Conceptual challenges of the construct ‘functioning and disabilities’ in the person-centered framework

Main Article Content

Luis Salvador-Carulla
Javier E. Saavedra
Mencia Ruiz


The publication of the International Classification of Functioning (ICF), the approval of the UN Convention on the Rights of Persons with Disabilities and the release of the 2011 World Report on Disability are cornerstones in the process of developing a functioning and disability (F&D) perspective in the care systems in the World. However, the significant advances on the conceptualisation of functioning and disabilities -mainly derived from the ICF model- have not produced an international consensus on the definition of this construct and different approaches persist even within the ICF framework. Reasons for dissent are, among others, holistic versus practical approaches to human functioning, universal versus health-related perspectives and assessment of individuals versus assessment of target groups (e.g. specific diseases or age groups). Different models of F&D are described as well as their related assessment instruments. In order to improve the definition of F&D, a clear distinction between the supra-domains ‘activity/participation’ and ‘inclusion/citizenship’ may be needed. Within this context, person-centered medicine and the related Person-centered Integrated Diagnosis (PID) model may provide a new perspective on this topic as it incorporates F&D into a broader frame where F&D domains can be differentiated from the health condition, the experiences of health and the determinants of health.

Article Details

Fourth Geneva Conference on Person-centered Medicine: Person-centered integrative diagnosis (PID)
Author Biography

Luis Salvador-Carulla, University of Cadiz; and Spanish Association for Research on Healthy Ageing (AECES)

Dr Luis Salvador-Carulla is professor of Psychiatry at the University of Cadiz (Spain). He has been member of the Advisory Board on disability and dependency of the regional government of Catalonia (Spain) and he is member of the advisory committee of the national strategy on Mental Health at the Ministry of Health and Social Policy. His field of interest is integrated support decision systems and policy in long-term care. He is honour member of the World Psychiatry Association and secretary of its section “Classification, Diagnostic assessment and Nomenclature”. He is also President of the PSICOST research association, and the Spanish Association on Scientific Research on Healthy Aging (AECES), as well as Vice-president of the Spanish Society of Epidemiological Psychiatry (SEEP). Dr. Salvador-Carulla has intensively participated in the development of international research networks in the fields mentioned as well as in social inclusion, person centered medicine, healthy ageing and bridging and knowledge transfer between the fields of disability and ageing. He has also collaborated with the European Commission (EC) and the World Health Organisation  (WHO) as external advisor. He coordinated the European Commission project eDESDE-LTC for the development of an European coding system for long term care, and he participates now on the EC project Refinement for analysing financing, quality and effectiveness of mental health systems in Europe. He chairs the WHO working group on the classification of intellectual disabilities at chapter V of the International Classification of Diseases (ICD-11).


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