No C 230/38 Official  Journal  of the European  Communities 10. 9. 81 
Opinion  on the situation  and  problems  of the handicapped 
The opinion  of the Committee  is not based  on any text. 
A. LEGAL  BASIS  FOR  THE  OPINION 
At its 183rd  plenary  session  held  on 19 and 20 November  1980  the Committee,  acting  on a 
proposal  from  the Bureau,  decided  to deliver  an opinion  on the abovementioned  subject  on its 
own initiative. 
B. OPINION  OF THE  ECONOMIC  AND  SOCIAL  COMMITTEE 
The Economic  and Social  Committee  prepared  its opinion  on the above  matter  at its 189th 
plenary  session  held  in Brussels  on 1,2  and  3 July  1981. 
The full text of the opinion  is as follows: 
THE  ECONOMIC  AND  SOCIAL  COMMITTEE, 
Having  regard  to the decisions  at its plenary  session  of 
20 November  1980,  following  a proposal  from  its Bureau 
on 18 November  1980,  to deliver  on its own  initiative  an 
opinion  on  the  situation  and  problems  of the 
handicapped, 
Having  regard  to the decision  taken  by its Bureau  on 
18 November  1980  instructing  the Section  for Social 
Questions  to draw  up an opinion  on the matter, 
Having  regard  to the  opinion  adopted  by  the 
abovementioned  Section  at its meeting  on 11 June 
1981, 
Having  regard  to the oral report  made  by the rapporteur, 
Mr Davies, 
Having  regard  to the discussions  at its 189th  plenary 
session  on 1,2  and  3 July  1981  (meeting  of 2 July 
1981), 
Whereas  there  is a need  to step  up elimination  of deeply 
rooted  prejudices  and  discriminations  against  disabled 
persons  who  number  approximately  27 million  in the 
European  Community; 
Whereas  there  is a general  attitude  to ignore  the disabled 
in our community,  the number  of handicapped  is most 
likely  larger; 
Whereas  the Economic  and Social  Committee  recognizes 
the difficult  and  often  tragic  conditions  under  which 
disabled  persons  live and has tried,  also  in past  opinions, 
to seek  out appropriate  solutions  to this  problem, HAS  ADOPTED  THE  FOLLOWING  OPINION 
unanimously: 
A. INTRODUCTION 
1.1. The  World  Health  Organization  estimates  that 
throughout  the world  at least  one person  in 10 is disabled 
by physical,  mental  or sensory  impairment.  The  lives  of 
these  500  million  people  and  their  families  are often 
characterized  by poverty,  frustration,  isolation  and 
dependency.  In recognition  of their  needs  in 1976  the 
General  Assembly  of the United  Nations  declared  1981 
the International  Year  of Disabled  People  and established 
five principal  objectives  for the Year: 
— to help  disabled  persons  in their  physical  and 
psychological  adjustment  to society, 
— to promote  efforts  to provide  to disabled  persons 
proper  assistance,  training,  care  guidance,  and work 
opportunities  for full integration  into  society, 
— to encourage  studies  and research  projects  designed  to 
facilitate  participation  of disabled  persons  in daily 
life, 
— to educate  and  inform  the public  of the rights  of 
disabled  persons  to participate  fully  in economic, 
social  and political  aspects  of life, 
— to promote  effective  measures  for the prevention  of 
disability  and  for  the  rehabilitation  of disabled 
persons. 
Another  objective  is to further  the implementations  of the 
1971  Declaration  of the Rights  of Mentally  Retarded 
Persons  and  the  1975  Declaration  on the  Rights  of 
Disabled  Persons,  both  adopted  by the UN  General 
Assembly. 
10. 9. 81 Official  Journal  of the European  Communities No C 230/39 
1.2. In  advance  of  the  International  Year 
Rehabilitation  International  has drawn  up in a Charter 
for the 80s international  priorities  for action  during  the 
decade.  The  four  aims  of the Charter  are: 
— to launch  in each  nation  a programme  to prevent  as 
many  impairments  as possible,  and to ensure  that the 
necessary  preventive  services  reach  every  family  and 
every  person; 
— to make  certain  that  every  person  with  a disability, 
and every  family  which  includes  a member  with  a 
disability,  receives  whatever  rehabilitation  services 
and other  support  and  assistance  may  be needed  to 
reduce  the handicapping  effects  of disability  and  to 
make  possible  for each  person  a full  life  and  a 
constructive  role  in society; 
— to take  all necessary  steps  to ensure  the fullest  possible 
integration  of and equal  participation  by people  with 
disabilities  in all aspects  of the  life  of their 
communities; 
— to disseminate  information  about  people  with 
disabilities  and their  potential,  and  about  disability, 
its prevention  and treatment,  so as to increase  public 
knowledge  and  awareness  of these  problems  and of 
their  importance  to every  society. 
1.3. The  Committee  fully  subscribes  to the  aims 
enunciated  above.  The  purpose  of this opinion  is to draw 
attention  of Member  States  and  the  Commission  to 
specific  actions  which  the  Committee  believes  are 
necessary  to realize  these  aims  within  the Community 
during  1981  and the coming  years.  If there  is one theme 
running  through  this opinion  that  theme  is 'integration'. 
Although  accepted  in all Member  States  as an ideal 
(indeed  in France  it is enshrined  in legislation)  the 
necessary  practical  measures  have  not  always  been 
forthcoming. 
1.4. A  change  in mental  attitude  is necessary  if the 
constraints  and  sufferings  of disabled  people  are to be 
alleviated.  We must  not look  on society  as a community 
where  the handicapped  person  is an exception  to the rule 
but as  one  where  both  handicapped  and 
non-handicapped  have  a place  and the same  rights.  It is 
not so much  a question  of remedying  specific  situations  as 
of ensuring  that  on all occasions  and in all programmes, 
everyone  - whether  in the minority  or the majority  - is 
considered  to be an equally  full  member  of society. 
Accordingly,  it is essential  that  disabled  people  should 
participate  in working  out the arrangement  to meet  their 
requirements  and  not  just  be passive  recipients  of 
services. 
1.5. In  this  opinion  the  definitions  of the  terms 
'impairment',  'disability'  and 'handicap'  will be those  used in the  International  Classification  of Impairments, 
Disabilities  and  Handicaps  of the  World  Health 
Organization  (1980),  as follows 
Impairment: 
'Any  loss or abnormality  of psychological,  physiological, 
or anatomical  structure  or function.' 
Disability: 
'Any  restriction  or lack  (resulting  from  an impairment)  of 
ability  to perform  an activity  in the manner  or within  the 
range  considered  normal  for a human  being.' 
Handicap: 
'A disadvantage  for a given  individual,  resulting  from  an 
impairment  or a disability,  that  limits  or prevents  the 
fulfilment  of a role that is normal  (depending  on age,  sex 
and social  and cultural  factors)  for that  individual.' 
1.6. Using  the WHO  yardstick  mentioned  above  there 
would  be 27 million  within  the Community  suffering  some 
form  of impairment.  Such  a general  figure,  while  useful  to 
draw  attention  to the size of the problem,  is unhelpful  in 
determining  policy.  Disabled  people  are  not  a 
homogeneous  group  and their  needs  vary  not only  from 
each other  but also  over  their  lifetime.  Studies  undertaken 
in individual  Member  States  have  produced  similar 
figures  which  provide  useful  information  on the structure 
of the disabled  population  in those  countries  but do not 
afford  adequate  information  for accurate  comparison 
between  Member  States  because  of differences  in 
definition  and  methodology.  We therefore  recommend 
that the  Commission  should  have  discussions  with 
Member  States  on  harmonizing  national  working 
definitions  of disability  and  handicap  e.g.  criteria  for 
benefit  payments,  special  employment  assistance.  We 
also recommend  that  the Commission  should  set in hand 
a Community-wide  survey  of disability  in order  to 
ascertain  what  the most  pressing  problems  are in different 
parts  of the  Community  which  merit  attention  at 
Community  level. 
1.7. Certain  general  statements  can,  however,  be 
made  on the basis  of available  information.  In the first 
place  it is clear  that  throughout  the Community  (in 
contrast  to developing  countries)  as whole  the largest 
category  of people  affected  by disability  are the elderly,  in 
particular  the very  old. For example,  a survey  undertaken 
in Great  Britain  in 1968/69  indicated  that in the small  but 
vitally  important  group  described  as very  severely 
handicapped  over  half were  over  75. The  number  in this 
age group  is also  expanding  rapidly  throughout  the 
Community. 
1.8. Balanced,  however,  against  the number  of very 
elderly  handicapped  people  must  be the fact  that when  a 
No C 230/40 Official  Journal  of the European  Communities 10. 9. 81 
child  is born  with  a severe  impairment  or who  sustains 
permanent  injuries  he faces  a lifetime  of disability. 
Equally  the effect  on the individual  and  family  when 
someone  of working  age  is struck  down  by injury  or 
disease  may  be far more  complex  than  the problems  of 
someone  disabled  later  in life.  To date  the Community 
has concerned  itself  mainly  with  disabled  people  of 
working  age.  This  opinion,  however,  attempts  to survey 
the broad  needs  of all age groups  and  in particular  to 
recommend  how  the Community  can intervene  effectively 
both to prevent  impairment  and in the rehabilitation  of 
those  who  have  become  disabled.  It also  addresses  itself  to 
the wider  question  of the place  of disabled  people  in the 
community  and  the actions  which  need  to be taken  to 
allow  them  not only  to influence  decisions  which  affect 
their  own  lives  but also  to play  a full and equal  part  as 
fellow  citizens. 3. Primary  prevention 
3.1. Primary  prevention  is essential  not  only  for 
humanitarian  reasons  but  in order  to release  more 
resources  for the treatment,  rehabilitation  and  care  of 
those  whose  handicaps  already  exist  or who  are 
unavoidably  disabled  in the  future.  The  developing 
countries,  and  in particular  their  children,  are  still 
ravaged  by malnutrition  and  killing  and  disabling 
diseases  which  are happily  now  little  more  than  a memory 
in most  Western  States.  Relative  prosperity  and  the 
advances  of science  and medicine  have  ironically  not only 
produced  new  causes  of impairment  but succeeded  so well 
in saving  and  prolonging  life that  injuries  and diseases 
that once  were  fatal  often  now  leave  people  to endure 
years,  even  lifetimes,  of severe  handicap.  The  imperative 
to seek  ways  of averting  impairment  is therefore  more, 
not less,  urgent. 
B. COMMENTS 
2. Preventive  measures 
2.1. Prevention  of handicap  is usually  defined  in three 
categories: 
— primary  prevention: 
an attempt  to prevent  disease  or impairment  before  it 
occurs, 
— secondary  prevention: 
the early  detection  and  treatment  of disease  or 
impairment  with  a view  to a return  to normal 
health, 
— tertiary  prevention: 
the continuing  treatment  of the disease  or disability  to 
avoid  needless  progression  or complications  and the 
rehabilitation  of the individual  in order  to minimize 
any consequent  handicap. 
2.2. Within  the Community  (if not in many  deprived 
areas  of the world)  it is true to say that in most  situations  it 
is the individual  who  must  take  the major  responsibility 
for his own  health.  To achieve  this each  Member  State 
must  give  priority  to health  education,  especially  for 
school  children.  For some,  however,  especially  the very 
young  and very  old, the responsibility  must  lie elsewhere; 
and in certain  specific  situations  which  we consider  below 
the individual  and social  consequences  of disability  are so 
serious  that  legal  measures  to reduce  the incidence  of 
impairment  are imperative. 3.2. Children 
With  victory  over  childhood  diseases  through 
environmental  health  measures  as much  as medical 
measures,  congenital  handicaps  have  assumed  increasing 
significance  as a cause  of disability  in children;  and within 
this group  of birth  handicaps  as care  during  pregnancy 
and at delivery  improves,  genetic  disorders,  at present 
susceptible  only  to genetic  counselling  or therapeutic 
abortion,  are an increasing  proportion.  Nevertheless,  on 
the most  reliable  comparative  statistics,  those  for 
perinatal  and  infant  mortality,  there  are  marked 
differences  between  different  regions  and  between 
different  social  classes.  In the  Federal  Republic  of 
Germany  over  25 000  children  are born  annually  with 
serious  disabilities.  It has been  estimated  that  every  20th 
child  in the  Federal  Republic  is born  in some  way 
handicapped. 
3.3. The  Commission  has  already  instituted  a 
research  programme  on the registration  of congenital 
abnormalities  (') and  has more  recently  extended  this to 
the criteria  for perinatal  monitoring  (2). We recommend 
that the Commission  should  expand  its role  in this area 
and fund  more  comparative  studies  in different  parts  of 
the Community.  Specifically  it should  consider 
establishing  a comprehensive  model  maternity 
programme  in one  of the  highest  risk  areas  of the 
Community  which  would  include  family  planning, 
genetic  counselling,  ante-natal  care,  nutrition  counselling 
and the best  possible  facilities  in the maternity  wards  and 
for neo-natal  care. 
(') OJ No L 52, 23. 2. 1978. 
(2) OJ No L 78, 25. 3. 1980. 
10. 9. 81 Official  Journal  of the European  Communities No C 230/41 
3.4. There  is, however,  no room  for complacency 
concerning  childhood  diseases  and  there  are  serious 
dangers  that a generation  of parents  spared,  for example, 
the ravages  of polio  by vaccination  in their  childhood  may 
no longer  think  it necessary  to protect  their  children.  We 
recommend  » therefore,  that  the  Commission  should 
monitor  at intervals  the  take-up  of vaccination  and 
immunization  throughout  the Community. prevention  programme.  We  also  recommend  that  the 
Commission  arrange  for research  to be conducted  into 
possible  different  hazards  both  of disease  and accidents 
faced  by children  in urban  and rural  areas  which  lead  to 
handicap. 
3.5. In  developed  countries,  after  the first  year  of life, 
accidents  become  a major  cause  of death  and handicap.  In 
the United  Kingdom  between  1967  and  1976  they 
claimed  27 % of deaths  in the age group  of one to four, 
38%  ages  five to nine  and 37%  ages  10 to 14. For very 
young  children  the home  can be highly  dangerous.  The 
Commission  is already  taking  action  in relation  to the 
design  of toys  and the labelling  of hazardous  household 
products.  Furthermore,  the Committee  has adopted  an 
opinion  on the proposal  for a Council  Regulation  on the 
approximation  of the  laws  of the  Member  States 
concerning  toy safety  and welcomed  the Commission's 
decision  to propose  an alignment  Directive  designed  not 
only to eliminate  trade  barriers  but above  all to enhance 
the protection  of children's  health  and  safety.  We 
recommend  the Commission  should  issue  guidelines,  and 
eventually  regulations,  on the design  of safe  homes  for 
children  and,  in particular,  put restrictions  on the use of 
unstrengthened  glass  at ground  level.  In the  United 
Kingdom  it is estimated  that  accidents  in the  home 
involving  architectural  glass  lead  to about  25 000  persons 
being  treated  in hospital  departments  each  year  and that 
about  half of these  accidents  are caused  by glass  in doors 
and just  over  half  of these  occur  to children. 
3.6. For  older  children  motor  vehicles  are a major 
hazard.  A major  reduction  depends  on a number  of 
factors,  better  education  of both  children  and  adults, 
better  environmental  planning,  etc. But some  causes  of 
injury  are susceptible  to immediate  action.  Car passenger 
accidents  claimed  80 child  deaths  and  1 280 serious 
injuries  in the United  Kingdom  in 1979.  In order  to 
reduce  the risk to child  passengers  we recommend  that  all 
cars manufactured  or imported  into  the Community 
should  be fitted  with  rear  seat  belts  and  that  the 
Commission  should  produce  a Directive  banning  children 
under  the age of 13 from  front  seats  except  in prescribed 
circumstances.  We  also  recommend  that  safety 
instruction  in schools  has  a prominent  place  in the 
curriculum. 3.8. Adults 
For adults,  too,  road  accidents  are a major  cause  of death 
and serious  injury.  In the Federal  Republic  of Germany 
about  14 000 deaths  per  year  are  caused  by traffic 
accidents.  In the United  Kingdom  between  1965  and 
1975  one-third  of deaths  from  injuries  were  attributable 
to road  accidents  although  their  proportion  has  been 
falling.  Comparative  figures  for less serious  injuries  are 
more  difficult  to obtain  but an estimate  was made  that  in 
1973  16%  of all injuries  were  from  road  accidents, 
whereas  34%  were  work-related.  In 1979  in Great 
Britain,  5 800  deaths,  66 700  serious  injuries  and 
181 900  slight  injuries  were  attributable  to road 
accidents.  The  cost  of road  accidents  is massive  - an 
estimated  £1 730  million  in 1979  (a figure  which  includes 
lost output,  police  and  administrative  costs,  medical 
costs,  damage  to property  and pain,  grief  and suffering). 
The importance  of reducing  this toll lies not only  in the 
direct  reduction  of human  suffering  but also  in the freeing 
of health  resources  for  the  many  life-enhancing 
operations  (e.g.  joint  replacement).  Two  measures  which 
have  proved  successful  in different  countries  in reducing 
injuries  are strict  penalties  on the consumption  of alcohol 
and the compulsory  use  of seat  belts.  In the United 
Kingdom  it is estimated  that  annually  1 000 deaths  and 
10 000 serious  injuries  would  be prevented  if seat  belts 
were  used  100%  of the time.  We understand  that  the 
Commission  is already  conducting  an overview  of road 
accidents  in Member  States,  which  includes  an 
investigation  of the causes  of injury  to vehicle  occupants 
in front  and side  impact  collisions,  the development  of 
suitable  dummies  for vehicle  testing,  and work  on injuries 
caused  to pedestrians  by cars.  We  recommend  further 
comparative  studies  within  the Community  and hope  that 
the Commission  will press  for harmonization  in this vital 
matter. 
3.9. Work  accidents 
3.7. We  recommend  that  the  Commission  should 
instigate  ways  of developing  routine  collection  and 
reporting  of accidents  to children  and  should  cooperate 
with Member  States  on a coordinated  child  accident The Committee  has already  considered  on a number  of 
occasions  the question  of health  and  safety  at work.  In 
1979  the Committee  passed  an opinion  on the proposal 
for a Council  Directive  on the approximation  of Member 
No C 230/42 Official  Journal  of the European  Communities 10. 9. 81 
States'  laws,  regulations  and administrative  provisions  on 
the protection  of the health  of workers  occupationally 
exposed  to vinyl  chloride  monomer. 
In 1979,  the Committee  produced  an own-initiative  study 
on the health  and environmental  hazards  arising  from  the 
use of asbestos  and is at present  considering  the proposal 
for a second  Council  Directive  on the protection  of 
workers  from  the risk  related  to exposure  to agents  at 
work:  asbestos.  Furthermore,  the Committee  has also 
passed  an opinion  on the proposal  for a Council  Directive 
on the protection  of workers  from  harmful  exposure  to 
chemical,  physical  and biological  agents  at work  (1). 
In 1980,  the  Committee  adopted  an opinion  on the 
proposal  for a Council  Directive  on the protection  of 
workers  from  harmful  exposure  to metallic  lead  and its 
ionic  compounds  at work  (2) and endorsed  the aim of this 
Directive,  since  many  dangers  of lead  have  been 
recognized  for a long  time  and have  been  the subject  of 
medical  and chemical  research.  The  Committee  pointed 
out in its opinion  that  all technical  means  should  be used 
to avoid  or reduce  to a reasonable  minimum  the harmful 
effects  of lead  on the health  of workers. 
In all of these  opinions,  the Committee  has made  clear 
that life and good  health  are the most  precious  human 
possessions  and  that  the risks  to which  workers  are 
exposed  at their  work  places  must  be controlled  and 
eliminated  wherever  possible.  The  development  of 
technology  and  of the sciences  is continually  leading  to 
the discovery  of new  materials  and  substances  whose 
effects  on human  health  are as yet unknown. 3.10.  Drugs 
The use and  misuse  of drugs,  including  the misuse  of 
medicinal  products,  are a significant  cause  of disease  and 
handicap.  In the United  Kingdom  it is estimated  that 
smoking-related  diseases  cost  the NHS  (National  Health 
Service)  £115  million  per year  (1979),  cause  50 000 
deaths  a year  and cause  50 million  working  days  a year  to 
be lost.  Diseases  attributable  to alcohol  consumption  may 
cost between  £36  million  to £52  million  a year  and  the 
cost of output  ranging  between  £159  million  to £260 
million  with  between  2 300  to 4 900  premature  deaths 
caused  by alcohol  excluding  deaths  resulting  from  traffic 
accidents  (1977  figures).  Drugs  may  of course  be 
particularly  dangerous  during  pregnancy. 
3.11.  While  there  is no possibility  of a dramatic 
change  in the habits  of millions  of Community  citizens  we 
are convinced  that  concerted  Community  action  must  be 
taken  steadily  to reduce  the  prevalence  of drug 
dependence  and in particular  the promotion  of childhood 
addiction.  We recommend  that  the Commission  examine 
all possible  methods  of reducing  the consumption  of 
tobacco  and alcohol  and in particular  urge  the Member 
States  to conduct  educational  campaigns  and issue  advice 
on which  methods  of reducing  such  consumption  have 
proved  most  successful  in the past.  In particular,  we 
recommend  the Commission  should  negotiate  on behalf 
of all Member  States  for a significant  reduction  in the 
advertising  of tobacco  and alcohol  products. 
We also  recommend  that the Community,  Member  States 
and local  authorities  give  particular  attention  to 
dependence  on hard  drugs. 
The Committee  devoted  a special  section  to the 
improvement  of the working  and  living  conditions  of 
workers  in general  and of the handicapped  in its opinion 
on the  development  of the  social  situation  in the 
Community  in 1979  (3). Already  then  it underlined  the 
necessity  of preventive  measures.  It also  has not neglected 
to mention  the cost  of health  and  security  measures. 
Better  information  about  the  benefits  secured  from 
preventive  measures  and the costs  involved  is needed.  For 
this reason,  'the  EEC  should  examine  the  cost 
effectiveness  of health  and safety  measures  - perhaps  by 
an across-Europe  study,  as well  as implementing  the 
proposed  Community  information  system  on accidents  in 
which  products  are involved'  (4). The Committee  reserves 
itself  the right  to set out these  principles  in a study  to be 
elaborated. 
(») OJ No C 297, 28. 11. 1979, p. 5. 
(2) OJ No C 300, 18. 11. 1980, p. 22. 
(3) OJ No C 205, 11. 8. 1980, p. 35. 
(<) OJ No C 252, 24. 10. 1978. 4. Secondary  prevention 
4.1. We  only  wish  to draw  attention  to two  areas  of 
secondary  prevention:  the treatment  of the very  young 
and the very  old. 
4.2. Children 
It is axiomatic  that  early  detection  of congenital 
conditions  is essential  for  successful  treatment.  For 
example,  the  simple  test  for  PKU  and  subsequently 
dietary  treatment  can  now  prevent  any  consequent 
disability.  Currently  methods  of detecting  deafness  in the 
newborn  are being  developed.  Equally,  the earlier  the 
recognition  of cerebral  palsy  the sooner  remedial  therapy 
10. 9. 81 Official  Journal  of the European  Communities No C 230/43 
and education  can  commence.  Ensuring  that  the 
appropriate  action  follows  identification  of impairment 
could  be a further  possibility  of the regional  committees 
we recommend  below  (paragraphs  10.5,  11.6,  and 
12.3). 
4.3. We  recommend  that  the  Commission  should 
review  the procedures  in Member  States  for the early 
detection  of handicap  (compulsory  health  checks,  etc.) 
and make  recommendations  for a standard  procedure 
throughout  the Community.  We  understand  that  the 
Commission  is already  thinking  along  these  lines  in its 
preparatory  work  for its Third  Programme. 
4.4. The  very  old 
We have  noted  in the introduction  the high  incidence  of 
severe  handicap  in the very  old.  Secondary  prevention 
amongst  the  elderly  by delaying  or arresting  where 
possible  the  progress  of disabling  conditions  and 
mitigating  the physical,  psychological  and  social  stress 
associated  with  ageing  offers  considerable  scope. 
Intervention,  both  surgical  and  biochemical  can  arrest 
the handicapping  consequences  of impairment;  we 
recommend  more  research  be undertaken  on the ageing 
process  and  on the causes  of specific  disorders  such  as 
arthritis  and dementia  in order  to ensure  that the years  we 
are adding  to our lives  are as enjoyable  as possible. 
4.5. The  services  of remedial  staff  are particularly 
important  for  the  care  and  rehabilitation  of elderly 
patients;  but  there  is still  considerable  shortage  of 
remedial  staff  in departments  of geriatric  medicine.  There 
is therefore  need  to encourage  recruitment  of more 
student  physiotherapists,  occupational  therapists  and 
speech  therapists  to be trained  to work  with  the 
elderly. (a) people  from  poor  families  often  tend  to enter 
unskilled  manual  employment  which  incurs  a 
relatively  higher  risk  of injury  or disease; 
(b) such  manual  employment,  although  incurring  a 
higher  risk of injury  or disease  or of just wearing  out 
the worker  well  before  retirement  age,  is often  less 
well rewarded  (with  certain  obvious  exceptions)  than 
office  work; 
(c) manual  workers  who  become  disabled  have  more 
difficulty  in retaining  their  jobs  or in finding 
alternative  employment. 
5.3. There  is also  a growing  body  of evidence  that the 
health  services  are not fully  used  by most  of those  in 
greatest  need  of such  services  and  that  there  is in 
particular  under-utilization  by them  of preventive  health 
measures. 
5.4. We  would  wish  to encourage  Member  States  to 
introduce  carefully  planned  health  measures  intended 
specifically  to reach  those  in greatest  need.  We also  stress 
that a prerequisite  for  any  major  inroad  into  the 
prevention  of handicap  is a significant  redistribution  of 
the Community's  resources  towards  the poor,  combined 
with special  measures  to bring  services  to groups  who 
cannot  or will  not  use  them  to best  advantage 
themselves. 
5.5. The  Community  has already  shown  its concern 
over the effects  of lead  on health  and each  Member  State 
is required  to carry  out  two  screening  campaigns 
coordinated  throughout  the Community.  We understand 
the second  campaign  is just  commencing.  We  fully 
support  this initiative  and hope  that any necessary  action 
to protect  Community  citizens,  especially  young  children, 
from  the effects  of lead  poisoning  which  is revealed  by the 
surveys  will be forthcoming. 
5. The  links  between  poverty  and  handicap 
5.1. We  noted  in paragraph  3.2  above  that 
environmental  measures  have  been  as significant  as 
medical  in reducing  disease  and  disability.  It is 
unfortunately,  however,  still  true  even  within 
comparatively  affluent  countries  in the  European 
Community  that  poverty  itself  is a major  cause  of 
handicap.  This  has  already  been  noted  in the higher 
incidence  of perinatal  and neonatal  mortality  and infant 
mortality  among  the  poor  general  ill-health  and 
deprivation  also  inevitably  arise  from  inadequate 
nutrition  and poor  housing.  There  is also  an inescapable 
higher  risk  of handicap  amongst  people  who  undertake 
manual  employment  throughout  their  lives. 
5.2. The  association  between  poverty  and  handicap 
can arise  in a number  of ways,  for example: 6. Rehabilitation 
6.1. 'Rehabilitation'  denotes  both  the objective,  the 
integration  of disabled  people  into  occupational,  social 
and cultural  life,  and  all the  medical  psychological, 
educational,  vocational  and social  measures  to attain  this 
objective.  Its most  important  precepts  are  that  the 
individual  should  be helped  to help  himself,  that  his 
available  capacities  should  be activated  and  that  he 
should  learn  self-respect  and  how  to develop  his own 
particular  talents. 
6.2. Successful  rehabilitation  demands  the 
coordination  of all relevant  phases  of rehabilitation  and 
cooperation  between  all the medical  and  para-medical 
professionals  and,  most  important,  the rehabilitee  and his 
family.  Indeed,  understanding  of members  of the family 
and teaching  within  it is of paramount  importance.  In 
many  cases  families  do not know  what  approach  to take 
or how  to go about  assisting  a member  of the family  who 
No C 230/44 Official  Journal  of the European  Communities 10. 9. 81 
is disabled.  We recommend  that  the families  of disabled 
people  be supplied  with  information  on how  best  they  can 
further  the rehabilitation  process.  For each  individual  a 
comprehensive  rehabilitation  plan  must  be agreed  and 
one of the professionals  given  the task  of overseeing  its 
fulfilment.  These  plans  should  be regularly  reviewed  and 
revised.  This  is particularly  important  for  mentally 
handicapped  people  since  it is so easy  to let matters  drift 
until  a crisis  arises. accepted  for the reason  that  their  integration  helps  them 
to make  progress  but the will or the resources  to achieve 
this ideal  has  often  been  lacking.  In the past  special 
education  has,  for the best  of motives,  usually  been 
provided  in segregated  institutions  which  have  been 
shown  to retard  children's  social  development.  It has also 
led to widespread  ignorance  of handicap  among 
non-disabled  children  which  has proved  a barrier  to later 
integration  in society. 
6.3. To  ensure  the  relevance  of rehabilitation  to 
individuals  and their  families  all institutions  engaged  in 
rehabilitation  should  develop  procedures  to permit 
disabled  people  to assist  in designing  and organizing  the 
services  that  they  and their  families  consider  they  need. 
6.4. Rehabilitation  is not only  an economic  necessity 
for the State  but an ethical  duty  and  as such  must  be 
financed  by the public  purse.  The  European  Community 
has already  had significant  involvement  in certain  aspects 
of rehabilitation  and  we  believe  these  should  be 
strengthened  and  extended. 
7. Medical  rehabilitation 
7.1. Medical  rehabilitation  should  commence  as soon 
as a patient's  life is out of danger  or he has recovered  from 
the effects  of an operation.  Too  often  in the  past 
rehabilitation  has  been  under-valued  or ignored  by 
doctors  and  deprived  of the necessary  resources.  To be 
effective,  rehabilitation  must  be  continuous  and 
comprehensive. 
7.2. Each  disabled  person  should  have  access  to a 
comprehensive  rehabilitation  department  with  facilities 
for full  time  attendance  by  both  in-patient  and 
out-patient.  Medical  rehabilitation  has hitherto  been  on 
the fringe  of Community  involvement  although  grants 
have  been  made  in the past  to some  demonstration 
centres.  There  is, however,  no equivalent  network  to that 
established  for vocational  rehabilitation.  We recommend 
that the Commission  forms  a parallel  network  of medical 
rehabilitation  centres  and funds  regular  seminars  so that 
personnel  in Member  States  can learn  from  each  other. 
If advanced  courses  of personnel  in vocational 
rehabilitation  are instituted  the possibility  of extending 
them  to personnel  in medical  rehabilitation  should  be 
considered. 
8. Education 
8.1. The  right  of handicapped  children  to education 
alongside  their  non-handicapped  peers  is generally 8.2. The  special  educational  needs  of handicapped 
children  vary  considerably.  For a child  with  no learning 
disability  and who  requires  no special  treatment  not to be 
able to attend  his local  school  solely  because  he cannot 
climb  stairs  is unacceptable.  Most  handicapped  children, 
however,  do require  extra  help  of various  kinds.  If this is 
not provided  it makes  a misery  of their  lives  and  a 
mockery  of integration.  It is understood  that  the 
Commission  are planning  a programme  of pilot  projects 
in the field  of special  education  to start  next  year.  The 
Committee  welcomes  this initiative. 
8.3. The  first  prerequisite  is adequate  teacher 
training.  All  teachers  in their  basic  training  should 
become  acquainted  with  the various  forms  of disability 
and the problems  they  cause  so that  they  are equipped  to 
identify  signs  of special  need  and  to appreciate  the 
importance  of early  assessment  of that  need.  The 
integration  of certain  handicapped  children  in ordinary 
schools  will also  necessitate  an increase  in the number  of 
teachers  trained  in techniques  of teaching  children  with 
learning  and communications  disorders.  We recommend 
that Community  funds  be made  available  for  this 
specialist  training  (similar  to the funds  currently  allotted 
to training  instructors  under  the existing  Social  Fund)  and 
that priority  be given  to the comparatively  neglected  areas 
of children  with  multiple  handicaps. 
8.4. The  presence  of severely  disabled  children  in a 
classroom  almost  always  necessitates  extra  staffing, 
whether  for their  education  or non-educational  needs 
(feeding,  toiletting,  etc.).  We  recommend  that  when 
resources  are allocated  to schools  the number  of disabled 
children  and  the severity  of their  handicap  should  be 
taken  into  account.  Teachers  of handicapped  children 
should  be remunerated  appropriately  according  to the 
special  qualifications  in teaching  children  with  special 
educational  needs. 
8.5. The  transition  from  school  to work  is a vital 
period  in any person's  life and doubly  so for the disabled 
child  who  runs  the risk of being  discharged  from  the care 
of one public  body  without  being  received  by another.  In 
the first  place  disabled  children  should  have  the absolute 
right  to free  education  with  no age restriction  in whatever 
institution  is most  suitable  for  them.  There  is a 
10. 9. 81 Official  Journal  of the European  Communities No C 230/45 
paramount  need  for institutions  of further  education  to 
make  provisions  for  handicapped  young  people  to 
continue  their  studies  after  they  have  attained  the age of 
18 years.  Secondly  before  they  leave  school,  unless  their 
future  is clear,  a fresh  plan  (see  6.2  above)  should  be 
devised  with  them  by the relevant  professionals  in the 
education,  health  and  careers  guidance  services  and  the 
most  appropriate  person  given  the duty  of guiding  them 
through  the  difficult  transition  to becoming,  where 
possible,  independent  members  of the community. 
8.6. Because,  unfortunately,  so  many  disabled 
children  will  emerge  from  schools  immature  and  lacking 
in social  skills  we recommend  that  the  Commission 
should  continue  to support  assessment  centres  such  as 
Banstead  Place  but without  the discrimination  according 
to the home  town  of the  disabled  individual  that  has 
become  necessary  as a result  of Article  9 (2) of Council 
Decision  71/66/EEC. 
9. Vocational  rehabilitation 
9.1. Among  all the  measures  designed  to integrate 
disabled  people  fully  into  society  vocational 
rehabilitation  plays  an especially  important  role  because 
it is frequently  the  pre-condition  for  entry  into 
employment  which  not  only  provides  financial 
independence  but  also  confers  social  status  and  is 
increasingly  the nucleus  of social  contact. 
9.2. It  is in vocational  rehabilitation  that  the 
European  Community  has contributed  most  to disabled 
people  through  the network  of rehabilitation  and training 
centres  and  the  Social  Fund.  The  report  on the initial 
Community  action  programme  indicates  that  not all the 
Commission's  aims  were  achieved  and  that  the  vast 
increase  in unemployment  throughout  the  Community 
and particularly  amongst  young  people  has necessitated 
an urgent  reappraisal  of the  programme.  We  wholly 
support  the Commission  in maintaining  that  there  can be 
not let-up  in the efforts  to train  disabled  people  and  find 
them  employment.  Although  unemployment  is a 
misfortune  for  anyone  it is a particular  tragedy  for 
someone  who  is severely  disabled.  A severely  disabled 
person  who  is out  of work  can  too  easily  become  a 
prisoner  of his home.  We therefore  recommend  that  the 
Commission  give  even  greater  priority  to disabled  people 
within  the Social  Fund  with  particular  emphasis  on the 
most  severely  disabled  who,  because  their  opportunities 
for open  employment  have  been  limited,  have  in the past 
been  excluded. 
9.3. The  Social  Fund  Guidelines  for 1981  to 1983 
are: 
First  priority: 
— demonstration  actions  related  to employment  and 
innovative  in character  involving  not more  than  200 persons.  Total  Fund  intervention  in these  cases  may 
not exceed  three  years; 
— programmes  for the integration  of the handicapped 
into open  employment  in Greenland,  the  French 
Overseas  Departments,  Ireland,  Northern  Ireland 
and the Mezzogiorno. 
Second  priority:  operations  consisting  of: 
— vocational  training  or rehabilitation; 
— adaptation  of jobs;  work  places  or equipment; 
— the  recruitment  of handicapped  persons  in an open 
economy. 
9.4. Although  the European^arliament  has increased 
the allocation  (commitment  appropriations)  to the 
handicapped  in 1981  it remains  to be seen  whether  any 
second  priority  operations  get funded  since  in the past 
applications  have  vastly  outstripped  funds.  In previous 
years  also  the  provisions  of Article  9 (2) of Council 
Decision  71/66/EEC  (') which  requires  at least  50%  of 
the Fund's  resources  to be allocated  within  ERDF  regions 
under  Article  5 has  left  little  or no  money  for 
demonstration  projects  outside  these  regions. 
9.5. While  we support  the absolute  priority  given  to 
certain  regions  we emphasize  that  disability  causes  similar 
problems  everywhere  and  it is inappropriate  for  the 
totality  of Community  funding  for the disabled  to be 
bound  up with  regional  redistribution.  We  therefore 
recommend  that  a separate  budget  be established  for 
demonstration  projects  and  that  the Commission  lift the 
various  restrictions  currently  imposed  (regionality,  the 
requirement  to obtain  50 % funding  from  a public  body, 
restriction  to three  years)  so that  the only  criteria  are the 
quality  of research  and  development  and  the  help 
afforded  to disabled  people. 
10. Obtaining  employment 
10.1.  We  fear  that  in current  economic  conditions, 
which  are leading  to a rising  level  of unemployment  in all 
Member  States  and  which  may  be of long  duration,  the 
employment  opportunities  for the disabled  will  decline 
more  rapidly  than  for others. 
10.2.  The  report  on  the  Community  action 
programme  emphasizes  the importance  of facilitating  the 
employment  of disabled  people  after  rehabilitation  but is 
rather  vague  in specifying  how  it will  achieve  this.  For 
example,  the Commission  says  it: 
'will direct  the  activities  which  it organizes  in the 
appropriate  manner;  will  ask  the representatives  of 
O 'Report  of Social  Fund'  (1978,  g. 47)  and  (1979,  p. 17.) 
No C 230/46 Official  Journal  of the European  Communities 10. 9. 81 
the Member  States  ... to coordinate  more  effectively 
the projects  which  receive  financial  aid from  the 
Community;  will,  if necessary,  propose  activities 
going  beyond  the present  framework  of the action 
programme'. 
10.3.  Most  Member  States  operate  a quota  scheme  to 
encourage  the employment  of people  with  disabilities,  but 
only in the Federal  Republic  of Germany  does  it appear  to 
obtain  general  acceptance.  In other  countries  government 
and employers  appear  to wish  to be rid  of it, 
organizations  for disabled  people  argue  for its retention 
for fear  of being  left with  nothing,  and disabled  people 
themselves  tend  to ignore  it by failing  to register.  The 
comparative  success  in the Federal  Republic  of Germany 
may be the result  of the compensatory  levies  which  help 
fund  rehabilitation. 
10.4.  The  main  defect  of all quota  schemes  is that they 
are a blunt  instrument  for dealing  with  the problems  of a 
heterogeneous  group  of workers.  The  needs  and 
problems  of the severely  disabled  school  leaver  with  his 
life ahead  of him are entirely  different  from  those  of a man 
in his fifties  or sixties  who  has perhaps  already  sacrificed 
his health  to his work  and for whom  early  retirement  may 
be both  desirable  and just.  We therefore  recommend  that 
the policies  of Member  States  should  take  account  of the 
different  needs  of different  groups  of disabled  people. 
10.5.  For  the severely  disabled  young  person,  finding 
a first  job  is often  a major  obstacle.  We  therefore 
recommend  that,  whatever  the general  quota  system  in 
each Member  State,  particular  priority  should  be given  to 
employing  disabled  school  leavers,  both  by employers 
and by the relevant  department  of government. 
10.6.  We  recommend  that  there  should  be a general 
duty on employers  towards  existing  employees: 
(a) to arrange  appropriate  training  and  re-training, 
career  development  and  promotion  for  disabled 
employees; 
(b) when  an employee  is able  to return  to work  after 
injury  or disease: 
(i) to cooperate  with  the relevant  bodies  over  his 
continuing  need  (if  appropriate)  for 
rehabilitation, 
(ii) to re-employ  him or her where  possible  in his or 
her old job,  but if not in another  post  which  will 
make  full use of his/her  remaining  abilities, 
(iii) to ensure  in conjunction  with  the  relevant 
insurance  scheme,  where  applicable,  that  the employee  is at as little  disadvantage  as possible 
as a result  of his disability. 
10.7.  Mention  should  be made  in this context  of the 
excellent  support  and  rehabilitation  provided  for their 
disabled  workers  by certain  large  unions  and  firms. 
Although  rehabilitation  must  remain  the responsibility  of 
the public  authorities  it can never  be effective  without  full 
cooperation  with  the social  partners.  The  attitude  of 
fellow  employees  is critical  to the successful  establishment 
in open  employment  of severely  disabled  people  especially 
the mentally  handicapped  and  those  with  hidden  or 
mysterious  disabilities  such  as epilepsy.  We recommend 
that (where  this is not already  done)  trade  unions  should 
include  information  on disability  in their  training 
programmes  for shop  stewards  and  that  for the most 
severely  disabled  new  employees  suitable  workers  should 
be allocated  to assist  their  integration  in the  work 
force. 
10.8.  The  nature  of employment  is changing  as 
rapidly  today  as in the first  industrial  revolution  and it is 
widely  accepted  that  few  workers  can  now  expect  to 
retain  the  same  job  throughout  their  working  lives. 
Although  the initial  training  and placement  for a young 
disabled  worker  may  be highly  successful,  he cannot  be 
insulated  from  changes  in the  world  around  him. 
Historically,  for obvious  reasons,  disabled  people  have 
been  amongst  the most  loyal  employees  and unless  special 
attention  is paid  to their  particular  problems  in 
re-training  and re-deployment,  their  inforced  loyalty  may 
leave  them  stranded  when  the tide  of change  moves  on. 
We recommend  that  all  those  running  industrial 
re-training  schemes  should  examine  their  suitability  for 
disabled  people.  We believe  that  this  is an area  which 
should  be urgently  examined  by CEDEFOP  (European 
Centre  for the Development  of Vocational  Training). 
10.9.  The  brighter  side  of the  technological 
revolution,  however,  is the opportunities  it affords  the 
most  severely  disabled  people  to undertake  remunerative 
employment  for the first  time.  People  with  minimal 
movement  have  been  trained  as computer  programmers 
and are  able  to work  from  their  own  homes.  The 
Commission  has  already  been  active  in the  field  of 
micro-technology  and has funded  research  projects  such 
as the development  of a typewriter  operated  by light 
impulses  at the De Hoogestraat  Rehabilitation  Centre  in 
the Netherlands.  It has also  funded  two  conferences  on 
technical  aids  and  is currently  undertaking  preliminary 
work  on the establishment  of an international  thesaurus 
and data  bank.  We support  this initiative  and recommend 
that the Commission  continue  to use all means  at its 
disposal  to publicize  the  ways  in which  modern 
technology  can revolutionize  the lives  of severely  disabled 
people.  We  further  recommend  that  the Commission 
10. 9. 81 Official  Journal  of the European  Communities No C 230/47 
examine  whether  there  is scope  in this  field  to integrate 
development  efforts  in the Member  States  to make  best 
use of available  resources  in this important  and growing 
sector  of industry. 
10.10.  Subsidies  and  sheltered  employment 
The question  of whether  the state  should  subsidize  either 
the disabled  worker  or his employer  is a thorny  one.  The 
majority  of disabled  people  given  the right  training  and 
facilities  can more  than  hold  their  own  alongside  their 
fellow  workers.  For  a few  this  will  never  be possible. 
Member  States  therefore  support  sheltered  workshops  for 
a minority  of severely  disabled  people  whose  capacity  is at 
least one  third  of normal.  Some  view  this  as the only 
practicable  way  of providing  them  with  worthwhile 
employment;  others  regard  sheltered  workshops  as 
fundamentally  segregationist  and believe  they  should  act 
primarily  as re-integration  centres.  We  believe  that 
sheltered  work  is a necessity  for some  but that  greater 
efforts  should  be made  to ensure  workers  are not isolated 
and that  those  who  can graduate  to open  employment 
(and probably  higher  wages)  are enabled  to do so. We 
recommend  that,  in order  to compensate  sheltered 
workshops  for losing  their  best  employees,  a premium 
should  be paid  for every  worker  transferred  to open 
employment.  While  a workshop  may  naturally  wish  to 
retain  its best  workers,  it also  may  be reluctant  to recruit 
the most  severely  disabled  for fear  that  their  standard  of 
work  may  not be adequate.  We therefore  also recommend 
that special  subsidy  arrangements  should  be made  for a 
limited  trial  and  training  period  for a minority  of new 
recruits.  In order  to combat  the isolation  of workshops 
we would  also  wish  to see the extension  of sheltered 
industrial  groups  or  'enclaves'  within  open 
employment. 
10.11.  The  major  problem  for sheltered  workshops  is 
obtaining  enough  suitable  work  and  in selling  their 
products  and services.  We recommend  the Commission 
should  review  the  preferential  schemes  to assist 
workshops  adopted  in Member  States  and examine  ways 
in which  Community  institutions  themselves  can assist  by 
placing  contracts  with  sheltered  workshops. 
10.12.  Wages  in sheltered  workshops  vary  widely 
within  as well  as between  Member  States.  In Belgium  in 
1977  they  varied  between  Bfrs  57 and Bfrs  166 per hour. 
In the United  Kingdom  the largest  employer,  Remploy, 
has yet to agree  to union  demands  that  wages  should  be 
fixed  to the local  authority  scale  for manual  workers  and some  employees  with  a family  may  be worse  off than  they 
would  be receiving  social  security;  but, on the other  hand, 
some  local  authorities  and voluntary  workshops  do not 
pay a wage  at all and the worker  is forced  to live on social 
security.  In France  workers  in 'Centre  d'Aide  par Travail' 
are guaranteed  70 % of the national  minimum  wage  and 
in 'Ateliers  Proteges'  90 %. We  believe  that  disabled 
workers  should  receive  due remuneration  for their  labour 
and recommend  that  the Commission  shall  require  each 
Member  State  to guarantee  a minimum  income  in 
sheltered  workshops. 
10.13.  Assistance  from  the European  Social  Fund  is 
not currently  available  for sheltered  workshops.  We 
believe  many  are seriously  under-funded  and unable  to 
adapt  to meet  both  changing  market  conditions  and 
modern  ideas  about  rehabilitation  and  appropriate 
employment  for disabled  people.  We recommend  that the 
Social  Fund  Guidelines  should  be extended  to provide  for 
expenditure  in respect  of the  sheltered  workshops 
demonstration  projects. 
10.14.  Other  than  for workers  in 'enclaves'  we do not 
believe  that  the  State  should  permanently  subsidise 
disabled  workers  in open  employment  since  this  is an 
admission  of the failure  of rehabilitation.  Grants  for 
adaptations  and special  equipment  should,  however,  be 
provided.  People  who  on account  of their  disablement 
can only  work  part  time  should  be entitled  to receive 
incapacity  benefit  for the period  when  their  disability 
prevents  them  from  working. 
10.15.  The  organization  of  rehabilitation  and 
employment  measures 
As we have  noted,  coordination  between  the different 
professionals  concerned  is essential  for  successful 
rehabilitation.  Disabled  people  often  find  that  there  is 
little  coherent  planning  between  the various  authorities 
on whom  they  may  be dependent  in different  aspects  of 
their  lives.  To  the  disabled  person  his  medical, 
employment,  financial,  social  and  housing  needs  will 
often  been  inextricably  linked,  but  each  may  be 
considered  in isolation  by  different  bodies.  We 
recommend  the establishment,  where  they  do not exist,  of 
regional  committees  to oversee  rehabilitation  and 
employment  measures.  These  committees  should  be 
composed  of the  relevant  professionals,  employers, 
unions,  representatives  of associations  of disabled  people 
themselves.  The  task  of the committees  would  be to 
ensure  the adequate  provision  of rehabilitation  facilities 
No C 230/48 Official  Journal  of the European  Communities 10. 9. 81 
and provide  guidance  and advice  to disabled  individuals. 
It could  also  have  additional  functions  (see  paragraphs 
11.7 and  12.3). 
11. Community  services 
11.1.  Identification 
In order  to play  their  full  part  in the community,  and 
sometimes  even  to continue  living  in their  own  homes, 
many  disabled  people  require  special  provisions  and 
special  services  which  are usually  the responsibility  of 
local  authorities,  complemented  in many  countries  by the 
work  of voluntary  organizations.  The  failure  of many 
disabled  people  to receive  the help  they  require  is often  the 
consequence  of total  ignorance  of their  needs  and even  of 
their  existence  by the relevant  authority.  We believe  the 
community  has a duty  to seek  out people  in need  and not 
wait for them  to ask for help.  We therefore  recommend 
that local  authorities  should  seek  to identify  disabled 
people  living  in their  area  and  inform  them  of services 
available  to them.  We  also  recommend  that  the 
Commission  issue  guidance  on ways  in which  this should 
be achieved  so that  information  assembled  by local 
authorities  in  different  Member  States  can  be 
compared. 
11.2.  Housing 
A house  in which  a disabled  person  can achieve  maximum 
independence  is an essential  precondition  for successful 
integration.  This  has been  accepted  by the Commission 
which  produced  in 1975  an excellent  document  on the 
elimination  of architectural  barriers  which  established  a 
two-tier  standard:  housing  specially  designed  for people 
confined  to wheelchairs;  and housing  which  incorporated 
certain  minimal  features  which  rendered  it suitable  for the 
majority  of  disabled  people.  The  document 
recommended  that  all new  housing  should  adhere  to at 
least the second  standard  but unfortunately  nothing  has 
been  heard  of it since.  As an alternative  to formulating  a 
Directive,  the Commission  financed  a number  of pilot 
studies  in 1976  followed  in 1977  by two  major  projects 
(in the United  Kingdom  and Italy)  involving  both  housing 
and social  services,  and in 1978  by a number  of smaller 
but equally  comprehensive  schemes.  So far, only  a brief 
note about  these  projects  has been  published  but the 
Commission  has  confirmed  its  impression  that 
appropriate  housing  is an important  starting  point  for the 
social  and  occupational  re-integration  of handicapped 
persons,  but it notes  that housing  alone  is not enough  and adaptations  to the social  infrastructure  and vocational 
training  institutions  are also  required.  It also  notes  that 
whereas  adaptations  if planned  in  advance  of 
construction  may  only  add  5 to 10 % to the  cost, 
adaptations  after  construction  can be nine  times  as costly. 
But it will  always  be necessary  to make  adaptations  to 
existing  houses  to enable  people  who  are struck  down  by 
disability  to continue  to live in the houses  they  are used  to 
living  in. The  housing  needs  of mentally  handicapped 
people  should  be given  special  consideration.  Services 
should  be available  to help  families  to look  after  a 
mentally  handicapped  person  at home  and  to enable 
adults  to live in homes  of their  own  if they  wish. 
11.3.  Following  the reconvened  meeting  of experts 
from  Member  States  held  in June  1981  to assess  the 
results  of these  programmes,  we recommend  that  the 
Commission  should  either  produce  proposals  for 
long-term  intervention  in this area  or produce  guidelines 
for implementation  by Member  States. 
11.4.  Access  and  transport 
Barriers  to mobility,  whether  they  are steps  at the office  or 
the local  library  or an inaccessible  railway  carriage,  are a 
major  source  of frustration  to people  with  physical 
handicaps.  Similarly,  failure  to take  account  of the 
specific  needs  of blind  and  deaf  people  can  seriously 
reduce  their  independence.  We believe  that  Article  3 (c) 
of the Treaty  of Rome  ('the  abolition  as between  Member 
States  of obstacles  to freedom  of movement  for persons, 
services  and capital')  and Article  3 (d) ('the  adoption  of a 
common  policy  in the sphere  of transport')  require  the 
Commission  to take  a more  active  role  in facilitating  the 
free movement  of disabled  people  throughout  the 
Community.  In particular  we recommend  that  minimum 
standards  of accessibility  should  be required  at all major 
airports  and  railway  stations.  The  question  of 
harmonized  parking  concessions  for disabled  people  has 
also been  under  consideration  for  some  time.  We 
understand  the Commission  will  be represented  at the 
Second  International  Conference  on Transport  for 
Elderly  and Handicapped  Persons  in Cambridge  in 1981 
and we hope  concrete  proposals  will  be forthcoming. 
11.5.  Domiciliary  services 
Many  disabled  and elderly  people  are only  able  to remain 
living  in their  own  homes  as a result  of the domestic  help 
provided  for them,  the delivery  of meals  as well  as the 
provision  of aids  and  adaptations  to their  homes.  The 
level  of care  required  from  a local  authority  depends  on 
the informal  support  available  from  family,  voluntary 
agencies  and local  community.  Some  research  has already 
10. 9. 81 Official  Journal  of the European  Communities No C 230/49 
been  funded  by the Commission  as part  of the Housing 
programme.  Social  structures,  however,  vary 
considerably  within  Member  States  as well  as between 
them,  and  the type  of support  needed  in a closely  knit 
village  community  may  be entirely  different  from  that  in a 
decaying  inner  city.  We  feel  those  providing  social 
services  in different  parts  of the Community  should  learn 
much  from  each  other's  experience  and  we recommend 
that the  Commission,  in  conjunction  with  the 
Associations  of Local  Authorities,  should  undertake  a 
comparative  study  of the delivery  of domiciliary  services 
to disabled  and  elderly  people. 
11.6.  Day  centres 
Day centres,  where  severely  disabled  people  can maintain 
social  contacts  while  receiving  any  care  necessary  and 
continuing  to live  with  their  families  are  a vital 
component  of community  care.  We  recommend  an 
increase  in this  type  of provision  where  it is required. nearing  completion.  We  would  emphasize  the  close 
correlation  which  exists  between  disability  and  poverty 
which  arises  from  two  reasons: 
(a) the  additional  costs  arising  from  a person's  disability 
which  accrue  to a disabled  person  and  their 
family; 
(b) the  total  or partial  loss  of earning  capacity. 
These  consequences  are  independent  of the  cause  or 
circumstances  of the  original  impairment  and  of the 
institution  which  is responsible  for  compensation. 
Through  the European  Community,  financial  assistance 
is based  on criteria  which  distinguish  according  to cause 
and circumstances  and  not  according  to need  (e.g. 
different  compensation  for  war  disabled,  industrially 
injured,  the insured  vis-a-vis  the child  or housewife,  etc.). 
Often  the scales  used  are also  based  on predominantly 
anatomical  criteria  and  do  not  distinguish  between 
additional  costs  and  the inability  to earn. 
11.7.  Residential  care 
Small  communities  in which  disabled  people  live 
alongside  others  who  are  not  disabled  in family 
surroundings  are in general  much  to be preferred  to large 
residential  institutions.  It would  be  a matter  of 
considerable  concern  if the expedient  of residential  care 
was seen  as a major  means  of providing  for those  with 
severe  mental  and  physical  disabilities.  Permanent 
institutional  accommodation  is unnecessary,  expensive  and 
undesirable  for the vast  majority  of even  very  severely 
physically  and  mentally  disabled  people.  This  is not to 
argue  that  some  required  and  that  national  factors  in 
Member  States  will  influence  the optimum  number  of 
residential  places.  Supreme  efforts  must  be made  not to 
isolate  these  residential  institutions  as has unfortunately 
often  happened  in the past.  Residential  care  should  be as 
intimate  and  as akin  to a family  home  as is possible. 
Residents  should  be involved  in the  running  of their 
homes  and should  be given  more  privacy  and choice.  The 
aim for  physically  or mentally  handicapped  residents 
should  be to promote  the maximum  development  and 
independence  of which  they  are capable.  Residence  in a 
home  should  in no way  affect  disabled  people's  access  to 
rehabilitation  services.  We recommend  that  the regional 
rehabilitation  committees  (see  paragraph  10.15)  should 
have  a duty  to satisfy  themselves  with  the rehabilitation 
services  provided  by all residential  institutions  in their 
area. 
12. The  financial  needs  of disabled  people 
12.1.  We  understand  the Commission  has  funded  a 
case study  of the  income  of disabled  people  which  is 12.2.  In  the first  place,  anyone  who  is unable  to earn  a 
living  on account  of his disability  should  be entitled  to a 
basic  income  support  benefit  which  is sufficient  to meet 
his normal  costs  of living  regardless  of his insured  status, 
his or her marital  status  and the cause  of circumstances  of 
the original  impairment. 
12.3.  Secondly,  an allowance  should  be paid  to help 
offset  the extra  costs  of disability  structured  according  to 
the severity  of handicap.  The  assessment  for the purposes 
of this  benefit  should  be part  and  parcel  of the 
rehabilitation  process  and  therefore  the responsibility  of 
the regional  rehabilitation  committee.  (It  may  be 
appropriate  for  a separate  body,  as in France,  to be 
responsible  for children.) 
12.4.  Since  in almost  all Member  States  plans  to 
introduce  a comprehensive  allowance  to meet  the costs  of 
disability  are still  embryonic,  we recommend  that  the 
Commission  should  host  regular  discussions  between 
Member  States  on the general  principles  to be followed  in 
constructing  such  an allowance  in order  to facilitate  the 
introduction  for  the  first  time  of a general  benefit 
conceived  on a European  scale  which  will  help  promote 
equality  of disabled  citizens  of the Community  wherever 
they happen  to live. 
13. Participation  is the  principal  theme  of the 
International  Year  of the Disabled  Persons  and  yet the 
opportunities  for  disabled  people  to help  formulate 
No C 230/50 Official  Journal  of the European  Communities < 
10. 9. 81 
Community  decisions  that  affect  them  are negligible.  We 
therefore  recommend  that  the  Commission  should 
establish  a Committee,  the  majority  of  whose 
membership  shall  consist  of disabled  people  and 
representatives  of organizations  of and  for  disabled 
people,  to advise  the Commission  on all matters  affecting 
disabled  people  and in particular  on the implementation 
of the proposals  in this  opinion  and  on the resolution  of 
the European  Parliament. 
14. Financing  Community  initiatives  for  disabled 
people 
Enabling  disabled  people  to become  full  and  equal 
citizens  of the  European  Community,  will  require 
substantially  more  finance  than  is available  within 
existing  Community  budgets.  Given  that  it is difficult 
within  the European  Social  Fund  to allocate  sufficient 
amounts  to support  initiatives  in favour  of the 
handicapped,  we recommend  that  a 'European  Fund  in 
Aid of the Handicapped'  be established  and administered 
by the Commission  under  the guidance  of the Advisory 
Committee  mentioned  above. 
15. This  opinion  has up to this  point  been  concerned 
exclusively  with  disabled  citizens  of the  European 
Community.  We cannot  however  ignore  the fact  that  the 
problems  of disability  and the needs  of disabled  people  in 
Europe  are dwarfed  by the magnitude  of the problems  of 
disability  in the Third  World.  The  Commission  is already 
involved  through  the European  Development  Fund  and, 
since  1976,  by  funding  projects  suggested  by 
non governmental  organizations.  We  recommend  that 
the Commission  should  review  its contribution  to the 
prevention  of  handicap  and  the  promotion  of 
rehabilitation  in developing  countries  in conjunction  with 
WHO  and  Rehabilitation  International. 
C. SUMMARY  OF RECOMMENDATIONS 
General 
1. The  Commission  should  have  discussions  with 
Member  States  on  harmonizing  national  working 
definitions  of disability  and  handicap,  e.g.  criteria  for 
benefit  payments,  special  employment  assistance,  etc. 
(cf. page  40, paragraph  2.1). 
2. The  Commission  should  set  in  hand  a 
Community-wide  survey  of disability  in order  to ascertain 
what  the most  pressing  problems  are in different  parts  of 
the Community  which  merit  attention  at Community 
level  (cf. page  40, paragraph  2.1). Prevention 
3. The  Commission  should  expand  its role  in the area 
of perinatal  mortality  and  handicap  and  fund  more 
comparative  studies  in different  parts  of the Community. 
Specifically,  it should  consider  establishing  a 
comprehensive  model  maternity  programme  in one of the 
highest  risk  areas  of the  Community,  which  would 
include  family  planning,  genetic  counselling,  antenatal 
care and  nutrition  counselling,  and  the  best  possible 
cilities  in the maternity  wards  and  for  neo  natal  care 
(cf. page  40, paragraph  3.3). 
4. The  Commission  should  monitor  at intervals  the 
take-up  of vaccinations  throughout  the  Community 
(cf. page  41, paragraph  3.4). 
5. The  Commission  should  issue  guidelines  and 
eventually  regulations  on the design  of safe  homes  for 
children,  and  in particular  put restrictions  on the use of 
unstrengthened  glass  at ground  level  (cf.  page  41, 
paragraph  3.5). 
6. All  cars  manufactured  or imported  into  the 
Community  should  be fitted  with  rear  seat  belts  and the 
Commission  should  produce  a Directive  banning  children 
under  the age of 13 from  front  seats  except  in prescribed 
circumstances  (cf. page  41, paragraph  3.6). 
7. Safety  instruction  in schools  should  have  a 
prominent  place  in the  curriculum  (cf.  page  41, 
paragraph  3.6). 
8. The  Commission  should  instigate  ways  of 
developing  routine  collection  and  reporting  of accidents 
to children  and should  cooperate  with  Member  States  on 
a coordinated  child  accident  prevention  programme 
(cf. page  41, paragraph  3.7). 
9. The  Commission  should  conduct  research  into 
possible  different  hazards,  both  of disease  and accidents, 
faced  by children  in urban  and  rural  areas  (cf. page  41, 
paragraph  3.7). 
10. The  Commission  should  continue  its studies  into 
injuries  from  road  accidents  and press  for harmonization 
on all aspects  of safety  relating  to cars  (cf.  page  41, 
paragraph  3.8). 
11. The  Commission  should  implement  the 
recommendations  of the Economic  and Social  Committee 
in relation  to the prevention  of industrial  disease  and 
accidents  at work  (cf. page  41, point  3.9). 
12. The  Commission  should  examine  possible 
methods  of reducing  the consumption  of tobacco  and 
alcohol  and  the misuse  of medicinal  products,  and  in 
particular  should  urge  the Member  States  to conduct 
10. 9. 81 Official  Journal  of the European  Communities No C 230/51 
educational  campaigns  and  issue  advice  on which 
methods  of reducing  such  consumption  have  proved  most 
successful  in the past  (cf. page  42, paragraph  3.11). 
13. The  Commission  should  negotiate  on behalf  of all 
Member  States  for  a significant  reduction  in the 
advertising  of tobacco  and alcohol  products  (cf. page  42, 
paragraph  3.11). 
14. The  Community,  Member  States  and  local 
authorities  should  give  particular  attention  to dependence 
on hard  drugs  (cf. page  42, paragraph  3.11). 
15. The  Commission  should  review  the procedures  in 
Member  States  for the early  detection  of handicap  and 
make  recommendations  for  a standard  procedure 
throughout  the  Community  (cf.  page  43, paragraph 
4.3). 
16. More  research  should  be undertaken  on the ageing 
process  and  on the causes  of specific  disorders  such  as 
arthritis  and dementia  (cf. page  43, paragraph  4.4). 
Rehabilitation 
17. Families  of disabled  people  should  be supplied 
with information  on how  best  they  can  further  the 
rehabilitation  process  (cf. page  43, paragraph  6.2). 
18. The  Commission  should  form  a network  of 
medical  rehabilitation  centres  to run in parallel  with  that 
of vocational  rehabilitation  centres  and  fund  regular 
seminars  so that  personnel  in Member  States  can learn 
from  each  other  (cf. page  44, paragraph  7.2). 
Education 
19. Community  funds  should  be made  available  for 
specialist  training  of teachers  and priority  should  be given 
to the comparatively  neglected  areas  of children  with 
multiple  handicaps  (cf. page  44, paragraph  8.3). 
20. When  resources  are  allocated  to schools  the 
number  of disabled  children  and  the severity  of their 
handicap,  should  be taken  into  account  (cf.  page  44, 
paragraph  8.4). 
21. Teachers  of handicapped  children  should  be 
remunerated  appropriately,  according  to their  special 
qualifications  in teaching  children  with  special 
educational  needs  (cf. page  44, paragraph  8.4). 
22. The  Commission  should  continue  to support 
assessment  centres  for disabled  school  leavers  irrespective of the place  of residence  of the disabled  adolescent  (cf. 
page  45, paragraph  8.6). 
Vocational  rehabilitation 
23. The  Commission  should  give  even  greater  priority 
to disabled  people  within  the European  Social  Fund  with 
particular  emphasis  on the most  severely  disabled  who, 
because  their  opportunities  for open  employment  have 
been  limited,  have  been  excluded  in the past  (cf. page  45, 
paragraph  9.2). 
24. A  separate  budget  should  be established  for 
demonstration  projects  within  the European  Social  Fund 
and the Commission  should  lift the various  restrictions 
currently  imposed  (cf. page  45, paragraph  9.5). 
Employment 
25. The  policies  of Member  States  should  take  into 
account  the different  needs  of different  groups  of disabled 
people,  such  as the severely  disabled  school  leaver  and the 
disabled  person  approaching  retirement  age (cf. page  46, 
paragraph  10.4). 
26. Particular  priority  should  be given  to employing 
disabled  school  leavers  both  by employers  and  by the 
relevant  department  of government,  whatever  the general 
quota  system  in each  Member  State  (cf.  page  46, 
paragraph  10.5). 
27. There  should  be a general  duty  on employers 
towards  their  existing  employees: 
(a) to arrange  appropriate  training  and retraining,  career 
training  and promotion  for disabled  employees; 
(b) when  an employee  is able  to return  to work  after 
injury  or disease: 
(i) to cooperate  with  the relevant  bodies  over  his 
continuing  need  (if  appropriate)  for 
rehabilitation, 
(ii) to re-employ  him or her where  possible  in his or 
her old job,  but if not in another  post  which  will 
make  full use of his/her  remaining  abilities, 
(iii) to ensure  in conjunction  with  the  relevant 
insurance  scheme,  where  applicable,  that  the 
employee  is at as little  disadvantage  as possible 
as a result  of his  disability  (cf.  page  27, 
paragraph  10.6). 
28. Trade  unions  should  include  information  on 
disability  in their  training  programmes  for shop  stewards 
and for the most  severely  disabled  employees  suitable 
workers  should  be allocated  to assist  their  integration  in 
the workforce  (cf. page  46, paragraph  10.7). 
No C 230/52 Official  Journal  of the European  Communities 10. 9. 81 
29. Those  running  industrial  retraining  schemes 
should  examine  their  suitability  for disabled  people.  The 
opportunities  for disabled  people  in vocational  training 
should  be urgently  examined  by the European  Centre  for 
the Development  of Vocational  Training  (cf. page  46, 
paragraph  10.8). 
30. The  Commission  should  continue  to use all means 
at its disposal  to publicize  the ways  in which  modern 
technology  can revolutionize  the lives  of severely  disabled 
people  (cf. page  46, paragraph  10.9). 
31. The  Commission  should  examine  whether  there  is 
scope  in the field  of modern  technology  to integrate 
development  efforts  in the Member  States  to make  best 
use of available  resources  in this important  and growing 
sector  of industry  (cf. page  46, paragraph  10.9). 
32. In  order  to compensate  sheltered  workshops  for 
losing  their  best  employees  a premium  should  be paid  for 
every  worker  transferred  to open  employment  (cf. 
page  47, paragraph  10.10). 
33. Special  subsidy  arrangements  should  be made  for 
a limited  trial  and  training  period  for a minority  of the 
most  severely  disabled  new  recruits  in sheltered 
workshops  (cf. page  47, paragraph  10.10). 
34. Th*e  Commission  should  review  the preferential 
schemes  to assist  workshops  adopted  in Member  States 
and examine  ways  in which  Community  institutions 
themselves  can assist  by placing  contracts  with  sheltered 
workshops  (cf. page  47, paragraph  10.11). 
35. The  Commission  should  require  each  Member 
State  to determine  minimum  income  in sheltered 
workshops  (cf. page  47, paragraph  10.12). 39. The  Commission  should  issue  guidance  on the 
ways  in which  identification  of disabled  people  should  be 
undertaken  by local  authorities  so that  information 
assembled  by them  in different  Member  States  can be 
compared  (cf. page  48, paragraph  11.1). 
40. The  Commission  should  then  either  produce 
proposals  for long-term  intervention  concerning  houses 
for disabled  people  or  produce  guidelines  for 
implementation  by  Member  States  (cf.  page  48, 
paragraph  11.3).  Small  communities  in which  disabled 
people  live  alongside  others  who  are  not  disabled  in 
family  surroundings  are in general  much  to be preferred 
to large  residential  institutions  (cf. page  49, paragraph 
11.7). 
41. Minimum  standards  of accessibility  for disabled 
people  should  be required  at all major  airports  and 
railway  stations  (cf. page  48, paragraph  11.4). 
42. The  Commission,  in conjunction  with  the 
associations  of local  authorities,  should  undertake  a 
comparative  study  of the delivery  of domiciliary  services 
to disabled  and  elderly  people  (cf. page  48, paragraph 
11.5). 
43. There  should  be an increase  in the provision  of day 
centres  where  they  are required  (cf. page  49, paragraph 
11.6). 
44. Regional  rehabilitation  committees  should  have  a 
duty to satisfy  themselves  of the rehabilitation  services 
provided  by all residential  institutions  in their  area 
(cf. page  49, paragraph  11.7). 
36. European  Social  Fund  guidelines  should  be 
extended  to provide  for  expenditure  in respect  of 
demonstration  projects  in sheltered  workshops  (cf. 
page  47, paragraph  10.13). 
37. Regional  committees  should  be established  to 
oversee  rehabilitation  and  employment  measures  (cf. 
page  47, paragraph  10.15). 45. The  financial  needs  of disabled  people 
The Commission  should  host  discussions  between 
Member  States  on the general  principles  to be followed  in 
constructing  a disablement  costs  allowance  (cf. page  49, 
paragraph  12.4). 
Community  services 
38. Local  authorities  should  seek  to identify  disabled 
people  living  in their  area  and  inform  them  of services 
available  to them  (cf. page  48, paragraph  11.1). 46. The  Commission  should  establish  a Committee, 
the majority  of whose  membership  shall  consist  of 
disabled  people  and  representatives  of organizations  of 
and for disabled  people,  to advise  the Commission  on all 
matters  affecting  disabled  people  and in particular  on the 
implementation  of the proposals  in this  opinion  and  on 
the resolution  of the European  Parliament  (cf. page  49, 
paragraph  13). 
10. 9. 81 Official  Journal  of the European  Communities No C 230/53 
47. Financing  Community  initiatives  (or  disabled 
people 
A 'European  Fund  in Aid of the Handicapped'  should  be 
established  and  administered  by the Commission  under 
the guidance  of the  Advisory  Committee  mentioned 
above  (cf. page  50, paragraph  14). 
Done  at Brussels,  2 July  1981. International 
48. The  Commission  should  review  its contribution  to 
the prevention  of handicap  and  the  promotion  of 
rehabilitation  in developing  countries  in conjunction  with 
the World  Health  Organization  and  Rehabilitation 
International  (cf. page  50, paragraph  15). 
The Chairman 
of the 
Economic  and  Social  Committee 
Tomas  ROSEINGRAVE