The Framework of Occupational Justice
The Framework of Occupational Justice (FOJ) offers an understanding of human rights, justices, injustices for every individual to feel included in everyday occupations they find meaningful and useful to themselves, family, or community regardless of disability, discrimination, health disparities, etc. (Townsend, 2012). It showcases how occupational programs i.e. policies, community support, education, and occupational rights i.e. the right to engage in occupations regardless of age, gender, sexual orientation, etc. are interlinked with one another to provide everyone with equal opportunities to participate, work-life balance, and overall well-being (Townsend, 2012).
The FOJ is made up of three components that OTs specifically would benefit aiding individuals in poverty. The first component is that society has to be accountable to include all people in everyday occupations without injustice i.e. increase awareness of their roles in society, network strengthening with government officials, etc. (Wahyunengseh, Budiarjo, and Ansoriyah, 2017). The second component is society needs to create changes to the institution regarding housing, employment, and community recreation centers; OTs can provide their services by educating individuals on what "jobs-housing" options are available, i.e. where individuals living in low-income areas are educated on "locally available housing-fits for locally employed workers to be able to afford inexpensive housing" that is also close to work (Benner and Karner, 2016). The last component is societies or OTs educating African Americans of local programs available that truly engages adults for any support needed in their community (Townsend, 2012).
Dr. Martin Luther King-Jr.
During the civil rights movement, which took place between the 1950s and 1960s, with African Americans fighting for social justice i.e. ending racial discrimination and racial segregation, one minister and human rights activist going by the name Dr. Martin Luther King Jr., fought long and hard during this pivotal movement in U.S. history sharing his nonviolent civil rebellion and boycotting to achieve integration into a "white-dominated society" (Bloom, 2019). The narrative below from Dr. Martin Luther King Jr’s speech, is an integral part of this critical time in United States history, briefly explaining what African Americans go through in their daily life when it comes to living in poverty, their occupations, and how the majority can address their abandonment of the issue.
“We are assembled here together today with common problems, bringing together ethnic groups that maybe have not been together in this type of meeting in the past. Like a monstrous octopus, it spreads its nagging prehensile tentacles into cities and hamlets, and villages all over our nation. Some forty millions of our brothers and sisters are poverty-stricken, unable to gain the basic necessities of life. The vast majority in poverty are African Americans in proportion to their size in the population. Now there is nothing new about poverty. It’s been with us for years and centuries. What is new at this point though, is that we now have the resources, skills, and techniques to get rid of poverty. And the question is whether our nation has the will. We must rapidly begin the shift from a “thing‐oriented” society to a “person‐oriented" society. When machines and computers, profit motives, and property rights are considered more important than people, the giant triplets of racism, materialism, and militarism are incapable of being conquered. A true revolution of values will soon look uneasily on the glaring contrast of poverty and wealth.” (Staff, 2017)
History of Poverty
In the United States (U.S.) 61.8% of people will experience living in poverty between the ages of 25 to 60 (Rank and Hirschl, 2015). Of this percentage, African Americans are the highest of all races in the U.S. to live in poverty at 18.8% (U.S. Census Bureau). The definition of poverty is the “denial of opportunities and choices basic to human development, causing a reduction in a long healthy life and a decent standard of living, freedom, and dignity” (Sofo and Wicks, 2017). Given this definition, an individual living in poverty in the U.S. is unable to partake in specific activities or occupations that an individual living in an affluent area can participate in since these impoverished areas lack adequate recreational centers, its communities have increased financial instability and increased gang influence or inadequate healthcare (Flowers, 2016).
African Americans experience many forms of occupational injustice i.e. denied or deprived of meaningful/unmeaningful activities. This paper will address the prominent concerns to understand the depth of the main causes of injustice on this group of individuals, given the vast history of injustices experienced starting with segregation of Jim Crow Laws extending to today (Lavallay and Johnson, 2020). From the end of the Civil War in 1865 to the start of the civil rights movement in 1968, Jim Crow Laws in the U.S. were created (Costly, 2019). These laws were established by the state and local officials that legalized the racial segregation, i.e., separate entrances for African Americans and Caucasians, separate textbooks were used to decrease “contamination” (Costly, 2019). Thus, African Americans in schools, theaters, and participation in other opportunities, or occupations were considered illegal.
Occupational injustice for African Americans
Occupational injustice is another main topic this paper will address in terms of how it affects the underprivileged, their occupational participation i.e. partaking in meaningful activities, and how occupational injustice and empathy, if understood correctly, can be used by future therapists and officials to understand new views to instigate change to a more occupational justice standpoint i.e. equal opportunities for all people (Law, 2002). This paper is structured in a way to not only give a brief history of segregation but taking a systematic approach to shed light on what injustices and justices African Americans go through concerning their occupations and daily inequalities. The topic of poverty in the U.S. is addressed specifically due to wanting to further understand the depths to which occupational apartheid, a form of deprivation, can affect underprivileged communities.
Foundation of Occupational Justice
To fully understand how injustices affect occupations and communities at large, it is important to understand the foundation of occupational justice, its linkage to occupational therapy and social justice. Occupational justice was first established in the late 1990s by Wilcock and Townsend leading to the development of The Participatory Occupational Justice Framework (POJF) in 2005 by Townsend and Whiteford who based the framework on “their experiences of working with different populations of people in differing sociopolitical contexts…it would be a useful tool for occupational therapists (OTs) working with groups of people facing occupational injustices” (Durocher, Gibson and Rappolt, 2013; Sakellariou and Pollard, 2017). The POJF is based on Western teachings of occupational science and occupational therapy; their underlying values and beliefs being on occupation, enablement, and justice, and what is advantageous or disadvantageous to populations or communities from participating in their daily life occupations given political, cultural, and physical forces (Sakellariou and Pollard, 2017). After the concept of occupational justice was established various OTs and occupational scientists were intrigued with this view, one OT “coining the term occupational apartheid”, which is an occupational risk factor (Kronenberg, 2005).
Occupational risk factors are a framework to assess positive and negative factors, environmental stressors for example, on a client’s occupational performance (Hammell, 2012). This means that it is a framework used to measure how the environment around a person or community affects their participation in their occupations either positively or negatively, which aligns with the PEOP model (Person-Environment-Occupational-Performance model) (Christiansen, Baum and Bass-Haugen, 2005, pp.1–680). The PEOP model is an occupational therapy-based model explaining a client’s overall well-being and quality life are positively or negatively affected by both intrinsic and extrinsic factors i.e. risk factors, and performance in occupations (Christiansen, Baum and Bass-Haugen, 2005, pp.1–680).
Occupational Apartheid is one risk factor out of five that is believed to be the most relevant in terms of context to the African American community concerning segregation experienced through poverty. Occupational apartheid is when individuals or communities are systematically deprived of meaningful occupations through segregation, due to social, economic, or political reasons (Maliftano, Souza, and Lopes, 2016). The African American community lives an impoverished life, not only being racially segregated since the late 1800s but residentially segregated due to being perceived as a threat to society or affluent occupations, leading to a wide gap in economic resources and acceptance (Kahlenberg and Quick, 2019). Due to this gap, African American students and families are excluded from attending high-performing schools, forced to work in low-income jobs, and living in socially deprived areas i.e., low-income housing, unstable government housing, and deteriorating ghettos compared to privileged majority areas (LaVeist, 1993). These poor housing areas and a wide wealth gap have drastic effects on the African American community and their environment i.e. decreased familial support due to long working hours, decreasing chances of partaking in meaningful occupations, succumbing to gang influence due to power or materialistic means, and decreasing of basic fundamental human rights, causing an increase in community calamity, personal drug use, and violence in these community areas (Teitz and Chapple, 1998). From an occupational perspective, African Americans have an increase in occupational segregation, or separation based on race, gender, etc., compared to the majority with privileges, leading to wage discrimination and increase in unchosen occupational traditions (Teitz and Chapple, 1998). For example, African Americans face the injustice of separation from “back-of-the-house labor minorities are commonly staffed in kitchens and cleaning rooms, and the front-of-the-house labor is where white receptionists and waiters are predominant”, or another example of occupational niches where “new low-skill jobs are being created in inner cities i.e. impoverish areas (Teitz and Chapple, 1998). The doing of these particular unjust low occupations causes for negative being or self-concept in life that this community is not welcomed to achieve any higher than they deserve, thus decreasing their overall becoming or personal growth and development for the better; restricting their belonging to the system at large (Appendix 2) (Wilcock, 1998).
On further analysis, since African Americans are forced to partake in these degrading unmeaningful occupations, these injustices will not only take a physical and mental toll on their families but the community at large, playing more on the culture of poverty i.e., experiencing what injustice poverty provides creates its own culture, that is learned or shared to others in the community and their families (Blair and Raver, 2016). The system should provide equality i.e. sameness, and equity i.e. fairness, for all no matter race, gender, social class as shown in Appendix 1, to promote fairness but allowing all individuals to have access to the same occupations; however due to the occupational apartheid encountered, this is not always the case and needs to be addressed by the community and legislation to provide liberation and justice for all (Lynch, Sutherland and Walton-Fisette, 2020).
Wilcock and Townsend (2009, p.192-199) define occupational justice as “the right of every individuals basic needs, equal opportunities and life chances to reach toward their potential but specific to that individual’s engagement in a meaningful occupation”. This means that every individual should, in theory, have equal human rights and chances to partake in any occupation that they desire regardless of status, environment, or financial obligations (Williams, Priest, and Anderson, 2016). In the context of poverty in the U.S., for poverty-stricken individuals, the United States government offers social assistance programs i.e. refundable tax credit for low-income families and Medicaid i.e. state and federally funded program to provide healthcare for low-income individuals, disabilities, etc. (Medicaid.gov, 2020; Shahidi et al., 2019; USAgov, 2020; USDA, 2018). According to Romig (2020), African Americans benefit extensively from provisions given from government assistance, providing them with equal rights and assistance, thus allowing them to take time off from work for recreational and leisure activities, receive great healthcare for their pre-existing conditions, and having paid time off.
However, given the extensive list of benefits above, it is not enough to support African Americans living in poverty when their sole source of income is their work wages and others do not qualify for assistance due to not meeting minor requirements, which is considered an occupational injustice (Williams, Priest and Anderson, 2016). Occupational injustice “deprives or excludes persons to participate or engage in meaningful occupations or when unchosen occupations are imposed upon individuals which limits health, wellbeing or overall life satisfaction” (Wilcock and Townsend, 2000). This means that injustices can occur to any person or individual to participate in any activity or pushed into specific occupations due to negative factors i.e. being restricted or deprived of their human right or participation, thus affecting their overall health and well-being (Burgard and Lin, 2013). When looking at this in connection with the African American community, this population receive the most occupational injustice due to racial and social disparities because of the “racist system of governance authorities intensively monitoring and restricting the occupations as a means to maintain power derived from enslavement and meet labor demands of their economic interests" (Lavallay and Johnson, 2020). Since the U.S. is rooted in the construct of race since the African slave trade began in the late 1800s, this mind-set has affected countless African Americans today, causing fewer opportunities when it comes to occupational engagement provided to them given this racial social construct (Lavallay and Johnson, 2020). Because of this, occupations available or sought after, to African Americans, are either lower-paying, provided poor benefits and healthcare, greater job instability, and hectic range of working hour compared to the majority, which in turn reduces the time spent on other leisure or work occupations that they find meaningful i.e. gardening, painting, or managerial positions (Weller, 2019). According to Hocking (2017), if occupational injustices like these can be understood then that can restructure policies or aid policymakers in understanding the responsibility and roles, they must encompass to change injustices and provide the proper qualifications for African Americans in poverty for more occupational justice and equal human rights.
However, another aspect to consider is how can these individuals escape the injustices and impoverish life they have grown accustomed to for decades. Individuals living in poverty have a one in three chance of escaping poverty, by excelling in education, or family members who work receive an increase in wages; thus, enabling the family to move from an impoverished area to a wealthier ‘safe’ suburban home (McKernan, Ratcliffe, and Cellini, 2009). Ratcliffe and Kalish (2017) argue that to aid African Americans or any minority and to ‘escape’ from the confines of poverty then more non-profit organizations or OTs need to:
connect parents and children early on with services, [mental health services, group outreach activities], employment and training opportunities, taking care to address the needs or occupations of children raised in families that are struggling, and addressing the conditions of their neighborhoods and schools, they could get more individuals on the pathway to success.
From a poverty perspective, occupational scientists need to show the causes of poverty and how it can be managed or reduced, however, this requires an occupational scientist to take on a more imaginative and constructive way of practice (Njelesani, Cameron, and Polatajko, 2012). This where an OT can be of benefit to the future of education and training needs given to low-income individuals. It is integral that OTs understand “value orientations between families who live with persistent poverty” to be culturally competent and provide therapy in a more patient-centered way, increasing the quality of healthcare these individuals so desperately require (Humphry, 1994; Saha, Beach, and Cooper, 2008). For example, an OT could teach time orientation, or living for the present to work for a better future, to a “teenager living in chronic poverty wanting to drop out of school to make money to support their family even though they realize that having an education would be beneficial long term” (Humphry, 1994).
In occupational science, research scholars have started applying “occupational perspectives to unjust experiences throughout the world” (Sofo and Wicks, 2017). Occupational science incorporates knowledge from a multitude of disciplines, perspectives, and knowledge base to inform new insights and ways programs can be developed for the greater good (Kinsella, 2012). For future practice, a new theoretical framework has been suggested that could be applied to the African American community living in poverty, i.e. SEED-SCALE, that is designed to bring social change by "focusing on what people can do and uses people's capacities as the energy for change and improvement", thus empowering people that live in poverty to understand their strengths and pursue their meaningful occupations (Sofo and Wicks, 2017). For example, an OT suggesting an individual partaking in a new concept of micro-business venture based on their perceived strengths and less financial obligation to not only build their self-identity, but provide more financial improvement, and improve their well-being (Sofo and Wicks, 2017).
The Culture of Poverty Theory
Oscar Lewis is an American anthropologist who devised the term “culture of poverty” which states that, “the values people living in poverty, plays a role in sustaining their condition” this means that poverty has its own culture and values that are spread from generation to generation or within communities itself thus extending the notion of poverty into their daily lives and activities they can and cannot partake in (Lewis, 1966). Oscar Lewis (1966) stated the individuals living in poverty experience “frequent violence, neglect of planning for the future, etc.”
African American families and children that grow up in poverty are significantly disadvantaged when it comes to planning, education, and specific skills required to obtain either a college degree, continuing education, or finding a job; decreasing their chances of obtaining or partaking in occupations that they find meaningful (Garcia and Weiss, 2017). They are then unable to escape poverty and their children and grandchildren succumb to poverty continuing the culture of poverty for generations to come (Sofo and Wicks, 2017).
This school of thought is seen as an occupational injustice that causes individuals living in this environment to not be equipped with the appropriate training, knowledge, skills, attitudes, and cultural capacity that is essential for success in modern society or partaking in meaningful occupations that other individuals in the majority have the exclusive opportunity of partaking in (Banks, 2001). In occupational therapy when it comes to the culture of poverty, the OT must not “view occupational injustice as a problem that requires fixing by an outsider, but addressing it by harnessing a community’s assets” (Davies, 2020).
In contemporary practice concerning systemic poverty over generations, an OT can take a top-down approach i.e. drawing on the strengths of low-income communities by conducting community assessments to understand what assets they currently have and building on them (Davies, 2020). For example, an OT can, “identify individuals’ skills i.e. create surveys to determine hidden talents, local community assets that may serve individual get-togethers i.e. churches, libraries, schools, or relationship building i.e. sports complex offering free exercise space to groups” (Davias, 2020).
However, until recently the culture of poverty has been known as a myth eradicating the notion that poor people share the same beliefs, values, and behaviors (Gorski, 2008). One "myth" suggested by Oscar Lewis (1999) is "poor people are unmotivated when it comes to working ethics", however, this is one stereotype that individuals and future OTs should try to avoid since people living on lower wages means that they are working two or three jobs at a time spending most of the week working then wealthier individuals. Gorski (2008) suggested this outdated theory overall can be seen as an injustice to ethnic minorities living in poverty since it plays on stereotypes and prejudices. The theory should be adapted to the changing times and be known as the ‘Culture of Classism’ which was coined by Koppelman and Goodhart (2011) for explaining the "societal promotion of negative beliefs and practices that tend to portray poor, less educated, or socially unacceptable persons as deficient, inferior, and responsible for their situation."
Concerning health care practice, and addressing classism with future clients, it is important to ask the client how they view themselves in their society, what experiences these individuals specifically go through, and how their surrounding environment affects their occupational engagement; if these are not understood initially then it would be difficult to find what the client finds meaningful and deliver an unjust and unethical frame of practice (Liu, 2011).
Conclusion
In conclusion, African Americans not only have a rich culture but are the most segregated race in all the U.S. that suffer from many injustices when it comes to where and how they live and what occupations are available to them. As health care professionals, in the future when delivering the best patient care possible, it is important as OTs to not only be empathetic to the population they are working with but truly understand the depth to which these individuals are suffering. In doing so, OTs can utilize their professional expertise to change the injustices that occur by training and providing education, for all races can equally partake in occupations they find meaningful. However, this is not only true for patient practice but the OT profession needs to be more diversified when it comes to OT and occupational science education and research, due to a lack of upward mobility for minority groups to think of OT or occupational science as a profession, only 7.6% of OTs are of minority groups and the rest being of Caucasian or the majority population (Wakeford and Fisher, 2019).
This topic, however, is not just related to African Americans, but it can be referenced to other disadvantaged communities globally i.e. African Countries, India, Asia, or any other country that have a history of segregation or inequalities. For example, South Africans have been suffering from racial segregation and occupational apartheid since European settlement in the Cape in 1652, by forcing Africans into cheap harsh labor by “white rulers” (Gradín, 2018). For future practice and the 20th century, we need to strive to spread knowledge of this new “poverty-era” where individuals are made to be dependent on the system instead of being independent, to shape future practice in understanding how the system and segregation both have shaped individuals’ thoughts and behaviors and to not only appreciate our patients but empower them to the justices they deserve (O’Connor, 2001). In future practice, Allied Health Professionals must take on leadership and empathetic roles in understanding the justices and injustices occurring to people suffering from occupational apartheid. This is vital to building trust with clients for an open form of communication, so all clients receive the equal justices they rightfully deserve. With all the above considered, the areas discussed can be used in new and emerging areas concerning poverty-stricken individuals in the United States and globally. In current practice, Heidi Cathcart (2019) an occupational therapist in New Zealand states that poverty has yet to be addressed along with violated occupational and human rights; she recommends OTs to use the idea of heart, head, and hands for addressing poverty in practice, which means that OTs:
take the time to understand and empathize with their client's situations; they grapple with issues of poverty head-on, specifically as these issues relate to ethics, justice, and human rights; and finally, they act in practical ways to address issues of poverty.
OTs can use the above recommendations to teach and inspire OTs globally on how to engage and address concerns of poverty with not only families but the larger global community.
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Appendix 1
Figure 1:Equality and equity (Lynch, Sutherland and Walton-Fisette, 2020)
Appendix 2
Figure 2:Doing, Being Belonging (Hitch, Pépin and Stagnitti, 2014)
©Raziqa Virani. This article is licensed under a Creative Commons Attribution 4.0 International Licence (CC BY).