Abstract

Despite improvements in objective measures of impairment, health, and working conditions, long-term incapacity and ill-health retirement are major problems in all western societies. This article explores three models that address disability: the medical, social, and biopsychosocial models. The medical model identifies the sequence from disease that causes an impairment to a disability that leads to incapacity; this model works best when identifiable pathology permits objective diagnosis and assessment but is inappropriate for many common health problems, particularly those that are subjective or when treatment is symptomatic and often ineffective. The social model is widely accepted as the basis for social inclusion and antidiscrimination policies but cannot be operationalized as the basis for individual entitlement for incapacity benefits. The biopsychosocial model attempts to tack account of biological, psychological, and social dimensions of health and is reflected in the International Classification of Functioning, Disability, and Health (ICF), which is the contemporary model of disablement used in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition. Powerful links exist among poor health, disability, social and regional disadvantage, worklessness, and poverty. Vocational rehabilitation, in the biopsychosocial model, reverses the question of why people develop long-term incapacity and instead asks why people with common health problems do not recover as expected. The answer involves addressing the biopsychosocial obstacles that delay or prevent expected recovery and requires a fundamental cultural shift in how we perceive and manage common health problems.

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