The social context for disability assessment concepts is implied in most schools of thought. The social context for SSA is the work environment. Establishing whether a person is capable of performing past relevant work or any type of substantial gainful activity in the national economy is part of the disability decision process. SSA has been using the Department of Labor’s (DOL’s) Dictionary of Occupational Titles (DOT) and selected characteristics of occupations as a basis for defining the work environment. SSA plans to replace the DOT as a description of work environment with the Occupational Information Network (O*NET) database of work requirements that is being developed by the DOL. (DOT and O*NET are discussed further in Chapter 6.) The importance of these descriptions is the interaction between the concept of an individual’s impairment and the requirements of work as influencing the ability to work in the national economy.
The underlying structure of models of disablement, as discussed above, maps a pathway between a health condition or injury and the ensuing work disability. Close inspection of the definitions given above suggests that a number of steps can be identified in the pathway between the health condition and the social consequences described as work disability. At a micro level there are pathological changes in the body and impairment in the structure and functioning of organs and body systems. There may be an impact on the activity of the person, ranging from simple movements, to basic activities of daily living, to instrumental activities of daily living, and so on. These then can contribute to the individual’s capacity to perform more complex social roles, and ultimately the person’s participation in all aspects of society can be adversely affected. Work is one such social role.
As indicated earlier, work disability is a function of whether the person can perform specific work-related tasks and of external factors. From the point of view of the measurement of work disability, it may be useful to distinguish between the degree of difficulty a person may have in carrying out an activity and the other factors (such as barriers in the environment, attitudes of employers or coworkers, and other restrictions) that might prevent the performance of that activity in daily life. In this way, the levels of impact described within the conceptual models are of importance because they allow us to locate where many of the current types of assessment of work disability might fit in.