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Disability in America: Toward a National Agenda for Prevention
been pointed out in the literature, however, the ICIDH is neither a classification of persons nor a research tool.
The original intent of the ICIDH was to provide a framework to organize information about the consequences of disease (Haber, 1990). As such, the ICIDH has been considered by some as an intrusion of the medical profession into the social aspects of life—as a "medicalization of disablement" (Badley, 1987). The WHO is planning a revision of the ICIDH in the near future, however, which will provide opportunities for significant improvements.
Both frameworks (i.e., the ICIDH and the Nagi) have four basic concepts. In the ICIDH the four concepts are disease, impairment, disability, and handicap. In the Nagi framework the four concepts are pathology, impairment, functional limitation, and disability. Several authors have compared the two frameworks, and most have noted similarities, particularly between Nagi's concept of pathology and ICIDH's concept of disease and between the two frameworks' characterizations of impairment (Nagi, Appendix A, this volume; Duckworth, 1984; Frey, 1984; Granger, 1984; Haber, 1990).
The more important distinctions between the Nagi framework and the ICIDH occur in the last two conceptual categories and go beyond simple terminology. The ICIDH concept of disability seems to correspond to Nagi's concept of functional limitation, or "activities of daily living" (as used in the National Health Interview Survey), and the ICIDH concept of handicap (which subsumes role limitations) seems to correspond to Nagi's concept of disability. Both frameworks recognize that whether a person performs a socially expected activity depends not simply on the characteristics of the person, but also on the larger context of social and physical environments. Conceptual clarity, however, seems to be a problem with some of the classifications in the ICIDH. As Haber (1990) points out, for example, some of the classifications in the ICIDH are confusing, such as classifying certain social role limitations (e.g., family role, occupational role) under "behavior disabilities," instead of "occupation handicaps'' or "social integration handicaps." Another example (Haber, 1990) is the distinction between "orientation handicaps" and disabilities associated with self-awareness, postural, or environmental problems.
In considering the options for a conceptual framework, the committee was faced with the fact that the ICIDH includes the term handicap in its classification. Traditionally, handicap has meant limitations in performance, placing an individual at a disadvantage. Handicap sometimes has been used to imply an absolute limitation that does not require for its actualization any interaction with external social circumstances. In recent years, the term has fallen into disuse in the United States, primarily as a result of a feeling on the part of people with disabling conditions that handicap is a negative term.
Although the term handicap is used often as a synonym for disability in American legislation, at least three federal agencies have changed their