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tors as a contributor to the neglect of health promotion opportunities for people with disabling conditions (USDHHS, 2000). The World Health Organization’s International Classification of Functioning, Disability and Health (a revision of the 1980 International Classification of Impairments, Disabilities and Handicaps [WHO, 1980]) likewise stresses the critical role of environmental factors in enabling the participation in society of people with physical or mental impairments and activity limitations (WHO, 2001).

The 1991 IOM report and a subsequent report, Enabling America (IOM, 1997), emphasized that much disability is preventable. Prevention extends beyond primary prevention (e.g., improving automobile safety) to include the prevention of progressive or secondary health problems (e.g., pressure sores related to spinal cord injury), the development of more effective rehabilitation strategies, the use of appropriate assistive technologies, and the elimination or mitigation of environmental barriers that restrict the participation in society of individuals with disabling conditions.

Beginning in late 2004, the IOM began a project to take a new look at disability in America. It will review developments and progress since the publication of the 1991 and 1997 Institute reports. For technical contracting reasons, the new project was split into two phases. During the limited first phase, a committee appointed by IOM planned and convened a 1-day workshop to examine a subset of topics as background for the second phase of project. As was agreed upon with the sponsor of the workshop, the Centers for Disease Control and Prevention (CDC), the topics were

  • methodological and policy issues related to the conceptualization, definition, measurement, and monitoring of disability and health over time;

  • trends in the amount, types, and causes of disability;

  • disability across the age spectrum and in the context of normal aging; and

  • secondary health conditions.

The phase-one workshop was held in Washington, D.C. on August 1, 2005. Its participants included researchers, clinicians, social service professionals, policy experts, and consumer representatives and advocates. The meeting agenda and list of participants are included in Appendix A.

This report summarizes the workshop presentations and discussions. The background papers prepared for the workshop are included in Appendixes B through O. Some papers were submitted and circulated in advance of the meeting, whereas others were first presented at the meeting. The analyses, definitions, and views presented in the papers are those of the paper authors and are not necessarily those of the IOM committee. Likewise, the discussion summary is limited to the views of the workshop participants. Although the discussion was wide ranging, it did not offer a



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