Week 6 W&S Chapter 45: Occupational Justice

Occupational Justice

• Challenges the long-term individual medically founded practices of

  occupational therapy (OT) by requiring consideration of the occupational needs of people in terms of communal equity, fairness, and opportunity

• Builds on the 1917 foundation objectives of the American Society to study of the effect of occupation upon the human being

•  Suggests a widening of practice to address occupational inequities arising from societal conditions in which people are born, grow, live, work and age that impact on the health of populations

• Was not named until the mid-1990s

• Concerned with ethical, moral, and civic issues such as equity and fairness for individuals and collectives, specific to engagement in diverse and meaningful occupation at is inclusive of “doing, being, belonging, and becoming”

Occupational Justice as an Idea and a Need

• A societal system that is occupationally just would be one in which each person and community could meet their own and others’ survival, physical, mental, and social health needs through occupations that recognize and encourage individual and communal strengths and respect the environment to meet the needs of future generations

The Naming of Occupational Justice Arose from Two Directions of Study in Different Parts of the Globe

• One of the directions made the discovery that many societal and practice determinants “overruled” occupational therapists’ “good intentions” of enabling justice with clients who could be populations, organizations, communities, groups, families, or individuals

• The other direction of study concerned with understanding the relationship between occupation and health made the discovery that beneficial or negative health outcomes of the relationship were often dependent on sociopolitical and cultural determinants which could be framed in social justice terms

  • Led to the first published definition of occupational justice

First Published Definition of Occupational Justice

• The promotion of social and economic change to increase individual, community, and political awareness; resources and equitable opportunities for diverse occupational opportunities that enable people to meet their potential and experience well-being

Occupation

• Viewed broadly as referring to all the things that people want, need, or have to do whether of a physical, mental, social, sexual, political, or spiritual nature and is inclusive of sleep and rest

• Refers to all aspects of actual human doing, being, belonging, and becoming at individual or population levels

• Is the activist element of human existence whether occupations are contemplative, restful, reflective and meditative, or action-based

• Is a unit of economy shaped by time, place, and social conditions

• Is a fundamental means of achieving implicit or explicit goals, so power relations are central to possibilities and limitations in pursuing goals

Social Justice

• A central concern in growing numbers of postmodern societies

• Can be described as just and nondiscriminatory relationships between individuals, groups, and the society in which they live

• Is applied to the ethical distribution and sharing of resources, rights, and responsibilities between people recognizing their equal worth, their equal right to be able to meet basic needs, the need to spread opportunities and life chances as widely as possible, and “reduce and where possible eliminate unjustified inequalities

• Was the central ideology of the Arts and Crafts movement that influenced the beginnings of OT in both the United States and England

• Is individual rather than population interventions around injustice that have been at the forefront of practice for a century

Assessing Social Justice

• Is assessed for differences according to wealth and social privilege, racial and gender equality, and opportunity for personal and population activity including for those with social, mental, or physical disability and those who are environmentally displaced

Occupational Rights

• Ethical, moral, and civic issues such as equity and fairness for both individuals and collectives specific to engagement in diverse and meaningful occupation

• Is inclusive of “doing, being, belonging, and becoming”

Townsend and Wilcock Exploratory Theory of Occupational Justice

• Proposed that occupation highlights the reality of justice in the occupations of daily life

• Exposes the everyday individual, group, and population experiences within broad social conditions and structures that shape options for and against justice in the lives of people in different cultures

• Accepts that occupation is central to human existence

• Recognizes that people are occupational beings

  • They participate in occupations as autonomous beings and as members of particular communities

  • Participation in occupation is interdependent and contextual

  • The context for occupational engagement is a determinant of health and well-being or the cause of illness and ill-being

• States that, for justice to prevail, there must be an ethical distribution and sharing of resources, rights, and responsibilities regarding what both population groups and individuals want, need, or are obliged to do within their socioeconomic milieu

Principles of Exploratory Theory of Occupational Justice on Human Empowerment

• Puts forward the principles that this is achieved or not through occupation

• This is highly dependent on the power relations that shape the context for occupational engagement

• A broad view of occupation demands a more inclusive occupational classification beyond paid or volunteer work

• Occupations have both economic and social value

• Societies are responsible for the individual and collective enablement of the diverse occupational potential of each occupational being individually and as members of populations

Occupational Injustice

• Can mean that many people are unable to meet even basic needs, or have unequal opportunities to reach their occupational potential

Social and Occupational Justice Share Two Powerful Social Requirements

• The creation of families, groups, and communities as structures in which people can define what they can and want to do, who they will be and become, and how they belong or not in particular social and populations contexts

• The organization of economic and human resources in which people are enabled to participate according to their potential, experience well-being, reduce illness, and thrive

1986 WHO Ottawa Charter for Health Promotion (OCHP)

• With the understanding that health is a fundamental right of all human beings without distinction of race, religion, political belief, or economic or social condition

• Called for “enablement,” “mediation,” and “advocacy” to reduce health inequities between and within countries where inequities are unfair and unacceptable

Key Strategies in the Charter

• The building of healthy public policy

• The creation of environments that are supportive of health

• The strengthening of community action for health

• The development of personal skills

• The reorientation of health services

Causes of Limitations or Restrictions in Occupations

• Regulations

• The media

• Changing technology

• Sociocultural, spiritual, or familial expectations or physical force

The Commission on Social Determinants of Health

• Talks of the “causes of the causes” of restrictions explaining them as “the fundamental structures of social hierarchy and the socially determined conditions these create in which people grow, live, work, and age”

• The causes of causes can marginalize or exploit

• They can disempower, restrict, alienate, and inflict physical, psychological, and spiritual harm on people who have too little or too much to do

Universal Declaration of Human Rights

• Advocates for all people to have a standard of living adequate for health and well-being

• Advocates for equal rights to participate in the cultural life of a community

• Advocates for meaningful work with free choice for employment

• Advocates for rest, leisure, and holidays

• Included are rights to take part in the arts and in national governments and access education directed to the full development of the human personality

Social Health

• Having a standard of living adequate for health and well-being

  • Equal rights to work, to free choice of employment

  • Equal rights to rest, leisure, and holidays

  • Equal rights to participate in the cultural life of a community

  • Equal rights to the arts and scientific advancement

  • Equal rights to take part in national governments

  • Equal rights to education directed to the full development of the human personality

Common Problems with Occupations

• Children and adolescents in more affluent countries are pressured to put aside particular interests and talents to excel within a limited range of occupations to follow the current rage or family or community traditions or be financially successful as adults

  • Such pressure may be a contributing factor to young people experiencing increased unhappiness in life as evidenced by the growing numbers of suicides

• The pressure put on older people to change their interests and decrease levels of activity at a given chronological age whatever they feel about it themselves or whatever their health status

  • Decreasing activity increases the likelihood of illness and early death

World Federation of Occupational Therapists (WFOT)

• Recognizes social health issues and occupational justice as occupational therapists’ human rights responsibilities, deploring global conditions such as poverty, social discrimination, displacement, disease, disasters, and armed conflict that threaten the right to occupational engagement and choice

• Recommends that occupational therapists become “partners in world changing initiatives related to regions dealing with the aftermath of war, social upheaval and revolution” working “in partnership with others to ensure clean water, safe housing, education and meaningful community engagement”

WFOT Minimum Standards for the Education of Occupational Therapists

• Have been updated to go “beyond education on bodily dysfunction” and to include health and wellness to “advance human rights” as core principles across all areas of practice

• The latest call for social inclusion and participation to be advanced globally, with the application of practical understanding of the social determinants of health and occupational justice

• Meeting the new Minimum Standards for enabling social as well as individual health requires major changes away from medically organized OT curricula

Mental Health

• A state in which people realize their own abilities, cope with the normal stresses of life, work productively and fruitfully, seek response to their spiritual quest for meaning, purpose, and belonging, and make contributions to their community

Justice in Promoting Mental Health

• Can be enhanced by attending to multiple and interacting social, psychological, and biological factors using assessments and interventions that respect and protect basic rights

Mental Health Promotion

• Is a fairly recent branch of public health associated with the WHO OCHP

• Is integral to the empowerment of people individually and at a population level, having the potential to enable and activate governments to design interventions aimed at early disorders of children and youth in disadvantaged populations and the empowerment of women and to fund appropriate supports for ageing populations as well as vulnerable groups such as indigenous peoples, migrants, refugees, and victims of disasters

WHO 66th World Health Assembly

• Embedded the idea of mental health as an international human right separate from mental illness

• Defined mental health as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community

WHO Through the Calouste Gulbenkian Foundation

• Recommended a multi-layered and multi-sectoral “health in all policies” approach to promote the mental health of populations and to reduce the risk of mental disorders throughout life

• Has called for action to improve the circumstances in which people are born, grow, live, work, and age; address disparities in the social determinants of mental health; and include interventions at environmental, structural, local, community, and national levels when necessary

Vicious Circle of Poverty and Mental Health Disorders

• Is rarely broken

• As well as poverty, in both the developed and developing world, the risk of mental illness appears to be associated with rapid social change such as multiculturalism or when displaced people seek asylum in new countries where they experience insecurity and hopelessness, the risks of violence, and physical ill-health

Within the Constraints of “Painful, Distressing, or Debilitating Symptoms”

• Those who live with ongoing mental illness can attain effective well-being; experience “a satisfying, meaningful, contributing life”; and attain effective well-being

Gruhl Arguments on OT and Occupational Justice

• Occupational therapists across the globe need to ensure that vulnerable people and particularly those with serious mental illness have access to participation in therapeutic regimes that address occupational justice and injustices they and their family members face

• Families from all backgrounds and communities need to be involved

Occupation-Based Programs Must

• Enable people to cope with the normal stresses of life and provide purpose (doing), meaning (being), community involvement

  (belonging), and the means for people to strive toward their potential

  (becoming)

• The guideline of “doing, being, belonging, and becoming” is

  useful to bear in mind as it integrates active, passive, reflective, familial,

  social, communal, world citizenship, and personal growth

A Dilemma that can Face OTs in Establishing Population-Based Programs

• Lack of information and experience outside the prevalent education

• Practice focus on individual function and dysfunction

Newest Minimum Standards

• Require entry-level OT education programs worldwide to include theories and practice experiences that will prepare practitioners with an adequate understanding and methods to address human rights issues and collective occupational injustices at population levels

• The implication is that all OT entry-level education programs in the world will now be required to include population health

Bernadino Ramazzini

• A pioneer figure of occupational health

• Raised very practical concerns about the early death and disorders suffered by workers in many types of basic and necessary employment in the eighteenth century

• His extensive research is a testament to the occupational injustices of that time and resonates with what still happens in many poor communities around the world in agrarian, industrializing, and industrialized countries

Physical Inactivity

• Has has now been identified as the fourth leading risk factor in global mortality

• Is one of only a few largely preventable risk factors that account for the majority of illness throughout the world

WHO (2013) Global Action Plan for the Prevention and Control of Noncommunicable Diseases (NCD)

• Recognizes that health and quality of life are influenced by lifestyles and the conditions in which people live and work recommending physical activity for the 1 in 4 adults and more than 80% of adolescents who are not sufficiently active

• Describes physical activity as any bodily movement produced by skeletal muscles that requires energy expenditure

  • Activities undertaken while working, playing, carrying out household chores, traveling, and engaging in recreational pursuits

  • Activity to improve physical dysfunction needs to engage individuals or communities in whatever they need, want, or are required to do and be in line with human rights, the social determinants of health, prevailing societal beliefs about disability or disfigurement, and the risk of contagion

Dilemmas for Occupational Therapists

• How to increase community understanding of the physical health benefits of meeting wide-ranging occupational needs

• How to continue occupation-based rehabilitation programs beyond shortened institutional stays

• How to assist compensatory cases to improve their fitness whilst under the restrictive jurisdiction of insurers

Townsend at the 2003 Conference of the European Network of Occupational Therapists in Higher Education (ENOTHE)

• Explained how injustices experienced when people are barred, trapped, confined, segregated, restricted, prohibited, unable to develop, disrupted, alienated, imbalanced, deprived, or marginalized can exclude them from participating optimally in the occupations they need and want to do to sustain health throughout the life course

In Order to Enable Occupational Justice

• Occupational therapists need consciousness raising experiences and support to reduce potential professional isolation and technical competency expectations that minimize the complex work of enabling occupational justice

Social Health Focus

• Accepting the professional responsibility of raising awareness of occupational injustices within communities and developing occupation-based programs that address injustices such as occupational deprivation, imbalance, and alienation

UN Universal Declaration of Human Rights Position Statement

• Was endorsed by the WFOT

• Includes its stand on human rights and occupational justice as a right and condemns the global conditions that threaten that right including “poverty, disease, social discrimination, displacement, natural and man-made disasters and armed conflict”

• Called for occupational therapists to identify and support individuals, groups, communities, and societies experiencing occupational injustices and to work with them to enhance participation in occupation

• This position was expanded in the 2016 WFOT Minimum Standards

Linking Individual, Group, and Collective Action for Local and Global Change

Linking Individual, Group, and Collective Action for Local and Global Change Case 1: Individual Action

• Relates to rehabilitation practices in health facilities where occupational therapists work primarily with individuals who have physical, mental, cognitive, and other bodily challengees

• What local actions change daily life-occupations?

• What global trends support local action?

• 1) Use Occupational Justice and Health Questionnaire (OJHQ) to document injustice and action

• 2) Advocate for paid community outreach

• 3) Form partnerships with advocacy groups

• 4) Implement occupation-based programs

Linking Individual, Group, and Collective Action for Local and Global Change Case 2: Group Action

• Addresses occupational injustice relating to the promotion of mental health

• Suggests action with a group of interested colleagues

• Who are logical partners for group action?

• What other groups exist?

• 1) Use OJHQ to document injustice and action

• 2) Advocate for paid community outreach

• 3) Form partnerships with advocacy groups

• 4) Form partnerships with socially disadvantaged groups

Linking Individual, Group, and Collective Action for Local and Global Change Case 3: Collective Action

• Suggests collective action through raising questions capable of generating debate and innovation to change an occupationally unjust world

• What global alliances are possible?

• What would attract local or global media attention?

• 1) Advocate for new program funding

• 2) Partner with nongovernmental organizations (NGOs)

  • Could stimulate ideas and dialogue for individual or group action in particular directions or situations

• 3) Invite global occupational therapy action

• 4) Send possible initiatives to WHO