Definition of Disability
Owing to improved health services disabled people are living longer, their presence in society is becoming more visible and their numbers are growing. Defining disability is difficult because there are dozens of definitions – each with a purpose to it. These range from the very narrow to the very broad, from the medical to the social, from the cultural to the local, from the one intended to integrate them in society to the one for exclusion and segregation. People are labelled as disabled or handicapped because they look different from the rest of the society on account of their appearance, behaviour or capacity to learn.
The WHO Manual gives the following definitions:
Disability : A disability is 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.
The ILO defines a disabled person as an individual whose prospects of securing, retaining and advancing in suitable employment are substantially reduced as a result of a duly recognised physical or mental impairment.
In the definition given by the Planning Commission of India, a disabled person means a person who is
iii. having orthopaedic disability; or
iv. having neurological disorder;
v. mentally retarded
The definition includes ‘any person who is unable to ensure himself/herself, wholly or partly, the necessities of a normal individual or social life including work, as a result of deficiency in his/her physical or mental capability’.
In 1986, The Ministry of Welfare, Government of India issued orders prescribing a standard set of definitions along with standard tests for the purposes of certification of disability. These definitions (whose suitability in the light of new legal safeguards must be carefully examined) were adopted and used. For major categories of disability the definitions are as follows :
‘Person with disability’ means a person suffering from not less than forty per cent of any disability as certified by a medical authority.
‘According to the Standard rules on the Equalisation of Opportunities for Persons with Disabilities, United Nations, 1994 the term ‘disability’ summarises a great number of different functional limitations occurring in any population in any country of the world. People may be disabled by physical, intellectual or sensory impairment, medical conditions or mental illness.
The term ‘handicap’ means the loss or limitation of opportunities to take part in the life of the community on an equal level with others. It describes the encounter between the persons with a disability and the environment. The purpose of this term is to emphasise the focus on the shortcomings in the environment and in many organised activities in society, eg., information, communication and education, which prevent persons with disabilities from participating on equal terms.
Medical and Social Models : There are two major models which explain disability and suggest approaches to deal with it in practical ways, the medical model and social model.
The medical model views disability as a personal tragedy. Disability such as the impairment of limb, organ or function has traumatic physical and psychological effects on a disabled person. Disabled people, in this model, are regarded as people with limitations who cannot ensure a reasonable quality of life because of their impairment. The medical model expects individuals to find ways of adapting to society. It puts the duty of adjusting and adapting to the society of able-bodied people and their environment on the disabled.
The social model presents disability as a consequence of oppression, prejudice and discrimination by the society against disabled people. It is the society which constructs economic, social, health, architectural, legal, cultural and other barriers in order to deliberately prevent people with impairments from enjoying full benefits of the society. The social model shifts the emphasis from a disabled individual to the society and its disabling attitudes and environment.
The Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995, identifies the following seven categories of disability which will now be used in India :
ii. Low vision
iii. Leprosy cured
iv. Locomotor handicapped
v. Hearing impairment
vi. Mental retardation
vii. Mental illness
Some people are born with disabilities, others become disabled later on in their lives. Some disabilities exhibit themselves only periodically like fits and seizures, others are constant conditions and are life-long. The severity of some stay the same. Others get progressively worse like muscular dystrophy and cystic fibrosis. Some are hidden and not obvious like epilepsy or haemophilia (impairment of blood clotting mechanism). Some disabilities can be controlled and cured, others still baffle the experts. Thus, finding a consensus on the different and frequently varying definitions of disabilities, whether sophisticated or practical, has never been easy.
Estimates of the number of disabled vary a great deal, depending on the definitions, the source, the methodology and the extent of use of scientific instruments in identifying and measuring the degree of disability. It is estimated that the population with disability in India is approximately over 90 million, of these 12 million are blind, 28.5 million are with low vision, 12 million are with speech and hearing defects, 6 million orthopaedically handicapped, 24 million mentally retarded, 7.5 million mentally ill, 1.1 million leprosy cured.
Another survey was conducted by NSSO in 1991 to estimate the magnitude of the persons with disabilities in India. The survey indicated the following important findings :-
1. About 1.9 per cent of the total population of the country, i.e., 16.15 million persons have physical or sensory disabilities which include visual, speech, hearing and locomotor disabilities. There was thus a slight increase in disability over the previous decade both in terms of absolute numbers and percentage.
2. In a separate survey of children (age 0-14 years) with delayed mental development, it was found that 29 out of 1000 children in the rural areas had developmental delays which are usually associated with mental retardation. Approximately 3 per cent of the children between 0-14 years of age have developmental delays associated with mental retardation.
3. The prevalence rate for physical disability was observed to be significantly more amongst males (22.77/1000) than females (16.94/1000).
4. As regards the State-wise distribution of physical disability, the States which have higher prevalence rate, than the national average, were Andhra Pradesh (24.98/1000), Himachal Pradesh (28.70/1000), Karnataka (21.31/1000), Madhya Pradesh (27/1000), Orissa (23.06/1000), Punjab (29.36/1000) and Tamil Nadu (23.72/1000). The national average is 19/1000.
5. The rate of prevalence of physical disability in urban population was 16.75/1000 as compared to 19.75/1000 in rural areas.
6. About 12.3 per cent of the disabled people identified were multihandicapped.
7. 9.14 and 6.77 per cent of the total estimated households respectively in rural and urban India were reported to have at least one disabled person in the household. The average household size in urban and rural sectors was 5.8 persons.
8. The incidence of physical disability (number born or otherwise rendered disabled) in the rural areas of the country was on an average 90 persons per 1,00,000 population during the past one year. The figure in respect of the urban areas was 83.
9. The incidence rate, as is the case with prevalence rate, is higher in the case of males than females. There were significant inter-state variations. The rates among males were 99 and 90 in rural and urban India respectively as against 81 and 75 among females in rural and urban areas respectively.
10. Among the physically disabled 25 per cent of the disabled people in the rural areas and 20 per cent in urban areas suffered from such severe disabilities that they could not perform activities of self-care and daily living even with aids/appliances.
Amongst the visually handicapped, nearly 70 per cent are in the age-group 60+ and less than 3 per cent are in the age group of 0-14. For speech disability, nearly 26 per cent are in 5-14 age group. Nearly 50 per cent of the locomotor disabled and the speech disabled are in the age group 15-59.
In most populations all over the world approximately two to three per cent of the population is expected to be mentally handicapped, mental handicap being defined as a condition characterised by significantly sub-average general intellectual functioning existing concurrently with deficits in adaptive behaviour and manifested during the developmental period.