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PREVENTION OF DISABILITY

PREVENTION OF DISABILITY COMMUNITY HEALTH STUDIES VOLUME X, NUMBER 4, 1986 Murray Couch Registrar’s Department, Flinders University of South Australia, Bedford Park, 5042. is pointed out that screening soon after birth for The Interim Report of the Better Health congenital dislocation of the hip, congenital Commission made passing references to a number of specific disabilities, but it did not hypothyroidism and phenylketonurea (PKU) include a separate chapter on the issue. Subse- can identify these conditions and appropriate quently, at the invitation of the Commission, intervention can allow many children to develop the Australian Council for the Rehabilitation of normally. The Chapter adopts a two-handed view of the the Disabled (ACROD) prepared a submission which became the Commission’s report on dis- place of medical procedures in childbirth and in ability. In a brief opening preamble, the Chapter the management of neonates. On the one hand argues that: it stresses the importance of “at risk” mothers Disabled people suffer much handicap in and babies in remote areas having access to terms of diminished opportunity for partic- intensive care units for the newborn, and advo- ipation in the life open to those who are cates the development of a national network of not disabled - and not only disabled regional units. people, for the handicap extends to those On the other hand, the Report expresses a measure of disquiet about the possibility of a closest to them through a forced dependence. new population of disabled people resulting from the application of high technology med- (P. 22) Although they are not elaborated upon, two icine, which has enabled extremely low birth strategic points in understanding prevention of weight babies, 500g - 1000g,to survive: disability are being made in the above passage. . . . but the incidence of major disability The first is that a distinction is necessary amongst them (involving major functional between “disability” and “handicap”. Disa- impairment of neuromotor and mental abil- bility is a loss or reduction of functiopal ability ities) has been estimated to be as high as which results from an impairment, whereas 20-25 per cent in one leading neo-natal handicap is a disadvantage caused by the disa- intensive care unit. (p. 23). bility. Prevention, then, needs to work on two Concern about some of the unintended dele- fronts: the reduction of the incidence of pre- terious effects of intrusive childbirth proce- ventable disability, and the minimizing of the dures, and high technology medicine and degree to which disability leads to handicap. neonates, is gathering some support from the The second point is that it isnot the individual research literature. with a disability, alone, who is “at risk”. The Chapter would have been remiss in not Spouses, parents, siblings and other people addressing questions of prevention to medical close to the person form a vulnerable group, practice itself; however, having raised the issue, about whom issues of prevention needs to be the Chapter fails to propose any pointers to a addressed. preventative strategy. Rather, it assumes and The body of the Chapter is set out on a life- hopes that the medical establishment itself will span basis: from pre-conception to adulthood. have the answers. Primary preventative measures available in ACROD notes with interest that the national relation to congenital disabilities are touched Health and Medical Research Council upon: genetic counselling for “at risk” groups; (NHMRC) has called for submissions on the amniocentesis programmes and support for ethical issues of limited treatment in certain women for whom the amniocentesis test results cases. (p. 23). are unfavourahle; immunization programmes, The pre-natal, birth and neo-natal stages of particularly against rubella. As well as these, it human development are crucial in the pro- COUCH 415 COMMUNITY HEALTH STUDIES somewhat mirrors the ambivalence previously duction of disability. The Chapter recognizes discernible in the Better Health Commissions’ this in identifying the possibilities for primary Interim Report about the importance of social intervention during these stages. However, as and economic factors. The following quote from the Chapter, following its life-span framework, that earlier document offers a view that social moves on beyond these stages it quickly loses its and economic factors are important, but only to sharp focus and moves off on an assortment of the extent that they impede the acceptance of disparate pronouncements, and moral exhorta- tions for personal responsibility. personal responsibility. Ultimately, it is the individual who must Inter ah, the Chapter gives superficial take the decision to eschew unhealthy treatment to: forming good nutrition habits in behaviour. But social and economic factors children; reducing road, domestic, sport and often discourage, or even prevent, such work accidents; first aid; AIDS; recreation and change, and individudls may not be aware research. The importance of any one of these of, or may be unwilling to acknowledge, issues is defensible, but any campaign to prevent the need for change. disability is not likely to be advanced by the (Interim Report, p. 85) facile treatment of them. More problems are Possibilities for the prevention of disability raised than solved, when after several sentences are unlikely to be maximized without questions it is glibly concluded that “improvements to being addressed concerning the evenness, or living conditions, hygiene and nutrition are seen otherwise of the distribution of specific disabil- by ACROD to be the major thrust towards ities across the population, and the inequalities prevention of disability in Aborigines.” Such in the distribution of the resources which might superficial treatment begs the accusation of be applied to prevent disabilities becoming “blaming-the-victim”. handicaps. Personal responsibility, education Criticism of the Chapter for its lack of rigour and counselling are not sufficient as a base for and depth may be misdirected. Perhaps it was prevention. The interests of preventing illness the manner of its preparation, and its inclusion, and promoting health might well be advanced unedited, which was injudicious. As was noted by this Chapter of the Report if the principles in earlier, ACROD made this submission between the preamble, discussed earlier, become the the interim and final reports, and it gives the basis for ongoing community discussion. The impression of having been stitched together in limited but crucial options for preventing disa- haste. It must be presumed that ACROD had bilities need to be separated from the more no intention of speaking on behalf of all interests numerous possibilities of enhancing health by about the prevention of the whole range of preventing handicap. The other set of concerns disabilities. Given what is often seen as centres around the recognition that the social ACROD’s bias towards the issues of the physi- network surrounding a disabled person becomes cally disabled and the interests of service prov- an “at risk” group and attention needs to be iders, it can be assumed that the Better Health directed towards preventive measures to alle- Commission might have benefited from submis- viate the illness-producing pressures of the sions from such national bodies as the Australian “forced dependence”. Association of Mental Retardation and Dis- The Better Health Commission has opened abled Persons International. the way for awareness of the potential to prevent disability and handicap, but the public dis- The Chapter’s overall approach to the pre- vention of disability is to minimize the signifi- cussion which the Report is intended to precip- cance of social structural issues and to emphasize itate will need to extend well beyond this responsible behaviour of individuals. This Chapter if it is to bring change. COUCH COMMUNITY HEALTH STUDIES http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Public Health Wiley

PREVENTION OF DISABILITY

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Publisher
Wiley
Copyright
"Copyright © 1986 Wiley Subscription Services, Inc., A Wiley Company"
ISSN
1326-0200
eISSN
1753-6405
DOI
10.1111/j.1753-6405.1986.tb00556.x
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Abstract

COMMUNITY HEALTH STUDIES VOLUME X, NUMBER 4, 1986 Murray Couch Registrar’s Department, Flinders University of South Australia, Bedford Park, 5042. is pointed out that screening soon after birth for The Interim Report of the Better Health congenital dislocation of the hip, congenital Commission made passing references to a number of specific disabilities, but it did not hypothyroidism and phenylketonurea (PKU) include a separate chapter on the issue. Subse- can identify these conditions and appropriate quently, at the invitation of the Commission, intervention can allow many children to develop the Australian Council for the Rehabilitation of normally. The Chapter adopts a two-handed view of the the Disabled (ACROD) prepared a submission which became the Commission’s report on dis- place of medical procedures in childbirth and in ability. In a brief opening preamble, the Chapter the management of neonates. On the one hand argues that: it stresses the importance of “at risk” mothers Disabled people suffer much handicap in and babies in remote areas having access to terms of diminished opportunity for partic- intensive care units for the newborn, and advo- ipation in the life open to those who are cates the development of a national network of not disabled - and not only disabled regional units. people, for the handicap extends to those On the other hand, the Report expresses a measure of disquiet about the possibility of a closest to them through a forced dependence. new population of disabled people resulting from the application of high technology med- (P. 22) Although they are not elaborated upon, two icine, which has enabled extremely low birth strategic points in understanding prevention of weight babies, 500g - 1000g,to survive: disability are being made in the above passage. . . . but the incidence of major disability The first is that a distinction is necessary amongst them (involving major functional between “disability” and “handicap”. Disa- impairment of neuromotor and mental abil- bility is a loss or reduction of functiopal ability ities) has been estimated to be as high as which results from an impairment, whereas 20-25 per cent in one leading neo-natal handicap is a disadvantage caused by the disa- intensive care unit. (p. 23). bility. Prevention, then, needs to work on two Concern about some of the unintended dele- fronts: the reduction of the incidence of pre- terious effects of intrusive childbirth proce- ventable disability, and the minimizing of the dures, and high technology medicine and degree to which disability leads to handicap. neonates, is gathering some support from the The second point is that it isnot the individual research literature. with a disability, alone, who is “at risk”. The Chapter would have been remiss in not Spouses, parents, siblings and other people addressing questions of prevention to medical close to the person form a vulnerable group, practice itself; however, having raised the issue, about whom issues of prevention needs to be the Chapter fails to propose any pointers to a addressed. preventative strategy. Rather, it assumes and The body of the Chapter is set out on a life- hopes that the medical establishment itself will span basis: from pre-conception to adulthood. have the answers. Primary preventative measures available in ACROD notes with interest that the national relation to congenital disabilities are touched Health and Medical Research Council upon: genetic counselling for “at risk” groups; (NHMRC) has called for submissions on the amniocentesis programmes and support for ethical issues of limited treatment in certain women for whom the amniocentesis test results cases. (p. 23). are unfavourahle; immunization programmes, The pre-natal, birth and neo-natal stages of particularly against rubella. As well as these, it human development are crucial in the pro- COUCH 415 COMMUNITY HEALTH STUDIES somewhat mirrors the ambivalence previously duction of disability. The Chapter recognizes discernible in the Better Health Commissions’ this in identifying the possibilities for primary Interim Report about the importance of social intervention during these stages. However, as and economic factors. The following quote from the Chapter, following its life-span framework, that earlier document offers a view that social moves on beyond these stages it quickly loses its and economic factors are important, but only to sharp focus and moves off on an assortment of the extent that they impede the acceptance of disparate pronouncements, and moral exhorta- tions for personal responsibility. personal responsibility. Ultimately, it is the individual who must Inter ah, the Chapter gives superficial take the decision to eschew unhealthy treatment to: forming good nutrition habits in behaviour. But social and economic factors children; reducing road, domestic, sport and often discourage, or even prevent, such work accidents; first aid; AIDS; recreation and change, and individudls may not be aware research. The importance of any one of these of, or may be unwilling to acknowledge, issues is defensible, but any campaign to prevent the need for change. disability is not likely to be advanced by the (Interim Report, p. 85) facile treatment of them. More problems are Possibilities for the prevention of disability raised than solved, when after several sentences are unlikely to be maximized without questions it is glibly concluded that “improvements to being addressed concerning the evenness, or living conditions, hygiene and nutrition are seen otherwise of the distribution of specific disabil- by ACROD to be the major thrust towards ities across the population, and the inequalities prevention of disability in Aborigines.” Such in the distribution of the resources which might superficial treatment begs the accusation of be applied to prevent disabilities becoming “blaming-the-victim”. handicaps. Personal responsibility, education Criticism of the Chapter for its lack of rigour and counselling are not sufficient as a base for and depth may be misdirected. Perhaps it was prevention. The interests of preventing illness the manner of its preparation, and its inclusion, and promoting health might well be advanced unedited, which was injudicious. As was noted by this Chapter of the Report if the principles in earlier, ACROD made this submission between the preamble, discussed earlier, become the the interim and final reports, and it gives the basis for ongoing community discussion. The impression of having been stitched together in limited but crucial options for preventing disa- haste. It must be presumed that ACROD had bilities need to be separated from the more no intention of speaking on behalf of all interests numerous possibilities of enhancing health by about the prevention of the whole range of preventing handicap. The other set of concerns disabilities. Given what is often seen as centres around the recognition that the social ACROD’s bias towards the issues of the physi- network surrounding a disabled person becomes cally disabled and the interests of service prov- an “at risk” group and attention needs to be iders, it can be assumed that the Better Health directed towards preventive measures to alle- Commission might have benefited from submis- viate the illness-producing pressures of the sions from such national bodies as the Australian “forced dependence”. Association of Mental Retardation and Dis- The Better Health Commission has opened abled Persons International. the way for awareness of the potential to prevent disability and handicap, but the public dis- The Chapter’s overall approach to the pre- vention of disability is to minimize the signifi- cussion which the Report is intended to precip- cance of social structural issues and to emphasize itate will need to extend well beyond this responsible behaviour of individuals. This Chapter if it is to bring change. COUCH COMMUNITY HEALTH STUDIES

Journal

Australian and New Zealand Journal of Public Health – Wiley

Published: Dec 1, 1986

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