in the world who consider themselves to have a disability.  An additional two billion people are considered stakeholders in disability (family/friends/employers), and when combined to the number of people without disabilities, represents 53% of the population.  This model states that, due to the size of the demographic, companies and governments will serve the desires, pushed by demand as the message becomes prevalent in the cultural mainstream.

Assistive technology
Assistive Technology is a generic term for devices and modifications (for a person or within a society) that help overcome or remove a disability. The first recorded example of the use of a prosthesis dates to at least 1800 BC. The wheelchair dates from the 17th century. The curb cut is a related structural innovation. Other examples are standing frames, text telephones, accessible keyboards, large print, Braille, & speech recognition computer software. People with disabilities often develop personal or community adaptations, such as strategies to suppress tics in public (for example in Tourette's syndrome), or sign language in deaf communities. Assistive technology or interventions are sometimes controversial or rejected, for example in the controversy over cochlear implants for children.

As the personal computer has become more ubiquitous, various organizations have formed to develop software and hardware to make computers more accessible for people with disabilities. Some software and hardware, such as Voice Finger, SmartboxAT's The Grid, Freedom Scientific's JAWS, the Free and Open Source alternative Orca etc. have been specifically designed for people with disabilities while other software and hardware, such as Nuance's Dragon NaturallySpeaking, were not developed specifically for people with disabilities, but can be used to increase accessibility. The LOMAK keyboard was designed in New Zealand specifically for persons with disabilities. The Internet is also used by disability activists and charities to network and further their goals. Organizations, such as AbilityNet and U Can Do IT in the US, provide assessment services that determine which assistive technologies will best assist an individual client. These organizations also train disabled people in how to use computer-based assistive technology.

Adapted sports
The Paralympic Games (meaning "alongside the Olympics") are held after the (Summer and Winter) Olympics. The Paralympic Games include athletes with a wide range of physical disabilities. In member countries organizations exist to organize competition in the Paralympic sports on levels ranging from recreational to elite (for example, BlazeSports America in the United States).

The Paralympics developed from a rehabilitation programme for British war veterans with spinal injuries. In 1948, Sir Ludwig Guttman, a neurologist working with World War II veterans with spinal injuries at Stoke Mandeville Hospital in Aylesbury in the UK, began using sport as part of the rehabilitation programmes of his patients.

In 2006, the Extremity Games was formed for people with physical disabilities, specifically limb loss or limb difference, to be able to compete in extreme sports. A manufacturer of prosthetics, College Park Industries, organized the event to give disabled athletes a venue to compete in this increasingly popular sports genre also referred to as action sports. This annual event, held in the summer in Orlando, Florida, includes competitions in skateboarding, wakeboarding, rock climbing, mountain biking, surfing, motocross and kayaking. Non-profit organizations have created programs to advance adaptive sports for regular recreation and sport opportunities.

United Nations
On December 13, 2006, the United Nations formally agreed on the Convention on the Rights of Persons with Disabilities, the first human rights treaty of the 21st century, to protect and enhance the rights and opportunities of the world's estimated 650 million disabled people. As of Autumn 2010, 95 of the 147 signatories had ratified the Convention. Countries that sign the convention are required to adopt national laws, and remove old ones, so that persons with disabilities will, for example, have equal rights to education, employment, and cultural life; to the right to own and inherit property; to not be discriminated against in marriage, etc.; to not be unwilling subjects in medical experiments.

In 1976, the United Nations launched its International Year for Disabled Persons (1981), later re-named the International Year of Disabled Persons. The UN Decade of Disabled Persons (1983–1993) featured a World Programme of Action Concerning Disabled Persons. In 1979, Frank Bowe was the only person with a disability representing any country in the planning of IYDP-1981. Today, many countries have named representatives who are themselves individuals with disabilities. The decade was closed in an address before the General Assembly by Robert Davila. Both Bowe and Davila are deaf. In 1984, UNESCO accepted sign language for use in education of deaf children and youth.

Costa Rica
Under the Ley de Igualdad de Oportunidades (Law of Equal Opportunities), no person can be discriminated by their disabilities if they are equally capable as another person. This law also promotes that public places and transport should have facilities that enable people with disabilities to access them.

May 28 is the Día Nacional de la Persona con Discapacidad (National Disabled People Day) to promote respect for this population.

Currently the political party Partido de Acceso Sin Exclusión (Access Without Exclusion Party) fights for the rights of disabled persons, and one congressman, Oscar López, is blind.

United Kingdom
Under the Disability Discrimination Act (DDA) (1995, extended in 2005), it is unlawful for organisations to discriminate (treat a disabled person less favourably, for reasons related to the person's disability, without justification) in employment; access to goods, facilities, services; managing, buying or renting land or property; education. Businesses must make "reasonable adjustments" to their policies or practices, or physical aspects of their premises, to avoid indirect discrimination.

A number of financial and care support services are available, including Incapacity Benefit and Disability Living Allowance.

Employment
The Employers' Forum on Disability (EFD) is a membership organisation of UK businesses. Following the introduction of the DDA the membership of EFD recognised the need for a tool with which they could measure their performance on disability year on year.

In 2005 80 organisations took part in the Disability Standard benchmark providing the first statistics highlighting the UK's performance as a nation of employers.

Following the success of the first benchmark Disability Standard 2007 saw the introduction of the Chief Executives' Diamond Awards for outstanding performance and 116 organisations taking the opportunity to compare trends across a large group of UK employers and monitor the progress they had made on disability.

2009 will see the third benchmark, Disability Standard 2009. EFD have promised that for the first time they will publish a list of the top ten performers who will be honoured at an award ceremony in December 2009.

Discrimination in employment
The US Rehabilitation Act of 1973 requires all organizations that receive government funding to provide accessibility programs and services. A more recent law, the Americans with Disabilities Act of 1990 (ADA), which came into effect in 1992, prohibits private employers, state and local governments, employment agencies and labor unions from discriminating against qualified individuals with disabilities in job application procedures, hiring, firing, advancement, compensation, job training, or in the terms, conditions and privileges of employment. This includes organizations like retail businesses, movie theaters, and restaurants. They must make "reasonable accommodation" to people with different needs. Protection is extended to anyone with (A) a physical or mental impairment that substantially limits one or more of the major life activities of an individual, (B) a record of such an impairment, or (C) being regarded as having such an impairment. The second and third criteria are seen as ensuring protection from unjust discrimination based on a perception of risk, just because someone has a record of impairment or appears to have a disability or illness (e.g. features which may be erroneously taken as signs of an illness).

African Americans and disability
According to the 2000 U.S. Census, the African American community has the highest rate of disability at 20.8 percent, slightly higher than the overall disability rate of 19.4%. Although people have come to better understand and accept different types of disability, there still remains a stigma attached to the disabled community. African Americans with a disability are subject to not only this stigma but also to the additional forces of race discrimination. African American women who have a disability face tremendous discrimination due to their condition, race, and gender. Doctor Eddie Glenn of Howard University describes this situation as the "triple jeopardy" syndrome.

Social Security Administration
The US 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.

Education
Under the Individuals with Disabilities Education Act, special educational support is limited to children and youth falling into one of a dozen disability categories (e.g., specific learning disability) and adds that, to be eligible, students may require both special education (modified instruction) and related services (supports such as speech and language pathology).

Insurance
It is illegal for California insurers to refuse to provide car insurance to properly licensed drivers solely because they have a disability. It is also illegal for them to refuse to provide car insurance "on the basis that the owner of the motor vehicle to be insured is blind," but they are allowed to exclude coverage for injuries and damages incurred while a blind unlicensed owner is actually operating the vehicle (the law is apparently structured to allow blind people to buy and insure cars which their friends, family, and caretakers can drive for them).

Difficulties in measuring
The demography of disability is difficult. Counting persons with disabilities is challenging. That is because disability is not just 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.

Estimates worldwide
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. For example, in 2004, the World Health Organization estimated a world population of 6.5 billion people, of those nearly 100 million people were estimated to be moderately or severely disabled. In the United States, 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. According to the U.S. Bureau of the Census, as of 2004, there were some 32 million disabled adults (aged 18 or over) in the United States, plus another 5 million children and youth (under age 18). If one were to add impairments—or limitations that fall short of being disabilities—Census estimates put the figure at 51 million.

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

Nearly eight million men in Europe returned from the World War I permanently disabled by injury or disease.

About 150,000 Vietnam veterans came home wounded, and at least 21,000 were permanently disabled. The number of disabled U.S. veterans has jumped by 25% since 2001 — to 2.9 million.

After years of war in Afghanistan, there are more than one million disabled people. This is one of the highest percentages anywhere in the world. An estimated 80,000 Afghans have lost limbs, mainly as a result of landmines.

Political issues
Political rights, social inclusion and citizenship have come to the fore in developed and some developing countries. The debate has moved beyond a concern about the perceived cost of maintaining dependent people with disabilities to an effort of finding effective ways to ensure that people with disabilities can participate in and contribute to society in all spheres of life.

Many are concerned, however, that the greatest need is in developing nations—where the vast bulk of the estimated 650 million people with disabilities reside. A great deal of work is needed to address concerns ranging from accessibility and education to self-empowerment and self-supporting  employment and beyond.

In the past few years, disability rights activists have also focused on obtaining full citizenship for the disabled.

However obstacles reside in some countries in getting full employment, also public perception of disabled people may vary in areas.

Disability rights movement
The disability rights movement, led by individuals with disabilities, began in the 1970s. This self-advocacy is often seen as largely responsible for the shift toward independent living and accessibility. The term "Independent Living" was taken from 1959 California legislation which enabled people who had acquired a disability due to polio to leave hospital wards and move back into the community with the help of cash benefits for the purchase of personal assistance with the activities of daily living.

With its origins in the U.S. civil rights and consumer movements of the late 1960s, the movement and its philosophy have since spread to other continents influencing self-perception, organization and social policy.

Disability insurance
Disability benefit, or disability pension, is a major kind of disability insurance, and is provided by government agencies to people who are temporarily or permanently unable to work due to a disability. In the U.S., disability benefit is provided within the category of Supplemental Security Income, and in Canada, within the Canada Pension Plan. In other countries, disability benefit may be provided under Social security systems.

Costs of disability pensions are steadily growing in Western countries, mainly European and the United States. It was reported that in the UK, expenditure on disability pensions accounted for 0.9% of Gross Domestic Product (GDP) in 1980, but two decades later had reached 2.6% of GDP. Several studies have reported a link between increased absence from work due to sickness and elevated risk of future disability pension.

A study by researchers in Denmark suggests that information on self-reported days of absence due to sickness can be used to effectively identify future potential groups for disability pension. These studies may provide useful information for policy makers, case managing authorities, employers, and physicians.

Private, for-profit disability insurance plays a role in providing incomes to disabled people, but the nationalized programs are the safety net that catch most claimants.