Disabling Rheumatic Diseases

Disability is the experience of any condition that makes it more difficult for a person to do certain activities or have equitable access within a given society. Disabilities may be cognitive, developmental, intellectual, mental, physical, sensory, or a combination of multiple factors. Disabilities can be present from birth or can be acquired during a person's lifetime. Historically, disabilities have only been recognized based on a narrow set of criteria—however, disabilities are not binary and can be present in unique characteristics depending on the individual. A disability may be readily visible, or invisible in nature.

The United Nations Convention on the Rights of Persons with Disabilities defines disability as:

Disabilities have been perceived differently throughout history, through a variety of different theoretical lenses. There are two main models that attempt to explain disability in our society: the medical model and the social model. The medical model serves as a theoretical framework that considers disability as an undesirable medical condition that requires specialized treatment. Those who ascribe to the medical model tend to focus on finding the root causes of disabilities, as well as any cures—such as assistive technology. The social model centers disability as a societally-created limitation on individuals who do not have the same ability as the majority of the population. Although the medical model and social model are the most common frames for disability, there are a multitude of other models that theorize disability.

There are many different terms that exist to explain different aspects relating to disability. While some terms solely exist to describe phenomena pertaining to disability, others have been centered around stigmatizing and ostracizing those with disabilities. Some terms have such a negative connotation that they are considered to be slurs. A current point of contention is whether it is appropriate to use person-first language (i.e. person who is disabled) or identity-first language (i.e. disabled person) when referring to disability and an individual.

Due to the marginalization of disabled people, there have been several activist causes that push for equitable treatment and access in society. Disability activists have fought to receive equal and equitable rights under the law—though there are still political issues that enable or advance the oppression of disabled people. Although disability activism serves to dismantle ableist systems, social norms relating to the perception of disabilities are often reinforced by tropes used by the media. Since negative perceptions of disability are pervasive in modern society, disabled people have turned to self-advocacy in an attempt to push back against their marginalization. The recognition of disability as an identity that is experienced differently based on the other multi-faceted identities of the individual is one often pointed out by disabled self-advocates. The ostracization of disability from mainstream society has created the opportunity for a disability culture to emerge. While disabled activists still promote the integration of disabled people into mainstream society, several disabled-only spaces have been created to foster a disability community—such as with art, social media, and sports.

History

Contemporary understandings of disability derive from concepts that arose during the scientific Enlightenment in the west; prior to the Enlightenment, physical differences were viewed through a different lens.

There is evidence of humans during prehistory that looked after people with disabilities. At the Windover Archeological Site, one of the skeletons that was found was a male about 15 years old, who had spina bifida. The condition meant that the boy, probably paralyzed below the waist, was taken care of in a hunter-gatherer community.

Disability was not viewed as a means of divine punishment and therefore disabled individuals were neither exterminated nor discriminated against for their impairments. Many were instead employed in different levels of Mesopotamian society including working in religious temples as servants of the gods.

In Ancient Egypt, staffs were frequently used in society. A common usage for them was for older persons with disabilities to help them walk.

Provisions that enabled individuals with impaired mobility to access temples and healing sanctuaries were made in ancient Greece. Specifically, by 370 B.C., at the most important healing sanctuary in the wider area, the Sanctuary of Asclepius at Epidaurus, there were at least 11 permanent stone ramps that provided access to mobility-impaired visitors to nine different structures; evidence that people with disabilities were acknowledged and cared for, at least partly, in ancient Greece. In fact, the Ancient Greeks may not have viewed persons with disability all that differently from more able-bodied individuals as terms describing them in their records appear to be very vague. As long as the disabled person in question could still contribute to society, the Greeks appeared to tolerate them.

During the Middle Ages, madness and other conditions were thought to be caused by demons. They were also thought to be part of the natural order, especially during and in the fallout of the Plague, which wrought impairments throughout the general population.Braddock, David, and Susan Parrish, "An Institutional History of Disability," in ''Handbook of Disability Studies'', ed. Gary Albrecht, Katherine Seelman, and Michael Bury (Thousand Oaks, Calif.: Sage, 2001). In the early modern period there was a shift to seeking biological causes for physical and mental differences, as well as heightened interest in demarcating categories: for example, Ambroise Pare, in the sixteenth century, wrote of "monsters", "prodigies", and "the maimed". The European Enlightenment's emphases on knowledge derived from reason and on the value of natural science to human progress helped spawn the birth of institutions and associated knowledge systems that observed and categorized human beings; among these, the ones significant to the development of today's concepts of disability were asylums, clinics, and prisons.

Contemporary concepts of disability are rooted in eighteenth- and nineteenth-century developments. Foremost among these was the development of clinical medical discourse, which made the human body visible as a thing to be manipulated, studied, and transformed. These worked in tandem with scientific discourses that sought to classify and categorize and, in so doing, became methods of normalization.

The concept of the "norm" developed in this time period, and is signaled in the work of the Belgian statistician, sociologist, mathematician, and astronomer Adolphe Quetelet, who wrote in the 1830s of ''l'homme moyen'' – the average man. Quetelet postulated that one could take the sum of all people's attributes in a given population (such as their height or weight) and find their average and that this figure should serve as a statistical norm toward which all should aspire.

This idea of the statistical norm threads through the rapid take-up of statistics gathering by Britain, the United States, and the Western European states during this time period, and it is tied to the rise of eugenics. Disability, as well as other concepts including: abnormal, non-normal, and normalcy came from this. The circulation of these concepts is evident in the popularity of the freak show, where showmen profited from exhibiting people who deviated from those norms.

With the rise of eugenics in the latter part of the nineteenth century, such deviations were viewed as dangerous to the health of entire populations. With disability viewed as part of a person's biological make-up and thus their genetic inheritance, scientists turned their attention to notions of weeding such as "deviations" out of the gene pool. Various metrics for assessing a person's genetic fitness, which was then used to deport, sterilize, or institutionalize those deemed unfit. At the end of the Second World War, with the example of Nazi eugenics, eugenics faded from public discourse, and increasingly disability cohered into a set of attributes that medicine could attend to – whether through augmentation, rehabilitation, or treatment. In both contemporary and modern history, disability was often viewed as a by-product of incest between first-degree relatives or second-degree relatives.

Disability scholars have also pointed to the Industrial Revolution, along with the economic shift from feudalism to capitalism, as prominent historical moments in the understanding of disability. Although there was a certain amount of religious superstition surrounding disability during the Middle Ages, disabled people were still able to play significant roles in the rural production based economy, allowing them to make genuine contributions to daily economic life. The Industrial Revolution and the advent of capitalism made it so that people were no longer tied to the land and were then forced to find work that would pay a wage in order to survive. The wage system, in combination with industrialized production, transformed the way bodies were viewed as people were increasingly valued for their ability to produce like machines. Capitalism and the industrial revolution effectively created a new class of "disabled" people who could not conform to the standard worker's body or level of work power. As a result, disabled people came to be regarded as a problem, to be solved or erased.

In the early 1970s, disability activists began to challenge how society treated disabled people and the medical approach to disability. Due to this work, physical barriers to access were identified. These conditions functionally disabled them, and what is now known as the social model of disability emerged. Coined by Mike Oliver in 1983, this phrase distinguishes between the medical model of disability – under which an impairment needs to be fixed – and the social model of disability – under which the society that limits a person needs to be fixed.

Theory

Like many social categories, the concept of "disability" is under heavy discussion amongst academia, the medical and legal worlds, and the disability community.

Disability Studies

The academic discipline focused on theorizing disability is Disability Studies, which has been expanding since the late twentieth century. The field investigates the past, present, and future constructions of disability, along with advancing the viewpoint that disability is a complex social identity from which we can all gain insight. As disabilities scholar Dr. Claire Mullaney puts it, "At its broadest, disability studies encourages scholars to value disability as a form of cultural difference". The field is increasingly interdisciplinary, often overlapping with the fields of Philosophy, History, English studies, Rhetoric studies, Ethnic & Racial Studies, Gender and Sexuality Studies, medical humanities, communications, pedagogy, and more. Scholars of the field focus on a range of disability-related topics, such as ethics, policy and legislation, history, art of the disability community, and more. Notable scholars from the field include Marta Russell, Robert McRuer, Johanna Hedva, Laura Hershey, Irving Zola, and many more. Prominent disability scholar Lennard J. Davis notes that Disability Studies should not be considered a niche or specialized discipline, but instead is applicable to a wide range of fields and topics.

International Classification

The International Classification of Functioning, Disability and Health (ICF), produced by the World Health Organization, distinguishes between body functions (physiological or psychological, such as vision) and body structures (anatomical parts, such as 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 nine 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 (for example, 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 have been proposed to understand and explain disability and functioning, which it seeks to integrate. These models include the following:

Medical model

The medical model views disability as a problem of the person, directly caused by disease, trauma, or other health conditions which therefore requires sustained medical care 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. The individual, in this case, must overcome their disability by medical care. 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 medical model focuses on finding causes and cures for disabilities.

Causes

There are many different causes of disability that often affect basic activities of daily living, such as eating, dressing, transferring, and maintaining personal hygiene; or advanced activities of daily living such as shopping, food preparation, driving, or working. However, it is important to note that causes of disability are usually determined by a person's capability to perform the activities of daily life. As Marta Russell and Ravi Malhotra argue, "The 'medicalization' of disablement and the tools of classification clearly played an important role in establishing divisions between the 'disabled' and the 'able-bodied. This positions disability as a problem to be solved via medical intervention, which hinders our understanding about what disability can mean.

For the purposes of the Americans with Disabilities Act of 1990, the US Equal Employment Opportunity Commission regulations provide a list of conditions that should easily be concluded to be disabilities: deafness, blindness, an intellectual disability, partially or completely missing limbs or mobility impairments requiring the use of a wheelchair, autism, cancer, cerebral palsy, diabetes, epilepsy, HIV/AIDS, multiple sclerosis, muscular dystrophy, major depressive disorder, spina bifida, bipolar disorder, post-traumatic stress disorder, obsessive compulsive disorder, and schizophrenia.

This is not an exhaustive list and many injuries and medical problems cause disability. Some causes of disability, such as injuries, may resolve over time and are considered ''temporary disabilities''. An ''acquired disability'' is the result of impairments that occur suddenly or chronically during the lifespan, as opposed to being born with the impairment. ''Invisible disabilities'' may not be obviously noticeable.

Cures

The medical model focuses heavily on finding treatments, cures, or rehabilitative practices for disabled people.

= 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, and speech recognition software. Disabled people often develop adaptations which can be personal (e.g. strategies to suppress tics in public) or community (e.g. sign language in deaf communities).

As the personal computer has become more ubiquitous, various organizations have formed to develop software and hardware to make computers more accessible for disabled people. Some software and hardware, such as Voice Finger, Freedom Scientific's ''JAWS'', the Free and Open Source alternative ''Orca'' etc. have been specifically designed for disabled people while other software and hardware, such as Nuance's Dragon NaturallySpeaking, were not developed specifically for disabled people, but can be used to increase accessibility. The LOMAK keyboard was designed in New Zealand specifically for persons with disabilities.
The World Wide Web consortium recognized a need for International Standards for Web Accessibility for persons with disabilities and created the Web Accessibility Initiative (WAI). As at Dec 2012 the standard is WCAG 2.0 (WCAG = Web Content Accessibility Guidelines).

Social model

The social model of disability sees "disability" as a socially created problem and a matter of the full integration of individuals into society. In this model, disability is not an attribute of an individual, but rather a complex collection of conditions, created by the social environment. The management of the problem requires social action and it is the collective responsibility of society to create a society in which limitations for disabled people are minimal. Disability is both cultural and ideological in creation. According to the social model, equal access for someone with an impairment/disability is a human rights concern. The social model of disability has come under criticism. While recognizing the importance played by the social model in stressing the responsibility of society, scholars, including Tom Shakespeare, point out the limits of the model and urge the need for a new model that will overcome the "medical vs. social" dichotomy. The limitations of this model mean that often the vital services and information persons with disabilities face are simply not available, often due to limited economic returns in supporting them.

Some say medical humanities is a fruitful field where the gap between the medical and the social model of disability might be bridged.

Social construction

The social construction of disability is the idea that disability is constructed by social expectations and institutions rather than biological differences. Highlighting the ways society and institutions construct disability is one of the main focuses of this idea. In the same way that race and gender are not biologically fixed, neither is disability.

Around the early 1970s, sociologists, notably Eliot Friedson, began to argue that labeling theory and social deviance could be applied to disability studies. This led to the creation of the social construction of disability theory. The social construction of disability is the idea that disability is constructed as the social response to a deviance from the norm. The medical industry is the creator of the ill and disabled social role. Medical professionals and institutions, who wield expertise over health, have the ability to define health and physical and mental norms. When an individual has a feature that creates an impairment, restriction, or limitation from reaching the social definition of health, the individual is labeled as disabled. Under this idea, disability is not defined by the physical features of the body but by a deviance from the social convention of health.

The social construction of disability would argue that the medical model of disability's view that a disability is an impairment, restriction, or limitation is wrong. Instead what is seen as a disability is just a difference in the individual from what is considered "normal" in society.

Other models

* The political/relational model is an alternative to and critical engagement with both the social and medical models. This analytic posed by Alison Kafer shows not only how the "problem" of disability "is located in inaccessible buildings, discriminatory attitudes, and ideological systems that attribute normalcy and deviance to particular minds and bodies" but also how mind and bodily impairments can still have disabling effects. Furthermore, the political/relational model frames the medicalization of disabled folks as political in nature given it should always be interrogated.
* The spectrum model refers to the range of audibility, sensibility, and visibility under which people function. The model asserts that disability does not necessarily mean a reduced spectrum of operations. Rather, disability is often defined according to thresholds set on a continuum of disability.
* 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 practicing witchcraft if not. Echoes of this can be seen in the doctrine of karma in Indian religions. It also includes notions that a disability gives a person "special abilities to perceive, reflect, transcend, be spiritual".
* 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 used by most people with no acknowledged disability 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, often the surrounding society and environment are more limiting than the disability itself.
* The economic model defines disability in terms of reduced ability to work, the related loss of productivity and economic effects on the individual, employer and society in general.
* The empowering model (also, customer model) allows for the person with a disability and his/her family to decide the course of his/her treatment. This 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 disabled people 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. "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."
* The consumer model of disability is based upon the "rights-based" model and claims that disabled people should have equal rights and access to products, goods, and services offered by businesses. The consumer model extends the rights-based model by proposing that businesses, not only accommodate customers with disabilities under the requirements of legislation but that businesses actively seek, market to, welcome and fully engage disabled people in all aspects of business service activities. The model suggests that all business operations, for example, websites, policies, and procedures, mission statements, emergency plans, programs, and services, should integrate access and inclusion practices. Furthermore, these access and inclusion practices should be based on established customer service access and inclusion standards that embrace and support the active engagement of people of all abilities in business offerings. In this regard, specialized products and specialized services become important, such as auxiliary means, prostheses, special foods, domestic help, and assisted living.
* Different theories revolve around prejudice, stereotyping, discrimination, and stigma related to disability. One of the more popular ones, as put by Weiner, Perry, and Magnusson's (1988) work with attribution theory, physical stigmas are perceived as to be uncontrollable and elicit pity and desire to help, whereas, mental-behavioral stigmas are considered to be controllable and therefore elicit anger and desire to neglect the individuals with disabilities.
* The 'just world hypothesis' talks about how a person is viewed as deserving the disability. And because it is the fault of that person, an observer does not feel obligated to feel bad for him or to help him.

Terminology

People-first language

People-first language is one way to talk about disability which some people prefer. Using people-first language is said to put the person before the disability. Those individuals who prefer people-first language would prefer to be called, "a person with a disability". This style is reflected in major legislation on disability rights, including the Americans with Disabilities Act and the UN Convention on the Rights of Persons with Disabilities.

"Cerebral Palsy: A Guide for Care" at the University of Delaware describes people-first language:

People-first terminology is used in the UK in the form "people with impairments" (such as "people with visual impairments"). However, in the UK, identity-first language is generally preferred over people-first language.

The use of people-first terminology has given rise to the use of the acronym PWD to refer to person(s) (or people) with disabilities (or disability). However other individuals and groups prefer identity-first language to emphasize how a disability can impact people's identities. Which style of language used varies between different countries, groups and individuals.

Identity-first language

Identity-first language describes the person as "disabled". Some people prefer this and argue that this fits the social model of disability better than people-first language, as it emphasizes that the person is disabled not by their body, but by a world that does not accommodate them.

This is especially true in the UK, where it is argued under the social model that while someone's impairment (for example, having a spinal cord injury) is an individual property, "disability" is something created by external societal factors such as a lack of accessibility. 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 organizations of disabled people, such as Disabled Peoples' International.

Using the identity-first language also parallels how people talk about other aspects of identity and diversity. For example:

Similarly, Deaf communities in the U.S. reject people-first language in favor of identity-first language.

In 2021, the US Association on Higher Education and Disability (AHEAD) announced their decision to use identity-first language in their materials, explaining:
"Identity-first language challenges negative connotations by claiming disability directly. Identity-first language references the variety that exists in how our bodies and brains work with a myriad of conditions that exist, and the role of inaccessible or oppressive systems, structures, or environments in making someone disabled."

Handicap

:The term ''handicap'' derives from the medieval game Hand-in-cap, in which two players trade possessions, and a third, neutral person judges the difference of value between the possessions. The concept of a neutral person evening up the odds was extended to handicap racing in the mid-18th century, where horses carry different weights based on the umpire's estimation of what would make them run equally. In the early 20th century the word gained the additional meaning of describing a disability, in the sense that a person with a handicap was carrying a heavier burden than normal. This concept, then, adds to the conception of disability as a burden, or individual problem, rather than a societal problem.

Accessibility

: Accessibility is the degree to which a product, service or environment is available for use to the people that need it. People with certain types of disabilities struggle to get equal access to some things in society. For example, a blind person cannot read printed paper ballots, and therefore does not have access to voting that requires paper ballots. Another example can be that a person in a wheelchair cannot ascend stairs and therefore does not have access to buildings without ramps. Accessible access to health clubs and fitness centers has been observed to be especially problematic.

Accommodation

: A change that improves access. For example, if voting ballots are available in braille or on a text-to-speech machine, or if another person reads the ballot to the blind person and recorded the choices, then the blind person would have access to voting.

Invisible disability

Invisible disabilities, also known as Hidden Disabilities or Non-visible Disabilities (NVD), are disabilities that are not immediately apparent, or seeable . They are often chronic illnesses and conditions that significantly impair normal activities of daily living. Invisible disabilities can hinder a person's efforts to go to school, work, socialize, and more.
Some examples of invisible disabilities include intellectual disabilities, autism spectrum disorder, attention deficit hyperactivity disorder, mental disorders, asthma, epilepsy, allergies, migraines, arthritis, progeria and chronic fatigue syndrome.

Employment discrimination is reported to play a significant part in the high rate of unemployment among those with a diagnosis of mental illness.

Episodic disability

People with health conditions such as arthritis, bipolar disorder, HIV, or multiple sclerosis have periods of wellness between episodes of illness. During the illness episodes people's ability to perform normal tasks, such as work, can be intermittent.

Disability activism

Disability activism itself has led to the revision of appropriate language, when discussing disability and disabled people. For example, the medical classification of 'retarded' has since been disregarded, due to its negative implications. Moreover, disability activism has also led to pejorative language being reclaimed by disabled people. Mairs (1986) explained how disabled people may choose to self-describe themselves as a 'cripple'. This may appear surprising that they are using stereotypically negative language associated with disability, to describe themselves; however the purpose is to reclaim the 'disabled identity' from medical professionals, and realign it with the preferred language of disabled people. The reclamation of language demonstrated above positions itself within the social model, as it highlights how as a society we construct concepts and perceptions of disability.Disability activists have drawn attention to the following issues:

Rights and policies

Rights movement

The disability rights movement aims to secure equal opportunities and equal rights for disabled people. The specific goals and demands of the movement are accessibility and safety in transportation, architecture, and the physical environment; equal opportunities in independent living, employment, education, and housing; and freedom from abuse, neglect, and violations of patients' rights. Effective civil rights legislation is sought to secure these opportunities and rights.

The early disability rights movement was dominated by the medical model of disability, where emphasis was placed on curing or treating disabled people so that they would adhere to the social norm, but starting in the 1960s, rights groups began shifting to the social model of disability, where disability is interpreted as an issue of discrimination, thereby paving the way for rights groups to achieve equality through legal means.

Advocacy for disability issues and accessibility in the republics of the former Soviet Union has become more organized and influential in policymaking.

Disability Justice Movement

Evolving from the disability rights movement is the Disability Justice movement, which aims to improve the lives of disabled people through prioritizing collective liberation, as opposed to prioritizing legislative change and traditional civil rights. This framework, dubbed the "second wave" of disability rights, seeks to examine the many systems of oppression that are intertwined with ableism, such colonialism, white supremacy, and heteropatriarchal capitalism. The term "Disability Justice" was coined in 2005 by LGBTQ disabled women of color, Mia Mingus, Patricia Berne, and Stacey Milbern, who sought to build an anti-ableist movement with a larger emphasis on intersectionality than mainstream disability rights, as to center marginalized voices. Their group, the Disability Justice Collective, also included notable disability activists such as Sebastian Margaret, Leroy F. Moore Jr., well known for his poetry and founding of the Krip Hop movement, and Eli Clare, well known for popularizing the bodymind concept within disability studies.

Convention on the Rights of Persons with Disabilities

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. , 182 nations have ratified or accepted accession to 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.; and to not be unwilling subjects in medical experiments. UN officials, including the High Commissioner for Human Rights, have characterized the bill as representing a paradigm shift in attitudes toward a more rights-based view of disability in line with the social model.

International Year of Disabled Persons

In 1976, the United Nations began planning for its International Year for Disabled Persons (1981), later renamed 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 the education of deaf children and youth.

Policies in former Soviet Union republics

UN programs and OSCE work to align policy and programs in countries that were part of the former Soviet Union with the Convention on the Rights of Persons with Disabilities.

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 disabled people to finding effective ways to ensure that disabled people can participate in and contribute to society in all spheres of life.

In developing nations, where the vast bulk of the estimated 650 million disabled people reside, a great deal of work is needed to address concerns ranging from accessibility and education to self-empowerment, self-supporting employment, and beyond.

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

There are obstacles in some countries in getting full employment; public perception of disabled people may vary.

Abuse

Disability abuse happens when a person is abused physically, financially, verbally or mentally due to the person having a disability. As many disabilities are not visible (for example, asthma, learning disabilities) some abusers cannot rationalize the non-physical disability with a need for understanding, support, and so on.iarchive:transformingdisa0000unse, Transforming disability into ability: Policies to promote work and income security for disabled people. Paris: Organisation for Economic Co-operation and Development Publication Offices. 2003. ISBN 9264158243 Digital object identifier, DOI 10.1787/9789264158245-en

As the prevalence of disability and the cost of supporting disability increases with medical advancement and longevity in general, this aspect of society becomes of greater political importance. How political parties treat their disabled constituents may become a measure of a political party's understanding of disability, particularly in the social model of disability.

Insurance

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

Costs of disability pensions are steadily growing in Western countries, mainly in Europe 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; two decades later it 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 policymakers, case managing authorities, employers, and physicians.

In Switzerland, social policies in the field of disability have been significantly reshaped over the last two decades by reducing the number of allowances awarded and by increasing the recourse to vocational rehabilitation measures. Drawing on interviews conducted with individuals who have been involved in programs set up by Swiss disability insurance, a study highlights their uncertainties and concerns relating to their place in society, as well as their reactions to disability insurance's interventions.

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.

Employment

Studies have illustrated a correlation between disability and poverty. Notably, jobs offered to disabled people are scarce. Marta Russell notes that "[a] primary basis for oppression of disabled persons (those who could work with accommodations) is their exclusion from exploitation as wage laborers."

= Intellectual Disability

=
Many countries have programs which aid intellectually disabled (ID) people to acquire skills needed in the workforce. Such programs include sheltered workshops and adult day care programs. Sheltered programs consist of daytime activities such as gardening, manufacturing, and assembling. These activities facilitate routine-oriented tasks that in turn allow ID people to gain experience before entering the workforce. Similarly, adult day care programs also include day time activities. However, these activities are based in an educational environment where ID people are able to engage in educational, physical, and communication-based tasks which helps facilitate communication, memory, and general living skills. In addition, adult day care programs arranged community activities by scheduling field trips to public places (e.g. zoos, and movie theaters). Despite both programs providing essential skills for intellectually disabled people prior to entering the workforce, researchers have found that ID people prefer to be involved with community-integrated employment. Community-integrated employment opportunities are offered to ID people at minimum or higher wages, in a variety of occupations ranging from customer service, clerical, janitorial, hospitality and manufacturing positions. ID employees work alongside employees without disabilities who are able to assist them with training. All three options allow intellectually disabled people to develop and exercise social skills that are vital to everyday life. However, it is not guaranteed that ID employees receive the same treatment as employees without ID; according to Lindstrom et al., community-integrated employees are less likely to receive raises, and only 26% are able to retain full-time status.

Finding a stable workforce poses additional challenges. A study published in the ''Journal of Applied Research in Intellectual Disability'' indicated that although finding a job may be difficult, stabilizing a job is even harder. Chadsey-Rusch proposed that securing employment for ID people requires adequate production skills and effective social skills. Other underlying factors for job loss include structural factors and worker-workplace integration. As stated by Kilsby, limited structural factors can affect a multitude of factors in a job, such as a restricted number of hours an ID person is allowed to work. This in return, according to Fabian et al., leads to a lack of opportunity to develop relationships with coworkers or to better integrate within the workplace. Nevertheless, those who are unable to stabilize a job often are left discouraged. According to the same study conducted by JARID, many who had participated found that they had made smaller incomes when compared to their co-workers, had an excess of time throughout their days, because they did not have work. They also had feelings of hopelessness and failure. According to the U.S. National Organization on Disability, not only do ID people face constant discouragement, but many live below the poverty line, because they are unable to find or stabilize employment and because of employee restricting factors placed on ID workers. This renders ID people unable to provide for themselves, including basic necessities such as food, medical care, transportation, and housing.

Poverty

The poverty rate for working-age people with disabilities is nearly two and a half times higher than that for people without disabilities. Disability and poverty may form a vicious circle, in which physical barriers and stigma of disability make it more difficult to get income, which in turn diminishes access to health care and other necessities for a healthy life. In societies without state funded health and social services, living with a disability could require spending on medication and frequent health care visits, in-home personal assistance, and adaptive devices and clothing, along with the usual costs of living. The World report on disability indicates that half of all disabled people cannot afford health care, compared to a third of abled people. In countries without public services for adults with disabilities, their families may be impoverished.

Disasters

There is limited research knowledge, but many anecdotal reports, on what happens when disasters impact disabled people. Individuals with disabilities are greatly affected by disasters. Those with physical disabilities can be at risk when evacuating if assistance is not available. Individuals with cognitive impairments may struggle with understanding instructions that must be followed in the event a disaster occurs. All of these factors can increase the degree of variation of risk in disaster situations with disabled individuals.

Research studies have consistently found discrimination against individuals with disabilities during all phases of a disaster cycle. The most common limitation is that people cannot physically access buildings or transportation, as well as access disaster-related services. The exclusion of these individuals is caused in part by the lack of disability-related training provided to emergency planners and disaster relief personnel.

Disability in society

Aging

To a certain degree, physical impairments and changing mental states are almost ubiquitously experienced by people as they age. Aging populations are often stigmatized for having a high prevalence of disability. Kathleen Woodward, writing in ''Key Words for Disability Studies'', explains the phenomenon as follows:

In ''Feminist, Queer, Crip'', Alison Kafer mentions aging and the anxiety associated with it. According to Kafer, this anxiety stems from ideas of normalcy. She says:

Societal norms

In contexts where their differences are visible, persons with disabilities often face stigma. People frequently react to disabled presence with fear, pity, patronization, intrusive gazes, revulsion, or disregard. These reactions can, and often do, exclude persons with disabilities from accessing social spaces along with the benefits and resources these spaces provide. Disabled writer/researcher Jenny Morris describes how stigma functions to marginalize persons with disabilities:

Additionally, facing stigma can cause harm to the psycho-emotional well-being of the person being stigmatized. One of the ways in which the psycho-emotional health of persons with disabilities is adversely affected is through the internalization of the oppression they experience, which can lead to feeling that they are weak, crazy, worthless or any number of other negative attributes that may be associated with their conditions. Internalization of oppression damages the self-esteem of the person affected and shapes their behaviors in ways that are compliant with dominance of those with no acknowledged disability. Ableist ideas are frequently internalized when disabled people are pressured by the people and institutions around them to hide and downplay their disabled difference, or, "pass". According to writer Simi Linton, the act of passing takes a deep emotional toll by causing disabled individuals to experience loss of community, anxiety and self-doubt. The media play a significant role in creating and reinforcing stigma associated with disability. Media portrayals of disability usually cast disabled presence as necessarily marginal within society at large. These portrayals simultaneously reflect and influence the popular perception of disabled difference.

Tropes

There are distinct tactics that the media frequently employ in representing disabled presence. These common ways of framing disability are heavily criticized for being dehumanizing and failing to place importance on the perspectives of persons with disabilities. As outlined by disability theorist and rhetorician Jay T. Dolmage, ableist media tropes can reflect and continue to perpetuate society's myths about disabled people.

= Inspiration porn

=
Inspiration porn refers to portrayals of persons with disabilities in which they are presented as being inspiring simply because the person has a disability. These portrayals are criticized because they are created with the intent of making viewers with no acknowledged disability feel better about themselves in comparison to the individual portrayed. Rather than recognizing the humanity of persons with disabilities, inspiration porn turns them into objects of inspiration for an audience composed of those with no acknowledged disability.

= Supercrip

=
The supercrip trope refers to instances when the media reports on or portray a disabled person who has made a noteworthy achievement but centers on their disability rather than what they actually did. They are portrayed as awe-inspiring for being exceptional compared to others with the same or similar conditions. This trope is widely used in reporting on disabled athletes as well as in portrayals of autistic savants.

Many disabled people denounce these representations as reducing people to their condition rather than viewing them as full people. Furthermore, supercrip portrayals are criticized for creating the unrealistic expectation that disability should be accompanied by some type of special talent, genius, or insight.

Examples of this trope in the media include Dr. Shaun Murphy from The Good Doctor (TV series), The Good Doctor, Marvel's Daredevil (Marvel Comics character), Daredevil, and others.

= Disabled villain

=
Characters in fiction that bear physical or mental markers of difference from perceived societal norms are frequently positioned as villains within a text. Lindsey Row-Heyveld shares ways students should be taught to begin to further analyze this issue. Disabled people's visible differences from the abled majority are meant to evoke fear in audiences that can perpetuate the mindset of disabled people being a threat to individual or public interests and well-being.

= Disability Drop

=
The "disability drop" trope is when a supposedly disabled character is revealed to have been faking, embellishing, or otherwise not actually embodying their claimed disability. Jay Dolmage offers Kevin Spacey's character, Verbal Kint, in the film ''Usual Suspects'' as an example of this, and depictions like this can reflect able-bodied society's mistrust of disabled people. In addition, this reveal of a character's nondisabledness often serves as the narrative climax of a story, and the use of disability as a source of conflict in the plot, narrative obstacle, or a device of characterization aligns with other disability studies scholars' theory of "Narrative Prosthesis", a term coined by David T. Mitchell and Sharon Snyder.

= The Disabled Victim

=
Another frequent occurrence is when someone with a disability is assumed to be miserable or helpless.

The Hunchback of Notre Dame (1996 film), The Hunchback of Notre Dame's Quasimodo, The Elephant Man (film), The Elephant Man's John Merrick, A Christmas Carol (2009 film), A Christmas Carol's Tiny Tim, and even news broadcasts that refer to people as "victims" or "sufferers" are just a few examples of this stereotype.

All of these situations include the utilization of a character's disability—often in conjunction with an especially charming personality—to elicit sympathy from the audience rather than true compassion. This is unquestionably an instance of putting the handicap before the person.

= The Butt of the Joke

=
Making fun of people's differences is, at best, cowardly, and it happens a frightening amount. Unfortunately, it's frequently used in movies and TV shows as a technique to score cheap laughs. Even the former president of the United States, Barack Obama, cracked a joke about bowling at the Special Olympics.

Modern TV "documentaries," like "Embarrassing Bodies," make fun of or mock medical issues or disabilities for entertainment value. Comedy programs have long made fun of people with impairments, and the R-word is frequently used in these jokes.

On a brighter note, though, some comedians who have impairments themselves are now redressing the balance by utilizing their performances to make fun of themselves and respectfully and humorously bring attention to disabilities.

= Eternally Innocent

=
Characters with disabilities are frequently portrayed in movies as being angelic or childish. These films include ''Rain Man'' (1988), ''Forrest Gump'' (1994) and ''I Am Sam'' (2001), all of which are excellent examples.

The innocent and endearing person with a disability often points out the inadequacies of their "normal" adult peers, which helps them achieve salvation.

Like all the others, this stereotype perpetuates patronizing perceptions that are simply untrue and are therefore damaging.

While there are many disability tropes, disability aesthetics attempts to dispel them by accurately depicting disabled bodies in art and media.

Self advocacy

Some disabled people have attempted to resist marginalization through the use of the social model in opposition to the medical model; with the aim of shifting criticism away from their bodies and impairments and towards the social institutions that oppress them relative to their abled peers. Disability activism that demands many grievances be addressed, such as lack of accessibility, poor representation in media, general disrespect, and ignorance, lack of recognition, originates from a social model framework.

The creation of 'disability culture' stemmed from the shared experience of stigmatization in broader society. Embracing disability as a positive identity by becoming involved in disabled communities and participating in disability culture can be an effective way to combat internalized prejudice; and can challenge dominant narratives about disability.

Intersections

The experiences that disabled people have to navigate social institutions vary greatly as a function of what other social categories they may belong to. For example, a disabled man and a disabled woman experience disability differently. This speaks to the concept of intersectionality, which explains that different aspects of a person's identity (such as their gender, race, sexuality, religion, or social class) intersect and create unique experiences of oppression and privilege. The United Nations Convention on the Rights of Persons with Disabilities differentiates two kinds of disability intersection: race-disability intersection, and gender-disability intersection. However, many more intersections exist. Disability is defined differently by each person; it may be visible or invisible, and multiple intersections often arise from overlapping identity categories.

= Race

=
Incidence of disability is reported to be greater among several minority communities across the globe, according to a systematic analysis of the Global Burden of Disease Study. Disabled people who are also racial minority group, minorities generally have less access to support and are more vulnerable to violent discrimination. A study in the journal ''Child Development'' indicated that minority disabled children are more likely to receive punitive discipline in low and middle income countries. Due to the fact that children with disabilities are mistreated more often than those without disability; racialized children in this category are at an even higher risk. With respect to disability in the United States, Camille A. Nelson, writing for the Berkeley Journal of Criminal Law, notes the dual discrimination that racial minorities with disabilities experience from the criminal justice system, expressing that for "people who are negatively racialized, that is people who are perceived as being non-white, and for whom mental illness is either known or assumed, interaction with police is precarious and potentially dangerous."

= Gender

=
The marginalization of people with disabilities can leave persons with disabilities unable to actualize what society expects of gendered existence. This lack of recognition for their gender identity can leave persons with disabilities with feelings of inadequacy. Thomas J. Gerschick of Illinois State University describes why this denial of gendered identity occurs:

To the extent that women and men with disabilities are gendered, the interactions of these two identities lead to different experiences. Women with disabilities face a sort of "double social stigma, stigmatization" in which their membership to both of these marginalized categories simultaneously exacerbates the negative stereotypes associated with each as they are ascribed to them. However, according to the framework of intersectionality, belonging to two (or more) marginalised groups at the same time does not – in essence, gender and disability intersect to create a unique experience that is not simply the coincidence of being a woman and having a disability separately, but the unique experience of being a woman with a disability. It follows that the more marginalised groups one belongs to, their experience of privilege or oppression changes: in short, a black woman and a white woman will experience disability differently.

According to The UN Woman Watch, "Persistence of certain cultural, legal and institutional barriers makes women and girls with disabilities the victims of two-fold discrimination: as women and as persons with disabilities." As Rosemarie Garland-Thomson puts it, "Women with disabilities, even more intensely than women in general, have been cast in the collective cultural imagination as inferior, lacking, excessive, incapable, unfit, and useless."

= Socio-economic background

=
Similar to the intersections of race and disability or gender and disability, a person's socio-economic background will also change their experience of disability. A disabled person with a low socio-economic status will experience the world differently, with more obstacles and fewer opportunities, than a disabled person with a high socio-economic status.

A good example of the intersection between disability and socio-economic status is access to education, as we know that there are direct links between poverty and disability - often working in a vicious cycle. The costs of special education and caring for a disabled child are higher than for a child with no acknowledged disability, which poses an immense barrier in accessing appropriate education. The inaccessibility of appropriate education (at any stage), can lead to difficulties in finding employment, which often results in the vicious cycle of being 'bound' by one's experience as a poor and disabled person to remain in the same social structure and experience socio-economic exclusion. In short, this vicious cycle exacerbates the lack of economic, social, and cultural capital for disabled people with a low socio-economic background. On the other hand, a disabled person of a high socio-economic status, may have an easier time accessing appropriate (special) education or treatment - for example by having access to better aids, resources, or programmes that can help them succeed.

Disability culture

Sport

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, Disabled Sports USA and BlazeSports America in the United States).

The Paralympics developed from a rehabilitation program 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 programs of his patients.

In 2006, the Extremity Games were formed for physically disabled people, specifically limb loss or limb difference, to be able to compete in extreme sports.

Demographics

Estimates of worldwide and country-wide numbers of disabled people 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 2012, the World Health Organization estimated a world population of 6.5 billion people. Of those, nearly 650 million people, or 10%, were estimated to be moderately or severely disabled. In 2018 the International Labour Organization estimated that about a billion people, one-seventh of the world population, had disabilities, 80% of them in developing countries, and 80% of working age. Excluding disabled people from the workforce was reckoned to cost up to 7% of gross domestic product.

United States

According to the Centers for Disease Control's Morbidity and Mortality weekly report, one-fourth of people in the United States are reported to be disabled as of 2016. 10% of young adults were reported to have mental disabilities. The rates of mobility-related issues were highest among middle-aged people and elderly people, with 18.1% and 26.9%, respectively. In terms of race or ethnicity, Asians have the lowest reported rate of disability at around 10%, while Native Americans, the ethnic group with the highest reported incidence, are reported to have a disability rate at an estimated 30% of adults. African Americans had a higher reported disability rate of 25%, compared to 16% for white adults and 17% for Hispanic people.

Canada

22.3% of Canadians over 15 are reported to have a disability, or 6,246,640 people, according to the 2017 Canadian Survey on Disability Reports. In Canada, women and older people are more likely to be disabled than working-class men. In comparison to working-age persons between 25 and 65, seniors over 65 reported a disability rate of 38%, which is nearly twice as high. In Canada, women over 15 had a reported disability rate of 24.3%, compared to men's 20%. According to reports from the 2017 Canadian Survey of Disability, South Asians over the age of 15 in Canada had the greatest proportion of disability at 4%, while Latin Americans had a lower rate at 1%.

Australia

Nearly 1 in 5 Australians, or 4.4 million people, were estimated by the Australian Bureau of Statistics to have a disability. A mental or behavioral issue was reported in over 25% of Australians with disabilities. Male prevalence was 17.6 million, while female prevalence was somewhat higher at 17.8 million between the sexes. Age-wise, 11.6% of adults between 0 and 64 in Australia had a disability, compared to 49.6% of seniors 65 and over. 53.4% of Australians aged 15 to 64 who have a disability are employed.

United Kingdom

According to the House of Commons Library, 14.6 million, or 22%, of the population in the UK, were reported to be disabled in 2020–2021. In the UK, there were 9% of children, 21% of working-age people, and 42% of persons over the state pension age who were disabled or impaired. Approximately 29% of White individuals, 27% of mixed-race people, 22% of Asian people, 21% of Black people, and 19% of people from other ethnic groups were reported as having impairments or disabilities, according to the Life Opportunities Survey, which surveyed 35,875 people in 2011. When compared to men, women are a little more likely than men to have a disability, with 31% of women reportedly having one as opposed to 26% of men, according to results of another survey taken the same year.

China

According to Twenty-Year Trends in the Prevalence of Disability in China, a medical publication from the National Library of Medicine, there were an estimated 84.6 million Chinese individuals living with a disability in 2006. In a 2006 poll of 83,342 men and 78,137 women, the age groups with the highest reported rates of disability are 18–44-year-old males (22.5%) and 65–74-year-old females (22.8%), according to polls published in the journal that were representative of the country as a whole. In China, the percentage of people with disabilities varies substantially between urban and rural regions, with men and women having reported rates of 72.4% and 72.2%, respectively, in rural China, compared to reported rates of 27.6% and 27.8%, respectively, in urban China. Hearing and speech disabilities are the most commonly reported in China, with males being more affected than females at rates 39.6% and 36.2% among the disabled, respectively.

South Korea

In South Korea, there were accounted to be 2.517 million people with disabilities in total, or roughly 5.0% of the population, in 2018. When compared to Koreans without disabilities, people with disabilities spent an average of 56.5 days in medical facilities, which was 2.6 more than the national average. 34.9% of the entire workforce was employed in jobs connected to disabilities. Families with disabilities made an average income of 41.53 million won, or 71.3% of total family earnings. According to the Korean 2020 Statistics on the Disabled The majority of persons with disabilities needed help with "cleaning" and "using transportation", among other everyday tasks.

Developing nations

Disability is more common in developing than in developed nations. The connection between disability and poverty is thought to be part of a "vicious cycle" in which these constructs are mutually reinforcing.

See also

* Ableism
* Accessibility
* Assistive technology
* Disability abuse
* Disability Flag
* Disability hate crime
* Disadvantaged
* Frailty syndrome
* Physiological functional capacity

Bibliography

* Vega, Eugenio (2022) Crónica del siglo de la peste. Pandemias, discapacidad y diseño. Madrid, Experimenta Libros.
* Williamson, Bess (2019). Accessible America. A History of Disability and Design. New York University Press.

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