Journal of Rehabilitation Medicine: Special Issue 50-4bokBW | Page 13

Rehabilitation: the health strategy of the 21 st century
rehabilitation research (22); (iii) the classification
of rehabilitation services (51, 52); and (iv) the basis
for an information reference system for collecting
functioning information relevant, not merely to
rehabilitation service delivery and assessment, but
across the healthcare system (53).
Within the conceptual framework of the ICF, a
person’s state of health is understood as a combi-
nation of levels o f functioning, across domains of
body functions and structures. This complex phe-
nomenon yields a capacity to carry out some action
or task, from the very simple to the very complex,
where capacity is understood as the intrinsic
ability to carry out the action irrespective of any
environmental barriers or facilitators that might be
in place. Arguably, this notion of capacity is fully
aligned with our commonsense understanding
of health as an attribute of an individual (“under
the skin” so to speak), rather than the person’s
environment. This sense of capacity also allows
us to make sense of the role of the person’s overall
“environment”, understood very broadly to en-
compass the basic elements of air, light, gravity, all
features of the climate and physical environment,
the full range of human-built environments, other
people, their attitudes, beliefs and values, and all
aspects of cultural, social, economic and political
environments. Different configurations of these
environmental factors may substantially affect the
manner in which the health state of the individual
is experienced in his or her actual environment.
Although this environmental context is not the
individual’s health as such, it is highly determi-
native of what, given the individual’s health, he
or she can actually perform by way of actions.
In short, in terms of the conceptual model pre-
sented in the ICF, when a person experiences a
problem in functioning in their lives, or disability,
we can both identify and measure that event as a
degree of actually-observed performance under-
stood as the outcome of an interaction between a
person’s health state (measurable as capacity) and
the facilitators and barriers present in the person’s
environment. The ICF allows us to conceptualize
and, with appropriate assessment instrumenta-
tion, measure the problems in functioning that are
linked to health states, such as those resulting, in
particular, from ageing and NCDs. As the ICF is
also a classification that provides an international
standard common language to describe capacity
and performance, it gives us the scientific means
for describing, and potentially measuring, at the
individual and population levels, the full impact of
the demographic and epidemiological trends that
will define the 21 st century.
315
CONCLUSION
Rehabilitation as a health strategy, incorporating rehabili-
tation medicine, the rehabilitation therapies and assistive
technology, is poised to become the key health strategy
of the 21 st century. With the help of the conceptual model
and information reference system provided by the ICF,
it is now possible to capture the relationship between
rehabilitation’s objective of optimizing functioning and
the powerful demographic and epidemiological trends
whose impact will be, across the population worldwide,
to create decrements in functioning that can be measured
both at the clinical or individual level, and at the popula-
tion level. Recently, relying on its own model of the 6
basic components of the health system, the WHO has
described in detail the policy, financial, service, human
resource, technological and informational barriers to
scaling up rehabilitation services worldwide (54, 55).
Overcoming these obstacles will not be easy, especially
in low- and medium-income countries; in some settings,
only small, incremental changes to healthcare systems
facilitating the scaling up of rehabilitation services
may be feasible. But, given the future that the world is
facing, and the impact of population ageing and the shift
towards NCDs, there is a powerful argument for making
the investment so that the rehabilitative health strategy
fulfils its promise in the 21 st century.
ACKNOWLEDGEMENTS
The authors would like to thank Professor Alarcos
Cieza for fruitful discussions, and Susanne Stucki and
Cristiana Baffone for their support in the preparation of
the manuscript.
REFERENCES
1. World Health Organization. World report on ageing and
DISC
health. Geneva: WHO; 2015.
2. United Nations. Department of Economic and Social
Affairs Population Division. World Population Ageing
2015. New York: United Nations; 2015. Available from:
ACKN
http://www.un.org/en/development/desa/population/
publications/pdf/ageing/WPA2015_Report.pdf.
3. Chatterji S, Byles J, Cutler D, Seeman T, Verdes E. Health,
functioning and disability in older adults – present
status
REF
and future implications. Lancet 2015; 385: 563–575.
4. United Nations. Department of Economic and Social
Affairs Population Division. World Population Ageing
2009. New York: United Nations; 2009. Available from:
http://www.un.org/esa/population/publications/WPA2009/
WPA2009_WorkingPaper.pdf.
5. World Health Organization. Preventing chronic diseases:
a vital investment. WHO global Report. Geneva: WHO;
2005.
6. World Health Organization. Global Action Plan for
the prevention and control of Noncommunicable
diseases 2013–2020. 2012 [cited 2016 Nov 30].
Available from: http://apps.who.int/iris/bitstre
am/10665/94384/1/9789241506236_eng.pdf.
7. Institute of Medicine. Living well with chronic illness:
a call for public health action. Washington, DC: The
National Academies Press; 2012.
8. World Health Organization. Global Status Report on
noncommunicable diseases, 2010. Geneva: WHO; 2011
[cited 2016 Nov 30]. Available from: http://www.who.
J Rehabil Med 50, 2018