It is important that there is a clear understanding of what is meant by
the different terms used in describing the sequelae of injury or illness.
In 1980 the World Health Organisation proposed the following International
Classification of Impairment, Disabilities and Handicaps (ICIDH).
Impairment is a change in normal structure or function resulting
from a disease, disorder or injury. It encompasses any loss or abnormality
of a psychological, physiological or anatomical structure or function.
The disturbance is at the level of the 'organ', e.g. loss of a limb, hearing
or sight. The result is a structural disablement.
Disability is any restriction or lack (resulting from an impairment)
of the ability to perform an activity, e.g. climbing stairs, operating
machinery, in the manner or within the range considered normal for a human
being. It reflects disturbance at 'person' level, e.g. behaviour, performance,
mobility, communication, memory. As a functional disablement it should
be seen as a continuum in terms of severity, ranging from very slight to
severe. This has importance in relationship to employment as progression
of the disability may require further modifications and adaptation of the
workplace to allow continuing employment.
Issues of fitness for work, disability, and rehabilitation
may need to be considered in the following contexts:
Handicap is a disadvantage for a given individual resulting from
an impairment or disability that limits or prevents the fulfilment of a
normal role for that individual. That role may be in relation to a particular
environment, e.g. work, and the consequences may be cultural, social, economic
and environmental. They may be manifested as physical, in relation to independence;
social, in respect of integration; and economic in relation to self sufficiency.
Handicap is a restrictive disablement.
Change of job within the company
Deterioration in performance
The assessment should be functional, i.e. in relation to what tasks an
individual is able to do. It is helpful to understand the terms, `impairment',
`disability' and `handicap', and to appreciate that work is important not
only as a means of providing for basic needs but has implications for self
esteem and has an important social aspect.
Considering retirement on grounds of ill-health
Having said that the assessment should be functional, one has to appreciate
that there may be other constraints to be taken into consideration, e.g.:
in assessing fitness account must be taken of:
Disability in this context may be the result of functional impairment in
various ways e.g.:
mobility, manual dexterity, or physical co-ordination
ability to lift, carry or otherwise move every day objects
speech hearing or eyesight
memory or ability to concentrate, learn or understand
perception of the risk of physical danger
Occupational disability may impinge on various aspects of workplace policy
recruitment and selection - (see fitness for work)
safety at work
alcohol & substance abuse
premature retirement through ill-health or redundancy