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Objectives, Background and Concepts
A strategy of prevention is essential for reducing the incidence
of impairment and disability. The main elements of such a strategy would vary according to
a country's state of development, and are as follows:
- The most important measures for prevention of impairment are: avoidance of war;
improvement of the educational, economic and social status of the least privileged groups;
identification of types of impairment and their causes within defined geographical areas;
introduction of specific intervention measures through better nutritional practices;
improvement of health services, early detection and diagnosis; prenatal and postnatal
care; proper health care instruction, including patient and physician education; family
planning; legislation and regulations; modification of life-styles; selective placement
services; education regarding environmental hazards; and the fostering of better informed
and strengthened families and communities;
- To the extent that development takes place, old hazards are reduced and new ones arise.
These changing circumstances require a shift in strategy, such as nutrition intervention
programmes directed at specific population groups most at risk owing to vitamin A
deficiency; improved medical care for the aging; training and regulations to reduce
accidents in industry, in agriculture, on the roads and in the home; and the control of
environmental pollution and of the use and abuse of drugs and alcohol. In this connection,
the WH0 strategy for Health for All by the Year 2000 through primary health care should be
given proper attention.
Measures should be taken for the earliest possible detection of the symptoms and signs
of impairment, to be followed immediately by the necessary curative or remedial action,
which can prevent disability or at least lead to significant reductions in the severity of
disability and can often prevent its becoming a lasting condition. For early detection it
is important to ensure adequate education and orientation of families and technical
assistance to them by medical social services.
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Rehabilitation usually includes the following types of services:
- Early detection, diagnosis and intervention;
- Medical care and treatment;
- Social, psychological and other types of counselling and assistance;
- Training in self-care activities, including mobility, communication and daily living
skills, with special provisions as needed, e g., for the hearing impaired, the visually
impaired and the mentally retarded;
- Provision of technical and mobility aids and other devices;
- Specialized education services;
- Vocational rehabilitation services (including vocational guidance), vocational training,
placement in open or sheltered employment;
- Follow-up.
In all rehabilitation efforts, emphasis should be placed on the abilities of the
individual, whose integrity and dignity must be respected. The normal development and
maturation process of disabled children should be given the maximum attention . The
capacities of disabled adults to perform work and other activities should be utilized.
Important resources for rehabilitation exist in the families of disabled persons and in
their communities. In helping disabled persons, every effort should be made to keep their
families together, to enable them to live in their own communities and to support family
and community groups who are working with this objective. In planning rehabilitation and
supportive programmes, it is essential to take into account the customs and structures of
the family and community and to promote their abilities to respond to the needs of the
disabled individual.
Services for disabled persons should be provided, whenever possible, within the
existing social, health, education and labour structures of society. These include all
levels of health care; primary, secondary and higher- education, general programmes of
vocational training and placement in employment; and measures of social security and
social services. Rehabilitation services are aimed at facilitating the participation of
disabled persons in regular community services and activities. Rehabilitation should take
place in the natural environment, supported by community-based services and specialized
institutions. Large institutions should be avoided. Specialized institutions, where they
are necessary, should be organized so as to ensure an early and lasting integration of
disabled persons into society.
Rehabilitation programmes should make it possible for disabled persons to take part in
designing and organizing the services that they and their families consider necessary.
Procedures for the participation of disabled persons in the decision-making relating to
their rehabilitation should be provided for within the system. When people such as the
severely mentally disabled may not be able to represent themselves adequately in decisions
affecting their lives, family members or legally designated agents should take part in
planning and decision-making.
Efforts should be increased to develop rehabilitation services integrated in other
services and make them more readily available. These should not rely on imported costly
equipment, raw material and technology. The transfer of technology among nations should be
enhanced and should concentrate on methods that are functional and relate to prevailing
conditions.
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To achieve the goals of "full participation and
equality", rehabilitation measures aimed at the disabled individual are not
sufficient. Experience shows that it is largely the environment which determines the
effect of an impairment or a disability on a person's daily life. A person is handicapped
when he or she is denied the opportunities generally available in the community that are
necessary for the fundamental elements of living, including family life, education,
employment, housing, financial and personal security, participation in social and
political groups, religious activity, intimate and sexual relationships, access to public
facilities, freedom of movement and the general style of daily living.
Societies sometimes cater only to people who are in full possession of all their
physical and mental faculties. They have to recognize the fact that, despite preventive
efforts, there will always be a number of people with impairments and disabilities, and
that societies have to identify and remove obstacles to their full participation. Thus,
whenever pedagogically possible, education should take place in the ordinary school
system, work be provided through open employment and housing be made available as to the
population in general. It is the duty of every Government to ensure that the benefits of
development programmes also reach disabled citizens. Measures to this effect should be
incorporated into the general planning process and the administrative structure of every
society. Extra services which disabled persons might need should, as far as possible, be
part of the general services of a country.
The above does not apply merely to Governments. Anyone in charge of any kind of
enterprise should make it accessible to people with disabilities. This applies to public
agencies at various levels, to non-governmental organizations, to firms and to private
individuals. It also applies to the international level.
People with permanent disabilities who are in need of community support services, aids
and equipment to enable them to live as normally as possible both at home and in the
community should have access to such services. Those who live with such disabled persons
and help them in their daily activities should themselves receive support to enable them
to have adequate rest and relaxation and an opportunity to take care of their own needs
The principle of equal rights for the disabled and non-disabled implies that the needs
of each and every individual are of equal importance, that these needs must be made the
basis for the planning of societies, and that all resources must be employed in such a way
as to ensure, for every individual, equal opportunity for participation. Disability
policies should ensure the access of the disabled to all community services.
As disabled persons have equal rights, they also have equal obligations. It Is their
duty to take part in the building of society. Societies must raise the level of
expectation as far as disabled persons are concerned, and in so doing mobilize their full
resources for social change. This means, among other things, that young disabled persons
should be provided with career and vocational opportunities - not early retirement
pensions or public assistance.
Persons with disabilities should be expected to fulfil their role in society and meet
their obligations as adults. The image of disabled persons depends on social attitudes
based on different factors that may be the greatest barrier to participation and equality.
We see the disability, shown by the white caner crutches, hearing aids and wheelchairs,
but not the person. What is required is to focus on the ability, not on the disability of
disabled persons.
All over the world, disabled persons have started to unite in organizations as
advocates for their own rights to influence decision-makers in Governments and all sectors
of society. The role of these organizations includes providing a voice of their own,
identifying needs, expressing views on priorities, evaluating services and advocating
change and public awareness. As a vehicle of self-development, these organizations provide
the opportunity to develop skills in the negotiation process, organizational abilities,
mutual support, information-sharing and often vocational skills and opportunities. In view
of their vital importance in the process of participation, it is imperative that their
development be encouraged.
Mentally handicapped people are now beginning to demand a voice of their own and
insisting on their right to take part in decision-making and discussion. Even those with
limited communication skills have shown themselves able to express their point of view. In
this respect, they have much to learn from the self-advocacy movement of persons with
other disabilities. This development should be encouraged.
Information should be prepared and disseminated to improve the situation of disabled
persons. The cooperation of all public media should be sought to bring about presentations
that will promote an understanding of the rights of disabled persons aimed at the public
and the persons with disabilities themselves, and that will avoid reinforcing traditional
stereotypes and prejudices.
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