To count or not to count? A vexing public health conceptual quagmire

Epidemiological surveillance, or counting and analyzing the magnitude and causal factors of a population's health status and intervention needs, has been a major epistemic and ontological foundation of public health. Within the past several decades, disability and its subsets increasingly have been the object of surveillance. While this trend is well intended to resolve health disparities experienced by population segments who have previously been omitted from public health attention, surveillance has raised definitional, conceptual, philosophical and ethical quagmires that have yet to be fully analyzed and negotiated. Specifying a population and measurement strategy requires prior detailed lexical definition, implying that constructs exist as characterized. However, given the multiple models of disability indicting the conceptual range from atypical embodied phenomena to social context and abrogation of human rights as causal of disability, identifying the parameters of this contested population is not trivial. Even the ICF, which attempts to consider context, begins with disability as an impairment, tautologically reifying the primary locus of disability as interior to the body and thus meets with opposition from diverse disability scholars. Defining and counting disability requires detailed discussion, analysis and clarity that invokes the richness of broad conceptual and theoretical work in many fields of inquiry. In this presentation, we identify the conceptual quagmires that emerge from surveillance of disability in public health, analyze their epistemic and philosophical tensions and then propose a synthetic theoretical approach for use in public health surveillance which builds on contemporary intellectual and methodological pluralism.