3.2 The theoretical framework and model used in the study
3.2.3 Medical and social model of disability
The prevailing model of disability has gone through a transitional gradual shift during the last thirty years from a medical to a social model of disability. This shift is of extreme importance as the two models represent two opposing approaches. The shift also relates to activities on the international level where the United Nations has, since the Second World War, developed a comprehensive global human rights’
system. The human rights’ influence is evident in the social model of disability (Grobbelaar-du Plessis and van Reenen 2011: xxiii).
3.2.3.1 Medical model of disability
Historically disability has been regarded as a health and welfare issue. Medical and social interventions were taken care of by medical practitioners and welfare associations and the care and treatment of persons with disabilities was the responsibility of civil society (Grobbelaar-du Plessis and van Reenen 2011: xxiii).
The medical model is based on scientific views and practices, typically in the medical and health knowledge base. The "problem" is located within the body of the individual with a disability. The context of the medical model is the clinic or institution. People with disabilities assume the role of patient, a role that may be of either short-term or long-term duration depending on several factors, including the
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individual’s condition, policies related to institutionalization and community support, and professional and social attitudes about disability. Authority lies with the professionals (Seelman 2004).
According to World Health Organization (2002) the medical model views disability as a feature of the person, directly caused by disease, trauma or a health condition, which requires medical care provided in the form of individual treatment by professionals. Disability, in this model, calls for medical or other treatment or interventions, to “correct” the problem with the individual. According to Chitereka (2010) the medical model of disability tends to view people with disabilities first and foremost as having physical problems to be addressed. People with disabilities are treated by professional experts where the desired effect is a cure. This model basically focuses on the lack of physical, sensory or mental functioning, and uses a clinical way of describing an individual’s disability.
From the above discussion it can be seen that the focus of the medical model was to cure people with disabilities. This was undertaken by medical professionals and not by creating an environment which allowed them to participate fully in society. This approach is regarded as limiting by the researcher because people with disabilities can participate in and contribute to society if the environment created by others allows them to do so. However at the same time it is important to note that the impairment will not be cured by enabling changes to the environment. This remains the task of medical professionals.
The medical model of disability also faces criticism from people with disabilities whose philosophy is that a disability is a social construction rather than a viewpoint that seeks to “fix” a person or to separate him or her from the rest of society. In addition, the medical model of disability has been rejected by people with disabilities because they argue that it results in emotions such as fear or pity because society has not recognized the needs of people with disabilities as “rights.” Where their needs have been met, it has often been through charitable giving that reinforces the idea of people with disabilities as passive recipients (Ndinda 2005).
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The social model of disability re-defines disability as a social construct which emphasizes the relationship between law and disability. That means the relationship of disability and law should determine how effectively the law protects the rights of those with disabilities in all aspects of society. In addition the social model of disability shows that environmental barriers, prejudices and exclusions from society eventually determine who is regarded as disabled and who is not (Grobbelaar-du Plessis and van Reenen 2011: xxv).
The social model of disability has been used by people with disabilities in their campaigns for anti-discrimination legislation and independent living. The model has also been used to analyze the way in which societal structures create barriers which exclude people with disabilities (Newton, Ormerod and Thomas 2007:611). With this model, responsibility for the rights of those with disabilities lies with society; it recognizes that here are various social and physical challenges which hinder the lives of people who have disabilities. In relation to this assertion, Radermacher (2006:20) claimed that impairment is something imposed by environmental structures and the implications of how society reacts to people with disabilities and intervenes in their lives. In practice it means that interventions may have to focus on removing challenges in society to accelerate the facilitation of access to all sorts of amenities for people with disabilities in the communities.
The focus of the model is on the community’s conception of disability that must be changed and not primarily on the treatment of the person’s disability. This approach requires a mind shift within the community with regard to obvious shortcomings within the community. For instance, environmental challenges such as the inadequate design of common appliances, inaccessible buildings, limited alternative means of communication, and the inability of schools and similar public institutions to accommodate and manage the different forms of disability (Grobbelaar-du Plessis and van Reenen 2011:xxv). Grobbelaar-du Plessis and van Reenen further claimed that the successful implementation of the social model of disability requires the realization that it is necessary to organize society in such a manner that the
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aspirations of people with disabilities are able to develop within an inclusive framework. In the same vein Mackelprang and Salsgiver (2009) insist that a social model considers a need for assistance to be a part of human existence for all people.
No one person is completely independent in today’s society.
3.2.3.3 The human rights perspective on disability within the social model of disability
Worldwide disability policy has changed its focus from the functional recovery of people with disabilities to the guaranteeing of human rights and social participation by this group of persons. Approaches to ensure the human rights and social participation of people with disabilities have been made since 2000. These include the adoption of the United Nations (UN) Convention on the Rights of Persons with Disabilities, and the launch of the regional Decade of Persons with Disabilities (Yokoyama 2012:23).
Human rights are moral and legal entitlements which are fundamental to people’s well-being, dignity and the pursuit of their full potential (Mikkelsen 2005:201 cited in Maredith 2009: 28). In relation to this assertion the human rights approach typified by Disability Rights Promotion International (2008:1) cited in Caga (2011 : 8) views disability as a human rights issue, emphasizes that people with disabilities are holders of rights, not objects of charity and are entitled to enjoy the same rights and freedom as all other people. As the construct of disability shifted from a medical to social model, disability issues shifted from care and welfare to human rights and the new paradigm began to be reflected in the international literature and the international human rights framework (Maredith 2009:28).
The human rights perspective within the social model of disability focuses on the essential human dignity of people with disabilities. This emphasis on human dignity is indicative of the essential value of people with disabilities who are seen as being on an equal footing with all other people. This view implies that the “problem of disability” does not lie with the people with disabilities but with the absence of equal protection, which must be afforded to all. The solution to the problem of the
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formerly limited option of those with a disability must be found in communities (Grobbelaar-du Plessis and van Reenen 2011: xxvi).
In addition the human rights’ perspective requires a community that is inclusive and respects human dignity and guarantees equality, notwithstanding differences. It is therefore obvious that the social model of disability also has human rights’
implications which include respecting human dignity and guaranteeing the equal treatment of people with disabilities (Grobbelaar-du Plessis and van Reenen 2011:
xxvi). Based on the social model of disability access to information is a human right and academic libraries, in providing for these rights should make sure that information resources housed in the library are accessible to people with disabilities, such as those with visual impairments and in wheelchairs. In relation to this assertion The Gaborone Declaration (1994:143) cited in Kiondo (1998:83) claimed that access to information services is a basic human right. Governments should ensure that this right applies to all citizens and especially to rural communities, the disadvantaged, disabled and the illiterate.
3.2.3.4 The International Classification of Functioning (ICF) model
The ICF Model is an interactive model that focuses mainly on health and functioning rather than disability. It is a tool for measuring functioning in society. It is broader than the medical and social model of disability and emphasizes the level of health rather than the individual disability. The ICF model is used as a framework to measure health needs, health of populations, health policies, and research and clinical needs. The ICF model has been developed to address the inadequacies of the two major models in disability, the medical and the social models. The medical model has been criticised for being too personal and personalizes disability as an individual problem, while the social model is criticized as seeing disabilty only from a social perspective. The ICF model therefore perceives disability as an interaction of personal and societal factors and thus argues that both personal and medical responses are appropriate. The ICF model synthesizes and integrates the medical and social models of disability to describe relationships in which various factors can operate on an individual’s impairment. It expands the number of factors affecting the
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individual to include the larger society. The integration of the medical and social models gives rise to the term biopsychosocial model. This model provides different perspectives of health, biological, individual and social aspects of disability. In a nutshell the biopsychosocial model views disability as the outcome of interaction between health conditions and contextual factors. The ICF model can therefore be used at different levels: individual (for example treatment, communication);
institutional (for example education, training, resource development) and societal (for example social benefits; social policy and needs assessment in general).
3.2.3.5 The International Classification of Functioning (ICF) model and the social model of disability
According to the International Classification of Functioning model and the social model, disability arises out of the interaction between functional limitations and an unaccommodating environment. In the ICF model people are not identified as having a disability based upon a medical condition, but rather are classified according to a detailed description of their functioning within various domains: body function and structure, activities, and participation (Mont and Loeb 2008:2).
Body structure and function is the domain most closely related to the medical model as it refers to the physiological and psychological functions of body systems. Body structures are defined by the ICF as anatomic parts of the body such as organs, limbs and their components. This domain relates to very specific capabilities, for example being able to lift one’s arm over one’s head or produce articulate speech sounds (Mont and Loeb 2008:2).
Activities pertain to a wide range of deliberate actions performed by an individual.
They are basic deliberate actions undertaken in order to accomplish a task, such as walking or climbing stairs. Participation refers to activities that are integral to economic and social life and the social roles that accomplish that life, such as being able to attend school or hold a job (Mont and Loeb 2008:2).
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