. "Conceptual Issues in the Measurement of Work Disability." The Dynamics of Disability: Measuring and Monitoring Disability for Social Security Programs. Washington, DC: The National Academies Press, 2002.
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The Dynamics of Disability: Measuring and Monitoring Disability for Social Security Programs
and other ADLs, IADLs, and some of the activity components of other role activities. The latter include, for example, activities that might be carried out in a work environment. Examples from the ICIDH-1 classification include activities such as organizing a daily routine (ICIDH 1980, Code D18.2), use of foot control mechanisms (ICIDH 1980, Code D67), and tolerance of work stress (ICIDH 1980, Code D76). The ICIDH-1 term disability then bridges the Nagi concepts of functional limitation and disability. In revision of the ICIDH, the term disability has been replaced by the positive term activity, which is defined as follows:
Activity is the nature and extent of functioning at the level of the person. Activities may be limited in nature, duration and quality. (WHO, 1997, p. 14)
To prevent further confusion, the rest of this paper will use the term disability solely in the Nagi sense and use the term activity limitation for the ICIDH concept.
In terms of definitions, the construct analogous to the Nagi definition of disability is embodied in the term handicap. This is defined as follows:
In the context of health experience, a handicap is a disadvantage for a given individual, resulting from an impairment or a disability, that limits or prevents the fulfillment of a role that is normal (depending on age, sex, and social and cultural factors) for that individual. (WHO, 1980, p. 29)
As is apparent from the definition, handicap, like Nagi’s disability, also embodies the notion of role. However, by referring to disadvantage it goes further than the actual performance of roles to attach a value judgment, that of disadvantage, to restrictions in role performance. The focus of handicap is the person in the society in which he or she lives and reflects cultural norms and expectations for performance.
The term handicap did not generally find favor, particularly among people who themselves had disabilities, as it carried within it a history of stigmatization (unrelated to its technical definition). In the ICIDH revision process, this questioning of the term handicap spilled over to the whole of the classification and led to the issue of why the emphasis was entirely on the negative. In other words there was a reaction against the whole classification being focused on deficiencies resulting from health conditions. In response to this there has been a switch to neutral terminology, as was illustrated above by the use of the term activity instead of the term disability. In the proposal for revision of the ICIDH, the concept of handicap, as defined above, has been replaced with the term participation, with negative aspects being referred to as restriction in participation: