Disability is part of the human condition. Everyone is likely to experience it, either permanently or temporarily, at some point in their life (WHO & World Bank, 2011, p. 3). People with disabilities are diverse and not defined by their disability (Al Ju’beh, 2015, p. 14; WHO & World Bank, 2011, p. 7). Disabilities may be visible or invisible, and onset can be at birth, or during childhood, working age years or old age.
The UN Convention on the Rights of Persons with Disabilities (UNCRPD) recognises that ‘disability is an evolving concept’ (UNCRPD, 2006, p. 1). ‘Persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others’ (UNCRPD, 2006, p. 4).
This fluid definition accommodates different understandings of disability or impairment (Schulze, 2010, p. 27, pp. 35-36), but by defining disability as an interaction, makes clear that disability is not an attribute of the person (WHO & World Bank, 2011, p. 5). ‘An impairment on its own would not lead to disability should there be a completely inclusive and comprehensively accessible environment’ (Al Ju’beh, 2015, p. 13), which includes addressing attitudinal barriers such as stereotypes, prejudices and other forms of paternalistic and patronising treatment (Schulze, 2010, p. 27). It enshrines the social model of disability (Schulze, 2010, p. 27).
Different models of disability inform how disability is understood and acted upon, and can be categorised as follows:
The charity model of disability focuses on the individual, and tends to view people with disabilities as passive victims – objects of pity who need care, and whose impairment is their main identifier (Al Ju’beh, 2015, p. 20).
The medical (or biomedical) model of disability considers ‘disability a problem of the individual that is directly caused by a disease, an injury, or some other health condition and requires medical care in the form of treatment and rehabilitation’ (Mitra, 2006, p. 237). It assumes that addressing the medical ailment will solve the ‘problem’ – that disability needs to be fixed or cured (Al Ju’beh, 2015, p. 20). This model is widely criticised on different grounds, including for not considering the important roles of environmental and social barriers (Mitra, 2006, pp. 237, 82; Rimmerman, 2013, p. 27).
Medical and charity models of disability have led to ‘development interventions based largely on impairment needs assessed by “expert” personnel, involving specialist services that are often severely limited in geographical, age, and impairment reach, as well as generally being expensive to run’ (Coe, 2012, p. 402).
The social model of disability developed as a reaction to the individualistic approaches of the charitable and medical models (Al Ju’beh, 2015, p. 20; Rimmerman, 2013, p. 28). It is human rights driven and socially constructed (Woodburn, 2013, p. 85). It sees disability as created by the social environment, which excludes people with impairments from full participation in society as a result of attitudinal, environmental and institutional barriers (Mitra, 2006, p. 237). It places emphasis on society adapting to include people with disabilities by changing attitudes, practice and policies to remove barriers to participation, but also acknowledges the role of medical professionals (DFID, 2000, p. 8; Al Ju’beh, 2015, pp. 20-21, 83).
The social model has been criticised for ignoring the personal impact of disability and for its emphasis on individual empowerment, which may be contrary to more collective social customs and practices in many developing countries (Al Ju’beh, 2015, p. 83-86; Rimmerman, 2013, p. 30).
Human rights model
This model of disability is based on the social model and also seeks to transform unjust systems and practices (Al Ju’beh, 2015, pp. 20-21, 87). It takes the UNCRPD as its main reference point and sees people with disabilities as the ‘central actors in their own lives as decision makers, citizens and rights holders’ (Al Ju’beh, 2015, pp. 20-21, 87).
The social and human rights models form the basis of many disability policies and practices (Kett & Twigg, 2007, p. 88). As development professionals may identify with the individual models of disability, it is important not to alienate them when introducing them to disability as a human rights issue, but to ‘help [them] to see that barriers are a more helpful and respectful lens with which to view disability’ (Al Ju’beh, 2015, p. 23).
Interactional models recognise that disability should be seen as neither purely medical nor purely social, as people with disabilities can experience problems arising from the interaction of their health condition with the environment (WHO & World Bank, 2011, p. 4).
The most commonly used interactional model is the model underlying the International Classification of Functioning, Disability and Health (ICF) (WHO & World Bank, 2011, p. 5). This views disability as arising from the negative interaction between health conditions and the context – including environmental factors (products and technology; the natural and built environment; support and relationships; attitudes; services, systems, and policies) and personal factors (e.g. age, sex, motivation and self-esteem) (WHO & The World Bank, 2011, p. 5).
The ICF is presented as representing a workable compromise between medical and social models as a result of its greater recognition of the impact of environmental and structural factors on disability (WHO & World Bank, 2011, p. 4; Groce et al., 2011, p. 1500; Al Ju’beh, 2015, p. 84; Woodburn, 2013, p. 86). However, it has been ‘severely criticised by prominent members of the disability movement, in the belief that it does not really analyse exclusion and discrimination of people with disabilities’ (Groce et al., 2011, p. 1500; see also Al Ju’beh, 2015, p. 84).
The capability approach to disability is another interactional model. It has been adapted from Sen’s capability approach in economics (Mitra, 2006, p. 236, 238; WHO & World Bank, 2011, pp. 10-11). The capability approach allows researchers to analyse disability at the capability level (disability occurs when an individual is deprived of practical opportunities as a result of an impairment); and, disability at the functioning level (an individual is disabled if they cannot do or be the things they value doing or being) (Mitra, 2006, p. 236, pp. 241-242). In this framework disability can be understood as a deprivation in terms of capabilities or functionings that results from the interaction of an individual’s personal characteristics (e.g., impairment, age, race, gender); the individual’s resources (assets, income); and the individual’s environment (physical, social, economic, political) (Mitra, 2006, pp. 236-237, 239, 241; Trani & Loeb, 2012, p. S20). This model has often been compared to the ICF model (Mitra, 2014, p. 268). It stresses the individual’s freedoms, as well as the possibility that economic resources, or the lack thereof, can be disabling (Mitra, 2006).
A meta-analysis of the use of social inclusion in disability studies (Rimmerman, 2013, p. 1) found it to mean:
- being accepted and recognised as an individual beyond the disability
- having personal relationships with family, friends and acquaintances
- being involved in recreation and social activities
- having appropriate living accommodation
- having employment
- having appropriate formal and informal support.
Disability inclusive development ‘seeks to ensure the full participation of people with disabilities as empowered self-advocates in development processes and emergency responses and works to address the barriers which hinder their access and participation’ (Al Ju’beh, 2015, p. 49).
- Al Ju’beh, K. (2015). Disability inclusive development toolkit. Bensheim: CBM. See document online
- Coe, S. (2012). More practical lessons from five projects on disability-inclusive development. Development in Practice, 22(3), 400-408. See document online
- DFID. (2000). Disability, poverty and development. London: DFID. See document online
- Groce, N., Kett, M., Lang, R., & Trani, J-F. (2011). Disability and Poverty: the need for a more nuanced understanding of implications for development policy and practice. Third World Quarterly, 32(8), 1493-1513. See document online
- Kett, M., & Twigg, J. (2007). Disability and disasters: Towards an inclusive approach. In World disasters report – Focus on discrimination. Geneva: IFRC. See document online
- Mitra, S. (2014). Employment challenges and successes in low- and middle-Income countries. In J. Heymann, M. Stein, & G. Moreno (Eds), Disability and equality at work. New York: Oxford University Press.
- Mitra, S. (2006). The capability approach and disability. Journal of Disability Policy Studies, 16(4), 236-247. See document online
- Rimmerman, A. (2013). Social inclusion of people with disabilities: National and international perspectives. Cambridge University Press.
- Schulze, M. (2010). Understanding the UN convention on the rights of persons with disabilities. Handicap International. See document online
- Trani, J-F., & Loeb, M. (2012). Poverty and disability: a vicious circle? Evidence from Afghanistan and Zambia. Journal of International Development, 24(S1), S19–S52. See document online
- UNCRPD. (2006). Convention on the rights of persons with disabilities and optional protocol. New York: UN. See document online
- WHO & The World Bank. (2011). World report on disability. Geneva: WHO. See document online
- Woodburn, H. (2013). Nothing about us without civil society: The role of civil society actors in the formation of the UN Convention on the Rights of Persons with Disabilities. Political Perspectives, 7(1), 75-96. See document online