Survey Measurement of Work Disability Summary of a Workshop (2000) / Chapter Skim
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2 Conceptual Issues in the Measurement of Work Disability
2 Conceptual Issues in the Measurement of Work Disability
Pages 4-27
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From page 4... ...
A commonly understood language can also influence the development of public policy in the area of work disability, the focus of the Institute of Medicine's workshop titled "Survey Measurement of Work Disability." The current lack of a uniform language and commonly understood definition of the concepts of "disability" and "work disability" is a serious obstacle to all these endeavors. Conceptual confusion is a particular barrier to the improvement of the Social Security Administration's (SSA)
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From page 5... ...
We will briefly review both of these conceptual frameworks. Both the Nagi Disablement Model and ICIDH frameworks have in common the view that overall disablement represents a series of related concepts that describe the consequences or impact of a health condition on a person's body, on a person's activities, and on the wider participation of that person in
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From page 6... ...
After reviewing the terms within each framework we will compare and contrast the two major models along with their major derivatives and explore how these relate more generally to the concept of "work disability." Nagi's Concept of Disability According to the conceptual framework of disability developed by sociologist Saad Nagi (1965) , "disability is the expression of a physical or a mental limitation in a social context." In striking contrast to the Social Security Act's definition of work disability as an inability to work due to a physical or mental impairment, Nagi specifically views the concept of disability as representing the gap between a person's capabilities and the demands created by the social and physical environments (Nag)
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From page 7... ...
This conceptual framework has come to be referred to as Nagi's Disablement Model. For Nagi, active pathology involves the interruption of normal cellular processes and the simultaneous homeostatic efforts of the organism to regain a normal state.
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Elaboration of Nagi's Disablement Model In their work on the disablement process, Verbrugge and Jette (1994) maintained the basic concepts of the Nagi Disablement Model and Nagi's original definitions.
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9 FIGURE 2-1. The disablement process.
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and a more recent Institute of Medicine (IOM) disablement model revision highlighted in a report titled Enabling America: Assessing the Role of Rehabilitation Science and Engineering (IOM, 1997~.
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We will not review this classification as such, except to note that, in principle, this system provides a scheme for coding and manipulating data on the consequences of health conditions. This classification and the related model of disablement are being revised and have been named ICIDH-2.
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From page 13... ...
In other words there was a reaction against the whole classification being focused on deficiencies resulting from health conditions. In response to this there has been a switch to neutral terminology, as was illustrated above by the use of the term activity instead of the term disability.
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From page 14... ...
The context refers both to external environmental factors and to more personal characteristics of an individual. The latter range from relatively uncontroversial characteristics, such as age and gender, to aspects of the person relating to educational background, race, experiences, personality and character style, aptitudes, other health conditions, fitness, lifestyle, habits, coping styles, social background, profession, and past and current experience (WHO, 1997~.
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From page 15... ...
It is for this reason that Nagi views the concept of disability as ranging from very basic ADLs to the exquisitely complex social roles such as one's occupation. Since activities of daily living (e.g., dressing, bathing, and eating)
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From page 17... ...
Work disability typically begins with the onset of one or more health conditions that may limit the individual's performance of specific tasks through which an individual would typically perform his or her job. The onset of a specific health condition say, a stroke or a back injury may or may not lead to actual limitation in performing the work role, a work disability.
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From page 18... ...
presented the disablement process as more or less a simple linear progression of response to illness or consequence of disease. One consequence of this traditional view is that disabling conditions have been viewed as static entities (Merge, 1988~.
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From page 19... ...
Most quality-of-life measures focus little attention on organ and body system functioning and focus more on the consequences of impairments at the personal activity or social role level. At the level of social roles, quality-of-life dimensions are broader than the disablement concepts that incorporate overall life satisfaction, energy, vitality, and emotional well-being (Levine and Croog, 1984~.
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From page 20... ...
CONCEPTUAL ISSUES RELATED TO THE MEASUREMENT OF WORK DISABILITY The underlying structure of models of disablement, as currently conceived, maps a pathway between the health condition and the ensuing "work disability" or other restrictions to social participation. Close inspection of the definitions given above suggests that a number of steps can be identified in the pathway between the health condition and the social consequences described as work disability.
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From page 21... ...
The juxtaposition of the two models in this way illuminates some nuances in the ways in which the impact of health conditions can been conceptualized as having an impact on the overall functioning of the individual. As indicated earlier, work disability is a function of whether the person can perform specific work-related tasks and of external factors.
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From page 22... ...
Such concerns are a reflection of the many steps in the disablement model between the health condition and work disability. Impairment Assessments of work disability, or at least of entitlement to compensation for work injury, are often made at the level of impairment.
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From page 23... ...
They look at the specific abilities of the individual for work in standardized ways not directly related to actual work settings. More importantly, they take no account of any environmental barriers or facilitators that might moderate the way in which a person's functional limitations are expressed as disabilities.
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From page 24... ...
Typical survey research questions also leave it to the respondent to attribute not working to an underlying health condition. It may be that the individual answers that he or she cannot work, yet the person may not be given the opportunity to specify the circumstances under which this might be possible.
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From page 25... ...
U.S. Census for Year 2000 General question about activity limitations (difficulty in carrying out specific activities)
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From page 26... ...
Without extra information it may be difficult to tell whether this is indeed the situation or whether the alternative description was seen as a less stigmatizing alternative to describing themselves as having a work disability. In a survey research situation, if a person is working, the typical approach is to assume that no work disability is present.
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From page 27... ...
As we have tried to show, a full understanding of work disability needs to take into account the individual's circumstances and the social and physical environments of the workplace. The research challenge is to apply the insights provided by the models of disablement to come to a common understanding of work disability and to understand the relationships and the dynamics of the pathway between health conditions and work disability.
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