Disability and well-being: towards a Capability Approach for marketplace access

Figures & data

Table 1. Further models of disability.

Model	Definition/basic tenets	Implications	Key references	Limitations
Moral model: disability as act of God (oldest model of disability)	Disability as a punishment from God for a sin or moral/religious transgression that may have been committed by the person with disability, of their family/ancestors. Disability as a test of faith or even salvific in nature: ‘individuals and families are specially selected by God to receive a disability and are given the opportunity to redeem themselves through their endurance, resilience, and piety’ (Niemann, 2005, p. 106) The challenges associated with disability may be viewed as a God-given opportunity for character development: ‘individuals are selected by God or a higher power to receive a disability not as a curse or punishment but to demonstrate a special purpose or calling’ (Niemann 2005, p.106).	This view may lead to PWD or entire families’ exclusion from their local communities. Worse, in certain cultures where the moral and/or religious model of disability is still the predominant view, PWDs may be severely marginalised, even facing the prospect of abandonment or infanticide (Anderson 2013, p. 11). PWDs may be regarded as ‘blessed’, as they can learn important life lessons that able-bodied people do not necessarily have the opportunity to learn.	Black (1996), Bryan and Henderson(2011), and Pardeck and Murphy (2012), Rimmerman (2013).	Weakening of religious thinking has considerably decreased the ‘appeal’ and prevalence of this model.
Medical Model: disability as disease (mid-1800s onwards)	Disability as a medical problem: it is a defect in or failure of a bodily system; it is inherently abnormal and pathological. Defines disability in a fundamentally negative way: Disability is regarded as objectively bad, as a pitiable condition, ‘a personal tragedy for both the individual and her family (Carlson 2010, p. 5) that needs to be prevented, treated and cured, via medical treatment or physical rehabilitation to maximise the ability of the individual (i.e. adaptation by the PWD to their environment).	The goals of intervention are cure, medical treatment seeing to improve the physical condition to the greatest extent possible, rehabilitation and the adjustment of the PWD to the condition and to the environment; in other words, the PWD needs to change or be fixed, not the conditions that might be contributing to the person’s disability. PWD are expected to use the variety of services offered to them, and to spend time in the role of patient or learner being helped by trained professionals. Negative language: ‘invalid’, ‘cripple’, ‘spastic’, ‘handicapped’ and ‘retarded’ are all derived from the medical model (Creamer 2009, p. 22). An essentially negative conception of disability, which has contributed to some questionable medical treatments including involuntary sterilisation and euthanasia.	Carlson (2010), Kasser and Lytle (2013), Olkin (1999), Parsons (1951), and Woods and Thomas (2003).	Central focus on the causes of disability. PWDs may feel stigmatised and of less value to society in general if seen only from the perspective of their dysfunction. The medical model’s ‘sick role’ approach is problematic, considering that many chronically ill people or those with a disability do not consider themselves as sick. No distinction between impairment and sickness.
Charitable model: disability as victimhood	PWDs are suffering victims of circumstance, to be pitied. The charity model seeks to act to the benefit of PWDs, encouraging ‘humane treatment of persons with disabilities’ (Bryan and Henderson 2011, pp. 7–8).	Able-bodied people should assist PWDs in whatever way possible, as ‘they need special services, special institutions, etc., because they are different’ (Duyan 2007, p. 71). PWDs depicted as helpless, depressed and dependent on other people for care and protection.	Duyan (2007) and Bryan and Henderson (2011)	Accusation of constructing and perpetuating damaging stereotypes, by portraying PWD as helpless, sad and in need of care and protection (Seale, 2006)
Biopsycho-social model	The synthesis of the medical and the social models, incorporating different perspectives of health: biological, individual and social. Disability is viewed neither as purely medical nor as purely social. Disability is understood as a dynamic interaction between health conditions and contextual factors, both personal and environmental. The biopsychosocial model assumes that disability is a complex phenomena that is both a problem at the level of a person’s body, and a complex and primarily social phenomena.	Disability is always the interaction between features of the person and features of the overall context in which the person lives, but some aspects of disability are almost entirely internal to the person, while another aspect is almost entirely external. In other words, both medical and social responses are appropriate to the problems associated with disability; we cannot wholly reject either kind of intervention” (ICF, 2018, p. 9).	ICF (2018) and WHO (2011)

Table 2. PWD models based upon individual rights.

Model	Definition/basic tenets	Implications	Key references	Limitations
Relational model Disability as relational	People with disabilities are disabled through dynamic relationships of body/mind and the environment. Disability is created through three relational processes: 1- the person/environment mismatch, 2- disability is a situational or contextual phenomenon, and 3- disability is a relative construct	Disabled people are excluded from communities, services and professional practices because of a mismatch of expectations, biological needs and environmental opportunities. Recognition that impairment is a predicament requiring sustained professional intervention.	Brennan et al. (2018), Egilson and Traustadottir (2009), and Kristiansen and Traustadottir (2004)	Lack of distinction between impairment and disability might reinsert a medicalised view of the disabled body and mind. Over-emphasis on professional practice and service delivery and lack of engagement with organisations for PWD. Realist interpretation of impairment ignores cultural, social and political aetiologies (Goodley & Runswick-Cole, 2015, p. 18).
Active model of disability	Focuses on the actions of PWD on disability, because they are not passive bystanders, powerless to reduce the restrictions of disability. Seeks to address the lack of inclusion in the current model of disability on the impact of the actions of PWD on disability.	Focus on the effects on disability of the individual and collective actions of PWD Engaging in self-help, using support groups and deploying assistive technology can all reduce the limitations of disability.	Levitt (2017)
Identity model or ‘affirmation model’: disability as identity	Disability as a marker of membership in a minority identity (e.g. gender, race). This model focuses on forging a positive definition of disability identity based on experiences and circumstances that have created a recognisable minority group called ‘people with disabilities’. The way they experience the world (a social and political experience of the effects of a social system not designed with PWD in mind), constitute PWD as a minority position in society who are devalued, stigmatised, discounted, and denied equal access and protection.	Model acknowledges the socially constructed dimension of disability. The identity model has influenced many in the disability community to adopt a positive self-image and pride. The model promotes a sense of belonging and involvement (i.e. campaigning) for PWDs, contributing to developing collective identity, and facilitating a group expression of frustration and anger. Such collective identity inspires PWDs to campaign for revolutionary ‘visions of change. Intervention should focus on the increased accessibility of places and services and broad systemic change.	Swain and French (2000).	The model seems to compel individuals to identify with a specific group culture. The identity model fails to pay sufficient attention to the reality of economic inequality faced by PWDs. Need for strong self-advocacy skills. Blurring of impairment and disability.
The Rights-based model: disability as a human rights issue	The human rights model moves beyond the explanations provided by the social model and offers a theoretical framework for disability policy that emphasises the human dignity of PWD. The human rights model encompasses … human rights, civil and political as well as economic, social and cultural rights. While the social model mostly fails to appreciate the reality of pain and suffering in the lives of some PWDs, the human rights model respects the fact that some PWDs are indeed confronted by such challenging life situations and argues that such factors should be taken into account in the development of relevant social justice theories. The human rights model ‘offers room for minority and cultural identification’ (Degener 2017, p. 49).	Demands cultural redefinition in opposition to cutthroat individualism of the dominant North American and Canadian societies. Challenges ableism (i.e. social biases against people whose bodies function differently to those with bodies considered to be normal, and the beliefs and practices resulting from and interacting with these biases to serve discrimination While the social model is mostly critical of public health policies that advocate the prevention of impairment, the human rights model recognises the fact that properly formulated prevention policy may be regarded as an instance of human rights protection for PWDs	Degener (2017)
Geographical model (GM) of disability	The geographical (geospatial) model of disability was created during research in the field of the geography of disability. This research has presented disability as a characteristic of the population that inevitably leads to marginalisation and spatial exclusion from otherwise normal social arenas and spaces within the built environment. The GM focuses mainly on the interrelation between PWD and geographical space. Limited ability is caused by both individual conditions (connected to a specific dysfunction) and those of the surrounding physical and social environment creating the restrictions which occur in the PWD – environment (social, physical) relation.	Geographers connect the nature of factors causing disability (disabling nature) both with social and spatial aspects of the human environment. They promote solutions which are more ‘inclusive’ and which provide access to sites and the full scope of life within society, taking different degrees and types of disability into consideration. The central postulate is not to concentrate on ‘disabilities’, but to focus on various social needs and adapt the geographical environment (social, as well as physical) accordingly. Universal design should therefore consider the nature of these needs in universal design, in the creation of maximally accessible buildings, sites and public services.	Butler and Bowlby (1997), Chouinard (2010), Gaines (2004, p. 80), Imrie (2012), Zajadacz (2015), and Śniadek and Zajadacz (2014).

Figure 1. A constellation of ability.

The figure represents a constellation of ability axis. To the vertical there is low to high capability, and to the horizontal there is low to high functionality. The figure represents some examples of physical impairment, in the form of a star, against capability and functionality. For example, cerebral palsy may be plotted as low on the functionality axis and slightly higher on the capability axis. A neurodevelopmental condition may be plotted as very high on the functionality axis, yet low on the capability axis.

Source: Authors.

Figure 2. Closing the gap – the market as conversion factor.

Fig 2 represents a model of the market as a potential conversion factor. To the extreme left of the image there is an image of a loop showing the capabilities and lack of resources. The constellations of ability (as shown in figure 1) feeds into the market. There is an arrow from constellations of ability pointing towards the market. From the market there emerges an arrow above and below indicating ‘conversion factor’. This conversion factor feeds into society and the economy, ultimately resulting in a maximisation of functionings though the availability of resources, thus minimising the gap - as depicted at the top of the model.

Source: Authors.

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