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This article is part of the supplement: Proceedings of What is disability? UN convention on the rights of persons with disability, eligibility criteria and the International Classification of Functioning Disability and Health

Open Access Editorial

From codes to language: is the ICF a classification system or a dictionary?

Luigi Tesio

Author Affiliations

Department of Human Physiology and Chair of Physical and Rehabilitation Medicine, Università degli Studi, Milan, Italy

Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Milan, Italy

BMC Public Health 2011, 11(Suppl 4):S2  doi:10.1186/1471-2458-11-S4-S2

Published: 31 May 2011

First paragraph (this article has no abstract)

In a recent international seminar held in Rome [1], an experts’ meeting explored the suitability of the International Classification of Functioning, Disability, and Health (ICF, [2]) as a tool to implement the Convention on the Rights of Persons with Disabilities [3] passed by the United Nations General Assembly in 2005, and now being an instrument of international law valid in many States across the world. The reader of this issue of BMC Public Health has the unique opportunity to get an overview of successful applications of ICF, but also of emerging concerns and difficulties. The ICF was introduced in 2001. Its history dates back to its progenitor, the International Classification of Impairments, Disabilities, and Handicaps, published in 1980 [4]. The ICDH conceptual framework was quite revolutionary: the “consequences of the disease” at organ, person, and person-community levels were given an official conceptualization (impairments, disabilities, and handicaps, respectively), and were coded according to a taxonomy independent of the old established taxonomy of diseases issued by the World Health Organization (International Classification of Diseases, ICD). “Symptoms” like “”difficulty walking” became a condition worth coding ( and thus, studying and treating) “per se”. “Phenomena” were upgraded to “reality” rather than being underestimated as “appearance” [5]. Rehabilitation became an autonomous form of medical care at any stage of the disease or the disablement process, and thus a respected Specialty: it was no more bound to a palliation coming after “true” care became ineffective. The new ICF model emphasized the value of the individual from a societal perspective: “disability” was up-coded (actually, sidelined) to a generic “umbrella term”, under which a positive gradient towards “enablement” was placed. Activity replaced disability, and participation replaced handicap. Whatever a disabled person can achieve “in the context of health experience” is now better than nothing, rather than being less than an ideal standard. The bidirectional flow from organ impairment to person’s performance, to his/her social participation actually became a 3D space expanding along two more axes, through the interactions with individual diseases and individual living environments, respectively (see ref. [6], Fig.1). “Limitations” and “restrictions” were severed from the “intrinsic” person’s status and were ascribed to the community context. Personal bad luck was obscured, and responsibilities of policy makers were spotlighted.