EDITORIAL
What is the difference between health and disability? Spec Care Dentist 34(3): 105, 2014
What is the difference between health and disability? The World Health Organization (WHO) defines health as “a state of complete physical, mental, and social well being and not merely the absence of disease or infirmity.”1 With the need for a conceptual framework for the description of health, the WHO developed the International Classification of Functioning, Disability and Health (ICF).2 The ICF provides a guide for definition, measurement, and public policy decisions related to health and disability. Historically, disability began where health ended and as a result, once a patient was labeled as disabled, the focus became his/her level of dysfunction rather than his/her level of health. The ICF recognizes that every person will experience a diminution in health and as a result experience some level of disability. By shifting the focus from the etiology of disability to the impact disability has on the patient, the ICF places all health problems on an equal plane allowing them to be compared along the lines of health and disability.3 The two commonly used conceptual models of disability are the medical and social models. In the medical model, disability is regarded as an inherent aspect of the individual, directly caused by disease or other health condition, which requires medical intervention. In the social model, disability is regarded as a
socially created problem and not an inherent aspect of the individual. Both of these models only partly describe disability. Disability hinges on the interaction between the attributes of a person and the attributes of the overall context in which the person lives. Thus, there are internal components (medical) and external components (social) of disability. An alternative model for disability, called the biopsychosocial model of health and disability3 unites the three different perspectives of health: biological, individual, and social. Disability and functioning are established by the interactions between an individual's health condition(s) and contextual factors. The contextual factors may include both external environmental elements (e.g. social attitudes) and internal personal elements (e.g. gender, age, social background, past and present experience, etc…), which may influence how the patient experiences disability. There are three levels of functioning described by the ICF. First, there is functioning at the level of the body part. Second, there is functioning of the whole person. Third, there is functioning of the whole person in their social context. Disability involves dysfunction at one or more of these levels triggering impairments, activity limitations, and participation restrictions. The Special Care Dentistry Association represents a unification of health
© 2014 Special Care Dentistry Association and Wiley Periodicals, Inc. DOI: 10.1111/scd.12072
scd12072.indd 105
rofessionals, represented by Councils p (SCDA Council of Dentistry for Persons with Disabilities, SCDA Council of Geriatric Dentistry and SCDA Council of Hospital Dentistry), who serve those patients with some type of disability. Regardless of the age of the patient, we share the common goal of treating oral disease and advocating for those individuals who do not have access to appropriate dental care. Marc Bernard Ackerman, DMD, MBA, FADPD, FACD e-mail: marc.ackerman@childrens. harvard.edu
References 1. The World Health Organization. 1946. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June, 1946; signed on 22 July 1946 by the representatives of 61 states (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. 2. The World Health Organization. 2001. International Classification of Functioning, Disability, and Health. World Health Organization, Geneva, Switzerland. 3. The World Health Organization. 2002. Towards a common language for functioning, disability, and health: ICF. World Health Organization, Geneva, Switzerland.
S p e c C a r e D e n t i s t 3 4 ( 3 ) 2 0 1 4 105
26/03/14 6:26 PM
What is the difference between health and disability? Spec Care Dentist 34(3): 105, 2014
What is the difference between health and disability? The World Health Organization (WHO) defines health as “a state of complete physical, mental, and social well being and not merely the absence of disease or infirmity.”1 With the need for a conceptual framework for the description of health, the WHO developed the International Classification of Functioning, Disability and Health (ICF).2 The ICF provides a guide for definition, measurement, and public policy decisions related to health and disability. Historically, disability began where health ended and as a result, once a patient was labeled as disabled, the focus became his/her level of dysfunction rather than his/her level of health. The ICF recognizes that every person will experience a diminution in health and as a result experience some level of disability. By shifting the focus from the etiology of disability to the impact disability has on the patient, the ICF places all health problems on an equal plane allowing them to be compared along the lines of health and disability.3 The two commonly used conceptual models of disability are the medical and social models. In the medical model, disability is regarded as an inherent aspect of the individual, directly caused by disease or other health condition, which requires medical intervention. In the social model, disability is regarded as a
socially created problem and not an inherent aspect of the individual. Both of these models only partly describe disability. Disability hinges on the interaction between the attributes of a person and the attributes of the overall context in which the person lives. Thus, there are internal components (medical) and external components (social) of disability. An alternative model for disability, called the biopsychosocial model of health and disability3 unites the three different perspectives of health: biological, individual, and social. Disability and functioning are established by the interactions between an individual's health condition(s) and contextual factors. The contextual factors may include both external environmental elements (e.g. social attitudes) and internal personal elements (e.g. gender, age, social background, past and present experience, etc…), which may influence how the patient experiences disability. There are three levels of functioning described by the ICF. First, there is functioning at the level of the body part. Second, there is functioning of the whole person. Third, there is functioning of the whole person in their social context. Disability involves dysfunction at one or more of these levels triggering impairments, activity limitations, and participation restrictions. The Special Care Dentistry Association represents a unification of health
© 2014 Special Care Dentistry Association and Wiley Periodicals, Inc. DOI: 10.1111/scd.12072
scd12072.indd 105
rofessionals, represented by Councils p (SCDA Council of Dentistry for Persons with Disabilities, SCDA Council of Geriatric Dentistry and SCDA Council of Hospital Dentistry), who serve those patients with some type of disability. Regardless of the age of the patient, we share the common goal of treating oral disease and advocating for those individuals who do not have access to appropriate dental care. Marc Bernard Ackerman, DMD, MBA, FADPD, FACD e-mail: marc.ackerman@childrens. harvard.edu
References 1. The World Health Organization. 1946. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June, 1946; signed on 22 July 1946 by the representatives of 61 states (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. 2. The World Health Organization. 2001. International Classification of Functioning, Disability, and Health. World Health Organization, Geneva, Switzerland. 3. The World Health Organization. 2002. Towards a common language for functioning, disability, and health: ICF. World Health Organization, Geneva, Switzerland.
S p e c C a r e D e n t i s t 3 4 ( 3 ) 2 0 1 4 105
26/03/14 6:26 PM
