As a result of advances in medical technology and dramatic improvements in the delivery of acute health care, the vast majority of children with rheumatic diseases can now expect to survive to adulthood. As life expectancy for persons with rheumatic disease approaches that of the general population, socio-economic factors are increasingly being recognized as important determinants of health (31), and quality-of-life and social integration as meaningful health outcomes (32,33). The International Classification of Functioning, Disability, and Health (ICF), introduced by the World Health Organization in 2001, provides a framework for understanding the impact of the social and physical environment on health (34). Unlike mortality statistics, this framework looks at how people live with their disability. The ICF assesses health not solely in terms of body functioning and structure (i.e., impairment) but also in terms of activities, social participation, and the physical environment. Understanding the health of a person "in his/her own world" can help to identify a variety of strategies for improving health. For example, setting up ramps to make community swimming pools accessible is an effective way to "treat" the attitudinal and physical barriers that contribute to obesity in young people with rheumatic disease.
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