Defining Disability Difficult

Disagreement continues over whether obesity is a lifestyle choice

Peter McKnight, Vancouver Sun
Published: Saturday, November 29, 2008

Having only one eye might be viewed as a disability, but it depends on what kind of world you live in. If, for example, you live in the land of the blind,
then you are not only not disabled but, as the adage has it, king.

That tells us that it’s simply not possible to define disability in isolation from one’s environment. And as well-known as the adage is, we often forget
that the environment plays a crucial role in determining whether someone qualifies as disabled.

This, in effect, is the argument made by many people in the disability rights movement, an argument that played a significant role in the Canadian Transportation
Agency’s “one person, one fare” decision, released in January of this year.

The decision was back in the news this week, as the Supreme Court of Canada dismissed an Air Canada and WestJet application for leave to appeal the decision.
The decision therefore stands, and means that the airlines will have to make accommodations, possibly by offering an extra seat, to disabled people who
need to fly with an attendant.

But the CTA decision didn’t end there — it also determined that obesity can be a disability, and that the airlines are therefore required to accommodate
some obese people who are unable to fit into airline seats. That aspect of the decision had commentators across North America arguing that obesity is not
a disability but a lifestyle choice, and that if obese people want to fly comfortably, they ought to lose weight.

This conflicts with the arguments of Linda McKay-Panos, an obese woman with Stein-Leventhal syndrome (polycystic ovarian disease). McKay-Panos intervened
in the CTA decision, arguing that the airlines should make certain accommodations — she didn’t demand an extra free seat — so that her flying experience
would be similar to that of other travellers.

So what we have here is a fundamental disagreement, not simply about how to accommodate people with disabilities, but about the nature of disability. Critics
of the CTA decision see disability as something immutable and beyond the control of the disabled person, and both of these assumptions are problematic.

After all, most conditions we refer to as disabilities are not immutable, but are, as disability theorist Tom Shakespeare says, “changeable and episodic,”
such as rheumatism and cardiovascular disease.

Further, while obesity is sometimes associated with a medical condition (as in McKay-Panos’s case), rather than merely the consequence of overeating and
laziness, many other conditions we commonly refer to as disabilities are at least partly within the control of those who experience them.

While some people will spend the rest of their lives in a wheelchair, others will walk again provided they take the necessary steps to recover. Yet we don’t
deny they are disabled when they are in the chair, even if they are unwilling to do what is necessary to recover.

This is so even if it was the individual’s own reckless behaviour — by driving drunk, for example — that resulted in his need to use a chair. In effect,
then, the cause of the disability doesn’t seem relevant to whether we consider the person disabled, except, for some reason, when the person is obese.

Leaving these considerations aside, the debate between critics of the CTA decision and disability advocates really involves a conflict between the individual
and social models of disability.

The individual (or medical) model became dominant with the rise of medicine in the 19th century. The individual model locates the source of the disability
in the body (or mind) of the person. As sociologist Anthony Giddens puts it, “bodily ‘abnormality’ is seen as causing some degree of ‘disability’ or functional
limitation — an individual ‘suffering’ from quadriplegia is incapable of walking, for example.”

The individual model therefore suggests that disabilities are solely the problems of individuals who experience them — rather than problems for society
— and that individuals should seek to overcome these disabilities, with the help of physicians. This is what we hear from critics of the CTA obesity decision,
who say obese people should simply lose weight. And not surprisingly, this model often results in the stigmatization of disabled people as it presents
them as broken versions of “normal” people.

Consequently, disability advocates developed an alternate way of viewing disabilities and the people who experience them. In the 1960s, the British Union
of Physically Impaired Against Segregation made a crucial distinction between impairment — a biomedical problem that involves defective functioning, and
disability — the disadvantage or restriction of activity caused by a society that takes little account of the needs of people with impairments.

The UPIAS therefore portrayed disability “not as an attribute of an individual, but rather as a complex collection of conditions, many of which are created
by the social environment.” This reorienting of the term “disability,” which has been called “the big idea” of the British disability movement, therefore
placed the onus on society to examine how it “disables” people with impairments, and helped dismantle barriers that prevented such people from fully participating
in society.

There is much truth to this social model of disability, since whether impairments — deviations from ideal functioning — are disabilities really does depend
on the social environment. Impairments that are disabilities in one situation might not be in another. For example, according to the social model, obesity
is a disability when trying to fit into an airplane seat, but is an advantage in a sumo wrestling ring.

As with any big idea, there is a danger of it becoming too big. Disability theorist Shakespeare, who has achondroplasia (dwarfism) and who is a critic of
the social model, notes that by overemphasizing society’s role in creating disabilities “we might not see impairment as something we should make efforts
to avoid.”

Indeed, some disability advocates, in their attempt to view impairments objectively, and perhaps in reaction to the medical model, object to any characterization
of impairments as something to be prevented or ameliorated. We have seen, for example, hostility toward cochlear implants in the deaf community, and the
rise of an autism rights movement that argues in favour of “neurodiversity.”

The problem here is that impairments themselves, aside from anything society does, can cause pain and suffering. To return to the example of obesity, societal
attitudes and institutions might well adversely affect obese people, but obesity itself is associated with many deleterious health conditions. And people
ought to be able to avail themselves of medical advances that could prevent or alleviate these conditions.

The social model therefore tells the truth, but not the whole truth, as does the medical model. In an effort to synthesize the two, the World Health Organization
developed the International Classification of Functioning and Disability (ICF), which identifies three dimensions of disability: Impairment, activity limitation
and participation restriction.

This formulation, which includes aspects from both the medical (impairment) and social (participation restriction) models of disability, was adopted by
all 190 WHO member states, including Canada. The CTA also relied on it heavily in coming to the conclusion that obesity is a disability, and it will likely
influence future court cases and decisions of government bodies which deal with the nature of disability.

This means that obesity, at least sometimes, will be considered a disability. But unlike a thoroughgoing social model, the ICF formulation recognizes that
impairment itself can be a problem, and might therefore be alleviated through medical interventions. And unlike a thoroughgoing medical model, it recognizes
that the social environment can also be a problem, and that society must therefore work to remove barriers.

A synthesis of the medical and social models therefore overcomes the disadvantages of these models considered in isolation, since it simultaneously recognizes
different dimensions of disability. And by employing such a synthesis, we can help many people to overcome disadvantages, whether they’re the product of
nature or nurture.

Reproduced from