Unit 1: Understanding Disability

1.1 Historical perspectives of

Disability - National and
International & Models of
Disability;
1.2 Concept, Meaning and
Definition - Handicap,
Impairment, Disability, activity
limitation, habilitation and
Rehabilitation;
1.3 Definition, categories
(Benchmark Disabilities) & the
legal provisions for PWDs in
India;
1.4 An overview of Causes,
Prevention, prevalence &
demographic profile of
disability: National and
Global;
1.5 Concept, meaning and
importance of Cross Disability
Approach and interventions;

Page 1 of 31
1.1 Historical perspectives of Disability -
National and International & Models of
Disability

Disability is not a new concept and not something that has

emerged as a result of increasing numbers of people
affected. Rather, disability is an ancient concept that has
existed for as long as people have existed. Although
disability has not changed, our views of the meaning of
disability have changed over time-for the better.
Early Views of Disability
In the medieval era, disability was considered a
punishment from God for one’s sin or misbehavior or that
of one’s ancestors. Others over the centuries have viewed
disability as the work of the devil. Disability was seen as a
failure, deformity or defect of the individual. As a result of
the myths about disability, people with disabilities were
feared and often stigmatized, shunned, abused, or
condemned. People with visible disabilities were even used
for entertainment (e.g., court jesters or oddities in circuses
and freak shows). Children and adults with severe disability
were kept at home, isolated and hidden from public view.
They were often denied what others received, including
education, care, employment, and a place in the family or
in society. Disability was viewed as inability and those with
disabilities were often viewed as a burden to their families
and to society as a whole.
People with disabilities have been considered sick or
unhealthy. Being healthy and having a disability have been
perceived as a contradiction in terms. Disability was seen
as an issue blamed on the individual with a disability.
Quality of life of individuals with disability was often seen--
-and still is by some---to be poor by others who have very
negative views about disability, even though only an
individual can determine the quality of life of his or her
own life.
Changing Views about Disability
By the 1800s disability began to be viewed as an issue that
had individual health and public health implications, as
well as social and policy implications. Disability was seen as
a medical problem due to disease, trauma, or other health
conditions. This generally led to the medical model of
Page 2 of 31
disability, which viewed disability as an issue of the person
with a disability. The goal of medical management was cure
of the disabling condition or modification of behaviors of
the individual with a disability. The medical model viewed
physicians as the experts who knew what was best for
those with disabilities. Those with disabilities were not
seen as capable of knowing what they needed in the way
of health care and other services.
More recently, disability has been viewed as a result of
environmental and societal factors that serve as barriers to
the ability of persons with disabilities to participate fully in
their communities or families or to obtain the care and
services they need. Individuals with disability, their
families, and advocacy groups have viewed disability as a
consequence of an inaccessible environment and rejected
the medical model in favor of other models, such as the
social and biopsychosocial models of disability that address
barriers to health care from different perspectives.

Page 3 of 31
The Models of Disability
Models of Disability are tools for defining impairment and,
ultimately, for providing a basis upon which government
and society can devise strategies for meeting the needs of
disabled people. They are often treated with scepticism as
it is thought they do not reflect a real world, are often
incomplete and encourage narrow thinking, and seldom
offer detailed guidance for action. However, they are a
useful framework in which to gain an understanding of
disability issues, and also of the perspective held by those
creating and applying the models.
For Models of Disability are essentially devised by people
about other people. They provide an insight into the
attitudes, conceptions and prejudices of the former and
how they impact on the latter. From this, Models reveal the
ways in which our society provides or limits access to work,
goods, services, economic influence and political power for
people with disabilities.
Models are influenced by two fundamental philosophies.
The first sees disabled people as dependent upon society.
This can result in paternalism, segregation and
discrimination. The second perceives disabled people as
customers of what society has to offer. This leads to choice,
empowerment, equality of human rights, and integration.
As we examine the different Models in this and subsequent
articles, we will see the degree to which each philosophy
has been applied.
Page 4 of 31
We should not see the Models as a series of exclusive
options with one superior to or replacing previous sets.
Their development and popularity provides us with a
continuum on changing social attitudes to disability and
where they are at a given time. Models change as society
changes. Given this degree of understanding, our future
objective should be to develop and operate a cluster of
models, which will empower people with disabilities, giving
them full and equal rights alongside their fellow citizens.

Biomedical Model of Health

The biomedical model of health is the most dominant in

the western world and focuses on health purely in terms of
biological factors. Contained within the biomedical model
of health is a medical model of disability. In a similar vein,
this focuses on disability purely in terms of the impairment
that it gives the individual.

Medical Model of Disability

The medical model of disability is presented as viewing

disability as a problem of the person, directly caused by
disease, trauma, or other health condition which therefore
requires sustained medical care provided in the form of
individual treatment by professionals.

In the medical model, management of the disability is

aimed at a "cure," or the individual's adjustment and
behavioral change that would lead to an "almost-
cure" or effective cure.
In the medical model, medical care is viewed as the
main issue, and at the political level, the principal
response is that of modifying or reforming health-care
policy.
What it looks like: People in your community perceive you
as “sick” because of your disability. Most services are
focused on curing your disability or making you appear
non-disabled, instead of making the environment more
accessible. For example, wheelchairs may be provided, but
the streets are not accessible.

Identity Model

Disability as an identity model is closely related to the

Page 5 of 31
social model of disability - yet with a fundamental
difference in emphasis - is the identity model (or
affirmation model) of disability.

This model shares the social model's understanding that

the experience of disability is socially constructed, but
differs to the extent that it 'claims disability as a positive
identity'

Social Model of Disability

The social model of disability sees the issue of "disability"

as a socially created problem and a matter of the full
integration of individuals into society.

In this model, disability is not an attribute of an individual,

but rather a complex collection of conditions, many of
which are created by the social environment. Hence, the
management of the problem requires social action and is
the collective responsibility of society at large to make the
environmental modifications necessary for the full
participation of people with disabilities in all areas of social
life.

The issue is both cultural and ideological, requiring

individual, community, and large-scale social change. From
this perspective, equal access for someone with an
impairment/disability is a human rights issue of major
concern.

Minority Model of Disability

The minority model of disability, also known as

sociopolitical model of disability, adds to the social model,
the idea that disability is imposed on top of impairment via
negative attitudes and social barriers, in suggesting that
people with disabilities constitute a entitative, (relating to
or possessing material existence), social category that
shares in common the experience of disability.

The minority model normalizes the experience of disability

as a minority experience no more or less aberrant or
deviant than other minority groups' experiences (sex, race,
sexual orientation, etc.). Essentially, this is the assertion
that people with disabilities are, in part, disabled not by
what's going on with our bodies per se, but by the manner
in which the able-bodied majority of society views us and

Page 6 of 31
either molds or does not mold itself to allow us to fit.

Expert or Professional Model of Disability

The expert or professional model of disability has provided

a traditional response to disability issues and can be seen
as an offshoot of the medical model.

Within its framework, professionals follow a process of

identifying the impairment and its limitations (using the
medical model), and taking the necessary action to
improve the position of the disabled person. This has
tended to produce a system in which an authoritarian,
over-active service provider prescribes and acts for a
passive client.

This relationship has been described as that of fixer (the

professional) and fixee (the client), and clearly contains an
inequality that limits collaboration. Although a professional
may be caring, the imposition of solutions can be less than
benevolent. If the decisions are made by the "expert", the
client has no choice and is unable to exercise the basic
human right of freedom over his or her own actions. In the
extreme, it undermines the client’s dignity by removing the
ability to participate in the simplest, everyday decisions
affecting his or her life. E.g. when underwear needs to be
changed or how vegetables are to be cooked.
Tragedy and/or Charity Model of Disability

The tragedy and/or charity model of disability depicts

disabled people as victims of circumstance who are
deserving of pity.

This, along with the medical model, are the models most
used by non-disabled people to define and explain
disability.

What it looks like: People in your community assume you

will always need help and pity you. You are considered a
burden requiring charitable resources for support.

Moral Model of Disability

The moral model of disability refers to the attitude that

people are morally responsible for their own disability. For
example, the disability may be seen as a result of bad
actions of parents if congenital, or as a result of practicing

Page 7 of 31
witchcraft if not.

This attitude may also be viewed as a religious

fundamentalist offshoot of the original animal roots of
human beings when humans killed any baby that could not
survive on its own in the wild. Echoes of this can be seen in
the doctrine of karma in Indian religions.

Legitimacy Model of Disability

The legitimacy model of disability views disability as a

value-based determination about which explanations for
the atypical are legitimate for membership in the disability
category. This viewpoint allows for multiple explanations
and models to be considered as purposive and viable.

Empowering Model of Disability

The empowering model of disability allows for the person

with a disability and his/her family to decide the course of
their treatment and what services they wish to benefit
from. This, in turn, turns the professional into a service
provider whose role is to offer guidance and carry out the
client's decisions. In other words, this
model "empowers" the individual to pursue his/her own
goals.

Social Adapted Model of Disability

The social adapted model of disability states although a

person's disability poses some limitations in an able-bodied
society, oftentimes the surrounding society and
environment are more limiting than the disability itself.

Economic Model of Disability

The economic model of disability defines disability by a

person's inability to participate in work.

It also assesses the degree to which impairment affects an

individual's productivity and the economic consequences
for the individual, employer and the state. Such
consequences include loss of earnings for and payment for
assistance by the individual; lower profit margins for the
employer; and state welfare payments. This model is
directly related to the charity/tragedy model.

Diversity Model of Disability

Page 8 of 31
Disability as Human Variation, an alternative model
intended to focus attention on how society's systems
respond to variation introduced by disability (Scotch and
Shriner 1997). Under this model, accessibility in the built
environment, for example, is not solely achieved by anti-
discrimination regulation requiring a 'universal solution;
the diversity of disability must be acknowledged (Scotch
and Shriner 1997). Shriner and Scotch (2001) further
question the socio-political definition of disability, in which
(all) barriers faced by people with disability are (built-
environment) imposed and therefore removable, feeling
that this common underlying ideology of disability rights
activists and independent living movements insufficiently
recognizes that impairment does have a bearing on
accessibility outcomes.

Seeking to overcome the false dichotomy of

ability/disability, Bickenbach et al. (1999) pursue the
concept of universalism, proposing: While the social model
is now universally accepted, it is argued that universalism
as a model for theory development, research and advocacy
serves disabled persons more effectively than a civil rights
or minority group approach.

Religious Model of Disability

The moral/religious model of disability is the oldest model

of disability and is found in a number of religious
traditions, including the Judeo-Christian tradition (Pardeck
& Murphy 2012:xvii). The religious model of disability is a
pre-modern paradigm that views disability as an act of
a god, usually a punishment for some sin committed by the
disabled individual or their family. In that sense, disability is
punitive and tragic in nature.

This model frames disability as something to be ashamed

of and insinuates that disabled people or their families are
guilty of some unknown action that caused their
impairment. But that mentality only serves to stigmatize
disability, and the claim that praying heals disability is
based on purely anecdotal evidence.

Sometimes the presence of "evil spirits" is used to explain

differences in behaviour, especially in conditions such as
schizophrenia. Acts of exorcism or sacrifice may be
performed to expel or placate the negative influence, or

Page 9 of 31
recourse made to persecution or even death of the
individual who is "different".
In some cases, the disability stigmatises a whole family,
lowering their status or even leading to total social
exclusion. Or it can be interpreted as an individual’s
inability to conform within a family structure. Conversely, it
can be seen as necessary affliction to be suffered before
some future spiritual reward.
It is an extreme model, which can exist in any society
where deprivation is linked to ignorance, fear and
prejudice.

Market Model of Disability

The market model of disability is a minority rights and

consumerist model of disability that recognizing people
with disabilities and their Stakeholders as representing a
large group of consumers, employees and voters. This
model looks to personal identity to define disability and
empowers people to chart their own destiny in everyday
life, with a particular focus on economic empowerment.

By this model, based on US Census data, there are 1.2

billion people in the world who consider themselves to
have a disability. An additional two billion people are
considered Stakeholders in disability
(family/friends/employers), and when combined to the
number of people without disabilities, represents 53% of
the population. This model states that, due to the size of
the demographic, companies and governments will serve
the desires, pushed by demand as the message becomes
prevalent in the cultural mainstream.

Human Rights Based Model of Disability

From the mid 1980's countries such as Australia enacted

legislation which embraced rights-based discourse rather
than custodial discourse and seeks to address the issues of
social justice and discrimination. The legislations embraced
the shift from disability being seen as an individual medical
problem to it instead being about community membership
and fair access to social activities such as employment,
education and recreation.

The emphasis in the 1980's shifted from dependence to

Page 10 of 31
independence as people with disabilities sought to have a
political voice. Disability activism also helped to develop
and pass legislation and entitlements became available to
many people. However, while the rights-based model of
disability has helped to develop additional entitlements, it
has not changed the way in which the idea of disability is
constructed. The stigma of 'bad genes' or 'abnormality' still
goes unchallenged and the idea of community is still
elusive.

What it looks like: A person with a disability is able to

attend a school, go to work, participate in community
activities alongside non-disabled people, perhaps using
disability-related accommodations or modifications that
make the environment more accessible to them.

Relational Model of Disability

In the late 1960s Nirje, a Swedish social theorist,

formulated the principles of normalization emphasizing
strong support of de-institutionalization, recognition of the
diversity of the human condition, and belief that people
with disability and 'normal' (ordinary) life, including access
to the built environment, are not mutually exclusive.

This work represents part of an emerging grand idea of

social inclusion for people with disability in the community
and within the neighborhood (Nirje [1969] 1994).
Following on in this continuum of Nordic interest in people
- environment interaction, a new disability model
developed around the end of 1990s - early2000s, and has
subsequently been recognized as the (Nordic) Relational
Model of Disability (Goodley 2011)

Affirmation Model of Disability

The affirmation model of disability is essentially a non-

tragic view of disability and impairment which
encompasses positive social identities, both individual and
collective, for disabled people grounded in the benefits of
lifestyle and life experience of being impaired and disabled.
This view has arisen in direct opposition to the dominant
personal tragedy model of disability and impairment, and
builds on the liberatory imperative of the social model.

Rooting their idea in the values of Disability Pride and

perspectives emerging from the disability arts movement,
Page 11 of 31
Swain and French identified the affirmation model as a
critique of the personal tragedy model corresponding to
the social model as a critique of the medical model.

Spectrum Model of Disability

The spectrum model of disability refers to the range of

visibility, audibility and sensibility under which mankind
functions. The model asserts that disability does not
necessarily mean reduced spectrum of operations.

1.2 Concept, Meaning and Definition - Handicap,

Impairment, Disability, activity limitation,
habilitation and Rehabilitation
Education is a lifelong process involving many planned and
unplanned experiences that enable children and adults
alike to develop and learn through interaction with the
society and culture in which they live. It involves
experiences at all stages of life, from infancy through to old
age.
Education also involves adaptations to society and culture.
With all the combinations of life events, adaptation will
mean that each person is subject to a unique set of
learning and problem-solving experiences that constitute
an understanding of the world and the events that take
place in it. However, if we limit our attendance to
intentional learning and instruction of children across the
time from preschool to tertiary education, this would
involve learning from a curriculum that has been
determined by the central or state education authority.
There are many children who, for some reason, are unable
to take full advantage of the school curriculum as it is
normally offered. For these children special arrangements
must be made to ensure that they receive the
opportunities and experiences, which will help them to
learn and develop to the extent of their capabilities.
To help us to deal with the question of who these children
may be, we need first to understand a few adjectives which
you will, no doubt, encounter in your reading about
children with special needs. These adjectives are
‘impaired’, ‘disabled’ and ‘handicapped’. Over the years,
these terms have often been used interchangably and at
times carelessly. However, they have specific meanings and

Page 12 of 31
conceptual differences, which are important for us to
know.

International Classification of Impairment, Disability and

Handicap as given by World Health Organisation (WHO)

The World Health Organisation (WHO) has defined the

terms ‘Impairment’, ‘Disability’ and ‘Handicap’ in 1980
through the publication of the International Classification
of Impairments, Disabilities and Handicaps (ICIDH), which is
a manual of classification relating to the consequences of
diseases. The ICIDH proposes the concepts and definitions
of Impairment, Disability and Handicap, and discusses the
relation between these dimensions. It is based on a linear
model (Figure 1) implying progression from disease,
impairment and disability to handicap.

Definitions of Impairment, Disability, Handicap

Impairment: According to the ICIDH, impairment is any loss
or abnormality of psychological, physiological or
anatomical structure or functions, generally taken to be at
organ level
Impairment is damage to tissue due to disease or trauma.
A person who has poor or no vision due to damage to
retina or optic nerve may be said to have a visual
impairment.
Disability: Disability has been defined as any restriction or
lack of ability (resulting from an impairment) to perform an
activity in the manner or within the range considered
normal for a human being, generally taken to be at the
level of the individual.
Disability denotes the consequences of impairment in
terms of functional performance and activity by the
individual. A person who has an optic nerve or retinal
damage would have limitations in performing those tasks
that requires the use of eyesight.
Handicap: The ICIDH defines Handicap as a disadvantage
for an individual, resulting from an impairment or disability,
which limits or prevents fulfillment of a role that is normal
(depending on age, sex and social cultural factors) for that
Page 13 of 31
individual.
Condition Concerned with Represents
Impairment Abnormalities of Disturbances at
body structure, organ / tissue
organs, level
appearance and
system functioning
Disability Limitations/loss of
functional Disturbance at
performance and personal level
activities
Handicap Disadvantages
resulting from Situation specific
impairment and limitations
disabilities

In order to understand children with special needs we must

know the different adjectives or terms by which they are
often described. Impairment, Disability and Handicap are
terms, which are frequently used interchangeably.
However, there are conceptual differences among the
terms.

The differences have been clearly outlined in the

definitions of each of the terms by WHO in the
International Classification of Impairment, Disability and
Handicaps.
Impairment represents exteriorization of a pathological
state and occurs at tissue level.
Disability refers to excesses or deficiencies of customarily
expected activity, performance and behaviour, and is
located at the level of the person.
Handicap reflects the consequences for the individual -
cultural, social, economic and environmental - that stem
from the presence of impairment and disability.

Activity limitation is a dimension of health/disability

capturing long-standing limitation in performing usual
activities (due to health problems). Indicators based on this
concept can be used to evaluate the general health status,
disability and related inequalities and health care needs at
the population level.
Example of an operational definition used within the
European Statistical System:
One question instrument – the Global Activity Limitation
Page 14 of 31
Instrument (GALI) - assessing the presence of long-standing
activity limitation: “For at least the past 6 months, to what
extent have you been limited because of a health problem
in activities people usually do? Would you say you have
been …” severely limited / limited but not severely or / not
limited at all? The question was developed by the Euro-
REVES project. It is used in European Health Interview
Survey (EHIS) (HS3 variable) and EU Statistics on Income
and Living Conditions (EU-SILC) (PH030 variable).
Although they work side-by-side, rehabilitation and
habilitation mean two different things:
Habilitation refers to a process aimed at helping disabled
people attain, keep or improve skills and functioning for
daily living; its services include physical, occupational, and
speech-language therapy, various treatments related to
pain management, and audiology and other services that
are offered in both hospital and outpatient locations.
Rehabilitation refers to regaining skills, abilities, or
knowledge that may have been lost or compromised as a
result of acquiring a disability or due to a change in one’s
disability or circumstances.
As defined in the CRPD, Habilitation and Rehabilitation
“enable persons with disabilities to attain and maintain
maximum independence, full physical, mental, social, and
vocational ability, and full inclusion and participation in all
aspects of life.”
Without adequate habilitation and rehabilitation services,
persons with disabilities may not be able to work, go to
school, or participate in cultural, sports, or leisure
activities. At the same time, barriers to other human rights
can prevent persons with disabilities from claiming the
right to habilitation and rehabilitation. Services may exist,
but if there is not accessible transportation, many persons
with disabilities will not receive the benefit of these
services. If information about habilitation and
rehabilitation services is not available in accessible formats,
persons with certain disabilities may never know that they
exist.

1.3 Definition, categories (Benchmark

Disabilities) & the legal provisions for PWDs in
India
The Ministry of Social Justice and empowerment of Person
Page 15 of 31
with Disability (Divyangjan) Department administers the
following three Acts:-
· The Rights of Persons with Disabilities Act, 2016
· The National Trust for the Welfare of Persons with
Autism, Cerebral Palsy, Mental Retardation and
Multiple Disabilities Act, 1999
· Rehabilitation Council of India Act, 1992
The RPwD Act, 2016 was enacted on 28.12.2016 which
came into force from 19.04.2017. The salient features of
the Act are:-
i. Responsibility has been cast upon the appropriate
governments to take effective measures to ensure
that the persons with disabilities enjoy their rights
equally with others.
ii. Disability has been defined based on an evolving
and dynamic concept.
iii. The Act covers the following specified disabilities:-
1. Physical Disability
a. Locomotor Disability
i. Leprosy Cured Person
ii. Cerebral Palsy
iii. Dwarfism
iv. Muscular Dystrophy
v. Acid Attack Victims
b. Visual Impairment
i. Blindness
ii. Low Vission
c. Hearing Impairment
i. Deaf
ii. Hard of Hearing
d. Speech and Language Disability
2. Intellectual Disability
a. Specific Learning Disabilities
b. Autism Spectrum Disorder
Page 16 of 31
 3. Mental Behaviour (Mental Illness)
4. Disability caused due to-
a. Chronic Neurological Conditions such as-
i. Multiple Sclerosis
ii. Parkinson’s Disease
b. Blood Disorder-
i. Haemophilia
ii. Thalassemia
iii. Sickle Cell Disease
5. Multiple Disabilities
iv. Additional benefits have been provided for persons
with benchmark disabilities and those with high
support needs.
v. Every child with benchmark disability between the
age group of 6 and 18 years shall have the right to
free education.
vi. 5% reservation in seats in Government and
Government aided higher educational institutions
for persons with benchmark disabilities.
vii. Stress has been given to ensure accessibility in
public buildings (both Government and private) in a
prescribed time-frame.
viii. 4% reservation in Government jobs for certain
persons or class of persons with benchmark
disability.
ix. The Act provides for grant of guardianship by
District Court or any authority designated by the
State Government under which there will be joint
decision – making between the guardian and the
persons with disabilities.
x. Broad based Central & State Advisory Boards on
Disability to be set up as policy making bodies.
xi. The Act provides for strengthening of the Office of
Chief Commissioner of Persons with Disabilities and
State Commissioners of Disabilities which will act as
Page 17 of 31
 regulatory bodies and Grievance Redressal agencies
and also monitor implementation of the Act. These
Offices will be assisted by an Advisory Committee
comprising of experts in various disabilities.
xii. Creation of National and State Fund to provide
financial support to the persons with disabilities.
xiii. The Act provides for penalties for offences
committed against persons with disabilities.
xiv. Designated special Courts to handle cases
concerning violation of rights of PwDs.
There are innumerable types of disabilities that can affect a
human being. Some of these conditions are more common
than others. Some of the types of disabilities are
recognized by the government in order to provide disability
benefits to the needy ones. Often people wonder what are
the disabling conditions that are more prevalent. Here is
the list of 21 disabilities that have been identified under
the RPWD Act 2016 of India.
1. Blindness
Blindness is defined as the state of being sightless. A blind
individual is unable to see. In a strict sense the word
blindness denotes the condition of total blackness of vision
with the inability of a person to distinguish darkness from
bright light in either eye.

2. Low-vision
Low-vision means a condition where a person has any of
the following conditions, namely:

1. visual acuity not exceeding 6/18 or less than 20/60

upto 3/60 or upto 10/200 (Snellen) in the better eye
with best possible corrections; or
2. limitation of the field of vision subtending an angle
of less than 40 degree up to 10 degree.

3. Leprosy Cured Persons

Leprosy, also known as Hansen’s disease (HD), is a chronic
infectious disease caused by a bacteria
called Mycobacterium leprae. The disease mainly affects
the skin, the peripheral nerves, mucosal surfaces of the
Page 18 of 31
upper respiratory tract and the eyes. Leprosy is known to
occur at all ages ranging from early infancy to very old age.
About 95% of people who contact M. Leprea do not
develop the disease.

4. Hearing Impairment
Hearing impairment is a partial or total inability to hear. It
is a disability which is sub-divided in two categories
of deaf and hard of hearing.

“Deaf” means persons having 70 dB hearing loss in

speech frequencies in both ears.
“Hard of hearing” means person having 60 dB to 70
dB hearing loss in speech frequencies in both ears.

5. Locomotor Disability
Strictly speaking Locomotor Disability means problem in
moving from one place to another — i.e. disability in legs.
But, in general, it is taken as a disability related with bones,
joints and muscles. It causes problems in person’s
movements (like walking, picking or holding things in hand
etc.)

6. Dwarfism
Dwarfism is a growth disorder characterized by shorter
than average body height.

7. Intellectual Disability
Intellectual disability, also known as general learning
disability and mental retardation (MR), is a condition
characterized by significant limitation both in intellectual
functioning (reasoning, learning, problem solving) and in
adaptive behavior which covers a range of every day, social
and practical skills.

8. Mental Illness
Mental illness or mental disorder refers to a substantial
disorder of thinking, mood, perception, orientation or
memory that grossly impairs judgment, behavior, capacity
to recognize reality or ability to meet the ordinary
Page 19 of 31
demands of life. But it does not include retardation which
is a condition of arrested or incomplete development of
mind of a person, specially characterized by sub-normality
of intelligence.

9. Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is a neurological and
developmental disorder which affects communication and
behavior. Autism can be diagnosed at any age. But still it is
called a “developmental disorder” because symptoms
generally appear in the first two years of life. Autism affects
affects the overall cognitive, emotional, social and physical
health of the affected individual.

10. Cerebral Palsy

Cerebral Palsy (CP) is a disabling physical condition in which
muscle coordination is impaired due to damage to the
brain. It occurs at or before child birth. Cerebral Palsy is not
a progressive condition; meaning it does not get worse
with time. However, muscle disuse could increase the
extent of disability over the period of time. At present
there is no cure available for this condition. Thus, Cerebral
Palsy is incurable and life-long condition, at present.

11. Muscular Dystrophy

Muscular Dystrophy (MD) is a group of neuromuscular
genetic disorders that cause muscle weakness and overall
loss of muscle mass. MD is a progressive condition;
meaning that it gets worse with the passage of time.

12. Chronic Neurological Conditions

Examples of Chronic Neurological Conditions:

1. Alzheimer’s disease and Dementia

2. Parkinson’s disease
3. Dystonia
4. ALS (Lou Gehrig’s disease)
5. Huntington’s disease
Page 20 of 31
 6. Neuromuscular disease
7. Multiple sclerosis
8. Epilepsy
9. Stroke
13. Specific Learning Disabilities
Specific Learning Disabilities is a group of disabling
conditions that hampers a person’s ability to listen, think,
speak, write, spell, or do mathematical calculations. One or
more of these abilities may be hampered.

14. Multiple Sclerosis

In Multiple Sclerosis (MS), the immune system of body
attacks the Central Nervous System, which includes brain
and spinal cord. As a result of MS, the myelin
sheath covering on neurons gets damaged. This exposes
the nerve fiber and causes problems in the information
flow through nerves. With time, MS can lead to the
permanent damage to nerves.

15. Speech and Language Disability

A permanent disability arising out of conditions such as
laryngectomy or aphasia affecting one or more
components of speech and language due to organic or
neurological causes.

16. Thalassemia
Thalassemia is a genetically inherited blood disorder which
is characterized by the production of less or abnormal
hemoglobin. As we know, hemoglobin is a protein found in
Red Blood Cells. Hemoglobin is responsible for carrying
oxygen around in the body. Thalassemia results in large
numbers of red blood cells being destroyed, which leads to
anemia. As a result of anemia, person affected with
Thalassemia will have pale skin, fatigue and dark coloration
of urine.

17. Hemophilia

Page 21 of 31
Hemophilia is a blood disorder characterized by the lack of
blood clotting proteins. In the absence of these proteins,
bleeding goes on for a longer time than normal.
Hemophilia almost always occurs in males and they get it
from their mothers. Females are rarely affected with
hemophilia.

18. Sickle Cell Disease

Sickle Cell Disease is a group of blood disorders that causes
red blood cells (RBCs) to become sickle-shaped, misshapen
and break down. The oxygen-carrying capacity of such
misshapen RBCs reduce significantly. It is a genetically
transferred disease. Red Blood Cells contain a protein
called hemoglobin. This is the protein that binds oxygen
and carry it to all the parts of the body.

19. Multiple Disabilities including Deaf-blindness

Multiple Disabilities is the simultaneous occurrence of two
or more disabling conditions that affect learning or other
important life functions. These disabilities could be a
combination of both motor and sensory nature.

20. Acid Attack Victims

An acid attack victim means a person disfigured due to
violent assaults by throwing of acid or similar corrosive
substance.

21. Parkinson’s disease

Parkinson’s disease (PD) is Central Nervous System disorder
which affects movement. Parkinson’s disease is
characterized by tremors and stiffness. It is a progressive
disease, which means that it worsens with time. There is
no cure available at present.

Government of India uses the term benchmark

disability quite often in the official communications
regarding persons with disabilities. Often you come across
question like “are you a person with benchmark
disability?”. For example, in the Rights of Persons with
disabilities Act 2016 (RPWD Act 2016), this term is used at

Page 22 of 31
many places. Department of Personnel and Training (DoPT)
also uses it often in their job vacancy ads where certain
seats are reserved for the disabled people. Then you also
find mention of this term in context of examinations like
UPSC, Bank Services, NET Exams etc.

But most people do not understand what exactly is this

benchmark disability. Well, here is the answer!

Benchmark disability refers to having at least 40%

disability of any type recognized under the RPWD Act
2016.

So, to be in the category of having benchmark disability, a

person has to have at least 40% disability as mentioned on
her disability certificate or UDID Card.

1.4 An overview of Causes, Prevention,

prevalence & demographic profile of
disability: National and Global;

Prevalence of a condition or disability in determined by

epidemiology.

Epidemiology is a science concerned with the study of

factors that influence the occurrence and distribution of
disease, defect, disability, or death in aggregation of
individuals. Epidemiology involves making a determination
or estimate of the number of cases of some condition in a
population. In addition, it attempts to relate this estimate
to other classification of population, such as age, sex, and
social class.

A good epidemiologist depends upon the definition of the

condition in question. If the condition is poorly or vaguely
defined, there will be a problem with the estimates of its
occurrence.

An epidemiologist uses two methods for estimating the

occurrence of a condition in a population: the incidence
rate and the prevalence rate.

Difference between Incidence and Prevalence

Page 23 of 31
Incidence refers to the number of new cases in population
during a specified period of time. Prevalence refers to the
total number of cases in a population group during a
specified period of time.

As per the Census 2011, the differently abled population

in India is 26.8 million. In percentage terms, this stands at
2.21 %. There has been a marginal increase in the
differently-abled population in India, with the figure rising
from 21.9 million in 2001 to 26.8 million over the period
of 10 years.
As per the Census 2011, there are 14.9 million men with
disabilities as compared to 11.9 million women in the
country. The total number of differently-abled people is
over 18.0 million in the rural areas and just 8.1 million
enumerated in the urban settings. The percentage of men
with disabilities is 2.41 per cent as against 2.01 in women.
Social groups wise analysis shows 2.45 per cent of the
total disabled population belong to the Scheduled Castes
(SC), 2.05 per cent to the Scheduled Tribes (ST) and 2.18
per cent to other than SC/ST.
About 15% of the world's population lives with some form
of disability, of whom 2-4% experience significant
difficulties in functioning. The global disability prevalence
is higher than previous WHO estimates, which date from
the 1970s and suggested a figure of around 10%. This
global estimate for disability is on the rise due to
population ageing and the rapid spread of chronic
diseases, as well as improvements in the methodologies
used to measure disability.
A few outstanding figures of disability around the world
(according to the WHO’s 2011 report):
· 253 million people are affected by some form
of blindness and visual impairment. This
represents 3.2% of the world’s population. That’s
twice Mexico’s population*!
· 466 million people have a disabling deafness and
hearing loss. This represents 6% of the world’s
population, that is to say all of the inhabitants of the
European Union!
· About 200 million people have an intellectual
disability (IQ below 75). This represents 2.6% of the
world’s population. It covers the number of
inhabitants in Brazil!
· 75 million people need a wheelchair on a daily basis.
This represents 1% of the world’s population. That’s

Page 24 of 31
 twice Canada’s population!
These statistics may remain an evolutionary average, but
one thing is certain: the number of people affected by any
form of disability represents a significant part of the world
population, from children to adults alike. It is also
important to underline the fact that some people may
have multiple disabilities. This explains why the total
number of people with disabilities in the world isn’t equal
to the sum of people with disabilities per disability type.
Indeed, the same person can be both deaf and blind.

CAUSES
Risk factors for the disabilities:
Communicable diseases (Infectious diseases) such as
lymphatic filariasis, tuberculosis, HIV/AIDS, and other
sexually transmitted diseases; neurological consequences
of some diseases such as encephalitis, meningitis, and
childhood cluster diseases (such as measles, mumps, and
poliomyelitis) contribute to disability.
Non communicable diseases (NCDs)–
· Chronic diseases such as diabetes, cardiovascular
disease, arthritis and cancer cause the majority of
long-term disabilities. The increase in NCDs observed
in all parts of the world, will have a profound effect
on disability.
· Lifestyle choices and personal behavior such as
obesity, physical inactivity, tobacco use, alcohol
consumption, illicit drugs that lead to non
communicable diseases are also becoming major
contributing factors;
· Air pollution, occupational disease, poor water
supply, sanitation, and personal and domestic
hygiene, malnutrition also contribute for disability.
Injuries due to road traffic accidents, occupational injury,
violence, conflicts, falls and landmines have long been
recognized as contributors to disability.
Mental health problems– mental health retardation and
mental illness are the causes of mental disability. In more
than 50% cases mental retardation has been reported to be
caused by serious illness or head injury in the childhood
and birth defects. Mental retardation was observed mostly
at birth or at very early ages of life while the problem of
mental illness is more of an old age problem.
Those with lower education levels, lower incomes, and

Page 25 of 31
those who are unemployed were also more likely to suffer
a disability.
There is higher risk of disability at older ages.

PREVENTION OF DISABILITIES

Primary Prevention – Action taken prior to the onset

of the disease/disability, which will remove the
possibility that a disease/disability will occur.
Secondary Prevention – Action, which halts the
progress of the disease/disability at its incipient stage
and prevents complications. The specific interventions
are early diagnosis and adequate treatment.
Tertiary Prevention – All measures available to reduce
or limit impairments and disabilities, and minimize
suffering caused by existing disability. This phase is
also called rehabilitation, which includes physical,
psychosocial and vocational measures taken to
restore the patient back to normal or near normal
condition
It is extremely important that the women undertake
adequate and effective preventive measures during their
pregnancy and immediate postnatal period and also for
their children especially during the early childhood period,
in order to significantly reduce the incidence of impairment
and disabilities in them. Therefore, in this chapter
examples of easily understood primary preventive
measures, for mother and child are summarized.
General preventive measure
1. Marriage between very close blood relations like
uncle, niece, first cousin should be avoided for
prevention of hereditary disorders.
2. Avoid pregnancies before the age of 18 years and
after the age of 35 years.
3. Consult a doctor before planning the pregnancy;

If there is incidence of birth defects in your

family.
If you have had difficulty in conceiving or have
had a series of miscarriages, still births, twins,
delivery by operation (Caesarean), obstructed

Page 26 of 31
 labour/prolonged labour(more than 12 hours)
and/or severe bleeding in previous pregnancy .
If you have RH - negative blood type.
If you have diabetes.
Care during pregnancy
1. Avoid hard physical work such as carrying heavy
loads, especially in fields, and other accident - prone
activities such as walking on slippery ground or
climbing stools and chairs.
2. Avoid unnecessary drugs and medications. Even the
normally considered safe drugs which are sold
commonly can potentially cause serious defects in an
unborn child.
3. Avoid smoking, chewing tobacco, consuming alcohol
and narcotics.
4. Avoid X - rays, and exposure to any kind of radiation.
5. Avoid exposure to illnesses like measles, mumps etc,
especially during the first 3 months of pregnancy.
6. Avoid sexual contact with a person having venereal
disease.
7. Take precautions against lead poisoning.
8. Avoid too much use of ‘Surma’ and ‘Kohl’.
9. Eat a well-balanced and nourishing diet
supplemented with green leafy vegetables, proteins
and vitamins.
[Link] women of the child bearing age need 0.4mg of
folic acid daily. It is also available in folic acid plus
iron tablets which should be taken for at least 3
months during the third trimester when the risk of
developing iron deficiency anemia is greatest.
[Link] weight gain of at last 10 kgs. Have regular
medical checkups.
[Link] pregnant women should be given tetanus
injection.
[Link] at ‘high - risk’, whose weight is < 38 Kg,
height is less than 152 cm, weight gain during
Page 27 of 31
 pregnancy <6 kg or who is severly anaemia c (Hb <
8mg), having frequent pregnancies, having a history
of miscarriage/ abortion/premature deliveries, must
get expert prenatal care so as to have a normal baby.
[Link] consult a doctor, in case of edema (swelling) of
feet, persistent headache, fever, difficulty or pain in
passing urine, bleeding from the vagina, and
yellowness of eyes (jaundice)
Care at the time of birth
1. Delivery must be conducted by trained personnel,
preferably in a hospital where all facilities are
available.
2. If a baby does not cry immediately after birth,
resuscitation measures should be undertaken at
once.
3. Babies born prematurely and with a low birth weight
(<2.5 Kg) may need Neonatal Intensive Care.
4. If the baby’s head appears to be abnormally small or
large then a physician should be consulted,
preferably a pediatrician. The approximate head size
for a male child at birth is 35 cm and for female child
is 34.5 cm.
5. To protect a child from infections, breast - feeding
must be started immediately after birth. First milk
(colostrum) must be fed to the baby and should not
be thrown away, as it has antibodies which are
protective.
Early childhood care
1. Do not allow a child’s temperature to rise above 101
degree F because of any reason. It can cause febrile
seizures
2. If a child gets a fit take him to doctor immediately.
3. Every child should be immunized against infectious
diseases as per the recommended schedule of
immunization.
4. Do not allow a child to have too much contact with
paint, newsprint ink, lead etc. as they are toxic.
5. Take precautions against head injury, and other
Page 28 of 31
 accidents.
6. Ensure that the child gets a well-balanced diet and
clean drinking water.
7. Introduce additional foods of good quality and in
sufficient quantity when the child is 4 -6 months old.
8. Vitamin A deficiency and its consequences including
night blindness can be easily prevented through the
use of Vitamin A supplementation.
9. Protect a child from Meningitis and Encephalitis by
providing a hygienic environment which is free of
overcrowding.
[Link] salt must be iodized as a precaution against
goiter and cretinism.
[Link] not allow a child to use hairpins, matchsticks and
pencils, to remove wax from the ears.
[Link] ear protectors to reduce the exposure to high
levels of noise, if children are living or working in a
noisy environment.
[Link] not slap a child over the face as this may lead to
injury of the eardrum and consequent hearing loss

1.5 Concept, meaning and importance of Cross

Disability Approach and interventions;

CROSS DISABILITY APPROACH:- This historical fact

changed with the emergence of DPI(Disabled people
international) the slogan of DPI is “nothing about us
without us”.
DEFINITION:- it is an approach that does not distinguish
between types of disability.
In other words – it is an approach which comprehensively
takes in to account all different kinds of disabilities
together and promote collective planning
In this approach focusing on particular subgroup should b
avoided whenever possible because “distinction often
leads the most vulnerable people to further
stigmatization.” This is about making policy decision
collectively and gives equal wattage across all disabilities
for the disabled people themselves. This approach seeks

Page 29 of 31
co-operation and network on various categories of
disabled.
Includes different disabled persons and with different
abilities.
NEEDS OF CROSS DISABILITY:-

For fulfillment of right to equality there is very necessary to

include all the persons in a same frame work unless they
have different abilities.
· Better access to decision-making.
Without involvement of all disabled/differently able
in a same context, it is not easy to access to making
decision on their rights and needs.
Disabled people should be participated their own
policies decision and program for themselves.
We cannot access the needs of disabled people
because the disabled people know their needs very
well. So, participation of disabled people is very
necessary.
· Main need is equal opportunities.
· Equal Membership to the society and respect
of the individual and equal right is necessary.
For respect of the equal right, there should be equal
membership of the entire person (normal/disabled)
to the society is needed.
· Need to be protected, need to be promoted
and spread out.

BENEFITS OF CROSS DISABILITY APPROACH: - The cross-

disability movement has rainbow approach to include all
those who are given a disability label in fact some have
named it the movement of the dis-labled.
It leads to-
o Independence: as we have discussed cross
disability approach provide exposure to
disabled to mix in society, the disabled learn
to live independent, work independent for
achieving equality level.
o Full citizenship: in past disabled person did not
consider as a full citizen because they were
not an active part of society due to disability,
but cross disability approach provided
opportunities in making decision and
participation, they considered as full citizen.
o Total inclusion:
Page 30 of 31
o Promote leader ship:
o Full enforcement and implementation of
disability related laws.
o Program-to enhances the life and it reduces
the poverty and unemployment.
o It ensures the right to live.
o Uniformity in the terminology of the disability.
o To educate the public and government policy
makers regarding issues and affecting people
with disability.

Page 31 of 31