Manifesto for occupation

Hanneke van Bruggen, Nick Pollard, Sarah Kantartzis

Health through occupation
Occupational therapy is about enabling people to do activities that are necessary and important to them and through these to participate in the society of which they are part. ‘Occupation’ means anything a person does. The significance of doing is often overlooked because it is so fundamental to human existence. All our human stories are accounts of things we have done, to become who we are, and the expression of our belonging in a world with others. Through our doing we have constructed, and continue to reconstruct what we do, where, when, how, why and with whom. Occupation, or simply ‘doing’, is something common to all people everywhere, at all stages of life. It is important not only for what each of us can do in our lifetimes, but also for the kind of world we are building for the future.
There is a fundamental relationship between health and occupation. Through our occupations we are able to orchestrate our lives in ways that enable us not only to survive, but also to develop our potential and express our skills, while creating and maintaining our connections with others. Through our occupation we can develop and maintain our families, neighbourhoods and communities as sources of belonging, opportunities and common action. Occupation therefore is not only important to each individual, but also, through our collective occupation we develop the kind of lives that we live together. Occupation is an essential factor in life quality, and in the experience of being human.
However, occupation does not always lead to such positive and health supporting outcomes, and there are many challenges to meaningful and purposeful occupation for some people. These include disability; illness, trauma and disease; differences in access to food, water, shelter, transport, utilities; relative poverty; differences in social status and citizenship rights; differences in legal status; the economic and social consequences of war and other forms of conflict, climate and climate change; pollution; the planning and development of built structures; the effects of social change arising from shifts in population such as ageing, migration or resulting from disease such as HIV/AIDS; the consequences of disaster; personal tragedy; poor government; economic restructuring. The list is not comprehensive, and the factors can be combined in multiple forms with localised and specific effects.
Our concern is that the link between occupation and health has been consistently overlooked. In occupational therapy there has been an ongoing focus on the impact of illness, disease and trauma on the individual. There has been less attention paid to the social determinants of health and to the impact of social exclusion. Health promoting occupation is a key element in public health and in preventing ill-health. Overlooking this has restricted working with the potential of occupation to express and support human flourishing and develop healthy communities.
We argue that the expression of human health is more than an index of outcomes or therapeutic interventions. We support a view of health as not a stable and normative concept but as unbounded and potentially ever extending, incorporating notions of people’s flourishing, the ongoing satisfaction of needs and the development of their potentials as fully included members of the society in which they live. We are calling for a discussion about the value and importance of occupation, not just for occupational therapists alone, but for everyone in health and social care and human sciences. We are calling for a rethink of the way health outcomes relate to personal and collective experiences and human values which are based in the understanding of doing. We need to work with others in reclaiming the value of occupation for all and as an important part of public health.
We are also concerned that the idea of occupation is bigger than can be realised through the profession of occupational therapy. Access to health promoting occupations can be a goal for social changes. These occupations have the potential to be owned by everyone, as they are concerned with how we live together and can be based in shared experiences. However, the knowledge and experience that is common to all is not always valued simply because of its common ownership, so there is a role for some people to critically explore ways to make this value more evident. Again, this should engage both those who are occupational therapists and people who are willing to work with them. The future of evidence for the transformative power of occupation is through co-production, participant action, and the sharing of the discussions about it with others.
A call for change
In order to promote health through occupation we need to work to address the multiple factors that influence people’s possibility to engage in health promoting occupation. We need to work together to move forward, to create opportunities for all, to achieve individual and societal flourishing. We need to work in partnership, across sectors, disciplines, political and social divides to create the conditions for change in our education, practice and research. To do this we must:

•   Build and maintain active dialogues, and negotiate alliances and strategies with disadvantaged and excluded groups and individuals, disability groups and carers’ organisations, practitioners and researchers.
•   Effectively campaign for health promoting occupation including participation rights across all levels of disability and social barriers
•   Develop different forms of action from protest to social enterprises which exemplify and are underpinned by health-promoting occupation
•   Challenge the acceptance of social and the resulting health inequalities, through occupation-based practices and particularly those that incorporate sustainable and inclusive economic growth
Call for contributors
This call for change requires multiple partnerships with many and diverse actions. In considering our own potential contribution to this process we consider that it may be useful to develop a book that will provide both theoretical discussions but also discussion of practical and specific projects and actions. We intend that the book will set out examples of practice, narratives, research and theory which explore, explain and promote the connection between occupation-based practices, social inclusion and health. Our intention is to solicit contributions from a wide range of stakeholders, individuals and chapter-writing teams, including:  lay persons, service users, administrators, students, professionals, building a ‘tapestry’ of experiences and ideas that is not only a textbook but a manual for practice, accessible to all. It will address:

•   Understanding the importance of occupation in people’s lives and its links with the social determinants of health, public health and prevention.
•   Why occupation based practice and occupational therapists? Towards a wider awareness of occupation, and making sense of what occupational therapists might offer community groups.
•   How occupation based practice fits in wider perspectives of social inclusion work
•   Moving from occupational therapy practice based around individuals to occupation based practice with groups and communities
•   The particular characteristics of occupation based practice, including:
•   Identifying significant variations with occupational therapy practice in traditional settings, including professional boundaries, compartmentalization of responsibilities and being a community member;
•   Recognising change – critical moments and turning points;
•   Managing risks and dependency;
•   Professionalism and power with vulnerable people as colleagues;
•   Managing delegation and responsibility for sustainability;
•   Common sense, tacit knowledge and articulating occupation;
•   Project and change management, progress and timescales
•   Strategies for identifying outcomes for funders, partners and managers;

Thank you

Occupational therapy originated in social reform, but early in its history became allied with medicine and a biomedical perspective. Over the last two decades the profession has recognized the value of the work of its pioneers and sought to argue for principles such as occupational justice and occupational balance, social inclusion, and for forms of involvement based in the community which centre on people doing things together.

The Editors of this important three volume work show how these ideas are being put into practice internationally. And a seed was planted...’ includes theoretical perspectives, evaluations of projects in practice and education, approaches to working with communities, participatory approaches and research.

 This, the first volume, looks at theoretical views and shifting perspectives

Manifesto for occupation Hanneke van Bruggen, Nick Pollard, Sarah Kantartzis
Foreword by Sridhar Venkatapuram
Foreword by Elizabeth Townsend
Prologue to Volume 1: Theoretical views and shifting perspectives
1. Social Inclusion Hanneke van Bruggen, Nick Pollard, Sarah Kantartzis
2. Introducing occupation Sarah Kantartzis, Hanneke van Bruggen, Nick Pollard
3. Occupation-based approaches for social inclusion Nick Pollard, Sarah Kantartzis, Hanneke van Bruggen
Introduction to Section 2: Theoretical views
4. Getting back my ability Tim Diggles
5. Emancipatory occupation: Labour as the conceptual basis for occupation-based social practices Aline Godoy, Luciana Cordeiro, Cassia Baldini Soares
6. Reflections on occupation transforming citizenship Hetty Fransen-Jaïbi, Inés Viana-Moldes, Nick Pollard, Sarah Kantartzis
7. Facilitating inclusion through occupation-based community development Roshan Galvaan
8. Social transformation in theory and practice: Resources for radicals in participatory art, occupational therapy and social movements Gelya Frank
9. Advancing understandings of inclusion and participation through situated research Robert B. Pereira and Gail E. Whiteford
Introduction to Section 3. Shifting perspectives
10. Opening Doors Ellen Ferguson Mary Jardine, Elizabeth Firth
11. Social enterprise and occupational therapy: New ways of working and modernisation of the profession in Scotland Gillian Funai
12. The Taieri Blokes Shed: A place of productivity and belonging James Sunderland, Linda Wilson, and the Membership of the Taieri Blokes Shed
13. Decolonising imposed occupation: A preventative strategy for foetal alcohol spectrum disorder Lizahn Gracia Cloete, Maria Konstabel, and Eve Madeleine Duncan
14. Promoting positive collective occupations in African settings: Exploiting the latent potentials for social inclusion and well-being Tongai Fibion Chichaya
15. Including people with vision impairments in museums Beaux Guarini and Alison Wicks

Hanneke van Bruggen Sarah Kantartzis Nick Pollard