Despite these complications, there have been continuing attempts to define universal and abstract standards for describing and treating disabilities. Although these systems are often criticized for being inequitable, unjust, and inadequate, they serve a necessary purpose. The health care system in this country has been built on the understanding that illnesses can be categorized and are likely to follow a predictable course. These systems, therefore, provide the structure essential to integrate disabilities into the U.S. social insurance and health care systems. This means that the imperative is to find a system suited to the nation's needs but to remain sensitive to its inherent problems and open-minded about alternatives.

The alternative to the acute care approach to disabilities explored in this report is the array of new methods and goals known as health promotion and disability prevention. This new approach makes room for broader notions of disability care and treatment, departing from the traditional disease model framework. Healthy behavior and the prevention of chronic and acute conditions through risk reduction are stressed, as in health promotion and disease prevention. However, in this approach, prevention is more comprehensive; that is, points of prevention for chronic illness and disability are defined throughout life, including periods after the onset of these difficulties. Rehabilitation and social supports tailored to the diverse needs of the over-50 population are also an important part of health promotion and disability prevention.

Although the health promotion and disability prevention approach escapes many of the constraints of traditional acute care frameworks, the majority of its services are not delivered independently of existing health care systems. It therefore requires a common set of definitions, shared concepts to guide health policies and permit the dialogue necessary to advance disability treatment and prevention among health care providers. The following section discusses two of the recent efforts to classify disabilities and presents the committee's recommendations for the future development of this field.


As noted above, defining standards for disability in its broader manifestations is exceedingly difficult. There have been numerous attempts to devise disability classification systems in the United States, in part because of the rise of social insurance programs such as workmen's compensation, veterans' benefits, and social security programs.7,10 Another important source of disability classifications has been health interview surveys. From the time of their introduction

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