Disability studies and health care curriculum: the great divide.

Models or paradigms of disability are used to guide health care professionals' perceptions so that they can serve people with disabilities, enhance their futures, and facilitate the resources they need. Health care curricula, which in essence train students to make such decisions, are influenced by these models. The medical model, which locates disability within the individual, assumes the individual with a disability is a victim who must be cured or made more normal. The functional-limitation paradigm expands on the medical model, focusing on the interaction of physical or mental limitations with social and environmental factors. The economic model, based on the concept of employability, emphasizes a health-related inability (or limited ability) to work rather than physical functioning of the individual. The sociopolitical model views disability as a policy and civil rights issue. Health care professionals face a dilemma as the disability rights movement demands a shift in social power from the paternalistic view of the medical model to the autonomist view of the sociopolitical model. The question is asked if curricula are preparing our future health care professionals to distinguish how to view each situation and each individual through the lens of the appropriate model. J Allied Health. 2004; 33:184-188. SEVERAL MODELS THAT ATTEMPT to define disability and understand the disabling process have been proposed,1 each influenced by the prevailing sociopolitical views. For many years, what is now referred to as the medical model prevailed, with a corresponding emphasis on pathology. Challenges by the disability rights movement have resulted in new models that place the emphasis on capabilities and social stigma. Health care curricula and rehabilitation professionals have yet to realize fully the sociopolitical model, however, and the demands of the disability rights movement. To understand better the dilemma facing health care professionals as they contemplate the sociopolitical model, several models of disability are presented, and the health care and disabilities studies curricula are compared. The discussion focuses on the social dimensions of disability and models of disability accepted by the disability community rather than on how the medical community manages disability via models of rehabilitation such as the community-based rehabilitation or client-centered rehabilitation, models. The purpose is to contrast the disability (which by definition implies social function) with rehabilitation perspectives and present why both must be included in health care curricula. Models of Disability MEDICAL MODEL The medical model of disability, emphasizing limitation of physical functioning, locates disability within the individual.2 It denotes a medical etiology that stresses a causal relationship between the origins and outcomes of disability. Disabilities are treated as diagnostic categories. Medical determination becomes an essential prerequisite for participation in a rehabilitation program. The medical model assigns individuals with disabilities a sick role,3 and their disability is defined according to the lack of a valued personal characteristic (e.g., "feeble-minded").4 In this role, individuals are exempt from social obligations and held blameless for their condition; however this role requires them to surrender their autonomy to professional direction. Treatment is preoccupied with the inabilities of the individual and focuses on methods to cure or return to normalcy. The medical model attempts to treat the body in isolation from the person inhabiting it by reducing the illness to disordered bodily functions. This type of reductionism precludes consideration of how aspects of the individual's social or emotional life affect their physical health. In addition, little consideration is given to modifying the environment, changing roles and tasks, or altering societal expectations. This model inhibits recognition of the social sources of disability, such as stigma, prejudice, and public policy. …