Defining Disability: An Ongoing Challenge for Research and Policymaking

The absence of a common definition and measurement of disability is an ongoing challenge that impedes the collection of reliable disability data and, hence, the formulation of effective integration policies. For instance, according to the Lebanese Law No. 220/2000 on the rights of persons with disabilities, a disabled individual is “a person whose ability has decreased or can no longer do the following: exercise one or more important life activity; secure his personal life needs on his own; participate in social activities on an equal basis with others; ensure a normal personal or social life as per his society’s standards; because of the loss or deficiency in physical, sensory or mental functions, totally or partially, temporarily or permanently, resulting from problems with delivery or an acquired disease or from a medical condition that has lasted for more than it should”.[1]  On the other hand, in Yemen, Law No. 61/1999 on the care and rehabilitation of the disabled classifies an individual with disability as “every person, male or female, medically proven as suffering from permanent disability total or partial disability, due to injury or illness which resulted in his inability to learn or engage in any activity partially or in full manner”.[2]

Even within the same country, the definition of disability varies depending on the purpose for which it is being used, including health care and rehabilitation, income protection, employment and social assistance. In the case of Egypt for example, the Maternal and Child Health Survey, which was conducted in 1991, defined a person with disability as any household member having any long-term condition or health problem that prevents or limits their participation in activities enjoyed by non-disabled counterparts.[3]  Another definition is adopted by Law No. 39/1975 in Egypt on the rehabilitation of persons with disabilities whereby a person with disability is any person who has become unable to rely on himself in engaging in work or doing some other stable work and whose ability decreased owing to organ failure, mental or sensory deficiencies, or as a result of a congenital disability since birth. A comparable albeit narrower perspective is adopted by most social security schemes that cover old age, survivor benefits and disability in the region. These schemes define disability as “a case in which the underlying condition and subsequent impairment prevent the affected individual from performing work that the individual would otherwise be qualified to undertake”.[4]

While there is no clear demarcation between the various definitions adopted by these countries, they remain different from the definition that has been developed by the World Health Organization (WHO) and that has so far proved to be globally accepted. Specifically, WHO describes disability as “an umbrella term, covering impairments, activity limitations, and participation restrictions. 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”.[5] This definition captures the social implications of disability and points that disability is not merely the outcome of a health condition, but rather that it also depends on how the immediate environment perceives and interacts with the impairment. As such, this definition cuts across a key dimension of social inclusion, namely, the ability to participate in public life without discrimination.

The International Classification of Functioning, Disability and Health (ICF) is the WHO framework for measuring health and disability at both individual and population levels.[6] ICF integrates the medical and social models that were proposed to explain disability; and looks at health from body, individual and societal perspectives and classifies it by means of two lists, namely, a list of body functions and structure, and a list of domains of activity and participation. Given that an individual’s functioning and disability occurs in a specific context, ICF also includes a list of environmental factors that are thought to affect disability outcome.[7]