Impaired, not disabled

By Garth A. Rattray

At long last, the Disabilities Bill has been tabled in Parliament. It is designed to protect the rights of persons with 'disabilities'. The press quotes the following provisions in the bill:

The statutory establishment of the Jamaica Council for Disabilities, primarily responsible for ensuring that disabled persons are not discriminated against.

A legal definition of the term 'discrimination'.

A requirement that all privileges, interests, benefits and treatment in the political, economic, social, cultural, civil, religious and educational benefits be made accessible to persons with disabilities.

Enshrining obligations that facilitate the removal of current stigma against persons with disabilities.

A requirement that persons with disabilities have access to health, education, transportation, employment, public and political life, housing and premises; and

Penalties where breaches occur.

Inaccurate term

It is a very welcome law, but I have a huge problem with the word, 'disabled'. It is not an accurate word. It unintentionally and erroneously conveys the impression that 'disabled' means the inability to do one or several tasks without assistance when, in fact, under the right circumstances ... nothing is farther from the truth. The word not only suggests a physical helplessness and dependence; it may also impart, to the afflicted individual, a psychological sense of loss of control over his/her life. The more accurate and apt word is 'impaired'.

The Word Health Organization (WHO) states: "Disabilities is an umbrella term, covering impairments, activity limitations, and participation restrictions. An impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations."

Disability is thus not just a health problem. It is a complex phenomenon, reflecting the interaction between features of a person's body and features of the society in which he or she lives. Overcoming the difficulties faced by people with disabilities requires interventions to remove environmental and social barriers.

Correct meanings

The best explanation that I found for the difference between 'disability' and 'impairment' and the importance of separating the two was this: "A disabled person is a person with an impairment who experiences disability. Disability is the result of negative interactions that take place between a person with an impairment and her or his social environment". Impairment is thus part of a negative interaction, but it is not the cause of, nor does it justify, disability.

Impairment: an injury, illness, or congenital condition that causes or is likely to cause a loss or difference of physiological or psychological function.

Disability: the loss or limitation of opportunities to take part in society on an equal level with others due to social and environmental barriers.

The difference between the two has been taking precedence in the courtroom (medico-legal cases). If someone is injured and loses the use of the right hand, should the person be granted 'disability' status? The answer depends on the impairment. Is the victim left-handed? Is there a device that can reduce or negate the loss of use of the affected body part?

If someone must climb a ladder for a living and loses the use of both lower limbs, the situation is a far cry from a person who earns a living from a desk job or can easily transition to a desk job.

I hope that our parliamentarians will consider requesting that the bill be amended to substitute 'impaired' for 'disabled' as much as possible and where applicable. This will accurately reflect the true situation that exists. It will de-stigmatise victims, highlight that impaired individuals are only made disabled by the impediments in society and (physically and psychologically) empower people with such impairments.

Garth A. Rattray is a medical doctor with a family practice. Email feedback to columns@gleanerjm.com and garthrattray@gmail.com