In her keynote address at the World Federation of Occupational Therapists conference held in Cape Town, Dr Karen Whalley Hammell, honorary professor in the Department of Occupational Science and Occupational Therapy at the University of British Columbia, discussed the importance of diversity in developing OT theories. She pointed out that 20% of the population are found in the so-called developed countries, while 80% are in the low-income countries. Yet most of research concerning disability derives from the urban regions and most disabled people in the global south.
“Northern theory embeds the viewpoint, perspectives and problems of Northern Europe and North America,” she said.
The neoliberalism practised in developed countries - characterised by tax cuts and reducing government spending to benefit the private sector - and which extolls individualism and productivism, erodes collective self-worth and expands the gulf of inequality between the haves and have-nots, Hammell explained.
The concept of independence is seen in the west as admirable, aspirational and universally valued, whereas in many cultures in the global south it is an alien premise.
Principles such as ubuntu in Southern Africa, where the interdependence of the community is valued, prevails in many low-income countries, and the associated ability to seek help as well as contribute to the community is welcomed by disabled people.
There is research evidence that opportunities are unequally distributed and disabled people are compelled to follow predetermined choices. In 2017, 21-million people are trapped in some form of slavery. Extreme poverty forces people into occupations such as begging, prostitution and theft, which frame their life choices.
Disabled people spend a lot of time trying to secure a means of survival and this shapes their occupation. “Choice is a mark of privilege. We need to build more inclusive theories,” Hammell said.
OT, therefore, needs to draw from diversity to incorporate multiple perspectives from varied knowledge. There needs to be a shift away from the traditional productive occupations of the west and look at those that foster value of the natural world, well-being, land, religion and cultural practices such as honouring ancestors.
“Only the privileged can indulge in theory that minimises oppression economic cultural, social, political, legal policies that constrain people’s lives,” she said.
Hummell supports cultural humility, aimed at developing a critical consciousness of our own assumptions, beliefs and values, and creating an understanding of how our own perspectives may differ from those of other people.
She said having an occupation is a human right, and OT should be enabling that right to engage in meaningful, purposeful occupations, irrespective of medical diagnosis. Accordingly, occupational therapy practices should address, not solely people's abilities, but their capabilities - their opportunities to do what they have the abilities to do.
