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WHO International Classification of Impairments, Disabilities and Handicaps (ICIDH)

The International Classification of Impairments, Disabilities and Handicaps (ICIDH) was published by the World Health Organization (WHO) in 1980 as a tool for the classification of the consequences of disease and of their implications for the lives of individuals. The ICIDH reaches beyond the conventional medical model, and therefore complements the International Statistical Classification of Diseases and Related Health Problems (ICD), in its emphasis on how societal and environmental norms are related to the disablement process.

The Council of Europe Recommendation No. R (92) 6 on A coherent policy for people with disabilities contains the ICIDH definitions of impairments, disabilities and handicaps as one of its conceptual bases. It also stresses that reliable statistics on disability are needed in the member states, and emphasises the advantages of having comparable data at European level.

In view of the relevance of the ICIDH to the Council of Europe’s work in the field of rehabilitation and integration of people with disabilities, the Committee of experts on the application of the ICIDH was set up in 1987 to study its use and usefulness.

The Committee’s review of experiences regarding the application of the ICIDH and of its promotion and diffusion by certain international bodies, especially WHO showed that knowledge, distribution, translation and application of the classification varied greatly between member states, and that those which had tried it out had done so in numerous fields, covering several specific aspects of rehabilitation.

Between 1987 and 1996 the Committee of experts issued publications on the following application fields of the ICIDH (year of publication in brackets):

Rehabilitation Medicine (1989)
The report The use of the International classification of impairments, disabilities and handicaps (ICIDH) in rehabilitation concludes that the ICIDH is particularly appropriate for rehabilitation as it provides a common international cross-disciplinary methodological basis.

Surveys and Health related Statistics (1990)
The report Evaluation of the use of the International classification of impairments, disabilities and handicaps (ICIDH) in surveys and health –related statistics includes recommendations regarding the use of the ICIDH in disability surveys and a set of questions intended for screening people with disabilities in general health surveys and specific disability surveys.

Mental Health (1991)
The report The use of the International classification of impairments, disabilities and handicaps (ICIDH) in mental Health aims to made the ICIDH better known amongst psychiatrists as the theoretical considerations underlying the ICIDH have proved useful for research and practice in the sphere of mental health.

Technical Aids (1992)
The report Use of the International classification of impairments, disabilities and handicaps (ICIDH) in the assessment of technical aids correlates the ICIDH with classifications of technical aids and recommends using it in addition to ISO 9999.

Conceptual Framework (1992)
The report The conceptual framework of the International International classification of impairments, disabilities and handicaps (ICIDH) aims at introducing the classification to a large circle of professionals, concentrating on the clarification of the concepts of "impairment", "disability" and "handicap" and of some frequent misunderstandings. It concludes that the ICIDH contains a range of basic concepts that are useful in several sectors of rehabilitation work.

Mental Retardation (1993)
The report Use of the International classification of impairments, disabilities and handicaps (ICIDH) in the field of mental retardation concentrates on a methodological analysis pointing out the relevant sections of the ICIDH to the assessment instruments of the field.

Vocational Assessment (1993)
The two-part report Use of the International classification of impairments, disabilities and handicaps (ICIDH) in the assessment of vocational aptitudes of people with disabilities, Part I: General Report, Part II: Methods of assessment and the index of characteristics, compares existing national assessment systems and their links with the ICIDH and concludes that between the different methods of assessing vocational aptitudes. The report resulted in Resolution Res AP (95) 3 on a Charter on the vocational assessment of people with disabilities, adopted by the Committee of Ministers on 12 October 1995.

Concept of Handicap (1993)
The report Applications of the concept of handicap of the International classification of impairments, disabilities and handicaps (ICIDH) and its nomenclature proposes a clarification of the conceptual distinction between the second level (disabilities) and the third level (handicap) by taking into account physical and social environmental variables.

Policy and Planning of Public Authorities (1995)
The report Use and usefulness of ICIDH for policy and planning of public authorities states that the ICIDH can be used as a coherent framework, especially in prevention-focused policy formulation. It underlines the usefulness of the classification in colleting and exchanging information by public authorities and in screening policy against unintended differentiation and discrimination.

Health professions (1996)
The report Use and usefulness of the ICIDH for health professions (nursing, physical therapy, speech therapy, occupational therapy, chiropody and orthoptics), analyses and promotes the use o the ICIDH in health professions and puts forward possible applications. The classification can offer a common standard language and can make a useful contribution to the various stages of treatment, including the interpretation of results.

Ageing (1997)
The report Use of the International classification of impairments, disabilities and handicaps (ICIDH) in relation to elderly people, aims to determine the classification’s contribution to the assessment of the general state of health of the elderly, indicating that the distinction between the second level (disability) and third level (handicap) is particularly difficult in relation to that group.

Education of children with disabilities (1997)
The report Use of the International classification of impairments, disabilities and handicaps (ICIDH) for the education of children with impairments or disabilities, studies how the impairments, disabilities and special needs of children are assessed and met in relation to education, and to what extent the ICIDH has been used, or may be useful, in this field.

Social Integration and Environment (1997)
The report Use of the International classification of impairments, disabilities and handicaps (ICIDH) in maintaining people with disabilities at home and in their own community, examines the use and usefulness of the ICIDH in defining and assessing individuals’ needs within the framework of policies and public programmes aimed at supporting people with disabilities in living at home and socially participating in community life.

Literature Review on Rehabilitation (1998)
The Literature review on the WHO International Classification of Impairments, Disabilities and Handicaps (ICIDH) and rehabilitation of people with disabilities, studies how and to what extent the ICIDH is used in rehabilitation, concluding that the main field of use is research.

The report Assessment of the evaluations of the application of the ICIDH to the various spheres of rehabilitation and integration of people with disabilities (1996) offers a synoptic analysis of 10 reports published between 1989 and 1996.

The 1995 landmark Charter on the vocational assessment of people with disabilities promotes a positive approach and calls for a shift in focus: away from disabilities towards abilities. The person’s vocational capacities should be assessed and related to specific job requirements. Comparison and matching of vocational aptitudes and specific job requirements should facilitate employment. The Charter also advocates the right of every person with a disability to active participation in the assessment process. The medical assessment is based on the ICIDH.

The activities culminated in the 1996 International Workshop on the use and usefulness of the ICIDH, organised by the Council of Europe in co-operation with the Commission of the European Communities and the World Health Organization (WHO), and with the participation of the European Disability Forum (EDF). The Workshop proceedings contain the speakers’ presentations and summaries of the discussions on the concepts, applications, use and usefulness of the ICIDH to the various areas of rehabilitation and integration of people with disabilities, the ICIDH and statistics, the Council of Europe Charter on vocational assessment of people with disabilities as well as the future use and revision of the ICIDH.

The thorough examination of the ICIDH, undertaken by the Council of Europe Committee of experts and its Working Group on the vocational assessment of people with disabilities, as well as the deliberations of the International Workshop have highlighted its strengths and weaknesses and hence contributed to the revision of the classification conducted by WHO.

In May 2001 the Fifty-fourth World Health Assembly endorsed the second edition of the International Classification of Impairments, Disabilities and Handicaps (ICIDH), with the title International Classification of Functioning, Disability and Health, henceforth referred to in short as ICF.

"Definitions and classifications must not have the effect of separating people with disabilities from society or excluding them from the possible steps of rehabilitation and integration, but point to their individual problems and prospects and ways in which all people with disabilities can gain access to the assistance they need to enable them to fully participate in society."

Recommendation No. R (92) 6 on A coherent policy for people with disabilities