Is Terminology of the World Health Organization Important?
Sherrill, Claudine, Palaestra
Are you still using such terms as normal, handicapped, and handicapping? Do you still assess capability and performance without regard for context and environment? Do you consider disability as all individual thing? If so, then the latest World Health Organization (WHO, 2000) documents have made little impact on your thinking. Is this because of ignorance or intention? Do you believe that nations should share a common vocabulary in relation to health conditions or that each nation should create its own terminology? Why?
The World Health Organization (WHO) periodically issues documents based on international input from many disciplines that update nomenclature for persons with disabilities and explain cultural and sociological changes that justify new thinking. The most recent of these documents are the International Classification of Impairments. Disabilities, and Handicaps (ICIDH, 1980, 1995) and the International Classification of Functioning, Disability. and Health (ICF, 2000). The purpose of this Issues article is to acquaint readers with ICIDH and ICF and to stimulate critical thinking about them in relation to physical education and recreation.
ICIDH (1980. 1995) is cited in some textbooks. Most often, however, international works are not mentioned, and no distinction is made among the terms impairment, disability, and handicap. For example, ICIDH is the source of the following (now outdated) definitions: impairment, any disturbance of, or interference with, the normal structure and function of the body; disability, the loss or reduction of functional ability and/or activity; and handicap, a condition produced by societal and environmental barriers. ICIDH (1980, 1995) presented a conceptual framework of disablement as a linear process in which impairment (organ level) could lead to disability (person level), which could lead to handicap (social level). Although called a disablement model, it was essentially a medical model that emphasized defects (Schumacher, 1999). Two decades, however, have changed beliefs tremendously (Sherrill, 2004; Ustun, 2003). In particular, reference to normal in the definition of impairment has been much criticized.
The ICF (2000) was designed as an interactive "components of health" biopsychosocial classification rather than the linear "'consequences of diseases" or "risk factors" classification taken by the ICIDH. As such, the ICE model can be applied to persons with and without disabilities. Figure 1 depicts the main components of the ICF, emphasizing that disability should be considered from an ecological perspective with primary attention given to the totality of personal and environmental interactions that contribute to activity limitations and participation restrictions.
[FIGURE 1 OMITTED]
The main components are body structure and function (referring to absence or presence of impairment), activities (referring to no limitations or limitations), participation (referring to no restrictions or restrictions), environmental factors (referring to societal affordances, which may be physical, social, attitudinal, or aspirational) and personal factors (referring to such variables as age, gender, ethnicity, fitness, habits, and past and current experiences). …