The I.C.F. (International Classification of Functioning, Disability and Health)
Context of ICF
The International Classification of Functioning, Disability and Health, known more commonly as ICF, is a classification of health and health-related domains. As the functioning and disability of an individual occurs in a context, ICF also includes a list of environmental factors.
ICF is the WHO (World Health Organization) framework for measuring health and disability at both individual and population levels. ICF was officially endorsed by all 191 WHO Member States in the Fifty-fourth World Health Assembly on 22 May 2001(resolution WHA 54.21) as the international standard to describe and measure health and disability.
ICF belongs to the WHO family of international classifications, the best known member of which is the ICD-10 (the International Statistical Classification of Diseases and Related Health Problems). ICD-10 gives users an etiological framework for the classification, by diagnosis, of diseases, disorders and other health conditions. By contrast, ICF classifies functioning and disability associated with health conditions. The ICD-10 and ICF are therefore complementary, and users are encouraged to use them together to create a broader and more meaningful picture of the experience of health of individuals and populations. Information on mortality (provided by ICD-10) and information about health and health-related outcomes (provided by ICF) can be combined in summary measures of population health.
The need for ICF was confirmed by the studies, which showed that diagnosis alone did not predict services demand, length of hospitalization, level of care, or functional outcomes. Likewise, neither was the presence of a disease an accurate predictor of required disability benefits, performance at work, return to work potential, or likelihood of social integration therefore, only using a classification of diagnosis will not provide enough information for health planning and management and therefore, complementary information on the levels of functioning and disability is missed. ICF was developed with the goal of collecting those data in a consistent and internationally comparable manner. ICF provides the framework and the classification system for determining the overall health of populations.
In the ICF, functioning and disability are multi-dimensional concepts, relating to:
- 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);
- the environmental factors which affect these experiences (and whether these factors are facilitators or barriers).
The ICF conceptualises a person’s level of functioning as a dynamic interaction between her or his health conditions, environmental factors, and personal factors. It is a biopsychosocial model of disability, based on an integration of the social and medical models of disability.
TASK. Reflect / discuss these topics:
- Which of the factors, mentioned in the Figure 1 are important for the tourism sector provider? Why?
- How tourism chain representatives can influence these contextual factors (positively and negatively) for the individual with the specific access requirement?
Sources, to learn more about the topic:
Video about ICF usability
Individual application of ICF
Although personal factors are recognised in the interactive model shown in Figure 1, they are not classified in the ICF. Such factors influence how disability is experienced by the individual and some, such as age and gender, are commonly included in data collections. The ICF can provide or underpin a descriptive profile of an individual’s pattern of functioning, not a ‘yes’ or ‘no’ answer about whether he or she is disabled. A decision about where to draw a line between ‘no disability’ and ‘disability’ depends on the purposes for doing so. Individual measures must be based on this understanding as well as the knowledge that there are multiple dimensions of disability, and potentially multiple perspectives to consider. For example:
Every participant of the tourism service chain seeking a good service should bear this in mind. Such prejudices as:
- Our product/service doesn`t suit you;
- Your disability prevents us from satisfying your specific requirements;
- We can`t solve your problems.
The customer`s visualization through ICF allows you to consider other options. For example:
- Why/For which purpose are you going to use our service/product?
- How can we help you – Do you have any particular requirements?
- Can we find a solution?
TASK: Use Figure 2 to discuss the questions that might be important to service personnel working for a tourism service provider, and find possible solutions to these situations:
- A customer calls a taxi company and orders a taxi for a person with reduced mobility.
- A person books a table via Facebook. The customer informs that he/she has hearing disability.
- An elderly couple contacts a tourism service company. They want to buy a trip abroad.
Because of its flexible framework, the detail and completeness of its classifications and the fact that each domain is operationally defined, with inclusions and exclusions, ICF can be used for a myriad of uses to answer a wide range of questions also important for the tourism service provider. For specific examples of the uses of ICF in the area of service provision, and the kinds of practical issues that can be addressed:
- For the needs assessments related to providing accessible tourism services: What are the needs of persons with various levels of disability – impairments, activity limitations and participation restrictions?
- For environmental assessment for universal design, implementation of mandated accessibility, identification of environmental facilitators and barriers, and changes to social policy: How can we make the social and built environment more accessible for all person, those with and those without disabilities? Can we assess and measure improvement?
Information prepared by World Health Organization information.