Disability
According to the WHO’s International Classification of Functioning,
Disability and Health (ICF), disability is an umbrella term for
impairments, activity limitations and participation restrictions
[1]. Impairments are ‘problems in body function
or structure such as significant deviation or loss’; activity
limitations are ‘difficulties an individual may have in executing
activities’; and participation restrictions are ‘problems
an individual may experience in involvement in life situations’
[1, pp.7-10]. The ICF recognises that how these
aspects impact on an individual are influenced by the ‘physical,
social and attitudinal environment in which people live and conduct
their lives’ [1, pp.16-17]. Thus, ICF emphasises
functioning rather than disability, and views it as an outcome of
interactions between health conditions (diseases, disorders and
injuries) and contextual factors [2]. It also brings
together the classifications of health and disability.
The AIHW is working on the application of the ICF to the classification
of disability in Australia (see, for example, National Community
Services Data Committee, 2004 [3]). However, much
of the information available in Australia about functioning (disability)
is based on the previous classifications that focused on disability
and handicap. Much of this information is derived from the periodic
surveys conducted by the ABS, but these surveys have never included
sufficient numbers of Indigenous people to enable any definitive
conclusions about disability.
The extent of disability among Indigenous people
There have been few studies of disability in the Indigenous population,
but evidence suggests that the level of disability and handicap
among Indigenous people is likely to be much higher – ‘perhaps
at least twice as high as’ – that of the total population
[4, p.223].
This estimate is consistent with a study undertaken in 1991 in the
Taree area of New South Wales [5, 6].
The study, which followed the methodology used by the ABS in its
national surveys of disability, found that 227 (25%) of the 907
Indigenous people living in households in the Taree area had one
or more disabilities [5].1 After adjustment for
differences in the age structures of the Indigenous and non-Indigenous
populations, the levels of reported disabilities among the Indigenous
regular residents of the Taree area were 2.5 times higher for males
and 2.9 times higher for females than for males and females in the
total Australian population. Almost one-fifth (19%) of regular Indigenous
residents reported having a disability of the sense organs, such
as hearing loss (8.4%) or loss of sight (1.4%). The next most frequently
reported disabilities were ‘disorders of the musculo-skeletal
system and connective tissues’ (16%), ‘circulatory system
disorders’ (15%), and ‘respiratory system disorders’
(13%). Bearing in mind that the study excluded people living in
health establishments and institutions – whose residents would
be expected to have higher levels of disability – the levels
of disability reported were much higher than those for the total
Australian population.
Virtually nothing is known about the overall level and types of
disability among Indigenous people in other parts of Australia,
but, given the overall levels of ill-health among Indigenous people
and the fact that many of the known risk factors for disability
are present at high levels in the Indigenous population, the levels
documented for the Taree area provide a useful conservative ‘working
basis’ until similar studies are undertaken in other parts
of the country [7].2
References
1 World Health Organization (2001) International
classification of functioning, disability and health. Geneva:
World Health Organization
2 World Health Organization (2002) ICF:
towards a common language for functioning, disability and health.
Retrieved 5 November 2004 from http://www3.who.int/icf/beginners/bg.pdf
3 National Community Services Data Committee
(2004) National Community Services Data Dictionary. Version
3. Canberra, ACT: Australian Institute of Health and Welfare.
4 Australian Institute of Health and Welfare
(1999) Australia's welfare 1999: the third biennial welfare
report of the Australian Institute of Health and Welfare. Canberra:
Australian Institute of Health and Welfare
5 Thomson N, Snow C (1994) Disability
and handicap among Aborigines of the Taree area of New South Wales.
(No. 9) Canberra: Australian Institute of Health and Welfare
6 Thomson N (1998) The Taree study: a
model for Indigenous disability research. Paper presented at
the Indigenous disability data: current status and future prospects.
Report on proceedings of the Canberra workshop, April 1998 Canberra
7 Burns J, Thomson N (2003) Disability. In:
Thomson N, ed. The health of Indigenous Australians. South
Melbourne: Oxford University Press:467-487
Endnote
1 The study did not include Indigenous
people living in institutions.
2 Bearing in mind the generally higher
levels of some risk factors documented for Indigenous people living
in more remote parts of Australia, the levels of disability among
Indigenous people in the Taree area may well be lower than in at
least some other parts of the country.
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