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
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
Jennifer Christian, MD, MPH
Moderator, Work Fitness and Disability Roundtable
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The text represents a revision of the International
Impairments, Disabilities, and Handicaps (ICIDH), which was
published by the World Health Organization for trial purposes
Developed after systematic field trials and international
over the past five years, it was endorsed by the Fifty-fourth
Health Assembly for international use on 22 May 2001
This volume contains the International Classification of
Disability and Health, known as ICF.1 The overall aim of the
classification is to provide a unified and standard language
framework for the description of health and health-related
defines components of health and some health-related
well-being (such as education and labour). The domains
ICF can, therefore, be seen as health domains and
domains. These domains are described from the perspective of
the individual and society in two basic lists: (1) Body
Structures; and (2) Activities and Participation.2 As a
classification, ICF systematically groups different domains3
person in a given health condition (e.g. what a person with a
or disorder does do or can do). Functioning is an umbrella
encompassing all body functions, activities and participation;
similarly, disability serves as an umbrella term for
activity limitations or participation restrictions. ICF also
environmental factors that interact with all these constructs.
way, it enables the user to record useful profiles of
functioning, disability and health in various domains.
ICF belongs to the "family" of international
by the World Health Organization (WHO) for application to
aspects of health. The WHO family of international
provides a framework to code a wide range of information about
(e.g. diagnosis, functioning and disability, reasons for
health services) and uses a standardized common language
communication about health and health care across the world in
disciplines and sciences.
In WHO's international classifications, health conditions
disorders, injuries, etc.) are classified primarily in ICD-10
(shorthand for the International Classification of Diseases,
Revision),4 which provides an etiological framework.
disability associated with health conditions are classified in
ICD-10 and ICF are therefore complementary,5 and users are
to utilize these two members of the WHO family of
classifications together. ICD-10 provides a
"diagnosis" of diseases,
disorders or other health conditions, and this information is
by the additional information given by ICF on functioning.6
information on diagnosis plus functioning provides a broader
meaningful picture of the health of people or populations,
then be used for decision-making purposes.
The WHO family of international classifications provides a
tool to describe and compare the health of populations in an
international context. The information on mortality (provided
ICD-10) and on health outcomes (provided by ICF) may be
summary measures of population health for monitoring the
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
classification (1980 version) to become a "components of
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
neutral stand with regard to etiology so that researchers can
causal inferences using appropriate scientific methods.
this approach is also different from a "determinants of
"risk factors" approach. To facilitate the study of
risk factors, ICF includes a list of environmental factors
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
. to provide a scientific basis for understanding and studying
and health-related states, outcomes and determinants;
. to establish a common language for describing health and
health-related states in order to improve communication
different users, such as health care workers, researchers,
policy-makers and the public, including people with
. 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
require the construction of a meaningful and practical system
be used by various consumers for health policy, quality
outcome evaluation in different cultures.
2.1 Applications of ICF
Since its publication as a trial version in 1980, ICIDH has
for various purposes, for example:
. as a statistical tool - in the collection and recording of
(e.g. in population studies and surveys or in management
. as a research tool - to measure outcomes, quality of life or
. as a clinical tool - in needs assessment, matching
specific conditions, vocational assessment, rehabilitation and
. as a social policy tool - in social security planning,
systems and policy design and implementation;
. as an educational tool - in curriculum design and to raise
and undertake social action.
Since ICF is inherently a health and health-related
is also used by sectors such as insurance, social security,
education, economics, social policy and general legislation
development, and environmental modification. It has been
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
appropriate instrument for the implementation of stated
human rights mandates as well as national legislation.
ICF is useful for a broad spectrum of different applications,
example social security, evaluation in managed health care,
population surveys at local, national and international
offers a conceptual framework for information that is
personal health care, including prevention, health promotion,
improvement of participation by removing or mitigating
hindrances and encouraging the provision of social supports
facilitators. It is also useful for the study of health care
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
and their components.
Impairments are problems in body function or structure such as
significant deviation or loss.
Activity is the execution of a task or action by an
Participation is involvement in a life situation.
Activity limitations are difficulties an individual may have
Participation restrictions are problems an individual may
in involvement in life situations.
Environmental factors make up the physical, social and
environment in which people live and conduct their lives.