Disability Policies in France: Changes and Tensions between the Category-based, Universalist and Personalized Approaches

Abstract

In this article, the authors show that the current French disability policy is traversed by conflicts between three different approaches to disability which came about at different periods in history. They begin by looking at the origins of disability policy in France. This policy was developed during the 20th century, from notions of repair, indemnification and compensation through rehabilitation. It became institutionalized in 1975, when two laws were passed, giving it the form of a category-based policy. Between 1970 and 2000, affected by the international situation, this policy came into conflict with a universalist policy. More recently there has been a desire to develop a personalized approach. Finally, the authors use two examples (taken from recent debates on the implementation in France of the new law of 11 February 2005) to show the tensions that have led to the coexistence of these three approaches within current disability policy.

Notes

1. It should be noted that the development of the “general hospital” did not homogenize the field of assistance. In the 19th century in France there was a great diversity of establishments, some old, some modern: hospitals only accepting people who were ill, hospices for old people, for the crippled, the incurable and orphans, general hospitals with mixed populations. There were also charity offices (Bauduret & Jaeger 2002).

2. Rehabilitation practices have often been interpreted in the sense of a reduction in difference and an alignment with the norm of able-bodiedness. Without denying this aspect, we wish to underline two arguments. Firstly, these practices cannot be understood independently of the contexts in which they occurred. For the persons concerned, in the middle of the century these practices represented a real opportunity, that of being able to leave the hospice or asylum. We have also shown through ethnography that current rehabilitation practices will allow actors to work on the norm and to transform the norm of validity (Ville & Winance 2006, Winance 2006).

3. In 1993, the “official scale for the assessment of the disabilities and impairments of handicapped persons” replaced that used for ex-servicemen since the First World War. “This guiding scale gives a level or a level bracket for the incapacity caused by each impairment in terms of an assessment of how said impairment affects day-to-day and social life.” (Sanchez 2005:100).

4. Of course, one might argue that this process also leads to the creation of a “persons in a disability situation” category. But unlike the “handicapped person” category, which, due to the assessment procedure is very homogenous, the “persons in a disability situation” category is likely to show high heterogeneousness and high variability over time. Furthermore, the fact of belonging to a category (the recognition that one belongs to this category of individuals) does not mean one will be granted rights. The category can only be obtained a posteriori through a census and grouping together of all persons having obtained certain rights. Category-based treatment is based on a priori categorization.

5. Such debates have been numerous and varied, involving different actors. We use the term here in a generic manner, to designate all such debates: debates which took place in the Conseil National Consultatif des Personnes Handicapées (see below), parliamentary debates, one-off debates such as when the government organizes themed meetings, etc. Later in the article we will give details of the venue for each debate mentioned. Finally, it should be noted that this debate received very little media coverage, particularly in the daily press, which only described, essentially in an informative manner, the key moments of the revision processes (the move over to the French National Assembly for example). We did not however carry out a systematic examination of the press, which would certainly have allowed a more detailed analysis.

6. During the numerous debates surrounding the evolution of the social model in Great Britain, some researchers (women) raised this question: the radicalization of the social model leads to some people being unaware of the problems that certain persons are facing, by denying and suppressing the importance of the individual experience of disability (Crow 1996, French 1993).

7. We must remember that the law of 1975 had maintained the different systems of indemnification whilst at the same time creating a new one, relating to assistance. This question of equalization is currently being debated within the framework of a project to standardize the levels of the disability pension (regime governed by the French health insurance system) and the AAH (“assistance”).

8. We believe that the definition of disability, as set out in the 2005 law, perfectly fits the analysis of laws proposed by P. Lascoumes. Basing himself on an analysis of laws in the field of the environment, he demonstrates in particular that “Every legal system is simply an adjustment, to varying degrees of stability, of diverging and sometimes contradictory social interests, under the arbitration of public authorities” (Lascoumes 1995:399).

9. The allocation of compensation finances five types of expenditure: 1) human aid, 2) technical aid, 3) adaptation of place of living and/or vehicle, along with any additional transport-related costs, 4) specific (i.e. the purchase of nutrients to improve a regime) or exceptional (one-off disability related) costs relating to the disability and not covered by other systems charges, 5) allocation and maintenance of animal assistance. It should be noted that, so far, only the decree relating to compensation for life at home has come into effect. A decree relating to compensation when living in an institution should be coming into effect soon.

10. Eligibility criteria are nevertheless still in force, making it possible to decide who is or is not entitled to the allocation of compensation. But these criteria no longer lead to an objectivation of individual characteristics. In order to be entitled to the allocation of compensation, one must show absolute difficulty in doing one activity or serious difficulty in doing two activities. The activities taken into consideration are those relating to mobility, looking after oneself, communication, the general ability to situate oneself within the environment and protect one's interests (i.e. to situate oneself in time and space, to ensure one's own safety) and one's relationships with others. A commission (commission of rights and autonomy) then grants or refuses an allocation of compensation based on the above criteria.