Human and social rights and occupational therapy: the need for an intersectional perspective

Access to human and social rights and inequalities in social opportunity have persisted throughout human history. Recent global challenges, such as adjusting to the permanence of COVID-19, call for a dynamic understanding of the ways that occupation/daily life interacts with multiple situations where human and social rights are compromised, and inequalities undermine capacities and opportunities for resiliency and recovery. The detrimental effects of these issues most affect is those whose lives are already complex through intersectional marginalisations and vulnerabilities, and who demand and claim services.

The measures governments have employed to control the pandemic have severely affected human interaction and social participation. The controls and required adaptations have created what appear to be an ongoing new normal of living (Buheji et al., 2020). The features of this new complex occupational context did not all originate with COVID-19. They arrived at a time when the reduction in services, infrastructure, and other social welfare measures had already impacted on rising inequalities (Bambra et al., 2020). Addressing such issues will be delayed by the pandemic and the spikes in public spending associated with it, although governments spent more money on propping up stock markets than addressing social welfare and health measures (Munasinghe, 2020). Government budgets and personal incomes are forecast to be affected for decades (Makin & Layton, 2021). Other changes which were already a consequence of neoliberal global market developments, were accelerated by COVID-19, such the loss of privacy through contact tracing, state-led data management, and growths and concentration in digital technology sectors (Munasinghe, 2020).

Over time neoliberal policies have compromised democracy and undermined the efficacy of health systems and social care measures (Max-Neef, 2010). These combined consequences of economic and political changes have impacted more on vulnerable groups, so that they are left behind in the health and life quality improvements that wealthier groups enjoy (Bambra et al., 2020). Along with other health and social care professionals, occupational therapists have to relate their work around the social determinants of life. This includes the consequences of social and economic inequalities and violations of human and social rights. While this editorial addresses the pandemic and its consequences to date, the outcomes will unfold over the coming decades and readers will already see that unfolding global events, such as the Ukraine conflict and the humanitarian and food crises it may produce, will contribute further to these complex problems.

An Intersectional Perspective of Occupation/everyday Life and Human and Social Rights

The relationship between participating in doing things that give life meaning and life quality is well established in occupational therapy and occupational science (e.g. Whiteford et al., 2018). Occupational therapy practices should be based in justice principles which respect dignity and full participation in everyday life for all. However, the profession has yet to fully develop its understanding of the intersectional (i.e. interconnected) relationship between people and their everyday life/occupations, on the basis of gender, race, class and other expressions of diversity which confer disadvantage or are the focus of marginalisations (Grandón, 2017), or any of these phenomena in relation to cultural influences (Frank, 2012).

The production of multiple disadvantages and vulnerabilities through economic measures, corporate decisions and government policy often impact the social life or experience of particular groups within a society and threaten fundamental rights to what Max Neef (2010) identifies as ‘a place in which to be’, i.e. a space to occupy, in which one can do, be, become and to which one belongs (Wilcock & Hocking, 2015). This human and social right to a space may imply everything from compromised land rights to the right to access the means to make a living, or to engage in the occupations/doing that sustain life at a supportable level. Thus, the use of occupation/everyday life as a means for intervention suggests a fundamental relationship to health, to welfare, to education, to justice, and rights (Frank, 2012; Durocher, Gibson & Rappolt, 2014).

These practices should operationalize the intersectional relationship between occupation/everyday life and human and social rights. Balanta-Cobo & Padilla-Muñoz (2019) identify five dimensions of these connections to be strategically addressed through the following actions:

• Validating and attending to the multiple voices, demands, and particular claims of the people and groups with whom occupational therapists work, recognizing that in every occupational scenario, health, education, work, and participation processes converge, generating diverse conditions and environments.

• Recognizing and emphasizing the pluridiverse occupational histories or different ways of living that guide, motivate and determine occupation/everyday lives.

• Analyze occupations/doings incorporating particular situations of inequality, exclusions, discriminations or restrictions.

• Creating alternative ways of understanding, adjusting, changing, and adapting environments by recognizing the diversity proposed in the previous points.

• Discovering, recognizing, and acting on structural complexity, as a way to begin to address disabling and oppressive situations that demand change or transformation

The Figure 1 bellow illustrates this discussion.

Figure 1
Human and social rights and occupational therapy: an intersectional perspective.

The pandemic has exposed the political obligation and moral responsibility of occupational therapy to include social protection and citizenship for all as a core aspect of practice (Malfitano et al., 2020, Fransen-Jaïbi et al., 2021). These responsibilities require critical reconfiguration of the principles of the profession (Fransen et al., 2015; Salas et al., 2015; Algado et al., 2016; Farias et al., 2018; Pollard et al., 2021; Lopes, 2021; Parraguez et al., 2021) e.g., being person-centered, critically evaluating the profession’s history, and considering rights and citizenship as elements of occupational therapy in connection with justice.

Contemporary Society and Political Obligation

Occupational therapists have been developing practices around responding to disaster, community development needs, and vulnerabilities throughout the profession’s history. They adapt and change to situations in the environment of practice and work to uncover disabling barriers experienced by individuals. Such obstacles are often the effects of macro issues of class, poverty, culture, and social exclusion which determine practice, and are repeated endlessly in narratives about occupation/everyday life (Marmot et al., 2020; Algado et al., 2016; Ikiugu & Pollard, 2015).

The post-pandemic global dynamic offers opportunities for occupational therapists to work with fellow citizens whether service users, community members, or other professionals using these intersectional dimensions of occupation/everyday life and human rights for practicable and sustainable transformations that promote social participation and inclusion. Such an approach requires continuous reflection concerning the politics of action at every level, from everyday micro level encounters to the creation of programs and public policies. Practice which defends human and social rights must also continue to recognize the ethical foundation of occupational therapy through which all people are dignified beings entitled to meaningful participation in occupation/everyday life: to do, be, become and belong (Wilcock & Hocking, 2015).

This is a political obligation present in different levels of practice arising from the social responsibilities of professionals working with individuals in a clinical approach, or with communities, asking about social conditions and the services available, and negotiating for resources to address identified demands and claims (Pollard et al., 2008). In the course of practice, occupational therapists have many opportunities to understand conditions and identify needs through work with different groups, discussing about policies, rights, and laws, employing their professional knowledge to inform negotiations with people and communities. Working with an intersectional perspective can give the profession tools to create new methodologies of working for human and social rights, and developing the person-centered strategies which are needed to accommodate transformation and transition in post-pandemic futures (Munasinghe, 2020). Intersectionality potentially offers a methodological and analytical approach with the potential to provide elements to understand the complexity of different perspectives about occupation and everyday life. It invites occupational therapists to account for and incorporate context, sensitivities, flexibilities, and the promotion of adjustments into a negotiated process for these futures. Such processes, by their very nature, acknowledge and uphold democratic principles, including human and social rights.

• How to cite: Balanta-Cobo, P., Fransen-Jaïbi, H., Gonzalez, M., Henny, E., Malfitano, A. P. S., & Pollard, N. (2022). Human and social rights and occupational therapy: the need for an intersectional perspective. Cadernos Brasileiros de Terapia Ocupacional, 30, e30202203. https://doi.org/10.1590/2526-8910.ctoED302022032

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Publication Dates

• Publication in this collection
  15 June 2022
• Date of issue
  2022