Mainstreaming community based rehabilitation in primary health care in Bosnia‐Herzegovina

There are over 600 million disabled people and over 20% of the world population is impacted by disability. However, the strategies for including disabled people in the process of reform of developing countries have been rarely considered. The paucity of research is striking. Mainstreaming Community Based Rehabilitation (CBR) in Bosnia‐Herzegovina is one example where the needs of disabled people were a development priority and research was conducted to evaluate this experience. The research demonstrated that unlike the pre‐war environment, disabled people are increasingly active members of the community. The significance is that the needs of disabled people were ‘targeted’ and CBR was ‘mainstreamed’ in the primary health care system creating opportunities for sustained development. CBR is contributing to the citizenship of disabled people. This partnership project set the stage for the continued development of disability policies. These are important lessons.     

Claiming loss in disability

Pervasive representations of disability carry associations with the idea of loss. These have been strongly rejected by the social model movement as stereotyping, which may perpetuate views of disabled people as ‘incomplete’, ‘vulnerable’ or needing rehabilitation. Discourses of ‘loss’, ‘acceptance’ and ‘denial’ remain a lens through which disabled persons are misknown. It is posited that ascribed notions of ‘loss’ serve to maintain feelings of control and mastery within the observer, quieting the destablising psychic threat which disability poses. Further, disabled people positioned as having to ‘deny’ imputed loss may be at risk of suffering self‐alienation relating to a mode of being which is (necessarily, understandably) preoccupied with ‘not being’ the personification of stereotype, at the expense of exploring aspects of identity and self; such an orientation embodies unstable foundations for an entitled, articulate disability movement. Conceptual ideas are based on the author’s experience as a disabled group psychotherapist working with severely physically impaired adults.     

Children’s conceptions of the word ‘disabled’: a phenomenographic study

The aim of this study was to investigate the qualitative differences in children’s conceptions of the word ‘disabled’. Two hundred and thirty children, aged 7–12 years of age, were instructed to make a drawing of what came into their minds when they heard the word ‘disabled’. A brief written commentary on their drawing was also requested. The drawings and comments showed that the children had a positive attitude towards the word ‘disabled’. They drew and commented that a disability had medical causes, a technical device was a prerequisite for disabled people, a disability had social consequences and that a disabled person needed support. The children also explained that there were obstacles which impaired disabled people’s performance of activities. Access to some environments and being an active part of society was limited for some disabled people.     

Understanding Social Movements: theorising the disability movement in conditions of late modernity

This article draws upon qualitative research carried out by the author and funded by the ESRC. One of the central aims of this research was to investigate the nature of the UK disability movement's ‘struggle’ and to evaluate critically the idea that it is a ‘new’ social movement. Consideration of the disability movement in relation to both ‘new’ social movements and to wider social movement theorising has suggested that it may not be possible to understand this movement, entirely, by using any of the existing models. This article concludes by outlining the possible starting point for a new approach to understanding the disability movement based upon forging a closer link between citizenship and social movement theory and upon a focus on the nature of engagement. Empirical evidence from the research is included in this article in the form of quotations from respondents, all of whom are/were members of organisations that are run by disabled people. All respondents' names have been removed to maintain their anonymity.     

Developing a model of disability that focuses on the actions of disabled people

Disabled people, writers on disability and disability activists stress the importance of disabled people being included in all aspects of society. I argue that a major omission from this inclusiveness is that no current model of disability focuses on the impact of the actions of disabled people on disability. Disabled people are not passive bystanders, powerless to reduce the restrictions of disability. On the contrary, we are central to actively limiting its constraints. I develop a model of disability, called ‘active’, which focuses on the effects on disability of the individual and collective actions of disabled people. I describe published findings which indicate that engaging in self-help, using support groups and deploying assistive technology can all reduce the limitations of disability. Recent increases in the number of disability support groups and developments in assistive technology have substantially augmented the potential for disabled people to combat the effects of disability.     

Achievements of and challenges facing the Korean Disabled People’s Movement

Abstract

This paper provides a critical review of the development of the disabled people’s movement in South Korea since 1945, reflecting both its achievements and the obstacles it has faced. In particular, political positions and responses to the movement’s agitation against socio-cultural discrimination and inequality are discussed. Further, three key theoretical foundations of the movement are examined in order to describe the diversity inherent therein. This paper concludes that the disabled people’s movement has heavily influenced the values, norms, and systems of Korean society, but it has predominantly focused on integrating disability issues into policy and legislation, not on changing society and culture. Hence, the Korean Disabled People’s Movement is currently facing many challenges that are major threats towards its future development.     

Tensions and unity in the struggle for citizenship: Swedish disability rights activists claim ‘Full Participation! Now!’

This article analyses the claims of contemporary disability rights activists mobilising in a context where de facto second-class citizenship co-exists with legal and political declarations about the rights of disabled people. As an empirical case, it focuses on the blog ‘Full Participation.Now’, which was initiated by disability rights activists in Sweden. Drawing upon citizenship research, the article points to the tensions and dilemmas featuring the bloggers’ demand for participation and equality, as well as the challenges relative to their struggle. Although the bloggers formulate contrasting arguments, the article highlights that the activists share a common aspiration for ‘full citizenship’.     

‘I’m not an activist’: an exploratory investigation into retired British Paralympic athletes’ views on the relationship between the Paralympic games and disability equality in the United Kingdom

One claim of the UK Government’s Department for Culture, Media and Sport is that the London 2012 Paralympic Games ‘improved attitudes to disability and provided new opportunities for disabled people to participate in society’. In addition, the International Paralympic Committee’s strategic plan suggests that the Paralympic Games is a vehicle for achieving ‘a more equitable society’. The aim of this study was to examine the reflections of a group of retired British Paralympic athletes on the relationship between the Paralympic Games and disability equality in the United Kingdom. Narrative interviews were conducted with five male retired British Paralympians and one female retired British Paralympian who had participated in a total of 22 Summer Paralympic Games events. I will argue that some Paralympic athletes who are not obvious ‘activists’ can still contribute to equality for disabled people.     

Notions of self: lived realities of children with disabilities

To research children’s notions of self, semi‐structured interviews, drawings and focused group discussions were used with 14 children with mobility ‘impairments’ aged 11–16 years. The objective was to capture children’s ‘lived realities’. Findings illuminated immense variation and fluidity in children’s understanding of ‘disability’. Children desired to appear similar to ‘non‐disabled’ children. Most attributed ‘disability’ to existential causes. Parents’ ambivalent attitudes and societal reactions to ‘disabled’ children are discussed. The study points out the unremitting hope and potential of these children, which is often silenced by the overarching ‘negativism’ that surrounds ‘disability’.     

The human right to health: exploring disability,migration and health

Across the globe, an estimated one billion people are on the move today, of whom 244 million are international migrants. Not only have global horizons expanded in the realm of work and study; global conflict and exploitation have resulted in forced migration. Migration is a political issue, which raises questions of identity, citizenship, diversity and integration and is utilised to play upon the fear of the stranger, the ‘Other’ and difference in contemporary society. Disabled migrants are a hidden population whose experiences are often overlooked or subsumed within wider debates around disability and ethnicity. This article considers the intersection of disability and migration in contemporary society through the lens of healthcare access. Reflecting on the impact of citizenship rights on the realisation of human rights in the context of contemporary migration, using health as an example, the article considers the implications for disabled migrants, focusing primarily on the European Union.     

‘A frog in a well’: the exclusion of disabled people from work in Cambodia

Based on ethnographic research conducted in north‐west Cambodia in 2000–2001, this paper examines why disabled people experience systematic marginalisation in the labour market. Although there are no official data on the relationship between disability and employment status in Cambodia, this research suggests that disabled people are more likely than their able‐bodied counterparts to be unemployed, in low status occupations, earn less or be out of the labour market altogether. Consequently, disabled people are more likely to live in poverty, experience social isolation and poor mental health. I argue that disabled people’s social status effectively shapes their work patterns through (mis)conceptions that associate ‘disability’ with ‘inability’ to work and to be employable. This paper illustrates how geographical processes fix disabled people in their socio‐spatial place, which together with ideological and structural inequalities distinguish and entrench their poverty from that of other social groups.     

Citizenship: reflections on a relevant but ambivalent concept for persons with disabilities

This article examines the significance of citizenship with respect to disability. The article first highlights the idea of citizenship as ‘social contract’. This means the possession of civil, political, economic, cultural and social rights as well as the exercise of duties in society. Due to societal barriers, many disabled persons have difficulties fulfilling citizenship roles. Further, this article draws on citizenship theories; it examines three types of citizenship participation – the social citizen, the autonomous citizen and the political citizen – and discusses their promises and ableist implications. To counterbalance the exclusionary aspects of citizenship, we argue that human rights prove important. At the same time, human rights are more easily proclaimed than enforced and citizenship remains a precondition for effectively implementing human rights. The article concludes that citizenship is a relevant but also ambivalent concept when it comes to disability; it calls for a critical understanding of citizenship in Disability Studies.     

Autonomy in long‐term care: a need,a right or a luxury?

Doyal and Gough’s theory of human need highlighted that personal autonomy is a universal need and human right, essential for well‐being. In applying their theory to older disabled people in the UK the author suggests that their ‘minimally autonomous’ threshold would exclude some older people in long‐term care who still have a fundamental need for autonomy or, alternatively, extant autonomy. The disability movement has highlighted that independent living is fundamental to achieving self‐determination for disabled people and debate on equality and caregiving emphasises the autonomy of carers. However, there is a lack of recognition in both academic research and government policy of autonomy as a need and right of older disabled people. The author argues that autonomy is a human right of older people living in long‐term care settings, but that social rights are necessary to facilitate their autonomy.     

Pushing the boundaries of our understanding of disability and violence: voices from the Global South (Guyana)

Our knowledge about disabled people’s lives is largely based on research in the Global North. This article considers disability and violence in the Global South, specifically in Guyana. It aims to push conceptual and empirical boundaries of our understanding of violence and disability. Conceptually, it argues for a social model materialist theory of disability attuned to how material barriers to disabled people’s inclusion in society and space are reproduced through processes of exclusion unfolding across geographic scales ranging from the global, to the inter-personal and intra-personal. It argues that Lacanian psycho-analytic theory provides a complimentary lens for understanding why people engage in acts that construct disabled people as ‘deserving’ of violence. Empirically, the article broadens our understanding of disability and violence by focusing on poverty, violence as a cause of impairment and disability, and disabled women’s and men’s experiences of violence in a majority world context.     

Institutional woes of participation: Bulgarian disabled people’s organisations and policy‐making

This paper presents a critical study of the participation of Bulgarian disabled people’s organisations in the policy‐making process on a national level. It describes how the ‘representatives’ of disabled Bulgarians become depoliticised and even depersonalised when their participation becomes institutionalised through the National Council on Integration of People with Disabilities. It is argued that such an instance of ‘participation’ actually sustains the status quo of underdevelopment and dependency. A parallel is drawn with the concerns of the British disability movement. The paper ends by suggesting some tentative solutions to the highlighted problems.     

Overcoming disabling barriers: disability and attitudes to disability within the Maltese context: an insider’s perspective

This article explores the way a number of disabled people and a parent of a disabled child living in Malta, a small island in the Mediterranean, look at their daily experiences of disability and talk about what changes they would like to see in Maltese society for them to feel more equal and included. While participants acknowledge that much progress has been made in terms of inclusion, they still feel that there are still disabling attitudes that are posing limits to their choices. Lacking a true disabled people’s movement, disabled people express the need for more unity within the disabled community. Even if the article offers hope for the development of a grassroots disabled people’s movement, this possibility remains inconclusive – but the report does offer hope for future action.     

Adult protection and ‘intimate citizenship’ for people with learning difficulties: empowering and protecting in light of the No Secrets review

The government are consulting on the introduction of legislation to give professionals powers to enter the homes of ‘vulnerable adults’ where abuse is suspected and remove the ‘victim’ without their consent . This article considers the consequences of such legislation for the ‘intimate citizenship’ of people with learning difficulties who have capacity to consent to sexual relationships. Proposals of the consultation are considered in terms of their practical relevance, finding that changes can be made with better guidance, resources, policy implementation and a sound evidence base for adult protection. A case is made that proposals contravene human rights, mental capacity laws and the ethos of personalisation, increasing the focus on risk in practice. An ecological model of vulnerability is supported, which offers an approach that can prevent sexual abuse through empowerment without the need for new legislation.     

Taking a risk? The mortgage industry and perceptions of disabled people

This paper examines a relatively overlooked force within disability; the appraisal of risk, with a specific focus on disability and housing. In this context the paper explores how risk can operate against disabled people, using a case study of mortgage industry responses to disabled people in the mortgage application process. Given the recent downward shift in the buoyancy of the housing market this is a timely focus. The events in the USA, which led to the sub‐prime market ‘collapse’, and the consequent impact on the UK have meant that lenders have become even more risk averse, withdrawing numerous mortgage products and reducing loan amounts. This has left many people unable to access the owner‐occupier sector, but for disabled people this can be even more difficult. The role of risk in ‘the disabling process’ is therefore of great importance, and is illustrated here through the practice of risk assessment.     

Empower,inspire, achieve: (dis)empowerment and the Paralympic Games

This paper undertakes a critical examination of the International Paralympic Committee’s desire to use the Paralympic Games as a vehicle to empower individuals with a disability. We achieve this by applying Pierre Bourdieu’s sociological concepts of habitus and capital to semi-structured interviews conducted with Paralympic stakeholders. Interviewees included current and former Paralympians, active and retired disability sport administrators, social researchers of disability and disability sport, and disability rights advocates. The paper starts by highlighting the distinctive cultural context of the Paralympic Movement, before exploring the potential for the Paralympic Games to act as a source of empowerment, through the creation of sporting and lifestyle role-models. Findings suggest Paralympians are considered most likely to gain empowerment from the Paralympic Games, yet their specific impairment, athletic lifestyles and failure to identify as ‘disabled’ were identified as potentially limiting the ability of the Paralympic Games to empower others.     

‘Access and achievement or social exclusion?’ are the government's policies working for disabled children and their families?

The past decade has seen significant developments in policy and practice for disabled children and their families. In particular there is a new focus upon access and inclusion, with increasing awareness of the need to see disabled children and families as active partners within policy development and implementation. There is growing awareness of the implications of disability discrimination legislation across children's services and of the importance of improving arrangements for early identification and intervention to maximise disabled children's participation within mainstream services. The National Service Framework, the advent of Children's Trusts and a new Special Education Needs (SEN) Action Programme, together with the introduction of direct payments, give encouraging messages about multi‐agency working and a strategic and ‘joined up’ approach to childhood disability. However, many disabled children and their families continue to experience discrimination, poverty and social exclusion. The challenge for the Government is to ensure that disabled children are ‘mainstreamed’ across all policy initiatives and to recognise the talents and ambitions of disabled children and their families in service design and implementation. Copyright © 2003 John Wiley & Sons, Ltd.