What classifications are used by the NDIA to understand disability, functioning and impairment?

This section provides an overview of disability demographics and trends in Australia and outlines the key policy instrument used by the NDIA to understand functioning and impairment as it relates to a person’s disability.  

What are the disability demographics and trends in Australia? 

The Australian Bureau of Statistics (ABS) developed the 2015 ‘Survey of Disability, Ageing and Carers’ (SDAC) to align with the International Classification of Functioning, Disability and Health The survey defines disability as any limitation, restriction or impairment which restricts everyday activities and has lasted, or is likely to last, for at least six months. The survey differentiates between those who have long-term health conditions that limit their activities (that is, those with disability) and those who have long-term conditions without restrictions and limitations.

In 2015, almost one in five Australians reported living with disability (18.3% or 4.3 million people). A further 22.1% of Australians had a long-term health condition but no disability, while the remaining 59.5% had neither disability nor a long-term health condition. The total number of people with profound and severe disability above is 1,368,600. It is from this cohort that the estimated 460,000 people with significant and permanent disability are expected to approach the NDIS for support in Australia. The table in the next section below [​1] denotes the total number of people with a disability compared to those without a disability.

[​1] Source – Table sourced directly from ABS 4430.0 - Disability, Ageing and Carers, Australia: Summary of Findings, 2015
 

What are the total number of people with a disability compared to those without a disability?

total number of people with a disability compared to those without a disability

Note:
- estimates have been rounded to the nearest one hundred persons
- due to rounding the sum of sub-totals may not equal totals
- derived from Table 3.1

(a) For more information on the terms used, refer to the Glossary and appendices associated with this publication.
(b) Excludes people with disability who have both a core activity limitation and a schooling or employments restriction.

Age group (years)

2003

2009

2012

2015

Age group (years)

2003

2009

2012

2015

ESTIMATE ('000)

Males

Females

 

 

 

 

0-4

20.8

20.9

19.2

20.5

0-4

15.1

10.6

17.2

11.1

5-14

88.1

92.2

90.7

96.9

5-14

42.7

39.9

43.4

47.5

15-24

31.2

30.3

36.2

47.1

15-24

29.8

26.0

31.3

30.5

25-34

34.2

27.4

28.6

30.9

25-34

33.3

33.5

40.8

37.5

35-44

46.9

35.6

43.8

39.6

35-44

51.9

50.9

49.7

56.2

45-54

57.0

54.1

54.9

49.4

45-54

74.3

71.3

82.2

59.2

55-59

37.1

37.7

37.0

39.6

55-59

46.3

50.8

46.3

47.1

60-64

32.5

47.8

49.5

45.6

60-64

41.7

51.4

59.6

54.7

65-69

32.8

35.7

50.0

47.5

65-69

36.7

40.8

48.0

50.4

70-74

34.3

42.2

44.4

40.1

70-74

56.8

53.4

50.1

60.2

75-79

43.5

41.0

41.1

44.9

75-79

62.9

56.1

65.1

55.4

80-84

40.2

44.9

51.5

47.1

80-84

88.8

77.7

80.7

81.0

85-89

26.0

37.9

43.3

39.8

85-89

71.3

86.3

87.6

84.1

90 and over

13.6

16.9

27.1

24.6

90 and over

54.7

57.3

74.3

80.5

Total

538.3

564.5

617.0

616.5

Total

706.2

706.1

774.0

753.3

 

All persons

2003

2009

2012

2015

0-4

35.9

31.5

36.4

31.0

5-14

130.8

132.1

134.8

145.1

15-24

61.0

56.2

69.3

78.3

25-34

67.5

61.0

68.0

69.3

35-44

98.8

86.5

92.1

95.7

45-54

131.4

125.4

136.6

108.4

55-59

83.4

88.4

83.9

86.8

60-64

74.3

99.2

108.7

99.7

65-69

69.5

76.5

98.4

98.0

70-74

91.1

95.6

94.1

99.8

75-79

106.4

97.1

106.3

100.0

80-84

129.0

122.6

132.0

127.8

85-89

97.3

124.3

130.7

124.0

90 and over

68.3

74.2

101.1

105.0

Total

1,244.5

1,270.6

1,391.0

1,369.6


The table above provides information on the estimated number of people with severe or profound disability, which is the focus of the NDIS, by age groupings for each survey since 2003 [​1].

[​1] Source - table sourced directly from Australian Bureau of Statistics

What is the relevance of the World Health Organisation’s International Classification of Functioning, Disability and Health to the NDIS?

A person’s eligibility for the NDIS is predicated on functioning and impairment as it relates to a person’s disability as opposed to disability per se. For this reason it is essential to understand what instruments the NDIA use to inform their understanding of functioning and impairment.

The World Health Organisation’s (WHO) International Classification of Functioning, Disability and Health (ICF) provides a standard international framework for health and health-related domains. This framework has directly influenced the design of the NDIS and the supporting NDIS legislative and policy framework were developed with reference to, or in alignment with, the ICF.

What are the historical models that have influenced our current understanding of disability, functioning and impairment?

The ICF health framework has two broad areas: (1) Body Functions and Structures and (2) Activities and Participation. In the ICF the term ‘functioning' encompasses all body functions, activities and participation, and ‘disability’ describes impairments, activity limitations and restrictions on participation. Two major conceptual models of disability have been proposed under the ICF:

The medical model of disability views disability as a feature of the person, directly caused by disease, trauma or other health condition, which requires medical care provided in the form of individual treatment by professionals. Disability, on this model, calls for medical or other treatment or intervention, to 'correct' the problem with the individual.

The social model of disability, on the other hand, sees disability as a socially-created problem and less attributable to an individual. Advocates of the social model suggest the experience of disability requires political and societal responses, since the ‘problem’ of disability is created by a combination of unaccommodating physical environment and / or prevailing societal attitudes about people living with disability’s abilities, and other features of the social environment.

On their own, neither model is considered adequate, although both are partially valid. A more comprehensive model of disability is one that integrates the positive aspects of both the medical and social models, without making the mistake each makes in reducing the whole, complex notion of disability to one of its aspects.

What is the current model shaping our understanding of disability, functioning and impairment?

The current model of disability, the biopsychosocial model, seeks to address the shortcomings of the medical and social models of disability.

The biopsychosocial model of disability considers disability as emerging from a combination of factors including biological, psychological and social factors. The elements of body, mind, and environment are considered to affect each other and it is the inextricable relationship between these parts that results in any particular outcome i.e. disability, health or illness.[​1]

The biopsychosocial model is an integrated approach to understanding functioning and disability and the interrelationship between the following:

  • the body functions and structures of people, and impairments thereof (functioning at the level of the body);
  • the activities of people (functioning at the level of the individual) and the activity limitations they experience;
  • the participation or involvement of people in all areas of life, and the participation restrictions they experience (functioning of a person as a member of society); and
  • the environmental factors which affect these experiences (and whether these factors are facilitators or barriers).[​2]

The following ICF 'Model of Disability and Functioning and Disability'[​3] represents the biopsychosocial model demonstrating the multidimensional and interactive nature of the various components of functioning and disability.

ICF Model of Disability and Functioning and Disability

The diagram identifies the three levels of human functioning classified by ICF:

  • functioning at the level of body or body part,
  • the whole person, and
  • the whole person in a social context.

Disability is considered to involve dysfunction at one or more of these levels and the interaction between these factors: impairments, activity limitations and participation restrictions. Definitions of these components can be accessed at ICF components and their contents
 

[​1] Source - Boundless. "The Biopsychosocial Model of Health and Illness." Boundless Psychology Boundless, 20 Sep. 2016. Retrieved 23 Mar. 2017
[​2] Source - ICF Overview
[​3] Source - ICF Overview

What is the relationship between the biopsychosocial approach and NDIS participants’ eligibility and planning?

As has been stated the ICF views disability and functioning as being determined by a complex set of interactions between health conditions (diseases, disorders and injuries) and contextual factors. Contextual factors are external environmental factors and internal personal factors. External environmental factors include for example: social attitudes, architectural characteristics, legal and social structures, as well as climate, terrain and so forth. Internal personal factors include for example:

  • gender,
  • age,
  • coping styles,
  • social background,
  • education,
  • profession,
  • past and current experience,
  • overall behaviour pattern,
  • character, and
  • other factors that influence how disability is experienced by the individual.

Therefore disability and corresponding support needs cannot be understood by aetiology alone. Rather, functional impairment is to be understood through a complex interaction of health and contextual factors. As such each person is considered by the NDIA to have potentially unique needs that must be understood for effective planning.

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