would not be able to engage in substantial gainful activity. Over the years, many changes have occurred. As the nature of work has shifted from the manufacturing to the service sector, more severely disabled persons are able to be employed because of medical and technological advances; and in recent years the public’s attitude about the employment of people with disabilities also has changed as reflected in the Americans with Disabilities Act of 1990 (ADA). In light of these changes, critics claim that SSA’s process of determining disability has not kept pace either with the understanding of disability or with advances in medical science and changes in the organization of work.

ORGANIZATION OF THE REPORT

The committee used three criteria for judging the contents of this report and its specific recommendations. First, the topic examined should be relevant to and within the scope and purview of the committee’s charge. Second, the evidence and analysis must be sufficient to support and justify its findings and recommendations. Third, a recommendation should be attainable at reasonable cost.

The research plan for the redesign of the disability decision process and the scope, statistical design and methods, and content of the NSHA represent separate, and yet related, subject areas of study with different issues. For the most part, therefore, they are discussed separately in the report. The report summarizes as appropriate the key conclusions and recommendations made by the committee in its interim reports to SSA during the course of the study and discusses the need for, and makes recommendations for, the development and maintenance of a national system to monitor the disability programs on an ongoing basis and the conduct of research needed to improve its evaluation of eligibility for disability benefits. This report is organized in a manner responsive to the contract charge.

Chapter 2 provides a brief overview of disability trends and discusses some of the factors that may have contributed to these trends.

Chapter 3 describes the meaning of the term disability and the relationship between the generic concept of disability and the term work disability.

Chapter 4 briefly reviews the design, sample size, content, and time line of the NSHA. The chapter then discusses continuing issues in survey measurement of disability and work disability, relating them to problems encountered in the research development, design, and time line of the NSHA. Finally it lays out a program of research in survey measurement issues that need to be addressed by SSA, other federal agencies, and other



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