Disablement in society: towards an integrated perspective.

Demographic and morbidity changes have undermined traditional responses to disease and disability. An expanded model of disablement is required, integrating consequences as well as causes. Three main concepts involved are impairment, disability, and handicap. These constitute a continuum ranging from bio-medical phenomena (impairment) through functional limitation and activity restriction (disability) to social disadvantage (handicap). Though complete sequences can occur, analytical and practical problems arise from the fact that their interrelationship is not always straightforward or predictable. From an analysis of available data it is calculated that 34% of the adult population in Great Britain are impaired. A tenth of these are severely disabled. The age structure and underlying causes of disablement challenge prevailing stereotypes: disablement becomes more frequent with age and it is caused in large part by chronic diseases. An attempt to assess handicap direct, rather than as a derivative of disability, displays severe disadvantages among the disabled. The model allows the possibility of gathering information relevant to different aspects of disablement and warns against reductionist or naive responses in health care and social policy.