related to conceptual clarity and data needs and presents a model for studying the progression of conditions toward disability. The disability model described in this report should facilitate the development of improved surveillance systems, an epidemiology of disability, and more effective means of prevention.

Interfering with the development of effective prevention programs, however, is the lack of an effective public health surveillance network for monitoring the incidence and prevalence of disability, including predisposing risk factors. Without such a surveillance network, programs and policies intended to prevent disability will continue to be based on educated guesses rather than a solid data base that describes the sizable population of people that have either disabilities or a high risk of developing them. Furthermore, the fragmentation, gaps, and redundancies in the nation's disability-related programs—the focus of criticism in other quarters besides this report—will persist.

Although the current system for providing medical and social support to people with disabling conditions suffers from many inadequacies, most of the elements required for longitudinal care, as recommended by this committee, are likely to be in place. Additional financial resources may not be needed for many of the prevention measures noted here so much as a commitment to coordination, program planning, and service delivery to form a network that is readily accessible by consumer populations.

TOWARD A COMPREHENSIVE APPROACH TO DISABILITY PREVENTION

Despite an officially stated national goal of independence and equality of opportunity for people with disabilities, current approaches to preventing disability and improving the lives of people with disabling conditions lack conceptual clarity and unity of purpose. Reducing the prevalence and incidence of disability poses challenges on many fronts and requires coherent, comprehensive responses rather than the piecemeal actions that now characterize medical, rehabilitative, and social programs related to disability. In short, disability prevention requires new thinking, new collaborations among researchers, new relationships between agencies and organizations, both public and private, new approaches to delivering services, and new societal attitudes.

In developing its framework for a national disability prevention program, the committee sought to identify issues and needs that cut across the major categories of health conditions that can result in disability. It developed a model for disability and disability prevention (see Chapter 3) based on the work of Saad Nagi and the World Health Organization, and expanded it to include risk factors and quality of life. The committee then reviewed current knowledge in four major areas; developmental disabilities (Chapter 4);



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