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From page 183... ... related to "work disability," as was illustrated in Me earlier Institute of Medicine workshop, "Measuring Functional Capacity and Work Requirements." A shared language and conceptual understand1This paper was originally prepared for the committee workshop titled "Workshop on Survey Measurement of Work Disability: Challenges for Survey Design and Method" held on May 27-28, 1999, in Washington, D.C. Read the entire page →
From page 184... ... The Social Security Act defines disability as the "inability to engage in any substantial gainful activity by reason of a medically determinable physical or mental impairment which can be expected to result in death or can be expected to last for a continuous period of not less than 12 months." As this background paper will illustrate, this definition in the Social Security Act is at odds with most contemporary thought about the concept of disability and is in itself a barrier to the SSA's work disability . Read the entire page →
From page 185... ... Nagi's Concept of Disability According to He conceptual framework of disability developed by sociologist Saad Nagi (1965) , "disability is the expression of a physical or a mental limitation in a social context." ~ striking contrast to the Social Security Act's definition of work disability as an inability to work due to a physical or mental impairment, Nagi specifically views the concept of disability as representing He gap between a person's capabilities and the demands created by the social and physical environments (Nag) Read the entire page →
From page 186... ... Consistent with Nagi's concept of disability, an individual's physical and mental limitations would not invariably lead to work disability. Not all physical or mental conditions would precipitate a work disability, and similar patterns of work disability may result from different types of health conditions. Read the entire page →
From page 187... ... At this point, a "work disability" example will illustrate the distinctions being drawn between the various concepts within Nagi's Disablement Model. Two patients with Parkinson's disease may enter the Social Security work disability benefits determination process with very similar clinical profiles. Read the entire page →
From page 188... ... Within their framework, "work disability" is clearly delineated as a specific subdimension under the concept of disability. In their 1994 work, Verbrugge and Jette attempted to extend Nagi's Disablement Model to attain full sociomedical scope. Read the entire page →
From page 189... ... FIGURE 1 The disablement process (Verbrugge and Jette, 1994~. Reprinted with permission from Elsevier Science. Read the entire page →
From page 190... ... ICIDH (WHO, 1980~. This model also differentiates a series of related concepts: health conditions, impairments, disabilities, and handicaps (WHO, 1980; Badley, 1993~. Read the entire page →
From page 192... ... agencies in the international ICIDH revision process. The first component of the ICIDH-1 model is impairment, which is defined as follows: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure orfunction. Read the entire page →
From page 193... ... 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 He use of the term activity instead of the term disability. Read the entire page →
From page 194... ... The context refers both to external environmental factors and to more personal characteristics of an individual. The latter range from relatively uncontroversial characteristics, such as age and gender, to aspects of the person relating to educational background, race, experiences, personality and character style, aptitudes, other health conditions, fitness, lifestyle, habits, coping styles, social background, profession, and past and current experience (WHO, 1997~. Read the entire page →
From page 195... ... CONCEPT OF SOCIAL ROLES To understand fully how Nagi's definition of disability and the ICIDH definition of handicap can be applied to the area of work disability, one must understand the concept of social role and tasks from a sociological perspective. Social roles, such as being a parent, a construction worker, or a university professor, are basically organized according to how individuals participate in a social system. Read the entire page →
From page 196... ... Work disability typically begins with Me onset of one or more health conditions that may limit the individual's performance of specific tasks through which an individual would typically perform his or her job. The onset of a specific health condition say, a stroke or a back injury�may or may not lead to actual limitation in performing Me work role, a work disability. Read the entire page →
From page 198... ... In other words, although the presence of a health condition is a prerequisite, "work disability" may be caused by factors external to the health condition's impact on the structure and functioning of a person's body or the person's accomplishment of a range of activities. DIRECTIONALITY AND THE DYNAMIC NATURE OF DISABILITY The earliest disablement models represented by the ICIDH-1 formulation (WHO, 1980) Read the entire page →
From page 199... ... 350) If we apply Birren and Dieckermann's perspective to work roles and work disability, objective dimensions of quality of life might include whether a person has had to change jobs because of a health problem, whereas the subjective dimension might include the individual's satisfaction with his or her job. Read the entire page →
From page 200... ... There appears to be considerable overlap between elements of the two formulations, and a conceptualization that acknowledges this overlap may be a more useful formulation (Figure 4~. CONCEPTUAL ISSUES RELATED TO THE MEASUREMENT OF WORK DISABILITY The underlying structure of models of disablement, as currently conceived, maps a pathway between the health condition and the ensuing Read the entire page →
From page 201... ... \ / l / "work disability" or other restrictions to social participation. 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. Read the entire page →
From page 202... ... In reality, the situation is likely to be more complex. For example, many people win functional and activity limitations may continue to work, but their labor force participation may be compromised in some way by the condition. Read the entire page →
From page 203... ... Such concerns are a reflection of the many steps in the disablement model between the health condition and work disability. Impairment Assessments of work disability, or at least of entitlement to compensation for work injury, are often made at the level of impairment. Read the entire page →
From page 204... ... Activity Limitation (at Work) A direct way of answering at least part of the question about work disability is to carry out a workplace assessment. Read the entire page →
From page 205... ... In population surveys the two main types of approaches to measurement of work disability are either (1) direct questioning about any limitations in work attributable to a health condition or (2) Read the entire page →
From page 206... ... If one or more of the final four conditions was met, the person was considered to have a severe work disability: 1. Does anyone in the household have a health problem or disability which prevents them from working or which limits the kind or amount of work they can do? Read the entire page →
From page 207... ... 24~. In the 1991 Canadian Health and Activity Limitation Survey, 64 percent of respondents with disabilities reported that they were not in the labor force, and over two-thirds of these said that they were completely prevented from working (Statistics Canada, 1993~. Read the entire page →
From page 208... ... CONCLUSION The problem with all the approaches to work disability, as indicated by our discussion of conceptual frameworks, is that there is unlikely to be a one-to-one relationship between the presence of health conditions, impairments, functional limitations, or activity restrictions and disability in employment. There is a pervasive assumption that work disability relates to the person's degree of functional limitation and activity restriction. Read the entire page →
From page 209... ... 1999. Adapting measurement of functional capacity to work to SSA's disability decision process. Read the entire page →
From page 210... ... 1994. The disablement process. Read the entire page →

From page 183...

... related to "work disability," as was illustrated in Me earlier Institute of Medicine workshop, "Measuring Functional Capacity and Work Requirements." A shared language and conceptual understand1This paper was originally prepared for the committee workshop titled "Workshop on Survey Measurement of Work Disability: Challenges for Survey Design and Method" held on May 27-28, 1999, in Washington, D.C.