An Introduction to the An Introduction to the International Classification International Classification of Functioning, Disability, of Functioning, Disability,

and Healthand Health

Daniel MontDaniel MontDisability and Development TeamDisability and Development Team

The World BankThe World Bank

UN SPECA Regional Workshop on Disability StatisticsUN SPECA Regional Workshop on Disability StatisticsBishkek, KyrgyzstanBishkek, Kyrgyzstan

Dec 13-15 2006Dec 13-15 2006

Presentation OverviewPresentation Overview

Introduction to the International Introduction to the International Classification of Functioning, Classification of Functioning, Disability and Health (ICF)Disability and Health (ICF)

How can the ICF inform disability How can the ICF inform disability measurement?measurement?

How does the purpose of data How does the purpose of data collection affect measurement collection affect measurement methodology?methodology?

What is the ICF?What is the ICF?

A framework for describing the facets A framework for describing the facets of human functioning that may be of human functioning that may be affected by a health conditionaffected by a health condition

A classification system – not a A classification system – not a measurement toolmeasurement tool

Where did the ICF come from?Where did the ICF come from?

Developed by the World Health Developed by the World Health Organization (WHO)Organization (WHO)

Large international and Large international and multidisciplinary participationmultidisciplinary participation

Extensive field testingExtensive field testing

The Aims of the ICFThe Aims of the ICF To provide a To provide a scientific basisscientific basis for the for the

consequences of health conditionsconsequences of health conditions To establish a To establish a common languagecommon language to to

improve communicationsimprove communications To permit To permit comparisonscomparisons of data across: of data across:

– CountriesCountries– Health care disciplinesHealth care disciplines– ServicesServices– TimeTime

To provide a To provide a systematic coding schemesystematic coding scheme for health information systemsfor health information systems

Human FunctioningHuman Functioning

ICF does not measure ICF does not measure disabilitydisability– It describes people’s functional abilities in It describes people’s functional abilities in

various domainsvarious domains

Health conditions that affect functional Health conditions that affect functional status are not part of classification systemstatus are not part of classification system

Disability is not an “all or nothing” conceptDisability is not an “all or nothing” concept– There is a wide range of functional limitationsThere is a wide range of functional limitations

ICF DomainsICF Domains

Body Function and StructuresBody Function and Structures ActivitiesActivities ParticipationParticipation

Body Function and StructuresBody Function and Structures

Physiological and psychological Physiological and psychological function of body systemsfunction of body systems

Very specific recording of detailed Very specific recording of detailed functional abilities and impairments functional abilities and impairments

Not linked to cause.Not linked to cause. For example, For example, fluency and rhythm of speech fluency and rhythm of speech functionsfunctions – could be from stuttering, – could be from stuttering, stroke, or autismstroke, or autism

Body Functions and Structures Body Functions and Structures Broken into Eight ChaptersBroken into Eight Chapters

Skin and related structuresSkin and related structuresFunctions of the skin and related Functions of the skin and related structuresstructures

Structures related to movementStructures related to movementNeuromusculoskeletal and Neuromusculoskeletal and movement-related functionsmovement-related functions

Structures related to the genitourinary Structures related to the genitourinary and reproductive systemsand reproductive systems

Genitourinary and reproductive Genitourinary and reproductive functionsfunctions

Structures related to the digestive, Structures related to the digestive, metabolic and endocrine systemsmetabolic and endocrine systems

Functions of the digestive, metabolic Functions of the digestive, metabolic and endocrine systemsand endocrine systems

Structures of the cardiovascular, Structures of the cardiovascular, immunological and respiratory immunological and respiratory systemssystems

Functions of the cardiovascular, Functions of the cardiovascular, haematological, immunological and haematological, immunological and respiratory systemsrespiratory systems

Structures involved in voice and Structures involved in voice and speechspeech

Voice and speech functionsVoice and speech functions

The eye, ear and related structuresThe eye, ear and related structuresSensory functions and painSensory functions and pain

Structures of the nervous systemStructures of the nervous systemMental functionsMental functions

Activities and ParticipationActivities and Participation

Describes Describes individual’sindividual’s functioning functioning as a whole person, as opposed to as a whole person, as opposed to function and structure of his/her function and structure of his/her body partsbody parts

Range from Basic to ComplexRange from Basic to Complex– basic would be, for example, dressing, basic would be, for example, dressing,

eating, and bathingeating, and bathing– complex include work, schooling, civic complex include work, schooling, civic

activities activities

Activities and Participation (cont.)Activities and Participation (cont.)

UN Washington Group approachUN Washington Group approach– Activities – tasks an individual can do that Activities – tasks an individual can do that

require multiple body functionsrequire multiple body functions– Participation – higher order activities that Participation – higher order activities that

involve integration in the communityinvolve integration in the community WHO approachWHO approach

– Activities – what people can do inherently Activities – what people can do inherently without assistance or barrierswithout assistance or barriers

– Participation – functioning taking into account Participation – functioning taking into account the impact of barriers and facilitators in the the impact of barriers and facilitators in the environmentenvironment

Activities and Participation (cont.)Activities and Participation (cont.)

What is most important is that there What is most important is that there are a range of activities going from are a range of activities going from basic to complex that describe a basic to complex that describe a person’s ability to live independently person’s ability to live independently and be integrated into their and be integrated into their communitiescommunities

Classification of Activities and Classification of Activities and ParticipationParticipation

11 Learning &Applying KnowledgeLearning &Applying Knowledge22 General Tasks and DemandsGeneral Tasks and Demands33 CommunicationCommunication44 MovementMovement55 Self CareSelf Care66 Domestic Life AreasDomestic Life Areas77 Interpersonal InteractionsInterpersonal Interactions88 Major Life AreasMajor Life Areas99 Community, Social & Civic LifeCommunity, Social & Civic Life

Universal Model vs. Minority ModelUniversal Model vs. Minority Model

Universal ModelUniversal Model -- everyone has a range -- everyone has a range of functional abilitiesof functional abilities– A continuum of functioningA continuum of functioning– MultidimensionalMultidimensional– Even those without what is commonly Even those without what is commonly

perceived as “a disability” have functional perceived as “a disability” have functional needsneeds

A A Minority ModelMinority Model is categorical and uni- is categorical and uni-dimensional. People are classified based dimensional. People are classified based on certain impairment groups without on certain impairment groups without reference to their functioning at the reference to their functioning at the activity and participation levelsactivity and participation levels

Medical versus Social ModelMedical versus Social Model PERSONAL PERSONAL vs. SOCIAL vs. SOCIAL Medical care Medical care vs. social integrationvs. social integration Individual treatment Individual treatment vs. social actionvs. social action Professional help Professional help vs. individual and collective vs. individual and collective

responsibilityresponsibility Personal adjustmentPersonal adjustment vs. environmental vs. environmental

adjustmentadjustment Behavior Behavior vs. attitudevs. attitude Care Care vs. human rightsvs. human rights Individual adaptationIndividual adaptation vs. social changevs. social change

Health Condition Health Condition ((disorder/diseasedisorder/disease))

Interaction of ConceptsInteraction of Concepts

Environmental Environmental FactorsFactors

Personal Personal FactorsFactors

Body Body function&structurefunction&structure (Impairment(Impairment))

ActivitiesActivities(Limitation)(Limitation)

ParticipationParticipation(Restriction)(Restriction)

Example: PolioExample: Polio

May have caused paralysis of legs May have caused paralysis of legs (Body Function)(Body Function)

Affects ability to walk or climb stairs Affects ability to walk or climb stairs (Activity)(Activity)

Impedes ability to attend school or Impedes ability to attend school or find employment within the current find employment within the current environment (Participation)environment (Participation)

BUT….BUT….

Example, continuedExample, continued

Mobility related activities, such as getting Mobility related activities, such as getting around the house or community can be around the house or community can be improved with accessible environment and improved with accessible environment and assistive devicesassistive devices

Participation can be increased with Participation can be increased with reduced stigma, accessible environments reduced stigma, accessible environments and flexible job designand flexible job design

DisabilityDisability is NOT independent of the is NOT independent of the environment, and therefore is not staticenvironment, and therefore is not static

Later PresentationsLater Presentations

How to use the ICF to guide in question How to use the ICF to guide in question and indicator developmentand indicator development– What are different purposes for measuring What are different purposes for measuring

disability?disability?– How do these purposes align with the ICF How do these purposes align with the ICF

model?model?– Under what circumstances does it make sense Under what circumstances does it make sense

to focus on Body Function, Activities, or to focus on Body Function, Activities, or Participation?Participation?

– How do you go about deciding who is How do you go about deciding who is “disabled”?“disabled”?