International Classification of Functioning, Disability and Health (ICF)

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After ten years of international revision efforts coordinated by the World Health Organization (WHO), the World Health Assembly on May 22, 2001, approved the International Classification of Functioning, Disability and Health and its abbreviation of "ICF." This classification was first created in 1980 (and then called the International Classification of Impairments, Disabilities, and Handicaps, or ICIDH) by WHO to provide a unifying framework for classifying the consequences of disease.

Revision activities for the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) in the United States and Canada have been under the auspices of the WHO Collaborating Center for the Classification of Diseases for North America since 1993. The North American Collaborating Center (NACC), which recently has been renamed the WHO Collaborating Center for the Family of International Classifications for North America, is housed at the National Center for Health Statistics (NCHS).

The Collaborating Center for the Family of International Classifications for North America (NACC):

• Represents the United States and Canada in international activities related to study and revision of the ICIDH/ICF
• Works with U.S. researchers conducting ICIDH/ICF studies and evaluations
• Collaborates with Canadian researchers through the Canadian Institute for Health Information (CIHI)

The ICF classification complements WHO’s International Classification of Diseases-10th Revision (ICD), which contains information on diagnosis and health condition, but not on functional status. The ICD and ICF constitute the core classifications in the WHO Family of International Classifications (WHO-FIC). The NACC has responsibilities to WHO in its "Terms of Reference" to promote the development and use of ICF in the light of practical experience.

The ICF is structured around the following broad components:

• Body functions and structure
• Activities (related to tasks and actions by an individual) and participation (involvement in a life situation)
• Additional information on severity and environmental factors

Functioning and disability are viewed as a complex interaction between the health condition of the individual and the contextual factors of the environment as well as personal factors. The picture produced by this combination of factors and dimensions is of "the person in his or her world." The classification treats these dimensions as interactive and dynamic rather than linear or static. It allows for an assessment of the degree of disability, although it is not a measurement instrument. It is applicable to all people, whatever their health condition. The language of the ICF is neutral as to etiology, placing the emphasis on function rather than condition or disease. It also is carefully designed to be relevant across cultures as well as age groups and genders, making it highly appropriate for heterogeneous populations.

The NCVHS Subcommittee on Populations in 1999 initiated an 18-month-long review concerning the feasibility of including functional status data in administrative records. A series of hearings and consultations were held with clinicians, researchers, and other data users. The WHO and NACC representatives also testified before the Subcommittee. The resulting report, "Classifying and Reporting Functional Status," was approved by the NCVHS at its June 2001 meeting and transmitted to the Secretary of the Department of Health and Health Services. The full report and transmittal letter can be found on the NCVHS Web site.

The NACC has sponsored ten annual ICF revision meetings in the United States and Canada from 1993-2004, hosted the annual WHO ICD meeting in 1993, and did so again in October 2001. The North American Collaborating Center also has sponsored several other ICF activities, such as the development of web-based training for ICF (called "CODE ICF"), the production of ICF videos, and the production of internationally comparable disability tabulations from six national disability surveys (called "DISTAB") back coded to ICF. In this effort, the DISTAB group worked closely with the United Nations (UN) in New York, which in June 2001 sponsored a Seminar on the Measurement of Disability. The background papers, and many of the papers presented, are on the UN Web site.

A searchable version of the ICF is available at the WHO Web site.