Impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. Disability is any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being. Handicap is a disadvantage for a given individual, resulting from an impairment or disability, that limits or prevents the fulfilment of a role that is normal, depending on age, sex, social and cultural factors, for that individual.
Disabled people do not form a homogeneous group. For example, the mentally ill and the mentally retarded, the visually, hearing and speech impaired, those with restricted mobility or with so-called 'medical disabilities': all encounter different barriers, of different kinds, which have to be overcome in different ways. Handicap is therefore a function of the relationship between disabled persons and their environment. It occurs when they encounter cultural, physical or social barriers which prevent their access to the various systems of society that are available to other citizens. Thus, handicap is the loss or limitation of opportunities to take part in the life of the community on an equal level with others.
The causes of handicaps vary throughout the world, as do the prevalence and consequences of disability. These variations are the result of different socio-economic circumstances and of the different provisions that each society makes for the well-being of its members. A survey carried out by experts has produced the estimate of at least 350 million disabled persons living in areas where the services needed to assist them in overcoming their limitations are not available. To a large extent, disabled persons are exposed to physical, cultural and social barriers which handicap their lives even if rehabilitation assistance is available.
Many disabled people are denied employment or are given only menial and poorly paid jobs. In times of unemployment and economic distress, disabled persons are usually the first to discharged and the last to be hired. In some industrialized countries the rate of unemployment among disabled job-seekers is double that of able-bodied applicants.
The relationship between disability and poverty has been clearly established. While the risk of impairment is much greater for the poverty-stricken, the corollary is also true: the birth of an impaired child places heavy demands on the limited resources of the family, thus thrusting it deeper into poverty.
There is a large and growing number of persons with disabilities in the world today. The estimated figure of 500 million in 1991 is confirmed by the results of surveys of segments of population, coupled with the observations of experienced investigators. WHO predicts that early in the 21st century the number will reach 1,000 million. In most countries, at least one person out of 10 is disabled by physical, mental or sensory impairment, and at least 25% of any population is adversely affected by the presence of disability. In 1991, the UK had 6 million disabled people. In 1993, China had an estimated 10 million disabled.
According to Eurostat estimates based on national surveys carried out in 1991 and 1992, great similarities exist throughout the EU regarding the proportion of the population afflicted by a disability (12% in the ten Member States surveyed); this figure is much higher only in Spain (15%), whereas it is lower in France, Greece and Portugal (10%). The elderly are over-represented among the populations afflicted with a disability. In all countries, between 35% and 45% of the disabled are 65 or over, except in Germany (45%) and Spain (55%). Less than 3% of the disabled are aged under 20; whence, according to the same estimates, from 45 to 65% of the disabled in the EU are of working age, which represents 6 to 8% of the population aged between 15 and 64.
In the industrialized world, the likelihood of being disabled for more than 6 months is 4 times greater than the probability of dying before retirement, but most people are not adequately insured for long-term illness and unemployment.
[Developing countries] The problems of disability in developing countries need to be specially highlighted. As many as 80% of all disabled persons live in isolated rural areas in the developing countries. In some of these countries, the disabled are estimated to represent as many as 20% of the population and thus, if families and relatives are included, 50% of the population could be adversely affected by disability. The problem is made more complex by the fact that, for the most part, disabled persons are also usually extremely poor people. They often live in areas where medical and other related services are scarce or even totally absent, and where disabilities are not and cannot be detected in time. When they do receive medical attention, if they receive it at all, the impairment may have become irreversible. In many countries, resources are not sufficient to detect and prevent disability and to meet the need for the rehabilitation and supportive services of the disabled population. Trained personnel, research into newer and more effective strategies and approaches to rehabilitation, and the manufacturing and provision of aids and equipment for disabled persons are quite inadequate.
In such countries, the disability problem is further compounded by the population explosion, which inexorably pushes up the number of disabled persons both in proportional and absolute terms. There is thus an urgent need, as the first priority, to help such countries to develop demographic policies to prevent an increase in the disabled population and to rehabilitate and provide services to the already disabled.