The International Classification of Functioning, Disability and Health (ICF) is a framework developed by the World Health Organization to describe and organize information on health, functioning, and disability. It promotes a universal and neutral classification applicable to all people, acknowledging the influence of environmental factors on disability. The ICF serves multiple applications across healthcare, research, and social policy, providing a systematic coding scheme to enhance understanding and communication regarding health-related states.

1. International Classification of
Functioning, Disability and Health
Radhika Chintamani

2. CONTENTS
• Introduction
• Principles
• Aims of ICF
• Properties of ICF
• Components of ICF
• Model of functioning and disability
• Applications
• Classification
• Ethical guidelines for using ICF

3. INTRODUCTION
• The International Classification of
Functioning, Disability and Health (ICF) is a
framework for describing and organising
information on functioning and disability.
• It provides a standard language and a
conceptual basis for the definition and
measurement of health and disability.
• ICF has been developed by the World Health
Organization (WHO) and was endorsed by the
World Health Assembly in May 2001.

4. • The ICF integrates the major models of
disability.
• It recognises the role of environmental factors
in the creation of disability, as well as the
relevance of associated health conditions and
their effects.

5. PRINCIPLES
Universality
• A classification of functioning and disability
should be applicable to all people irrespective
of health condition and in all physical, social
and cultural contexts.
• The ICF achieves this and acknowledges that
anyone can experience some disability.
• It concerns everyone’s functioning and
disability, and was not designed, nor should be
used, to label persons with disabilities as a
separate social group.

6. Parity and aetiological neutrality
• In classifying functioning and disability, there
is no explicit or implicit distinction between
different health conditions, whether ‘mental’
or 'physical'.
• In other words, disability is not differentiated
by aetiology.
• By shifting the focus from health condition to
functioning, it places all health conditions on
an equal footing, allowing them to be
compared using a common metric.

7. Neutrality
Domain definitions are worded in neutral
language, wherever possible, so that the
classification can be used to record both the
positive and negative aspects of functioning and
disability.
Environmental Influence
• The ICF includes recognition of environmental
factors and its impact on people’s functioning.
• These factors range from physical factors to
social factors.

8. AIMS
• To provide a scientific basis for understanding
and studying health and health-related states,
outcomes and determinants.
• To establish a common language for describing
health and health-related states in order to
improve communication between different
users.
• To permit comparison of data across countries,
health care disciplines, services and time.
• To provide a systematic coding scheme for
health information systems.

9. PROPERTIES OF ICF
• Universe of ICF
ICF encompasses all aspects of human health
and some health-relevant components of well-
being.
The classification remains in the broad context
of health and does not cover circumstances that
are not health-related, such as those brought
about by socioeconomic factors.

10. • Scope of ICF
ICF provides a description of situations with regard
to human functioning and its restrictions and serves
as a framework to organize this information.
It structures the information in a meaningful,
interrelated and easily accessible way.
ICF organizes information in two parts.
Part 1 - Functioning and Disability
Part 2 - Contextual Factors.

11. • Unit of classification
ICF classifies health and health-related states.
The unit of classification is categories within health
and health-related domains.
ICF does not classify people, but describes the
situation of each person within an array of health
or health-related domains.
It also includes environmental and personal factors.

12. • Presentation of ICF
ICF is presented in two versions in order to
meet the needs of different users for varying
levels of detail.
The full version of ICF, provides classification at
four levels of detail. These four levels can be
aggregated into a higher-level classification
system that includes all the domains.
The two level system is also available as a short
version of ICF.

13. ICF
Functioning and Disability
- Body Functions and Structures
- Activities and Participation
Contextual Factors
- Environmental Factors
- Personal Factors
• Each component can be expressed in both positive and
negative terms.
• It consists of various domains and, within each domain ,
categories, which are the units of classification.
• Health and health-related states of an individual may be
recorded by selecting the appropriate category code or
codes and then adding qualifiers

16. MODEL OF FUNCTIONING AND DISABILITY
1. Process of functioning and disability
• As a classification, ICF does not model the
“process” of functioning and disability.
• It can be used to describe the process by
providing the means to map the different
constructs and domains.
• It provides a multi-perspective approach to the
classification of functioning and disability as an
interactive and evolutionary process.

19. 2. Medical model
• Views disability as a problem of the person,
directly caused by disease, trauma or other
health condition, which requires medical care
provided in the form of individual treatment
by professionals.
• Management of the disability is aimed at cure
or the individual’s adjustment and behaviour
change.

20. 3. Social model
• sees the issue mainly as a socially created
problem, and basically as a matter of the full
integration of individuals into society.
• the management of the problem requires
social action, and it is the collective
responsibility of society at large to make the
environmental modifications necessary for
the full participation of people with
disabilities.
In order to capture the integration of the
various perspectives of functioning, a “bio-
psychosocial” approach is used.

21. APPLICATIONS
• Statistical tool – in the collection and recording of
data
• Research tool – to measure outcomes, quality of
life or environmental factors
• Clinical tool – in needs assessment, matching
treatments with specific conditions, vocational
assessment, rehabilitation and outcome evaluation
• Social policy tool – in social security planning,
compensation systems and policy design and
implementation
• Educational tool – in curriculum design and to raise
awareness and undertake social action.

22. • The ICF provides a framework for the description
of human functioning, on a continuum.
• It has a wide range of potential applications.
• ICF can be used across broad sectors including
health, disability, rehabilitation, community care,
insurance, social security, employment,
education, economics, social policy, legislation
and environmental design and modification.
• The ICF offers an international, scientific tool to
study disability, in all its dimensions.

23. CLASSIFICATION
• One level classification – includes list of chapter headings

27. • Two level classification - includes list of chapter
headings and first branching level in the
classification.

28. Body structure

29. Activity and Participation

30. Environmental factors

31. ETHICAL GUIDELINES FOR THE USE OF ICF
Respect and confidentiality
• ICF should always be used so as to respect the inherent value
and autonomy of individual persons.
• ICF should never be used to label people or otherwise identify
them solely in terms of one or more disability categories.
• In clinical settings, ICF should always be used with the full
knowledge, cooperation, and consent of the persons whose
levels of functioning are being classified. If limitations of an
individual's cognitive capacity preclude this involvement, the
individual's advocate should be an active participant.
• The information coded using ICF should be viewed as personal
information and subject to recognized rules of confidentiality
appropriate for the manner in which the data will be used.

32. Clinical use of ICF
• Wherever possible, the clinician should explain to the
individual or the individual's advocate the purpose of
the use of ICF and invite questions about the
appropriateness of using it to classify the person’s levels
of functioning.
• Wherever possible, the person whose level of
functioning is being classified(or the person's advocate)
should have the opportunity to participate, and in
particular to challenge or affirm the appropriateness of
the category being used and the assessment assigned.
• Because the deficit being classified is a result of both a
person's health condition and the physical and social
context in which the person lives, ICF should be used
holistically.

33. Social use of ICF information
• ICF information should be used, to the greatest extent feasible,
with the collaboration of individuals to enhance their choices
and their control over their lives.
• ICF information should be used towards the development of
social policy and political change that seeks to enhance and
support the participation of individuals.
• ICF, and all information derived from its use, should not be
employed to deny established rights or otherwise restrict
legitimate entitlements to benefits for individuals or groups.
• Individuals classed together under ICF may still differ in many
ways. Laws and regulations that refer to ICF classifications
should not assume more homogeneity than intended and
should ensure that those whose levels of functioning are being
classified are considered as individuals.

34. References:
1. World Health Organization 2001. The International
Classification of Functioning, Disability and Health (ICF).
Geneva: WHO. http://www.who.int/classifications/icf/en/
2. Australian ICF-related data standards:
http://meteor.aihw.gov.au/content/index.phtml/itemId/32
0319

35. THANK
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