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Full Course Details: Public course page
Learn more about our guest: Vikram Pagpatan EdD, OTR/L, ATP, CLA, BCP, FAOTA
Agenda
Intro (5 minutes)
Breakdown and analysis of journal article (5 minutes)
- 00:00:00 Intro
- 00:01:15 OT Potential Podcast Intro
- 00:03:00 About this address
- 00:03:45 Terminology
- 00:04:15 The genesis of “Northern” OT theories
- 00:05:00 The problem with excluding multiple perspectives
- 00:05:35 What is neoliberalism?
- 00:07:07 Neoliberalism and OT values
- 00:08:26 Neoliberalism in our dominant models
- 00:09:33 Building a more relevant and inclusive theoretical base
- 00:11:42 How OT can contribute to society
Discussion on practical implications for OTs (50 minutes)
- 00:13:37 Intro to Vikram Pagpatan
- 00:15:30 Becoming an OT advocate
- 00:21:00 Impressions of this article
- 00:26:10 Expanding our understanding of valued occupations, beyond ADLs
- 00:31:17 Practicing cultural humility
- 00:35:44 Triangulating knowledge with individual clients
- 00:40:33 Ensuring the diversity of our membership
- 00:49:39 Triangulating our knowledge on a national level
- 00:53:07 Association’s role in addressing inequitable structures
- 00:55:38 Opportunities do you see for global collaboration
- 00:59:16 Hope for the future of OT
Supplemental Materials
- Estimation and Comparison of Current and Future Racial/Ethnic Representation in the US Health Care Workforce
- A call to resist occupational therapy’s promotion of ableism
Article Review
Read Full Text: Building globally relevant occupational therapy from the strength of our diversity (This is a paid article, but we still thought it was important to cover.)
Journal: World Federation of Occupational Therapists Bulletin
Year Published: 2018
Ranked 63rd on our 2019-2023 list of the 100 Most Influential OT Journal Articles
I’ve been eager to review this keynote address from the World Federation of Occupational Therapy Congress, which has been cited so many times since its 2019 publication that it made our list of the 100 most-cited OT journal articles.
It’s easy to see why this article is such a popular read. It explores some of the narrow ways of thinking that undergird our theory and practice—in particular, our focus on individualism.
The author challenges us to see this problem clearly—and calls upon us to leverage the strength of our diversity to build globally relevant occupational therapy.
To talk about the practical implications of creating this type of change, we are excited to welcome Vikram Pagpatan EdD, OTR/L, ATP, CLA, BCP, FAOTA, to the podcast next week.
About this address
This keynote was delivered by Dr. Karen Whalley Hammel, the most frequently featured author on our list of the top 100 OT articles. Each time we review a work of hers, I feel myself being stretched, and I really have to sit with the concepts she introduces.
In this address, Dr. Hammel states that her goals are to:
- Pinpoint some of the issues arising from a lack of diversity in our dominant theories and models.
- Explore some of the specific values embedded in our way of thinking about occupation.
- Suggest how things could be different—and explain why those things must be different for OT to have a globally-relevant impact.
Terminology
Throughout the article, the author references “Northern” countries. This is not a geographically precise designation, but rather a label for high-income countries. These countries constitute less than 20% of the world’s population, making them the global minority.
Middle and low-income countries of the “South” are home to the other 80% of the world’s population, and thus comprise the global majority.
The genesis of “Northern” OT theories and models
The ideas set forth in dominant occupational therapy theories and models did not fall from the heavens fully formed.
Rather, they arose from the specific experiences and perspectives of various individuals.
Historically, ideas originating in the Global North (particularly North America, Australasia, and Britain) have dominated OT theory. The dearth of representation from the Global South means this theory was based on partial insights. This becomes especially problematic when the resulting knowledge is presented as universally relevant—despite excluding the experiences, thoughts, and perspectives of the overwhelming world majority.
The problem with excluding multiple perspectives
When theorists are primarily privileged members of a dominant population, it becomes far too easy for their ideas to go unchallenged.
Their beliefs and assumptions are taken at face value without much critical examination—by themselves or others.
The author argues that this has indeed been the case in OT—and that one harmful ideology, in particular, has endured unchecked:
Neoliberalism.
What is neoliberalism?
Neoliberalism does NOT refer to liberal politics.
And, honestly, it is a complicated term to define. (For a deeper exploration of this concept, I encourage you to check out the neoliberalism Wikipedia article.) The author of this paper summarizes it as follows:
Neoliberalism positions the free market as the most efficient mechanism for organizing virtually all aspects of human life. Implementing a neoliberal agenda can mean:
- Cutting taxes.
- Reducing government spending on health and social services.
- Slashing regulation for the benefit of private business.
In short, this ideology puts profit over people.
Neoliberalism also extols individualism, celebrating individual freedom and self-interest. It promotes independence and self-reliance, suggesting that people themselves are to blame for their own ill health and social problems. It advances “productivism,” which essentially means people are only worth what they produce.
Thus, neoliberalism effectively erodes a sense of collective responsibility for the wellbeing of others.
Critics of neoliberalism believe it has given way to an expanding gulf of inequality, including unequal access to opportunity. And, for people who are disabled or positioned at the bottom of the socio-economic hierarchy, neoliberalism has increased the cost of services.
Neoliberalism and OT values
Neoliberalism has left a discernable imprint on our values as OTs, but it has rarely been named or challenged.
The author argues that this neoliberal imprint can actually prompt us to act contrary to our Code of Ethics. For example, we might:
- Promote models of service delivery that allocate care based on a person’s ability to pay, rather than their need.
- Develop self-management programs without challenging the underlying assumption that health results solely from individual behaviors.
- Uphold ideologies that separate individuals from their environment—and thus, seek individualized solutions to problems caused by inequitable social structures.
- Prioritize occupations deemed “productive.”
- Adopt the “client-centered” language of consumerism to imply choice, when in reality none exists.
- Reinforce the message that independence is admirable, aspirational, and universally valued—when in reality, the majority of the global population assigns a higher value to interdependence.
Neoliberalism in our dominant models
One way the neoliberal focus on individualism and independence shows up in our models is through the division of all occupations into three categories:
- Activities of daily living/self-care
- Work/productivity
- Play/leisure
These categories focus on the self. And, many critics have expressed concern that they are:
- inapplicable across the human lifespan,
- simplistic,
- exclusionary, and
- value-laden.
Another example of neoliberalism manifesting in OT ideologies is our assumption that people choose, shape, and orchestrate their everyday occupations—as if these choices are always made by individuals and not by couples, families, or communities. This is a uniquely privileged assumption that:
- does not leave much room for other values, and
- ignores the reality that choice may be severely constrained by structural inequalities like poverty and racism.
Building a more relevant and inclusive theoretical base
The above critique illustrates why the author believes the OT community needs to harness the strength of our diversity to build a more relevant and inclusive theoretical base. She offers several examples of how this could be accomplished, including:
Triangulating our knowledge
Common in the social sciences, triangulation is a method for cross-checking data by gathering perspectives from multiple sources. As occupational therapy professionals, we could harness the strength of our diversity by triangulating our knowledge (i.e., consciously drawing from multiple perspectives).
For example, we could triangulate “Northern knowledge” with Southern and Indigenous knowledge.
Resisting colonialism
European colonialism has left its mark on 85% of the world. Our actions as OTs can advance colonialism by effectively exporting Northern ideals to the Southern majority—without amendment and without consideration of their relevance! Occupational therapy interventions informed by irrelevant theories are more likely to create irrelevant, inappropriate, and oppressive experiences for our clients. Resisting colonialism begins with practicing cultural humility.
Cultural humility
Cultural humility requires us to:
- Develop a critical consciousness of our own assumptions, beliefs, values, and biases.
- Understand how our own perspectives may differ from other people’s.
- Acknowledge the unearned advantages, privileges, and power that may derive from multiple dimensions of our social position.
Ultimately, cultural humility helps us recognize that our profession’s diversity offers strength from which to build.
How OT can contribute to society
The occupational therapy profession has set a visionary mandate for ourselves.
As stated by the World Federation of OT, occupational therapy’s contribution “to the global health of society and individuals is by enabling the right to engage in meaningful, purposeful occupation, irrespective of medical diagnosis, social stigma, or prejudice.”
If we are to meet this mandate, we need to draw on the theoretical and practical wisdom from all of our diverse membership—not solely those in the Global North. We must employ theoretical models, assessments, interventions, and outcome measures that identify and address the inequitable structures that may constrain occupational rights—not solely of individuals, but of entire disadvantaged communities.
Our national occupational therapy associations should be at the forefront of this important work. Furthermore, they should make a sustained effort to increase diversity within our own membership in accordance with the diversity of our nations.
Conclusion
The author ends this address by sharing her hope and belief that the international OT profession can evolve to have a relevant and significant impact by building from the strength of our diversity and working to ensure that all people, regardless of difference, can engage in occupations that contribute to their own wellbeing and the wellbeing of their communities—as is their right.
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