A new World Health Organization (WHO) publication to classify the functioning, health and disability of people across the world challenges mainstream ideas on how we understand health and disability. The ICF (International Classification of Functioning, Disability and Health), released today, has been accepted by 191 countries as the international standard to describe and measure health and disability.
Using the ICF framework, WHO estimates that as much as 500 million healthy life years are lost each year due to disability associated with health conditions. This is more than half the years that are lost annually due to premature death. The ICF provides a common metre about this immense problem.
While traditional health indicators are based on the mortality (i.e. death) rates of populations, the ICF shifts focus to "life", i.e., how people live with their health conditions and how these can be improved to achieve a productive, fulfilling life. It has implications for medical practice; for law and social policy to improve access and treatment; and for the protection of the rights of individuals and groups.
ICF changes our understanding of disability which is presented not as a problem of a minority group, nor just of people with a visible impairment or in a wheelchair. For example, a person living with HIV/AIDS could be disabled in terms of his/her ability to participate actively in a profession. In that case, the ICF provides different perspectives as to how measures can be targeted to optimize that person’s ability to remain in the workforce and live a full life in the community.
The ICF takes into account the social aspects of disability and provides a mechanism to document the impact of the social and physical environment on a person’s functioning. For instance, when a person with a serious disability finds it difficult to work in a particular building because it does not provide ramps or elevators, the ICF identifies the needed focus of an intervention, i.e. that the building should include those facilities and not that the person be forced out of the job because of an inability to work.
ICF puts all disease and health conditions on an equal footing irrespective of their cause. A person may not be able to attend work because of a cold or angina, but also because of depression. This neutral approach puts mental disorders on a par with physical illness and has contributed to the recognition and documentation of the world-wide burden of depressive disorders, which is currently the leading cause, world-wide, of life years lost due to disability.
The ICF is a result of a 7-year effort involving the active participation of some 65 countries. Rigorous scientific studies have been undertaken to ensure that the ICF is applicable across cultures, age groups and genders so as to collect reliable and comparable data on health outcomes of individuals and populations. WHO is presently carrying out world-wide health surveys to collect data based on the ICF.