Notes to Submission to the Productivity Commission Inquiry into the ...

This “hierarchical” perspective contrasts with both the “synonymous” view which definesthe three concepts as equivalent, and with an “either-or” view which defines a persononly in terms of whether they do or do not have an impairment, activity restriction ordisability. From a policy perspective, the main problem with the synonymous view is thatit leads to inefficiently targeted policy while the problem with the either-or view is that itis inequitable in failing to distinguish between degrees of impairment, activity restrictionor disability, thus treating individuals who are a significant distance from the norm nodifferently from those closer to the norm but beyond the definitional threshold. Forexample, where each of the curves have been normalised to have an average of zero andstandard deviation of 4, and where activity-restriction is defined in terms of beingassociated with an index value greater than say 7, and then:• the either-or view does not distinguish between an individual with an activityrestrictionindex value of 7.3 and another individual associated with an index value of11.5• the synonymous view assumes that a person with an impairment index value of7.3 also has an activity-restriction index value and disability index value of 7.3 and• the hierarchy view suggests that a person may have an impairment index value of11.2 (i.e. significantly impaired relative to the norm), an activity-restriction index valueof 3.1 (if they can afford a wide range of assistive devices) and a disability index 7.1 (ifthe public design infrastructure is enabling and inclusive of people with impairments).Implications• The critical difference between impairment, disability and activity restriction iseconomic. A policy focus on impairment involves expenditure on research anddevelopment of medical technologies; a focus on activity-restriction involvesenhancing purchasing power; and a focus on disability involves expenditure onenhancing the accessible design in the social environment.• Policy makers, researchers and statisticians need to distinguish betweenimpairment, activity restriction and disability. The confusion between the threeterms is not only evident in common language and understanding, but also in theAustralian Bureau of Statistics’ Survey of Disability, Ageing and Carers wheredisability is treated as synonymous with activity restriction, as well as in much ofthe political debate over income support and workforce participation.• A major difficulty in policy involves distinguishing between the three concepts.That one person with a particular impairment might face little activity restrictionor disability in one area of life but significant activity restriction or disability inanother is important for an efficient policy response. For example, a radioannouncer with a missing arm may not need special assistance to facilitateemployment participation, while a butcher with a missing arm will needassistance. Similarly, a courier with brain injury affecting vision-depth will notneed help a photographer with the same brain injury will need it.• The definition of impairment, activity-restriction and disability is a socialconstruct which is fluid. In terms of the “hierarchy” perspective, these categoriesare defined in terms of threshold values which are an arbitrary number of standard7