1 1 Dementia and the social model of disability: does responsibility to adjust lie with society rather than people with dementia? Christine Milligan and Carol Thomas In the Winter 2015-16 volume of this journal, Philly Hare set out the Joseph Rowntree Foundation’s (JRF) vision for a future in which the UK became a good place for people with a diagnosis of dementia to live. In her words, the JRF wanted to, “ensure that people living with dementia are more understood, more heard, more included, more connected and more supported” (p. 9). Part of the drive toward this goal was to think about how we might change society’s thinking and attitudes toward dementia and what an inclusive UK society in the context of dementia actually means. One outcome of this goal was the commissioning of a ‘think piece’ by the authors of this article about how we might draw on the well-established social model of disability to develop this thinking (REF). We discuss the key elements of this think-piece in this article, but it is worth noting that this was paralleled by companion paper written by Toby Williamson (Mental Health Foundation, 2015), designed to encourage new thinking and debate about dementia as a human rights issue. What is the social model of disability? Before applying the social model of disability to dementia, we need to look at what this model is, and where it has come from. The social model of disability was first coined by the disabled activist and writer, Mike Oliver in the early 1980s in his attempt to capture novel ideas about disability, developed by disabled people themselves in the previous decade (Oliver, 1983). At its core was the view that disabled people were socially disadvantaged - not so much by their impairments - but by the negative responses of those deemed to be non- disabled. Oliver and his contemporaries thus drew attention to a form of social relationship between disabled and non-disabled people predicated on social inequality. This relationship makes its presence felt in a number of ways: in interactions between individuals; through rules and practices in social institutions (such as schools and hospitals); and in the disabling structure of the physical environment including buildings, systems of travel and so forth. This perspective contrasted markedly with the dominant biomedical view of the time: that being impaired is an abnormality that causes major problems and limitations in the lives of ‘the disabled’. It also takes issue with assumptions that disabled people should be pitied because it is their damaged bodies and minds that stop them participating in ‘normal’ activities. Instead, the social model of disability drew attention to the social and physical barriers erected by non-disabled people in all social arenas and captured the idea that people with physical impairments are a socially oppressed group in modern societies. Before long, those with impairments beyond the straightforwardly physical began to question their apparent exclusion from this initial formulation of the model. In the 1980s and 1990s, the case was made – and won – that people who live with sensory or intellectual/cognitive impairments (principally learning difficulty) are also disabled people in that they too experience similar forms of exclusion and social barriers (Barnes, 2012). Who counts as disabled was further widened in the 1990s and 2000s to include people with chronic illnesses and mental health problems (e.g. Walmsley, 1991; Beresford, 2002). Hence, the social model of disability can be seen to apply to a growing proportion of the population with lifelong, acquired or attributed impairments. In 2004, Oliver clarified his original thinking, stating: …the social model of disability is about nothing more complicated than a clear focus on the economic, environmental and cultural barriers encountered by people who are viewed by others as having some form of impairment – whether physical, mental or intellectual. The barriers disabled people encounter include inaccessible education systems, working environments,