Examining disabling environmental health conditions: An adapted international classification of functioning, disability and health (ICF) model

Background: The International Classification of Functioning, Disability, and Health (ICF) model classifies components of functioning and disability in the enabling-disabling process. Practitioners and researchers use the model for assessments, measurement and intervention development. While the model identifies some environmental factors that impact the enabling-disabling process, it does not address the role of the environment in the onset of disabling conditions resulting from toxic exposures. The authors propose an adapted, interdisciplinary conceptual model based on the ICF to guide future research investigating disabling environmental conditions. Methods: A review of existing conceptual models and frameworks in exposure science and public health was conducted to identify components for the adapted model. Results: We identified the Cumulative Risk Assessment Framework as a key conceptual framework for studying conditions resulting from toxic exposures. We combined elements of the framework with the ICF to create an adapted model that expands the ability to utilize both models. The adapted model offers a more detailed description of the exposure-disease paradigm and identifies potential sources, environmental stressors, and exposure pathways. In our adapted model we also included several components of existing public health models that illustrate how stressors in the social and built environment, as well as individual characteristics, can worsen health disparities. Conclusion: Our adapted model provides a unique perspective to understanding the mechanisms of environmental diseases. By understanding the onset and/or exacerbation of disabling conditions, interventions can be better targeted. Information from this model will assist public health and rehabilitation professionals to identify appropriate risk reduction interventions.