If we are to look at the controversies over Personal Independence Payment (PIP) in the UK, it is necessary to be alert to the fact that the concept of disability in UK law is not an inevitable occurrence. Rather it is an exercise in political choice between many concepts or models of disability, which during the 20th century fought to dominate the discourse on disability. Carol Thomas explains that in the UK the different models (medical and social) fall broadly into a disciplinary divide between disability studies and medical sociology. Invariably, this choice in UK law has repercussions for how policy and further legal regulation is conceived and thus, it is not an incidental matter.
For example, in the UK Equality Act, the definition of a person with a disability has a number of elements – there must be a physical/mental impairment with long-term substantial effects on the ability to carry out normal day-to-day activities. This definition draws on what Michael Bury refers to as a socio-medical model, which defines disability as ‘a restriction or lack of ability to perform an activity in a normal manner’. This is the current strand of the medical model. It differs from earlier medical models in that it acknowledges the influence of social and cultural barriers in conjunction with the emphasis on the physical or mental ‘impairment’. Thus, disability is a restriction on “normal” ability caused by the ‘impairment’, albeit with an influence by ‘culture and context’. Yet, the latter is a cause for social disadvantage of persons with disabilities rather than oppression. As Thomas explains, Bury recognizes disability as ‘both biologically and socially caused, though the more significant causal weight lies with the former’. Thus, the aim of law and policy is the provision of a treatment, care and protection ‘to change the person so that they may be assimilated to the social norm’. In Ian Duncan Smith’s interview with the BBC’s Andrew Marr, we can hear in the undercurrents of this notion of disability.
Yet the medical model (including the current strand) ‘privileges normalcy over “abnormal”’ and supports the assumption that ‘able-bodied norms are inevitable’, valuing economic productivity ‘as an essential aspect of personhood’. It does not recognize the significance of the role of the social environment in disabling persons and how this leads to a ‘disabling culture’ that preserves negative social responses and discriminatory practices.
In contrast, the United Nations Convention on the Rights of Persons with Disabilities (CRPD) ) is underpinned by the social model of disability although the Preamble states that disability is an evolving concept. The social model emerged in the 1970s from the work of Finkelstein and Hunt, who founded the Union of the Physically Impaired against Segregation (UPIAS) and from the work of sociologist Mike Oliver. In its earliest form, the social model conceived disability only as oppression by the social environment and in its radical form, rejects ‘impairment’ as the cause of disability. According to Kayess and French, the social model refocuses the agenda to accepting impairment as a positive dimension of human diversity and to challenge and reject a social norm that results in exclusion of people with disabilities. Nevertheless, they criticize the CRPD as having internal inconsistencies as some provisions seem better explained by either the medical model or the radical social model. In parallel, the World Health Organization describes its 2001 International Classification of Functioning, Disability and Health as adopting a concept of “disability” which acknowledges disability as a ‘universal human experience, sometimes permanent, sometimes transient’ –‘that every human being may experience some degree of disability in their life through a change in health or in environment’. Although, it suggests that the concept takes into account critical factors other than purely medical, such as the impact of environment. But this does not necessarily suggest that the social environment is a significant or dominant factor.
How does the above discussion have relevance for the PIP assessment? When we consider the concept of disability in UK law, we can see how it translates into an assessment by Capita that tries to test the extent of the impairment, such as ‘Can you walk 20m unaided?’ which Ian Duncan Smith tries to defend in the Andrew Marr interview. This doesn’t acknowledge that underpinning the assessment is a particular model of disability that is contested by a competing model. It also doesn’t acknowledge that one of the key criticisms of the chosen model is that it fails to challenge the ‘social norm’ or the dichotomy of “normalcy/abnormalcy”.
Dr Aisling O’Sullivan is a Lecturer in Law, University of Sussex