And causing the need for his social. Coursework: Contradictions of integration and adaptation associated with the social rehabilitation of disabled people

1.1. THE CONCEPT OF DISABILITY AND ITS TYPES.

The UN Declaration “On the Rights of Persons with Disabilities”, adopted in December 1971 and ratified by most countries of the world, gives the following definition of the concept of “disabled person”: this is any person who cannot independently provide, in whole or in part, his needs for a normal social and personal life due to a lack of physical or mental capabilities. This definition can be considered as a basic one, which is the basis for the development of those ideas about people with disabilities and disability that are inherent in specific states and societies.

In modern Russian legislation, the following definition of the concept of "disabled person" is adopted - this is a person who, due to limitation of life, due to physical and mental disabilities, needs social assistance and protection. Thus, according to the legislation of the Russian Federation, the basis for providing a disabled person with a certain amount of social assistance is the restriction of the system of his life, i.e., the complete or partial loss of a person's ability to self-service, movement, orientation, control over their behavior and employment.

The concept of disability is defined by a number of authors differently, as defined by Khrapylina L.P. Disability is a disharmony of a person's relationship with the environment, manifested as a result of a health disorder in the persistent limitation of his life activity.

According to the definition of the domestic sociologist E.R. Yarskaya-Smirnova: "disability is the result of social agreements, and the meaning of this concept changes depending on cultural traditions, social conditions and other status differences."

The International Movement for the Rights of the Disabled considers the following concept of disability to be the most correct: “Disability is the obstacles or restrictions on the activities of a person with physical, mental, sensory and mental disabilities caused by the conditions existing in society under which people are excluded from active life.”

People with handicapped have functional difficulties as a result of illness, deviations or deficiencies in development, health status, appearance, due to the unsuitability of the external environment for their special needs, and also because of the prejudices of society towards themselves. To reduce the impact of such restrictions, a system of state guarantees for the social protection of persons with disabilities has been developed.

Social protection of the disabled is a system of state-guaranteed economic, social and legal measures that provide disabled people with conditions for overcoming, replacing (compensating) life restrictions and aimed at creating equal opportunities for them to participate in society with other citizens.

The term "disabled" goes back to the Latin root (volid - "effective, full, powerful") and in literal translation can mean "unfit", "inferior". In Russian usage, starting from the time of Peter I, such a name was given to military personnel who, due to illness, injury or injury, were unable to perform military service and who were sent to serve in civilian positions.

It is characteristic that in Western Europe this word had the same connotation, that is, it referred primarily to crippled soldiers. From the second half of the nineteenth century. the term also applies to civilians who also became victims of the war - the development of weapons and the expansion of the scale of wars increasingly exposed the civilian population to all the dangers of military conflicts. Finally, after the Second World War, in line with the general movement to formulate and protect human rights in general and certain categories of the population in particular, the concept of “disabled person” was formed, referring to all persons with physical, mental or intellectual disabilities.

Today, people with disabilities belong to the most socially unprotected category of the population. Their income is well below average, and their health and social care needs are much higher. They are less able to get an education, often they cannot be engaged in labor activity. Most of them have no family and do not want to participate in public life. All of this suggests that people with disabilities in our society are a discriminated and segregated minority.

An analysis of the history of the development of the problem of disability indicates that, having gone from the ideas of physical destruction, isolation of "inferior" members of society to the concepts of attracting them to work, humanity has come to understand the need for the reintegration of persons with physical defects, pathophysiological syndromes, psychosocial disorders.

In this regard, there is a need to reject the classical approach to the problem of disability as a problem of "inferior people" and present it as a problem affecting society as a whole.

In other words, disability is not a problem of one person, and not even of a part of society, but of the whole society as a whole. Its essence lies in the legal, economic, industrial, communicative, psychological features of the interaction of disabled people with the outside world.

This genesis of social thought is explained by the corresponding development of economic opportunities and the level of social maturity of various historical epochs.

“A disabled person,” the Law “On the Social Protection of the Disabled in the Russian Federation” says, “is a person who has a health disorder with a persistent disorder of body functions caused by a disease, the consequences of injuries or defects, leading to limited life activity and causing the need for his social protection.”

“Restriction of life activity,” the same law explains, “is a complete or partial loss of the ability or ability of a person to carry out self-service, move independently, navigate, communicate, control their behavior, learn and engage in work activities.”

There is currently a debate at the international level, initiated by organizations of persons with disabilities, who advocate for a non-discriminatory treatment of disability. The Dictionary of Social Work defines a person with a disability as "one who is unable to perform certain duties or functions because of a particular physical or mental condition or infirmity. This condition may be temporary or chronic, general or partial"

Blind, deaf, dumb, people with impaired coordination of movement, completely or partially paralyzed, etc. are recognized as disabled due to obvious deviations from the normal physical condition of a person. Persons who do not have external differences from ordinary people, but suffer from diseases that do not allow them to work in various fields as they do healthy people. For example, a person suffering ischemic disease heart, is not able to perform heavy physical work, but he is quite capable of mental activity.

All disabled people are divided into several groups for various reasons:

1. By age - disabled children, disabled adults.

2. By origin of disability: disabled since childhood, war disabled, labor disabled, disabled common disease.

3. According to the degree of ability to work: disabled able-bodied and disabled, disabled people of group I (incapacitated), disabled people of group II (temporarily disabled or able-bodied in limited areas), disabled people of group II (able-bodied in sparing working conditions).

4. According to the nature of the disease, disabled people can be classified as mobile, low-mobility or immobile groups.

Depending on belonging to a particular group, the issues of employment and organization of the life of the disabled are resolved. Persons with limited mobility (able to move only with the help of wheelchairs or on crutches) can work at home or have them delivered to their place of work. Even more difficult is the situation with immobile disabled people who are bedridden. They cannot move without outside help, but they are able to work mentally: analyze socio-political, economic, environmental and other situations; write articles, works of art, create paintings, engage in accounting activities, etc.

If such a disabled person lives in a family, many problems are solved relatively simply. What if he's lonely? Special workers will be needed who would find such disabled people, identify their abilities, help to receive orders, conclude contracts, acquire the necessary materials and tools, organize the sale of products, etc. It is clear that such a disabled person also needs daily care, starting with the morning toilet and ending with the provision of products. In all these cases, disabled people are assisted by special social workers who receive wages for caring for them. Blind but mobile disabled people are also assigned employees paid by the state or charitable organizations.

The population of the planet should be aware of the presence of disabled people and the need to create normal living conditions for them. According to the UN, every tenth person on the planet has a disability, one in 10 suffers from physical, mental or sensory defects, and at least 25% of the total population suffer from health disorders. According to the Agency for Social Information, there are at least 15 million of them. There are a lot of young people and children among the current disabled.

In the general contingent of disabled people, men make up more than 50%, women - more than 44%, 65-80% are elderly people. Along with the growth in the number of disabled people, there are trends in qualitative changes in their composition. The society is concerned about the increase in the number of people with disabilities among people of working age, they make up 45% of the number of citizens initially recognized as people with disabilities. Over the past decade, the number of disabled children has increased at a faster pace: if in the RSFSR in 1990. 155,100 such children were registered with the bodies of social protection of the population, then in the Russian Federation in 1995. this figure rose to 453,700, and in 1999 to 592,300 children. It is also alarming that, according to the Ministry of Health of the Russian Federation, every year in our country 50,000 children are born who are recognized as disabled since childhood.

In recent years, the number of disabled people due to war injuries has also increased. Now their number is almost 42,200 people. The share of people of retirement age accounts for 80% of the total number of disabled people; invalids of the Great Patriotic War - more than 15%, group I - 12.7%, group II - 58%, Group III - 29,3 %.

The structure of the distribution of disability due to a common disease in Russia is as follows: in the first place are diseases of the cardiovascular system (22.6%), followed by malignant neoplasms (20.5%), then injuries (12.6%), respiratory diseases and tuberculosis (8.06%), in fifth place are mental disorders (2.7%). The prevalence of disability is generally higher among urban populations than among rural residents.

The dynamics of the growth of disability in Russia is characterized by the following indicators:

 Disabled people predominate by age structure retirement age;

 according to nosology - most often disability is associated with diseases of the circulatory system;

 in terms of severity - invalids of group II prevail.

The availability of statistical data on the number of disabled people in the country, forecasting and identifying the dynamics of growth in the number of disabled people, the causes of disability, developing a system of measures to prevent it, and determining the possible costs of the state for these purposes has importance. The forecasts of the growth dynamics of the number of people with disabilities in the world, especially of active working age, are alarming.

The growth of persons with disabilities on an international scale is explained both by the growth of the indicator itself, indicating the deterioration of the health of the inhabitants of the planet, and by the expansion of the criteria for determining disability, primarily in relation to the elderly and especially to children. The increase in the total number of disabled people in all developed countries of the world, and especially the number of disabled children, has made the problem of prevention of disability and the prevention of childhood disability among the national priorities of these countries.

1.2. CURRENT PROBLEMS OF INTERACTION OF THE DISABLED AND SOCIETY.

The problem of social and psychological adaptation of disabled people to the conditions of life in society is one of the most important facets of the general integration problem. Recently, this issue has gained additional importance and urgency in connection with big changes in approaches to people who are disabled. Despite this, the process of adaptation of this category of citizens to the basics of the life of society remains practically unexplored, namely, it decisively determines the effectiveness of the corrective measures taken by specialists working with people with disabilities.

The moment has come to present disability not as a problem of a certain circle of "inferior people", but as a problem of the whole society as a whole. Its essence is determined by the legal, economic, industrial, communicative, psychological features of the interaction of disabled people with the surrounding reality. The most serious aspects of the problem of disability are associated with the emergence of numerous social barriers that do not allow people with disabilities and people with chronic diseases, as well as children with impaired social behavior, to actively participate in society.This situation is the result of an incorrect social policy that is focused only on part of the "healthy" population and expresses the interests of this category of citizens. That is why the structure of production and life, culture and leisure, social services remains unadapted to the needs of sick people.

The needs of disabled people can be conditionally divided into two groups: - general, i.e. similar to the needs of other citizens and - special, i.e. needs caused by a particular disease.

The most typical of the “special” needs of persons with disabilities are the following:

 in the restoration (compensation) of impaired abilities for various types of activity;

 on the move;

 in communication;

 free access to social, cultural and other objects;

 in the opportunity to acquire knowledge;

 in employment;

 in comfortable living conditions;

 in socio-psychological adaptation;

 financial support.

Satisfaction of the listed needs is an indispensable condition for the success of all integration measures in relation to the disabled. In socio-psychological terms, disability poses many problems for a person, so it is necessary to highlight the socio-psychological aspects of persons with disabilities.

The relationship between the disabled and the healthy is a powerful factor in the adaptation process. As foreign and domestic experience shows, people with disabilities often, even having all the potential opportunities to actively participate in society, cannot realize them because other fellow citizens do not want to communicate with them, entrepreneurs are afraid to hire a disabled person, often simply because of established negative stereotypes. Therefore, organizational measures for social adaptation, not prepared psychologically, may be ineffective. The few studies on this issue revealed the following: representatives of various segments of the population in principle admit (97%) that there are weak and vulnerable groups in need of social assistance, and only 3% of respondents said that when providing social assistance, no one should be given preference . Regarding the priority of assistance to certain groups of people, opinions were distributed as follows: more than 50% of citizens believe that disabled children need it most, followed by elderly people living in nursing homes (47.3% of respondents), orphans (46 .4%), disabled adults (26.3%), Chernobyl victims (20.9%), single mothers (18.2%), families with many children (15.5%), refugees, alcoholics, homeless people, drug addicts (according to 10%), WWII veterans (6.4%).

The idea of ​​social integration of disabled people into society is verbally supported by the majority, but in-depth studies have revealed the complexity and ambiguity of the attitude of the healthy to the sick. This attitude can be called ambivalent: on the one hand, people with disabilities are perceived as different for the worse, on the other, as deprived of many opportunities. This gives rise to both the rejection of unhealthy fellow citizens by other members of society, and sympathy towards them, but in general, there is an unpreparedness of many healthy people for close contact with the disabled and for situations that allow the disabled to realize their potential on an equal basis with everyone else. The relationship between the disabled and the healthy implies responsibility for these relationships on both sides. Therefore, it should be noted that the disabled in these relationships do not occupy an entirely acceptable position. Many of them lack social skills, the ability to express themselves in communication with colleagues, acquaintances, administration, and employers. Disabled people are far from always able to catch the nuances of human relations; they perceive other people in a somewhat general way, evaluating them on the basis of only some moral qualities: kindness, responsiveness, etc.

Relationships between people with disabilities are not quite harmonious either. Belonging to a group of people with disabilities does not mean at all that other members of this group will be attuned to him accordingly.

work experience public organizations of disabled people shows that disabled people prefer to associate with people who have identical diseases and have a negative attitude towards others. One of the main indicators of the socio-psychological adaptation of persons with disabilities is their attitude towards their own lives. Almost half of the disabled (according to the results of special sociological studies) assess the quality of their lives as unsatisfactory (mostly disabled people of the 1st group). About a third of disabled people (mainly of the 2nd and 3rd groups) characterize their life as quite acceptable. Moreover, the concept of "satisfaction-dissatisfaction with life" often comes down to a poor or stable financial situation of a disabled person. The lower the income of a disabled person, the more pessimistic his views One of the factors of attitude to life is the disabled person's self-assessment of his state of health.According to the results of studies, among those who define the quality of their existence as low, only 3.8% rated their well-being as good.

An important element of psychological well-being and social adaptation of persons with disabilities is their self-perception. Surveys have shown that only every tenth disabled person considers himself happy. A third of the disabled considered themselves passive. Every third person admitted to being uncommunicative. A quarter of disabled people consider themselves sad. Data on the psychological characteristics of disabled people differ significantly in groups with different incomes. The number of "happy", "kind", "active", "sociable" is greater among those whose budget is stable, and the number of "unhappy", "evil", "passive", "unsociable" was greater among those who are constantly in need. Psychological self-assessments are similar in groups of disabled people of different severity. The most favorable self-assessment in disabled people of the 1st group. Among them, there are more “kind”, “sociable”, “funny”. The situation is worse for disabled people of group 2. It is noteworthy that among disabled people of group 3 there are fewer “unhappy” and “sad”, but much more “evil”, which characterizes the trouble in socio-psychological terms.

This is confirmed by a number of deeper individual psychological experiments that reveal psychological maladjustment, a sense of inferiority, and great difficulties in interpersonal contacts among disabled people of the 3rd group. There was also a difference in self-esteem between men and women: 7.4% of men and 14.3% of women consider themselves "lucky", 38.4% and 62.8%, respectively, consider themselves "kind", 18.8% and 21.2%, which indicates the high adaptive capacity of women.

A difference was noticed in the self-assessment of working and unemployed disabled people: for the latter, it is much lower. This is partly due to the financial situation of the workers, their greater social adaptation, compared with the unemployed. The latter are withdrawn from this sphere of social relations, which is one of the reasons for the extremely unfavorable personal self-esteem. Lonely disabled people are the least adapted. Despite the fact that their financial situation does not differ fundamentally for the worse, they represent a risk group in terms of social adaptation. Thus, they more often than others negatively assess their financial situation (31.4% and the average for disabled people is 26.4%). They consider themselves more “unhappy” (62.5%, and on average among disabled people 44.1%), “passive” (respectively 57.2% and 28.5%), “sad” (40.9% and 29. %), among these people there are few people who are satisfied with life.The features of socio-psychological maladaptation of lonely people with disabilities take place, despite the fact that they have a certain priority in social protection measures.But, apparently, first of all, psychological and pedagogical assistance is needed for these The deterioration in the moral and psychological state of persons with disabilities is also due to the difficult economic and political conditions in the country.Like all people, people with disabilities experience fear of the future, anxiety and uncertainty about the future, a sense of tension and discomfort.General concern takes the form characteristic for today's political, economic and socio-psychological conditions.Along with material disadvantage, this leads to the fact that the slightest difficulties cause panic and severe stress in disabled people.

So, we can state that at present the process of social adaptation of disabled people is difficult, because:

 satisfaction with life among disabled people is low;

 self-esteem also has a negative trend;

 Significant problems face disabled people in the field of relationships with others;

 The emotional state of the disabled is characterized by anxiety and uncertainty about the future, pessimism.

The most disadvantaged in the socio-psychological sense is the group where there is a combination of various unfavorable indicators (low self-esteem, alertness to others, dissatisfaction with life, etc.). This group includes people with poor financial situation and housing conditions, single disabled people, disabled people of the 3rd group, especially the unemployed, disabled since childhood (in particular, patients with cerebral palsy).

In people with cerebral palsy, along with a violation of motor functions, deviations in the emotional-volitional sphere, behavior, and intelligence are observed. Emotional-volitional disorders are revealed in increased excitability, excessive sensitivity, anxiety (or lethargy), fussiness (or passivity), excessive disinhibition (or lack of initiative). Patients with cerebral palsy have been disabled since childhood, which means that they did not have the opportunity for full-fledged social development, since their contacts with the outside world are extremely limited.

Usually a child with infantile paralysis does not have the opportunity to go through all the cycles of socialization, his maturation is delayed. All this comes from the fact that adults do not provide proper social and psychological adaptation to such a child. As a result, for the rest of his life he remains infantile, dependent on others, passive, feeling comfortable only with close people. The social consequences of this situation are manifested in the fact that these disabled people become a special socio-demographic group separated from society. Studies have found that most of all they experience a feeling of insecurity in their abilities and are aware of the uselessness of society of persons suffering from cerebral palsy. Their income level is lower than that of people with other diseases, and their educational opportunities are also lower. A small number of these people are employed, among patients with infantile paralysis there are significantly fewer people who have their own family, the majority have no desire to engage in any useful activity. As the so far poor domestic experience shows, disabled people with cerebral palsy, even having the desire and opportunity to participate in society, cannot realize them because of the negative attitude of others around them, while young people are most negatively inclined (for this category of young disabled people who have a visible defect, contact with healthy peers is especially difficult). It is impossible not to say how the young disabled people themselves, suffering from infantile paralysis, relate to the possibility of personal active participation in public life. To the question of the questionnaire “In your opinion, should disabled people live, study and work among healthy people, or should they live separately, in special institutions?” all respondents answered, which speaks of its relevance. Among the opponents of integration (43%) are those young people who often met with the neglect of others. Their opinion is as follows: "Healthy people still will not understand disabled people." As a result of our research, it also turned out that people with disabilities living in rural areas are more often supporters of integration than young people living in large cities of the region. An interesting fact is that older people with disabilities (25-30 years old) have a positive attitude towards active-personal participation in surrounding life. Among young people aged 14-24 there are much fewer such persons. The greater the degree of damage in patients with cerebral palsy, the less they are socially active. We also noticed that young people with disabilities, whose families have a low material level and poor living conditions, also turned out to be among the opponents of the idea of ​​integration. This is probably due to the fact that people who have already failed in something do not hope that life in other conditions will be better. Often, young people with cerebral palsy do not always have stable relationships with loved ones. Many people prefer to communicate with their peers by sitting "within four walls" under parental care. Approximately 30% of the surveyed young disabled people with cerebral palsy generally refuse to contact anyone (mostly girls aged 18-28 years with severe In the process of observation, it was noticed that in the families of these young people psychological problems of this kind are extremely acute: most parents have various negative feelings, they begin to feel embarrassment and shame in front of others for a disabled child and therefore narrow the circle of his social It is important to dwell on the reason for the occurrence of such situations in more detail.When a child with disabilities appears in a family, it experiences two crises, as it were: the birth of a child itself is a crisis in the life cycle of the family, since it leads to a rethinking social roles and functions, sometimes conflicts arise. When a child has signs of disability, then this crisis proceeds with a double severity. This extremely dramatically changes the socio-economic status of the family, disrupts social ties. Moral and psychological problems are extremely aggravated. The vast majority of parents have a feeling of guilt, which is accompanied by a sense of their own inferiority. Family life begins to flow in a stressful situation, when parents not only hide a sick child from others, but also try to isolate themselves from the world. Often these families break up, and the child, as a rule, remains with the mother. The family, which is one of the main guarantors of the social adaptation of the child, does not always retain the ability to perform this function. Relatives often lose self-confidence, are unable to properly organize communication and upbringing of the child, do not notice his real needs, and cannot correctly assess his capabilities. Therefore, it is quite reasonable that many young disabled people with cerebral palsy complain about parental overprotection, which suppresses any independence. This drastically reduces the possibility of adaptation of such disabled people. Most of the young disabled people we interviewed – “supporters” (56.7%) need to eliminate conflict situations in the family.

However, the current socio-economic situation is gradually forcing some young people with disabilities to change their own lives. At the moment, their number is still small, but we can expect a further increase in the number of such people, and therefore, there is a need to think in advance about ways to realize their opportunities in social integration, striving for self-improvement of life.

Own observations and analysis of social psychological features young people with cerebral palsy, made it possible to identify four main types of adaptation of these disabled people to society:

The active-positive type is characterized by the desire to find an independent way out of negative life situations. Young disabled people of this type have a favorable internal mood, a fairly high self-esteem, optimism that infects others, vigor and independence of judgments and actions.

The passive-positive type is characterized by the presence of low self-esteem in young people with disabilities. With a passive-positive type of adaptation, the currently existing situation in which the disabled person is located (for example, constant guardianship of relatives) suits him, therefore, there is a lack of desire for change.

Passive-negative type. Young people have dissatisfaction with their situation and at the same time there is no desire to improve it on their own. All this is accompanied by low self-esteem, psychological discomfort, a wary attitude towards others, the expectation of global catastrophic consequences even from minor domestic troubles.

Active-negative type. The psychological discomfort and dissatisfaction with one's own life present here do not deny the desire to change the situation for the better, but this has no real practical consequences due to the influence of various objective and subjective factors.

Unfortunately, among young people with the consequences of infantile paralysis, people with an active-positive life position are extremely rare. There are few of them, but they are the most socially active (including in terms of creating public organizations of the disabled). Most young disabled people with cerebral palsy either do not feel the desire to somehow change their lives, or consider themselves incapable of such an important step. As a rule, they are at the mercy of certain circumstances. Therefore, these people especially need a clearly planned and scientifically based system of socio-pedagogical and psychological measures aimed at developing their independence of judgments and actions, work skills and a culture of behavior, a worthy spiritual and moral character, and the ability to live in society.

People with disabilities are not a homogeneous group, each person is an individual, different from everyone else. An important role is played by the characteristics of communication and the degree of freedom of movement, because this group is differentiated by sex and age, social status and type of disability, education, and geography of residence.

As experience shows, disabled people living in cities and district centers have more opportunities to integrate into society, while disabled people from villages and small villages sometimes do not use the services intended for them at all and, apart from pensions, do not know about anything. However, in large settlements, megacities, people with disabilities are more likely to experience harassment and resentment in their daily interaction with society.

The process of social rehabilitation is two-sided and reciprocal. Society should meet the needs of the disabled, adapting their environment and motivating them to integrate into society. On the other hand, which is very important, people with disabilities should themselves strive to become equal members of society.

Criteria for assessing disability in ITU institutions

Introduction

The cardinal political and socio-economic transformations that have taken place in Russia in the last decade have led to fundamental changes in the social policy of the state in relation to the disabled, contributed to the formation of new approaches to solving the problems of disability and social protection of the disabled.
The main provisions of the state policy in relation to the disabled were reflected in the Federal Law "On the Social Protection of the Disabled in the Russian Federation" (No. 181 of November 24, 1995), which contains new interpretations of the concepts of "disability" and "disability", new positions for the definition of disability .
The implementation of this Law required the development of a modern concept of disability, the creation of a new methodological framework for its definition and assessment, the transformation of the service medical and labor expertise in medical and social expertise.
In 1997, the "Classifications and temporary criteria used in the implementation of medical and social examination" developed by the employees of TSIETIN were published, approved by the Decree of the Ministry of Labor and Social Development of the Russian Federation and the Ministry of Health of the Russian Federation No. 1/30 dated January 29, 1997, as well as methodological recommendations for their application for employees of institutions of medical and social expertise and rehabilitation (Moscow. 1997, TsBNTI. Issue 16).
In the period 1997-2000. new approaches to the definition of disability have been widely introduced into the practice of ITU agencies. Them practical use showed significant advantages of modern positions of medical and social expertise to improve the social protection of people with disabilities.
At the same time, the fundamental difference between the criteria for medical and social expertise and the criteria for medical and labor expertise, the stereotype of the old thinking, some imperfection of new methodological approaches caused certain difficulties in practical work ITU bureau.
In 1999-2000 TSIETIN staff studied the initial experience of applying the “Classifications and temporal criteria used in the implementation of medical and social expertise” in the practice of 72 ITU bureaus of general and specialized profiles of different subjects of the Russian Federation and all clinical departments of TSIETIN, where they analyzed the data of expert rehabilitation diagnostics of 654 examined persons.
Comments and suggestions made by specialists of the ITU services and employees of TSIETIN, as well as representatives of public organizations of the disabled, doctors of medical institutions, scientists from research institutes, etc. were carefully analyzed and, taking into account them, the necessary adjustments and additions were made to the basic concepts, classifications , criteria and methodology for assessing disability in the implementation of medical and social expertise, which are presented in these guidelines.

1. Basic concepts
1.1. Disabled person - a person who has a health disorder with a persistent disorder of body functions due to diseases, the consequences of injuries or defects, leading to limitation of life and necessitating his social security.
1.2. Disability - social insufficiency due to a health disorder with a persistent disorder of body functions, leading to a limitation of life and the need for social protection.
1.3 Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
1.4. Violation of health - physical, mental and social ill-being associated with the loss, anomaly, disorder of the psychological, physiological, anatomical structure and (or) function of the human body.
1.5. Life restriction - a deviation from the norm of human activity due to a health disorder, which is characterized by a limitation in the ability to carry out self-service, movement, orientation, communication, control over one's behavior, learning, work and play activities (for children).
1.6. Social insufficiency - the social consequences of a violation of health, leading to a limitation of a person's life and the need for his social protection or assistance.
1.7. Social protection is a system of state-guaranteed economic, social and legal measures that provide disabled people with conditions for overcoming, replacing, compensating for life restrictions and aimed at creating opportunities for them to participate in society on an equal footing with other citizens.
1.8. Social assistance - periodic and (or) regular activities that contribute to the elimination or reduction of social insufficiency.
1.9. Social support - one-time or episodic short-term activities in the absence of signs of social insufficiency.
1.10. Rehabilitation of disabled people - a system of medical, psychological, pedagogical, socio-economic measures aimed at eliminating or, if possible, more fully compensating for limitations in life activity caused by a health disorder with a persistent disorder of body functions. The purpose of rehabilitation is to restore the social status of a disabled person, to achieve material independence and social adaptation.
1.11. Rehabilitation potential - a complex of biological, psycho-physiological and personal characteristics of a person, as well as social and environmental factors that make it possible to compensate or eliminate his life limitations to one degree or another.
1.12. Rehabilitation forecast - the estimated probability of realizing the rehabilitation potential.
1.13. Clinical prognosis is a scientifically based assumption about the further outcome of the disease based on a comprehensive analysis of the clinical and functional characteristics of health disorders, the course of the disease and the effectiveness of treatment.
1.14. Specially created conditions for labor, household and social activities - specific sanitary-hygienic, organizational, technical, technological, legal, economic, micro-social factors that allow a disabled person to carry out labor, domestic and social activities in accordance with his rehabilitation potential.
1.15. Special jobs for the employment of disabled people - jobs that require additional measures on the organization of labor, including the adaptation of the main and auxiliary equipment, technical and organizational equipment, additional equipment and the provision of technical devices, taking into account the individual capabilities of the disabled.
1.1.16. Auxiliary means - special additional tools, objects, devices and other means used to compensate or replace disturbed or lost functions of the body and contribute to the adaptation of a disabled person to the environment.
1.17. Full working capacity - working capacity is considered complete if the functional state of the body meets the requirements of the profession and allows you to perform production activities without harm to health.
1.18. Profession - gender labor activity(occupations) of a person who owns a complex of special knowledge, skills and abilities obtained through education, training, work experience. The main profession should be considered the work of the highest qualification or performed for a longer time.
1.19. Specialty - kind professional activity, improved by special training; certain area of ​​work, knowledge.
1.20. Qualification - the level of preparedness, skill, degree of fitness for work in a particular profession, specialty or position, determined by rank, class, rank and others qualification categories.
1.21. Ongoing help and care
- the implementation by an outsider of constant systematic assistance and care in meeting the physiological and domestic needs of a person.
1.22. Supervision is supervision by an unauthorized person necessary to prevent actions that can harm the disabled person and other people.
2. Classification of violations of the basic functions of the human body:
2.1. Violations of mental functions (perception, memory, thinking, intellect, higher cortical functions, emotions, will, consciousness, behavior, psychomotor functions).
2.2. Language and speech disorders - violations of oral and written, verbal and non-verbal speech, not caused by mental disorders; violations of voice formation and speech forms (stuttering, dysarthria, etc.).
2.3. Violations of sensory functions (vision, hearing, smell, touch, vestibular function, tactile, pain, temperature and other types of sensitivity; pain syndrome).
2.4. Violations of static-dynamic functions (motor functions of the head, trunk, limbs, statics, coordination of movements).
2.5. Visceral and metabolic disorders, nutritional disorders (circulation, respiration, digestion, excretion, hematopoiesis, metabolism and energy, internal secretion, immunity).
2.6. Disfiguring disorders (structural deformities of the face, head, torso, limbs, pronounced external deformity; abnormal openings of the digestive, urinary, respiratory tracts; violation of body size: gigantism, dwarfism, cachexia, overweight).
3. Classification of violations of the basic functions of the human body according to the severity
A comprehensive assessment of various qualitative and quantitative indicators characterizing a persistent violation of body functions provides for the allocation of mainly four degrees of violations:
Grade 1 - minor dysfunction
Grade 2 - moderate dysfunction
Grade 3 - severe functional impairment
Grade 4 - significantly pronounced dysfunction.

4. Classification of the main categories of life activity and disability according to the degree of severity.
4.1. Self-service ability- the ability to independently satisfy basic physiological needs, perform daily household activities and personal hygiene skills.
The ability to self-service is the most important category of human life, assuming its physical independence in the environment.
Self-care ability includes:
satisfaction of basic physiological needs, management of physiological functions;
observance of personal hygiene: washing the face and the whole body, washing the hair and combing, brushing the teeth, cutting the nails, hygiene after physiological functions;
dressing and undressing outerwear, underwear, hats, gloves, shoes, using fasteners (buttons, hooks, zippers);
eating: the ability to bring food to the mouth, chew, swallow, drink, use tableware and cutlery;
fulfillment of daily household needs: the purchase of food, clothing and household items;
cooking: cleaning, washing, cutting products, their heat treatment, using kitchen utensils;
use of bed linen and other bedding; bed making, etc.;
laundry, cleaning and repair of linen, clothing and other household items;
use of household appliances and appliances (locks and locks, switches, taps, lever devices, iron, telephone, household electrical and gas appliances, matches, etc.);
cleaning of the premises (sweeping and washing the floor, windows, dusting, etc.).

To implement the ability to self-service requires the integrated activity of almost all organs and systems of the body, violations of which in various diseases, injuries and defects can lead to a limitation of the possibility of self-service.
Parameters in assessing the limitations of the ability to self-service can be:
assessment of the need for assistive devices, the possibility of correcting the ability to self-care with the help of assistive devices and adaptation of the home;
assessment of the need for outside assistance in meeting physiological and domestic needs;
assessment of time intervals through which such need arises: periodic need (1-2 times a week), long intervals (1 time per day), short intervals (several times a day), constant need.

Limitation of the ability to self-service by severity:
I degree - the ability to self-service with the use of aids.
The ability to self-service and independent performance of the above actions with the help of technical means, adaptation of housing and household items to the ability of a disabled person is preserved.
II degree - the ability to self-service with the use of auxiliary means and with the partial help of other persons.
The ability to self-service is retained with the help of technical means, adaptation of housing and household items to the capabilities of a disabled person with the obligatory partial assistance of another person, mainly for domestic needs (cooking, buying food, clothing and household items, washing linen, using some household appliances, cleaning the premises and etc.).
III degree - inability to self-service and complete dependence on other persons (the need for constant outside care, help or supervision). Lost the ability to independently fulfill even with the help of technical means and adaptation of housing most of the vital physiological and domestic needs, the implementation of which is possible only with constant help other persons.

4.2. Ability to move independently- the ability to independently move in space, overcome obstacles, maintain body balance within the framework of everyday, social, professional activities.

The ability to move independently includes:
- independent movement in space: walking on flat terrain at an average pace (4-5 km per hour for a distance corresponding to average physiological capabilities);
- overcoming obstacles: climbing and descending stairs, walking on an inclined plane (with an inclination angle of not more than 30 degrees),
- maintaining the balance of the body during movement, at rest and when changing the position of the body; the ability to stand, sit, get up, sit down, lie down, maintain the adopted posture and change the position of the body (turns, torso forward, to the side),
- performing complex types of movement and movement: kneeling down and getting up from your knees, moving on your knees, crawling, increasing the pace of movement (running).
- use of public and private transport (entrance, exit, movement inside vehicle).
The ability to move independently is carried out due to the integrated activity of many organs and systems of the body: musculoskeletal, nervous, cardio-respiratory, organs of vision, hearing, vestibular apparatus, mental sphere, etc.
When evaluating the ability to move, the following parameters should be analyzed:
- the distance that a person can move;
pace of walking (normally 80-100 steps per minute);
walking rhythm coefficient (normally 0.94-1.0);
double step duration (normally 1-1.3 sec)
speed of movement (normally 4-5 km per hour);
needs and availability of aids.
Limitation of the ability to move independently according to the degree of severity:

I degree - the ability to move independently with the use of auxiliary means with a longer expenditure of time, fragmentation of performance and a reduction in distance.
The ability to move independently when using assistive devices is retained with a decrease in speed when performing movement and movement, with limited ability to perform complex types movement and movement while maintaining balance.
At the first degree, the ability to move is characterized by a moderate decrease in speed (up to 2 km per hour), pace (up to 50-60 steps per minute), an increase in the duration of a double step (up to 1.8-2.4 seconds), a decrease in the coefficient the rhythm of walking (up to 0.69-0.81), the reduction in the distance of movement (up to 3.0 km.), the fragmentation of its implementation (breaks every 500-1000 m or 30-60 minutes of walking) and the need to use auxiliary means.
II degree - the ability to move independently with the use of assistive devices and partial assistance of other persons.
The ability to move independently and move with the help of assistive devices, adapt housing and household items to the capabilities of a disabled person, and involve another person when performing certain types of movement and movement (complex types of movement, overcoming obstacles, maintaining balance, etc.) is retained.
In the second degree - the ability to move is characterized by a pronounced decrease in speed (less than 1.0 km per hour), walking pace
(less than 20 steps per minute), an increase in the duration of a double step (less than 2.7 seconds), a decrease in the coefficient of rhythm of walking (less than 0.53), the fragmentation of its implementation, a reduction in the distance of movement mainly within the apartment if it is necessary to use aids and partial assistance other persons.
III degree - inability to move independently, which is possible only with the help of other persons.

4.3. Ability to learn- the ability to perceive and reproduce knowledge (general educational, professional, etc.) to master skills and abilities (professional, social, cultural, everyday).
The ability to learn is one of the important integrative forms of life, which depends, first of all, on the state of mental functions (intelligence, memory, attention, clarity of consciousness, thinking, etc.), the safety of communication systems, orientation, etc. Learning also requires the use of the ability to communicate, move, self-service, determined by the psychological characteristics of the individual, the state of the locomotor apparatus, visceral functions, etc. The ability to learn is impaired in diseases of various body systems. Of all the criteria of vital activity, the impairment of the ability to learn has the greatest social significance in childhood. It is equivalent to a violation of the ability to work in adults and is the most common cause social insufficiency of the child.

Characteristics of educational activities include:
the content of training (obtaining education of a certain level and in a certain profession);
teaching aids (including special technical means for teaching, equipment of a training place, etc.);
the learning process, including forms of education (full-time, part-time, part-time, at home, etc.), teaching methods (group, individual, interactive, open, etc.);
learning conditions (according to severity, tension and harmfulness);
terms of study.

When assessing the degree of learning disability, the following parameters should be analyzed:
education, professional training;
the volume of training according to general or special state educational standards;
the possibility of studying in an educational institution general type or in a correctional educational institution;
terms of training (normative-non-normative);
the need to use special technologies and (or) teaching aids.
the need for the help of other persons (except for the training staff);
the level of cognitive (mental) activity of a person in accordance with the age norm;
attitude to learning, motivation for learning activities;
the possibility of verbal and (or) non-verbal contact with other people;
the state of communication systems, orientation, especially sensory, motor functions of the body, etc.;
the state of visual-motor coordination for mastering the technique of writing, graphic skills, manipulative operations.
Limitation of the ability to learn by severity

I degree - the ability to learn, master knowledge, skills and abilities in full (including - to receive any education in accordance with general state educational standards), but in non-normative terms, subject to a special regime of the educational process and (or) using auxiliary means.
II degree - the ability to learn and acquire knowledge, skills and abilities only according to special educational programs and (or) training technologies in specialized educational and correctional institutions using auxiliary means and (or) with the help of other persons (except for teaching staff).
III degree - inability to learn and the inability to acquire knowledge, skills and abilities.

4.4. Ability to work- the state of the human body, in which the totality of physical and spiritual abilities allows for a certain volume and quality of production (professional) activity.
Ability to work includes:
- The ability of a person, in terms of his physical, psychophysiological and psychological capabilities, to meet the requirements imposed on him by production (professional) activities (in terms of labor complexity, working environment conditions, physical severity and neuro-emotional tension).
- The ability to reproduce special professional knowledge, skills and abilities in the form of industrial (professional) labor.
- The ability of a person to carry out production (professional) activities in normal production conditions and in a normal workplace.
- The ability of a person to social and labor relations with other people in the work collective.

Restriction of the ability to work according to the degree of severity
I degree - the ability to perform professional activities in normal production conditions with a decrease in qualifications or a decrease in the volume of production activities; inability to perform work in the main profession.
II degree - the ability to perform labor activity
in normal production conditions with the use of auxiliary means, and (or) at a special workplace, and (or) with the help of other persons;
under specially designed conditions.

III degree - inability or impossibility (contraindication) of labor activity.

4.5. Orientation ability- the ability to be determined in time and space
The ability to orientate is carried out through direct and indirect perception of the environment, processing the information received and adequately defining the situation.
Orientation ability includes:
- The ability to determine the time by the surrounding features (time of day, season, etc.).
- The ability to determine the location by the attributes of spatial landmarks, smells, sounds, etc.
- The ability to correctly locate external objects, events and oneself in relation to temporal and spatial reference points.
- The ability to realize one's own personality, mental image, scheme of the body and its parts, differentiation of "right and left", etc.
- The ability to perceive and adequately respond to incoming information (verbal, non-verbal, visual, auditory, gustatory, obtained by smell and touch), understanding the relationship between objects and people.
When evaluating orientation limitation, the following parameters should be analyzed:
the state of the orientation system (vision, hearing, touch, smell)
state of communication systems (speech, writing, reading)
ability to perceive, analyze and adequately respond to the information received
the ability to realize, highlight one's own personality and external temporal, spatial conditions, environmental situations.

Limitation of the ability to orientate according to the degree of severity:

I degree - the ability to orientate, subject to the use of aids.
It remains possible to determine in place, time and space with the help of auxiliary technical means (mainly improving sensory perception or compensating for its violations)
II degree - the ability to orientate, requiring the help of others.
It remains possible to realize one's own personality, one's position and definition in place, time and space only with the help of other persons due to a decrease in the ability to realize oneself and the outside world, understand and adequately define oneself and the surrounding situation.
III degree - inability to orientate (disorientation) and the need for constant supervision.
A condition in which the ability to orient in place, time, space and one's own personality is completely lost due to the lack of the ability to realize and evaluate oneself and the environment.

4.6. Ability to communicate- the ability to establish contacts between people through the perception, processing and transmission of information.

When communicating, the relationship and interaction of people, the exchange of information, experience, skills, and results of activities is carried out.
In the process of communication, a commonality of feelings, moods, thoughts, views of people is formed, their mutual understanding, organization and coordination of actions are achieved.
Communication is carried out mainly through the means of communication. Speech is the main means of communication, reading and writing are auxiliary means. Communication can be carried out both with the help of verbal (verbal) and non-verbal symbols. In addition to the preservation of speech, communication requires the preservation of orientation systems (hearing and vision). Another condition for communication is the normal state of mental activity and psychological characteristics of the individual.
Communication skills include:
the ability to perceive another person (the ability to reflect his emotional, personal, intellectual characteristics)
the ability to understand another person (the ability to comprehend the meaning and significance of his actions, actions, intentions and motives).

The ability to exchange information (perception, processing, storage, reproduction and transmission of information).
- the ability to develop a joint strategy of interaction, including the development, implementation and control over the implementation of the planned, with possible adjustment if necessary.

When assessing the limitations of the ability to communicate, the following parameters should be analyzed, characterizing mainly the state of communication and orientation systems:
the ability to speak (fluently pronounce words, understand speech, pronounce and produce verbal messages, convey meaning through speech);
the ability to listen (perceive oral speech, verbal and other messages);
the ability to see, read (perceive visible information, written, printed and other messages, etc.);
the ability to write (code language into written words, compose written messages, etc.);
the ability to symbolic communication (non-verbal communication) - to understand signs and symbols, codes, read maps, diagrams, receive and transmit information using facial expressions, gestures, graphic, visual, sound, symbols, tactile sensations).

The possibility of contacts with an expanding circle of people: with family members, close relatives, friends, neighbors, colleagues, new people, etc.

Limitation of the ability to communicate by severity
I degree - the ability to communicate, characterized by a decrease in speed, a decrease in the amount of assimilation, receipt, transmission of information and (or) the need to use auxiliary means.
The possibility of communication remains with a decrease in the speed (tempo) of oral and written speech, a decrease in the speed of assimilation and transmission of information in any way, while understanding its semantic content.
II degree - the ability to communicate using auxiliary means and the help of other persons.
The possibility of communication is retained when using technical and other auxiliary means that are not typical for the usual establishment of contacts between people, and the help of other persons in receiving and transmitting information and for understanding its semantic content.
III degree - inability to communicate and the need for constant outside help.
A condition in which contact between a person and other people is impossible, mainly due to the loss of the ability to understand the semantic content of the information received and transmitted.

4.7. The ability to control your behavior- the ability to realize and adequate behavior, taking into account moral, ethical and socio-legal norms.
Behavior - human interaction with the environment, mediated by its external (motor) and internal (mental) activity. When control over one's behavior is violated, a person's ability in his actions, deeds, to comply with the legal, moral, aesthetic rules and norms officially established or established in a given society is violated.
The ability to control one's behavior includes:
The ability to realize oneself, one's place in time and space, one's social position, state of health, mental and personal qualities and properties.
The ability to evaluate one's own actions, actions, intentions and motives of another person with an understanding of their meaning and significance.
The ability to perceive, recognize and adequately respond to incoming information.
The ability to correctly identify people and objects.

The ability to behave correctly in accordance with moral, ethical and socio-legal norms, to observe the established public order, personal cleanliness, order in appearance, etc.
- The ability to correctly assess the situation, the adequacy of the development and choice of plans, achieving goals, interpersonal relationships, performing role functions.
- The ability to change one's behavior when conditions change or behavior is ineffective (plasticity, criticality and variability).
- The ability to realize personal security (understanding external danger, recognizing objects that can cause harm, etc.)
- The usefulness of the use of tools, sign systems in managing one's own behavior.
When assessing the degree of limitation of the ability to control one's behavior, the following parameters should be analyzed:
the presence and nature of personality changes
degree of awareness of one's behavior
the ability to self-correct, or the possibility of correction with the help of others, therapeutic correction;
the direction of the violation of the ability to control one's behavior in one or more areas of life (industrial, social, family, household);
the duration and persistence of violations of control over one's behavior;
stage of compensation for a defect in behavior (compensation, subcompensation, decompensation);
state of sensory functions.

The term "disabled" goes back to the Latin root ("valid" - effective, full, powerful) and in literal translation can mean "unsuitable", "inferior". In Russian usage, starting from the time of Peter I, such a name was given to military personnel who, due to illness, injury or injury, were unable to perform military service and who were sent to serve in civilian positions. Peter tried to rationally use the potential of retired military men - in the system of state administration, city security, etc.

It is characteristic that in Western Europe this word had the same connotation, i.e. applied primarily to crippled warriors. From the second half of the XIX century. the term also applies to civilians who also became victims of the war - the development of weapons and the expansion of the scale of wars increasingly exposed the civilian population to all the dangers of military conflicts. Finally, after the Second World War, in line with the general movement to formulate and protect human rights in general and certain categories of the population in particular, there is a rethinking of the concept of "disabled", referring to all persons with physical, mental or intellectual disabilities.

Today, according to various estimates, on average, almost every tenth inhabitant in developed countries has certain health limitations. The classification of specific types of limitations or disabilities as disabled depends on national legislation; consequently, the number of persons with disabilities and their proportion in the population of each particular country may differ significantly, while the level of morbidity, loss of certain functions in countries that have reached a certain level of development is quite comparable.

The Federal Law of November 24, 1995 No. 181-FZ "On the Social Protection of the Disabled in the Russian Federation" provides a detailed definition of disability.

Disabled person- a person who has a health disorder with a persistent disorder of body functions due to diseases, consequences of injuries or defects, leading to limited life activity and causing the need for his social protection.

Limitation of life activity is expressed in the complete or partial loss of the ability or ability of a person to carry out self-service, move independently, navigate, communicate, control their behavior, learn and engage in work activities.

Thus, in accordance with internationally recognized criteria, disability is determined by deviations or disorders in the following areas.

Blind, deaf, dumb, people with limb defects, impaired coordination of movement, completely or partially paralyzed are recognized as disabled due to obvious deviations from the normal physical condition of a person. Disabled persons are also recognized as persons who do not have external differences from ordinary people, but suffer from diseases that do not allow them to function in various spheres of life in the same way as healthy people do. For example, a person suffering from coronary heart disease is unable to perform heavy physical work, but mental activity may be quite within his power. A patient with schizophrenia can be physically fit, in many cases he is also able to perform work related to mental stress, but during the period of exacerbation he is not able to control his behavior and communication with other people.

At the same time, most people with disabilities do not need isolation, they are able to independently (or with some help) conduct independent life, many of them - to work in ordinary or adapted jobs, have families and support them on their own.

Social changes that are objectively taking place in modern society and reflected in the minds of people are expressed in the desire to expand the content of the terms "disabled", "disability".

Thus, WHO adopted as standards for the world community such signs of the concept of "disability":

• any loss or impairment of psychological, physiological or anatomical structure or function;
• limited or absent (due to the above defects) ability to perform functions as is considered normal for the average person;
• an embarrassment arising from the above deficiencies that completely or partially prevents a person from fulfilling a role (taking into account the influence of age, gender and cultural affiliation).

At the same time, given the complexity and inconsistency of understanding and defining such concepts as "health", "health standard", "deviation", functionalist concepts of the interpretation of disability based on the assessment of deviations and defects in several scales related to biophysical, mental , social and professional aspects of life of a disabled person .

At the same time, the importance of developing valid criteria and methods for assessing and regulating the status of a disabled person is determined by the fact that in a society in which the principle of equality of rights is fundamental, disability is one of the mechanisms that predetermine inequality and can become a source of marginalization of people with disabilities and families, in which they live.

The World Health Organization has developed international classification Disabilities and Handicaps (International Classification of Impairments, Disabilities and Handicaps), in which the starting point for the definition of disability is an injury, a defect, which is understood as a mental, physiological and (or) anatomical inferiority of the body structure. Losses can be global (general) or partial; injury may have different level and depth, may be permanent or curable, congenital or acquired, stabilized or progressive (in which the person's condition worsens).

Handicap, which is the result of injury (mutilation) and disability, determines less favorable social conditions for a person, since the ability to perform standard functions for a given society, role identification in it is either completely blocked or significantly limited. It also makes it difficult to achieve one's own life goals, related to age, gender and cultural traditions.

The degree of role impairment can manifest itself in difficulties in the performance of social roles; in emerging constraints (not all desirable roles can be performed satisfactorily); in total absence opportunities for appropriate role-playing behavior.

The systemic understanding of disability presented by WHO departs from its narrow interpretation, which emphasized occupational limitations and the ability (inability) to work. The presence of disability and the degree of impairment is considered as an indicator of disorders in regulating the relationship of a disabled person with his social environment. At the same time, the analysis of social practice shows that there are people who have a disorder of communication and social behavior, maladjustment and social marginalization are not associated with health problems. Such individuals (of deviant behavior) also need social rehabilitation, however, in order to organize specialized assistance, it is necessary to distinguish between marginalized people who have difficulties in the field of social adaptation, based on sociopathy or behavioral disorders, and people with psychosomatic deviations.

A multivariate analysis of the social status of disability allows us to conclude that:

• from an economic point of view - it is a limitation and dependence arising from poor ability to work or from disability;
• medical point vision - long-term state of the body, limiting or blocking the performance of its normal functions;
• legal point of view - status giving the right to compensation payments, other measures of social support, regulated by the norms of national or regional legislation;
• professional point of view - a state of difficult, limited employment opportunities (or a state of complete disability);
• psychological point of view - this, on the one hand, is a behavioral syndrome, and on the other, a state of emotional stress;
• sociological point of view - the loss of former social roles, the inability to participate in the implementation of a set of social roles standard for a given society, as well as stigmatization, sticking a label that prescribes a certain, limited social functioning to a disabled person.

If we pay attention to the last two provisions, we can conclude that social restrictions and barriers for persons with disabilities are partly formed not only by physical barriers, but also by subjective social restrictions and self-restraints. Thus, the stigmatization of disabled people in the public mind prescribes them the role of unfortunate, pitiable, in need of constant protection, although many self-sufficient disabled people emphasize their equal subjectivity to all other people. At the same time, some people with disabilities adopt the mentality and behavioral standards of a victim who is unable to solve at least part of their own problems on their own, and place responsibility for their fate on others - relatives, employees of medical and social institutions, on the state as a whole.

This approach, reflecting the specifics of the social position of people with disabilities in various fields, allows us to formulate a new idea: person with disabilities this is an individual who has all the rights of a person, who is in a position of inequality, formed by the barrier restrictions of the environment, which he cannot overcome due to the limited possibilities of his health.

At a conference organized by the UN Secretariat in 2006 and dedicated to the problems of disability, it was noted that the UN Convention on the Rights of Persons with Disabilities recognizes the dynamic development of the concept of disability and the development of social ideology, which necessitates regular and timely adaptation of tools for social protection of persons with disabilities. Currently, the following markers of disability are recognized: biological (organism defects due to diseases, injuries or their consequences, persistent functional disorders); social (impaired interaction between an individual and society, special social needs, restriction of freedom of choice, special social status, need for social protection); psychological (special collective personal attitudes, special behavior in the social environment, special relationships within the population and with others social groups population); economic (limitation of freedom of economic behavior, economic dependence); physical (accessibility barriers). All these markers, or factors, form the social specificity of the state of disability, which interferes with the normal for a given environment, i.e. socially recognized set of functioning models.

All disabled people but for various reasons are divided into several groups:

• according to the age - disabled children, disabled adults;
• the origin of the disability invalids from childhood, war invalids, labor invalids, general illness invalids;
• general condition - invalids of mobile, low-mobility and fixed groups;
• degree of working capacity - able-bodied and disabled people, disabled people of group I (incapacitated), disabled people of group II (temporarily disabled or able-bodied in limited areas), disabled people of group III (able-bodied in sparing working conditions).

Criteria for determining first group of disability is a social insufficiency that requires social protection or assistance due to a health disorder with a persistent, significantly pronounced disorder of body functions due to diseases, the consequences of injuries or defects, leading to a pronounced limitation of any category of life activity or a combination of them.

Criteria for establishing second group of disability is a social insufficiency that requires social protection or assistance due to a health disorder with a persistent pronounced disorder of body functions caused by diseases, the consequences of injuries or defects leading to a pronounced limitation of any category of life activity or a combination of them.

Criteria for determining third group of disability is a social insufficiency that requires social protection or assistance due to a health disorder with a persistent slight or moderately pronounced disorder of body functions due to diseases, the consequences of injuries or defects, leading to a mild or moderately pronounced limitation of any category of life activity or their combination.

• ability to self-service the ability to independently satisfy basic physiological needs, perform daily household activities and personal hygiene skills;
• ability to move the ability to independently move in space, overcome obstacles, maintain body balance within the framework of everyday, social, professional activities;
• ability to work - the ability to carry out activities in accordance with the requirements for the content, scope and conditions of work;
• orientation ability - the ability to be determined in time and space;
• ability to communicate - the ability to establish contacts between people through the perception, processing and transmission of information;
• ability to control one's behavior the ability to realize oneself to adequate behavior, taking into account social and legal norms.

Allocate also learning ability, the limitation of which may be the basis for establishing the second group of disability, when combined with one or more other categories of life activity. The ability to learn is the ability to perceive and reproduce knowledge (general educational, professional and others), mastering skills and abilities (social, cultural and domestic).

When considering childhood disability, there are usually 10 categories of children with developmental disabilities. These include children with disorders of one of the analyzers: with complete (total) or partial (partial) loss of hearing or vision; deaf (deaf), hard of hearing or with specific speech deviations; with disorders of the musculoskeletal system ( cerebral paralysis, consequences of spinal injuries or poliomyelitis); With mental retardation and with varying degrees severity of delay mental development (various forms mental underdevelopment with predominantly unformed intellectual activity); with complex disorders (blind mentally retarded, deaf-blind, deaf-blind with mental retardation, blind with speech impairment); autistic (having a painful communication disorder and avoiding communication with other people).

Despite the increasingly impressive advances in medicine, the number of people with disabilities is not only not declining, but is steadily growing, and in almost all types of societies and all social categories of the population.

There are many different causes of disability.

Depending on the cause can be divided into three groups:

• 1) hereditary conditioned forms:
• 2) forms associated with the intrauterine position of the fetus, damage to the fetus during childbirth and in the most early dates child's life;
• 3) forms acquired in the process of development of a disabled person as a result of diseases, injuries, other events that led to a permanent health disorder. Acquired Disability divided into the following forms:
  • a) disability due to a general illness;
  • b) disability acquired in the course of labor activity - as a result of a labor injury or occupational disease;
  • c) disability due to military trauma;
  • d) disability associated with natural and man-made emergencies - radiation exposure, earthquakes and other disasters.

There are forms of disability, in the origin of which hereditary and other (infectious, traumatic) factors interact. In addition, it is often not so much the objective state of his health that makes a person disabled, but rather his inability (due to various reasons) of himself and society as a whole to organize the full development and social functioning in the conditions of just such a state of health.

Considering disorders of the musculoskeletal system, it should be noted that the pathology of the musculoskeletal system may be the result of a congenital defect, the consequences of injuries, degenerative-dystrophic changes in the musculoskeletal system.

In accordance with the International Nomenclature of Disorders, Disabilities and Social Insufficiency, movement disorders are presented quite differently. Allocate movement disorders:

• due to the complete or partial absence of one or more limbs, including amputations;
• due to the absence of one or more distal parts of the limbs (finger, hand, foot);
• due to the absence or violation of voluntary mobility of four limbs (quadriplegia, tetraparesis);
• due to lack of or impairment of mobility lower extremities(paraplegia, paraparesis);
• due to impaired voluntary mobility of the upper and lower limbs on one side (hemiplegia);
• due to impaired muscle strength of the lower extremities;
• in connection with a violation of the motor functions of one or both lower extremities.

The consequence of these violations is the limitation of life in the field of self-service and movement.

All causes of disability (both congenital and acquired) can be divided into medical and biological, socio-psychological, economic and legal.

Medico-biological causes are in the formation of pathologies. Among them, the main places are occupied by:

• pathology of pregnancy;
• consequences of injuries (including birth);
• poisoning;
• accidents;
• hereditary diseases.

The reasons for the formation of pathologies also include poor organization of medical care:

• irregularity of examinations by specialists;
• Most often, disabled people are not covered by medical examination due to mental and nervous diseases;
• there is no systematic supervision by doctors;
• there are no specialized medical institutions- departments rehabilitation treatment, rehabilitation centers;
• the severity of the pathology.

Among the biological reasons, the age of the parents, especially the mother at the birth of a child, is of primary importance. Among the socio-psychological causes of disability are:

• a) low educational level of parents, their low literacy in matters of upbringing and education;
• b) poor living conditions (lack of sufficient communal amenities in everyday life, poor sanitary and hygienic conditions).

Socio-psychological reasons can be family, pedagogical, household, etc.

Among economic and legal reasons disability, low material well-being of the family, ignorance and practical non-use of their rights to receive one or another type of benefits, allowances, provision by health care and social protection institutions of the necessary amount of medical and social assistance to people with disabilities are essential.

Lagging income levels behind the rising cost of living, lower consumption standards, protein and vitamin deficiency experienced by certain segments of the population directly affect both the health of adults and especially the health of children, making it difficult to correct the development of those who need enhanced care, additional help for their medical, psychological, pedagogical and social rehabilitation. Lack of skills healthy lifestyle life, poor nutritional standards, the use of alcohol substitutes also adversely affect health. There is a direct and significant correlation between socioeconomic difficulties and the increase in disability.

As a result of transport injuries, an unprecedented number of residents die, while the number of those who lost their health is many times higher. Military conflicts also result in massive disability of both direct participants in hostilities and the civilian population.

Thus, for our country, the problem of providing assistance to people with disabilities is one of the most important and relevant, since the growth in the number of people with disabilities acts as a steady trend in our social development, and so far there is no data indicating a stabilization of the situation or a change in this trend.

Provisions on the protection of the rights of persons with disabilities are also contained in many international instruments. The integrative of them, covering all aspects of the life of persons with disabilities, are the Standard Rules for Ensuring Equal Opportunities for Persons with Disabilities, approved by the UN in 1994.

The philosophy of these rules is based on the principle of equal opportunity, which assumes that persons with disabilities are members of society and have the right to remain in their communities. They must receive the support they need through the regular systems of health, education, employment and social services. There are 20 such rules in total.

Rule 1 - increasing understanding of issues - provides for the obligation of states to develop and encourage the implementation of programs aimed at increasing the understanding of persons with disabilities of their rights and opportunities. Increasing self-reliance and empowerment will enable persons with disabilities to take advantage of the opportunities available to them. Increasing understanding of the problems should be an important part of educational programs for children with disabilities and rehabilitation programs. Persons with disabilities could help raise awareness of the problem through the activities of their own organizations.

Rule 2 - medical care - prescribes the adoption of measures for the development of programs for the early detection, assessment and treatment of defects. Disciplinary teams of specialists are involved in the implementation of these programs, which will prevent and reduce the scale of disability or eliminate its consequences; to ensure the full participation in such programs of persons with disabilities and their families on an individual basis, as well as organizations of persons with disabilities in the planning and evaluation process.

Rule 3 - rehabilitation - involves the provision of rehabilitation services to persons with disabilities in order to enable them to achieve and maintain an optimal level of independence and functioning. States are required to develop national rehabilitation programs for all groups of persons with disabilities. Such programs should be based on the actual needs of persons with disabilities and the principles of their full participation in society and equality. Such programs should include, inter alia, basic training to restore or compensate for lost function, counseling for persons with disabilities and their families, developing self-reliance, and providing, as needed, services such as expertise and referrals. Persons with disabilities and their families should be able to participate in the development of programs aimed at changing their situation.

States should recognize that all persons with disabilities who require assistive devices should be able, including financially, to use them. This may mean that assistive devices should be provided free of charge or at such a low cost that persons with disabilities and their families can afford them.

The following rules form the standards regarding the removal of barriers between the disabled person and society, the provision of additional services to persons with disabilities that would allow them and their families to realize their rights.

Thus, in the field of education, states have recognized the principle of equal opportunities in primary, secondary and higher education for children, youth and adults with disabilities in integrated structures. Education for the disabled is an integral part of the general education system. Parents' groups and organizations of the disabled should be involved in the education process at all levels.

A special rule is dedicated employment - States have recognized the principle that persons with disabilities should be able to exercise their rights, especially in the field of employment. States should actively support the inclusion of persons with disabilities in the free labor market. This active support can come through a variety of activities, including vocational training, setting incentive quotas, reserving or targeted employment, providing loans or subsidies to small businesses, special contracts and preferential rights to production, tax incentives, contract guarantees or other types of technical or financial assistance businesses employing disabled workers. States should encourage employers to take reasonable steps to create appropriate conditions for persons with disabilities, to take measures to involve persons with disabilities in the development of training programs and employment programs in the private and informal sectors.

Under the income support and social security rule, states are responsible for providing social security to persons with disabilities and maintaining their income. States should take into account the costs often incurred by persons with disabilities and their families as a result of disability, and provide financial support and social protection to those who take care of the person with a disability. Welfare programs should also stimulate the efforts of persons with disabilities themselves to find work that would generate income or restore their income.

The Standard Rules on Family Life and Personal Liberty provide for the possibility for persons with disabilities to live with their families. States should encourage family counseling services to include appropriate services related to disability and its impact on family life. Families with disabilities should be able to use patronage services, as well as have additional opportunities for caring for people with disabilities. States must remove all undue barriers to individuals wishing to either adopt a child with a disability or provide care for an adult with a disability.

The rules provide for the development of standards that ensure the involvement of persons with disabilities in cultural life and participation in it on an equal basis. The standards provide for the adoption of measures to provide people with disabilities with equal opportunities for recreation and sports. In particular, states should take measures to ensure that persons with disabilities have access to places of recreation and sports, hotels, beaches, sports arenas, halls, etc. Such measures include support for recreational and sporting staff, projects to develop methods for access and participation of persons with disabilities, information and training programs, promotion of sports organizations that increase opportunities for the participation of persons with disabilities in sports activities. . In some cases, such participation is sufficient merely to ensure that persons with disabilities have access to these activities. In other cases, it is necessary to take special measures or organize special games. States should support the participation of persons with disabilities in national and international competitions.

In the area of ​​religion, the standard rules are intended to encourage measures aimed at ensuring the equal participation of persons with disabilities in the religious life of their common.

In the area of ​​information and research, States are required to collect regular statistical data on the living conditions of persons with disabilities. Such data can be collected in parallel with national population censuses and household surveys, and in particular in close collaboration with universities, research institutes and organizations of persons with disabilities. This data should include questions about programs, services, and usage.

Consideration should be given to the establishment of databanks on persons with disabilities, which would contain statistics on available services and programs and on various groups of persons with disabilities, the need to protect the privacy and freedom of the individual should be taken into account. Programs should be developed and supported to study the social and economic issues affecting the lives of persons with disabilities and their families. Such research should include an analysis of the causes, types and extent of disability, the existence and effectiveness of existing programs and the need for development and evaluation of services and assistance measures. It is necessary to develop and improve the technology and criteria for conducting surveys, taking measures to facilitate the participation of persons with disabilities themselves in the collection and study of data. Information and knowledge on issues relating to persons with disabilities should be disseminated to all political and administrative bodies at the national, regional and local levels. The Standard Rules define the policy and planning requirements for persons with disabilities at the national, regional and local levels. At all stages of decision-making, organizations of persons with disabilities should be involved in the development of plans and programs concerning persons with disabilities or affecting their economic and social situation; the needs and interests of persons with disabilities should be integrated into overall development plans where possible, rather than considered separately.

The Standard Rules state that States are responsible for establishing and strengthening national coordinating committees or similar bodies to serve as national focal points for issues relating to persons with disabilities.

The Standard Rules recommend that, economically and otherwise, encourage and support the creation and strengthening of organizations of persons with disabilities, their families and/or advocates, and ensure that organizations of persons with disabilities have an advisory role in decision-making on matters relating to persons with disabilities.

States have a responsibility to ensure adequate training at all levels of personnel involved in the design and implementation of programs and services relating to persons with disabilities.

Special aspects of the standard rules are devoted to the responsibility for the ongoing monitoring and evaluation of the implementation of national programs and for the provision of services aimed at ensuring equal opportunities for persons with disabilities, as well as other provisions.

The years that have passed since the adoption of the standard rules, the analysis of the experience of their application, the achievements of democratic, humanistic development have made it possible to raise international legislation on the rights of persons with disabilities to a new level.

On the basis of the Decree Documents, the Council of Europe adopted an Action Plan to Promote the Rights and Full Participation of Persons with Disabilities in Society: Improving the Quality of Life of Persons with Disabilities in Europe, 2006-2015. It reaffirms the universal, indivisible and interrelated nature of all human rights and fundamental freedoms and emphasizes the need for persons with disabilities to be able to enjoy them (rights and freedoms) without any discrimination. The share of people with disabilities in the population of Europe is estimated at 10-15%, while it is noted that the main causes of disability are diseases, accidents and the disabling living conditions of older people. It is predicted that the number of people with disabilities will constantly increase, also due to the increase medium duration life.

The main areas of activity are: the participation of disabled people in political and public life, in cultural life; information and communications; education; employment, vocational guidance and training; architectural environment; transport; life in the local community; health protection; rehabilitation; social protection; legal protection; protection from violence and abuse; research and development, awareness raising.

The main purpose of the Disability Action Plan is to serve as a practical tool for developing and implementing effective strategies to ensure the full participation of people with disabilities in society.

Analyzing the content of modern documents regulating the obligations and technologies of the activities of states for the realization of equal rights and opportunities for people with disabilities (persons with disabilities), we can conclude that the result of major political, economic, social and technological changes recent years is a radical transformation of public consciousness and, at the same time, a global change in the paradigm of social policy towards disabled people: the transition from the concept of "patient" to the concept of "citizen".

Development of information and communication technologies, changes in demography and social relations, legislative framework and the mentality of the population lead to the fact that the processes of social exclusion that affected people with disabilities (as well as representatives of national minorities, migrants, the poor, etc.) are considered as reversible. The integration of people with disabilities is now interpreted not as the inclusion of some separate part into a single whole, but as the integration of people with disabilities and society. The understanding of the activity of providing social support measures to the disabled as a one-way public charity, albeit comprehensively regulated by law, is gradually being overcome, and the task of the state is now considered to be the creation of conditions so that all categories of people, with all special needs, can freely and equally exercise their universal rights. .

Attitudes towards people with disabilities are changing: now they are perceived not as patients in need of care who do not contribute to social development, but as people who need to remove barriers that prevent them from taking their rightful place in society. These obstacles are not only of a social, legal nature, but also of the rudiments of attitudes that still exist in the public mind towards the disabled only as victims of biological and social inferiority. It is characteristic that European parliamentarians, despite the developed ideas and effective technologies of complex social rehabilitation, which proved their effectiveness during the second half of the 20th century, still consider it relevant to stimulate the transition from an outdated medical model of disability to a model associated with the implementation of a complex of social human rights. . It can be briefly formulated that the strategy of isolation and segregation is being replaced by a strategy of social inclusion - this implies not only inclusive education, but in general inclusive social functioning.

The transformation of the paradigm of the patient into the paradigm of a citizen assumes that the basis for providing all the necessary types of support is not a diagnosis, not a list of existing disorders and methods for their medical correction, but an integral person whose rights and dignity cannot be diminished. As a result, since the last years of the XX century. Until now, in many European countries, such a transformation of social policy towards people with disabilities is taking place, which allows a person with disabilities to control his own life and act as the main expert in evaluating social support measures and social services organized by public administration and local self-government.

The Action Plan identifies groups of people with disabilities who are particularly in need of equal opportunity services: women (and girls) with disabilities; people with complex and complex disabilities who need a high level of support; elderly people with disabilities.

The main principles that should guide all decision-making bodies and developers of programs for the social inclusion of people with disabilities are:

• prohibition of discrimination;
• equality of opportunity, full participation of all people with disabilities in society;
• respect for differences and attitude towards disability as part of the inherent diversity of humanity;
• dignity and personal autonomy of persons with disabilities, including freedom to make their own decisions;
• equality between men and women;
• the participation of people with disabilities in all decisions that affect their lives, both at the individual level and at the level of the whole society, through organizations representing them.

Of great importance for the implementation of the rights of persons with disabilities belongs to the Convention on the Rights of Persons with Disabilities, adopted by the PLO General Assembly on December 6, 2006, as well as the European Social Charter, revised on May 3, 1996, to which Russia has also joined.

Both of these international instruments emphasize the importance of disability issues as an integral part of relevant sustainable development strategies.

For our country, the problem of providing assistance to people with disabilities is one of the most important and relevant, since the growth in the number of people with disabilities acts as a sustainable trend in social development, and so far there is no data indicating a stabilization of the situation or a change in this trend.

In addition, the general negative characteristics of the processes of population reproduction, depopulation processes, and a decrease in the birth rate make high demands on the social and labor resources of the future. Disabled people are not only persons in need of special social assistance, but also a possible significant reserve for the development of society. It is believed that in the first half of the XXI century. they will make up at least 10% of the entire workforce in industrialized countries Comprehensive rehabilitation of children with disabilities due to diseases of the nervous system. Guidelines. - M.; SPb., 1998. - T. 2. - S. 10.

Rice. 1. The scheme of socialization of the disease

In this way, defect or deficiency (impairment)- it is any loss or anomaly of psychological, physiological, or anatomical structure or function. The disorder is characterized by loss or deviation from the norm, which may be temporary or permanent. The term "impairment" refers to the presence or appearance of an anomaly, defect, or loss of a limb, organ, tissue, or other part of the body, including the mental system. A violation is a deviation from a certain norm in the biomedical state of an individual, and the definition of the characteristics of this status is given by medical specialists who can judge deviations in the performance of physical and mental functions, comparing them with generally accepted ones.

Life restriction(disability) is any restriction or absence (as a result of impairment) of the ability to carry out activities in a way or within the limits that are considered normal for a person of a given age. If the violation affects the functions of individual parts of the body, then the limitation of life activity refers to complex or integrated activities that are common to an individual or an organism as a whole, such as performing tasks, mastering skills, behavior. The main characteristic of disability is the degree of its manifestation. Most people involved in providing assistance to people with disabilities usually base their assessment on the gradation of the severity of the restriction in the performance of actions.

Social insufficiency(handicap or disadvantaged) - these are the social consequences of a health disorder, such a disadvantage of a given individual, arising from a violation or limitation of life, in which a person can only perform a limited or completely unable to perform a normal role for his position in life (depending on age, gender). , social and cultural status).

Thus, this definition follows from the modern concept of WHO, according to which the reason for the appointment of disability is not the disease or injury itself, but their consequences, manifested in the form of violations of the psychological, physiological or anatomical structure or functions, leading to disability and social insufficiency (social disability). maladaptation).

Basic concepts.

1. Disabled- a person who has a health disorder with a persistent disorder of body functions due to diseases, the consequences of injuries or defects, leading to a limitation of life and causing the need for his social protection.

2. Disability- social insufficiency due to a health disorder with a persistent disorder of body functions, leading to a limitation of life and causing the need for social protection.

3. Health- a state of complete physical, mental and social well-being and not merely the absence of disease or anatomical defects.

4. health disorder- physical, mental and social ill-being associated with the loss, anomaly, disorder of the psychological, physical, anatomical structure and (or) function of the human body.

5. Disability- deviation from the norm of human activity due to a health disorder, which is characterized by limited ability to carry out self-service, movement, orientation, communication, control over one's behavior, training and work.

6. Degree of disability- the magnitude of the deviation from the norm of human activity due to a violation of health.

7. Social insufficiency- social consequences of a health disorder, leading to a limitation of a person's life and the need for his social protection or assistance.

8. Social protection- a system of state-guaranteed permanent and (or) long-term economic, social and legal measures that provide conditions for disabled people to overcome, replace (compensate) life restrictions and aimed at creating equal opportunities for them to participate in society with other citizens.

9. Social assistance- periodic and (or) regular activities that contribute to the elimination or reduction of social insufficiency.

10.Social support- one-time or episodic short-term events in the absence of signs of social insufficiency.

11. Rehabilitation of the disabled- the process and system of medical, psychological, pedagogical, socio-economic measures aimed at eliminating or possibly more fully compensating for life limitations caused by a health disorder with a persistent disorder of body functions.

The purpose of rehabilitation are the restoration of the social status of a disabled person, the achievement of material independence and his social adaptation.

12. Rehabilitation potential- a complex of biological and psychophysiological characteristics of a person, as well as social and environmental factors that allow, to one degree or another, to realize his potential abilities.

13. Recovery prognosis - estimated probability of realization of the rehabilitation potential.

14. Specially created conditions labor, household and social activities - specific sanitary and hygienic, organizational, technical, technological, legal, economic, macro-social factors that allow a disabled person to carry out labor, domestic and social activities in accordance with his rehabilitation potential.

15. Profession- the type of labor activity, occupation of a person who owns a complex of special knowledge, skills and abilities acquired through education, training. The main profession should be considered the work performed by the highest classification or work performed for a longer period of time.

16. Speciality- type of professional activity improved through special training, a certain area of ​​work, knowledge.

17. Qualification- the level of preparedness, skill, degree of fitness for work in a particular specialty or position, determined by rank, class, rank and other qualification categories.

Social protection and social and economic support of the population are integral factors of any normally functioning social system.

Social assistance in maintaining the physical life of people, meeting their social needs, existed already in the initial period of human development and was carried out on the basis of customs, norms, traditions, and rituals.

With the development of civilization, technological progress and culture, the disintegration of family, kinship and community ties, the state increasingly actively assumed the function of a guarantor of human social security. The formation and development of a market economy led to the allocation of social protection of the population in an independent activity, which has acquired a new meaning.

The system of social protection, as practice shows, is involved in the market system and is its integral element. Through it, the principle of social justice is realized. Social support for those who objectively do not have the opportunity to secure a decent standard of living is, in essence, the necessary payment for the possibility of entrepreneurial activity and income generation in a stable society.

The objective reality, determined by the logic of the development of market relations, highlights the formation of a scientifically based system of social protection and social support for the population, its most vulnerable strata. The need to create this system is due to a number of factors. One of the fundamental factors operating within society and determining the content of social support for the population is "a certain system of property relations and rights." It is private property that determines, according to Hegel, the independence of civil society from the state, makes a person a full-fledged subject and guarantees necessary conditions his social life.

With the change in the forms of ownership, the dismantling of the system of distribution of material goods and services begins. New relationships are formed between members of society, which they enter into in the process of appropriation. Relations of appropriation in the narrow sense should be understood as the relationship of people to the conditions of production and material goods.

The emergence of new forms of ownership of the means of production leads to the problem of their alienation. This problem is directly closed on the category of satisfaction of human needs (material, social, economic, spiritual, cultural, etc.), on the expression of the interests of the individual. Here we are talking primarily about wages, the level of which must be sufficient to ensure the reproduction of the labor force.

In the conditions of market relations, a person can ensure the satisfaction of his needs only by receiving income from property or in the form of wages for his work.

However, in every society there is a certain part of the population that does not have property and is not able to work due to objective reasons: illness, disability due to old age or age that does not allow a person to enter the sphere of production relations (children), the consequences of environmental, economic, national, political and military conflicts, natural disasters, obvious demographic changes, etc. These categories of the population will not survive without the protection and social assistance of the state, when capital is increasingly becoming the main factor of production and distribution.

“The state is objectively interested in supporting socially vulnerable segments of the population for several reasons:

• 1) a state that has proclaimed itself civilized is guided by the idea of ​​humanism and is obliged, according to the Universal Declaration of Human Rights, “to ensure a decent standard of living for the population”;
• 2) every state is interested in the expanded reproduction of skilled labor;
• 3) socio-economic support for the poor levels the economic condition of various groups and strata of the population, thereby reducing social tension in society” Karelova G.N., Katulsky E.D., Gorkin A.P. and others. Social Encyclopedia. - M: Bolyi. Ros. Ents-ya, 2000. - S. 148 ..

That is why market relations inevitably give rise to their opposite - a specialized institution of social protection of the population. The system of social protection involves, first of all, the protection of constitutional human rights.

The development of a civilized market can only be carried out normally together with the expansion and deepening of social protection.

“In a broad sense, social protection is the policy of the state to ensure constitutional rights and minimum guarantees to a person, regardless of his place of residence, nationality, gender, age, otherwise all constitutional rights and freedoms of the individual need social protection - from the right to property and freedom of entrepreneurship to personal integrity and environmental safety” Dictionary-reference book on social work / Ed. E.I. Single. - M.: Lawyer, 2004. - S. 212 ..

A narrower concept of social protection is that “this is an appropriate policy of the state to ensure rights and guarantees in the field of living standards, satisfaction of human needs: the right to minimally sufficient means of subsistence, to work and rest, protection from unemployment, health and housing, for social security in old age, illness and in case of loss of a breadwinner, for the upbringing of children, etc.” Dictionary-reference book on social work / Ed. E.I. Single. - M.: Lawyer, 2004. - S. 145.

The main purpose of social protection is to provide needed help a particular person in a difficult life situation.

Life requires new economic approaches in order to strengthen the social security of citizens. It is necessary to create legal and economic conditions for:

• - Ensuring a decent standard of living through their work;
• - the use of new incentives for work and economic activity: entrepreneurship, self-employment, ownership, land, etc.;
• - creation of civilized income distribution mechanisms (stock and other forms of participation of the population in the distribution of profits, social partnership, non-state social insurance, etc.);
• - formation of an economic system of self-defense and equalization of starting opportunities for this on the basis of civil law.

The state participates in the mechanism of free enterprise by its economic policy. The economic policy of the state is part of its general policy, a set of principles, decisions and actions aimed at ensuring the optimal functioning of the market mechanism with the greatest economic efficiency.

At the same time, the state is called upon to influence the competitive system of the market by economic methods. At the same time, the economic regulators themselves should be used very carefully, without replacing or weakening market incentives.

The social orientation of the economy is expressed, first of all, in the subordination of production to the consumer, the satisfaction of the social needs of the population and the stimulation of these needs. At the same time, it presupposes the necessary redistribution of income between the more affluent and less affluent segments of the population, the accumulation of funds in the budgets of different levels and various funds for the provision of social services to the population and the provision of social guarantees.

The influence of economic factors on social well-being, the satisfaction of the needs of members of society in the transition to market relations is extremely increasing. The degree of satisfaction of the needs of a person, various strata of society, as you know, is the main criterion for the economic efficiency of social work.

Social needs are affected by the volume and structure of production, the size and sex and age composition of the population; its social structure and cultural level; climatic, geographical and national-historical conditions of life; changes physiological characteristics person.

The effective demand of the population depends on the size of the distribution of the national income, the monetary incomes of the population and their distribution among social groups, prices for goods and services, commodity funds, and the size of public consumption funds.

An analysis of the change in these factors reveals the reasons for the growth of social tension: a drop in production in general and consumer goods in particular; unfavorable demographic situation - aging of society as its consequence; structural changes in the economy and the reduction of the army, leading to an expansion of the unemployment base; inflation and depreciation of savings of the population; an increase in the cost of energy carriers, provoking an increase in the cost of utilities, transport, etc.

It is important to note that capitalism has learned to combine the market and social protection through the development and implementation of economic policy, having gone through several stages of this interaction.

The period of classical liberalism is characterized by the dominance of free competition. The main goal of production during this period was to maximize profits, and the individual was seen as an "economic man". The state pursued a policy of non-intervention in the economy.

It was a period of flourishing entrepreneurship and rejection of political reforms, a period of flourishing of the bourgeois-parliamentary system and bourgeois "freedoms" in the economic sphere. Charity (and this was the basis of social work) was mainly done by devout people, guided by the ideas of altruism and philanthropy.

“The idea of ​​economic liberalism as a consistent and comprehensive political and economic concept was developed by A. Smith. He actively supported the put forward slogan "Laisser faire" - "do not interfere with action": full scope for private initiative, the release of economic activity from state tutelage, the provision of conditions for free enterprise and trade. Proclaimed "equality of opportunity" agents of commodity-capitalist production" Karelova G.N., Katulsky E.D., Gorkin A.P. and others. Social Encyclopedia. - M: Bolyi. Ros. Ents-ya, 2000. - S. 320 ..

The consumer has sovereign power; the demand that he makes in the market, like a ballot dropped into the ballot box, forces the entrepreneur to reckon with his desires.

The function of the state was limited to the protection of private property of citizens and the establishment of a general framework for free competition between individual producers.

In the 20th century, with the entry of capitalism into a monopolistic stage, the concept of "neoliberalism" arose: the mechanism of one market creates the most favorable prerequisites for efficient economic activity, regulation of economic and social processes, rational distribution of economic resources and satisfaction of consumer demands.

Like A. Smith, "neoliberalists" believed that a free economic policy should be governed by moral norms of personal and social responsibility in the traditional religious concepts of charity. But assistance must be rational, with clearly defined goals and expected results.

By the 30s of the XX century. it became clear that it was necessary to introduce some restrictions on personal freedoms and abandon the policy of free competition.

After the crisis of the 1930s, the so-called "Keynesian" period began, when society recognized the need for state intervention in the market economy, the need for social protection of the poor: the state has the right and should intervene in the redistribution of income in the direction of social protection of the poor.

The influence of J. M. Keynes on public opinion turned out to be the strongest. His main work is “The General Theory of Employment; percent of money” (1936) showed that government measures are necessary to meet the modern needs of society: a satisfactory level of prices and employment should be established through state regulation, state policy.

Thus, the period of Keynesianism is characterized by the fact that the state assumes responsibility for providing social assistance, although it is bureaucratic in nature.

The post-Keynesian stage came after World War II and was characterized by the concept of the "social market economy". One of its authors, L. Erhard, put forward a model of social protection of the population based on a strong social policy.

Unlike Keynesianism, social protection is implemented not by state-bureaucratic methods, but through a policy aimed at creating conditions that allow a person to earn his own living and, moreover, aimed at increasing the number of owners.

The process of recognizing the fact that the state should level the unfair market regulation of incomes ended with the expansion of the economic functions of the state, which was actively involved in the redistribution of incomes.

In the mid-70s, a new stage began, characterized by the aging of the population in developed countries.

The idea of ​​a "welfare" state was a resounding success as a means of social planning and innovation in the 1950s and 1960s. But this idea did not allow solving many economic and social problems that arose acutely in the 70-80s, namely:

• - constantly high level of unemployment in many countries of the world;
• - strengthening of migration processes;
• - serious changes in the social stratification of society;
• - Falling birth rate, population aging and much more.

This led to the need to revise the entire system of protection of the population, the adoption of the concept of social innovation, which is based on the joint actions of the central government, local authorities, and the public.

Thus, in a society of market relations, there is objectively a part of the population that is not capable of providing itself with a decent life. The main prerequisites for the need for social protection of the population in a market economy society are dictated by the laws of the market, stem from its essence and determine the formation of a social protection system as a specialized public institution. Social protection of the population is becoming an essential part of the economic and social policy of the state.