Occupation, citizenship and participation

Occupational therapy is a health profession which centres on the significance of doing. It is a well understood principle that doing things can be good for your health. The treatment medium for many occupational therapists is activity. Occupational therapy uses the word ‘occupation’ in the broader sense of being occupied, rather than the narrower connection with work and employment. Many people assume that occupational therapy is linked to occupational health and so is primarily vocational. Occupational therapists rarely work in occupational health. The significance of doing and activity is that this is how people interconnect with others and the environment around them. It is the basis for individual and social engagement, for a participative society in which people experience health through a social exchange, which might be expressed as forms of citizenship. Through doing things in the world people gain experiences and develop the substance of their life narratives. Every day events are the basis of social interaction and give people the sense of belonging to a community. Health is not merely physical and mental health, but is expressed in a social context of experiences. People may be ill or dying, but they may still enjoy healthy participation in life through occupation, through opportunities to express themselves or be part of a community. The quality of health, participation and citizenship depend on a number of social determinants of health such as poverty, experience of relative inequality and of the institutional aspects of the health system, all of which contribute to the production of health inequities. This presentation will explore a couple of case studies which illustrate how issues of citizenship and rights are challenged by everyday experiences which impact on health, the experience of literacy and of accessing health services. It is based on work from the European Network of Occupational Therapy in Europe (ENOTHE) Citizenship Working Group which has been exploring the concept of “participatory citizenship” (Hoskins & Kerr, 2012) since the European Year of the Citizen in 2013.