Disability, impairment and chronic illness Flashcards
Distinguish between disability and impairment
As per International Classification of Functioning, Disability and Health (2001)
- Impairments refer to problems in body function or structure.
- Disability signifies a restriction or lack of ability to perform an activity within the range considered normal for a human being.
One can be impaired and not disabled, but cannot be disabled without also being impaired.
an example:
- Distinguishing between impairment and disability.
- Deaf: impairment not disability
- Embracing “Deaf” culture vs. being deaf: an enabler vs a disabler
- preserving it among children
- controversy re designer babies and “making” children who are Deaf
note e.g.s of impairments that are not disability = glasses
Discuss deafness in the context of impairment and disability
prelude:
### The Decline of Deafness Awareness
- Challenges faced by the deaf community.
- Impact of cochlear implants on cultural identity and fewer deaf people overall due to fewer causative infections
- Thus fewer people who are familiar with the culture, can sign etc.
- Thus fewer supports especially the working world e.g. “prving” deafness in NDIS
- if someone lives as deaf, or chooses to be, emerges as… socially Deafness becomes a disability
Describe different models of disability and policy impacts
Medical Model of Disability
- Viewing disability as a medical problem.
- Principle of rescue.
- Devaluing the lived experience of the disabled.
Social Model of Disability
- Recognizing disability as a social phenomenon.
- Principle of equivalence: all people have the right to basic access, that disability may prevent
- aims to make accommodations
- Destigmatizing disability especially for psychological disabilities
- Use of language of human rights.
- Examples: Improving access and availability of work and education.
e.g. Graeme Innes case
Biopsychosocial Approaches
- Recognizing individual variations in suffering.
- Principle of respect for difference: principle of customisation
- Prepares to address, recognise and respond to fluctuations in physical and emotional capacity.
- Recognise that internal and physical world of the person requires appropriate health care provision
- In theory, this is the working principle of the NDIS
Heroes, Charity Cases, and Objects of Medical Rescue
- Paralympics and the heroic model of disability.
- Disabled people can transcend disability
- Can become objects of admiration and inspirations e.g. sportspeople
- “obliges” disabled people to be ‘better’ than everyone else
Objects of charity
- disabled require help from the able-bodied
- principle of moral obligation
- example: fund-raising charities
- focus is often on the giver as much as the recipient
Explore links between poverty and chronic illness
The Link Between Poverty and Chronic Illness
- The prevalence of chronic illness among the poor: more likely
- The burden of chronic illness on individuals, made poorer by condition
The Lived Experience of Chronic Illness
- Balancing ongoing attention to one’s physical self.
- Getting embroiled with the healthcare and compensation systems.
- Financial and personal losses due to chronic illness.
Factors Contributing to Chronic Illness in the Poor
Some of these have been raised:
- Genetic determinants, lifestyle choices, and lack of access to healthcare.
- Poor health hardware
- Downward drift
- Environments conducive to ill-health
Especially: access, lack of hardware, and environments
Discuss actions doctors can take to address disability
Acting locally
- The health system is opaque and not geared to the relapsing needs of patients with chronic illnesses
- Collaborating with patients to develop responsive and imaginative healthcare plans.
- Advocating for better interactions with various institutions (Centrelink, NDIS, education, housing, worker’s comp.).
Income Support and Accessibility
- Overview of income support through Centrelink
Discuss the NDIS
- Focuses on impairment AND disability
- NDIS is not granted for impairment alone
- Aim is to address the disability while acknowledging impairment
- First major Australian example of patient- owned and directed health care
- Increasingly NDIS policies are at odds with its underlying principles and ignore the fact that disability and impairment are intertwined
Note: owned and directed, in theory, not in practice
In HG Wells’s short story “The Country of the Blind”, a mountaineer called Nunez stumbles into a remote South American valley where everyone has been blind for generations. He remembers the proverb “In the country of the blind, the one-eyed man is king”, and believes that he can become their leader.
Using your knowledge of disability and impairment, from the perspective of Nunez which of the following is correct?
A. The villagers are disabled but not impaired
B. The villagers are impaired but not disabled
C. The villagers are impaired and disabled
D. The villagers are neither disabled nor impaired.
Impairment = any loss or abnormality of psychological, physiological or anatomical structure or function
Disability = any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being;
So correct answer = C. Nunez thinks (as evidenced by the proverb) that the villagers are disabled by their impairment.
Nunez soon finds that the villagers have adapted so well to lack of sight that they have no need of light, and have developed heightened senses of hearing and touch. He himself is unable to function in the village without light. When he falls in love with one of the locals, they request that he have his eyes surgically removed so that he can lose his “unstable obsession” with seeing. Nunez comes to see them as perfectly adapted to blindness. He has come to realise:
A. The villagers are disabled but not impaired
B. The villagers are impaired but not disabled
C. The villagers are impaired and disabled
D. The villagers are neither disabled nor impaired.
The villagers are not disabled by their impairment
In asking him to remove his eyes, the villagers believe they are doing him a service by welcoming him into the wider world of senses and their own culture. Which of the following is/are correct?
A. In asking him to remove his eyes they are appealing to a social model of disability.
B. In refusing to have his eyes removed, Nunez is using a medical model of disability
C. If the villagers were to move into a large city and demand that their children receive corneal transplants that would restore their sight, they are using a biopsychosocial model of disability.
D. If the villagers were to establish a hearing-dog program for people like Nunez so that his ability to hear in the darkness can be improved, they would be using a medical model of disability
A and B are correct. Here, the villagers argue that removing Nunez’s eyes enables him to live more fully and freely in their world, and that his vision constitutes a disability, while Nunez himself makes the case that he is not impaired and that removal of his eyes will result in medically induced impairment. C is incorrect as it is a medical correction – we should note that the villagers do not regard visual loss as a disability (nor would it work! Their visual cortex has probably become very underdeveloped). D is incorrect because it’s a social model of disability
“Paralympians Inspire Others to Be Better and Do More” Press Release US House Committee on Veteran’s Affairs July 30, 2009.
The House Committee advocated for more funding for disabled athletes, many of whom were war veterans. The title of this press release encapsulates:
a) the heroic narrative about disability
(b) the charity narrative about disability
(c) the medical rescue narrative about disability
A
. “I’m not all that interested in lower sidewalks and better wheelchairs. It’s nice to have good equipment and access while you’re disabled, but I think all of us with these problems should be allowed to regard them as a temporary setback rather than a way of life.” Christopher Reeve, in an interview with Time magazine.
In the disability activism field, Christopher Reeve was a divisive figure, whose influence was often felt to be retrograde for disabled persons.
Which of the following statements (all true) may explain this:
A. Most of his fundraising efforts were focused on finding a cure for disability.
B. He did not devote time to campaigning for the Americans with Disabilities Act
C. He stated that he would suicide if he thought that he was always going to be disabled.
D. He raised a large amount of money for neurological research for spinal injuries.
E. He raised public expectations that disabled persons were always high achievers.
You might think all of the above; and you might also think that some of the disapproval expressed by disabled people was unfair.
Correct answers: C and E.
In the disabled literature the real issues that led to a sense that Christopher Reeve was not useful in advancing their cause were that he was not interested in the human rights narrative, but instead really focused on the “embodiment and selfhood” and medical models. He spoke frankly about how physically unpleasant it was to live in a dysfunctional body, and expressed that the only right way forward was to find a “cure”. For disabled people, Christopher Reeve represented someone who did not identify as disabled, and devoted his energy to raising money often using arguments about how bad the lives of disabled people were.
So on the one hand they saw him as self-hating, and therefore not a good role model. At the same time the media used the heroic narrative when writing about him – Superman was always Superman – and this raised impossible expectations of disabled persons who did not have wealth and celebrity behind them.
Why are people with chronic illnesses more likely to be poor? List and explain reasons for this association.
The connections work both ways. Being chronically ill can make you poor, and being poor makes you more likely to develop chronic illness and have difficulty controlling it.
Chronic illness can make you poor
(a) Downward drift (across socioeconomic centiles) – people with chronic illnesses may find it harder to keep down a job because of chronic illness, and thus may lose their income earning capacity. Relationships may come under threat, again reducing the income the individual has.
(b) Health care costs – it costs money to be ill and to be constantly accessing services.
Poverty increases the likelihood that you will become chronically ill
(c) Poorer environments, with (eg poorer quality food, more exposure to environmental pollutants) can predispose one to many chronic illnesses, and difficulty controlling them.
(d) Reduced access to health services (these tend to be fewer, with less access to technological services, in poorer areas)
(e) Poorer health hardware – eg lack of access to plumbing, refrigeration (that this does occur in Australia, esp in remote indigenous communities, is egregious)- means that the range of health promoting choices is limited (eg can’t store foods),
