Library Collections: Document: Full Text

People who age and people with disabilities have traditionally been split into two opposing camps in the eyes of both providers of services as well as their own self perceptions. By focusing on several cross cutting phenomena -- issues of prevalence, the ever changing nature of chronic conditions, the effects of which I call the technicalisation and medicalisation of services, and the full implications of the home care revolution -- I argue for the importance of their finding a common ground.

Whether the unit of study be a city, a state, or a country, it is generally estimated that one out of eight people has a disability (National Centre of Health Services 1982; Office of Technology Assessment 1982). Those numbers themselves would be of concern (e.g. three million people in the United States), but cast as a ratio, the numbers still convey the notion of a statistical minority. Thus a major question is whether or not such figures are likely to increase.

Now recent declines in various mortality statistics such as the total death rate, infant and maternal mortality, condition-specific death rates, increases in life expectancy, at birth and at various later ages cause many to claim that world health is improving. Time series studies of illness and disability, however, provide a very different and less optimistic picture.

A review (Wilson and Drury 1984) of the twenty-year trends in fifteen major broad categories of chronic illness (1960-81) found that the prevalence of seven conditions (heart disease, diabetes, hypertension, bronchitis-sinusitis, arthritis-rheumatism, visual and hearing impairments) had more than doubled. Two conditions had increased their prevalence by 50% to 99% (asthma-hay fever, impairments of back or spine); five had increased by up to 50% (peptic ulcer, hernia, paralysis, varicose veins, and haemorrhoids); and only one condition (impairments of lower extremities) had become less prevalent. The so-called greying of the population did not explain the increases, since a similar pattern was observed across all age groups. For persons 45-64 (the core of the working population) these figures translated directly into limitations on activity, more than doubling the number of males who claimed they were unable to work because of some illness or disability (from 4.4% to 10.9%).

Looking at two subsets, the young and the old, heightens the issue of increases in disability. Thus, where children are concerned, the absolute numbers in the under-17 age group are not expected to increase. The National Health Interview Survey (Newacheck, Budetti & Halfon 1986) indicates that the prevalence of activity-limiting chronic conditions among children doubled between 1960 and 1981 (from 1.8% to 3.8%), with the greatest increase in the past decade. This is added to by what is often referred to as 'the new morbidity,' an interest in psychosocial issues such as behavioural adjustments and learning difficulties. It is also clear that changing educational concerns are making learning problems the fastest growing disability on university campuses. What new learning disabilities we will discover as computer literacy becomes a sine qua non for success in contemporary society is anybody's guess.

Now turning to the older population; in absolute number they are on the increase around the world. All census data affirm that the fastest growing segment of the US population is made up of those over the age of 65. In 1880 their number was less than two million (3% of the total population), but by 1980 it was twenty-five million (11.3%). By the year 2030 an estimated one in four or five citizens (20% to 25%) is likely to be over 65. Put another way, throughout most of history only one in ten people lived past 65; now nearly 80% do (Liu, Manton, Alliston 1983).

While such data are clear for the industrialised world, a longer term projection claims a similar trend throughout the developing world as well. Thus the United Nations Department of Economic and Social Affairs (1982), using what they dubbed 'medium' assumptions of fertility and mortality, projected a near doubling of the world population of people over the age of 65.

For the United States population, virtually all figures on disability increase with age. Thus one in four of those aged 65 or older has a limiting disability and one in seven, a 'severely limiting one'. Translated into service implications only 3% of all persons 65-69 need any personal assistance because of these problems, but by age 85 this rises to one-third (Feinstein, Gornick, and Greenberg 1984).

Thus whether measured by the growing prevalence of certain chronic conditions, the increased limitations in activity, the inevitable ageing of the population, the changing awareness of parents and professionals, and the ever changing demands and structure of society, the number of people with conditions interfering with their full social participation is so steadily increasing that the word 'minority' can hardly apply. Ray Lifchez puts this into perspective when he concludes: