2312AHS- Context of Occupation 2025 MID-TRI

Justice

Justice is a moral concept understood within worldwide views and cultural contexts/peoples' places in the world.

- Various Forms: social, distributive, procedural, retributive, restorative, political, epistemic and occupational justice

- Indigenous and African views of justice challenge Western legalistic approaches: peaceful community relations (vs adversarial response), humane treatment of all people, rewarding goodness over punishing ill deeds, interconnectedness with land

- Example: The Ekuanitshit people used justice systems to reclaim land rights eg. the Mapie River in Quebec, showing how justice can be a tool of reclamation and sovereignty

Define social justice

Social justice refers to the concept of fair and just relations between individuals and society.

It encompasses the distribution of wealth, opportunities, and privileges within a society, aiming to eliminate inequality and ensure that all individuals have equal access to resources and rights.

define social injustice

Social injustice occurs when unfair practices, discrimination, or inequalities exist within a society, leading to unequal access to resources, rights, and opportunities.

It manifests in various forms, including economic disparities, discrimination based on race, gender, or other characteristics, and the denial of basic human rights.

Examples of Social Justice

- A right to be active, productive participants in society

- Equity in society

- Equitable distribution of resources

- Opportunities to reach potential

- Concerned with how humans relate to each other

- Social rights and fairness

- Human rights

Examples of Social Injustice

- Experiences of oppression

- Maintained inequalities/inequities

- Rich getting richer, poor getting poorer (agent groups acting on target groups)

- Inequitable allocation of resources and opportunities

- Dehumanisation

- Violation of human rights

- Discrimination between groups to perpetuate inequalities

- Inhibits development

Occupational injustice arises when:

- People are forced into occupations that are not meaningful eg. indentured labor

- Health ir quality of life is compromised eg. excessive work hours

- Participation is barred due to systemic issues eg. limited access to education

- People are inhibited from developing capabilities essential for a florishing life

Critiques and limitations of occupational Justice

- Criticised for lack of clarity, insufficient integration of theory from other disciplines and limited scholarly critique

- Dominated by Western, white, middle-class perspectives which often:

- Ignore colonial privilege and systemic oppression

- Fail to address contextual realities of Non-Western communities

- Emery- Whittington notes that occupational justice, shaped by Western academic norms, often results in a repackaged form of colonialism, under the guise of development and equity

Procedural and Structural Opression

- Indigenous governance and justice systems: eg. community, courts, land managment, are often overriden or excluded by colonial systems

- Example of exclusion: Alberta's eugenics program 1928-1972 lead to forced sterilisation of people with disabilities and Metis people - demonstrating systemic abuse in the name of justice

Canadian goverment ideologies: historically favoured Western nuclear family ideals and punished indigenous children for speaking native languages or participating in cultural occupations

- The justice system can both opress and liberate, depending on their design and application

define oppression

Oppression refers to the systematic and pervasive mistreatment, discrimination, or injustice imposed on a group or individual by those in power.

It often involves the unjust use of authority or power, resulting in the marginalisation, exploitation, or denial of rights to certain people based on characteristics such as race, gender, sexual orientation, socio-economic status, or other attributes.

define privilege

Privilege refers to the unearned advantages, rights, or benefits that individuals receive based on aspects of their identity, such as race, gender, socio-economic status, sexuality, or other characteristics. These advantages often occur at the expense of those who do not share the same characteristics and can lead to disparities in access to resources, opportunities, and treatment within society.

examples of oppression

- domination

- Based on 'isms' (e.g., racism, sexism)

- Restrictive

- Hierarchical

- Internalised

- Negative actions seen as reflective of the group rather than the individual

- Historically and socially constructed

examples of privilege

- Invisible to privileges (agent group)

- Subconscious

- Intersectional

- Involves more freedom

- Individuality assumed (earned viewpoint)

- Unfair advantages

- Unearned nature

- Can have privilege in some areas and not in others (part of an agent group and target group at the same time)

- Experience unjust treatment, persecution, or maltreatment (in cases of target group membership)

Social Justice: Structural Inequities

Some inequities are created by structures in society rather than by the individual or group who experience the downside of the inequity.

Social Justice: Potential for Change

Societies could do something different—alter the social arrangements in some way—to make the situation more equitable.

Social Justice: Impact of Social Institutions

Social institutions (politics, economy, religion, schools, the family) have a real-world impact on people's material circumstances.

Contemporary Racial and Colonial Justice Issues

- Black, indigenous, people of colour (BIPOC) experience disportionate surveillance, punishment and systemic exlusion, shaped by ongoing colonial legacies

- Settler colonialism continues to define and distort justice, making "good citizenship" conditional on conformity to Western standards

- Diliberate inattention to occupational rights, equity and justice for these groups is part of structural opression

- Occupational injustice: is sustained by colonial and racial power, controlling what occuaptions are seen as valuable or deviant

Human Rights

- Rooted in international norms that are both emancipatory (empowering) and regulatory (controlling)

- Includes rights to: life, liberty, freedom of expression, education, leisure, rest, community participation

- UN Declarations, the Canadian Humans Right Act, and the Canadian Charter of Rights and Freedoms project against discrimination and uphold freedoms eg. religion, speech, assembly

- Despite these protections, implemation through legal systems is slow, and rights may not be enforced effectively or equitably

Social Justice

- Emerged in 1920s Europe aiming to redistribute wealth and equalise treatment

- Define by the United Nations (UN) as promoting peacful coexistence and equality within and across nations

- Includes gender equality, indiginous rights, migrant justice and breaking down systemic barriers based on race, ethnicity, religion, culture age, gender and disability

what are the 3 Social justice parameters?

1. How resources, rights, responsibilities, and opportunities in life are distributed ethically

2. Whether people's equal worth and right to meet their basic needs is recognised

3. Whether unjustified inequities are reduced or eliminated

Social Determinants, Inequites and Occupation

- WHO defines equity as the absence of avoidable or unfair differences in health and access to reources

- Health euqity is a result of restricted access to occupational and health opportunities

- Occupational choices are shaped by intersections of social class, race, caste, ability, gender and colonial legacies

- Equity, justice and rights ate interwoven into occupational experiences, but their impacts can oftern be invisible

Summary - Social Justice

- Social justice is about the structuring of society (at an institutional level) to ensure equitable treatment of all people, and part of this is the equitable distribution of resources.

- Social justice is inherently tied up with power and oppressionOppression is pervasive, restrictive, hierarchical, intersectional, can be internalised, and is based on "isms".

- Isms reflect target (oppressed) and agent/dominant (oppressor) groups

- Oppression is manifest at an individual level and structural level

- Things can be done to change the structures that cause oppression (and social injustice)

Historical Origins and Foundational Concepts

- The concept of occupational justice emerged in the late 1990s, introduced by Anne Wilcock and Elizabeth Townsend

- It is rooted in broader frameworks of social justice and human rights, positioning occupations as a means to support equity and human well-being

- Humans are viewed as occupational beings, with each individual possessing a unique constellation of habits, values, needs and capacities, shaped by sociopolitical and historical contexts

Relevance to Occupational therapy summary

- Occupational justice links personal, social and political rights to occupational participation

- OT practitioners must reconise how systems of oppression, colonial histories and unequal power dynamics shape what occupations people can engage in

- Justice in OT is not only about inclusion, but also about transforming structures that exlude or harm - challenging dominant norms and centering equity in practice

Occupational Opportunities and Justice

- Justice in this context refers to the fair distribution of occupational opportunites, allowing individuals to grow, thrive, and participate meaningfully in life.

- Occupational justice assumes that access to appropiate occupations enhances individual and collective well-being

Occupational justice vs social justice

Equitable allocation of resources for engagement in occupation vs engagement in society more broadly

• Occupational justice is a form of social justice

• Occupational justice can be seen as ensuring the actual realisation of peoples' doings (ie occupations/functioning's according to the capabilities approach) rather than simply providing the conditions for people to do things they want, and hoping that's effective.

Occupational justice vs social justice (continued)

• Occupational justice being a subset/form of social justice

• Social justice as equitable allocation of resources, whereas occupational justice is about equitable opportunities to do things we need/want/have (occupations)

• Occupational justice can be considered as bringing an occupational perspective to social justice

Relevance of occupational justice to OT

-As OTs we can educate the person on their rights (human rights) and that a large contributor to occupational issues is environmental

- Occupational justice practice can involve advocating for our clients to be able todo the things they want/need to do. To have real opportunities to do these things, or for their rights and inclusion in society

- Occupational justice acknowledge systemic barriers (as part of environment) that can hinder or enable engagement in occupation

Relevance of occupational justice to occupational therapy

"Occupational justice is a part of the domain of occupational therapy because environmental forces impact:

1. participation in occupation

2. the provision of occupational therapy services

3. patient health and well-being outcomes

How do you predict this course is relevant to enhancing your ability to practice in an occupationally-just ways as a practitioner

• Using social and occupational justice to identify peoples needs, wants desires

• Develop knowledge on what can cause inequities

• Learn how we can address these barrier in practice

• Broaden critical lens

• Develop ethical reasoning skills

Capabilities approach & occupational justice similarities

• Both have a real world focus, what people can achieve/do

• Focus on enabling people to do what they want to do

• Both look at meaningful activities/aligned with peoples values - what they want to do

• understand the relationship between participation, health and justice

• Capabilities look at being and doing - we also do this (occupations) in a meaningful way

- Both focus on peoples' doings (functionings and occupations)

- Both focus on peoples' doings as the best markers of justice (whether people are actually free and capable to do the things they value)

- Both highlight that peoples' doings are largely dependent on their environments

Transcendental institutionalism approach

- Focus is on characterising what a perfectly just society is, in terms of institutional / governing arrangements.

- Critique is this is impossible because this suggests there is one impartial idea of what is 'just'.

- Critique is that justice is not only about institutions but also the virtues and vices of individuals.

Realisation-focused comparison approach to justice (the capabilities approach)

Focus is the desirability of particular social realisations (capabilities to do), rather than a search for a set of perfectly just principles for governing.

"It may not be possible to agree on perfectly just institutions, but using a comparative approach we can at least arrive at widespread consensus on the injustice of certain practices or outcomes relative to others."

key takeaways

Occupational engagement and the relationship of this to justice, is highlighted in disciplines outside of OT, ie is not unique to occupational therapy.

The capabilities approach adds to the theoretical justification for occupational therapy as a profession focused on justice.

The capabilities approach argues that the best marker of justice is a society in which people are actually able to do the things they value.

Realisation-focused comparison (RFC) approach to justice is an ..... approach to transcendental institutionalism

alternative

RFC is about ensuring the actual ....

realisation of peoples' doings rather than simply providing the conditions for people to do things they want, and hoping that's effective (which is transcendental institutionalism)

The Capabilities Approach is an example of a ....

RFC approach to justice

Occupational justice can be seen as ....

situated within the capabilities approach/is reflected in the capabilities approach

RFC approach-> Capabilities approach-> Occupational justice

define micro level

The micro level focuses on individuals and small groups, examining personal interactions, behaviors, and individual experiences within specific contexts.

define meso

the meso level involves the study of larger groups, communities, and organizations, analyzing how they function, their dynamics, and their influence on individuals and society

define macro

The macro level looks at large-scale social processes, structures, and systems, including societal norms, policies, institutions, and how they shape and are shaped by the broader social environment.

define classism

Classism is prejudice and discrimination based on socio-economic status, leading to inequalities in resources, opportunities, and rights

give characteristics of a "social justice issue"

• Inequitable allocation of resources to participate in society

• Disadvantaged suburbs experience socioeconomic hardship

• Target group (low income/poverty) and an agent group (high income groups/governing bodies

• Classism is at play resulting in health and well-being outcomes - 20 year lower life expectancy

examples characteristics of an occupational justice issue

• denies youth opportunity to participate in physical activity

• Inequitable opportunities to participate in basketball/sporting activities more broadly

OT Role in Addressing Occupational Injustice

Advocacy: Lobby for policies that promote equitable access to resources and opportunities.

Education: Raise awareness about the impacts of classism and occupational injustice.

Intervention: Develop and implement programs that improve access to meaningful occupations for marginalised groups.

Collaboration: Work with community organisations to support systemic changes.

Research: Conduct studies to highlight occupational injustices and effective interventions.

OT Contributions to Occupational Justice

Holistic Approach: OTs consider the whole person, including physical, emotional, and social aspects of well-being.

Focus on Meaningful Occupations: Emphasize the importance of engaging in meaningful activities for overall health and well-being.

Client-Centered Care: Tailor interventions to meet the unique needs and goals of each individual.

Empowerment: Enable individuals to take control of their own lives and participate fully in society.

Interdisciplinary Collaboration: Work with other professionals to address broader systemic issues.

Advocacy and Policy Change: Advocate for changes in policies and practices that create barriers to occupational participation and equity.

Define Cultural Imperialism

Cultural imperialism refers to the domination and imposition of one culture's values, beliefs, and practices over another culture

This often occurs through media, education, and other means of cultural transmission, leading to the marginalisation or erasure of the subordinate culture's identity and traditions

Two perspectives of occupational justice issues

1. An occupational injustice perspective

2. An occupational rights perspective

Define occupational rights

Occupational rights refer to the universal entitlement of all individuals to engage in meaningful and purposeful activities that contribute to their well-being and development. These rights include the right to:

- Participate in a range of occupations that promote health and well-being

- Make choices about which occupations to engage in

- Access resources necessary for meaningful participation

- Experience social inclusion and equity in occupational opportunities

- Develop through engagement in diverse and fulfilling occupations

Compare an occupational injustice perspective to an occupational rights perspective

occupational injustice:

Focuses on barriers and inequities that prevent meaningful participation in occupations.

Addresses issues like deprivation, marginalisation, and imbalance.

whereas occupational rights:

Emphasizes the universal entitlement to engage in meaningful occupations.

Advocates for access, inclusion, and the protection of these rights for all individuals

Recognise the five variants of occupational injustices in real-world scenarios

Occupational Deprivation:

External factors prevent engagement in meaningful activities (e.g., refugees in detention centers).

Occupational Marginalisation:

Exclusion due to invisible norms (e.g., employment bias against people with disabilities).

Occupational Imbalance:

Over-occupation or under-occupation affecting well-being (e.g., single parents working multiple jobs).

Occupational Alienation:

Engagement in meaningless tasks leading to disconnection (e.g., repetitive factory work).

Occupational Apartheid:

Systematic segregation restricting access (e.g., racial laws barring education/professions).

Recognise the breach/violation of an occupational right, in real world-scenarios

Right to Meaningful Occupation:

A person with a disability is denied access to recreational facilities, limiting their ability to engage in meaningful leisure activities.

Right to Inclusion:

An immigrant is excluded from community events and social networks due to language barriers and cultural differences.

Right to Fair Employment:

Women in certain industries face gender-based pay gaps and limited career advancement opportunities.

Right to Participation:

Elderly individuals in nursing homes are not provided with opportunities to participate in decision-making about their daily routines and care plans.

Right to Access Resources:

Low-income families are unable to access adequate healthcare, education, and housing due to financial constraints and systemic barriers.

Critiques of these injustices

- OverlapLack conceptual clarity

- Requires judgement on behalf of the person who assesses something as being one or the other

- This judgement will be influenced by the positionality of the judger (Hammell & Beagan, 2017

what is hocking's defintion of occupational injustice?

breaches of occupational justice occur when participation in health enhancing occupations is inequitable across different groups in society, with some people unfairly benefiting and others subjected to patterns of occupation that are detrimental to health and well -being" (Hocking, 2017)

Patterns of occupation so deficient that the result is...

- Restriction of children's development

- Significant health issues

- Shortening of people's lifespan

- Undermining the economy by wasting human potential and creating a health burden

- Reducing social cohesion by planting seeds of discontent and social unrest

- Threatening peoples' sense of safety

define Occupational deprivation

Preclusion from engagement in occupations. Due to factors outside the immediate control of the individual

E.g. people in prison, people in immigration detention, people insecure mental health units, people in aged care facilities, people in rural/remote communities.

Rights perspective of occupational justice issues?

An occupational injustice is a violation of an occupational right. Some scholars say this approach is better than using the five occupational injustice terms.

Argument for this perspective:

- removes the need for someone to use personal judgement

- rights state unequivocally what all people are entitled to

- rights focus more on doing, than the concept of justice (which is about distribution of resources)

Occupational Rights: Definition and Global Recognition

- Occupation rights: refer to the entitlement to engage in meaningful occupations that support personal and communal wellbeing

- The UN Universal Declaration of Human Rights 1948 and the World Federation of Occupational Therapy (WFOT) affirm the right to participate in the occupationas a funamental human right

- Using the language of occupational justice and occupational theapy rights links OT to braoder social justice and human rights movements, emphasising equity and inclusion while also enabling diverse aproches to tackling injustice

Four Core Occupational Rights: Wilcock & Townsend

1. The right to experience occupaiton as meaningful and enriching

2. The right to develop through occupational participation

3. The right to exert choice in occupations

4. The right to benefit from privileges associated with participation in occaupation

- These rights form the foundation of just occupational participation and aim to ensure that can pursue occupations that align with their goals and values.

World Federation of Occupational Therapy (WFOT) 2019Occupational justice requires occupational rights for all to

Participate in a range of occupations that support survival, health and wellbeing, so all can flourish and realise their potential.

Choose occupations without pressure, force, coercion, or threats, but with acknowledgement that with choice comes responsibility for other people, lifeforms and the planet.

Freely engage in necessary and chosen occupations without risk to safety, human dignity, or equity

Expand Definitions and Social Dimensions: Occupational Rights

- Hammell expand on this by defining occupational rights as "the right of all people to engage in meaningful occupations" that support their own wellbeing and the wellbeing of their communities

- This perspective incorporates collective and relational aspects, not just individual rights - stressing the social dimensions of occupational participation

Perspectives on freedom, Discrimination and Capability

- Scholars like Wilcock and Hocking highlight the need to respect divirse interpretations of what constitutes a meaningful occupation

- People must have the freedom to define, purse and attach meaning, to their occupations in ways that align with their culture, identity and lived experiences

- Sen's and Nussbaum's Capability approaches are cited to emphasise the importance of freedom to choose occupations without restrictions impose inequites, distrimination or marginalisation

- These frameworks support justice by focusing on people's capabilities to do and to be what they have reason to value

- They critique social systems that constrain freedom, especially due to systemic discrimination and exculsion

hammel (2008)

The right of all people to engage in meaningful occupations that contribute positively to their own well-being and the well-being of their communities

Townsend & Wilcock (2004)People have the occupational right to...

Experience occupation as meaningful and enriching. (meaning)

Develop through participation in occupations for health and social inclusion. (participation)

Exert individual or population autonomy through choice in occupations. (choice)

Benefit from fair privileges for diverse participation in occupation.(balance)

Human rights

• Universal human rights are entitlements and freedoms that belong to all human beings

• WFOT endorses UN Universal Declaration of Human Rights (1948)

• Governments commit to human rights responsibilities as signatories to theUniversal Declaration of Human Rights and other legally binding human rights treaties

• Convention on the Rights of Persons with Disabilities (2006)

• Convention on the Rights of the Child (1989)

• These add weight to occupational justice issues to change policy, funding, developing programmes, advocating etc

Capitalism

A profit-driven political and economic system in which a nation'sresources and means of production and profits are privately held (e.g. bycorporations and shareholders). Focus on maximising profits at all costs. Values:productivity, efficiency, competition

Relationship Between Occupational Instruments, Determinants, and Outcomes

Occupational Instruments:

Tools and assessments used to evaluate an individual's occupational performance and participation.

Occupational Determinants:

Factors influencing occupational engagement, such as socio-economic status, environment, and personal abilities.

Occupational Outcomes:

Results of occupational engagement, including health, well-being, and life satisfaction.

Relationship:

Assessment: Instruments evaluate how determinants impact occupational performance.

Intervention: Data from instruments guide interventions to modify determinants and improve outcomes.

Evaluation: Outcomes are measured to assess the effectiveness of interventions and determine further needs.

Definition and context of Citizenship

• Citizenship is defined broadly to include all members of society—regardless of nation-state legal status—who are involved in or impacted by occupational engagement, education, practice, or scholarship.

• It is a contested and evolving concept, shaped by political, cultural, and socioeconomic contexts.

• Western (Anglophone/European) views have historically emphasized:

• Legal rights (e.g. protection under law, voting).

• Social rights (e.g. access to education, public services).

• Passive rights (legal protection) and active rights (e.g. political participation).

Unequal Acess to citzenship

• Citizenship is often granted only to those with legal status, denying others rights and limiting occupational engagement.

• Indigenous peoples historically denied Canadian citizenship, restricted from occupations such as travel, governance, and decision-making.

• Immigrants and refugees face varying access to rights depending on immigration status.

• Even in countries with formal citizenship rights, access is often conditional on contributing in a "useful" or economically productive way (e.g., employment, service).

• Discourses of capacity and productivity reinforce ableist and exclusionary norms, marginalizing those with physical, intellectual, or social impairments.

• This exclusion is referred to as "dis-citizenship" or "really existing citizenship", highlighting how many are excluded from fully accessing civic, political, and social rights.

Citizenship in Occupational Therapy (OT)

• In OT, citizenship is redefined as:

• A right and responsibility to participate in cultural, social, and economic life.

• Independent of legal status — includes refugees, undocumented persons, and stateless groups.

• OT practitioners can promote citizenship by:

• Supporting inclusive decision-making.

• Enabling community participation and collaborative program development.

• Helping people transform oppressive conditions (e.g., illness, violence, inequality).

OT scholars use the term participatory citizenship, which emphasizes:

• Recognition, voice, and power — being seen, heard, and included.

• Equal participation in conflict resolution, decision-making, and community dialogue.

• Transforming structures that reinforce marginalization.

• It is a relational and active practice, requiring OTs to co-create with clients as equals, not as superior helpers.

• This avoids othering, and instead fosters shared citizenship and mutual participation.

Equity and Anti-Oppressive Practice

• OT must examine how power relations impact whose voices are included/excluded.

• Emphasis on decolonization and anti-oppressive approaches is essential to:

• Promote equity, justice, and inclusive occupational participation.

• Prioritize marginalized groups, such as racialized, disabled, or immigrant communities, in shared decision-making and power-sharing processes.

• Participatory citizenship demands interrogating power, centering excluded perspectives, and working beyond traditional paradigms.

Citizenship in Relation to Justice, Rights, Equity, and Occupation: Relevance to Occupational Therapy Practice:

OT professionals must:

• View all clients as citizens with rights, regardless of legal status.

• Actively foster participation, inclusion, and voice in community and clinical settings.

• Challenge systems that restrict occupational access, and reimagine citizenship as a shared, inclusive process.

• Embracing participatory citizenship enables OT to become a vehicle for social transformation, equity, and liberation.

Definition and Purpose of Allyship

• Allyship is a collaborative and partnership-based practice involving people from privileged groups working alongside oppressed communities to eliminate oppression.

• Effective allyship requires:

• Ongoing self-reflection,

• A genuine commitment to justice,

• And active disruption of unjust systems.

• Allies seek to understand and transform social structures rather than act as saviors.

Key Elements of Allyship (per Rhoades & Mio)

a) Recognising the oppression others face.

b) Recognising one's own privilege.

c) Taking active steps to speak out and stand with oppressed groups.

Community Support and Limitations

Allyship is not permanent; it must be recognised and validated by affected communities.

• The term accomplice is sometimes preferred over ally because it implies:

• Shared risk-taking,

• Active participation in dismantling systems, and

• A commitment to equity, diversity, and justice.

• Critiques of allyship note that it can reinforce "us-them" dynamics unless it includes shared power and decolonization.

Types of Solidarity

• Social solidarity unites people through shared community goals.

• Political solidarity focuses on collective action and advocacy, such as campaigns or systemic reforms.

• People in positions of privilege must educate themselves, act ethically, and support change alongside equity-deserving groups.

Overview of Citizen Advisory Models

• These are part of community engagement efforts to include citizens in public decision-making.

• Tools such as the International Association for Public Participation (IAP2) spectrum promote collaboration and shared power.

• Citizen advisory groups aim to ensure inclusive community-based solutions that reflect the voices of those most impacted.

Promote Citizen Engagement and Work with Citizen-Run Associations and Citizen Advisory Groups: Relevance to Occupational Therapy

• OTs must support inclusive participation and respect the expertise of lived experience.

• OT should move away from tokenism, where individuals are invited into decision-making but are excluded from real influence.

• Tokenistic engagement reinforces dominant power structures and delegitimizes citizen voices.

Addressing Power Imbalances

• OTs must:

• Critically reflect on their own roles in reinforcing dominant systems.

• Avoid treating citizen voices as supplemental to professional knowledge.

• Recognize that knowledge generated by citizens is equally valid.

Addressing Power Imbalances

Key Principles for Meaningful Engagement

• Include equity-deserving groups from the start in agenda-setting and planning.

• Follow participatory approaches that empower communities.

• Encourage shared leadership, shifting power dynamics.

Practical Application

• OTs are urged to:

• Engage citizens as partners.

• Support decision-making processes grounded in community experience.

• Use advisory councils as legitimate contributors to policy, service design, and occupational participation strategies.

Promote Citizen Engagement and Work with Citizen-Run Associations and Citizen Advisory Groups: Relevance to Occupational Therapy

• OTs should be active allies, not passive supporters.

• They must critically examine and challenge power structures, support shared decision-making, and embed anti-oppressive approaches in their practice.

• Collaboration with citizen-led groups is essential to create inclusive, just, and effective occupational environments.

Promoting Equity, Rights, and Justice: A Critically Reflexive Look at Education, Practice, and Scholarship

• Encourages critically reflexive thinking to confront assumptions and expose embedded injustices in OT education and practice.

• Hammell critiques OT models that perpetuate colonialism and neoliberalism via culturally narrow interventions.

• Ramugondo highlights the importance of understanding people's everyday actions (occupational consciousness) in sustaining or resisting injustice.

Reflexivity

• Critical reflexivity = Interrogating personal beliefs and biases in relation to social power.

• Epistemic reflexivity = Examining how knowledge is constructed, privileging some perspectives over others.

• Aims to uncover systemic inequities and shift practice toward inclusive, just approaches.

Occupational Education

• Education is a determinant of health, yet systemic inequities exclude marginalized groups from equitable access (e.g. racism, poverty, ableism).

• Inclusion policies exist but are inconsistently applied; many universities retain white, ableist, colonial norms.

• Calls for:

• Addressing systemic barriers in admissions and pedagogy.

• Recognizing and integrating Indigenous, disabled, and racialized knowledge systems.

• Training OTs to disrupt oppression, not reinforce it.

Participatory Citizenship in Education

• Calls for anti-oppressive, anti-racist education that empowers students and those with lived experience.

• Emphasizes partnership and collaboration in curriculum design and health reform.

• Encourages shared decision-making, not just passive learning.

Practice

• OT practice is shaped by dominant worldviews about what is "professional," often excluding cultural variation.

• Professionalism is not neutral—it can uphold white, ableist standards.

• Standardized assessments can discriminate based on race, class, disability, etc.

• Calls for:

• Culturally responsive, decolonized assessments.

• Recognition of Indigenous and community-defined occupational constructs.

• Focus on equity, rights, and social transformation, not conformity.

Participatory Citizenship in Practice

• Occupational justice includes transforming societal-level systems (e.g. bathrooms, services, spaces).

• Encourages OT programs like the Equity Lens for Occupational Therapy to embed justice in all levels of practice.

• Emphasizes power-sharing, stakeholder engagement, and culturally appropriate interventions.

Scholarship

• Scholarship must question: Whose voices count? Whose knowledge is legitimized?

• Epistemic injustice excludes racialized, disabled, Indigenous, and queer perspectives.

• Calls for:

• Decolonizing research through Indigenous methodologies.

• Valuing relationship-based, reciprocal, and community-led research (e.g. Two-Eyed Seeing, Etuaptmumk).

• Universities and journals must recognize non-Western knowledge as legitimate.

Participatory Citizenship in Scholarship

• Encourages citizen-led research and co-creation of knowledge.

• Involves people in research design, data collection, and dissemination (e.g. community blogs, art installations, citizen-led sessions).

• Helps shift from tokenism to true partnership, enabling equity-deserving groups to lead in scholarship and innovation.

Conclusion

• Occupational therapists have power and responsibility to address injustice and inequity.

• Requires critical reflexivity, redistribution of power, and conscious inclusion of marginalized voices in education, practice, and research.

• Justice and equity require collective, sustained action—therapists must ask: Where can you effect change?