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(Title)What is “Disability?” Terminology Related to Social Welfare Systems, Legislation and Services for People with Disabilities

Commentary : OKABE Takayoshi (Director, Hajimari Art Center)

(About this story)

Social welfare cannot be separated from the problems of legislation and systems. The dictionary defines “welfare” as the “happiness that should be available to everyone equally.” The legislation and welfare systems developed by both central and local governments play a role in achieving this goal. We will here introduce and explore various examples of terminology related to social welfare for people with disabilities, including discussion on what a “disability” is and the latest information regarding different welfare systems and services. These insights are provided by Takayoshi Okabe, who previously worked as a care worker at a welfare facility for people with disabilities and is currently the director of Hajimari Art Center.

(Date updated)07 June, 2019

This article is a translated version, which was originally published in Japanese language on 26 May, 2017.

CREDIT

[Illustrations]  OBATA Saki

[Text ]  SATO Emi

10 Years of Radical Changes to Legislation and Welfare Systems for People with Disabilities

Japanese Systems Improved Based on International Conventions

The legislation and welfare systems for people with disabilities have undergone heavy reform over the past 10 years. We will examine some examples of terminology related to the systems and laws alongside the development of the social welfare sector.

The previous decade witnessed a significant turning point when the Convention on the Rights of Persons with Disabilities was adopted in the General Assembly of the United Nation in 2006. Signed by the Japanese government the following year, this convention ensures the dignity and rights of people with disabilities. However, Japan could not ratify the convention immediately after due to its domestic policies regulating working environments, education,accessibility,01 and so on for people with disabilities falling short of the standards required by the convention.

The Japanese government amended the Basic Act for Persons with Disabilities in 2011, established the Services and Supports for Persons with Disabilities Act in 2012 as well as the Disability Discrimination Act, and also revised the Act on Employment Promotion of Persons with Disabilities in 2013. With these subsequent reforms, Japan was finally able to conclude the convention in 2014.

Shifting to a System that Lets Users Choose Their Services

What was the situation with legislations and welfare systems for people with disabilities before the ratification of the Convention on the Rights of Persons with Disabilities?

The Basic Act for Persons with Disabilities, which was enacted in 1970, stands as the basis for the fundamental principles and various measures regarding welfare policies for people with disabilities. This act defines the rights of people with disabilities, basic principles regarding their support, and responsibilities of the national as well as local governments.

A welfare measurement system was established as part of the early development of welfare services in the aftermath of World War II. The administration decided the types of services people were eligible to use, based on the degree of their disability, and paid the service providers. The problem with this system, though, was that users could not choose the services they needed themselves, which led the government to switch to an assistance-funding system in 2003. It was innovative in the sense that it now allowed users to select the necessary services for them. A user made a contract with a service provider and the government would then subsidize the cost of the service. As users’ needs surfaced, however, the government was faced with a huge fiscal deficit. It also became apparent that certain areas were not covered by the system, with exemptions including people with mental disabilities, intractable diseases, and higher brain dysfunction. As such, there were increasing calls to revise the law.

Unification of Laws Covering Three Different Disabilities

In response to the growing opposition, the Services and Supports for Persons with Disabilities Act was enacted. The three separate laws that had functioned independently for people with physical, intellectual, and mental disabilities were unified along with an expanded targeted area. The Classification of Disability Levels (today, Classification of Disability Assistance), which uses six categories based on how much assistance a person needs, was newly adapted to accommodate the change. It determines the content, hours, and frequency of services for an individual recipient. However, while the legislation aimed to ensure people with disabilities can live independently, the fact that users had to be responsible for partially paying costs was heavily criticized from the start. The legislation was challenged in the courts as unconstitutional. In 2013, the Services and Supports for Persons with Disabilities Act was replaced by the Comprehensive Services and Supports for Persons with Disabilities Act.

Legislation with “Accommodation”

Around the same time as the Comprehensive Services and Supports for Persons with Disabilities Act also saw the development of the Disability Discrimination Act, which was enacted in 2016. This law “aims to eliminate discrimination on the basis of disability, and ensures that no citizens are divided according to whether or not they have a disability through realizing an inclusive society based on mutual respect for personality and individuality.”

This legislation requires reasonable accommodation for people with disabilities in different sectors of society, including public administration, corporations, and schools. As defined in the Convention on the Rights of Persons with Disabilities, reasonable accommodation implies actions made in different social settings to remove barriers that prevent people with disabilities from leading their daily and social lives. Governments are mandated to implement “reasonable accommodation” and the private sector is also obliged to make efforts in this regard.


From Family-Based Care to Community-Based Care

A Wide Range of Services for People with Disabilities

Various types of services have emerged as a result of the many legislative reforms. In the past, for instance, it was taken for granted that people with disabilities were taken care of by their families during hours when no services were available. But today different types of services exist that enable people to live in their communities, offering assistance with going out on the weekends and short-stay facilities at night in addition to day-care services on weekdays.

Examples of daytime services offered to people with disabilities include daily life care, training to live independently, employment transition support, and continued employment support. Whether a user is eligible for these services depends on the degree of disability defined by the classification of disability assistance. Daily life care, for instance, is for people who need constant assistance. People who want to work and engage with activities can use employment-related services. While employment transition services have age restrictions, they equip people with basic abilities for working in society. Continued employment support is divided into type A and type B. Type A is an employment-based service that guarantees the minimum wage while type B ensures up to half the minimum wage. Other services include training people to live independently through improving their physical abilities and life skills.

Support Matching Individual Needs

Along with these daytime-based services, people with disabilities are also eligible to use other assistance such as live-in residential facilities as well as receiving home-based care that helps people with bathing and preparing food. As the range of services has diversified, providers are catching up with ongoing changes while also developing further services. Although users have more choices today, some of them still do not know that these services exist or how to use them, which has led to the establishment of consultation services to provide advice and information.

Welfare facilities offer consultation services as part of their operations. In accordance with a user’s needs, an advisor proposes available services and ways to combine multiple services to structure their daily life. For a user to receive assistance, he or she needs to have an “individual support plan,” and creating such personalized plans is one of the important jobs of an advisor. Occupying a role in between users, government, and welfare facilities, the significance of consultation services, with their objective standpoint that ensures people receive the necessary services, will surely increase further in the future.


Discussions on “Disability”

Is Disability an Individual Issue or Social Issue?

What is a “disability” in the first place? According to the Basic Act for Persons with Disabilities, “people with disabilities” are defined as follows: “people who face constant obstacles and barriers in leading their everyday and social lives due to physical, mental, intellectual disabilities.” In other words, they experience severe difficulties because of various physical and mental conditions. But anyone must surely feel a certain level of difficulty in life.

Two models—the medical model of disability and social model of disability—help us to think about the causes of these difficulties and disabilities. The medical model, also called the “individual model,” links a disability to an individual problem. The model supposes that medical treatment, care, and rehabilitation are necessary to fix different conditions and physical impairments of individuals.

In contrast, the social model of disability stresses the fact that society is not yet conditioned to ensure people live freely, which means society is the main contributing factor in disabling people. The social model of disability attempts, based on a human rights standpoint, to solve problems by creating a society where everyone, regardless of ability or disability, is guaranteed to have a quality life. In recent years, the social model of disability is used more often to discuss issues related to disability. The World Health Organization classifies disabilities based on the idea that both models are necessary to creating approaches.

From Normalization to Social Inclusion

Many people have probably heard the terms normalization and social inclusion. Although they sound similar, they have different meanings and contexts. The former implies building a society that ensures everyone, regardless of ability or disability, can enjoy life on an equal basis. It is a social principle guaranteeing anyone can lead a “normal life.” The latter means that every member of society should be included and embraced despite their differences. The term “normalization” is criticized on the grounds that disability is something that needs to be overcome. For this reason, “social inclusion” is increasingly used in recent years and the term “diversity” has also been adopted in the same context.

Why there are two ways to write “disability” in Japanese.

There has been much debate about how to write “disability” in Japanese. Currently there are two ways: 障害 and 障がい. Both can be read as “shōgai.” Though it continues to be used in legislation, the first version (障害) has been heavily criticized as its second character () also means “harm” and “damage.” Related groups02 working to improve the lives of people with disabilities have campaigned against the use of the second character due to its negative connotations. They suggest that the second character be replaced with the syllabic Japanese characters for “gai” (がい), which are completely neutral. As such, some local governments and service providers have adopted “障がい” instead of “障害” to accommodate the wishes of campaigners.

However, some point out that replacing “” with “がい” merely hides the prejudice and discrimination faced by many people with disabilities. They argue that continuing to use “” is more effective at reminding people that society still uses this prejudiced way of writing and, until it stops, society will remain the main contributing factor in disabling people.

Advocates for both versions share a similar awareness of the problems, which lie in how these terms are used in unconsciously discriminatory ways, and are rooted in apathy and lack of understanding. Fear and rejection caused by ignorance often leads to prejudice, discrimination, and even war. What we need to do is pause and give more consideration to how people with disabilities feel. Only then can we create a truly diverse and tolerant society rich in the power of the imagination.


KEYWORDS

01: Accessibility

“Accessibility” refers to designing places, information and services to make them easier for people with disabilities to use.

02: Related Groups

This refers to groups comprising people with disabilities as well as those led by legal protectors and guardians, and families.

PROFILE

OKABE Takayoshi

(Profile of OKABE Takayoshi)

Director of Hajimari Art Center. OKABE Takayoshi graduated from Kushiro Public University of Economics and completed Bukkyo University’s distance learning program. After working at a social welfare work facility and as a junior high school teacher, he joined Asaka Aiikuen, a social welfare service corporation, in 2003. While working as a care worker at one of its facilities, he became involved in unico, which supports creative activities for the residents with mental disabilities. Okabe assumed his current position in June 2014 and also serves as an editor of “Te o Tsunagu”, a monthly publication for people with disabilities.

(Sites related to OKABE Takayoshi)