Work Forum on the Implementation of the UN Convention on the Rights of

Persons with Disabilities in the EU and the Member States

European Commission

Disability assessment from a human rigths perspective

Catalina Devandas, United Nations Special Rapporteur on the Rights of persons
with disabilities

Introduction
Disability assessments are an important component of the implementation of social
protection systems. The level of fairness and accuracy of these evaluations can
significantly impact on the wellbeing of persons with disabilities as they usually
represent a filter to access disability-related benefits, services or support.

It is important to distinguish between disability assessment, determination and

eligibility. Disability assessment is the evaluation of the type and level of disability
that a person has, but it does not determine if an individual is a person with
disabilities vis-à-vis a particular benefit or services, or if the individual has the right
to be eligible to access them - as other criteria may apply.

Therefore, in my presentation today, I am going to refer only to the process to

determine who has a disability and to what extent.

Disability assessment: a medical tradition

Historically, disability assessments have been carried out under a medical
understanding of disability, which do not take into consideration the attitudinal and
environmental barriers that hinders participation of persons with disabilities.

Some scholars identify two different approaches under this paradigm: i) the
‘impairment approach’ and the ii) ‘functional limitations approach’. The impairment
approach focuses on identifying the presence of health conditions or impairments.
The functional approach focuses on identifying limitations in functional domains,
such us walking, seeing, hearing or concentrating. In both cases, health professionals
traditionally carry out the assessment.

These approaches raise many objections:

 They do not assess the attitudinal and environmental barriers that determine
the experience of disability;
 They focus on the individual and therefore they cannot predict actual levels
of disability, - resulting in an unfair allocation of benefits and services.
 They do not enable to identify the support needs of the individual.

Moreover, under these approaches, in many countries disability assessments are

linked to work capacity assessments, and thus they are frequently used to exclude
people from the labour market. This is a consequence of focusing on the
"incapacities" rather than on capacities and support needs.

Regrettably, the majority of disability assessment systems that exist today follow a
narrow medical approach and do not take into account contextual factors.

However, since the adoption of the CRPD, there is growing recognition that disability
assessments, in the context of social protection, cannot be merely based on
diagnosis, impairments or functional capacity.

For example, the Committee on the Rights of Persons with Disabilities has contested
disability assessments based on the medical and charity models in its concluding
observations to State parties to the Convention (e.g., CRPD/C/GTM/CO/1, para. 9;
CRPD/C/SVK/CO/1, para. 11). The Committee has called instead to implement
human rights-based disability assessments, which reflect the characteristics,
circumstances and needs of persons with disabilities.

I have also join a group of United Nations agencies working together to develop
guidelines on CRPD-compliant disability assessments. So far, two expert meetings
have been held in Geneva, and a preliminary document based on those discussions
was drafted. Many of the ideas that I will present today have already been discussed
during those meetings.

Making CRPD-compliant assessments

Social understanding of disability

A CRPD-compliant approach to disability assessments needs to take into

consideration the impact of environmental and contextual factors. Following the
social understanding of disability, disability assessments need to assess the
interaction between personal factors (such as health conditions, impairments and
functional limitations) and environmental factors.

This approach does not make assumptions based on health conditions and/or
impairments of a person. It assesses how an individual with certain characteristics
participates in a given context, rather than using functional or capacity limitations as
a proxy for disability.

I would like to stress that this call for comprehensive disability assessments does not
have to be translated into very complex procedures and tools. Many countries face
challenges to develop complex instruments based on the ICF, which are not
necessarily useful to identify support needs of persons with disabilities.

It is necessary to develop simpler instruments that facilitate access to social

protection programmes, including disability benefits and support services. Complex
systems are expensive and are impossible to replicate in most low and middle-
income countries. They also may limit the expansion of social protection benefits, as
their decentralization is challenging due to the scarcity of human and economic
recourses. For example, many countries lack the administrative capacity required for
disability assessments in urban, rural and remote areas.

Taking into account the principles and rights of the CRPD

CRPD-compliant disability assessments need to abide by the purpose, principles and

rights of the CRPD.

The purpose of the CRPD is to promote, protect and ensure the full and equal
enjoyment of all human rights by all persons with disabilities. Therefore, disability
assessment and determination processes should not be used to restrict a person’s
human rights. However, in practice in many countries, disability assessments trigger
restrictions on legal capacity, inclusive education and employment. Therefore,
disability assessments should contribute to promote the participation of persons
with disabilities, rather than to restrict it.

Disability assessments must be also respectful of the dignity and privacy of persons
with disabilities. Processes must be voluntary, and respect the will of those persons
with disabilities who may choose not to undergo an assessment (this may be linked
to the need to raise awareness to combat stigma).

Importantly, disability assessments should not be used to provide persons with

disabilities access to universal / mainstream services and benefits; or to protect
them from discrimination. Universal policies and legislations should cover everyone,
including persons with disabilities. Persons with disabilities should not need a
disability certificate or card to be protected against discrimination.

It is also important to ensure that processes are accessible. Lack of accessibility, lack
of information, and lack of awareness, explain why so many persons with disabilities
do not undergo disability assessments.

Finally, disability assessment processes should include gender and child approaches.

Closing

The discussion on disability assessments is a critical one. During my country visits,

this issue has been a priority topic for national authorities and persons with
disabilities.

To conclude, let me reiterate that States need to rethink the way in which they
conduct disability assessments and even question their purpose. When the benefit
package is small, as it is the case in many countries, is it even worth to conduct a
disability assessment? Mainstreaming benefits and services is the preferred way to
reduce the burden of assessments, although there is still a need to find better ways
to target persons with disabilities in social protection systems.