The so-called medical model has influenced the development of most of the nation's disability-related programs. The model defines disabling conditions as principally the product of physical and mental impairments that constrain performance. Influenced by this view, health and social agencies provide a mix of services that, for the most part, categorize affected individuals as permanently ill and incapable of meeting their own needs. Therefore, the problems that disability-related programs seek to address are often viewed as inherent to the individual and as independent of society.

The independent-living and disability-rights movements blame adherence to the medical model for the creation of disability-related programs that foster dependence rather than personal autonomy. Members of these movements correctly argue that disability is the result of a dynamic process involving complex interactions among biological, behavioral, psychological, social, and environmental factors. Some have called for the "demedicalization" of disability in order to reflect the broader role of society. To do so in the extreme sense, however, would allow the pendulum to swing too far in the other direction.

An example illustrates the need for a more balanced approach to disability. The 1987 survey commissioned by the International Center for the Disabled (ICD) reported that two-thirds of the unemployed respondents, more than 8 million people, would like to be working (Taylor, 1989). Were the majority of these people not working because their disabling conditions prevented them from doing so, or were they not working because of hiring discrimination, transportation difficulties, or other societal barriers? Doubtless, these and other reasons account for why at least a portion of these respondents do not have jobs, but they probably do not account for the majority.

A follow-up survey of U.S. employers, also done for ICD, found that the biggest single obstacle to employment for people with disabling conditions is the lack of qualifications (Taylor, 1989). Thus the survey results indicate that education and training are important elements of efforts to help people with disabling conditions secure jobs. Such training and education programs must be designed with full recognition of the limitations imposed by one's physical or mental condition. Moreover, continued employment will often require medical interventions that help maintain the health of the worker who has a disabling condition.

Timely and appropriate medical intervention is an essential element of the committee's recommended approach to disability prevention—an integrated system of longitudinal care. However, the committee agrees with Caplan (1988), who has argued that "health care should not be the major preoccupation of public policy" related to disability. "[T]reating chronic illness and disability strictly as medical problems," Caplan has written, "'disenfranchises'

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