Gender approach in the evaluation of impairment in Colombia

Introduction
Workers' compensation and social security systems aim to compensate the damages occurred to worker's health due to adverse, unhealthy or unsafe working conditions. Benefits vary according to the deficiency caused to the person and how severely it affects the person’s functionality at different levels of interaction.
Since the Social Security Reform conducted in 1994, Colombia created and applied two unique Manuals for Evaluation of Impairment. A new one is being proposed in accordance with the evolution of WHO's International Classification Functionality and the Model of Human Occupation MOHO.

Methods
A review of the methods to evaluate impairment around the world was carried out, to compare such models with the Colombian one. As well, several series of Colombian cases were evaluated and analyzed to determine equity, justice and objectivity of the evaluation, taking into account that the decisions derived from the evaluation yield or reject a cash, in-kind and/or pension benefits to an injured or sick worker.

Results
Many gaps were found between/within the three Colombian Manuals. They transformed other manuals such as the AMA Guidelines for Evaluation of Impairment, the WHO Manual of Consequences of Diseases and the WHO International Classification of Functionality. The basic conceptual model of each manual, the proportional distribution of the evaluation (in formulas and %) and the degree of subjectivity in each, were key elements for determining the differences.

Discussion
Evaluation of impairment is a difficult practice that requires skilled, well trained and knowledgeable practitioners. Baremology is a young science that is evolving at high speed, as much as the health frameworks that define the determinants of health. Evaluation of impairment should evolve at the same rhythm as these new health theories evolve, since this is the way to provide equity, social justice and fair evaluations, and to grant the benefits workers right to have.