A. How disability works

Many people see disability as a condition that is inherent in the person—for example, a medical condition that requires the person to be in a wheelchair or to take medication. However, as becomes clear in this module, the modern concept of disability perceives disability as an interaction between an individual's personal condition (such as being in a wheelchair or having a visual impairment) and environmental factors (such as negative attitudes or inaccessible buildings) which together lead to disability and affect an individual's participation in society. For example:

• Being in a wheelchair (personal factor) combined with living in a city with accessible buildings (environmental factor) leads to participation in the community on the same terms as someone who is not in a wheelchair: there is little or no disability.
• Having an intellectual impairment (personal factor) combined with a belief in the community that persons with intellectual disabilities lack the capacity to vote (negative environmental factor) leads to exclusion from society and denial of the right to vote: there is a disability.

Personal factors are multilayered and can be both physical and socioeconomic. For example:

• Physical factors: gender, ethnicity, impairment (physical, visual, hearing, intellectual, mental), size and weight, and so on;
• Socioeconomic factors: wealth, class, inclusion in society, education level and so on.

Personal factors can interact to exacerbate disability or alleviate it. For example, someone with a physical disability who is wealthy might be able to access tertiary education and so find a job. This might increase participation in society and alleviate disability to an extent.

Environmental factors can relate to at least four sub-factors as follows:

• Accessibility: hilly or flat cities, accessibility of buildings (ramps, toilets, braille signs etc.), accessible information (websites, documents in easy-to-read formats), accessible public transport, etc.
• Legal/policy: existence of protection from discrimination compared with denial of rights on the basis of disability, pro-poor policies, policies that refer explicitly to disability rights compared to policies that ignore persons with disabilities, etc.
• Socioeconomic: rural/urban (present different accessibility issues), rich/ poor, positive community awareness of disability, openness of society to change, etc.
• Services: inclusive services or segregated services (health, education, youth centres), community-based rehabilitation (CBR) services, social support services, affordability of services, etc.

Environmental factors can also combine to exacerbate or alleviate disability. With the increasing awareness of disability, there is often a mix of both positive and negative environmental factors. For example, a school might be made accessible by including ramp access. However, public transport is still not accessible, which means that a child with a physical impairment cannot make it to school, in spite of the openness of the school environment.

All these factors combine to determine the extent to which an individual can participate in society and, as a result, the extent to which disability exists.