Conceptual consensus: The good, the (Potentially) not so good and the still to be determined

The 2010 Affordable Care Act requires standards to improve data collection and reporting, including data on disability status. As the World Health Organization (WHO) seeks to unite perspectives of disability through use of the International Classification of Functioning, Disability and Health (ICF), implications of conceptual consensus, manifested in the way disability is measured and the implications for related programs and policy, must be considered. With this in mind, the ICF frames “activity” as functioning from an individual perspective while “participation” is functioning from a societal perspective. The importance in distinguishing these components centers on the contextual role of the environment, conceptually linked to participation and not activity. We examine outcomes from ICF coding of national survey questions to distinguish between activity and participation content questions and to compare survey content with ICF coding of recommended disability questions endorsed by the Secretary of Health and Human Services (HHS) in 2011. Our findings suggest that data that capture information about activity have different utility compared to data focusing on participation. Therefore, it is important to recognize the implications of conceptually distinguishing ICF components with respect to measurement purposes; and, programmatic and policy need. We also compare ICF coding of the SSA Listings for adults, used to determine disability benefits, to ICF coding of the Australian Social Security Tables for the Assessment of Work-related Impairment for Disability Support. This comparison provides the opportunity to examine international approaches to the determination of public program (Social Security) benefits using a consistent conceptual lens, the ICF.