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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”



WHO (the World Health Organization") just released its new ICF -International Classification of Functioning, Disability and Health. WHO describes the ICF as useful to understand and measure health outcomes (and functional status). It can be used in clinical settings, health services or surveys at the individual or population level. Thus ICF complements ICD-10 , The International Statistical Classification of Diseases and Related Health Problems.  Just like ICD-9, CPT, DRG and other seemingly-complicated classification systems have become part of our everyday world in health care services, disability communications and outcomes research, this may be our future "bible".

ICF describes how people live with their health conditions. ICF is a classification of health and health-related domains that describe body functions and structures, activities and participation. The domains are classified from body, individual and societal perspectives. Since an individual's functioning and disability occurs in a context, ICF also includes a list of environmental factors.  ICF also considers both abilities and inabilities.



My first reaction to this 25 page document is that it is way too complicated for use on-the-fly -- but then on the other hand, that was my first reaction to ICD-9 and CPT, too!  If it's useful, we'll  all have to learn how to use it.  And imagine if all the participants in the disability "system" -- healthcare providers, employers, wc and disability carriers, FMLA/ADA compliance vendors, social security, etc. etc. -- had a common language to describe the functional status of the people they "serve" or employ.

You can read the WHO's introduction to the document by going to:

20 & my title=Introduction

If you want a simpler web address to type in, start at:, then click on ICF Home page, then click on Introduction, then click on English -- and you'll see the PDF version of the ICF classification scheme.

Jennifer Christian, MD, MPH
Moderator, Work Fitness and Disability Roundtable

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The text represents a revision of the International Classification of
Impairments, Disabilities, and Handicaps (ICIDH), which was first
published by the World Health Organization for trial purposes in 1980.
Developed after systematic field trials and international consultation
over the past five years, it was endorsed by the Fifty-fourth World
Health Assembly for international use on 22 May 2001 (resolution

1. Background

This volume contains the International Classification of Functioning,
Disability and Health, known as ICF.1 The overall aim of the ICF
classification is to provide a unified and standard language and
framework for the description of health and health-related states. It
defines components of health and some health-related components of
well-being (such as education and labour). The domains contained in
ICF can, therefore, be seen as health domains and health-related
domains. These domains are described from the perspective of the body,
the individual and society in two basic lists: (1) Body Functions and
Structures; and (2) Activities and Participation.2 As a
classification, ICF systematically groups different domains3 for a
person in a given health condition (e.g. what a person with a disease
or disorder does do or can do). Functioning is an umbrella term
encompassing all body functions, activities and participation;
similarly, disability serves as an umbrella term for impairments,
activity limitations or participation restrictions. ICF also lists
environmental factors that interact with all these constructs. In this
way, it enables the user to record useful profiles of individuals'
functioning, disability and health in various domains.

ICF belongs to the "family" of international classifications developed
by the World Health Organization (WHO) for application to various
aspects of health. The WHO family of international classifications
provides a framework to code a wide range of information about health
(e.g. diagnosis, functioning and disability, reasons for contact with
health services) and uses a standardized common language permitting
communication about health and health care across the world in various
disciplines and sciences.

In WHO's international classifications, health conditions (diseases,
disorders, injuries, etc.) are classified primarily in ICD-10
(shorthand for the International Classification of Diseases, Tenth
Revision),4 which provides an etiological framework. Functioning and
disability associated with health conditions are classified in ICF.
ICD-10 and ICF are therefore complementary,5 and users are encouraged
to utilize these two members of the WHO family of international
classifications together. ICD-10 provides a "diagnosis" of diseases,
disorders or other health conditions, and this information is enriched
by the additional information given by ICF on functioning.6 Together,
information on diagnosis plus functioning provides a broader and more
meaningful picture of the health of people or populations, which can
then be used for decision-making purposes.

The WHO family of international classifications provides a valuable
tool to describe and compare the health of populations in an
international context. The information on mortality (provided by
ICD-10) and on health outcomes (provided by ICF) may be combined in
summary measures of population health for monitoring the health of
populations and its distribution, and also for assessing the
contributions of different causes of mortality and morbidity.

ICF has moved away from being a "consequences of disease"
classification (1980 version) to become a "components of health"
classification. "Components of health" identifies the constituents of
health, whereas "consequences" focuses on the impacts of diseases or
other health conditions that may follow as a result. Thus, ICF takes a
neutral stand with regard to etiology so that researchers can draw
causal inferences using appropriate scientific methods. Similarly,
this approach is also different from a "determinants of health" or
"risk factors" approach. To facilitate the study of determinants or
risk factors, ICF includes a list of environmental factors that
describe the context in which individuals live.


2. Aims of ICF

ICF is a multipurpose classification designed to serve various
disciplines and different sectors. Its specific aims can be summarized
as follows:

. 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, such as health care workers, researchers,
policy-makers and the public, including people with disabilities;

. to permit comparison of data across countries, health care
disciplines, services and time;

. to provide a systematic coding scheme for health information

These aims are interrelated, since the need for and uses of ICF
require the construction of a meaningful and practical system that can
be used by various consumers for health policy, quality assurance and
outcome evaluation in different cultures.

2.1 Applications of ICF

Since its publication as a trial version in 1980, ICIDH has been used
for various purposes, for example:

. as a statistical tool - in the collection and recording of data
(e.g. in population studies and surveys or in management information

. as a research tool - to measure outcomes, quality of life or
environmental factors;

. as a clinical tool - in needs assessment, matching treatments with
specific conditions, vocational assessment, rehabilitation and outcome

. as a social policy tool - in social security planning, compensation
systems and policy design and implementation;

. as an educational tool - in curriculum design and to raise awareness
and undertake social action.

Since ICF is inherently a health and health-related classification it
is also used by sectors such as insurance, social security, labour,
education, economics, social policy and general legislation
development, and environmental modification. It has been accepted as
one of the United Nations social classifications and is referred to in
and incorporates The Standard Rules on the Equalization of
Opportunities for Persons with Disabilities.7 Thus ICF provides an
appropriate instrument for the implementation of stated international
human rights mandates as well as national legislation.

ICF is useful for a broad spectrum of different applications, for
example social security, evaluation in managed health care, and
population surveys at local, national and international levels. It
offers a conceptual framework for information that is applicable to
personal health care, including prevention, health promotion, and the
improvement of participation by removing or mitigating societal
hindrances and encouraging the provision of social supports and
facilitators. It is also useful for the study of health care systems,
in terms of both evaluation and policy formulation.


4. Overview of ICF components


In the context of health:

Body functions are the physiological functions of body systems
(including psychological functions).

Body structures are anatomical parts of the body such as organs, limbs
and their components.

Impairments are problems in body function or structure such as a
significant deviation or loss.

Activity is the execution of a task or action by an individual.

Participation is involvement in a life situation.

Activity limitations are difficulties an individual may have in
executing activities.

Participation restrictions are problems an individual may experience
in involvement in life situations.

Environmental factors make up the physical, social and attitudinal
environment in which people live and conduct their lives.