And causing the need for his social. Employment of disabled people in Russia

Chapter 1.: General provisions of the social protection of the Russian Federation

In Russian legislation, the definition of disability is based on the model of disability recognized by the state.

In Soviet times, the concepts of "disabled" and "disability" were defined based on the economic model. So, according to Art. 18 of the Law of the USSR "On State Pensions" of 1956, disability is a permanent or prolonged loss of ability to work.

In the 1990s, the definition of disability in the legislation changed due to the influence of the medical and social model of disability. The definition of the term “disabled person” was enshrined in the USSR Law “On the Basic Principles of Social Protection of Disabled Persons in the USSR” (Article 2): “a disabled person is a person who, due to the restriction of life due to the presence of physical or mental disabilities, needs social assistance and protection” .

The development of the medical and social model in Russia was influenced by a review published in 1993 by M.V. Korobov "International classification of disorders, disability and social insufficiency and the possibility of its use in practical medical and social expertise", in which the author proposed to use this classification to clarify the criteria for disability, determine the needs of people with disabilities in rehabilitation measures and evaluate the effectiveness of its results.

Finally, the medical and social approach in the definition of the concept

"disabled person" was enshrined in the Federal Law "On the Social Protection of the Disabled in the Russian Federation". In accordance with Art. 1 of this Law, a disabled person is a person who has a health disorder with a persistent disorder of body functions, caused by diseases, the consequences of injuries or defects, leading to a limitation of life and causing the need for his social protection. According to the same article, disability is a complete or partial loss by a person of the ability or ability to carry out self-service, move independently, navigate, communicate, control their behavior, learn and engage in work.

In 1997, by the Decree of the Ministry of Labor and social development The Russian Federation and the Order of the Ministry of Health of the Russian Federation approve the Classifications and time criteria used in the

medical social expertise, which became the basic document serving the Decree of the Government of the Russian Federation of August 13, 1996 No. 965 “On the Procedure for Recognizing Citizens as Disabled”.161 Classifications and criteria used in the implementation of medical and social expertise, which were approved in 2009163 (Classifications and criteria), are in force. They are based on the same principles and approaches as the previous Classifications. Thus, Russian legislation is based on scientifically developed and accepted by the international community medical and social models of disability.

After the adoption of the Federal Law "On the Social Protection of the Disabled in the Russian Federation", a new definition of the concept of "disability" was introduced, which was contained in the Classifications and temporary criteria adopted in 1997 used in the implementation of medical and social expertise. According to clause 1.1.2. of these Classifications, disability is a 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.

630, these Classifications were canceled, there is currently no legal definition of the concept of "disability" in Russian legislation.

Definition of disability in modern legislation can only be identified through a consistent analysis of legal norms. From paragraph 4 of Art. 3 of the Federal Law “On the Fundamentals of Social Services for the Population in the Russian Federation” dated December 10, 1995 No. 195-FZ, it follows that disability is a difficult life situation, objectively disrupting the life of a citizen, which he cannot overcome on his own. However, this definition does not capture the essence of disability.

The concept of “disabled person” currently enshrined in legislation corresponded to the international documents that existed at the time of its introduction, since the general methodological basis for defining this concept both in the Federal Law “On the Social Protection of Disabled Persons in the Russian Federation” and in the World Program of Action for Disabled Persons and in the Standard Rules for Ensuring Equal Opportunities for Persons with Disabilities was the MCS adopted in 1980. However, after the adoption of the ICF in 2001 and the Convention on the Rights of Persons with Disabilities in 2006, the definition of the concept of “disabled person” contained in Russian legislation is outdated and no longer corresponds to modern international acts, since it does not indicate such an element of disability as the inability to adapt the external environment to a disabled person. In this regard, the development of a new definition is currently very relevant.

Considering the issue of introducing a new concept into the legislation

"disabled", it is necessary first of all to dwell on the terminology used. In Russia, the Latin word “invalid” is used to designate persons with significant health impairments, which means “unfit” in translation. In Russian, this word appeared in the 18th century. in relation to military personnel who, as a result of injuries, did not allow them to support and serve themselves. In the 19th century All persons who have lost the ability to support and serve themselves due to a health disorder began to be classified as disabled.

In modern scientific and socio-political literature, there is a tendency not to use the term "disabled" to refer to people with health problems, explaining this with ethical considerations. There is an opinion that this word offends dignity, discriminates against rights, inspires the idea of ​​one's own inferiority and thus hinders the normal formation of personality. The term "disabled person" is being intensively replaced by the terms "person with handicapped"(sometimes "... health" is added), "a person with disabilities", "a person with visual impairments (or other impairments)", etc. For example, the First International Festival of Young Disabled People, held in Moscow in 1992, proposed the term

“disabled person” should be replaced by the concept of “disturbed condition”, since there are no people called disabled, but there are people with various physical, mental, etc. states.

The debate about replacing the word "disabled" with other terms is not new. In the 1930s, the Soviet medical community discussed the question of whether this term should be used, and such names as “limitedly able-bodied”, “persistently disabled”, etc. were proposed.

Since this trend can be reflected in legislation, it is necessary to dwell in more detail on the use of relevant terms.

The term "person with disabilities" is the Russian translation from English of the North American term "people with disabilities". This term does not reflect the specifics of the state of a citizen, because it does not determine in what sphere of life a given person has limited opportunities (in health, commercial activities, creativity, opportunities for prestigious recreation, etc.).

The terms "a person with disabilities", "a person with disabilities", "a person with visual (hearing, etc.) impairments" reflect the specifics of the state of a citizen, but the Latin term

"disabled" allows you to form a generalizing noun - disability, which is impossible when using the above terms.

The term "disabled person" most clearly conveys the essence of the phenomenon in comparison with other terms in the Russian language. Therefore, its replacement is especially unacceptable in the legislation, since legal technique requires clarity and uniformity of the terminology used.

The proposal by Yu.V. Ivanchina to exclude the term “disabled person” from the circulation of the Labor Code of the Russian Federation and replace it with the terms “capacity for work” and “incapacity for work.” Firstly, such an innovation would contradict the rule on the use in labor law of the concepts of other branches of law in the same meaning that is attached to them “ parent industries.

Secondly, the concept of "disabled" is broader than the concept of "disabled", since it covers both temporarily disabled persons and persons with permanent disability. The Labor Code of the Russian Federation171 (Labor Code of the Russian Federation) provides for a number of benefits directly for disabled people (who can conditionally be classified as persons with permanent disability) (Articles 92, 94, 96, 99, 113, 128, 179, 224). Usage general concept“disabled” will not allow to single out this category and additional definitions will have to be introduced (temporarily disabled, permanently disabled, etc.).

Thirdly, as noted above, it is wrong to equate disability and incapacity for work. Not every disabled person can be recognized as disabled. In the Classifications and criteria used in the implementation of medical and social examination of citizens by federal government agencies medical and social expertise, three degrees of limitation of the ability to work are established (clauses “g” of clause 6):

I degree - the ability to perform labor activities in normal working conditions with a decrease in qualifications, severity, tension and (or) a decrease in the volume of work, the inability to continue working in the main profession while maintaining the ability to perform labor activities of a lower qualification under normal working conditions;

II degree - the ability to perform labor activities in specially created conditions using auxiliary technical means;

III degree - the ability to perform labor activity with significant assistance from other persons or the impossibility (contraindication) of its implementation due to existing limitations of life.

As an example, consider the case of determining the degree of working capacity of a disabled person with no lower extremities who is a programmer. This disabled person can work full time at home or in the office and does not require specially created working conditions. Therefore, he cannot be recognized as disabled, based on the specified Classifications and criteria, although he is undoubtedly disabled.

Thus, labor legislation should contain special legal norms that ensure the exercise by disabled people of their right to work (rules on limiting the involvement of disabled people in night work and overtime work, the preferential right to remain at work when the number or staff of employees is reduced, etc. ). Based on the analysis carried out, it is not possible to differentiate the legal regulation of the labor of disabled people without using the term "disabled person".

The concepts "disabled" and "disability" cannot be regarded as equivalent due to the fact that "one of them characterizes the subject, personality, and the second - a special state of health or even a social category." Thus, both concepts should be defined in the legislation.

In order to bring Russian legislation into line with the Convention on the Rights of Persons with Disabilities, in March 2014, amendments were prepared to the Law on the Social Protection of Persons with Disabilities, according to which the definition of the term “disabled person” is supposed to be reworded: “a disabled person is a person who has health disorder with a persistent disorder of body functions due to diseases, consequences of injuries or defects, disorders anatomical structure organism, its organs and systems, leading to a limitation of life and causing the need for its social

protection." However, the proposed changes, in our opinion, do not solve

the problem of compliance of the considered international documents. The new legal concept of "disabled person" must meet the following requirements:

1. The definition must use the terms contained in the ICF.

2. The definition should indicate that the impairment of a person's health entails both a limitation of his opportunities and the social limitations that this person faces. It is advisable to define the limitation of opportunities with the help of the phrase "restriction of life", and social limitations - with the help of the phrase "reduced adaptability to the social environment", the use of which indicates the need to adapt to the disabled environment.

3. Since, from the point of view of law, a person becomes disabled after being recognized as such by competent specialists, this should also be recorded in the definition. The need to reflect this circumstance in the definition, in particular, is indicated by S.Yu. Golovin 174 and V.S. Tkachenko.

In view of the foregoing, the following definition can be given: a disabled person is a person who has a change in health established by the conclusion of a medical and social examination due to a persistent impairment of the functions and systems of the body, leading to a limitation of life, expressed in the complete or partial loss of the ability to independently carry out domestic, social and professional activities , as well as to reduce adaptability to the social environment and causing the need for its social protection.

The concept of "disabled" defines a person with certain properties. The concept of "disability" should reflect the properties of a person defined as a disabled person. Therefore, based on the formulated definition of "disabled person" for fixing in regulatory legal acts

the following definition of "disability" can be proposed: disability is a change in human health due to a persistent violation of the functions and systems of the body, leading to a limitation of life, expressed in the complete or partial loss of the ability to independently carry out domestic, social and professional activities, as well as to reduce adaptability to social environment and causing the need for its social protection.

This data should include questions about programs, services, and usage. Consider establishing databanks on persons with disabilities, which would contain statistical data on the services and programs available, as well as on the various groups of persons with disabilities. At the same time, it is necessary to take into account the need to protect the privacy and freedom of the individual. Develop and support programs 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. 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. At all stages of decision-making, organizations of persons with disabilities should be involved in the development of plans and programs relating to persons with disabilities or affecting their economic and social status, and the needs and interests of persons with disabilities should, if possible, be included in general development plans, and not considered separately. The need to promote the development of programs and activities for people with disabilities by local communities is specifically stipulated. One form of such activity is the preparation of training manuals or lists of such activities, as well as the development of training programs for field staff.

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. 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. Despite the elaboration of these international documents, they do not fully reflect the essence and content of such broad and complex concepts as "disability", "disabled person". In addition, social changes that objectively occur in modern societies or are reflected in the minds of people are expressed in the desire to expand the content of these terms. Thus, the World Health Organization (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 in a way that is considered normal for the average person;

♦ difficulty arising from the above disadvantages, which completely or partially prevents a person from performing a certain role (taking into account the influence of age, gender and cultural affiliation) 1 ..

An analysis of all the above definitions allows us to conclude that it is rather difficult to give an exhaustive presentation of all the signs of disability, since the content of the concepts opposite to it is rather vague in itself. Thus, the allocation of medical aspects of disability is possible through the assessment of loss of health, but this latter is so variable that even reference to the influence of gender, age and cultural affiliation does not eliminate difficulties. In addition, the essence of disability lies in the social barriers that the state of health erects between the individual and society. Characteristically, in an attempt to move away from a purely medical interpretation, the British Council of Disabled Associations proposed the following definition: "Disability" is a complete or partial loss of opportunities to participate in the normal life of society on an equal footing with other citizens due to physical and social barriers. "Disabled" - persons who have 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 social protection. 2.

International public opinion is increasingly asserting itself in the idea that full-fledged social functioning is the most important social value of the modern world. This finds its expression in the emergence of new indicators of social development used to analyze the level of social maturity of a given society. Accordingly, the main goal of the policy towards the disabled is recognized not only as the most complete restoration of health and not only providing them with the means of life, but also the maximum possible recreation of their abilities for social functioning on an equal footing with the rest of the citizens of this society who do not have health restrictions. In our country, the ideology of disability policy has developed in a similar way - from a medical to a social model.

In accordance with the Law "On the Basic Principles of Social Protection of the Disabled in the USSR", a disabled person is a person who, due to the restriction of life due to the presence of physical or mental disabilities, needs social assistance and protection "3. Later it was determined that a disabled person is a "person who has a health disorder with a persistent disorder of body functions, caused by diseases, the consequences of injuries or defects, leading to a limitation of life and causing the need for his social protection" 4 ..

Decree of the Government of the Russian Federation of January 16, 1995 No. No. 59, the Federal Comprehensive Program "Social Support for the Disabled" was approved, consisting of the following federal target programs:

♦ medical and social expertise and rehabilitation of the disabled;

♦ scientific support and informatization of the problems of disability and the disabled;

♦ development and production of technical means of rehabilitation to provide disabled people.

Currently, the world's disabled people make up approximately 10% of the population, and the fluctuations in different countries are quite significant. Yes, in Russian Federation, officially registered and registered persons with disabilities make up less than 6% of the population 5

while in the US - almost a fifth of all residents.

This is, of course, not due to the fact that the citizens of our country are much healthier than Americans, but to the fact that certain social benefits and privileges are associated with the status of disability in Russia. Persons with disabilities strive to obtain an official status of disability with its benefits, which are essential in the face of a shortage of social resources; the state, on the other hand, limits the number of recipients of such benefits by fairly strict limits.

There are many different causes of disability. Depending on the cause of occurrence, three groups can be conditionally distinguished: 6 a) hereditarily conditioned forms; b) associated with intrauterine damage to the fetus, damage to the fetus during childbirth and in the most early dates child's life; c) acquired in the process of development of the individual as a result of diseases, injuries, other events that led to a permanent health disorder.

Paradoxically, the very successes of science, primarily medicine, have their reverse side in the growth of a number of diseases and the number of people with disabilities in general. The emergence of new medicinal and technical means saves people's lives and in many cases makes it possible to compensate for the consequences of a defect. Labor protection is becoming less consistent and effective, especially at non-state enterprises - this leads to an increase in occupational injuries and, accordingly, disability.

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. Disabled people are not only citizens in need of special social assistance, but also a possible significant reserve for the development of society. It is believed that in the first decade of the XXI century. they will make up at least 10% of the total workforce in industrialized countries 7 and not only in primitive manual operations and processes. Understanding social rehabilitation also passed its own quite substantial way of development.

Rehabilitation is aimed at helping the disabled person not only to adapt to his environment, but also to have an impact on his immediate environment and on society as a whole, which facilitates his integration into society. The disabled themselves, their families and local authorities should participate in the planning and implementation of rehabilitation measures 8 . From the point of view of L.P. Khrapylina, this definition unreasonably expands the obligations of society towards the disabled, while at the same time not fixing any obligations of the disabled themselves "to perform their civil functions with certain costs and efforts" 9 .. Unfortunately, this one-sided emphasis remains in all subsequent documents. In 1982 The United Nations adopted the World Program of Action for Persons with Disabilities, which included such areas as:

♦ early detection, diagnosis and intervention;

♦ advice and assistance in the social field;

♦ special education services.

At the moment, the final definition of rehabilitation is the one adopted as a result of the discussion in the UN of the Standard Rules for the Equalization of Opportunities for Persons with Disabilities cited above: Rehabilitation means a process aimed at enabling persons with disabilities to achieve and maintain optimal physical, intellectual, mental or social performance by providing them with the means to change their lives and expand their independence.

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 medical and labor examination service into a medical and social examination.
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 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 ITU services and employees of TSIETIN, as well as representatives public organizations disabled people, doctors of medical institutions, scientists of 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 methods for assessing disability in the implementation of medical and social expertise, which are presented in these guidelines.

1. Basic concepts
1.1. A disabled person is a person who has a health disorder with a persistent disorder of body functions, caused by diseases, the consequences of injuries or defects, leading to a limitation of life and causing the need for his social protection.
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 health disorder, 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 the disabled - a system of medical, psychological, pedagogical, socio-economic measures aimed at eliminating or possibly more fully compensating for life restrictions 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 - a kind of labor activity (occupation) 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 work of the highest qualification or more long 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 realize 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 possibility 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, assistance 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 in 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 (entry, exit, movement inside the vehicle).
The ability to move independently is carried out due to the integrated activity of many organs and systems of the body: musculoskeletal, 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 assistive devices with a longer expenditure of time, fragmentation of performance and a reduction in distance.
The ability to move independently when using auxiliary means 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. Learning Ability- 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 assistance of other persons (except for training personnel);
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) learning 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 team.

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 - ability to orientation, 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 features personality.
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 assistance 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. If control over one's behavior is violated, a person's ability in his actions and 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 standards, to observe the established public order, personal cleanliness, order in appearance others
- 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.

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, 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 unable 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 state policy to ensure rights and guarantees in the field of living standards, satisfaction of human needs: the right to minimally adequate 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 goal of social protection is to provide the necessary assistance to 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 in the budgets of different levels and various funds of funds to provide the population with social services and providing 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 national income, cash incomes of the population and their distribution between social groups, prices for goods and services, commodity funds, 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 to solve many economic and social problems, which 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 protecting 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.

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, this name was given to servicemen 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. Persons who do not have external differences from ordinary people, but suffer from diseases that do not allow them to function in various areas of life as they do healthy people. For example, a person suffering ischemic disease heart, unable to perform heavy physical work, but mental activity can 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 performing 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 a consequence 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 performance social roles; in emerging constraints (not all desirable roles can be performed satisfactorily); in the complete absence of opportunities for adequate 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 social adaptation, based on sociopathy or behavioral disorders, and people with psychosomatic deviations.

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 assigns 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 some 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 social protection tools for people 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 the 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 other social groups of the 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 disabled from childhood, war disabled, labor disabled, disabled common disease;
• 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 Group III(able-bodied in gentle 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, slightly or moderately pronounced disorder of body functions caused by diseases, the consequences of injuries or defects, leading to a mild or moderately pronounced limitation of any category of life activity or a combination of them.

• 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 roughly 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 earliest stages of the 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 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 the absence or impaired mobility of the 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 population in the required amount of medical and social assistance to people with disabilities are essential.

Lagging income levels behind the rising cost of living, lowering 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, make it difficult to correct the development of those who need enhanced care, additional assistance 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 stable 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 - awareness raising - 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 to increase understanding 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. The implementation of these programs involves disciplinary teams of specialists, 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 process of planning and evaluation of activities.

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, reserved or earmarked employment, loans or subsidies to small businesses, special contracts and preferential production rights, tax breaks, contract guarantees, or other types of technical or financial assistance to businesses employing workers with disabilities. 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 encourage measures to ensure equal participation of persons with disabilities in the religious life of their community.

In the field of information and research, States are obliged to regularly collect 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 need to protect the privacy and freedom of the individual when considering 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. 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 status; the needs and interests of persons with disabilities should be integrated into overall development plans where possible, rather than considered in isolation.

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 persons with disabilities in the 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 objective 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 demographics 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 regarded 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 suggests that the basis of the activity to provide 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 and social services organized by state and local governments.

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 General Assembly of the PLO 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 nervous system. Guidelines. - M.; SPb., 1998. - T. 2. - S. 10.