Deafness is often regarded as just a one and only phenomenon. Accordingly, deaf people are pictured as a unified body of people who share a single problem. From a medical point of view, we find it usual to work with a classification of deafness in which pathologies attributable to an inner ear disorder are segregated from pathologies attributable to an outer/middle ear disorder. Medical intervention is thus concerned more with the origin, degree, type of loss, onset, and structural pathology of deafness than with communicative disability and the implications there may be for the patient (mainly dependency, denial of abnormal hearing behaviour, low self esteem, rejection of the prosthetic help, and the breakdown of social relationships). In this paper, we argue that hearing loss is a very complex phenomenon, which has many and serious consequences for people and involves many factors and issues that should be carefully examined. The immediate consequence of deafness is a breakdown in communication whereby the communicative function needs to be either initiated or restored. In that sense, empowering strategies-aimed at promoting not only a more traditional psychological empowerment but also a community one-should primarily focus on the removal of communication barriers. (J Epidemiol Community Health 2000;54:40-44) Pathology/disability model versus sociocultural model of deafness Over the past few years, two opposing perspectives of conceptualising deafness in contemporary society have been reported and discussed in scientific literature.
The concept of disability is related to discrimination and social exclusion; that is, this issue is a socio-political question whose effects go well beyond the health of the individual. The social and human rights based model of disability points the way to fresh opportunities for action to promote the wellbeing and health of the seventy million Deaf people living in the world today. The key factors in preventing discrimination against the Deaf are recognition of their specific cultural and linguistic identity (including sign languages and Deaf culture), bilingual education, the availability of professional sign language interpreting, and access to information and communication. The present article aims to encourage greater understanding of the significance of adopting this new perspective on disability, its congruence with current national and international legislation on the rights of persons with disabilities in general and of Deaf persons in particular, and its implications in the policies and praxis due to be implemented in Spain over the next few years on enhancing the health of the Deaf community through significant examples of good practice. Examples of good practice for distinct Deaf communities include collaboration between these communities and the health sector, health training for sign language users, the inclusion of the language and culture of Deaf persons in training programs for healthcare professionals, training of Deaf specialists as future health researchers and workers, and health care services that are more accessible via different sign languages.
Implementing health-promoting programmes for the most excluded and at-risk social groups forms a key part of any efforts to address underserved populations and reduce health inequalities in society. However, many at-risk children, particularly children in deaf communities, are not reached, or are poorly served, by health-promoting programmes within the school setting. This is so because schools are effective as health-promoting environments for d/Deaf children only to the extent that they properly address their unique communication needs and ensure they are both able and enabled to learn in a communication-rich and supportive psycho-social environment. This article examines how the usually separate strands of school health promotion and d/Deaf education might be woven together and illustrates research with deaf community members that involves them and gives their perspective. The primary objective of this study was to map deaf pilot bilingual education programmes in Spain-one of the first countries to ratify the Convention on the Rights of Persons with Disabilities (United Nations. (2006) Convention on the Rights of Persons with Disabilities, Resolution A/RES/61/106.)-with particular attention to their compliance to the Convention's article 24. Following pre-testing, 516 key informants were surveyed by mail (response rate: 42.08%) by using a snow-ball key-informant approach, within a Participatory Action Research framework, at a national, regional and local level. The results show that although some schools have achieved recommended standards, bilingual programmes are in various stages of formulation and implementation and are far from being equally distributed across the country, with only four regions concentrating more than 70% of these practices. This uneven geographical distribution of programmes probably reflects more basic differences in the priority given by regions, provinces, and municipalities to the deaf community's needs and rights as an important policy objective and may reinforce or widen inequalities by favouring or discriminating rather than achieving access and equity for this noticeably overlooked community.
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