Health promotion and education: application of the ICF in the US and Canada using an ecological perspective.

Health promotion is an issue comprised of complex and multi-layered concepts that involves a process of enabling people to increase control over and improve their health. The aims and applications of the World Health Organization's International Classification of Functioning, Disability and Health (ICF), with its focus on components of functioning, activities and participation, and environmental factors are salient to health promotion and health education efforts. For individuals with or without disabilities, health promotion occurs within the community in which they reside and is influenced by a complex interaction of personal and environmental factors. The aim of this paper is to discuss how the ICF can be useful in enhancing social change through health promotion and health education for all people, in particular those with disabilities and chronic conditions. In doing so health promotion concepts and the ecological approach linked with the ICF, the relationship of social change and social support to the ICF, the potential role of the ICF for national and local (city) policies, and the role of health professionals in this process will be examined. Building on this body of knowledge, the authors recommend that future research should focus on the relationship between policies and the social participation of people with disabilities in the community, the use of ICF measurement tools to improve the indicators established by the National Organization on Disability, the development of a new ICF core set for community accessibility and inclusion, better interventions to enhance social support, and enhancing the role of professionals in health promotion for people with disabilities or chronic health conditions.