Using U.S. National Health Interview Survey (NHIS) Data to Construct, Measure and Understand Disability

There is no univocal concept of disability. Instead, there are concepts of disability. Such concepts are doubly heterogeneous; they cover a variety of experiential states of individuals, and they reflect how disabilities emerge from individuals' interactions with their natural and social environments. The latter sense of heterogeneity entails that it is possible to understand disability, and so what it means for a person to be disabled, only relative to specified social values of normalcy. It follows that concepts of disability are dynamic, varying with changing values of what is “normal”, and that there is no value-neutral fact of disability. That the concept of disability is, at least partially, socially constructed poses substantial challenges for creating sound public health policies that aim to address health disparities linked to disabilities. Only data sets offering rich accounts of people's functional capabilities (and functional limitations relative to social norms) and activities (and activity limitations relative to social norms) provide the needed quantifications. This presentation uses data from the 1997-2008 U.S. National Health Interview Survey (NHIS), available in harmonized form in the Integrated Health Interview Series (IHIS) created at the University of Minnesota, to construct different concepts of disability, each reflecting a specific set of interests and values. Based on these different concepts of disability, the presentation demonstrates that there are non-equivalent conceptions of what it means to improve public health, and so differing conceptions of the aims of public health policy when it comes to justly addressing health disparities in the context of disabilities.