Contributors to Health
In order to achieve “optimal health,” it is important to examine what factors contribute to health status. Determinants of population health outcomes have been grouped into five categories: genetic predispositions, environmental conditions, social circumstances, behavioral patterns, and medical care access (McGinnis, Williams-Russo, & Knickman, 2002). While the determinants of genetics, environmental exposures, and social circumstances are less easily modified, individual behaviors and access to medical care are more amenable to intervention. The Institute of Medicine has identified a number of behavioral, social, and clinical interventions that effectively address health promotion behaviors (Smedley & Syme, 2000). Policy and systemic changes can be instituted that increase medical care access, thereby contributing to health and wellness.
Defining Disability
Disability often reflects the zeitgeist of a particular era: what is considered a disability at one point may change through formal and informal social or political processes. When contemporary public health considers disability, most of its perspectives derive from the medical model of disability, although functional and social models are increasingly present. Each of these approaches to disability is described below.
Under the medical model, disability derives from disease, trauma, or health impairments or deficits located within an individual that can be cured or ameliorated through a particular treatment or intervention (Bickenbach, Chatterji, Badley & Ustun, 1999; Johnston, 1996;
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Llewellan & Hogan, 2000; Rioux, 1999).
Examples of disability from a medical model perspective include consideration of diagnostic categories such as spinal cord injury, multiple sclerosis, and traumatic brain injury. The medical model is based in the etiology of the condition. The functional model to disability differs from the medical model in that, while the source of the disability is individualistic and linked to medical, physiological, or cognitive impairments or deficits, the expression of disability is the inability to perform a number of functional activities regardless of etiology. For example, someone has a disability under the functional model if, due to an underlying impairment or condition, they are unable to perform vital physical or mental activities such as breathing, moving, living independently, or working (Bickenbach, et al., 1999; Rioux, 1999).
A number of social models of disability have been developed as an alternative to medical and functional models. Social models to disability typically shift disability from considering deficits or impairments within an individual to examining the barriers people (with underlying impairments or conditions) face when interacting with the environment (Drum, 1998; Humphrey, 2000). Social models argue that disability is a consequence of social (dis)organization that creates or results in inaccessible environments. For example, under the social model, a woman with quadriplegia who wants to work experiences a disability when she is excluded from a work site due to an inaccessible entrance.