Observing International Day of People with Disability

Dec 02, 2014 Letters

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DEAR EDITOR,
The theme for this year is “Sustainable Development: The Promise of Technology”.
The world observes ‘International Day of People with Disability’ tomorrow, December 3, 2014. It is estimated that some 20 million people in the world are blind, 35 million are deaf or hard of hearing, 15 million are suffering from leprosy, and 30–40 million are mentally retarded to such an extent as to require some assistance with routine activities of daily living.
Poliomyelitis is still a major orthopedic problem in most developing countries of the world; hundreds of thousands of new cases of paralysis occur each year and the number of untreated patients requiring orthopedic care totals several millions. Leaving aside the ending problem of malnutrition, which itself may put a large proportion of the world’s population at risk of disabling diseases, various estimates indicate that at least 200 million people, representing 6% of the world’s population, are disabled as a result of congenital defect, injury, chronic disease (especially cardiovascular diseases, diabetes and diseases of the musculoskeletal system) or acute disease.
Modern social legislation contains provisions for protecting workers and their families from economic consequences of invalidity and for compensating workers for the economic loss that results from an occupational accident or disease.
Social protection of this type is extremely widespread and is included in even the most primitive forms of legislation. The scope and extent of protection do vary, however, from country to country; in addition, there is constant development in the degree of protection afforded and, in many countries with advanced social legislation, social security in this respect has virtually been achieved.
The object of this social protection is not so much to safeguard or repair the health of the worker, but to ensure that the worker’s income is maintained at an adequate level even though his earning capacity (i.e. his or her ability to work) is reduced or eliminated either temporarily or permanently. Consequently, to ensure that social required period of time, it is necessary to accurately evaluate the degree of disability and the probable duration of this disability.
Incapacity for work may be defined as temporary or permanent. The term “temporary incapacity” is used in the case of a pathological condition that prevents the worker from following his or her normal occupation, and thus designates a specific and not a general condition. This provides confirmation of the statement that this form of social protection is concerned less with the morbid condition than with the resultant loss of earning capacity.
A worker may, of course, suffer from an injury or illness which does not prevent him or her following them normal occupation and in such a case there is no right to the benefit payable for temporary disability, which usually takes the form of an allowance. In certain countries there is a waiting period (either mandatory or contingent) before benefit becomes payable; the waiting period is contingent if there is provision to make payments retroactively for the waiting period once the contingency deadline has been exceeded.
In most cases of temporary disability, payments are made only where the disability is total; however, in some countries such as Belgium, there are reduced benefits for partial disability.
Permanent disability or disablement, whether total or partial, means loss or reduction of working capacity, productivity or ability to earn, or, as it has been defined, loss or reduction of biological earning capacity due to the virtually permanent consequences of a pathological event casually related to an occupational accident or disease.
The task of distinguishing between temporary and permanent incapacity may sometimes prove to be very difficult, more so because the terms temporary and permanent have not been given precise and absolute meanings, but only meanings related to prognosis based on serious consideration.
In fact, much legislation provide for the periodical revision of benefit payments, either upwards or downwards, until restoration of the original working capacity, following on changes in pathological conditions that were nevertheless originally declared practically permanent.
However, it is possible to identify the dividing line between temporary and permanent incapacity, since the main criterion of temporary incapacity is the fact that it is limited in time to a period which, although varying in length, can still be estimated approximately; hence, incapacity may be considered permanent when its duration can no longer be reliably estimated.
The following example will render this concept more comprehensible: chronic osteomyelitis may be considered the cause of incapacity of unlimited duration if the condition is found to be unresponsive to medical and surgical therapy; the condition must therefore be considered one of permanent disability although this does not mean that a cure may not one day be found.
The basic principle that the worker should be compensated for the economic loss he or she incurs should be achieved in the case of permanent incapacity by paying the worker the real difference between his or her incomes before or after the pathological event. However, due to practical difficulties, compensation does not deal with the matter this way.
In a system employing collective bargaining, a decline in fitness is hardly ever accompanied by a decline in remuneration, and employment and level of remuneration depend above all on state of the labour market. Consequently, it has been found preferable to base compensation not on the effective reduction in earnings, but on the nature and importance of the residual anatomical and functional consequences of the accident or illness, and their effect on working capacity, and to assume that there will be a corresponding reduction in earning capacity.
This method has the advantage of basing the evaluation on the objective anatomical and functional criteria constituted by the injury, and hence on concrete datum that can be verified at any time. In addition, although not perfect, it has nevertheless proved highly practicable.
It may be applied in various ways: one can ignore differences between accidents causing equivalent injuries, or one can assign to each injury a value in relation to the importance of the organ affected in the injured person’s execution of his work.
Opinions diverge as to whether evaluation of loss should be based on work in general or on a specific activity, i.e. on the subject’s ability to earn his or her living doing non-specialized manual work requiring only average working capacity, or on his or her ability to continue in the occupation he or she pursued before his or her accident or illness. The use of the abstract concept of “work in general” will tend to give arbitrary results; this tendency will increase as modern industrial technology demands increasingly specialized workers.
On the other hand, the use of a specific activity as a criterion also presents problems; firstly, it makes it impossible to draw up disability ratings for different injuries and secondly, it inconveniences and produces inconsistencies in cases where, for example, specific working capacity is totally destroyed whilst general capacity remains almost intact.
Perhaps a better system is one that classifies work in large categories on the basis of the main human capabilities required for the work, e.g. physical strength, manual dexterity or intelligence.
Nevertheless, with all systems there remains the problem as to whether evaluation of the degree of disability should be left to the judgment of an assessor, or whether there should be a set schedule of ratings for at least the most common injuries. This latter system is anti-scientific, empirical and arbitrary; it takes no account of the victim’s personality and is concerned only with the disability and not with the disabled person. Nevertheless, practical requirements, such as the need for uniformity and impartiality have usually resulted in a system of standard disability ratings and have led to the incorporation of disability schedules into legislation of many countries. Criteria for the formulation and application of these schedules vary considerably.
Sherwood Clarke
General President
Clerical & Commercial Workers Union

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