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Sectoral Session D-3 Tuesday, September 6 16:00 - 17:30



Chairperson: Dr Hana Hermanova Regional Officer for Elderly,Disability & Rehabilitation (WHO)
Co-chairperson: Dr. Yasufumi Hayashi Head, Department of Rehabilitation, Tokyo Metropolitan Geriatric Hospital (Japan)



Regional Officer, Elderly, Disability and Rehabilitation World Health Organization Regional Office for Europe, Copenhagen, Denmark

It is a great honour for me to have been invited to take part in this meeting. It is of great interest to me to hear the subjects you are discussing and to compare them with the very similar issues which concern most countries in Europe, particularly disability of elderly people, with subsequent loss of independence; possibilities of families, neighbourhood to assist a dependent elderly person; availability of compensating services (health, social) at the community level. In-patient care. Continuity of care. long-term care. Rehabilitation of elderly people. Financial/staffing implications, education and training of personnel.

General deliberations

WHO policy Health for All
"The World Health Organization launched a worldwide policy "Health for all by the year 2000"- The WHO Regional Office for Europe has a Strategy for Health for All, supported by thirty-eight regional targets. One of the targets (Target 2) "Add life to years" emphasizes health promotion in old age, another target (Target 3) "Better opportunities for disabled persons" aims at equalization of opportunities for disabled persons and their full participation.

Demographic and epidemiological studies carried out in different parts of the world, have shown decreasing functioning with advancing age in most elderly men and women. In some of them, the decreased functioning is due to a pronounced disability, and we can usually identify its etiology, either a chronic disease or consequence of an injury.

Most old people nowadays live in houses built several decades ago, but many live in houses built centuries ago? Who would have thought that the habit of building houses on several levels would have created so many problems for the residents of these houses a few decades or centuries later. If we want to assist the elderly who have lost their independence, we have to be familiar with the environmental pressures and tensions they are facing in their daily life.

We have to by fully aware of the thoughts and anxieties of the elderly and of their families as well. We have to be able to convey this wealth and breath of outlook to our students, so that they realize that a complexity of problems requires a great breath of outlook if solutions appropriate to the well-being of elderly people are to be found.

The capacity of our elderly patients and old people in general to overcome the complexities of life and the hostility of their environment is something constantly admired and something which we all have to cultivate ourselves, if we are going to overcome these problems in our own old age.

The dependent elderly: Implications for rehabilitation

Much of our present thinking is based upon research and human experience that occurred when there were fewer old persons, and when many case managements programmes of elderly disabled people were either individualized or at least small scale, often exempted from excessive administration and dependent on a dynamic enthusiastic leader. No wadays, the extent of the problem is much bigger, and we have to take into account how the large systems of health and social care actually perform.

The policy makers seem to be more concerned with the well-being of the elderly community, while the planners are more concerned with the well-being of individuals.

It is not true that large numbers of older persons are users of multiple services. The services we often associate with older persons, home maker, home help, meals on wheels, domiciliary nursing, special transportation, are used by less than 8% of persons aged 65+.

The requirement on any system created to serve the elderly is in the area of adequate case management. Adequate case management comprises the following basic capacities:

  1. case finding, in order to reach all people who need help;
  2. medico-social screening in order to respond to those who are in most need and can benefit most from the services;
  3. assessment, in order to understand the client as a whole person and be aware of all aspects of the client's situation (assessment of function; balance in the system "man-environment");
  4. motivation of client and care provider. Goal setting;
  5. planning of care;
  6. planning of maximization of the client's potential;
  7. care plan implementation (quality; without delay).
  8. Termination of services when they are not any more necessary.

In closing my contribution, I will leave you with this thought - "the efforts we devote today to assuring a better quality of life for our elderly will be the guarantee of our own happy and healthy future". (Hon. Th. Lavoie-Roux, Ministry of Health and Social Services, Quebec, 1987).

  1. Targets for Health for All. WHO Regional Office for Europe 1985
  2. WHO Technical Report Series No.668, 1981. Disability Prevention and Rehabilitation: Report of the WHO Expert Committee on Disability
  3. International Rehabilitation Medicine Vo1. 7/1985 No. 2 pp 45-92, and Vol 8/1986 No. 1. EULAR Publishers, Basel, Switzerland
  4. Periodical on Aging, Vol. 1, No. 1, 1984, New York, 1985
  5. The elderly in eleven countries - A sociomedical survey, Public Health in Europe 21, WHO/EURO, 1983
  6. Education in Care of the Elderly, Report on a Consultation, Thonex, November 1985
  7. WHO/EURO extract on approaches to multidimensional assessment of the elderly, based on consultations held on same topic in 1984, 1986 and 1987


Institution Senator Neumann Heim, F.R.G.

Every human being, including the disabled, is formed by their surroundings. For many disabled people with reduced mobility their home is the only environment they have. Living comfort therefore means quality of life. This comprises: independence, a feeling of security, and the possibility to satisfy personal desires and needs.
In order to secure these fundamental rights, the following four points have to be observed:

1. Respecting Personal Rights.
Many disabled people, especially with growing age, are depending on outside help and are liable to get under someone else's influence.
All disabled people must therefore have the possibility to decide for themselves whether they want to live together with other people or prefer to stay by themselves.

2. The Right of Self-Determination.
The right of self-determination and taking responsibility for themselves has to be respected in all fields of rehabilitation of the disabled. It is necessary to enable the disabled to participate actively in the decisions concerning their own environment. There is no other way of learning social responsibility again.

3. Maintaining Privacy.
The home of a disabled person has to secure a private and individual atmosphere. Disabled persons therefore have to have the possibility of maintaining privacy and deciding who may enter their living area. Disabled persons who are completely dependent on treatment as well as social care by others, should be able to decide when they wish to receive the care and how it could be done in the most appropriate way. Adequate nursing care has to be made available.

4. Improvement of the possibilities of participation in community life.
Active participation in community life requires access to a wider field of experiences and environment as well as the choice of ways and spheres of living. For many of the disabled the course of their life is primarily pre-conditioned by the type of their handicap. Conditions should be provided to extend their environments as optimally as possible. Furthermore the disabled should get access to new fields such as spending their leisure time.

These fundamental demands have been raised by the German Caritas Organization in 1979.

In the following the situation of the elderly disabled in the Federal Republic of Germany will be examined.

Every person's dream of growing very old is becoming more and more true. This makes the age pyramid rise considerably. The number of people advanced in years, i.e. 75 years old and older, was 1.4 million in 1950; in 1985 it was 4.2 millions with a decreasing total population. Today, for every 75-year old person there are 8.7 people in the ages of 20 - 60 years. Out of this group the nursing personnel for the disabled is recruited.

The Board of Trustees of the German Geriatric Aid Society has estimated that the number of people living at home will increase to 2.7 millions until 1990. Only 10% live in residential homes, 90% are cared for in their own houses; only 13% receive support by outside professional nursing personnel.

For the past four years, the Federal Ministry for Youth, Family, Women and Health in Germany has been carrying through a program on ambulatory services to people needing care. The program is based on the assumption that home care is more humane and less expensive than accommodation in a residential home. Staying in a nursing home, the disabled tend to change their sense of self-confidence and elderly persons get a negative selfesteem. In such a house independent persons become very dependent upon the rules of the organization. Disabled persons lose their familiar environment, the apartment with the interior they were used to, as well as the social contacts with neighbours and friends and all existing relationships. Having to get used to new ways of living, to other people and new surroundings, creates fear and insecurity.

The purpose of the government program is to support and stabalize the already existing potential of care through members of the family, neighbours and voluntary helpers by ambulatory services from social centers and additional rehabilitation aids, thereby securing that the persons needing care may stay at home permanently, or at least as long as possible.

Social centers offer services such as:
- public nursing care
- geriatric care
- family care
- neighbourhood care.

Their services are requested by relatives, doctors or social workers. Most of the social centers work from 0700 - 1700 hours, not including the weekend. Some federal states, such as Hamburg, meanwhile offer an emergency nursing service for the rest of the time in order to avoid emergency hospital admission just because of lack of nursing care.
In case of insufficient own funds of the disabled, payment of these services normally is taken over by public welfare.

Long-term, very intensive nursing care exceeds the possibilities of the social center. To relieve relatives and to prepare disabled persons for nursing care at home, they are admitted to a short-term nursing home with a residential environment in order to get trained to help themselves and to learn about rehabilitation measures. This short-term care proves to be an essential help in home-care. It closes the line of ambulatory services. The intensity of care of these guest patients is very high.

The majority of disabled elderly people want to stay in their own apartments and often accept deficiencies of furnishing. A particular handicap is the lack of mobility which leads to isolation and exclusion.

For the aged who are living alone, the market offers apartments which are suited for the disabled (wheelchair users). Depending upon the type of disability and the care a disabled person needs, continuous change and disruption of social contacts are unavoidable.

During the FIMITEC Congress in Hanover in May 1986, O. RandRinga from Norway reported about a "lifetime-apartment" accessible to the disabled. In Germany, a model "lifetime-apartment" with many different requirements is also under discussion.
The social welfare of the city of Stuttgart has facilitated the conception of service houses. In these apartments the disabled can live autonomously and individually required services are available.
Other service houses, as for instance in Bonn-Dottendorf and Hamburg, provide the disabled with an emergency call system the size of a match box, which enables them to call for help from the service station at any time.

The hospitals in the Federal Republic of Germany are often not sufficiently equipped for the care of the elderly disabled. The mostly young doctors and nursing staff have not made themselves acquainted with aging and disability, and a sick, old disabled person consequently means a psychical and physical strain upon them.

The German National Insurance Act differentiates between illness and the need for nursing care. The latter is not paid for by health insurance companies but by social insurance, and is limited. It is up to the doctor in charge to decide if and for how long he acknowledges and attests an illness of a disabled person who primarily needs nursing care. The severely handicapped and the elderly disabled receive an average hospital treatment of 35 days, other patients of 18 days.
In this case a day-care hospital would be required. The average stay there which also cares for the elderly disabled is about 18 days.

The patients are picked up at their homes in the morning and are brought back at night. Aside from medical treatment and nursing care they get physiotherapy, occupational therapy and speech therapy. The ergo- and hysiotherapists visit their houses and give advice to the disabled themselves as well as their family as far as the provision of aids, self-initiative and household training are concerned.

The social worker is available for family discussions. This type of rehabilitation close to the residence has proved to be successful.

Further alternatives for the elderly disabled are:

- a day-care nursing home which helps to relieve the relatives from their burden.
- day-care centers for mobile, independent, elderly residents and the disabled.
- gatherings of the elderly arranged by the parishes and welfare organisations.
- attendants for leisure time.
- delivery of one daily meal at home.
- bathing service.
- cleaning service, etc.

10% of the elderly and disabled persons live in special residential homes. These houses have more possibilities of accommodating the disabled according to their age. For the disabled, it is important that they can choose between single-bed or double-bed rooms. Sufficient medical, therapeutic and social services have to be offered. The disabled will decide for themselves, however, whether they accept this offer and take advantage of it. This requires continuous information, which also includes the preventive field. Preventive measures are an effective diet, sports for the elderly disabled, avoiding risks such as misuse of nicotine, alcohol and drugs as well as the training of an active mind. Especially the senses, perception, agility and creativity should be trained. This can be done playfully, thereby establishing good contacts to people of different age who are not disabled.

In old people's residential homes, great attention is given to mobility. German legislation meets these requirements by granting reduced taxi fare rates and free transportation in buses for the disabled. It is surprising how mobile many elderly disabled people get after being in a home for a short while, if the nursing personnel relieve them of their worries about basic nursing care. In the institution for the severely handicapped for which I was responsible in my capacity as medical doctor during the past 22 years, the presence and availability of medical care and treatment, as well as accurate nursing care, were essential for recreational activities up to journeys of 2 - 3 weeks with accommodation in hotels of no institutional nature.

Difficult situations arise in an institution where mentally confused and mentally retarded elderly disabled live together with mentally normal persons. They need regular daily care and training of orientation, memory, toilet training and hygiene and the same place and with the same staff. These abilities improved their balance and self-esteem, which lessened the rejection by the mentally healthy disabled.

Humane nursing care of the elderly, regarding all groups of disabled persons, is much more than mere support and care. Every human being has to die some day, including the disabled. Accompanying the dying is mostly an unsolved problem, with ambulatory persons as well as with in-patients. How to cope with dying and death has mostly been forgotten and excluded from life. Doctors and nursing personnel experience death as a failure for which they blame themselves, especially when they had a personal relationship with the disabled. Very often the last consequence will be admission to a hospital where the disabled die anonymously in unfamiliar surroundings, losing much of their dignity. Dying in the familiar environment of the family, the home, in the arms of a partner, are an essential part of the quality of life. Anyone engaged in the care of the elderly disabled should be aware of this.



Social Service Department, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan

1. Introduction
The Tokyo Metropolitan Geritaric Hospital (703 beds) was established in 1972 with the purpose of specializing in treatment of geriatric patients with semi-acute illnesses. It goes without saying that it has comprehansive Rehabilitation services.
I have been working as a social worker in the hospital since it's inception and my primary function is to deal with problems stemming from social needs of the patients. In reflection of the social trend of having more people enjoy longer lives, the number of elderly patients in their 70's through 90's has rapidly soared in the last 2 decades. This has created the particular problem for the elderly patients: their main problem and concern have become "where could I be cared for", meaning "where will I stay until my death". The longer life used to be equated with happy life in the past, but this no longer holds true with aged patients who could not expect to regain previous health.
Based on the analysis of several thousand cases which I have worked with in the last 16 years, I would like to discuss the issues regarding the particular social problems of the patients who have finished medical rehabilitation program in both acute phase and chronic phase of his illness.

2. Trend and philosophy of Rehabilitation programs for the aged in Japan
Rehabilitation programs for the aged showed a remarkable progress in 1970's when the rehabilitation staff expanded their scope to include aged patients whreas their primary target in the past had been physically disabled. I consider that there are three phases/steps in the development of Rehabilitation services for the aged.
The first stage was when rehabilitation staff (physiatrists, physical thera- pists, occupational therapist, just name a few) began to emphasize the effect of rehabilitation for the aged, followed by the second stage where patients began to have extremely high expectation for rehabilitation. In this second phase, the patient as well as family expected that if he received and get involved in "rehabilitation", he could regain all the faculty, and his disability and illness would be mended. This illusion had driven the aged patients to go after "rehabilitation" regardless of their own reality.
Currently, in the third stage, it is taken for granted that the aged patients are to be involved in Rehabilitation program through high expectation of the previous stage has subsided. Since treatment system for the aged has been well established, it has become a rule that unless the patient receives Rehabilitation services, his treatment plan is incomplete.
As a result, the sole purpose of Rehabilitation has become "self-help", and even a 100 year old patient is expected to be involved in the vigorus ( and often obsessive) programs aiming at better function of his body and mind. It is not uncommon for the patient to say "I am going to Rehabilitation" instead of "going to physical therapy room" which indicates that the broader meaning of "rehabili- tation" has been narrowed to the concept of "doing something for himself and by himself".
Consequently, regardless of ages of the patients, whether he is 90 or 100, "rehabilitation programs for him" must be added to the final treatment regimen. This is based on the assumption that "rehabilitation" is necessary to prevent him from being bed-ridden or degenerate into senile dementia.
I feel that this indicates the fact that people in the modern society are not able to accept the fact of inevitables such as "getting old" and "dying". In order to cling to their illusion that "life" could go on indefinitely, they not only ignore, but try to hide impending reality even from themsevles. This leads to the fact that as long as the aged person is well and functioning in the society he is accepted and able to live within his family or community, but once he becomes ill or disabled, he will be excluded and expelled from his environment. This imply that the concept of death itself is forgotton, or excluded from ordinary life.

3. Discharge plans for the patients who finished intensive Rehabilitation programs at the hospital.
When a patient finishes his rehabilitation program at the hospital following his illness which necessitated his hospitalization to begin with, he is ready to move onto the life outside of the hospital. There are three places where he can be discharged or transferred..
1)Home:his own home or his children's home
2)Nursing home:in case of patient in his old-old stage, he is most likely to be transferred to a rest home among chronic, bed-ridden and senile pateints even when he is alert if he is unable to move about.
3)Hospital specializes in geriatric care:This type will provide neither intensive medical treatment nor rehabilitation services which is essential in treating acutely ill, but accepts patients with chronic condition which requires minimal medical care. Some hospitals specialize in terminal care for geriatric patients are included in this category.
In planning discharge, it is necessary to consider his "place to live" might become his "place to die". It is often difficult, however, for both medical staff and family to face the fact as both live in the society which refuse to accept the hard fact.
According to the statistics of our hospital, approximately 90% of the patients return home upon initial discharge, but closer analysis indicates that as they repeat hospitalization, the chance of returning home become slimer. The statistics of my section shows marked increase in the number of patients unable to return home, and being transferred to other facilities, especially to geriatric hospitals. Most of the patients want to return home, but their wish is hard to be satisfied. My prediction is that this trend will continue to the forseeable future.

4. The factors in determining the place of discharge
The determining factors are 1)ability of the patient 2)ability of his family to take care of him 3)ability of people in the community and 4)combination of the above three. The ability of the patient means his activity in daily living, but more precisely, whether he is self-sufficient in caring for himself or not. A degree of dependence on medical care, nursing and care needs determine his ability. Ability of family means whether they could sustain and fulfill the aged patient's dependency needs. Factors determining ability of the family might be
1)whether family has key person, 2)his/her ability to care for the patient, 3) whether he/she has capacity to mobilize other relatives and summon their help. In addition, economic factors and living arrangement such as having and extra room for the patient contribute to the determining factors. Ability of the community means whether that community can provide support-system for the patient and his family. Broadly stated, acceptance of the community could be demonstrated by budget allocation and other social actions, but maturity of the community is also judged by it's willingness in extending helping hands.
In reality, however, the first factor, the ability of the patient himself, has little impact in determining the place of discharge. Except very few cases, the place of his discharge is determined by the concept of death that his family or those who have some influence over the family hold.
According to my own study on the physically disabled elderly and senile patients, the relationship between him and his family definetely plays a very significant role. Two factors, namely, strength of emotional bond between him and family, family's outlook and philosophy on aging and life/death questions seem to contribute to the choice of discharge plan (home or other hospital) and the quality of life that the patient leads after the discharge. My findings have been supported by the similar trend described in several articles in the journals of America and Europe.
Reasons given by families who refuse to take patient home are many. "He cannot walk" "unable to use bathroom""cannot leave him alone during my working hours" "Afraid he might fall and fracture again. Should continue rehabilitation so that he can walk without assistance" "His case is too serious to be looked after at home". They emphasize the seriousness of illness or disability, but I feel that the real reason lies somewhere else. To support my reaction, one family chose to care for him at home whereas another family decides to send him to a geriatric hospital when the patient's needs for care and family situation are just about equal. In case of latter family, they are not ready to accept the process of aging and death, thus insists upon his physical needs and disability, claiming their inability to cope with them.
Majority of old-old pateints want to return home with good reason. He wants to spend his final days among his family in familiar environment, his home and the place he had grown up in. However, along with advancement of medical care and services and socialization of death, the number of patients who are not able to return home are increasing.
The reason for rejection of elderly patient's wish to return home are many. Increase in nulear families, women's holding part-time jobs, seriousness of disability and illnesses of the elderly, under-developed support system to care for them at home are but a few. The biggest reason often recited is the lack of living space at home. I feel, however, that behind those explicit excuses lies an implicit message that says "we understand what those old folks want, but by providing good rehabilitation programs for them, we are doing our best under the circumstances" and hide themselves behind this false pretext. The following may illustrate the bases for my statement.
A 92 year old gentleman has become bed-ridden after a bout of pneumonia. His son in his late 60's asks if his father could get his weakened legs back to "normal" if he get "rehabilitation". Family members get panicky when the old man runs high fever or reports "feeling not good" as they fear his impending death. At the same time, they wish secretly of his death as it is natural feeling of the family. People involved in the situation such as relatives and neighbours as well as medical staff develop ambivalent feeling about the situation and feel confused. This might be the result of people having lost a concept of natural death and senile decay. This phenomena of people refusing to face the reality of aging and death could be pathological and unhealthy in avoiding reality.
How to fill the void left by the above pathology depends on the development of pertinent social support system which not only provide care for daily living, medical and nursing care, but also staffed with people who are willing to deal with the problems of aging and death, and help family deal with the issues also.

5. Conclusion
The patient in old-old stage will find it difficult to be self-sufficinet in terms of caring for himself. He is no longer able to function as a productive member of his family or society, and instead, needing care from others. It is important for family and society to find meaning and significance in the presence of the aging patient as his "being". The quality of the patient's life and his being will be impacted only when it is achieved. What I mean by "quality of life" is how he could acquire satisfaction and fulfillment in his "being". "The place of living" means where he resides such as home and community, and "satisfaction in living" should be found in his relationship with his family cultivated over the years in which his "mere being" could be accepted as significant.

In order to accomplish this goal, the following should be considered.
1)It is necessary to establish a rehabilitation program which includes the issue of death.
The existing program which aims at restoration of ability to the point of self sufficiecy ignores the inevitable reality of aging and death and encourage the illusion of eternal life. This might invite longer and unnecessary hospitalization with a false hope that continual treatment and rehabilitation will help restore life.
It is necessary to assess individual patient's physical, phychological and social function at the time of completion rehabilitation program and establish the future program based on the projection of the assessment. This program should take into the consideration of his final stage, death. This program will be used primarily for his family so that they could accept his natural process of aging and eventual death while acknowleding and fulfilling his psychological needs. This program will extend itself to the area of death education. It is necessary to develop a program which is created by patient, his family, medical and rehabilitation staff to see where the patient is in terms of his life stage, and by sharing accurate and shared information. It will best serve the pateint and of help to others who will work with him.

2)It is necessary to have a program that will help elderly patient to be independent.
In the field of rehabilitation, the physical autonomy, independence and self-sufficiency have been greatly emphasized. For example, the "highest" goal might be to walk, and whether he can go to the bathroom alone would become the most significant of his achievement. The pateints in old-old stage are in need of changing and shifting their self-image. Unless he can accept himself as "person who accepts from others" instead of prvious images of "person who gives to others" it will be extremely difficult for him to live comfortably. As long as he insists on his old self-image and that being supported by his family and society, it will be hard for him to find meaning of life when he is no longer able to function as such. The time has come to question what dose it mean for an elderly patient in his old-old stage to be "truly self-sufficient".


Director of Social Welfare, Hong Kong

In this 16th World Congress of Rehabilitation International and as very clearly indicated by the Conference Theme of "Realistic approaches, looking ahead towards comprehensive rehabilitation", rehabilitation is seen as a humanitarian task for mankind as a whole.

Population Trend

2. Demographic trends point to a significant aging of population over the next few decades. The most salient change in the current population structure shows that people over 60 years old are the fastest increasing segment of the population. With longer life expectancy and falling birth rates, Hong Kong, like many other countries, is experiencing a growing aged population, as illustrated by a 20-year projection of Hong Kong population below:

1986 1996 2006
Total population (in thousands) 5524.3 6134.6 6526.6
Population aged 60 years & over 640.3 901.1 1048.5
% of aged population 11.6% 14.7% 16.1%

The unprecedented fact that many more people can live to old age is one of the greatest triumphs of modern civilization. But this triumph also presents major challenges for the future. Thus, any key social and economic policies will inevitably have a direct impact on this very important part of our community, and this has aroused concern over the general welfare of elderly people, so as to better prepare and adapt society to the changing needs of its people.

Attitudes and Aging

3. It is difficult to make comparisons with practices and attitudes between countries in view of the diverse social, economic, political and historical backgrounds of the peoples involved. However, it is true to say that aging is a natural process which can be seen in different aspects, including the physiological, psychological and socio-economic changes of a person. "Aging" should not be regarded as a cause of death, a disease, or a generic form of disability. Indeed, the aged population by definition covers a wide and nonhomogeneous group of people with different needs. Those who face specific problems through frailty, need special care, additional to the general health protection.

4. In the context of extending the principles of rehabilitation to elderly people and to attain the golas of maintaining their well-being, significant questions must be asked and important issues addressed now. For example, fundamental questions about the way society views and treats its elderly members need to be asked: How are the rights of elderly people protected? How are social systems coping with the changing population pattern? What is the framework within the legal system of our respective societies to enable elderly people to enjoy life and participate fully in the activities of their society in which they live? Does the right framework exist for achieving humanitarian objectives for this vulnerable group of society? What are the services which are available to maintain an improved quality of life for the elderly people in our midst? These questions need to be asked so as:

  • To research into the needs of the elderly people and to stimulate awareness of these needs;
  • To promote the development of services and to encourage and design programs in anticipation of these needs;
  • To advocate and encourage at different levels and in a global sense, mutual co-operation and concern;
  • To share information and experience in order to strengthen different levels and modes of service;
  • To facilitate and improve the dialogue between different groups of society concerned with the promotion of the principles of social justice, equality, normalization, integration and choice.

5. Generally, under the principles of rehabilitation, the deliveries of services for elderly people have regard to the promotion of health, training and education; economic, social and cultural provision; support for community care in a proper way to enable an elderly person to feel valued, safe and wanted.

6. Of paramount importance, the promotion of geriatric health care services, both mental and physical, include early stages of diagnosis to facilitate the provision of preventive, curative and rehabilitative care. In this respect, the training of medical and paramedical staff, volunteers, and the elderly people themselves is a very important subject. Provision of public health services in all forms, from both the public and private sectors, involves the promotion of general knowledge on health for the elderly people. Promotion of knowledge can be done through the motivation of the media, through public and family life education and self preparation by the aged people for entering old age.

7. Based on the premise that an informed person is also the best able to protect his or her own rights, the elderly person needs to be given opportunities for training and re-training. Every effort should be made to render access to information both easy and understandable. Society should be provided with opportunities to sustain traditional and cultural values of respecting and caring for the elderly persons. It is often argued that elderly people deserve to be honoured and need to be accepted in society in dignity and with love; not only for their past contribution but also for the wealth of the experience which they can share with the younger generation. Elderly people willing and able to remain economically active should be assisted in training the younger generation, using the expertise gained by them through their many years of experience.

8. Pressures of industrialization and urbanization weaken, in some cases, the capacity of the family to provide economic support for its elderly members. Often elderly people, with possibly their diminishing roles in nuclear families, are finding it difficult to adjust to the ever changing environment, resulting in conflicts with their families or alienation from society. Their role and status are often downgraded even further by their decreasing economic activity. Poverty amongst edlerly people, particularly amongst older women, is a phenomenon which should invite the adoption of special measures to ensure that in their later years, these elderly people are not unfairly treated. To the extent possible, social security systems should accommodate elderly people, having regard to their different levels of ability to work. Discrimination, age-related punitive and or discriminatory levels of taxation should be eliminated. * (1) It rests with each society to provide community support to encourage the family unit to extend their loving support to elderly people. Also to provide these families with enhanced support systems for caring for elderly people and to assist them to retain self respect and remain in the community for as long as possible. Where necessary, residential care should be provided to suit the varying needs of elderly people.

9. The question of old age must never be used to disqualify old people on the basis of age from exercising their rights. Laws regarding consent should be judiciously carried out, and tests for competency of the frail and vulnerable should give the elderly person the maximum ability to participate in the decision making process. The right of freedom of choice and access to information should be guaranteed, so that the frail and the vulnerable may enjoy the protection as promulgated in the law of the land. * (2)

* (1) and (2) - ICSW Berlin Conference 1988 (Commission on The Elderly - A Challenge for Law)

The Hong Kong Perspective

10. In Hong Kong services the elderly people are expanded on a wide front, with the object of providing their welfare through care both in and by the community. * (3) We have accepted that there is a need, as in many countries in the West, for the community to take responsibility for the well-being of their elderly people in all aspects of living to enable them to retain their self-respect and to remain in the community for as long as possible. Where necessary, residential care is provided to suit the varying needs of this age group. Under the guiding principle of care in the community, our strategy has been three-fold: -

(a) to provide a range of community services and improve cash benefits that will encourage families to look after their elderly members, or which will enable old people to live on their own independently, and in dignity in the community for as long as possible;
(b) to provide residential institutional facilities for those who, for health or other reasons, can no longer live with their families or on their own; and
(c) to promote a better understanding of the process of aging so that old age can become a more positive and productive period, not only for the elderly themselves, but also for the community at large.
* (3) - 1979 White Paper "Social Welfare into the 1980's".

11. The services provided for elderly people can, in general, be grouped into the following categories: -

(a) Social Security;
(b) Community Support Services;
(c) Housing;
(d) Residential Services;
(e) Health Services;
(f) Other Support Services.

12. Government departments concerned include: Medical and Health Department for health services, Housing Department for housing, Labour Department for employment services and Municipal Councils for the provision inter alia of cultural and recreational services. The Social Welfare Department is the major Government department for the provision of planning and organization of home help, counselling services, day and residential care services and cash assistance in the form of Public Assistance, Old Age Allowance and Disability Allowance.

13. There are two social security schemes directly related to the needs of the elderly: the Public Assistance Scheme and the Special Needs Allowance Scheme, the rates of which are under constant review to maintain their purchasing power. The Public Assistance Scheme aims to bring the income of the needy individual or family up to a prescribed level at which essential basic needs can be met. The Scheme is means-tested and noncontributory. An old age supplement is payable to public assistance recipients aged 60 and over to meet the special needs arising from old age. Additional grants to cover certain expenses and additional disability supplement and long term supplement are also payable in certain circumstances. The Special Needs Allowance Scheme has two separate elements, an Old Age Allowance, a non-means-tested allowance to meet the additional needs of those aged 70 or over, and a disability allowance, a non-means-tested allowance to meet the additional needs of the severely disabled. These allowances are aimed at enabling the elderly people to be better accepted within their families in keeping with the principles of care in the community. In 1987 - 88, payment of Public Assistance to the elderly was $425 million, and the Special Needs Allowance was $838 million.

14. Apart from cash assistance to elderly people, the Social Welfare Department subvents a number of voluntary agencies to provide services for the elderly. (The subvention for elderly services in 1988 - 89 is estimated to be $152 million from a total estimated subvention of $788 million.) Additionally, a number of indigenous interest groups also fend for elderly people's interests.

15. Community support services include a wide range of home and centre-based services. Many of these services are aimed at enabling the elderly people to remain living in the community for as long as possible. Employment service is provided to assist those who are able and willing to remain economically active to seek appropriate forms of employment; transport service to meet the special transport needs of elderly people. Community education service is provided to promote a better understanding of care and concern about the needs of old age, to assist old people to adjust better to the process of aging and to foster the concept that old people are an integral part of the community who should be cared for in and by the community, and to promote mutual understanding between young and old. Through different forms of activities for elderly people (such as drama competition, dancing contest, public speaking, sports meeting), through publications and newsletters, the multi-faceted approach contributes to the overall well-being of the elderly people in our midst.

16. Additionally, specific forms of service have developed over the years with the aim of helping elderly people to cope with their different degrees of frailty.

Home Help: provides domestic help to those who cannot take care of themselves adequately and for whom help from family or friends is not available.

Day Centres

(a) Multi-service centres, where a full range of services such as home help, counselling, laundry, bathing and social activities are provided.
(b) Day care centres, which provide services for elderly people who, although still able to live at home with their families, require personal care and limited nursing service during the day.
(c) Social clubs and social centres, which provide social and recreational activities.

Volunteer Service: which motivates volunteers to visit elderly people living alone, to escort group outings or visits to doctors.

A Telephone Service: which provides information and regular contacts with home-bound elderly persons.

Residential care: which provides for those aged who for personal, social or health reasons, are in need of services in a residential setting. These include hostels, which provide communal living accommodation for old people, organized programs and supervisory staff round the clock, homes for the aged, which provide accommodation, meals and a limited degree of personal care, and care and attention homes, which provide, in addition to meals and accommodation, general personal care and limited nursing care. In the context of residential services, respite care is being introduced in Hong Kong to reinforce the concept of care in the community.

17. Where there is relationship problem, a counselling service is available to family members through a family services centre. Voluntary admission to elderly homes, where necessary, will also be arranged to emergency places provided in these homes as a temporary measure, while long-term placement or family reunion will be contemplated as the eventual solution to the problem. Most of these services are presently provided by voluntary organizations whose valuable contribution towards the well-being of the elderly people is widely acknowledged.

18. In Hong Kong, housing continues to be a priority commitment and the Housing Authority maintains a high level of production of public housing units each year. The efforts of the Housing Department in housing elderly people are through the provision of various types of public housing, e.g. small flats, single person accommodation, sheltered housing hostels, home-cum-care and attention units. To encourage care in the community and to provide adequate housing for elderly people who remain in the community, the Housing Department plans and runs inter alia, accommodation for elderly people who can look after themselves, for example, there is compassionate rehousing for elderly persons who have housing needs, there are priority schemes provided for families who live with their parents and in each of the new public housing estates with over 3,000 falts, a sheltered housing unit is included.

19. The effectiveness of services for the elderly relies on the concept of "care in the community", supported by the principles of rehabilitation and reinforced by the support of self, the family and the community as a whole. The opportunity, as provided by this Congress, is of great importance to provide a network through which people from around the world can come together to exchange views, to share expertise in theory and in practice so as to enhance the wellbeing of elderly people worldwide and to lay the foundation for new initiatives.

Sectoral Session D-4 Tuesday, September 6 16:00 - 17:30


Chairperson: Ms.Barbara Kolucki Media & Disability Consultant (Hong Kong)
Co-chairperson: Mr.Norio Umahashi Information Assistant, United Nations Information Centre (Japan)


Media & Disability Consultant, Hong Kong

People involved in Communications Theory tell us that exposure to the mass media shapes our beliefs about what the world is like (our "social reality"). In fact, we do know that children who watch, for example, a great deal of violence and aggression on television tend to believe that the world is a more violent and threatening place to live than do children who are infrequent viewers of these types of programmes.
Perhaps the same is true regarding the "social reality" about people who are disabled. If this is true, then our new and more positive "experimental" media approaches might change children's and adults' perceptions about people with disabilities. They might, as a result, come to believe that people with disabilities are more "like" and more "multi dimensional" than they previously thought. Stereotypes (those sometimes oversimplified or overgeneralized beliefs about a "group" of people) and therefore people's "social reality" are countered.
I mentioned children's television. There has been a great deal of research in this area of media. And since it is one of my major fields of interest and work, I would like to share one example (though there are many more) of a prosocial television series which modelled positive alternatives for children -- and was successful. The series was called "Freestyle" and was produced in the USA in the early 1980's. The programmes imbedded prosocial messages in compelling stories FOR children ABOUT children and USING children as the main actors (itself a winning format). The research indicated that children from both sexes and different SES backgrounds reevaluated the competance of children and adults in several non traditional activities. It CHANGED what the children believed to be true about their own world. "Freestyle" harnessed the magic of media to challenge and remake the cultural worlds - the social reality - of the audience.
We are here to talk about other media efforts -- those specifically aimed at promoting positive social integration of individuals who are disabled and not. This is still a new area -- it is and will continue to be "experimental". But there has been a great deal that has happened over the past ten years in both developing and more industrialized nations. The projects have varied and are a tribute to the many disabled and non-disabled people who have taken the time to learn about what can sometimes be a very frightening area.
We often, and necessarily hear that our media attempts -- be they ad campaigns, seminars or documentaries -- are unsuccessful. Then other times we hear how wonderful and helpful our efforts are. Which is it? Often too, when we get discouraged, we blame "the community"-- they are too narrow-minded or they don't care. Still more often, if we aren't the producers ourselves -- we blame the media.
But because we have these difficulties, it does not mean that we should stop trying. Change, especially positive change, as everything else in life -- takes time. My own experiences working in both children's television and public education proves this to be true. People who said it couldn't be done and then saw it being done are now the ones telling others to do it! (I will informally discuss SESAME STREET and Hong Kong/other Asian projects). And everyone here on the panel is here because of the perseverance and change that happened in their respective Countries. Each will talk about either individual/national/international efforts that have as their goal disseminating accurate, sensitive and timely information as well as dispelling myths and insensitive stereotypic beliefs.

Let us briefly review some of what we have learned through our successful efforts and our failures in this area. This list is by no means exhaustive. And numerous sets of Guidelines have been published throughout the world, particularly since IYDP. But these lessons have proven to be true in most cases in most countries for most media. It therefore behooves us to listen carefully and act accordingly in our future efforts:

1. The information MUST be of interest to the target audience. It must be professional (not synonymous with expensive), regardless of our budget and resources.

2. The information MUST be useful to the target audience. We all use what we need to use -- then either store or dismiss the rest. We have to provide our audience with the answers to "WHY do I need this information?" and "HOW can I use it?"

3. The information and the presenter(s) MUST be credible -- and understandable.

4. Do NOT model negative behaviours whenever possible -- especially with any media product for children. Research tells us that not only can people be turned off or insulted, but people often do not listen to the "don't " in our audio messages. (I will give an anecdotal example regarding children's television). The one possible exception to this rules is the use of humour -- but again -- only for adults.

5. Messages about prevention SHOULD stress preventing the disease, not the person. The images shown should be positive and life affirming -- not dehumanizing. (I will give an example from UNICEF regarding messages about the prevention of polio).

6. Whenever possible, multi-media is best. This simply means that a media presentation PLUS personal contact or at least a question and answer discussion usually yields the best results.

7. Do what the particular medium does best. For example, television can best provide entertaiment and create an alternative world or "social reality". But seminars do what real people do best -- they serve as personal guides to this new world of information and can help participants feel at home with the new information. Traditional folklore probably works best in places where there is limited visual literacy skills. None, however, are at their best when they simply instruct or sermonize.

8. Just as we have to be respectful and sensitive to people with disabilities, we must also treat the non-disabled public with respect and sensitivity. Their lack of knowledge, religious or cultural beliefs and their fears might be based on their own feelings about themselves. Developmental theory -- or helping others to realize that they can affect change in their own life -- can build many bridges.

9. People need to VISUALLY see that people who are disabled can grow and change. This is especially true in parts of the developing world where children and adults with disabilities have been hidden from mainstream life. It is important that people hear this message but it has greater impact when they see it. There is a quote from People First, a self advocacy group that is appropriate here: "People need to see that there is no sub-species here, that we are all multi-dimensional human beings, every last one of us."

10. Our MOST important guideline is this: Paraphrasing a statement from Project IMPACT- "People can develop without electricity. They cannot develop without real participation in decision-making." And here of course I am talking about the empowerment and decision-making of people who are disabled. They should be the spokespersons whenever possible. They should be the leaders whenever possible. They have been and can continue to be the best teachers -- the best media -- for social integration.

Let us now hear from my distinguished colleagues about their efforts using Mass Media as an Influence for Social Integration. I know many of them personally and am honored to share on this panel with them today.

Thank you.



Polish Society for Rehabilitation of the Disabled, Poland

By the mass media I am thinking of: the written world: books, periodicals and the press: the spoken word: radio, drawings, various forms of art and the spoken word accompanied by the pictures: TV, cinema etc.

For a long time the mass media have been interested in people with both physical and mental anomalies, their features and problems. They have done this in various ways depending on the accepted standards, values, customs, religions and living conditions. The ideas of the disabled and attitudes to them have been transmitted by way of social heritage and then through the mass media.

Initially, the ideas underlying the practice and theory of rehabilitation and the different ways of considering the abilities and features of the disabled occurring since 1940's and 1950's did not seem correctly understood by the mass media.

The information which the mass media transmitted about the disabled very often did not correspond with the purposes of rehabilitation and the achievement of the disabled in their private and collective lives. More often than not they were contradictory.

However, gradually, the situation changed when the writers, employees of the radio, television and artists obtained a closer knowledge of the lives of the disabled; their needs and the conditions which we should ensure them to make them able to function as well as the non-disabled. Then they gradually became our allies. Let us also add that we professionals understood better the style of work of the mass media, and this made cooperation easier.

The Warsaw Symposium on: "Mass Media and Disabled People" concentrated on two problems.

The first was the evaluation of the present engagement of the mass media in presenting the problems of the disabled, their methods of work and effects.

Secondly it was our intention to suggest ways for the mass media how best to present the problems of the disabled to the public in general and to specific social groups.

In evaluating the role of the mass media at the present time, we should point out the following issues:

1. They are a powerful tool in shaping the ideas and providing information about the disabled, their private lives, their position in society, and conditions which should be created for them.

2. (Though at present, to a much smaller degree.) The mass media, the press in particular, still employ stereotypes which echo the past. This is indicated by such article titles as "Help for the Week", or "Let Us Help the Unhappy".

3. Too often the mass media deal with dramatic situations, but, after all, such situations are characteristic of not only the disabled.

4. As a rule, they reproduce the current state, and do not always care for the effects of the presentation.

5. The problems of the disabled, as hardly attractive in the financial sense, is shown on television, e.g. at hardly popular hours.

6. The presentation of the problems of the disabled is more and more often the object of evaluation by the disabled persons, their parents and caretakers. This is a positive phenomenon.

7. The disabled persons are still presented in an extreme way. The mass media seldom penetrate the personal and unique contents of their lives in the same way as those of any other person.

8. The mass media limit themselves rather to the "typical" problems: school, work and forms of assistance to them; quite seldom do they discuss problems of family and personal life which are more subtle.

On the basis of the delivered lectures and the vivid discussions in two groups/the first - the book, the press, and the second - the radio, cinama and television/, we can formulate the following conclusions for the mass media:

1. The mass media will continue to play a very important role in the formation of ideas and supply of information about the disabled, Mainly in a popular way, they will pass expert knowledge to the general public or specific social groups. They will suggest to the non-disabled standards of behaviour towards the disabled, the conversely the disabled towards the non-disabled. But the information does not have an independent and direct effect. Its effects depend on the other concurring factors, such as the awareness of the disabled themselves, their the personnel engaged in rehabilitation services, the conditions of life, the views of scientific researchers and others.

2. To a greater extent than before, the mass media should discern the fact that disability is not always an objective state or the feature of an individual (that is a condition inherent in an individual). It also results from the relation between the disabled individual and the community.

3. We should not dramatize the physical and psychological features of the disabled which deviate from the norm. Instead, we should give reliable information. We should speak about the natural human situations of the disabled with which public opinion should identify itself - what is of interest are the situations in the family, school, among these of the same age, in work, in free time etc. The result of being treated normally result in normal behaviour.

4. There are more than expected problems which are common between the non-disabled and the disabled, indentical rather than different and specific. This follows from the everyday observation of investigations carried out systematically for many years, e.g. by the Department of Revalidation Pedagogy of the Pedagogical Faculty of Warsaw University. The former division into "us" and "them" was based on evaluating on the basis of one feature which was disability. The intellectual, volitical characteristics, or the character, or spirit, were hardly looked into.

5. It is necessary to show the competence of the disabled rather than their defects; demonstrate their results and achievements in different living situations, and illustrate that most of them are able to be responsible for themselves.

6. An open question is the choice of the most effective forms of presenting the problems of the disabled. If one is to use special programs, e.g., short or long films, or integrate the problems of the disabled into different other problems undertaken by the mass media. If we talk abut, e.g., the results of a production plant, factory, it is well-advised to say that also the handicapped work in it and that they make their contribution to the production level. We shuld assume the fact that the disabled live among us, and their problems are ours in everyday situations of living.

7. Opinion differs if one is to present the general problems of the disabled to the general public, or do so in terms of specific problems of particular grous of the disabled to the professionals. It is believed that in good conditions both forms give positive results.

8. An essential matter is to answer the question: who speaks, what does he say, by what means, to whom and with what result? Who is to present the problems of the disabled in the mass media? For centuries this has been the work of writers. As the radio and television emerged, journalists were mostly non-disabled people, and recently, more and more often the disabled themselves. And we should develop this trend, as it makes the message more authentic. The thing is to ensure that the receivers have confidence in the source of information.

9. We have little information on the effect of the mass media on the attitudes of the non-disabled to the disabled. Previous studies show that changes in the attitudes caused by the mass media are rather small. We should therefore concentrate on the behavior of the non-disabled to them and the conditions which should be created for the disabled - social, psychological, physical.

10. We also know little about the effect of the mass media on a change in the living situation of the disabled. Studies and analysis of this kind were carried out in particular on the effectiveness of the so-called "campaigns" and street collections for the disabled. The results of these studies are vary greatly from negative to positive.

11. Meeting the needs of the disabled is increasingly based on knowledge on the results of studies in medical, vocational and social rehabilitation, special education and the functioning of social organizations and other services supporting these basic actions. Both in Poland and abroad, the scientific developments are transmitted in different forms by the mass media to the general public and to particular professional groups. In this range, we note great progress and considerable engagement of many writers and journalists, but the effects of their work are hardly known. At the same time, general publicity must represent the essence of the matter. Unfortunately, it is not always so. In this presentation to the general public, they do not always show the heart of the matter, or the objective state of the things or the situational factors. We still come across such reported terms as "the people of the margin", "let us help the poor", "They are characterized by an inferiority complex" etc.

The believe that in this way they bring the problems of the disabled closer to the general public. It is not true. It only reinforces stereotypes. Instead of this, let us report the information: "he has had good results in school and work, he is socially active, his family lives a full life" etc. We should admit that both in the press, radio and television this positive trend seems to increase.

12. Rehabilitation services should co-operate closely with the mass media. In a purposeful and selective way they should pass the subjects to the appropriate media and discuss together the probable effects of the presentation of given themes.

13. Writers, journalists and artists should be invited to seminars and conferences devoted to the problems of the disabled. This will give them the opportunity to gain better knowledge of the problem rather than just passing data.

14. The language of the mass media should be unambiguous and exact. However, this depends on the kind of the mass medium.

15. There is a need for further studies on the information sources, ways of its transmission/form and content/, and the receiver reactions.

This would be immodesty if I were to evaluate the effect of the mass media on the development of rehabilitation and the position of the disabled in particular countries. We have no appropriate data to make such an evaluation. There is no doubt that the effect is quite considerable. To an increasing extent, the mass media are engaged in promoting the interests of the disabled and corresponding services in the developing countries. On the other hand, the picture is diverse.

For many years there has been specialization of some mass media in the specific problems of the disabled.


  • Desertine A.: Synthesis. General Report. In: Medias et Handicapes. Seminaire International sur le Representation Sociale des Personnes Handicapes et le Role des Medias. Paris, UNESCO, 25-28 Septembre, 1978.
  • Hulek A.: The Role of Mass Media in Rehabilitation of the Disabled. International Symposium on the Mass Media and Disabled People. Warsaw, 23-25 September, 1987.
  • International Round Table on the Subject: "How the Handicapped are Presented to the General Public". Held at UNESCO, Paris, 1 June, 1977. Annex to the Final Report.
  • Improving Communications about People with Disabilities. Recommendation of United Nations. Seminar 8-10 June, 1982. Vienua.
  • Radio and Television's Role in the Education of Handicapped Children in Japan. Japan Radio-TV Education Association. Tokyo, 1982.
  • Ruffner R.H.: Communications and Disabled People: The Role of the U.S. President's Committee on Employment of the Handicapped. In: Medias et Handicapes. Seminaire International sur le Representation Sociale des Personnes Handicappes et le Role des Medias. Paris, UNESCO, 25-28 Septembre, 1978.
  • Saint - Martin's Ph.: Final Report on International Round Table on the Subject: "How the Handicapped Are Presented to the General Public". Held at UNESCO House, Paris, 1 June, 1977.


Nippon Hoso Kyokai (Japan Broadcasting Corporation), Tokyo, Japan

Japan's Broadcast Law stipulates that NHK shall carry out its broadcasting in a manner that will enable it to be received all over the country in the cause of public welfare.
In this sense, NHK, Japan's sole non-commercial, public broadcasting organ, cannot exist without contributing to the improvement of public welfare.
At present, NHK is offering 3 radio and 8 TV programs on welfare and for physically-handicapped people.
But, the history of its welfare programs is in no way a long one when viewed from the standpoint of NHK's broadcasting history.
NHK started braodcasting 63 years ago, in 1925, and radio was the broadcasting medium used at that time.
On the other hand, it was in 1952, or after the end of World War Two, that NHK began to broadcast welfare programs.
This came 27 years after the start of NHK's broadcasting service. This means that NHK started offering regular welfare programs 7 years after the end of World War Two.
We had some reasons for a 27-year delay in launching welfare programs. The major reason was that before the start of the Second World War, welfare activities in Japan had been conducted as charity projects which were undertaken mostly by private volunteers.
In those days, the state played almost no role in social welfare projects. Today, the spirit of welfare for "assuring people an affluent life" is considered to be a prerequisite common to almost all countries. But, pre-war Japan had no such practice. Japan's surrenderin the last war left most Japanese people in a state of extreme poverty, but after the end of the war, the Japanese Government translated, for the first time, the spirit of welfare in to action under the name of the state.
Various welfare steps were taken during the first several years following the end of the war. Among them were the 1947 Children's Welfare Law assuring children's rights and welfare, the 1949 Law for the Welfare of Physically Handicapped which is designed to stabilize the livelihood of physically-handicapped people and to improve their welfare, and the 1950 Daily Life Security Law which assured the nation's people of a minimum standard of living.
With the promulgation of these three welfare laws, social welfare projects began to be undertaken as the responsibility of the state. The law which pledged it to make these efforts was the Social Welfare Project Law put in force in June, 1951. Responding to this move, NHK started a radio program titled "A handbook for social welfare" in January, 1952.
In those days, people were not accustomed to such phrases as social welfare or welfare projects.
So, this NHK program was aimed at explaining social welfare projects based on the three related laws, keeping people informed of the meaning of social welfare and helping them have a clearer understanding of such projects.
Under such circumstances, NHK took its first step in launching programs on welfare.
The program was initially designed to cover the whole nation, but the broadcasting medium for it changed from radio to TV with the passage of time. And, the title of the program and its content were changed to meet changing needs.
But, the aim of this broadcasting endeavor was to tackle from various angles welfare problems concerning physically-handicapped people, aged people, children and household matters in order to give people a better understanding of welfare problems as problems common to all Japanese adults.
This program has been on the air for the past 36 years, since 1952, and is now being broadcast over TV under the title "Tommorow's Welfare." We are now planning to change it for a new program.
Now, I wish to discuss welfare programs which have been put on the air as educational problems. NHK is broadcasting this kind of programs for two audiences. One is directed to households and the other to schools.
A program titled "A TV School for those with hearing and speaking troubles" began to be broadcast in 1961 for households (mothers and fathers) with physically-handicapped children. In those days, Japan had poor educational facilities for such children, both public and private, and both in quality and quantity, except in such heavily populated areas as Tokyo and Osaka. And, there was a need for providing households with troubles in rearing such children with some sort of educational information.
This program was started with the aim of serving this purpose. There was another similar TV program titled "A school for treating speaking troubles" which was started in 1966. It was intended for a household audience, especially for mothers with children with speaking troubles.
It was designed to give its audience basic knowledge about retarded development in speaking ability, abnormal pronunciation, hearing difficulties and the cleft palate, and related guidance. At present, a program titled "Counselling for children's development covering the contents of the programs just mentioned is being offered.
NHK is also offering a new welfare information program intended for the household audience.
This program, which started in 1984, is titled "Silver Sea." It is intended for households that have aged people needing a helping hand, or that have to take care of physically-handicapped people. The major reason for starting this program 4 years ago is the fast pace in the trend of aging populations seen in advanced countries. The speed of this in Japan in extraordinarily great, with Japan greeting an era of an aging society after a lapse of only 25 years as against more than one century taken by European countries in seeing such an era begin. (A related paper issued by the United Nations describes as an aging society one in which more than 7% of the total population is 65 years old or over.)
In 2020, or 32 years from now, 21.82, of Japan's population will be aged 65 or over. This percentage will be the highest in the world. We Japanese must make preparations for such a situation.
The ratio of such aged people is now steadily increasing in Japan, and the nation will have to face various unexpected problems at that time, including those of senile dementia and bed-ridden people. We started this program, thinking it necessary to make preparations mentally and help people develop a fund of knowledge for settling these problems.
These I have mentioned were programs intended for household consumption.
NHK makes other similar broadcasts. These are intended for school classes. A program title "A special TV school" was started in 1964, intended for primary school classes for physically-handicapped children and for mentally-retarded children attending protective institutions. This program is still being broadcast, being divided into two: one titled "A Cheerful Class" intended-for lowergrade classes and the other titled "Let's go out and do something" intended for higher graders. The "Cheerful Class" program is designed to encourage handicapped children to do personal chores by themselves in their daily life. And the "Let's go out and do something" program for higher graders is designed to help handicapped children to expand the scope of their daily life, and to give them some hints to help them solve problems by themselves when go out into the world.
In other words, the "Cheerful Class" is the basic part of the program and the "Let's go out and do something" is the application part of the program. It is being used at schools for learning through broadcasting.
Next, I wish to take up NHK programs intended for physically handicapped people themselves. Among such programs is a radio program titled "Together with Physically-handicapped people." It was originally started in 1962 under the name of "A special radio class." It was later renamed "For weak-minded children" and then "With weak-minded children."
Behind the change of the title from "--for" to "With--" was the fact that people's views about physically-handicapped people changed greatly during the period. Therefore, this program is aimed at probing into the way people who are not physically handicapped and those who are can live together, by taking up current problems concerning education, labor and livelihood and medicare for physically-handicapped persons.
Another program, "The time for blind people" which started in 1964, is a radio program designed to provide people with visual troubles with information on daily life and related topics. Such afflicted people now number 350-thousand. At the same time, it is a practical program to provide them with the latest information on three related treatments--acupucture, moxa cautery and massage--which are usually taken up in Japan as occupations for blind people.
For those with hearing troubles, NHK has a 10-year-old program titled "The time for people with hearing difficulties."
It provides various items of information useful for the daily life of people with these problems and related topics. In this program, NHK employs a method of "total-communication" production by using pictures of hand sign language, super-imposed subtitles, photographs and illustrations, capitalizing on the traits of TV broadcasting.
Furthermore, we are broadcasting tele-text and subtitled programs for those with hearing troubles, using multi channels.
The tele-text programs give information necessary for daily life and cover such programs as a morning serial drama which is put on the air daily by NHK from Monday through Saturday. This program is enjoying an audience rating of more than 40%. Another such program presented is a major period drama broadcast every Sunday evening. This program boasting an audience rating of more than 30% is one of the most-enjoyed TV programs in Japan. Tele-text broadcasting is used so that viewers can understand the outline of these popular TV programs.
Super-imposed subtitle programs cover four programs including the ones just mentioned and an animation program for children, titled the "Three Musketeers." Each part of these programs are given super-imposed subtitles for the convenience of those with hearing troubles. Of course, these services are offered free of charge.
Initially, tele-text and super-imposed subtitled programs were intended for limited areas, but the are now being enjoyed nationwide. These broadcasts are being made by utilizing the so-called New Media techniques which saw rapid development in recent years. In the future, it is believed that broadcasting services for physically-handicapped people will improve further through the use of such information and telecommunication means as word-processors or personal computers, as well as broadcasting employing New-Media techniques. In 1991, we will mark the 10th anniversary of the inauguration of the International Year of Disabled Persons. NHK is determined to renew its efforts to have these members of sciety live a more comfortable life through broadcasting. This is because a society in which physically-handicapped people can live comfortably must be also a comfortable one perhaps for all of us.
We shall be most grateful if NHK's experiences that I have mentioned here today would be helpful in some way or other to people in countries whose representatives are attending this meeting.


National Council for the Welfare of Disabled Persons Quezon City, Philippines

The existence of extensive media networks in the Philippines makes media a potent tool to prevent disability and help the disabled persons.
In its Profile of Media Penetration, the government's Philippine Information Agency (PIA) reported that in 1987 there were about 396 print media outlets dishing out publications in English, Pilipino, and various dialects; 329 radio stations, and 60 television stations. These media facilities are scattered all over the country's three main islands: Luzon, Visayas, and Mindanao.
The same PIA report showed that of the country's 9.8 million households, 70 percent own radio sets, and 30 percent have television sets. Although the study did not quantify the extent of print media penetration, there is no doubt that it is also substantive.
Mass media's role in Philippine setting is unique in the sense that it serves both as a source of information and as a link among the people in the country's more than 7,000 islands.
Cognizant of these realities, the National Council for the Welfare of Disabled Persons (NCWDP) has adopted a strategy designed to fully utilize media resources for the benefit of the disabled Filipinos. This strategy includes:

  1. Establishment of information networks in all 12 regions of the country Each network serves as the NCWDP's direct link with the existing media facilities within the region. Information from the NCWDP's main office in Manila for dissemination in the regional and provincial levels are channeled through its regional information network.
    Gathering of feedbacks on information being disseminated is also one of the responsibilities of the regional network. NCWDP-Manila formulates information dissemination approaches based on these feedbacks. In effect, the regional information network serves as a two-way channel of communication.
  2. Preparation and distribution of technical reports, brochures, magazines, fact sheets and other informative materials.
    NCWDP-Manila regularly comes up with informative materials for distribution to various media practitioners, social workers, rehabilitation centers, civic groups working for the disabled, coordinating government agencies, legislators and policymakers.
    These materials serve as reference materials for media practitioners on topics concerning disability prevention, rehabilitation, and other dis- ability related issues.
  3. Close linkages with media in Manila
    Since all national dailies and the main offices of the various media facilities are based in Manila, NCWDP had maintained close linkages with them. Up-to-date information, in the form of press releases, concerning disability are regularly distributed among the various media outlets.
    Our stories carried by the national media networks are usually picked up by other networks in the cities and provinces.

So far the results have been encouraging. Our efforts to generate nation-wide concern for the disabled persons through the use of media are paying off. Our people have begun to realize the urgency of helping the disabled people become productive and self reliant members of the community.
Yet so much remains to be done.
Right now, there is a need to further educate and inform the people of the issues about disability. This is where the continued use of media as a channel of information comes in. For how can we expect people to understand and to help, if they are unaware of the needs and the problems of the disabled persons.
Some people think that information concerning disability and the disabled population do not make good copy. Only crime, violence, business, politics do, they claim. I disagree. As a practicing journalist, I know that there are a lot of stories concerning the disabled persons that media could use. The rehabilitation centers, for one, are teeming with interesting stories.
The blind who makes earthenwares; the orthopedically-handicapped who crafts furniture; the armless who paints portraits with his foot; the suffering of a one-year old baby with severe burns all over her body; the young doctor who devotes his spare time to take care of the medical needs of the disabled; the nun or the social worker who selflessly attends to the routine needs of the handicapped-these are all very interesting stories. And they must be told so that others would know, understand, and inspired to help.
Media could not simply ignore stories of anguish, sacrifice, hope, courage, and success.
This brings me to a point I want to stress. It is not enough to provide media with technical information. We have to come up with well-crafted items that reflect the day-to-day struggle of the disabled people.
Also, we must take into consideration the fact that media's primary objectives is to sell. In order to sell, they need to come up with stories that are only relevant but interesting to the readers as well. To make media a partner in our mission, we need to meet certain standards in dishing out information for media to disseminate. The initiative should come from us, and not from media.
To be able to come up with a publicity program designed to effectively attain our objectives, research and extensive planning are necessary. Priority areas, target readership or listenership, the extent of exposure, and budgetary requirement must be clearly defined. Likewise, the feedback mechanism should be set to determine the results of the campaign and to see where improvements could be made. In short, every component that makes up for a successful publicity campaign should be taken care of.
Building up good relations with media is another part of the agenda. Public relations projects designed to give media practitioners or institutions appropriate recognition for their efforts in helping the disabled must be drawn up. Recognition could be in the form of awards and citations.
To enable media practitioners to gain first-hand knowledge of the world of the disabled people, it is advisable that they be invited from time to time to visit the rehabilitation centers, attend conferences, or better still join volunteer groups serving the disabled people.
Through this, a closer and more lasting relationship could be established.
In a society that has become dependent on information, media plays a crucial role. It helps shape public opinion that in turn influences government policy.
This is of paramount consideration specially in our country where several laws have yet to be passed to alleviate the plight of the disabled people. Policy makers and legislators must act to promote the rights of the disabled: their right to education, employment, and mobility; their right to fully develop their potentials as human beings, to enjoy the constitutional rights enjoyed by able-bodied citizens; their right to integrate themselves into the mainstream of society, to play meaningful roles in their communities, and to seek their own self-fulfillment and happiness.
The freedom that Philippine media now enjoys enables it to objectively assess controversial issues. It has the clout to criticize government policies, crusades for worthy causes.
Filipino media practitioners, although known for their incisive and hard-hitting commentaries, have often been involved in charity drives. The newspapers are replete with instances where a columnist appeals for help for individuals who are in dire need of help. Oftentimes, these appeals get enthusiastic response from the readers.
From this, one could see that the Philippine media is not only free, it has also a soft spot for the underdog - for the less privileged.
This is another welcome development for us who are working for the disabled people. We know that in our country, we have a willing ally in media. What we try to do now is to further strengthen that alliance so that we could pool our resources for the benefit of the disabled people.


United Nations Office at Vienna, Centre for Social Development and Humanitarian Affairs

It is my pleasure to extend cordial greetings to the participants at the 16th World Congress of Rehabilitation International and to congratulate its organizers for focussing attention on this important topic. I was asked to talk on Media and Disability with reference to the World Programme of Action concerning Disabled Persons (WPA). To be able to do this, I should define the media first to know to whom we are referring.

The term media signifies a means of transmission between two individuals, between an individual and a group (or vice-versa), or between two groups. The communication media have been powerful agents of social influence since human history started. The art of story-tellers, actors, or the puppeteer has always played an important role to record and preserve human history and culture and to define it, to inform people about its nature and developments. Modern media - television, radio, magazines, newspapers, films, books and theatre - still serve these ancient goals. The spread of media poses the problem of knowing which means and which terms to employ in order to be received and to make the connection, in our case media and disability, bearing in mind that social communication problems assume different forms in developed countries and developing ones.

In this regard, you might still remember the remarkable success of the 1981 International Year of Disabled Persons and the way it was perceived and supported by the mass media in many countries. In order to strengthen public awareness on disability topics in 1982, the United Nations General Assembly adopted the WPA (resolution 37/52) and declared at the same time the United Nations Decade of Disabled Persons, 1983-1992, which was reviewed at its mid-point during the Global Meeting of Experts which was held in Sweden in August 1987. In the WPA a set of guidelines is recommended to encourage action at all levels by Governments, organizations and mass media on all matters relating to information and public education programmes. In that context a United Nations seminar was held in 1982 at the Vienna International Centre in Vienna, the outcome of which was a booklet entitled "Improving Communications about People with Disabilities, " which recommended the following:

- Depict people with disabilities at home, at work, at school, at leisure and in avariety of other ordinary social and physical situations;
- Acknowledge the natural curiosity and occasional awkwardness that may develop in social situations involving disabled and non-disabled individuals. Where appropriate, provide positive examples in which such curiosity is satisfied and in which awkwardness is lessened;
- Include people with disabilities as part of the general population in media products in addition to those in which their story is the primary focus;
- Avoid presenting people with disabilities as dependant or pitiful. Other stereotypes to be avoided include presenting people with disabilities as inherently saintly or asexual, gratuitously dangerous or uniquely endowed with special skills due to a disability;
- Consider carefully the words used to describe or characterize disabled individuals. Recognize and avoid phrases that may demean these individuals (e.g. blind as a bat, deaf and dumb);
- Portray people with disabilities in the same multi-dimensional fashion as others. Present the achievements and difficulties of people with disabilities in ways that do not overemphasize the impairment or exaggerate or emotionalize the situation. For example, in news stories and documentary reports, the fact of a person's disability should be reported only when it is directly relevant;
- Information should be provided to the public about prevention and treatment of impairments that lead to disability, as well as the availability of services for people with disabilities and their families. This can be done through public information campaigns and also can be integrated into general media products.

This set of guidelines, together with a separate set of 11 guidelines developed for organizations of/for disabled persons was created to assist media personnel in improving public perception of persons with disabilities.

It should be also obviously in the interest of society to develop a general understanding and mutual co-operation with disabled persons. To achieve this goal, what else should be used by interested bodies if not the instruments provided by the UN to call the attention of Member States to their moral commitment to implement the UN recommendations since they became Members of the Organization. What else should be used to call the attention of the media to this issue of media and disability, a topic the importance of which is so much recognized by an international organization like the UN? Let us use the help and support the UN is giving to establish a new, interacting dialogue with the media. It is evident that the UN sees the media as an important means of informing and promoting a positive change in attitudes of the general public and of people with disabilities themselves.

The question of terminology and image is at the basis of the problem. Wrong use of terminology and images will increase distortion of messages, reinforcing stereotypes already existing. For centuries mass media have been concerned with people through images, symbols, writings, spoken words in very diversified ways. This depended on the norms, values, religious and living conditions of a country. Therefore, notions on disabled persons and attitudes towards them were passed on through history by social heritage. Erroneous views of such thinkers as Aristotele, Kant, Jaspers or Darwin affected attitudes towards persons with disabilities. One dangerous example of the transmission of a negative portrayal of persons with disabilities to children, recalling what I was previously saying on historical and generational heritage, is stories. Negative images are reinforced in story characters like Captain Hook, or the cat and fox in the book "Pinocchio," that stir up children's fears of disabilities in adults. Dangerous perpetuating of negative myths and messages presented to the general public are often present in films, shows and literature, just to mention a few, portraying monster people or criminals, usually with disabilities, attacking people. This is a favourite theme of horror movies for instance. The connection of criminality and disability implies that deformity of body symbolizes deformity of soul. In another example of erroneous media communication, the stigma and discrimination are reinforced when referring to sexuality and romance, in which the stereotyped image of a disabled person is often presented with contempt. In a culture that places so much emphasis on the "look", on attractiveness, persons with disabilities may be, and often are, perceived as dangerous or sexually deviant or unable to have a sexual life either emotionally or physically. On the contrary a positive example of pre- senting persons with disability maybe found in the film "Children of a Lesser God."

From these few examples we realize how often negative images have been used through history to subjugate disadvantaged groups of the population like women and more recently, disabled persons. A direct consequence of this is the use of inappropriate terminology and language. How often do we hear about persons "confined to wheelchairs," "afflicted" with disabilities, or mentally-impaired persons who "go crazy". Most of the terms commonly used by media to describe disabled persons or their disabilities imply that the individual is as undesirable as the disability. This was at least until recently. In fact, though there is still a long way to go, it has to be recognized that the media are slowly becoming more accurate, also about disability. Therefore, the message should be that a disability that "afflicts" someone represents only some inconvenience to others, that the wheelchair liberates far more than it confines and so on. Bodies may disable a person (impose limitations on what a person is able to do), but it is society that handicaps a person (it limits what one is allowed to do).

It is evident that education of media in dealing with disability appears to be extremely important so to bring together education and communication - the right to learn and to know, to be known and to communicate and participate in the flow of images and cultural changes. Images and attitudes through right information and education, provided not only to the public but first of all to those who work in the media and are the creators of messages, will change so that we can see and feel that handicap is not a condition inherent in an individual but a relationship between the environment and the person, the society in which the individual lives. The degree of a handicap depends on how the society around the person with the handicap is constructed, on its attitude, on the images it carries. It also depends on the knowledge on the part of the non-disabled of what it is like to be, for example, in a wheelchair or visually impaired. Knowledge prevents hesitation in talking to a hearing-impaired person or to a person with a mental impairment and so on. Many prejudices, also on the side of media operators presenting disability topics, result simply from ignorance and stereotyped ideas. Since information campaigns on disability matters often are not able to arouse interest in the whole subject in the general public, the employment of "educated" media may help to achieve a certain surprise effect and provoke individual members of the public to more social commitment. Although the employment of persons with handicaps in the media should cover all media sectors, since above all we are citizens and therefore the disability whether present or not in an individual should play a marginal role, I would like to mention an example to foster a positive view of person. with disabilities - advertising. We assume that advertising has an effect on the viewer's attitudes and images towards an object, situation or person. Let us take as an example the private sector. It is recognized, especially in certain societies, that disabled persons are a market. Disabled persons are consumers of general products and services and of specific ones such as technical aids. Corporations may identify on one hand persons with a disability as a market on the other as a significant factor in the labour force. There are already some interesting examples of advertisements oriented in this direction. An example, a certain company sells blue jeans. This company has created an advertisement which conveys the idea that real people who have fun, self-confidence, people who are somebody, wear blue jeans. It is interesting to notice that among the actors who play a role in that advertisement there is a young man using a wheelchair. Disabled persons are a large segment of the society that eats, drives, uses, wears products. Disabled persons are among the largest "minority groups" in the world, about five-hundred million (500), and can be portrayed as part of a strong political and civil rights movement. To improve and strengthen positive images of disabled persons they themselves should be educated to build up self-confidence, self-respect and awareness of personal talents and resources - not only of possible shortcomings. Since for too long persons with disabilities have had to face segregation and isolation in various aspects of life, nowadays they have to show themselves their ability of living an independent, individual and social life sharing the same rights, duties and aspirations of all human beings.

Stereotypes, among patterns and values are caused by recognizing the standard as a reference factor whether mental, physical or social. Whatever differs from standard, the "norm," in a prejudicial sense deprives a person of normality, beauty, value, harmony.

But what is normal if not the things we have learned to tolerate, since everything and everyone is different? Therefore normality is what falls inside frontiers we have established as our paramaters to confront situation. Normality is what we experience as a majority, learn to cope with, learn to tolerate. That is why media can play an important role. Through access to appropriate information there is mobility of ideas, images, values and mobility is the way to success. I would like to go into more details talking about how we could help the creators of messages, who they are, how to contact them, why they should be trained, who our audience is, and how to send messages to it.

I would like to discuss: the need to train and employ disabled persons themselves in the media business, in order to assure their participation on all levels and forms of the media; the important role of non-governmental organizations, intergovernmental organizations, associations and individuals in working together with media on disability issues. There is still a lot to be said but I would like to conclude referring to those mentioned 11 guidelines. They were prepared six years ago but I think they still provide useful models to ensure that media presents people with disability and the issues related to disability in ways that are constructive.

Thank you.



Commissioner for Rehabilitation, Hong Kong

The importance of public education is taken for granted in this discussion, which is basically for an informed audience. Also I do not want to speak pretentiously from a professional educator or journalist's point of view. Given my responsibility, it is perhaps more appropriate to explore the subject from an administrator's angle.

Insofar as public education is concerned, I think it should fulfil three main functions and thereby serve the respective clientes accordingly. The foremost, of course, is the need to foster an understanding between the disabled and the non-disabled thereby promoting and assisting the causes of integration and mutual acceptance. However, public education should not be regarded as a propaganda for hard selling certain concepts. Beneath all the noble and sometimes idealistic messages being put across, it is the dissemination of information, especially on the services which are being provided, which is instrumental to the attainment of equality of opportunities. From the Government's own point of view, it is imperative to gauge the genuine demand for services and this is only a possible task if demand is not suppressed because of general unawareness. This aspect is very important because the basis for our planning of services has gradually been shifted from projections based on prevalence of diseases to actual demand.

By mass media, I refer to the television, the radio and the press. Generally speaking, the mass media in Hong Kong, like their counterparts in other parts of the world, are very capable of taking initiatives to report on rehabilitation matters. Firstly, it is always the critical and solemn debate and forums on rehabilitation policies and services, e.g. employment of the disabled, transport for the disabled, etc, which are practically geared towards the well informed, educated and motivated clients, e.g. rehabilitation professionals, who are already interested in and aware of what is going on. Secondly, news is another spontaneous form of reporting but it also tends to be superficial and sensational, without being able to provided much substance and background for the reader or audience. Thirdly, tragic and happy incidents involving the disabled are another good topic for feature articles by reporters. Fourthly, real or imaged stories about the disabled often provide inspiration for drama producers.

However, all the above categories suffer from some setbacks : firstly, they may not be balanced; secondly, they are normally not informative enough, if not occasionally distorting; thirdly, they may not provide an unemotional and objective framework within which to understand issues.

Thus, for public education, there is a need to systematically involve the mass media so as to achieve the desired result. In Hong Kong, a mechanism exists for this purpose. The Committee on Public Education on Rehabilitation (COMPERE) is responsible for the planning and coordination of publicity efforts for rehabilitation. The Committee is chaired by the Commissioner for Rehabilitation and represented by the relevant government departments concerned and the Joint Council for the Physically and Mentally Handicapped. Apart from assistance in kind from the Government Information Services, the Committee receives a small but nevertheless increasing budget from the central government for a publicity campaign on rehabilitation. In 1985-86, a sum of about HK$100,000 (or US$13,000) was available and this has increased further from $200,000 for 1985-86 and 1986-87 to $300,000 for 1988-89. The majority of the budget is used on the production of Announcements of Public Interest (API) for televsion. These APIs usually last about 15 to 30 seconds and are shown on the commercial television channels alongside other advertisements. Their purpose is to put across to the public important information and message from the Government. The themes for the campaign differ, depending on the priority at the time, the need for a change for avoidance of boredom, etc. Thus, when in 1984, the Government was facing tremendous opposition from the local population against the building of half-way houses for the ex-mentally ill in public housing estates, attention was given to mental health education, as a result of which two APIs were produced in the last three years. Similarly, as a result of the recommendations of the Working Party on the Transport Needs of the Disabled, an API on transport courtesy for the disabled was produced. For 1988-89, the emphasis is on employment, hence three APIs on employing the disabled, vocational training for the disabled, and technical aids for the disabled, respectively.

How effective are these APIs? I think I have to point out the constraints which they have been facing. Firstly, there is not a government TV channel in Hong Kong. Thus air time available would be subject to negotiation with the commercial channels based on the terms of their licence. Usually this is rather limited. A study in 1986 indicated that a total of only 1 1/2 minutes per channel per day were available for all government APIs during prime time, i.e. 6:30 p.m. to 10:30 p.m. whereas 4 1/2 minutes were available for other time of the day. Against this background it must be recognized that there are very severe competition for air time. Thus, in early 1986, there were about 9 major themes and 35 minor themes per month for showing on TV. Rehabilitation had not been regarded as a major theme, which was attributed to subjects such as fight crime, constitutional reforms, renewal of identity cards, and the like; whereas the minor themes cover such subjects as family planning, tourism, industrial safety, new traffic legislation, etc. Thus, statistically, it was discovered that the two themes on rehabilitation, i.e. mental health and employ the mentally disabled, were only shown 50 times a month in early 1986, against a total of 2,146, accounting only for 2.3% of the air time.

However, notwithstanding this constraint, a survey conducted by an independent survey for the Government Information Service in 1986 indicated that TV APIs were the most effective source of public awareness of rehabilitation.

The limitation of APIs in terms of the air time available to them and their too condensed content has raised the need to have more varieties for showing on the television. There are three types I want to talk more. They are documentaries, magazines type programme and drama.

As regards documentaries, they are usually produced at the initiative of the professionals but there are exceptions. Where proper social causes can be demonstrated, the Government can, to some extent, influence the choice of the television producers to cover rehabilitation matters. For example, in 1984 when the Government's half-way house building programme in public housing estates was met with huge opposition, the Radio and Television Hong Kong had responded, at the request and with the assistance of the Government and the voluntary sector, to produce a documentary on mental health and the functions of half-way houses with a view to facilitating the public's understanding about mental illness and the concept of integration through the provision of half-way traditional facilities. The disabled as well as the policies and services for them have been an increasingly popular subject for documentaries, not only because of their own sake but also because when other related topics such as shortage of rehabilitation personnel, social security, etc. are touched on, they invariably spill over into the rehabilitation arena.

However, documentaries may tend to be critical : they introduce a subject, quite often with the depth and educated comments and criticisms which are more suitable for the more intellectually serious members of the public. Though not by design, these programmes may often show up the unfortunate aspects of the disabled so as to reflect inadequacy of policies and services could be counter productive as the disabled may be conceived as a rather helpless group, relying on assistance and services and deserving, great sympathy may fortify prejudice and bias. Thus the presentation aspects will need very careful professional and sensitive handling.

Drama can to some extent fill the gap. It brings the disabled closer to real life as a person and therefore is a good means to foster a personal touch on the non-disabled members of the community. Hong Kong, in the past few years, have seen greater efforts along that direction, again sometime through the initiatives of the professionals and sometimes the effort by the Government and the community by providing financial resources and ideas. A very good case in point was a drama programme on sex education produced in 1987 through a joint effort of the Government, the voluntary sector, and the production professionals. One episode in the series was the sexual life and adjustment problems of a couple, the husband being an accident victim. This was a bold and the first attempt of its kind in Hong Kong and was quite well received. In the past few years, there has been an increasing trend, though still not very significant, to use disability as a theme for television soap dramas. Surprisingly, the effects are quite positive and indeed commemdable as they often highlights the ability side rather than the disability side.

Hong Kong first systematically embarked on the production of magazine type programmes for the television last year under the aegis of COMPERE. Two programmes, one on mental health education and one on employment for the disabled were produced, but unfortunately they were only shown once on the television and hence their impact was relatively unknown. This year, through the initiative of the voluntary sector, notably Barbara Kolucki, and with the support of our office, we have, on the basis of the experience of the LINK programme in the UK, produced through the Radio Television Hong Kong a series of 12 programmes each of 15 minutes and covering a wide range of topics such as prevention and assessments, services available to different disability groups, sports and recreation, etc. It is hoped that the availability of this longer series will allow better dissemination of information and in a systematic and sustained way, hence bridging a gap in production.

How about the radio and newspaper? Their limitations are obvious and common sense along would predict that they are not as effective as the television, in terms of impact, audience coverage, and scope for treatment of subject matters. This was reflected in an independent survey conducted for the Government Information Services in 1986.

Overall I think Hong Kong is on the right track in utilizing the mass media. My own personal view is that future efforts show lie in the sustaining of the current momentum in the face of the more concerned mass media and in the further development within the mass media of motivation and expertise in the handling of such a delicate and sensitive subject as disasbility.

Sectoral Session D-5 Tuesday,September 6 16:00 - 17:30


Chairperson: Mr. John R.Garrison Chief Executive Officer, National Easter Seal Society, Inc. (U.S.A.)
Co-chairperson: Mr. Takumi Shimoda Director,National Federation for the Advancement of Special Education (Japan)



National Easter Seal Society, Chicago,U.S.A.

Education for transition requires that we know clearly what options exist for students with disabilities, and which option seems most appropriate for each student. Because societies and institutions tend to focus on meeting the needs of persons that fall into statistically average categories, those persons whose needs fall outside the statistical average, including the gifted at the high end and the disabled at the low end, often have no clear focus on the options that exist. And they often have even less focus on which offers the most personal opportunity.
Because every disabled person has unique aspirations and needs, and because each community varies in the opportunities and expectations it holds for persons with disabilities, each approach to education for transition requires a keen sensitivity to these variables. Transition from school to work presents different aspects for youths who live in rural areas when compared with youths who live in urban areas. Many organizations have important roles in assisting with the transition, but mechanisms for coordination and intergration of their roles on behalf of the student often present the greatest challenge.
In the United States, the Office of Special Education and Rehabilitation Services (OSERS) in the Department of Education has made transitional services and supported employment priorities in its approach to preparing students with disabilities for socio-economic integration into the community. The initiative for transitional services reflects the concerns of persons with disabilities and their families that the entitlement to a public education does not automatically lead to normal opportunities for employment and community integration on the one hand, or to appropriate adult services on the other hand.
The bewildering array of programs and service providers complicates transition. Each participant in the array of service providers often has its own perspective on goals and process. They may compete or cooperate. They may confuse and mislead. Our challenge is to assure that they succeed. To that end, we have a distinguished panel to help us think through helpful approaches to education for transition.


RI National Secretary for Denmark, Copenhagen, Denmark

Integration as a principle: Despite the differences in tradition and legislation, the issue associated with integration of disabled people has occasioned professional and political discussions over decades in national and international organizations.
Integration ought rather be considered an instrument of normalization than a general objective of the disabled child's life.
A school for all: A condition that the disabled child may be educated within a school system which is open to all is that the system offers the possibility of individualized instruction.
Looking back: An international breakthrough in the idea to solve the school problems related to disabled pupils in accordance with the general school legislation was effected during the 60es, a.o. resulting from the initiative of Rehabilitation International towards Unesco.
As time passed, isolation in handicap environments - originally enforced - was idealized by the thesis that "equal children play best". Each group of handicapped had their own school system which prepared them to spend a life-time in small "model" communities.
Action: Attempts to break down this self-increasing development provided a solid basis for correlating instruction and training of disabled children with the general educational system.
Pupils with special needs: All balance is difficult - also the balance between fear of categorization and the wish of accepting differences among people. Many and good reasons are in favour of softening the barriers between the different groups of handicapped. In professional and human regard it would, however, not be opportune to express oneself ambigously on concrete differences. The term "special needs" must necessarily be followed by a rational explanation of the prevailing difficulties.
Studies in twelve European countries: My first reference is the study on special educational measures within the countries in the European Community which I conducted at the end of the 70es and beginning of the 80es.
Private initiative: Private initiatives are still playing an important role. It is yet in the nature of the case that the increasing demands to staff and aids necessitate public financing. The obligation resting with the education authorities to implement special educational measures includes normally the age group from 0 to 18 years.
Priority of resources: In a school for all, this may give rise to doubts whether general or special costs should be given priority. The investigation suggests a political necessity to "earmark" grants for special educational measures and that special pedagogical experts should be given influence on the release of such grants. Any technical aid being essential for the school work which will not be classified as a prosthesis should be given free of charge by the school.
Flexibility: The interchange between individual considerations and fellow-ship is the vital nerve and daily challenge to the school. There is a trend toward increased cooperation across the class units.
As an example be mentioned a sucessful experiment where a special class with a maximum of 5 pupils was arranged alongside a normal class with 15 pupils, and with a co-teachers' arrangement for these two classes.
General legislation: The extended compulsory education of disabled children is being replaced by uniform rules with supplementary offers for education in general of adults. In this connection, compensation is given for extra costs for aids and transportation of disabled pupils.
Transition of young people into open employment: Other things being equal, growing up together with an ordinary group of people of the same age is a preparation for future employment.
Training of teachers: The consequences of the endeavours for integration will necessarily involve that, during basic teacher training, all student teachers receive thorough information about disabled pupils and their instruction. In continuation of this training and after practical experience as teacher, further training for special teacher may be commenced.
Methods and aids in half a dozen handicap fields are so comprehensive that any of them has to be integrated as a special module for at least half a year. Training should be an interchange between theory and practice, and we are speaking of qualified training.
Trying to reach some conclusions: The investigation supports the use of the word "integrate" rather than "integration". This means that we are dealing rather with a process than with a static situation.
Nordic report on a school for all: My second reference is a report issued by the Secretariat of Nordic Cultural Cooperation in 1984. Special education is being conformed to the School Acts, governing education in general.
A decentralization is taking place in the school system with the objective to placing the decisions as close to the child's home as possible. This means increased parental influence on the school board concerned as well as on the choice of the child's school.
Examples of parental influence: According to Danish legislation, parents of pupils in special classes at a normal school elect 2 of the 7 members of the school board. This ensures a strong advocacy for the severely disabled in the school.
Research: It was forthwith anticipated that a decentralization and dissipation of pupils might weaken special educational research and dissimination of experience.
Yet it is correct that the need of centres with new technology and fundings for pilot projects may seem controversial to the new administrators.
General and advanced special education: It is very difficult, in every respect, to try to distinguish between general and advanced special education.
Referral: Referral for special educational measures is made according to the national regulations on basis of an assessment by the school psychologist.
It is possible to choose between the following possibilities: Assistance in the class, supplementary instruction in one or several subjects together with other pupils, or on an individual basis,or letting the pupil follow all lessons in one or several subjects at a special education centre, or in a special class. Short intensive courses are used more frequently, and with a good result.
National statistics: The number of pupils in special classes has been decreasing since 1973. Such classes are placed more and more often at ordinary schools.
Of the total number of pupils, 13,1% of them received some kind of special educational assistance during 1981/82 - 2,4% of whom attended instruction in special classes.
At a specific time, 9% of all pupils in the school received special educational assistance.
The number of preschool children receiving special educational assistance amounts to about 3%. Great importance is attached to counselling of parents, to technical aids and to speech stimulation.
Conclusion: The primary task has a political character. Medias, organizations of interest, and the school play significant roles in influencing "society's attitude".
Equally important as the attitude in society, is the suitability of school. It is imperative that all teachers know something about handicaps and possibilities of helping. Brief instructions must be permanently kept up-to-date and distributed to all teachers.
There will always exist pupils who do not receive a meaningful schooling in an ordinary class, even despite the fact that the class teachers are fully capable of coping with the task. There should be a moderate concentration of such needed special classes.
Our experiments indicate that pupils with minor learning difficulties with language and motoric difficulties, psychic deficiency and perhaps deaf pupils are categories who will have an advantage of being placed together at their respective "host" school in a borough centrally situated and of adequate size to assume the administrative responsibility and to accomodate a technical service center, and to offer transporattion facilities and a consultancy centre with an affiliated staff of itinerant teachers.
Special education and psycho-educational counselling are two aspects of the same question.
The school psychologists and consultants are to maintain a few lessons per week for professional as well as collegial reasons.
Itinerant teachers, including audio-logopaeds and preschool teachers with special training constitute a significant link in the school psychological service, especially in relation to disabled preschool children who receive assistance in their home or at day-care centres.
The national school psychological offices have furthermore at their disposal social advisors and counsellors.
Medical experts as well as physiotherapists and occupational therapists are affiliated to the special education centres.
Special education will have to be developed in keeping with the national educational system on the whole. This is the condition for integration. Disabled people do not wish to have privileges, but equal rights, i.e. differentiated, individualized and qualified offers for education at a school for all.
(1) Skov-Jorgensen, I. - Special Education in Denmark (Copenhagen 1979).
(2) Skov-Jorgensen, I. - Special Education in the European Community (Brussels 1980)
(3) Skov-Jorgensen, I. - Special Pre-School Education Facilities in the European Community (duplic. Brussels 1981).
(4) Skov-Jorgensen, I. - Special Education in the European Community - Supplement (duplic. Brussels 1982).
(5) Skov-Jorgensen, I. - Special Education in Greece, Portugal and Spain (duplic. Brussels 1982).
(6) Dahlgren, Inger and Nielsen, Henning W. - A School for All (Copenhagen 1984).
(7) National Union of School Psychologists - Educational Rehabilitation (Copenhagen 1986).



University of Tsukuba, Institute of Special Education, Tsukuba City, Japan

1. Introduction

It need scarcely be said that for the future self-support living of handicapped children, appropriate educational preparation and assistance from their early stage of life are indispensable. Each handicapped child should be offered the most suitable educational opportunities and adequate school education depending upon their abilities, developmental stages and conditions of disability. With increasing emphasis on full participation of the handicapped to the society, special education, particularly in its secondary level, assumes a important responsibility for cultivating the desirable competences to meet the needs for their future social adjustment. For bridging the gap between school and society, secondary education at the special schools and special classes for handicapped students should challenge to realistic goal actively. Transition from school to society of handicapped students is a matter of major concern of rehabilitation professionals as well as teachers in special schools for the handicapped.

Compulsory education for the schools for the blind and the deaf have been provided in Japan since 1948 though these schools have long history. On the contrary, compulsory education for the schools for the mentally ratarded, the motor handicapped and the health impaired was commenced in 1979, aiming at providing educational services no matter how severe or complicated children's disabilities are. As a result, all primary and lower secondary departments in every special schools are compulsory now. This means that educational opportunity has now secured for all handicapped children whatever the level of their handicaps, also, this progress of the educational provision has entailed that the special school for the handicapped encountered with new and greater problems. Vocational education for the handicapped has been largely influenced by this change and the transition from school to society is faced with many difficulties.

2. Role of career guidance for the handicapped

While the concept of transition education is still not clear in Japan, career guidance as a educational activity, and vocational education at the secondary level play this role in order to make the handicapped transfer smoothly. Career guidance is devided into next six sub-activities.

  1. self-understanding of the students and evaluation of the student's aptitude, personality and interests etc.
  2. vocational and career informations.
  3. exploratory experiences including observation and practice, inside or outside of the school.
  4. career counseling to assist better adjustment and choice of the future plan.
  5. placement assistance for the job, higher education, institution and home bound program.
  6. follow up activities after school life.

As shown above, the career guidance is not only for assistance of placement at when the students leave school but also it includes various guidance activities necessary to the future life of the students. From the psychological viewpoint, career guidance has a role to develop the self-concept, career awarness and career planning ability of the handicapped.

Recently, there are many teacher's reports concerning serious difficulties to carry out career guidance for the handicapped due to the students handicaps increasing become severe and complex. But a great deal of emphasis should be placed on the formation of desirable personality, attitude and skills which assists students to transfer more smoothly into the world of work or adult life.

3. Vocational education for the handicapped

Vocational education is generally defined as an education to teach knowledge, skills and attitude required by the vocation in which a student will engage. However, present status of vocational education provided by the special schools in Japan does not exactly conform with the education defined hereabove. Because many enrolled students at the secondary level are so severely handicapped that their vocational self-support is considered to be remarkably difficult or almost impossible. This trend is dominant at the special schools for the motor handicapped and the mentally retarded. Under this circumstances, vocational education at the special schools is necessarily modified in its concept and content in order to adjust to the current students needs. The types of vocational education, in my opinion, are classified as follows.

  1. Vocational education to acquire specific job skills
  2. Vocational education to learn general skills for vocation
  3. Vocational education carried out as a sort of instruction (mainly for the M. R. )
  4. Vocational education to expand living skills (for the severely handicapped)

4. Assistance in transition

(1) Need for transition program

Importance of the transition program was pointed out in the OECD/CERI Report (1985), APEID Regional Seminar on Special Education (1986) in Japan. Also, most of teachers in the special schools in Japan would realize seriously the need for establishing transition program. The program based on future perspectives of each handicapped student should include such teaching elements as self-understanding, independent living skills, interpersonal and social skills, work attitude, leisure skills etc.

(2) Need for leisure education

Tranditionally, teacher's concern has concentrated largely on teaching academic skills even in the secondary level of the special schools. However, to meet the growing needs of young adolescents, the schools should recognize the significance of leisure education, particularly, for those whose handicaps are too severe to get job in the open industries or welfare workshops. Acquisition a knowledge how to organize free time for the constructive pourpose should be included actively in the teaching content of the secondary level. Each student is needed to encourage an effective use of leisure time.

(3) Active cooperation with schools, families and community resources

In order to make the students to transfer from school to society more easily, close cooperation between schools, families, public organizations, facilities, and private companies, togather with the service such as career counseling and placement, are to be pursued.

5. Placement after graduation

Accrording to the statistics of the Ministry of Education, Science and Culture in Japan, as of May 1st, 1987, employment ratio of graduates from upper secondary departmetnts of the special school was about 30%. Other graduates have gone to higher educations, welfare institutes or staying home. Under the circumstances, the promotion of employment for handicapped persons, the expansion of social services, and improvement in the quality of living of home bound handicapped persons, are key factors in determining their future lives. In order to minimize the gap between school and society, improvements in life environment after graduation including promotion of employment are the target of present efforts.


(1) Japanese National Commission for UNESCO, National Institute of Special Education, Final Report of the Sixth APEID Regional Seminar on Special Education. 1986.
(2) National Association for Employment of the Handicapped (in Japan), Physically and Mentally Handicapped People in Japan and Countermeasures to Promote their Employment, 1985.
(3) Ministry of Education, Science and Culture, Special Education in Japan, 1988.
(4) Misawa G. Employment Promotion of the Disabled Workers and Attitude Modification of Employers and Co-workers, paper presentation, 15th World Congress of R. I. 1984.
(5) Misawa G. A Study of Vocational Adjustment of Mentally Retarded Adults in Competitive Employment paper presentation, International Special Education Congress, Nottingham University U. K. 1985.



The need to make special provision for those members of the community who suffer from the effects of disability has long been recognized in Pakistan and has been given a high priority by the government. The creation of special facilities for the education training and rehabilitation of disabled persons is regarded as being of central importance and as concerning the rights of a significant percentage of our population.

The provision of a comprehensive range of facilities for the disabled ranging from pre-natal care through education, vocational training, employment and support during adult life can not be a matter for a single government department or agency. The growth of services of real quality will require the active cooperation of many organizations in the public and private sectors and the professional who work within them. It will require coordination in the planning and implementation of policy which must be reflected in the service which is provided to the individual child or adult who is disabled.

The programmes in Pakistan have been formulated against a background of information about the number of children and adults in Pakistan based upon the US estimates of 10% of the population and upon more detailed information provided by Pakistan based studies. The figure which follow provide a reasonable basis for future planning but given the lack of detailed scientific research, cannot be regarded as being definitive.

The global estimates of 10% would indicate that up to 10 million of children and adults suffer from some significant disability. This would include those who have mild or temporary condition but who will require access to some sort of support or assistance.

The studies which have been undertaken in Pakistan and elsewhere would indicate that within the larger percentage indicated by UN agencies, a smaller group of individuals exists who have serious or severe disabling conditions which will require detailed intervention and support on long term basis. The size of this group will amount to 2 to 4% of the population as a whole. Pakistan has an estimated 1.1 million young people between the ages of 14 and 20 years who suffer from the effects of some form of disability. The special need of this group include:

  • supplementary general education
  • vocational skills training
  • career guidance and counselling
  • job finding and support

We are at the beginning of a long journey towards the provision of comprehensive services for the disabled. Nevertheless the philosophical basis on which our institutions are planned and developed is in accord with those countries which have reached a level of sophistication in their provision towards which we aim.

The national programme provides for needs of young people with disabilities in a variety of ways. Those who can attend normal schools and skill centers are encouraged to do so. The government has the responsibility of providing aids and equipment required. In addition, a programme to train teachers to recognize and understand the specific problems, both academic and social, has been started. The initial response from the education system has been most encouraging. To ensure understanding of special needs by both educators and community at large, a project using the mass media has been prepared and launched. At the same time, a more personalized approach has been adopted - that is to enlist volunteers we call special friends.

As a matter of policy, the national government promotes and coordinates the establishmnent of services through local governments, and voluntary agencies by training the professional and offering financial assistance required by them.

The national agency in the government has established a network of centres planned to provide for comprehensive education and rehabilitation which would also serve as resource centres for other organizations involved in similar work.

For continuation of process from school to employment, the task of computerized registration has been entrusted to a body called National Council for Rehabilitation of Disabled Persons, which is also developing community based skill centres that would offer further potential for disabled school leavers and those who acquire disabilities later in life, to have the opportunity to train and receive guidance. This council has also undertaken an initiative to assist financially those disabled persons who have the potential for self-employment.

Legislation in Pakistan requires all public and private employers, with 50 or more employees to reserve a quota of 1% jobs for disabled persons. It has created a growing demand for vocational training by disabled young people and adults.

Our ability to meet that need will depend upon the development of a pattern of educational provision which has continuity. It will also rely on the extension and growth of a curriculum response in schools which allow disabled young people to make a smooth transition to further education and skill centres.

If this can be achieved in the coming years we will benefit greatly from the presence of such people who are truly active and participating members of society.

16th World Congress of Rehabilitation International No.9 P.376-P.417

The Organizing Committee of 16th World Congress of Rehabilitation International

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