Impaired Encoding

Abstract

Work injury compensation and pensions are often determined according to medical disability rating scales attributing a percentage to each impaired body part or function. Incorporated into central medical–administrative networks of committees and examinations, these produce disability as a calculable space. This article examines the specific case of the Israeli National Insurance regulations regarding work injuries of 1956 and analyzes the shifted order they set. Looking at this system in the specific historical context of transition from the British Mandate workmen’s compensation system to the “disability percentages” system, provides insight into the process of structuring and stabilizing durable numerical forms and the production of centralized government. Drawing on conceptualizations regarding the sociotechnical role of classification systems, I contend that through encoding and calculating classifications of disability, heterogeneity is eliminated and an ordering based on physiology is “black boxed,” illustrating the importance of technoscientific formations in structuring the “medical model of disability.”

Keywords

politics power governance justice inequality protest Israel

The door is opened by a man dressed in white…we enter a small room with bare walls, a long table is in the center. Against one of the walls, a bed and a curtain, that if stretched can hide the person lying in bed. The team includes four people—three men and one woman.

I roll down my pants, he begins to push, pull, stretch, lift, bend and swing my bare legs. He is hurting me. A sharp cry escapes me…Other disabled people, wanting my own good, advised me that in these medical committees I need to scream loud and fast, show that it hurts, even before it really does…but the doctors always remained indifferent, even when the cries were real they were apathetic, maybe they got used to it, maybe they thought they were being deceived.

“OK you can get dressed” he walks over to the women to complete the registry. Mum helps me get dressed. Unknown words are thrown in the air. They are encoding me. I sit on the bed and look at them. “We’re finished, you can go.” (Broyer 2008)

In this vivid autoethnography of her experience, Broyer describes the mechanization, bureaucratization, and the power/knowledge relationship present when unrecognized words are thrown in the air, and a person is encoded for disability status. It is within medical committees, a mundane part of the lives of people with disabilities in many countries, that impairments are classified, bodies numbered, and eligibilities determined.¹ This article discusses the technoscientific disability classification system underlying the work of such medical committees, framing disability as a physiological, bodily manifestation that coproduces the people meeting these classifications as calculable persons and the government institutions set out to encode and treat them as centers of calculation (Jasanoff 2004, 13-45; Rose 1999). As a test case, I focus on the emergence of this system and its application for work injuries in Israel during the 1950s.

The Israeli Disability Percentages system (Ahuzei Nehut) is based on schedules listing impairments and their associated percentages, and is similar to those used throughout the twentieth century in other western countries (e.g., United Kingdom, France). The lists and evaluation methods are defined in legal regulations (takanot), with other laws and procedures denoting various eligibilities based on the disability percentage. For example, tax reductions are given to people with 100 percent disability and parking permits to people with more than 60 percent disability who can demonstrate reliance on a car for mobility.² Thus, most disabled people in Israel will at some point or other turn to these medical evaluation committees to have their disability percentage evaluated.

Disability percentage tables are not a new phenomenon. Their origin is attributed to Francois Bareme a French mathematician living in the eighteenth century who translated medieval Germanic law into mathematical tables for calculation of compensation (Brend, Prinz, and Quisser 2003). These tables were further developed in Europe and applied to cases of disability, especially for compensating disabled veterans around the world (for United States, see Hickel 2001; McGeary et al. 2007). In Israel, such a system was legislated in 1951 for disabled veterans and in 1956 a similar system was applied to people injured at work who had previously been compensated through the Workmen’s Compensation Ordinance. Congenital and other disabilities were dealt with through the poverty welfare system until 1973, when they were added to the National Insurance Law (Mor 2006) and began to be evaluated by the disability percentages system. Thus, application of the disability percentages system developed simultaneously to the social groupings which they apply to and the government administration for treating and caring for them.

This article analyzes the classification system set in the National Insurance regulations for determining disability percentages for work injured (Kovetz Takanot [KT] 612 1956), addresses the shift it structures, and points to ways in which the system creates a center of calculation. The details presented in this article are part of a wider research program dealing with the specific historical and political background of the emergence of this system in Israel during the 1950s and its role in the process of state building and social ordering, based mainly on documentation maintained in the Israel State Archives.

Classifications, Translations, and Disability

Bowker and Star (1999, 10-11) define a classification system as a “spatial, temporal or spatio-temporal segmentation of the world,” which is consistent, mutually exclusive, and all encompassing. In order to analyze the Disability Percentages regulation document as a classification system, I use the concepts of encoding and calculation; Encoding being the attribution of numbers to objects, and calculations the functions on the numbers producing categories and ratings. Both produce the three attributes of the classification as defined by Bowker and Star. This analysis draws attention to the delicate arrangement and somewhat inconsistent demarcations set in place to produce a working classification system, presented as a rational, scientific formulation (Callon and Law 2005).

Bowker and Star (1999) continue their analysis by claiming that although classificatory systems are transparent and seemingly neutral, they embody values and prejudices, embedding the social and ethical orders in stabilizing practices. Through disability classifications other more “messy” elements dissolve into the definition and only physiology is left for describing, treating, and administrating disability. In a similar way, authors such as Winance (2006) and Mosser (2006) have pointed to the tension between the seemingly neutral and objective nature of disability, and the complex relationship and mutual adjustment taking place in its structuring, involving technology, body, class, gender, and ethnicity. Latour (2004) has also suggested viewing the body as a connected articulation, as opposed to the dualistic body/subject versus world/objects model. The second section in the article discusses how such a seemingly ordered, yet rather heterogeneous framing of disability is stabilized through the technosocial mechanism of disability percentages, acting to consolidate multiplicity into numbers.

This physiological definition of disability becomes durable and sustainable over time, stabilized as a terminological standard (Timmermans and Epstein 2010), and “black boxed” (Law 1992). The third section illustrates the act of translation occurring during the 1940s and early 1950s leading to this black boxing by looking at the shifting meanings of the object 100 percent, from a term depicting loss of salary to be compensated, to one defining the completely uninjured body, and the maximum injury at the same time.

Located within the framework of the National Insurance Institute, the system works as a technology of governance, inscribing numbers to people, mobilizing inscriptions to the center, making complex issues legible and simplified by creating a standard grid for monitoring and record taking (Rose 1999; Lynch 1985; Scott 2000). These participate in stabilizing the National Insurance Institute as a center of calculation, delineating the roles of government and citizens, defining center and periphery, enabling registration of this emerging calculable group of people by transforming it into statistics (Rose 1988; Miller 2004; Porter 1995). These processes shall be discussed in the fourth section.

In disability studies the term Medical Model of Disability indicates the common way of viewing impairment and personal tragedy as the main features of disability, while ignoring other social aspects and barriers (Oliver 1990, 46-50; Brisenden [1986] 2005). This article analyzes the medical model as a form of technoscience. Furthermore, several writers in disability studies have openly discussed bodily impairment as a part of the critique of social order (Hughes 1999; Siebers 2001). Following their practice, this article employs the names and descriptions of bodily impairments in a way which may be discomforting at times. Yet, all descriptions are quoted from existing and practiced regulations, both defining body abnormality and claiming to control it through seemingly rational administrative practices.

Encoding, Calculating, and Classifying

The disability percentages system set in the Israeli regulations forms a classification system as defined by Bowker and Star (1999), meeting the three attributes of (1) operating under a consistent classificatory principle, (2) employing categories which are mutually exclusive, and (3) forming what seems a complete and all-encompassing system. This section describes how encoding and calculating process contribute to the production of such a classification system.

Anatomical Encoding as a Classificatory Principle

The National Insurance regulations for determining disability percentages for work injured (KT 612, 1956), include a long inventory of injuries and impairments, organized into chapters as follows—Chapter 1: internal organs; Chapter 2: the nervous system; Chapter 3: the musculoskeletal system; Chapter 4: mouth, nose, ear, throat; Chapter 5: eyes; and Chapter 6: scars. Within each chapter body organs are detailed. For example, the first chapter titled Internal Organs includes subsections for chest, blood vessels, intestines, liver and gall, spleen, peritoneum, kidneys, urine system, hernia, testes, and anus. The second chapter “the nervous system” is divided into the following sections—brain nerves, peripheral nerves, epilepsy due to damage of the brain, psychoneurotic situations. The musculoskeletal system includes spine, chest muscles, upper limb bones, upper limb large joints, upper limb muscles, upper limb nerves, fingers, etc. (KT 612, 1956).

The system resembles an anatomical order, systematically encompassing all body organs and functions. Nevertheless, when compared to standard anatomy atlases, such as Gray’s Anatomy, the order differs from the anatomical arrangement and resembles a practical segmentation based on types of medical expertise; chapters are organized as the hospitals at the time would be arranged—internal medicine, neurology, orthopedics, and so on.³ This ordering provides both the aura of the scientific anatomical order, and the practical, administrative reassurance, that the system is applicable for bureaucratic needs, calling for a specialized expert on each case.

Calculating Mutually Exclusive Categories

Within the ordered classification system, each injury is further detailed into subanatomical classifications described as “damage” (pgima), with three to four ratings usually listed for each topic, producing a scale. For example:

Chapter 3: Musculoskeletal System

17. Spine

(11) Injury of Neck Muscles

(a) Hyoid, Sternomastoid, Trapezius

1. Medium—10 percent

2. Extensive—20 percent

3. Severe—30 percent (KT 612, 1956, 273)

The worst condition receives the highest “score” and the most minor condition the lowest; scoring is presented in percentages. This organization of the regulations forms a mechanism for ensuring that categories are by definition mutually exclusive, encoding one category per impairment.

In some cases, an injury may be attributable to several categories; for example, an injury of the limb will be an injury to the bones, joints, nerves, and so on, of the same limb. In order to make sure that the complex injury will only be associated with one category, it is specified as an instructive example that if several categories are attributable to one injury, the most severe one should be applied, or as the regulations put it: “if a joint is injured in several ways—the percentage allocated will be for the stiffness of this joint” or “For several damages in one eye—[the disability percent] will not be more than the percentages determined for blindness in that eye” (KT 612, 1956, 865). Hence, a calculation is put in place to produce mutually exclusive categories, attributing one specific classification to each injury.

No diagnostic technologies are prescribed in the regulation, envisioning that the evaluator, or the medical specialist, can “see” the injury, understand the internal workings of the body, and know what the physiological cause of any difficulty or injury is (Stone 1984, 107-11). The list of injuries is defined as “tests” emphasizing their objectivity and simplicity. The work of the physician or committee determining disability percentages becomes comparable to that of a teacher, examiner, or evaluator of any kind. Just as a teacher can mark a test, by determining for each section if it is correct or not, the disability percentage can be determined almost automatically based on this list.

However, the elaborate system of appeal committees and courts implicitly acknowledge that instability of the classification may occur as a result of separate assessors coming to different conclusions using the same set of classifications (Lotan 1964, 34).

Regulating an All-encompassing System

The list of impairments is presented as final and all encompassing; there is no method prescribed for updating it, and during the year it underwent very few revisions. After being slightly revised in the 1970s with the widening of its application to congenital and other disabilities, it remained practically the same until recently, when a project of updating the entire classification system was initiated. Nevertheless, the regulation also includes a list of diseases that has been constantly debated, and diseases were added, omitted, and changed.

Initially, the list included only industrial diseases, and it replaced a previous list of industrial diseases established for the purposes of the Workmen’s Compensation Ordinance (1947). While the original document listed diseases caused by specific working conditions, which when diagnosed as related to a person’s work place were recognized for compensation, the regulations of 1956 set a system in which the listed disease does not enable compensation per se, but if diagnosed would be encoded according to the disease’s physiological outcomes. For example, the entry for Anthrax states: “Anthrax—according to the damage in the various body systems as result of this disease” (KT 612, 1956, 884), thus referring to the list of impairments for allocation of disability percentages.

In another example, as part of the work of a special committee for updating the list of industrial diseases in 1958, the ministry of agriculture proposed to add a list of zoonotic diseases to the schedule including Rabies, Erysipelas, Q. Fever, Malleus, and Leptospirosis. The National Insurance Institute answered that while other diseases may be listed, “Rabies will practically always appear in the form of an injury, and therefore there is no need to include this disease specifically in the list of industrial diseases” (Neuman 1958). It is interesting to note that although what the writer means is that Rabies will always be a result of a bite and almost always leads to death, the preferred usage of this classification is a reference to the list of impairment categories, which is viewed as all encompassing, applicable for a wide variety of cases, enabling definition of diseases as well as injuries in physiological terms.

Encoding Heterogeneity Out

Besides adhering to its three attributes, Bowker and Star (1999) claim that classification systems also form a simplified representation of heterogeneity of values, culture, opinions, and such, with one category conveying a wide variety of meanings. Encoding the body into the disability classification system also embeds various cultural attitudes into the numerical figures, “black boxing” them, eliminating the possibility of discussion and critique and at the same time stabilizing their existence. Three such elements will be discussed—function, tragedy, and aesthetics.

Function

The issue of function is relevant to classifications when something may be gained by using a prosthetic, such as in the case of amputated limbs. Amputation of a leg is part of the chapter on the musculoskeletal system and its section reads as follows:

Chapter 26: Lower Limbs Bones,

(6) Amputated leg:

(a) At hip joint—80 percent

(b) At the upper third of the thigh or close to it, with no possibility of affixing a prosthesis—80 percent

(c) At the center or lower third of the thigh; with a possibility of affixing a prosthesis—60 percent (KT, 612, 1956, 878)

Adhering to the principles discussed above, the first and second items should be different, according to the severity of impairment. Nonetheless, the regulations attribute the same percentage to any amputation that does not enable usage of prosthesis, that is the classification includes function as well as physiology. Further insight may be gained by looking at a physician’s report describing the evaluation of a person with amputated limbs:

Amputation of both legs is undoubtedly a serious thing, and it is to be assumed that during the first years after the accident the person…needed help extensively. For approximately 5 years, his disability was one hundred percent …. but through time he got used to the situation also extensively, walks some distance with the prostheses and can reach his work place, he is not dependent on assistance in daily activities, and the situation of the stumps is good. The special committee…determines that the permanent disability percentage…is 65%. (Heilbronner 1954)

Considering this text as a reflection of the language and practice at the time the schedule was implemented, it highlights several elements embedded in assessing disability, and especially the importance attributed to the possibility to regain function by assistive devices, in this case prostheses. Function is not enough, as it is the independence, or at least nondependence on the assistance of others, that is strived for. Other issues involved are those reflecting normativity such as performance of daily activities and employment. In addition, it is implied that walking “normally” with a prosthesis is preferable to using a wheelchair, even if other elements of normativity and independence are adhered to. Therefore, it is through disability percentages that all these attributes, pointed out in disability studies (e.g., Shakespeare 2006), are consolidated into one numerical figure which both includes and replaces them.

Tragedy

A second example sheds light on additional elements embedded in the code. Chapter 5 of the regulation is devoted entirely to the issue of eyes, encoding disability ratings for loss of visual acuity and visual field. The remainder of the chapter refers to other conditions such as damage to various parts of the eye (lens, retina, tear ducts), but most of these other impairments are not allocated a percentage of their own. Rather, it is stated that disability will be determined according to the visual loss itself, turning the evaluator back to the sections dealing with visual function. Furthermore, only impairments are listed and not the various diseases that may cause blindness such as trachoma, which was common in the region during the first half of the twentieth century, or neurological blindness.

It seems that the regulations are keeping to the anatomical logic of including only impairments of body organs, and the visual impairments are presented in such terms. Nevertheless, because the list refers impairments to loss of vision, in fact what is being measured is not the anatomy, but its functions. Consequently, functionality is encoded into the bodily impairment, and as with prostheses, also in the case of vision: if there is a possibility to correct visual function with glasses the disability percentage is reduced.

Maximum levels of visual impairment, cases of total loss of visual acuity (1/60 in both eyes) and visual field (less than 10⁰ in both eyes), are attributed a 100 percent disability. This is one of the very few classifications in the regulations that receive this maximum disability rating. Yet, blindness is culturally connected to tragedy and to emotions of pity and misery, often bearing symbolic reference—not only to lack of vision but also to helplessness and dependency, which are viewed as the maximum loss of function or a unique existence (e.g., Kudlick 2001; Gerber 2001; Scott 1969). Thus, what is being translated into the numerical disability percentage attributed to blindness beyond loss of function, sense, or body part, are all these culturally constructed references to blindness.

Aesthetics

A third example of heterogeneity embedded within the coding system is the section regarding scars. Scars are discussed in the sixth chapter, including five subsections as follows: (1) surface (2) of the abdomen (3) connected to tissue (4) face scars and (5) muscle scars. Whereas the first and second categories are attributed to negligible (10 percent) disability, the third and fifth categories refer to the “limitations in movements and damages” in the relevant organs, sending the evaluator back to the coding list. The fourth section regarding facial scars is exceptional, as it includes a graphic specificity of types of scars as follows:

Facial scars

wide and ugly—10 percent

cause change in shape of eyelids or ears—30 percent

acute, either unilateral or bilateral; spurring nausea—50 percent. (KT 612, 1956, 863)

This is also the only example in the regulations in which the evaluator’s perception, body, and emotions are explicitly mentioned in the classification as part of the calculation process, requiring him or her to register their personal feeling of nausea. Here the evaluation process as a human interaction, dressed as rational, mathematical encoding, surfaces (Callon and Law 2005). In this paragraph, scars are classified not according to their physiological essence, but according to their aesthetic value or lack thereof, assuming that ugliness is relevant to function. Although this perception of facial scaring and ugliness can be explained by turning to the construction of aesthetics, beauty, and normativity in Israeli society (Wiess 2002), it is important to note that the encoding process itself translates these cultural notions into a bureaucratic object.

Through this process, social influences such as cultural attitudes, superstitions, and lack of tolerance, which act as barriers to participation of people with disabilities, and reduce their ability to function, are deemed negligible. The regulations, therefore, play a role in producing and stabilizing the demarcation between physiology as the scientific and objective definition of disability, and the social aspects of disability, setting the latter aside.

Function, tragedy, and aesthetics are therefore embedded into the encoding system, disappearing within it alongside other elements such as pain, suffering, personal interaction, and social or material barriers. This system is situated in a heterogeneous formation, held together by administrative practices, mundane materialities such as forms and committees, professionals, and record collecting procedures, as discussed in the next section.

Translating Meaning, Framing Government⁴

Structuring disability benefits via a system of disability percentages attributes a specific role to the figure 100 percent, as the whole against which all other percentages are calculated, also demarcating the maximum disability level. By focusing on this object, we can follow the shifts in its meanings and practical usages from the British Mandate system of workmen’s compensation established in 1927 and updated during the 1940s, to the Israeli National Insurance system of disability percentages emerging in 1953–1956. Within this context, while maintaining the same numerical formation, the 100 percent value took on new interpretations; consolidating a new code for understanding the worker and the injured body, transforming injured workers compensated by their employers into disabled citizens.

The Workmen’s Compensation Ordinance of 1927, which was based on the British law of 1925 and revised in 1947 (Doron 2003), defined two types of injury categories as a result of an accident at the workplace—partial incapacity and total incapacity, both construed as the relationship between a worker’s salary prior to the injury and after it. If fully unable to work, one would receive two-thirds of the previous weekly wages, but if only partially able to work one would be eligible for what is defined as no more than the “difference between the pre-accident weekly earnings and what he is able to earn in some suitable employment or business after the accident” (The Palestine Gazette 1947). In this system, incapacity was viewed as loss of wages and not as bodily damage, and it was determined not by medical assessment alone, but by negotiation between worker and employer, sometimes with the involvement of insurance agents, courts, and arbitrations. Accordingly, 100 percent stands for the wages prior to the injury, and what is assessed is the difference between a person’s wages before and after it.

There were several flaws in this system, which were addressed by a special committee on workmen’s compensation headed by the Director of the Department of Labour, Richard Graves, who was posted in Jerusalem between 1944 and 1946. One of the problems was that since insurance wasn’t mandatory, upon bankruptcy of the employer it was impossible to secure compensation for the worker. Additional problems were the scope of the ordinance: it did not apply to all workers, and it quoted nominal levels of compensation that, due to rises in the cost of living, became insufficient. Allocation of some of the funds as profit for the insurance companies was also mentioned as a reason for the lower compensation payments (Gal 2005).

One of the ways to rectify this situation was to implement a state or government insurance scheme. During 1944, the committee was presented with the recommendations of the UK’s Minister of Reconstruction regarding state-run industrial injury insurance, with the possibility to implement a similar system in Mandatory Palestine. Developed in the United Kingdom following the Beveridge plan for a central–national social insurance, these recommendations introduced a radical change in the understanding of loss of work capacity due to injury as evident in the following quotation:

… if disablement is prolonged, there will be industrial pensions based, not on loss of earning capacity, but upon the extent to which the workman has suffered disablement by the injury, by comparison with a normal healthy person of the same age and sex…this system is in many respects like that which is the basis of war pension schemes. It thus recognizes a certain similarity between the position of the soldier wounded in battle and that of the man injured in the course of his productive work for the community. Neither is liable to have his pension reduced on account of what he may earn after the injury; each is compensated not for loss of earning capacity but for whatever he has lost in health, strength and the power to enjoy life. (CMD 6551 1944, 5)

The proposed plan sets forth the understanding that both workers and soldiers contribute to the nation through combat or productive work, and as such they are to be set on a comparable status, both to be compensated for their injury, conceived as loss in health, strength, and happiness, rather than for loss of earning capacity. This juxtaposition meant that both veterans and civilians would be measured in the same way in relation to a full, uninjured body of a comparable ideal person of the same sex and age, depicted as the 100 percent able body, from which impairments are deducted. Within such a structure, not only the understanding of disability as loss of the ideal body emerges but also an ideal civility based upon it. Civilian workers are cast as equal subjects of the state in the same way that soldiers are subjects of the army, both ready for encoding, evaluation, calculation, and administration, as well as rehabilitation.

Although such a system was eventually not implemented during the British Mandate period, the practice of applying percentages for evaluating work injury compensation gradually gained ground within government procedures to be applied for government workers, covered by the ordinance since 1947. In a circular issued by the Mandatory Government’s chief secretary’s office, a mathematical formula for calculating partial incapacity was introduced (see Figure 1). In this formula, D means “difference in weekly earnings” and is multiplied by two-thirds of the average weekly salary prior to the injury in order to calculate the weekly compensation to be paid. Although defined in terms of difference in earnings, in practice the calculation is set in percentages, depicting the proportion of decrease in possible earnings. The 100 percent continues to represent the previous salary and not an unimpaired body, but it now depends on a medical evaluation process that determines the injury’s impact on possible earnings.

Figure 1.

Compensation for Partial Incapacity (Bradley, 1946).

A similar usage of percentages is apparent in the form used to inform the Department of Labour on agreements between worker and employer, a practice which continued after the British Mandate period within the Israeli Ministry of Labour. The form includes entries on various issues including entries on employer, insurer, and worker. Information regarding the accident, the injury, and the “infirmities” it caused are provided as descriptions. In contrast, in the segment titled “Extent of loss of earning capacity if such has been estimated in the course of negotiations or arbitration proceedings,” the entries are often registered in percentages such as “Extent of loss of working capacity has been estimated by medical authorities to be approx, 17.5%” (Israel State Archives 1949). Therefore, in line with the law—although the medical situation, injury, or infirmity themselves were not presented in numbers—loss of salary was quoted in percentages as an estimation of a medical authority. Additional documentation attached to this form indicates that although presented as a medical evaluation, the quoted percentages were negotiated and agreed upon between the parties, and were based not only on the medical assessment but also on the person’s profession, place of work, whether or not different work was provided, and other criteria.

The lengthy process of reaching an agreement, sometimes involving costly court litigation, was also criticized, and the idea that a more objective, scientific system would resolve this was raised again by the interministerial committee headed by Itzhak Keinievsky/Kanev (Inter-ministerial Report 1950). The committee discussed a wide scope plan for social insurance including health, old age, death, unemployment, disability, maternity, and workmen’s compensation.

The work injury scheme proposed by the interministerial committee distinguished between temporary injury, which entitled payment of 75 percent of the wages for up to twenty weeks, and permanent injury defined as disability, measured by disability percentages. Although disability was still defined as the future loss of income due to injury, it was now to be determined by a professional assessment to examine the suitability of a person to the workplace. The figure 100 percent gains another transformation, from salary to adaptability, and a mechanism was set for evaluating bodies that became unsuitable for the workplace, calculating their prospects to fit in. This evaluation was foreseen as the work of experts using “lists which include details of the damages (pgiyot),” indicating the “percentage of loss of wages caused by the injury and usually related to it” (Inter-ministerial Report 1950, 184). Claiming that scientific experts formulating the list are able to know the specific impact of an injured organ on wages, these percentages were understood as an encoding of the influence of injury on the full earning potential, creating a direct connection between impairment and disability, between physiology and labor.

It seems that even Kanev, writing the inter-ministerial report, viewed this possibility to evaluate injuries according to percentages as somewhat simplistic, and therefore proposed that the evaluation would also take into account the “entire scope of issues which influence absorption at work,” as well as physiology. Hypothetically, a wide array of issues could have been included in such an evaluation, involving the possibility of accommodations in the place of work to meet the person’s disability, possibility to get to work, willingness of employers to employ an injured person, and the situation of the job market; yet, the report lists only two issues as relevant—the person’s professional training and age. These individualized features, focusing only on physiological and personal attributes, completely disregard the social and environmental facets of disability.

The inter-ministerial report was to be subsequently implemented in the National Insurance Law of 1953, finalizing the shift from negotiated workmen’s compensation to administrated state insurance. In 1956, the regulations for determining disability percentages for the purpose of National Insurance were promulgated. Similar, but not identical to the military regulations for evaluating injured veterans (KT 165, 1951), they maintain some of the same sections, readily adopting a similar logic. In the regulations described above, 100 percent no longer depicts previous wages or earning capacity, a heterogeneous outcome of negotiation and evaluation of personal and social issues; instead, it describes the ideal full and healthy body from which injuries are to be deduced.

Within this system, the figure 100 percent holds an additional meaning- that of the highest level of disability, a total disability allowing for the highest compensation and benefit levels, reached only in specifically defined cases. Theoretically, as the coding system allocates specific percentages to all impairments, it could be possible to reach any disability level by summing up disabilities. Nevertheless, a process of calculation is prescribed that makes it impossible to reach 100 percent or to go beyond it: additional disabilities are to be calculated as a percentage of the difference between 100 percent and the disability left after deduction of the other impairments. To demonstrate, if the first injury receives 40 percent, the second injury receiving 5 percent is calculated as 5 percent of the remaining 60 percent (i.e., only 3 percent), and so forth. Hence, it is not possible to reach 100 percent by calculation alone, and this level is maintained for special cases only. One such case is defined as a situation in which a person has more than 65 percent disability and the committee deems him or her completely unable to work. In addition, the figure 100 percent is allocated to a very small number of special impairments including blindness, active tuberculosis, issues causing loss of control over secretions—whether urine or feces, and loss of the bottom jaw. These may be viewed as impairments of the interface between interior and exterior of the body, symbolizing the disintegration of the body (Douglas 1966). Therefore, within the regulations, 100 percent disability is not a mathematical number, but a result of procedural calculations.

Consolidating this new meaning of 100 percent as depicting both the ideal body and the most extreme impairment, the 1956 regulations stabilize and black box a new understanding of the injured body. An injured worker is no longer a laborer whose wages were reduced, but a work-disabled person, measured according to his or her impairments by a central government office, the National Insurance Institute.

National Insurance Institute as a Center of Calculation

Rose (1999, 211-13) following Latour (1987, 215-50) points out several important process in producing centers of calculation. First, events are inscribed and standardized forms created transported and collected in a central locale where they are aggregated, compared, and compiled in the form of statistics. These establish “calculable spaces” in which the center can act for the benefit of the population. As an outcome of this process, defined groups of calculable persons are produced. The following section shall briefly follow these attributes in this specific case.

The Israeli National Insurance Institute was founded on April 1, 1954, as an independent organization to be supervised by the Ministry of Labor and managed by a public board of directors. With compulsory membership for some, and public campaigns to convince others to join, it branched out to many aspects of life. For example, each woman would be entitled, in addition to her maternity leave, to full payment of medical fees and a monetary gift as long as she received medical treatment and gave birth in hospital (Morgenstern-Lissner 2006); all employers and factories were to pay premiums according to their assessed risk and were therefore required to report on accidents at the workplace; workers received a special booklet in which weekly salary registration slips were to be inserted, so that a person’s average salary prior to injury (the basis of calculating pensions) was no longer an estimate but a concrete sum of salary slips carried by a person and visible to the central office upon request (Israel State Archives 1959). Thus, in more ways than one, the National Insurance regulated and supervised, producing a center of governance.

Mirroring the income tax structure, a central National Insurance was formed, with seventeen branches throughout the country. Figure 2 shows how each of the branches reach out to even smaller towns and villages, marking state borders. Although offices were spread out, medical committees, as well arbitration committees and special tribunals, were located in three central and three regional branches. Travel and accommodation expenses were paid by the government to enable citizens to reach those centers and be inscribed (KT 612 1956, 869).

Figure 2.

Map of National Insurance Branches (Lotan 1964, 130).

Calculated disability percentages were sent to the central office by application of a punch card system in which all relevant data were coded, stored, and processed and computerized during the 1960s. Punching instructions from 1958 show that registries regarding work injuries included details of the work place, accident type, and cause, as well as coding of the disability percentage itself. Injured body parts and disability types were also entered (Israel State Archives 1958). These data and, inscriptions registered and standardized, allowed flattening and producing statistics.

One such statistic proclaiming the importance of the National Insurance for the lives of injured workers was presented in a book celebrating ten years of the institute (1964), using graphic imagery in which the calculable person, the disabled worker, is presented in a visual depicting the percentage of bodily difference (see Figure 3).

Figure 3.

“Disability Percentages” (Lotan 1964, 33).

The text explains the visual image by stating that “90% of all disability cases reach disability level of 24%, at the most” and “only in 2.5% of the cases (which is 30 cases each year) a disability of more than 50% remains.” Seemingly, there are very few cases and they are all being treated, but using percentages, numbers, and graphic symbols to represent injury removes other aspects of the issue away from discussion. The people behind the cases and their life stories dissolve and disappear. Lotan, the director of the National Insurance who wrote the text, seems to be aware of this and makes one last effort to bring them back into the discussion by stating that “each case of this kind may destroy the happiness of a person and his family” (Lotan 1964, 70).

Thus, the disabled worker, calculated by the medical committees using the lists and procedures defined by regulation, becomes a calculable person, an administrative kind (Hacking 1995), rendered in percentages. The process constitutes a clearing in which the National Insurance can inscribe, register, flatten, and act from center to periphery. This calculable space will gradually be widened to include other people with disabilities who in turn will become defined calculable, administrative groups.

Conclusion

Up until recently, short stature was not included within the impairments list of the National Insurance…but since…I was identified in the list of impairments…and it alone gave me 80%. Not like the changing levels of pains which raised the physicians’ doubts, short stature turned into an unquestionable fact, and as a result I could allow myself to breath a little …. (Broyer 2008)

For Broyer, having a number, a percentage, meant recognition, a civil identity, and a gateway to receive government subsidy for the expensive wheelchair she needed. Although in other circumstances she might resist being defined as disabled or classified into a listed impairment (and she clearly elaborates in her academic work how this medical labeling alienates her from her own body), in this specific context of disability as a calculable space disability percentages are deemed essential (Broyer 2011). Often struggled with but rarely debated, this system, complex and inaccessible, is viewed by administrators and people with disabilities alike as an inevitable part of mundane practice.

This article has shed light on the technosocial work involved in emergence of disability as such a calculable space, allowing for the mutual production of disabled bodies and central government. To do so, I focused on the issue of work injuries, analyzing the details of the classification system and its emergence, proposing the concepts encoding and calculation to decipher its specific arrangement.

I argued that this classification system works to eliminate a wide array of heterogeneities and barriers, producing a calculated object demarcating disability as a bodily impairment. In addition, I demonstrated how the meanings of the object “100%” shifted from a reduction of wages to bodily deficiency. Once stabilized, the system produced a new understanding of the injured body, as well as a mechanism of population legibility, enabling the collection of data and calculation of statistics, producing the National Insurance Institute as a center of calculation.

Black boxed within this structure, disability percentages become an accepted instrument of government, to be applied in a wide variety of cases regarding people with disabilities. Seemingly neutral and objective, determining “real” eligibility, it continues to be used in various legislation and policies; not only for distribution of benefits but also for other policies such as affirmative action in public sector employment, to which only those reaching a certain disability percentage level are entitled. Disability benefits for congenital disabilities are also based on this system. In their case, it is applied as a first gateway and then followed by a second layer of an even more opaque “earning capacity” evaluation determining the actual compensation (Gal 2001).

In a recent study of the disability benefit system in Israel, it was pointed out that although the disability rights approach was introduced as comprehensive legislation in 1998 (Sefer Hahukim 1998), the prevailing individualized, medical approach to disability did not disappear and is integrated into many recent legislation and policy acts. The resistance to change is explained there as a result of attitudes, expertise, and conservatism (Rimerman et al. 2011). Prevailing technoscientific objects such as the disability percentage system, although overlooked by those writers, play an important role in keeping this approach in place, leaving the discussion of social barriers and lack of accessibility disregarded and nonintuitive.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Notes

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Impaired Encoding

Abstract

Keywords

Classifications, Translations, and Disability

Encoding, Calculating, and Classifying

Anatomical Encoding as a Classificatory Principle

Calculating Mutually Exclusive Categories

Regulating an All-encompassing System

Encoding Heterogeneity Out

Function

Tragedy

Aesthetics

Translating Meaning, Framing Government 4

National Insurance Institute as a Center of Calculation

Conclusion

Footnotes

Declaration of Conflicting Interests

Funding

Notes

References

Translating Meaning, Framing Government⁴