Chapter I

Introducing Disability

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CONCEPTUALIZING DISABILITY

Disability is any condition that makes it difficult for a person to do certain activities or
effectively interact with the world around him or her. These conditions or impairments may be
cognitive, developmental, intellectual, mental, physical, sensory, or a combination of two or more
such factors. Impairments causing disability may be present from birth or can be acquired during a
person's lifetime. The United Nations Convention on the Rights of Persons with Disabilities defines
disability as, “Long-term physical, mental, intellectual or sensory impairments which in interaction
with various barriers may hinder a person's full and effective participation in society on an equal
basis with others. According to the World Health Organization, disability has three dimensions: (i)
Impairment in a person’s body structure or function, or mental functioning. For example,
impairments include loss of a limb, loss of vision or memory loss; (ii) Activity limitation, such as
difficulty seeing, hearing, walking, or problem solving; and (iii) Participation restrictions in normal
daily activities, such as working, engaging in social and recreational activities, and obtaining health
care and preventive services.

Difference between impairment and Disability: Definitions of disability often vary

according to different classifications used. The most commonly cited definitions are by the World
Health Organisation (WHO, 1980) and the United Nations Enable (2009), which draws a distinction
between impairment and disability. According to WHO, impairment is any loss or abnormality of
psychological, physiological or anatomical structure or function while disability is any restriction or
lack of ability to perform an activity in the manner or within the range considered normal for a
human being. According to disability advocacy movement, these definitions of the World Health
Organisation created an individual or medical approach to ‘disability' and 'impairment', because of
its focus on the ‘loss’ of the individual by referring to the physical or cognitive limitations.
Similarly, disability in this definition also focuses on activity limitations and participation
restrictions resulting in various social approaches in conceptualizing disability. Since, 1970s,
number of psychosocial approaches to disability theory have been developed. The following
Knowledge Box gives a summary of the review of different conceptualizations of disability.

Knowledge Box 1. Review of different conceptualizations of disability

Source
Hahn (1986)

Oliver (1990,
1996)
Bickenbach
Models
• Medical
• Economic
• Minority
Individual (medical)
• Social
Biomedical
Basic Understanding
 Disability as functional loss
• Disability as a socioeconomic issue (work)
 Disability as oppressed minority
Disability as functional loss
• Disability as product of disabling environment
Disability as functional loss
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(1993) • Economic • Disability as a socioeconomic issue (work)

• Minority
Priestley (1998) • Individual materialist (medical)
• Individual idealist
• Social materialist
• Social idealist (constructionist)
• Disability as oppressed minority
Disability as functional loss
• Disability as stigma (disabled/non- disabled)
• Disability as product of disabling environment
• Disability as cultural representation

WHO Report on Disability

The United Nations Convention on the Rights of Persons with Disabilities (CRPD) adopted
a resolution in 2006, which aims to promote, protect and ensure the full and equal enjoyment of all
human rights and fundamental freedoms by all persons with disabilities, and to promote respect for
their inherent dignity. In fact, the resolution reflects the first major shift in the understanding of
responses and responsibilities towards disability. The resolution explained that disability is a part of
the human condition and almost everyone will be temporarily or permanently impaired at some
point in life, and those who survive to old age will experience increasing difficulties in functioning.
It further highlighted that disability is a complex issue, and the interventions to overcome the
disadvantages associated with disability are multiple and systemic, varying with the contexts.
Therefore, the report provided an extensive picture of the situation of people with disabilities, their
needs and unmet needs, and the barriers they face in participating fully in their societies. Successive
chapters in the report documented about the data, health; rehabilitation, assistance and support,
enabling environments, education, and employment relating to disability. For each area, the report
highlights a range of good practice examples which governments and civil societies can emulate, to
help establish an inclusive and enabling society in which people with disabilities can flourish. The
main messages of the report are as follows:
(i) Paradigm shift in approaches to disability: In recent decades the move has been away
from a medical understanding towards a social understanding of disability. According to the
changed approach, disability arises from the interaction between people with a health condition and
their environment. Therefore, the CRPD reflects the emphasis on removing environmental barriers
which prevent inclusion of disability in the mainstream of life.
(ii) Disability prevalence is high and growing: There are over one billion people with
disabilities in the world of whom between 110-190 million experience very significant difficulties.
This corresponds to about 15% of the world’s population and is higher than previous World Health
Organization (WHO) estimates, which date from the 1970s and suggested a figure of around
5% increase. The prevalence of disability is growing due to population ageing and the global
increase in chronic health conditions. Patterns of disability in a particular country are influenced by
trends in health conditions and trends in environmental and other factors such as road traffic
crashes, natural disasters, conflict, diet and substance abuse. Hence, there has to be more efforts to
check the growing prevalence of disability.
(iii) Disability disproportionately affects vulnerable populations: The report pointed out
prevalence of disability is not uniform across the vulnerable populations. For example, disability is
more common among women, older people and poor households than their counterparts in the
society. Further, lower income countries have a higher prevalence of disability than higher income
countries. Hence, these disability factors need to be taken care of to help a comprehensive effort in
dealing with disability.
(iv) Disability is very diverse. Stereotypical views of disability only emphasize wheelchair
users and a few other “classic” groups such as blind and deaf people. However, the disability
experience is not so limited. Individuals with disabilities not only intersect across all walks of life,
in all professions, across all races, and religions but also in the diverse range of each different types
of disability.
(v) Barriers of disability: People with disabilities face widespread barriers in accessing
services of health, education, employment, transport as well as information. These include
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inadequate policies and standards, negative attitudes, lack of service provision, inadequate funding,
lack of accessibility, inadequate information and communication and lack of participation in
decisions that directly affect their lives.
(vi) Health and Socioeconomic conditions: People with disabilities have worse health and
socioeconomic outcomes. Across the world, people with disabilities have poorer health, lower
educational achievements, less economic participation and higher rates of poverty than people
without disabilities.
Recommendations of the Report
(i) Enable access to all mainstream systems and services: People with disabilities have
ordinary needs, which can and should be met through mainstream programmes and services.
Mainstreaming is the process by which governments and other stakeholders address the barriers that
exclude persons with disabilities from participating equally in any service intended for the general
public, such as education, health, employment, and social services. This requires changes in laws,
policies, institutions and environments. Mainstreaming not only fulfils the human rights of persons
with disabilities, it can also be more cost effective.
(ii) Invest in programmes and services for people with disabilities: Some people with
disabilities may require access to specific measures, such as rehabilitation, support
services, or vocational training, which can improve their functioning and independence and foster
their participation in the society.
(iii) Adopt a national disability strategy and plan of action: All sectors and stakeholders
should collaborate on a strategy to improve the well-being of people with disabilities. This will help
improve coordination between sectors and services. Progress should be monitored closely by the
government and civil societies.
(iv) Involve people with disabilities: In formulating and implementing policies, laws and
services, people with disabilities should be consulted and actively involved. At an individual level,
persons with disabilities are entitled to have control over their lives and therefore, need to be
consulted on issues that concern them directly.
(v) Improve human resource capacity: Human resource capacity can be improved through
effective education, training and recruitment. For example training of health professionals,
architects and designers should include relevant content on disability and be based on human rights
principles.
(vi) Provide adequate funding and improve affordability: Adequate and sustainable funding
of publicly provided services is needed to remove financial barriers to access and ensure that good
quality services are provided.
(vii) Increase public awareness and understanding about disability: Mutual respect and
understanding contribute to an inclusive society. It is vital to improve public understanding of
disability, confront negative perceptions, and represent disability fairly
(viii) Improve the availability and quality of data on disability: Data need to be standardized
and internationally comparable to benchmark and monitor progress on disability policies and on the
implementation of the CRPD nationally and internationally. At the national level, all types of
relevant disability data should be collected, organized, and explained by professional experts.
Dedicated disability surveys can also be carried out to gain more comprehensive information.
(ix) Strengthen and support research on disability: Research is essential for increasing
public understanding about disability, informing disability policy and programmes, and efficiently
allocating resources. More research is needed, not just about the lives of people with disabilities, but
also about social barriers, and how these can be overcome.

Factors Affecting the Impact of Disability

Understanding the disability experience can be a multi-faceted process. In addition to living

with potentially functional limitations, individuals with disabilities face system-level barriers such
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as stigmas and discrimination. These barriers can impact how they think, feel and interact with the
world around them. Their specific challenges include issues relating to personal development,
educational achievement, vocational goals, socialization, recreational activities and general aspects
of well being. These challenges, however, can be addressed and confronted through a variety of
interventions, including assistive technology. People respond to disabilities in different ways. Some
react negatively and thus their quality of life is negatively affected. Others choose to focus on their
abilities as opposed to their disabilities and continue to live a productive life. There are several
factors that affect the impact of disability on an individual. The following are often considered the
most significant factors in determining a disability's impact on an individual.
 The Nature of the Disability – Was the disability acquired (a result of an accident, or
acquired disease) or congenital (present at birth)? If the disability is acquired, it is more likely to
cause a negative reaction than a congenital disability. Congenital disabilities are disabilities that
have always been present, thus requiring less of an adjustment than an acquired disability.
 The Individual’s Personality - Is the individual typically positive or negative, dependent or
independent, goal-oriented or laissez-faire? Someone with a positive outlook is more likely to
accept a disability than someone with a negative outlook. Someone who is independent will
continue to be independent and someone who is goal-oriented will continue to set and pursue goals,
despite disability, and hence, is likely to be less affected by disability.
 The Meaning of the Disability to the Individual - Does the individual define himself/herself by
his/her looks or physical characteristics? If so, he/she is more likely to feel defined by his/her disability and
thus it will have a negative impact. 
 The Individual’s Current Life Circumstances - Is the individual independent or dependent on
others (parents)? What is the economic status of the individual or the individual's caregivers? What
is the individual's education level? If the individual is happy with their current life circumstance,
they are more likely to accept their disability, whereas if they are not happy with their
circumstances, they often blame their disability.
 The Individual's Support System - Does the individual have good support from family,
significant others, friends, or social groups?  If so, he/she will have an easier time coping with a
disability and thus will not be affected negatively by his / her disability.

Knowledge Box 2. Factsheet on persons with disabilities Organization

 The first ever report on disability was produced jointly by WHO and the
WHO
World Bank in 2011
 Around 15 per cent of the world’s population, or estimated 1 billion people,
WHO
live with disabilities. They are the world’s largest minority.
 This figure is increasing through population growth, medical advances and
WHO
the ageing process.
 In countries with life expectancies over 70 years, individuals spend on Disabled
average about 8 years, or 11.5 per cent of their life span, living with disabilities. World
 Disability rates are significantly higher among groups with lower
educational attainment. On average, 19 per cent of less educated people have OECD
disabilities, compared to 11 per cent among the better educated.
 Women report higher incidents of disability than men. Women with
disabilities are recognized to be multiply disadvantaged, experiencing exclusion on
account of their gender and their disability. Women and girls with disabilities are
Disabled
particularly vulnerable to abuse. A small 2004 survey in Orissa, found that virtually
World
all of the women and girls with disabilities were beaten at home, 25 per cent of
women with intellectual disabilities had been raped and 6 per cent of women with
disabilities had been forcibly sterilized.
 Comparative studies on disability legislation shows that only 45 countries in
the world have anti-discrimination and other disability-specific laws.
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 Ninety per cent of children with disabilities in developing countries do not

UNESCO
attend school
 The global literacy rate for adults with disabilities is as low as 3 per cent,
and 1 per cent for women with disabilities, UNDP

 Unemployment among the persons with disabilities is as high as 80 per cent

in some countries. Often employers assume that persons with disabilities are unable ILO
to work
 Even though persons with disabilities constitute a significant 5 to 6 per cent
of India’s population, their employment needs remain unmet, says a study by
India’s National Centre for Promotion of Employment for Disabled People, in spite
NCPED
of the “People with Disabilities” Act, which reserves for them 3 per cent of
government jobs. Of the some 70 million persons with disabilities in India, only
about 100,000 have succeeded in obtaining employment
WHO-World Health Organization OECD- Organisation for Economic
Co-operation and Development
ILO-International Labour Organization UNESCO-United Nations Educational,
Scientific and Cultural Organization
UNDP-United Nations Developmental Program NCPED- National Centre for Promotion of
Employment for Disabled

Types of Disability

Disability of people can be categorized into different types basing on their physical and functional
impairments. Major types of disabilities include physical, sensory, intellectual, and emotional disabilities.
(i) Physical Disability: Physical disability is a limitation on a person's physical functioning. It is a
substantial and long-term condition affecting a part of a person’s body that impairs his / her physical
functioning, mobility, stamina or dexterity. A person may be born with a physical disability or acquire it in
life due to an accident, injury, illness or as a side effect of a medical condition. Physical disabilities can be
caused by hereditary, congenital or acquired reasons. A person with a hereditary or congenital physical
disability has had the condition since birth, and developed the condition because of inherited genetic
problems. Similarly, a person can acquire a physical disability due to a number of reasons. These can be
severe accidents, brain injuries, infections, diseases and as a side effect of disorders and other medical
conditions, such as a stroke and dementia. There are a vast number of physical disabilities, each affecting
people differently.
Musculoskeletal disability: Musculoskeletal disability affects the joints, bones and muscles and
includes loss or deformity of limbs. These disabilities result in an inability to perform movements of body
parts due to deformities, diseases or degeneration affecting the muscles or bones. Common musculoskeletal
disabilities include back and neck pain, osteoarthritis, fractures associated with bone fragility and
inflammatory conditions like rheumatoid arthritis. Brittle bone disease and muscular dystrophy are common
diseases of musculoskeletal disability.
Neuromusculoskeletal disability: Neuromusculoskeletal disability is defined as the inability to move
affected body parts due to diseases, degeneration or disorder of the nervous system, resulting in physical
disability. Conditions that create neuromusculoskeletal disabilities are cerebral palsy, spina bifida, spinal
cord injury, multiple sclerosis, arthritis, and poliomyelitis.
(a) Cerebral palsy occurs in young children and is a group of non-progressive disorders that damage
the brain, causing impairment of motor function. Including associated disabilities such as intellectual and
behavioural, a person with cerebral palsy usually has problems with movement and co-ordination.
(b) Spina bifida occurs when there are problems in the development of a baby’s spinal cord, resulting
in a gap in the spine, causing spinal nerves to be exposed. The developmental defect of the spinal canal may
cause paralysis of the lower part of the body. Additionally, the person may lose bowel and bladder control as
a result.
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(c) Spinal cord injuries can result in total or partial impairment of sensory and motor functions in the
body and limbs. A spinal cord injury can lead to paraplegia, and tetraplegia.. Paraplegia affects the lower
limbs and results in a loss of movement and bowel and bladder control. Tetraplegia is a paralysis affecting
arms and legs, the stomach and some chest muscles, resulting in total impairment of sensory and motor
functions.
(d) Multiple sclerosis (MS) is a condition affecting a person’s brain and spinal cord, causing a range
of physical problems including movement, sensation and balance. Symptoms can include but are not limited
to fatigue, loss of motor control, numbness and visual disturbances.
(e) Arthritis comes in many forms and causes pain and inflammation in joints and can affect children
as well as adults. The most common form of arthritis is osteoarthritis, which affect the smooth cartilage
lining of the joint, making movement more difficult and can cause pain and stiffness.
(f) Poliomyelitis commonly known as polio is an acute viral disease usually affecting children and
young adults. The disease is characterized by inflammation of the motor neurons of the brain stem and spinal
cord resulting in a motor paralysis followed by muscular atrophy and often permanent deformities.
(ii) Sensory Disability: Sensory disability is a neurological disorder that affects the human brain to
process sensory information such as sight, hearing, taste, touch, and smell normally and properly. The most
common sensory disabilities include:
(a) Vision impairments - Vision impairments are either categorised into low vision or blindness. Low
vision can affect people of all ages and impact on many aspects of a person’s life, including recognising
faces, reading the newspaper, using a telephone and reading road signs, whereas a complete loss of vision
causes difficulty in mobility and everyday tasks.
(b) Hearing impairments - Hearing impairments are problems that occur within the hearing pathway.
They can cause learning and speech difficulties in young children which can be supported through speech
therapy. Hearing impairments can be a total or partial loss of hearing.
(c) Autism Spectrum Disorder - A lifelong developmental condition categorised by difficulties in social
interaction, communication, sensory processing and restricted interests and behaviours. People with Autism
relate to their environment and other people differently.
(d) Sensory Processing Disorder - A neurological condition causing misinterpretation of the world and
other people through hearing, vision, taste, smell, touch, pressure and movement.
(iii) Intellectual Disability: Intellectual disability, also called developmental disability or mental
retardation is a conditions characterized by subnormal intellectual functioning and impaired adaptive
behaviour that are identified during the individual's developmental years. It is defined by an IQ under 70, in
addition to deficits in two or more adaptive behaviours that affect every day’s general living. Subnormal
intellectual functioning among the intellectually disabled include deficiencies in reasoning, problem solving,
planning, abstract thinking, judgment, academic learning, and learning from instruction and experience.
Similarly, adaptive behaviour is defined in terms of conceptual, social, and practical skills involving tasks
performed by people in their everyday lives. Intellectual disability is subdivided into syndromic intellectual
disability non-syndromic intellectual disability Syndromic intellectual disability is characterized by the
presence of associated medical and behavioural sign and symptoms. Down syndrome and fragile X
syndrome are examples of syndromic intellectual disabilities. In non-syndromic or idiopathic intellectual
disability, intellectual deficits appear without other abnormalities. 
The common types of intellectual disabilities include autism, Down’s syndrome, fragile X syndrome,
fetal alcohol syndrome, and Prader-Willi syndrome.
(a) Autism- Autism is an intellectual disability affecting the nervous system and the structure and
function of the brain. The disability affects the way an individual communicates acts, learns, and interacts
with other people. An individual with autism has social skill challenges, including interacting with other
people, communication, repetitive behaviours, and restricted interests. Different individuals with autism can
show different symptoms, making the disability referred to as a spectrum disorder. A spectrum disorder is a
group of disorders with a range of similar characteristics. Some of the common signs and symptoms of
autism are difficulty in communicating, restricted behaviours , avoiding social groups and relationships ,
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challenges with abstract thinking , dislike for changes in routine, repetitive behaviour and challenges
following social norms 
(b) Down’s Syndrome- Down’s syndrome is an intellectual disability stemming from having a part of or
an extra copy of chromosome 21 in the DNA. It is the most common chromosomal cause of mild to
moderate intellectual disabilities in children. Down syndrome affects development in children in reaching
key developmental stages later than the rest of the same age children. Down syndrome’s common symptoms
include slow learning, short attention span, impulsive behaviour, poor judgment, and delayed language and
speech development. Children with Down syndrome have poor muscle tone, making them take longer to
learn how to make some movements such as turning over, walking, standing, and sitting. Some of the
physical characteristics of individuals with Down syndrome include flattened facial profile and nose, upward
slanting eyes, and small head, ears, and mouth.  Additionally, individuals with Down syndrome are prone to
other health factors such as heart abnormalities, hearing loss, vision problems, and respiratory conditions.
Although children with Down syndrome have a slower development rate, they will eventually meet all or any
of the development milestones. Also, the lifespan of individuals with Down syndrome has increased due to
increased research and technology in the area.
(c) Fragile X Syndrome- Fragile X Syndrome is the most prevalent form of inherited developmental and
intellectual disability. This genetic disorder results from a change or mutation in the X chromosome. The
disability affects the development of a person, more so in the areas of learning and behaviour. What’s more,
it can affect physical appearance, communication skills, and sensitivity to the individual’s light and noise
with intellectual disability.  It is worth noting that the fragile x syndrome disability is more prevalent in boys
than girls.  Individuals with fragile x syndrome do not exhibit the same signs and symptoms. However, they
have common signs, including: Problems with speech and language, Attention disorders Problems with
hyperactivity, Anxiety  Developmental delay , Problems processing sensory information, Aggressiveness
(ADHD), Trouble making eye contact 
(d) Fetal Alcohol Syndrome- Fetal alcohol syndrome is an intellectual disability caused by exposure to
alcohol during pregnancy. Women who drink alcohol during pregnancy expose their children the risk
of this disability. The severity of the disability depends on the child’s level of exposure to alcohol during
pregnancy, where mothers who drink large quantities of alcohol during pregnancy increase the risk of severe
symptoms in their children.  The common symptoms found in children with fetal alcohol syndrome include:
Facial, limb, and joint deformities, Poor memory and judgment, Learning disabilities, Poor social skills,
Sensory difficulties, including hearing and vision, Heart problems and defects, Behavioural problems, Slow
physical growth 
(e) Prader-Willi Syndrome (PWS)- Prader-Willi syndrome is a genetic disorder occurring due to a
problem with a part of chromosome 15. Babies born with the disability are poor feeders at infancy. Still, the
feeding habit changes at the age of two, where the kids’ hunger becomes insatiable making them unable to
control their appetite. The voracious hunger leads to problems such as diabetes and obesity.  Symptoms of
individuals with Prader-Willi syndrome include: Intellectual disability (problem-solving, language, and math
difficulties), Poor muscle tone, Diabetes Obesity, Short stature, Hyperphagia, Emotional difficulties, Skin
picking, Hormone deficiencies Sleep issues such as sleep apnea.
(iv) Emotional Disability: An emotional disability is a condition that impacts a person's ability to
effectively recognize, interpret, control, and express fundamental emotions such as anger, love, hatred,
jealousy, affection etc. Emotional disability is a condition exhibiting one or more of the following
characteristics over a long period of time and to a marked degree that adversely affects the person’s life
skills. (i) An inability to learn which cannot be explained by intellectual, sensory, or health factors;
(ii) An inability to build or maintain satisfactory interpersonal relationships with peers, teachers and
other significant relations; (iii) Inappropriate types of behaviour or feelings under normal
circumstances; (iv) A general pervasive mood of unhappiness or depression; and (v) A tendency to
develop physical symptoms or fears associated with personal problems.
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Assessment and Diagnosis of Disability

Disability assessments are used to determine the nature of an individual's physical or mental
limitations to help the process of diagnosis, treatment, rehabilitation and support. There are defined
methods of assessment for different types of disability, and specific professionals are assigned with
the assessment process with each type of disability. From assessment to diagnosis, specific norms,
standards and procedures are formalized. The following are descriptions of assessment and
diagnosis of some common disabilities.
(i) Assessment of visual impairment
Tests of visual functions are at the core of current disability determination practices for
visually impaired. The assessment of visual functions includes visual acuity, visual field, contrast
sensitivity, and visual efficiency. Visual acuity (VA) is a measure of the ability of the eye to
distinguish shapes and the details of objects at a given distance. The visual acuity of a person is
commonly measured by using Snellen chart and the results of visual acuity testing are expressed in
Snellen notation. In Snellen notation, the visual acuity can be reported by two measures called
Snellen VA or VA (LogMAR). Snellen’s VA of ≥ 6/18 is considered mild vision loss, or near-
normal vision; < 6/18 to 6/60 is considered as moderate visual impairment, or moderate low vision;
<6/60 to 3/60 is considered as severe visual impairment, or severe low vision; < 3/60 to 1/60 is
considered profound visual impairment, or profound low vision, and finally <1/60 is considered
blindness. The corresponding LogMar and the category of impairment is given in Box 2 below.
Similarly, the visual field refers to the spatial extent over which the visual system is
sensitive to light. The size of the visual field is expressed in terms of visual angle, which is simply
the angle subtended at the eye. In normal eyes, the total monocular visual field extent is
approximately 160° horizontally and 100° vertically. Although, there are several problems
associated with the current method of making disability determinations for visual field loss, less
than central 30o location of the visual field is considered as visual impairment.
Contrast is a measure of the differences in luminance (brightness) across borders of the
objects of vision. For example, typical text, consisting of black print on a white background, has
very high contrast as much as 100 % in a good print. Contrast sensitivity is a measure of the lowest
contrast that an observer can detect. A subject's contrast sensitivity on such a chart is expressed as a
measure of the lowest contrast letters he or she can read correctly. Ideally, a contrast sensitivity test
for disability determination should satisfy several criteria, but when a person’s contrast sensitivity is
only above 70%, he or she is considered to have visual impairment.
Visual efficiency refers to the ability to effectively view visual information. While visual
efficiency refers to nearsightedness and farsightedness, it also includes problems with how the eyes
move in order to focus on visual information. Visual efficiency is measured by examining how
effectively the eyes work together as a team. The visual efficacy is calculated basing on the visual
skills such as Eye tracking and convergence. Poor visual efficacy is also considered as visual
impairment.

Knowledge Box 2. Snellen VA and VA Log MAR for levels

of visual impairment
Snellen VA VA Log MAR Category Classification
≥ 6/18 0.0-0.50 0 Mild or no VI
< 6/18-6/60 0.50-1.0 1 Moderate VI
< 6/60 – 3/60 1.00 -1.30 2 Severe VI
< 3/60-1/60 1.30-1.80 3 Blindness
< 1/60 –LP 1.80-3.00 4 Blindness
NLP 4.0 5 Blindness
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Note: VA- Visual acuity; LogMAR- logarithm of the

minimum angle of resolution; LP- Light perception, and
NLP- no light perception

(ii) Assessment hearing impairment

Hearing impairment is the inability of an individual to hear sounds adequately. This may be
due to improper development, damage or disease to any part of the hearing mechanism. Hearing is a
prerequisite for the development of normal speech & language. The three basic categories of
hearing loss are ensorineural hearing loss, conductive hearing loss and mixed hearing loss. A
ensorineural hearing loss (SNHL) is a hearing loss that results from loss of or damage to the tiny
hair cells in the cochlea in the inner ear. A conductive hearing loss happens when sounds cannot get
through the outer and middle ear. Sometimes, a conductive hearing loss happens at the same time with a
ensorineural hearing loss, which is called mixed hearing loss. Hearing loss can be classified according to
the severity or degree of the disease. Hearing losses between 26 and 40 dB are considered mild, 41
and 55 dB moderate, 56 and 70 dB moderately severe, 71 and 90 dB severe and greater than 91 dB
profound

Knowledge Box 3. Audiometric ISO and grade of hearing

impairment
Grade of impairment Audiometric ISO for the better ear
0 No impairment 25 db or better
1 Slight impairment 26-40 db
2 Moderate impairment 41-60db
3 Severe impairment 61-90db
4 Profound impairment 91db or greater
Note : Adapted from the WHO report

(iii) Assessment of orthopedically impairment

Orthopaedic impairment is defined as a person’s disability relating to a bone, joint, or

muscle, that is severe enough to affect the person’s physical functioning, mobility, stamina or
dexterity. These can be divided into three main areas: neuromotor impairments, degenerative
diseases, and musculoskeletal disorders. Neuromotor impairment is an abnormality of, or damage
to, the brain, spinal cord, or nervous system that sends impulses to the muscles of the body. These
impairments are acquired at or before birth, and often result in complex motor problems that can
affect several body systems. Degenerative disease is the result of a continuous process based on
degenerative cell changes, affecting tissues or organs, which will increasingly deteriorate over time.
Musculoskeletal disorders (MSD) are injuries or disorders of the muscles, nerves, tendons, joints,
cartilage, and spinal discs. In all these conditions, above 40% of dysfunctional assessment is
considered as criteria for impairment.

(iv) Assessment of intellectual disability

The DSM-5 diagnosis of intellectual disability (ID) requires the satisfaction of three criteria:
(i) Deficits in intellectual functioning such as reasoning, problem solving, planning, abstract
thinking, judgment, academic learning, and learning from experience, which needs to be confirmed
by clinical evaluation and individualized standard IQ testing. (ii) Significant limitations in adaptive
behaviour that impact a person's daily life and affect the ability to respond to a particular situation
or to the environment and (iii) onset before the age of 18. IQ is considered as the standard measure
for the assessment of intellectual disability. The levels of intellectual disability are referred to as
 10

mild having IQ range between 50-70, moderate having IQ range between 35 to 50, severe having IQ
range between 20 to 35, and profound having IQ range up to 20.

Level of ID IQ Intellectual age

Mild 50-70 7/8 to 12 years
Moderate 35-50 4/5 to 7/8 years
Severe 20-35 2 to 4/5 years
Profound 20 below 0 to 2 years

Chapter II
DISABILITY POLICY IN INDIA

According to the census 2011, there are 2.68 crore persons with disabilities who constitute
2.21 percent of the total population in India. This includes persons with visual, hearing, speech,
locomotor and mental disabilities. Seventy five percent of persons with disabilities live in rural
areas, 51 percent of disabled population is illiterate and only 34 per cent are employed. Among the
disabled population 56% (1.5 Cr) are males and 44% (1.18 Cr) are females. Hence, this large
population of disability needs to be addressed not only on humanitarian grounds but also at the level
of law and policy making. In fact, during the past 30 years, India is forging ahead in making and
implementing sustainable acts and policies for disability.
Responding to these disability policies, there has been vast positive changes in the attitude
and perception of the society towards persons with disabilities in the recent years. It has been
realized that a majority of persons with disabilities can lead a better quality of life if they have equal
opportunities and effective access to rehabilitation measures. In fact, the earlier emphasis on only
medical rehabilitation of disability has now been replaced by an emphasis on social rehabilitation.
There is an increasing recognition of abilities of persons with disabilities and emphasis on
mainstreaming them in the society based on their capabilities.
The Constitution of India ensures equality, freedom, justice and dignity of all individuals
and implicitly mandates an inclusive society for all. In respect of such constitutional command, the
Government of India has enacted two significant legislations for persons with disabilities to provide
them with equal opportunities, protection of rights, and full participation in the society. Those
legislations are; “Rehabilitation Council of India Act, 1992”, and “The Persons with Disability Act,
1995”
(i) Rehabilitation Council of India Act, 1992: The Rehabilitation Council of India (RCI) was
set up as a registered society in 1986. On September, 1992 the RCI Act was enacted by Parliament
and it became a Statutory Body on 22 June 1993. The Act was amended by Parliament in 2000 to
make it more broad-based. The mandate given to RCI is to regulate and monitor services given to
persons with disability, to standardise syllabi and to maintain a Central Rehabilitation Register of
all qualified professionals and personnel working in the field of Rehabilitation and Special
Education. The Act also prescribes punitive action against unqualified persons delivering services
to persons with disability. The act provided the following objectives and performances by the
rehabilitation Council of India

 To regulate the training policies and programmes in the field of rehabilitation of persons
with disabilities.
 To bring about standardization of training courses for professionals dealing with persons
with disabilities.
 11

 To prescribe minimum standards of education and training of various categories of

professionals/ personnel dealing with people with disabilities.
 To regulate these standards in all training institutions uniformly throughout the country.
 To recognize institutions/ organizations/ universities running master's degree/ bachelor's
degree/ P.G. Diploma/ Diploma/ Certificate courses in the field of rehabilitation of persons with
disabilities.
 To recognize degree/diploma/certificate awarded by foreign universities/ institutions on
reciprocal basis.
 To promote research in Rehabilitation and Special Education.
 To maintain Central Rehabilitation Register for registration of professionals/ personnel.
 To collect information on a regular basis on education and training in the field of
rehabilitation of people with disabilities from institutions in India and abroad
 To encourage continuing education in the field of rehabilitation and special education by
way of collaboration with organizations working in the field of disability.
 To recognize Vocational Rehabilitation Centres as manpower development centres.
 To register vocational instructors and other personnel working in the Vocational
Rehabilitation Centres.
 To recognize the national institutes and apex institutions on disability as manpower
development centres.
 To register personnel working in national institutes and apex institutions on disability under
the Ministry of Social Justice & Empowerment.

(ii) The Persons with Disability Act, 1995: The Persons with Disabilities (Equal
Opportunities, Protection of Rights and Full Participation) Act, 1995 has come into enforcement on
February 7, 1996. This law is an important landmark and is a significant step in the direction to
ensure equal opportunities for people with disabilities and their full participation in the nation
building. The Act provides for both preventive and promotional aspects of rehabilitation like
education, employment and vocational training, reservation, research and manpower development,
creation of barrier-free environment, rehabilitation of persons with disability, unemployment and
establishment of homes for persons with severe disability. Main Provisions of the Act are:
 Prevention and early detection of disabilities:
 Surveys, investigations and research shall be conducted to ascertain the cause of
occurrence of disabilities
 Various measures shall be taken to prevent disabilities. Staff at the primary health
centre shall be trained to assist in this work.
 All the children shall be screened once in a year for identifying “at-risk” cases.
 Awareness campaigns shall be launched and sponsored to disseminate information.
 Measures shall be taken for pre-natal, perinatal, and post-natal care of the mother and
child.
 Education
 Every child with disability shall have the right to free education till the age of 18 years
in integrated schools or special schools.
 Appropriate transportation and removal of architectural shall be ensured for the benefit
of children with disabilities.
 Children with disabilities shall have the right to free books, scholarships, uniform and
other learning material.
 Special schools for children with disabilities shall be equipped with vocational training
facilities.
 Non-formal education shall be promoted for children with disabilities.
 Teachers training institutions shall be established to develop requisite manpower.
 12

 Parents may move to appropriate forum for the redressal of grievances regarding the
education of their children with disabilities

 Employment
 Three percent of vacancies in government employment shall be reserved for people with
disabilities, one percent each for persons suffering from blindness or low vision, hearing
impairment, locomotor disabilities and cerebral palsy
 Suitable scheme shall be formulated for the training and welfare of persons with
disabilities.
 The relaxation of upper age limits regulating the employment.
 Health and safety measures and creation of a non-handicapping environment in places
where persons with disabilities are employed.
 Non-discrimination,
 Public building, rail compartments, buses, ships and aircrafts will be designed to give
easy access to disabled people.
 In all public places and in waiting rooms, toilets shall be wheel chair accessible.
 Braille and sound symbols are also to be provided in lifts.
 All the places of public utility shall be made barrier-free by providing ramps.
 Research and Manpower Development
 Research in the following areas shall be sponsored and promoted: Prevention of
disability, Rehabilitation including CBR, Development of assistive devices, Job
identification, and modifications of offices and factories.
 Social Security
 Financial assistance to non-government organisation for rehabilitation of persons with
disabilities.
 Insurance coverage for the benefit of the government employees with disabilities
 Unemployment allowance to people with disabilities registered with the special
employment exchange for more than a year and who could not be placed in any gainful
occupation
 Grievance Redressal
In case of violation of rights as prescribed in the act people with disabilities may move
an application to-
 Chief Commissioner for Persons with Disabilities in the Centre
 Commissioner for Persons with Disabilities in the States.

Infrastructure Development
In addition to the legal frameworks, extensive infrastructure has also been developed
throughout the country. The following seven national Institutes are working for development of
manpower in different areas disability:
 Institute for the Physically Handicapped, New Delhi.
 National Institute of Visually Handicapped, Dehradun
 National Institute for Orthopedically Handicapped, Kolkata
 National Institute for Mentally Handicapped, Secunderabad
 National Institute for Hearing Handicapped, Mumbai
 National Institute of Rehabilitation Training & Research, Cuttack
 National Institute for Empowerment of Persons with Multiple Disabilities, Chennai
Furthermore, there are five Composite Rehabilitation Centres, four Regional Rehabilitation
Centres and 120 District Disability Rehabilitation Centres (DDRCs) providing various kinds of
 13

rehabilitation services to persons with disabilities. There are also several national institutions under
the Ministry of Health & Family Welfare working in the field of rehabilitation, like National
Institute of Mental Health and Neuro Sciences, Bangalore; All India Institute of Physical Medicine
and Rehabilitation, Mumbai; All India Institute of Speech and Hearing, Mysore; and Central
Institute of Psychiatry, Ranchi. In addition, certain State Government institutions also provide
rehabilitation. Besides, these government institutes, 250 private institutions are also conducting
training courses for rehabilitation professionals. National Handicapped and Finance Development
Corporation (NHFDC) has been established to provide loans on concessional terms for undertaking
self employment ventures by the persons with disabilities.
National Policy Statement
The National Policy recognizes that Persons with Disabilities are valuable human resource
for the country and seeks to create an environment to provide them equal opportunities, protection
of their rights and full participation in society. The Policy focuses of the on the following issues:
 Prevention of Disabilities: Since disability, in a large number of cases, is preventable, there
will be strong emphasis on prevention of disabilities. Programme for prevention of diseases, which
result in disability and the creation of awareness regarding measures to be taken for prevention of
disabilities during the period of pregnancy and thereafter will be intensified and their coverage
expanded.
 Rehabilitation Measures: Rehabilitation measures can be classified into three distinct
groups: (i) physical rehabilitation, which includes early detection and intervention, counseling and
medical interventions and provision of aids and appliances. It will also include the development of
rehabilitation professionals. (ii). Educational rehabilitation including vocational education and (iii)
economic rehabilitation for a dignified life in society.
Physical Rehabilitation Strategies
(a) Early Detection and Intervention: Early detection of disability and intervention through
drug or non-drug therapies helps in minimization of impact of disability. Therefore, there will be
emphasis on early detection and early intervention, and necessary facilities will be created towards
this end. Government will take measures to disseminate information regarding availability of such
facilities to the people especially in rural areas.
(b) Counseling & Medical Rehabilitation Physical rehabilitation measures including
counseling, strengthening capacities of persons with disabilities and their families, physiotherapy,
occupational therapy, psychotherapy, surgical correction and intervention, vision assessment, vision
stimulation, speech therapy, audiological rehabilitation and special education shall be extended to
cover all the districts in the country by active involvement and participation of State Governments,
local level institutions, NGOs including associations of parents and persons with disabilities.

Assistive Devices
The Government of India has been assisting persons with disabilities in procuring durable
and scientifically manufactured modern aids and appliances that can promote their physical, social
and psychological independence by reducing the effect of disabilities. Every year persons with
disabilities are provided with devices such as prostheses and orthoses, tricycles, wheel chair,
surgical footwear and devices for activities of daily living, low vision aids, special mobility aids
like canes for blind, hearing aids, educational kits, communication aids, assistive and alerting
devices and devices suitable for the persons with mental disabilities. The availability of devices will
be expanded to cover uncovered and under-serviced areas. Private, public and joint sector
enterprises involved in the manufacture of high tech assistive devices for persons with disabilities
will be provided financial support by the public sector banks

Education for Persons with Disabilities

Education is the most effective vehicle of social and economic empowerment. In keeping
with the spirit of the Article 21A of the Constitution guaranteeing education as a fundamental right
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and Section 26 of the Persons with Disabilities Act, 1995, free and compulsory education has to be
provided to all children with disabilities up to the minimum age of 18 years. There is a need for
mainstreaming of the persons with disabilities in the general education system through Inclusive
education. Sarva Shiksha Abhiyan (SSA) launched by the Government has the goal of eight years of
elementary schooling for all children including children with disabilities in the age group of 6-14
years by 2010. Children with disabilities in the age group of 15-18 years are provided free
education under Integrated Education for Disabled Children (IEDC) Scheme. Under SSA, a
continuum of educational options, learning aids and tools, mobility assistance, support services etc.
are being made available to students with disabilities. This includes education through an open
learning system and open schools, alternative schooling, distance education, special schools,
wherever necessary home based education, itinerant teacher model, remedial teaching, part time
classes, Community Based Rehabilitation (CBR) and vocational education.

IEDC Scheme implemented through the State Governments, Autonomous Bodies and Voluntary
Organizations provides hundred percent financial assistance for various facilities like special
teachers, books and stationery, uniform, transport, readers allowance for the visually handicapped,
hostel allowance, equipment cost, removal/ modification of architectural barriers, financial
assistance for purchase/ production of instructional material, training of general teachers and
equipment for resource rooms. 24. There will be concerted effort on the part of the Government to
improve identification of children with disabilities through regular surveys, their enrollment in
appropriate schools and their continuation till they successfully complete their education. The
Government will endeavor to provide right kind of learning material and books to the children with
disabilities, suitably trained and sensitized teachers and schools which are accessible and disabled
friendly. 25. Government of India is providing scholarships to students with disabilities for pursuing
studies at post school level. Government will continue to support the scholarships and expand its
coverage. 26. Facilities for technical and vocational education designed to inculcate and bolster skill
development suited to various types of productive activities by adaptation of the existing institutes
or accelerated setting up of institutes in un-served / underserved areas will be encouraged. NGOs
will also be encouraged to provide vocational training. 27. Persons with disabilities will be provided
access to the Universities, technical institutions and other institutions of higher learning to pursue
higher and professional courses.

Chapter III

Models of Disability
THEORIZING DISABILITY

Although people have various individual perspectives on disability, these viewpoints can be
summarized into five basic models of disability namely; charity model, moral or religious model, medical
model, social model, and economic model. Each model emphasizes some specific aspects disability and
perceived causes relating to those aspects. The models also explain the sources and causes of disabilities,
some deeper meaning of specific disabilities, and suggests for appropriate social behaviour and responses
towards persons with disabilities.
 15

Charity model of disability. The charity model is an older and outdated model, which
assumes that people with disabilities deserve pity and need to be supported by charity. Founded on
humanitarian and moral values, the model views disability as a tragedy and disables are the victims.
The model assumes that persons with disability are dependent on the society and they need
sympathy of others to provide assistance in a charity or welfare. The model is primarily based on an
emotional appeal towards the disabled. The disables are treated as helpless victims needing ‘care
and protection’.
Under this model disabled people are depicted as people deserving pity. The charity model
approach makes the disabled as powerless individuals instead of empowering them. Rather than
addressing their issue by creating a suitable environment for them, the state donates money for their
maintenance. Charity model driven largely by the emotive appeals relies heavily on the charity and
benevolence rather than justice and equality. This model accepts the act of exclusion of persons
with disabilities from social arrangements and mainstreams of life in public domain. Charity model
justifies the exclusion of persons with disabilities from the mainstream education, services and
employment. Their entitlement rights are substituted by relief measures creating a group of
powerless individuals, without any control or bargaining power, and depending either on the state
allocated fund or benevolent individuals. This model survives on social support mechanism for the
benefit of person with disability. In the purview of this model, government was allocating large
chunk of fund for the welfare of persons with disabilities. The non-governmental organisations’
working for the benefit of persons with disabilities also relies on the donations and government
grants. There are large numbers of charity foundations in India which are supporting this model of
disability.
Medical model of disability: The medical model of disability is based on a biomedical
perception of disability. This model links disability diagnosis to an individual's physical body. The
model supposes that disability may reduce the individual's quality of life and hence, it is required
diminish or correct this disability with medical intervention. The model actually equates the
physical or mental impairment from a disease or disorder with the disability that the person
experiences. From a policy viewpoint, in this model, the person with disability is viewed as the
“problem”, and is in need of cure and treatment. In terms of services, the general approach within
this model is towards special institutions for people with disabilities, e.g. special schools, sheltered
workshops, special transport etc. As the medical model approach to disability holds that disability
result from an individual’s physical or mental limitations, the development of medical science and
curative approach of the physician has direct consequences on the successful functioning of the
medical model. Since many disabilities have medical origins the problems that are associated with
disability are deemed to reside within the individuals and therefore, the disabled individuals are the
only target in the medical model. The individual with a disability is in the sick role under the
medical model. In other words, if the individual is “cured” then these problems will not exist. On
this basis persons with disabilities are considered as ‘abnormal’ in comparison with ‘normal human
being’. Such a view encourages dependence on doctors, rehabilitation professional and charity. This
approach thus lays all emphasis in clinical diagnosis and medical treatment rendering the disabled
individuals as the recipient of public assistance and charity. The medical welfare approach to
disability offers the following four assumptions.
 Disability is basically a disease state and absolutely falls under clinical framework and
essentially a problem focusing on the individual as a deviation from the norm. The role of the
 16

medical and paramedical professionals is to cure and ameliorate this problem in order to enable
them to be as normal as possible.
 There is an objective state of normality for any person with disability defined by the medical
professionals, which means the extent to which a person’s disability can be medically corrected. In
the process, the medical team takes up the total responsibility and leaves little scope for the disabled
and their families to participate in the decision making process.
 The disabled individuals are biologically and psychologically inferior to their able bodied
counterparts and they are, thus, not treated as fully human and by implication, lack the competence
to decide for themselves, and;
 The phenomena of disability are visualized as a personal tragedy, which affects individuals.

In summary, the Medical model supports the postulate that persons with disabilities are
biologically and psychologically inferior to other able bodied counterparts. So they are not treated
as fully human because they lack the competence to decide for themselves. This model reduces
disability to impairment and sought to locate it within the body or mind of the individual and the
power to define, control and treat disabled individual is located with the medical and paramedical
professionals. This model restricts the rehabilitation efforts to medical treatment in terms of
protection and care.
Such an approach towards the disability may be regarded matter of personal tragedy which
encourages dependence on medical and paramedical professional, rehabilitation professionals and
charity. Obviously, the medical paradigm stigmatizes the disabled people by describing them as not
normal. The medical welfare approach to disability has been well represented by the World Health
Organisation. The classification of disability made by World Health Organisation in 1980 also
supports the medical welfare approach which lays all emphasis on clinical diagnosis and medical
treatment rendering the disabled individual as recipient of public assistance and charity.
In 1980, the World Health Organization (WHO) introduced a framework for doctors working with
disability in its publication "International Classification of Impairments, Disabilities and Handicaps". The
framework proposed to approach disability by using three terms: Impairment, Handicap and Disability. (i)
Impairment = a loss or abnormality of physical bodily structure or function of logic-psychic origin, or
physiological or anatomical origin. (ii) Disability = any limitation or function loss deriving from impairment
that prevents the performance of an activity considered normal for a human being. Handicap = the
disadvantaged condition deriving from impairment or disability limiting a person performing a role
considered normal in respect of age, sex and social and cultural factors.

Social or functional model of disability: Contemporary approaches to disability reject the

medical welfare model and locate disability in social context. The model assumes that human
differences are constructed by the society and residing in social relationships. The social and
physical structures that exclude the disables from the mainstream of life are manmade The
advocates of social relationship model insist that the society as a whole has the responsibility to
eliminate social and physical structures that exclude people with disabilities in having access to
opportunities . The social relations model also emphasises the concept of “independent living”
which means that the disabled persons are the best judge about their own concern and are full
citizens with equal civil rights. The disability rights discourses insists on a concept equality that is
based on the needs of all members of the society rather than on those deemed “normal”. The
demand for equality is based upon the concept of human autonomy, which consists of personal
capacities to have an access to the opportunities that society offers to all the people.

This model of disability places the emphasis on promoting social change that empowers and
incorporates the experiences of person with disabilities, asking society itself to adapt. This model
emphasizes institutional, environmental and attitudinal discriminations as the real basis for
 17

disability. Thus it is the society at large which disables the person with disabilities through
discrimination, denial of rights, and creation of economic dependency. In the social model of
disability the difficulties experienced by a person are seen as arising from the society’s incapacity to
match to the biological condition of the disabled person. In this model disabled people are not
stereotyped as individuals who are unable to function, who deviate from the normal, or who
naturally have a poor quality of life, but they are accepted as citizens who are prevented from
realizing their personal and civil rights that are supposed to be common to all. The social model is
also known as functional model and is similar to the medical model, it regards the person with
disability as in need of services from a rehabilitation professional who can provided training,
therapy, counseling or other services to make up for the deficiency caused by the disability. A key
element of this new concept is the recognition that exclusion and segregation of people with
disabilities do not logically follow from the fact of impairment, but result from political choices
based on false assumptions about disability.

In contrast to medical model, which locates disability within the person with disabilities, social
model postulates that a person is disabled because of architectural, attitudinal and social barriers
created by the society. The social model presents disability as a consequence of oppression,
prejudice and discrimination by the society against disabled people. It is the society, which
constructs economic, social, health, architectural, legal, and cultural and other barriers in order to
deliberately prevent people with impairments enjoying full benefits of social life. The social model
shifts the emphasis from a disabled individual to the society and its disabling attitudes and
environment. People who believe on social model are of the view that handicap is made and not
acquired. The therefore solution lies in social management by all necessary environmental
modification.

A disability is regarded as a result of interaction between societal barriers and the impairment. A
person is disabled not because of his personal tragedy but because of the disadvantages suffered by
him by a disabling environment besides the prevalence of stereotypes, prejudices and neglect of the
so called ‘normal’ individuals. The advocates of social relation approaches, therefore, insist that the
society as whole has the responsibility to eliminate social and physical structures that exclude
people with disabilities in having access to opportunities.

5. Rights-Based Model

Rights-based model of disability builds on the insights of the social model to promote creation of
communities which accept diversities and differences, and have a non-discriminating environment
in terms of inclusion in all aspects of the life of society. The disability rights model position
disability as an important dimension of human culture. This model regards disability as normal
aspect and that the disabled are equally entitled to rights as others. This model is also known as the
human rights model which affirms that, all human beings irrespective of their disability have certain
rights which are inalienable. This model ensures that criteria for support programmes are prioritized
by people themselves respecting their autonomy and freedom of choice. The disability rights model
focuses on equality and non –discrimination, reasonable accommodation, accessibility, breaking
down barriers, equal participation and inclusion and private and public freedom. The disability
rights model has over the years evolved to afford greater protection to the rights and freedoms of
disadvantaged groups in both public and private domain by enlarging the obligations of the states in
relation to actions of private entities. With the paradigm shift from the medical to the social model
of disability, disability was reclassified for disabled people and to expose their segregation,
institutionalization and exclusion as typical form of disability based discrimination. Hence, the
disability rights discourse insists on a concept of equality and not based on discrimination. Hence,
 18

the disability rights discourse insists on a concept of equality that is based on the needs of all
members of the society rather than on those deemed “normal”.

This new dimension of disability law has been welcomed as a major milestone on the path towards
eventual recognition of the human rights of disabled people, a path which more and more
governments seem to be willing to take. Thus the human rights approach to disability regards legal
measures as constituting the fundamental framework by which mechanism for equality can be
ensured.

Thus, the human rights discourse on disability recognizes the disability rights and insists on a
concept of equality that is based on the needs of all members of the society. The equal opportunity
principle should be the basis of interpretation which implies that affirmative action programmes are
essential for reasonable accommodation to ensure social integration of people with disabilities.
Disability is positioned as an important dimension of human culture by human rights model.
According to human rights model all human beings irrespective of their disabilities have certain
rights, which are unchallengeable. By emphasizing that the disabled are equally entitled to rights as
others, this model builds upon the spirit that ‘all human beings are born free and equal in rights and
dignity’ enshrined in the Universal Declaration of Human Rights, 1948. This model emphasis on
viewing persons with disabilities as subjects and not as objects thus locating the problem outside the
disabled persons and addresses the manners in which the economic and social processes
accommodate the differences of disability.

Economic Model

The economic model of disability tries to establish the linkages between the individual and society
in term of their contribution to productive capabilities towards the society. The emphasis here is on
health related limitations on the amount and kind of work performed by persons with disabilities.
This approach suggests that the employment problems of person with disabilities stem from faulty
economic system and deficiencies on the part of such disadvantage individuals. The vocational
rehabilitation programmes or income generation programmes may be the solutions to the problems
faced by persons with disabilities. Existing policies plays a greater role in condemning the disabled
man and women to a life of perpetual dependency thus providing low pay work ad limited
opportunities for all around development. Unlike other models, economic model suggest that the
modifications in the persons in the form of education, training and employability, rather than
changing the environment and worksite changes or changes in the perception of employees is the
most desirable means of fulfilling the social and economic needs of the disadvantages strata of the
society.

Disability movement has succeeded in changing the approach towards disability from moral model
to charity model but limited has been achieved in the direction of human rights model. Collective
efforts on the part of person with disabilities, their advocates, voluntary organisations, government
and society at large are required to create real world where abilities and disabilities are not seen on
the basis of physical or mental impairment but disability is seen as diverse abilities.
 19

The model is based on the understanding that disability is something in the body that can
and should be cured. It is complementary to, and in many ways the moralistic extension of, the
Medical Model.
The Charity Model has been developed by non-disabled people and it’s both a way of
understanding and relating to disability, as well as an industry around disability. Where the Medical
Model sees medical professionals as experts in disability, the Charity Model sees non-disabled
people as the saviours of disability. Disability is not only something that should be cured, but
something that is tragic. It therefore creates a view of disabled people’s lives as tragic and pitiable.

People with disabilities are often treated as objects of charity and pity. The charity model is an
older and outdated model of disability. The Charity Model is concerned with seeing disability as
tragic and in need of support. The model isn’t about supporting disabled people to live our lives on
our own terms; it’s not concerned with civil rights, independent living, meaningful employment or
equal access to education. There are a number of charities for disabled people constructed on this
basis. Led by non-disabled people to help disabled people live better lives or find cures. This is a
problem as it not only means that services aren’t shaped by people who truly understand the needs
of disabled people, but they also offer no role-modeling or alternative narratives for disabled
people.

The charity model sees people with disabilities as victims of their impairment. Depending on
the disability, the disabled persons cannot walk, talk, see, learn, or work. Disability is seen as a
deficit. Persons with disabilities are not able to help themselves and to lead an independent life.
Often Charity Model charities fundraise through imagery and messaging that shows disabled people
as helpless and tragic – to generate emotive responses from non-disabled people who will hopefully
feel enough pity to put their hands in their pocket – Children in Need is a clear example of this as a
fundraising drive for disabled, poor and/or disenfranchised children.

The Tragedy/Charity Model depicts disabled people as victims of circumstance, deserving of pity.
This and Medical Model are probably the ones most used by non-disabled people to define and
explain disability.

Traditionally used by charities in the competitive business of fund-raising, the application of the
Tragedy/Charity Model is graphically illustrated in the televised Children in Need appeals in which
disabled children are depicted alongside young "victims" of famine, poverty, child abuse and other
circumstances. Whilst such appeals raise considerable funds for services and equipment which are
not provided by the state, many disabled people find the negative victim-image thoroughly
offensive. In fact Children in Need has been described as "televisual garbage … oppressive to
disabled people" M. Oliver quoted in C. Donnellan "Disabilities and Discrimination Issues for the
Nineties" 1982. Some go as far as interpreting the tragic portrayal as a means of maintaining a flow
of donations and keeping able-bodied people in work.

The Tragedy/Charity Model is condemned by its critics as dis-enabling, and the cause of much
discrimination. Speaking on the BBC Everyman programme The Fifth Gospel (date?), Nabil
Shaban said: "The biggest problem that we, the disabled have, is that you, the non-disabled, are
 20

only comfortable when you see us as icons of pity." Because disabled people are seen as tragic
victims, it follows that they need care, are not capable of looking after themselves or managing their
own affairs, and need charity in order to survive.

From tragedy and pity stems a culture "care". Although highly praiseworthy in many respects, it
carries certain dangers. Numerous charities exist to support and care for people with a particular
type of disability, thereby medically classifying, segregating and often – as with the Medical Model
– institutionalising many disabled people. Over 400,000 adults in Great Britain are affected by
institutionalisation. Given the choice, many, if not most would opt for community life with
adequate support.

The idea of if being recipients of charity lowers the self-esteem of people with disabilities. In the
eyes of "pitying" donors, charitable giving carries with it an expectation of gratitude and a set of
terms imposed upon the beneficiary. The first is patronising; the second limiting upon the choices
open to disabled people. Also, employers will view disabled people as charitable cases. Rather than
address the real issues of creating a workplace conducive to the employment of people with
disabilities, employers may conclude that making charitable donations meets social and economic
obligations.

This is not to advocate dismantling charities and outlaw caring, charitable acts, which enrich our
society and bring badly needed funds. But we do need to educate charity managers and
professionals to review the way they operate and ensure that funds are channelled to promote the
empowerment of disabled people and their full integration into our society as equal citizens –
requiring our respect and not our pity.

(i) Moral or religious model: Moral model is the oldest model of disability in which people are
thought to be morally responsible or to be blamed for their disability, as a retribution for their sin. Under this
model, disability was considered as punishment from God for the wrong doings in the past or even in the
past life. In this model, disability is seen as having meaning about the person’s or the family’s character,
deeds, thoughts, and karma. This perspective actually created stigma, shame and blame for the disabled
people. Until the mid 1800s, most people thought about disabilities and about the people who had disabilities
using the moral model. However, due to resolute efforts of civil societies, government, and organizations for
disabilities, this model of disability is gradually is gradually going weak in the mind of the common people.
(ii) Medical model: The medical model of disability is based on a biomedical perception of
disability. This model links disability diagnosis to an individual's physical body. The model supposes that
disability may reduce the individual's quality of life and therefore, it aims to correct or diminish the disability
with medical intervention. The medical model focuses on curing or managing disability. By extension, the
medical model also advocates for a "compassionate" or just society in the health care and related services for
medical management of disability. This model has the aim to expand functionality and to allow disabled
persons a more "normal" life.
(iii) Social model: The social model of disability identifies systemic barriers, derogatory attitudes,
and social exclusion, which make it difficult or impossible for individuals with impairments to attain their
valued functioning in life. The social model assumes that physical, sensory, intellectual, or psychological
variations may cause functional limitation or impairments in the individual; but those limitations lead to
disability only when the society fails to take account of people regardless of their individual differences.
Hence, the social model of disability is based on a distinction between impairment and disability. In this
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model, the word impairment is used to refer to the lack of attributes that affect a person, such as the inability
to walk; and disability is used to refer to the restrictions caused by society when it does not give equivalent
attention to the needs of individuals with impairments. The starting point for the social model of disability
was the publication of The Fundamental Principles of Disability by the Union of the Physically Impaired
against Segregation (UPIAS) in 1976. Following the UPIAS social definition of disability, in 1983 the
disabled academic Mike Oliver coined the phrase social model of disability in reference to these ideological
developments. The social model of disability focused on following changes in society.
 Change in Attitude- Creating a more positive attitude toward certain mental traits or behaviours, and
not underestimating the potential quality of life of those with impairments.
 Social support- Creating social awareness to help people with impairments in dealing with barriers
and providing them with resources and aids to overcome those barriers.
 Information/ system support- Creating information support system to help people with impairment
cover up their limitations. For example, using braille as a suitable format for teaching the visually impaired;
providing suitable hearing aids to hearing impaired to help them adequately participate in communication.
 Physical structures- Building physical structures to help the behavioural functions of people with
impairment. For example buildings with sloped access and elevators are very supportive to the physically
impaired.
(iv) Economic model: 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. This model assumes that society
should take responsibility to help people with impairment get training and education for their economic
welfare and activities. For example, they may be provided vocational training to acquire particular skills
meant to prepare them for a specific occupation for which their impairment does not hinder.
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