Article Canadian Journal of Occupational Therapy

2017, Vol. 84(1) 58-68

DOI: 10.1177/0008417416638858

Occupational injustice: A critique ª CAOT 2016

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L’injustice occupationnelle : une critique

Karen R. Whalley Hammell and Brenda Beagan

Key words: Capabilities; Human rights; Occupational well-being; Social justice; Theory; Wellness.
Mots clés : bien-être occupationnel; capacités; droits de la personne; justice sociale; mieux-être; théorie.

Abstract
Background. Although the idea of occupational injustice pervades the occupational therapy literature, there has been little
scholarly debate concerning this construct or the parameters of the five identified forms of occupational injustice. Purpose. The
aims of this paper are to highlight conceptual confusions, foreground some inherent questions that have been neither
acknowledged nor addressed, and question the theoretical and practical utility of five manifestations of occupational injustice.
Key Issues. Few theorists have contributed to the occupational injustice literature. Significant definitional confusion exists
concerning the five forms of occupational injustice with some forms described as subsets of others. The inherent problems of
judging occupational injustice have not been addressed. Implications. If occupational injustice were understood as a violation of
occupational rights—human rights to achieve well-being through occupation—many of the problems of identifying a situation
of occupational justice or injustice would be resolved. Using the capabilities approach to human rights would facilitate this
endeavour.

Abrégé
Description. Bien que la notion d’injustice occupationnelle soit répandue dans la littérature en ergothérapie, il y a eu peu de
débats savants sur ce construit ou sur les paramètres des cinq formes d’injustices sociales identifiées. But. Le but de cet article est
de mettre en relief certaines confusions conceptuelles, d’attirer l’attention sur quelques questions inhérentes n’ayant pas été
reconnues ou abordées, et de remettre en question l’utilité théorique et pratique de cinq manifestations d’injustice
occupationnelle. Questions clés. Peu de théoriciens ont contribué à la littérature sur l’injustice occupationnelle. Il existe une
certaine confusion quant à la définition des cinq formes d’injustice occupationnelle, car certaines formes sont décrites comme des
sous-ensembles des autres formes. Les problèmes inhérents à l’identification d’une situation d’injustice occupationnelle n’ont pas
été abordés. Conséquences. Si l’injustice occupationnelle était considérée comme une violation des droits occupationnnels—
les droits de la personne d’atteindre le bien-être par l’occupation—bon nombre des problèmes liés à l’identification d’une
situation de justice ou d’injustice occupationnelle seraient résolus. L’adoption de l’approche par les capacités permettrait de
déterminer plus facilement si les droits de la personne ont été enfreints.

Funding: No funding was received to support this work.

Corresponding author: Karen R. Whalley Hammell, Box 515, Oxbow, SK, S0C 2B0, Canada. Telephone: þ1 306 483 2380 or þ1 604 564 7252. E-mail:
ik.hammell@sasktel.net
Canadian Journal of Occupational Therapy 84(1)
T
he idea of occupational injustice pervades the literatures
of occupational science and occupational therapy, and
five manifestations of occupational injustice have been
identified, described, and re-circulated. However, there has been
little scholarly debate concerning the constructs and utility of
either occupational justice or injustice, or concerning the para-
meters of the five selected forms of occupational injustice. Exist-
ing contradictions, confusions, and overlaps between the
definitions of these five perceived forms of injustice are bewil-
dering for students and unhelpful for practitioners.
In the absence of scholarly debate, the theoretical constructs
that inform occupational therapy are in danger of becoming just
whatever a theorist says they are. Thus, definitions of occupa-
tional injustices that were originally proposed by theorists tend
to be reiterated as if they are ‘‘carved in stone’’ and imbued with
‘‘truth.’’ Within occupational therapy ‘‘there has been a notable
lack of scholarly articles presenting counter-arguments to theo-
retical ideas’’ (Duncan, Paley, & Eva, 2007, p. 200), and it is
therefore imperative for occupational scientists and occupa-
tional therapists to empirically study and critically analyze
dominant theoretical ideas, such as those concerning occupa-
tional justice and injustice (Frank, 2012). Such critical analysis
is overdue. Thus, for example, a Wikipedia entry titled ‘‘Occu-
pational injustice’’ (Wikipedia, 2014) has been patched together
from a handful of sources cherry-picked from the occupational
therapy literature. Yet the dearth of scholarly debate within
either occupational therapy or occupational science about the
definition of occupational justice, the parameters of occupa-
tional injustice, and serious questions concerning the utility and
value of these concepts makes a deposition in such an important
public forum premature, at best.
Stadnyk, Townsend, and Wilcock (2010) have recognized
‘‘the need for questioning, testing, refinement, and critique of
the ideas, reasoning, beliefs, and principles related to occupa-
tional justice’’ (p. 334). A previous paper has provided a cri-
tique of occupational justice (Hammell, in press). Accordingly,
this paper seeks to add a critique to the tiny body of work that
critically analyzes occupational injustice with the hope that this
will encourage many others to engage in scholarly and reflec-
tive debates about justice and injustice, human rights, and
occupation. The aims of this paper are to highlight conceptual
confusions concerning occupational injustices, to foreground
some of the inherent questions that have been neither acknowl-
edged nor addressed, to question the theoretical and practical
utility of a plethora of vaguely defined ‘‘occupational injus-
tices,’’ and to encourage occupational therapists to consider
injustice as a violation of occupational rights that might be
identified and addressed using a capabilities approach: a
means to examine people’s opportunities and abilities to
‘‘do’’ from a human rights perspective.
Occupational Justice and Injustice(s)
Occupational justice was first named and defined by Wilcock
(1998) as ‘‘the promotion of social and economic change to
59
increase individual, community, and political awareness,
resources, and equitable opportunities for diverse occupational
opportunities which enable people to meet their potential and
experience well-being’’ (p. 257). Subsequent work undertaken
by Wilcock and Townsend (2000) resulted in a new definition,
such that occupational justice was said to be ‘‘equitable oppor-
tunity and resources to enable people’s engagement in mean-
ingful occupations’’ (p. 85). Thereafter, Nilsson and Townsend
(2010) described occupational justice ‘‘from a Western per-
spective as a justice of difference: a justice to recognize occu-
pational rights regardless of age, ability, gender, social class, or
other differences’’ (p. 58).
Despite the longevity of the concept, very few scholars
have participated in advancing the concept of occupational
justice. In their conceptual review, Durocher, Gibson, and
Rappolt (2014) noted that the number of scholars who had
contributed to the occupational justice literature was
remarkably small, with 11 of the 13 works identified in their
review being authored by combinations of only four theor-
ists: Townsend, Wilcock, Whiteford, and Stadnyk. It has
been suggested that lack of conceptual clarity has deterred
others from engaging with occupational justice and that as a
consequence, occupational justice has some demonstrable
deficiencies, including the lack of a clear definition, lack
of guidance as to how occupational justice might be iden-
tified, lack of differentiation between the concepts of justice
and of rights, and lack of justification for the differentiation
between occupational justice and social justice (Hammell, in
press).
From 2004, Townsend and Wilcock (2004a) began to iden-
tify occupational injustices, which were defined as ‘‘socially
structured, socially formed conditions that give rise to stressful
occupational experiences’’ (p. 251). Later, occupational injus-
tice was redefined by Nilsson and Townsend (2010) as ‘‘an
outcome of social policies and other forms of governance that
structure how power is exerted to restrict participation in the
everyday occupations of populations and individuals’’ (p. 58).
More recently, it has been asserted that ‘‘by definition, occu-
pational injustice refers to ongoing deprivation or patterns of
disruption that jeopardize children’s development, create sub-
stantive health issues, and reduce individual’s [sic] lifespan’’
(Wilcock & Hocking, 2015, p. 392). Occupational injustices
have thus been depicted both as the conditions that produce
stressful occupational experiences and as the outcomes of these
conditions.
Townsend and Wilcock (2004a) identified three outcomes
of occupational injustice: occupational deprivation (which had
originally been named and described by Whiteford, 2000),
occupational alienation, and occupational imbalance, to which
an additional outcome—occupational marginalization—was
subsequently added by the same pair of theorists (Townsend
& Wilcock, 2004b). Earlier, the concept of occupational apart-
heid had been identified and described by Simó-Algado,
Mehta, Kronenberg, Cockburn, and Kirsh (2002). Thus, the
existing literature identifies five specific manifestations, or out-
comes, of occupational injustice.
Revue canadienne d’ergothérapie
60
Outcomes of Occupational Injustice
Occupational Deprivation
The concept of occupational deprivation was originally defined
by Whiteford (2000) as ‘‘a state of preclusion from engagement
in occupations of necessity and/or meaning due to factors that
stand outside the immediate control of the individual’’ (p. 201).
Townsend and Wilcock (2004b) subsequently offered a differ-
ent perspective, proposing that ‘‘occupational deprivation may
also arise when populations have limited choice in occupations
because of their isolated location, their ability or other circum-
stances’’ (p. 81). This broad approach to the notion of occupa-
tional injustice prompts such questions as Does residence in a
remote, rural area, by definition, result in occupational depri-
vation, and is rural living thus inherently detrimental to human
well-being? Do limited physical or cognitive abilities inevita-
bly result in occupational deprivation, or does the environment
have any influence on the creation of occupational injustice
among disabled people?
Stadnyk et al. (2010) more recently identified occupational
deprivation as a form of social exclusion resulting from restric-
tions on populations in diverse contexts (e.g., refugee camps or
other isolating situations) to participate in occupations that
would promote their health and well-being. Congruent with
Whiteford’s (2000) original depiction of occupational depriva-
tion, this injustice was now reframed as being an outcome of
factors outside the control of individuals and no longer located
in the residential location or inabilities attributed to individuals.
However, Whiteford’s important emphasis on occupations of
necessity and/or meaning (and those that might not necessarily
enhance health or well-being) was omitted. Further, the funda-
mental idea of occupational choice and attention to those struc-
tural inequities that constrain choice—identified by Townsend
and Wilcock (2004b)—were erased with Stadnyk et al.’s def-
inition. The importance of structural inequities to the ability
and opportunity to act on one’s occupational choices is revis-
ited later in this paper.
To date, there appears to have been no scholarly debate to
achieve a clear and practical definition of occupational depri-
vation or to achieve consensus on its perceived parameters. Nor
have there been any guidelines for the assessment of occupa-
tional deprivation, nor suggestions for how the remediation of
occupational deprivation might be identifiable.
Occupational Alienation
Occupational alienation was defined by Townsend and Wil-
cock (2004a) as ‘‘the outcome when people experience daily
life as meaningless or purposeless’’ (p. 252). Surprisingly, the
substantial body of scholarly work by Marx (1964) and his
followers (e.g., Kohn, 1976) concerning occupational aliena-
tion was not referenced by Townsend and Wilcock. Nor have
there been subsequent efforts by scholars within the occupa-
tional injustice literature to identify congruencies or diver-
gences between original and recent conceptualizations of
occupational alienation. Because the concept of occupational
Canadian Journal of Occupational Therapy
Hammell and Beagan
alienation is not unique to occupational therapy and occupa-
tional science, and had already been the subject of considerable
academic interest, it is important that attention be paid to the
different meanings with which the term has been imbued
and the implications of discrepant understandings. When
occupational therapists and occupational scientists speak of
occupational alienation, their meaning and intent may be mis-
understood by scholars from other disciplinary traditions and
by colleagues, such as social workers, whose educational back-
ground has been informed by the social sciences and philoso-
phy. This is of obvious importance if we wish to work in
collaboration with others to counter injustices that negatively
impact people’s occupational opportunities and their lives.
Moreover, occupational therapists and scientists need to be
aware of the customary way in which occupational alienation
is understood.
Marx (1964) focused his analysis of occupational aliena-
tion on the meaning for workers of losing choice and control
over the conditions of their occupational lives and of the impact
on their physical and mental well-being of work devoid of
interest, satisfaction, and inherent reward or that failed to chal-
lenge their abilities. This conceptualization appeared to be
echoed in Townsend and Wilcock’s (2004b) characterization
of occupational alienation as ‘‘demeaning, soulless, tiresome,
coercive participation in occupations [people] find meaning-
less’’ (p. 81). Clearly, Marx understood occupation in terms of
paid employment, whereas occupational scientists and occupa-
tional therapists use the term occupation to encompass every-
thing that humans do in their everyday lives, but the ongoing
failure of theorists within occupational science and occupa-
tional therapy to acknowledge and engage with the existent
body of literature concerning occupational alienation is
regrettable.
Marx’s concern with alienation centred on the structural
conditions of work within a capitalist context and of the ways
in which many workers are estranged from the products of their
labours. Kohn (1976) addressed alienation from a psychologi-
cal perspective and argued that because ‘‘alienation . . . refers
to people’s conceptions of the external world and of self, in
other words, to their orientations’’ (p. 114), it is unclear how
occupational alienation might be identified or measured. More-
over, Kohn also pointed out that ‘‘‘alienation’ is an extraordi-
narily vague and imprecise term’’ (Kohn, 1976, p. 114), and he
therefore questioned ‘‘the theoretical utility of retaining as an
analytic concept a term with such diverse meanings’’ (Kohn,
1976, p. 115). Surprisingly, these important issues have been
neither identified nor addressed within the occupational injus-
tice literature.
Stadnyk et al. (2010) explained that among those in paid
work, ‘‘some occupations may enrich people mentally and
spiritually, whereas other occupations are experienced by some
or all people as boring or lacking meaning’’ (p. 339), and they
indicate specific occupations that may generate a sense of
occupational alienation: ‘‘These are usually occupations that
are highly standardized, rigidly repetitive, and without oppor-
tunities for individual choice, control, decision making, or
Canadian Journal of Occupational Therapy 84(1)
creativity’’ (p. 339). This depiction of occupational alienation
thus melds Marx’s emphasis on structural conditions with
Kohn’s focus on psychological reactions.
Sociologists contend that work that is rich in gratifying
experiences, such as self-fulfilment, meaning, pride, and self-
esteem, is ‘‘the privilege of the few, a distinctive mark of the
elite’’ (Bauman, 1998, p. 34), suggesting that work that lacks
meaning may be the norm rather than the exception. Research
suggests, however, that mundane occupations are not inher-
ently meaningless. For example, Muslim Albanian immigrant
men living in Switzerland explained that because their daily
occupations were primarily focused on doing things for their
families, their menial and exhausting jobs were experienced as
a meaningful contribution toward their children’s futures
(Heigl, Kinébanian, & Josephsson, 2011). Critics note, how-
ever, that ‘‘meaningful’’ is not necessarily positive: The mean-
ing derived from occupation might be, for example,
demeaning, boring, or frustrating (Hammell, 2009). Moreover,
meaning may be experienced on a continuum, with some occu-
pations more meaningful than others. Clearly, this complex
issue deserves further attention from theorists of occupational
injustice.
Recently, occupational alienation has been described by
occupational scientists and therapists as a form of social
exclusion through restricting a population from experiencing
meaningful and enriching occupations (Nilsson & Townsend,
2010; Stadnyk et al., 2010). How this differs from occupa-
tional deprivation (a form of social exclusion resulting from
restrictions on populations; Stadnyk et al., 2010) or from
occupational marginalization (see below) is unclear. Stadnyk
et al. (2010) have further asserted that ‘‘to be regimented,
confined, and possibly exploited in daily occupations at work
or elsewhere becomes a matter of justice when some people
are privileged while others are alienated’’ (p. 340), suggesting
additional overlap with the concept of occupational
marginalization.
Importantly, this concept surely belies assessment. How
might occupational alienation be evaluated and from whose
perspective? And how might it be determined whether aliena-
tion has been alleviated?
Occupational Imbalance
Townsend and Wilcock (2004a) named occupational imbal-
ance as an occupational injustice, citing the assumption that
human health and well-being depend upon a variation in peo-
ple’s occupational engagement. The culturally specific nature
of this assumption has yet to be addressed. A second depiction
of occupational imbalance was also provided, ‘‘in which some
people are overoccupied [sic], or occupationally overburdened,
and others are underoccupied [sic], or occupationally
deprived’’ (Townsend & Wilcock, 2004a, p. 253). Clearly,
these are two very different phenomena: One depiction of
imbalance refers to the nature or quality of one’s occupations
(variation); the other, to the quantity of one’s occupations (too
much or too little).
61
The latter depiction of occupational imbalance was reas-
serted by both Stadnyk et al. (2010) and Nilsson and Townsend
(2010), who described this as a form of social exclusion result-
ing from restricting a population so that some people have too
little to do every day while others have too much to do. This
implied that occupational balance pertained to the quantity of
occupations that ought to be undertaken within populations but
was promptly confounded by Stadnyk et al.’s assertion that
balance would result when all persons experienced a range of
the occupations that would promote their health and well-
being—a statement that seemingly returned the definition of
occupational imbalance to that outlined by Townsend and
Wilcock (2004a), who had initially depicted imbalance as con-
stituting problematic patterns within individuals’ daily occupa-
tions (i.e., variation).
It is, perhaps, surprising that the concept of occupational
imbalance has not been critiqued by occupational scientists and
occupational therapists with reference to the significant body of
scholarly work exploring occupational balance (e.g., Backman,
2004; Wagman, Håkansson, & Björklund, 2012; Westhorp,
2003), and this raises several pressing concerns: Without a
clear conceptualization of what constitutes occupational bal-
ance, how might it be determined whether an occupational
imbalance exists? And if occupational balance cannot be iden-
tified, how will it be determined whether an occupational
imbalance has been resolved? There are other significant chal-
lenges, already identified within the literature pertaining to
occupational balance (Hammell, 2004): Who is privileged to
determine what constitutes occupational balance or imbalance?
Whose values are reflected in judgements about the ‘‘proper’’
use of time? And is balance among occupations a function
solely of the distribution of time, or of subjective experience,
or of the fulfilment of individual or collective needs? Further
questions include If balance—or imbalance—is defined by
someone other than the people engaged in the occupations,
by what authority does he or she do so, and of what value is
his or her opinion? By what measure might it be possible to
determine whether an imbalance has been converted to a bal-
ance? Without an objective way of appraising balance, how
will imbalance be determined? By subjective opinion? Whose?
The fundamental reality that the determination of occupa-
tional imbalance requires a judgement to be made about
whether people’s use of time is suboptimal has not been
addressed within the occupational injustice literature. This is
problematic because decisions about which occupations and
patterns of occupational participation are deemed desirable and
healthy tend to be made by the dominant social group (Bail-
liard, 2016) without recourse to the views and values of those
whose occupations are being judged. Neither has there been
any ethical debate about the inherent risk of imperialism—of
injustice—when the occupations of others are diagnosed as
imbalanced.
Further, the existent literature suggests its own imbalance,
wherein occupational imbalances are most frequently identi-
fied among people who are poor, marginalized, and disadvan-
taged. The occupations of the privileged, the élite, the
Revue canadienne d’ergothérapie
62
successful, the famous, the powerful, and the wealthy are rarely
critically interrogated and labelled ‘‘unbalanced.’’ Thus, for
example, aspiring Olympic athletes who focus every waking
minute on training for their chosen sport are unlikely to be
disparaged as ‘‘occupationally unbalanced.’’
Neither has there been scholarly debate about the perspec-
tive from which judgements of occupational imbalance are to
be made: individualistic or collective. Thus, a variety of daily
occupations selected to meet needs for self-care, self-
expression, self-identity, and self-fulfilment might be judged
nicely balanced if undertaken by an adult who lives alone. The
identical pattern of daily occupations might be judged to be
unbalanced if that adult has obligations to other family or com-
munity members, such as small children whose simultaneous
needs for care and nurture have not been addressed. Clearly,
context matters, but how might this be appraised? And what is
to be appraised: a balance between self-care, productive, and
leisure occupations; between obligatory and chosen occupa-
tions; or between occupations that meet different subjective
experiences of meaning?
The temporal dimension of occupational balance is an
additional factor. Is assessment of imbalance to be ascertained
at a specific period in time—a week, for example—or over a
longer span of time? Thus, is a week spent in caring 24 hours a
day for a seriously ill partner—perhaps to the short-term detri-
ment of one’s own physical health—to be judged as ‘‘occupa-
tionally imbalanced,’’ or would this chosen preoccupation be
judged ‘‘balanced’’ in the ongoing stream of time that consti-
tutes one’s month or year? And if a commitment to caring for
someone is judged to be ‘‘unbalanced,’’ whose values inform
this judgement? How relevant is such a judgement to the person
who has chosen this occupation?
As with the previous forms of occupational injustice, con-
ceptual boundaries are fuzzy and occupational imbalance has
been used ‘‘to identify populations that do not share in the
labour and benefits of economic production’’ (Townsend &
Wilcock, 2004b, p. 82). This blurs the margins between the
concept of occupational imbalance and Marxist descriptions
of occupational alienation, which focus on the impact on work-
ers’ lost control over the economic conditions and product of
their labour (Marx, 1964). Further, many people do share in the
labour that contributes to economic production yet do not
share, in a balanced or equitable way, in the benefits of their
productivity.
Moreover, by also describing occupational imbalance
‘‘as a form of occupational apartheid [that incorporates] three
major occupational classes: un-occupied, under-occupied, and
over-occupied’’ (Townsend & Wilcock, 2004b, p. 82), occu-
pational imbalance is subsumed within the construct of occu-
pational apartheid: Imbalance is a form of occupational
apartheid. Occupational apartheid was first named by Simó-
Algado et al. (2002) and subsequently defined as the sys-
tematic segregation of occupational opportunity that occurs
on the basis of such characteristics as colour, social status, or
gender ‘‘through the restriction or denial of access to digni-
fied and meaningful participation in occupations of daily
Canadian Journal of Occupational Therapy
Hammell and Beagan
life’’ (Kronenberg & Pollard, 2005, p. 67). If occupational
imbalance is, indeed, construed to be a form of occupational
apartheid, this suggests that occupational apartheid is a
broader and more loosely defined construct than that invoked
by Kronenberg and Pollard’s (2005) clear definition (dis-
cussed below). The assertion that occupational imbalance is
a form of occupational apartheid suggests a hierarchy of
injustices, with some injustices being subcomponents of oth-
ers. To date, there has been no scholarship to elaborate on
this idea or to provide further elucidation of the proposed
hierarchy.
Occupational Marginalization
First named as a ‘‘case’’ of occupational injustice by Townsend
and Wilcock (2004b), occupational marginalization, although
not defined, was characterized as ‘‘speak[ing] to the need for
humans to exert micro, everyday choices and decision making
power as we participate in occupations’’ (p. 81). Because few
members of the global population enjoy the privilege of freely
selecting every micro element of their everyday occupational
choices, this would seem to be an almost universally experi-
enced form of injustice! One wonders how such injustices
might reasonably be resolved. Clearly, this again raises ques-
tions of assessment: By whom, using which measures, and
according to what criteria?
Subsequently, Stadnyk et al. (2010) narrowed the defini-
tion of occupational marginalization to a description of injus-
tice experienced by specific groups, describing occupational
marginalization as social exclusion by restricting a population
from experiencing autonomy through lack of choice in occu-
pations. This is said to occur ‘‘when some social groups more
than others are denied or restricted in making choices and
decisions about their participation in everyday occupations,
often resulting from invisible expectations, norms, and
standards’’ (Townsend & Polatajko, 2007, p. 371). Like occu-
pational deprivation (Townsend & Wilcock, 2004b), occupa-
tional marginalization is described by Townsend and Wilcock
(2004b) through reference to normative standards and expec-
tations concerning the ways in which participation in occupa-
tions ought to be undertaken, suggesting that this injustice is
defined according to culturally specific criteria. It would there-
fore seem appropriate to seek diverse cultural perspectives to
determine the appropriate parameters of this construct. More-
over, if injustices deriving from ‘‘invisible expectations, norms,
and standards’’ are to be addressed, these norms and standards
need to be identified and made visible. Are these thought to
arise, for example, from racism, colonialism, ableism, disabi-
lism, homophobia, heterosexism, ageism, and classism; or from
cultural expectations concerning the appropriate occupations
for people of certain ages or social groups; or from what?
Importantly, the assumption that autonomy is universally val-
ued and desired itself advances an invisible Northern/Western
neoliberal expectation, one contested by critical disability
scholars and researchers from the majority world (Hammell,
2009).
Canadian Journal of Occupational Therapy 84(1)
Critical theorists carefully use the language of marginali-
zation to refer to those people and populations who are nega-
tively impacted by historical, structural, and social inequities
(Gerlach, 2015), noting that ‘‘particular populations are not
inherently marginalized, rather, it is the marginalizing condi-
tions that create and sustain inequities’’ (Browne et al., 2012,
p. 2). Thus, critical theorists alert our attention to the importance
of appropriately identifying the source of marginalization—the
inequities that circumscribe the lives of specific people—such
that marginalization is understood as a consequence or out-
come of inequity and not an inherent characteristic of certain
groups of people.
Once again, the distinction between occupational depriva-
tion—in which people have limited choice in occupations and/
or are precluded from engagement in occupations of necessity
and meaning—and occupational marginalization, in which
people may be prevented from participating in their choice of
occupations, appears blurred. Moreover, Stadnyk et al. (2010)
suggested that ‘‘people experiencing occupational marginaliza-
tion may be occupationally imbalanced’’ (p. 339), indicating a
further conceptual confusion. All these concepts are further
tangled by the overlapping ideas of occupational alienation
(in which people are restricted from experiencing meaningful
and enriching occupations) and of occupational apartheid. This
is compounded by Stadnyk et al.’s (2010) claim that ‘‘occupa-
tional marginalization at its worst is a form of occupational
apartheid’’ (p. 339), which again suggests a hierarchy of occu-
pational injustices, with some injustices deemed to be subsets
of others, an assertion that demands further theoretical
elucidation.
Occupational Apartheid
First named and described by Simó-Algado et al. (2002) and
later outlined and defined by Kronenberg and Pollard (2005),
occupational apartheid ‘‘refers to systematic segregation of
occupation opportunity’’ (Kronenberg & Pollard, 2005, p. 59)
that occurs ‘‘through the restriction or denial of access to dig-
nified and meaningful participation in occupations of daily life
on the basis of race, colour, disability, national origin, age,
gender, sexual preference, religion, political beliefs, status in
society, or other characteristics’’ (Kronenberg & Pollard, 2005,
p. 67). This clear definition is accompanied by a clear state-
ment concerning the causes and consequences of occupational
apartheid: ‘‘Occasioned by political forces, its systematic and
pervasive social, cultural, and economic consequences jeopar-
dize health and wellbeing as experienced by individuals, com-
munities, and societies’’ (Kronenberg & Pollard, 2005, p. 67).
In light of the very distinct and specific delineation of occupa-
tional apartheid and its uniquely political causation, it is surely
erroneous and misleading to misappropriate this term and apply
it to a wide array of situations deemed unjust (such as occupa-
tional imbalance and occupational marginalization, outlined
above).
Of the five forms of occupational injustice that have been
proposed and promoted, only occupational apartheid appears to
63
have an unambiguous definition and a clearly identifiable cau-
sation. Moreover, it would surely not be difficult to identify
when such injustice had been overcome and when equity of
access to dignified and meaningful participation in the occupa-
tions of daily life had been assured. Importantly, the existence
of occupational apartheid might reasonably be identifiable both
by an external appraiser, such as an occupational therapist, and
by the person whose access to occupational opportunities is
systematically restricted or denied. This possibility for consen-
sus reduces the risk of an injustice, wherein the judgement of
the powerful is conferred upon the powerless.
Occupational Injustice: Further Critiques
A consistent criticism of theories arising within the occupa-
tional science and occupational therapy literatures centres on
the presumed universalism of theorists’ perspectives (Ham-
mell, 2009; Hocking, 2012; Iwama, 2006; Lim & Duque,
2011), and there has been little recognition that theorists’ posi-
tioning is not incidental but integral to the shaping of theory.
Clearly, theoretical conceptualizations of ‘‘occupational injus-
tice’’ ought to incorporate multiple worldviews and values if
they are to be relevant and inclusive (Bailliard, 2016) rather
than ethnocentric and culturally unsafe (Gray & McPherson,
2005). Because critical theorists contend that the imposition of
one’s own worldview upon theories and practices is unjust
(Young, 1990), this is of clear concern to any examination of
theories of occupational justice and injustice, not least because
a judgement is currently required to determine whether an
occupational injustice exists.
It is therefore relevant and important to consider: How has
occupational injustice been defined? By whom? Whose per-
spectives are reflected in these definitions? Whose are not?
Moreover, is the word justice viewed as positive and impartial
by those whose positioning differs from theorists’ norms, or is
it viewed by those in different positions as inevitably biased, as
consistently discriminatory, and as a disempowering and pro-
foundly unjust manifestation of domination and/or colonial-
ism? (In North America, for example, ‘‘justice systems’’ are
largely designed, administered, and wielded by the dominant
population and are frequently viewed as a tool of oppression by
those whose racialized statuses differ from dominant norms.)
These are important questions and not ones that can be
answered solely by those in positions of privilege.
Hammell (2008) alleged that the plethora of terms used to
identify perceived occupational injustices ‘‘may serve to
muddy rather than elucidate the . . . theoretical waters’’
(p. 62), and this paper has sought to highlight a few of the
confusions inherent in existent depictions of the five named
forms of occupational injustice. Durocher et al. (2014)
observed that ‘‘proposed definitions of occupational justice and
related terms lack conceptual clarity, have not been developed
with reference to other bodies of scholarly work, and are not
supported by empirical evidence’’ (p. 427). Indeed, the over-
laps between the various forms of injustice are so profuse and
Revue canadienne d’ergothérapie
64
the parameters of the forms so porous that it is currently impos-
sible to determine what someone means when he or she refers
to a situation as constituting, for example, occupational
marginalization.
The concept of occupational injustice focuses on occupa-
tional exclusion as well as on the imposition of occupations in
which individuals might not wish to engage or that might be
detrimental to their well-being. These are very different phe-
nomena. Durocher et al. (2014) additionally noted that one of
the difficulties with the concept of occupational injustice ‘‘lies
in the lack of conceptual clarity regarding how to determine
which occupation should be prevented or compelled for which
individuals’’ (p. 423). Further, there is conceptual confusion
concerning whether occupational injustices are viewed,
assessed, or addressed through an individualistic or a collecti-
vistic lens.
Indeed, the question of assessment is central: Who are
those privileged to determine whether a situation of occupa-
tional injustice exists? By whom are they privileged? How do
they determine or assess a situation of injustice? How do they
assess and determine when a situation of injustice has been
resolved? How is occupational justice identifiable? If these
judgements are made exclusively by professionals, then the
fundamental human right of people to participate in the deci-
sions shaping their own lives—their freedom—will be violated
(see below), leading to a further and profound injustice. Of
importance to this debate is the realization that ‘‘it is possible
to cause injustice through naı̈ve and ill-informed attempts to
promote justice’’ (Bailliard, 2016, p. 8). This is important,
because cultural imperialism—the imposition of the values and
views of the powerful on the powerless—has been identified as
a form of violence (Young, 1990). If terms such as occupa-
tional injustice are to be bandied about, these concerns need to
be addressed by both occupational scientists and occupational
therapists.
There are other issues that demand critical analysis. For
example, if occupational alienation, occupational deprivation,
occupational marginalization, and occupational imbalance are
all forms of social exclusion, as Stadnyk et al. (2010) have
claimed, then are occupational injustices solely about the prob-
lems of the marginalized and the socially excluded? Are
wealthy, successful, famous, powerful, and privileged people
immune from occupational injustices? Does occupational
imbalance, for example, fail to constitute an injustice if it is a
consequence of personal choice in orchestrating one’s occupa-
tions, and who makes this judgement? Does the construction of
these five specific manifestations of occupational injustice
effectively serve to reinforce perceptions of certain populations
(e.g., the racialized, colonized, impoverished, and disabled) as
helpless victims? Does the language of our theorizing thus
serve to push marginalized people further to the margins—not
solely of society but of our theories? Moreover, the notion of
justice invokes the metaphorical image of scales (Hammell &
Iwama, 2012), in which one end sinks when the other rises.
Thus, if it is unjust for some people to have few opportunities,
is it also unjust for others to have unfettered opportunities?
Canadian Journal of Occupational Therapy
Hammell and Beagan
Importantly, there has been no scholarly debate to deter-
mine whether occupational injustice pertains solely to depriva-
tion, marginalization, imbalance, alienation, and apartheid or
whether there are other forms and instances of occupational
injustice. In light of these and other problems, it is suggested
that without considerable scholarly debate and theoretical
refinement, the term occupational injustice should be used with
extreme caution.
The Problem of Judgement
This paper has repeatedly posed the question, How might occu-
pational injustice be identified? It has also sought to demon-
strate that identifying a situation of ‘‘injustice’’ inevitably
requires a judgement, and the positioning of the judge will
determine the perception of (in)justice. This poses a fundamen-
tal dilemma that has not been addressed in relation to occupa-
tional injustice: the problem of position, of bias, and of opinion.
The following example demonstrates this dilemma.
In Canada, girls (but not boys) in some rural prairie com-
munities are compelled to leave school (including home
schooling) at the earliest legal opportunity and are prevented
from continuing their education, irrespective of their own
aspirations, due to the fundamentalist religious traditions of
their families. From the first author’s position as a highly edu-
cated woman, a religious agnostic, a passionate opponent of
misogyny and patriarchy, a financial sponsor of girls’ educa-
tion in southern countries, and a daughter of parents who placed
a high value on women’s education, I judge this to be a devas-
tating violation of the inherent rights of these girls to choose
whether they wish to exploit their educational opportunities on
an equal basis with others in Canada and thus as a profound
occupational injustice.
However, I am aware that others would deem this situation
to be wholly appropriate because it obviously aligns with the
community’s traditional cultural and religious values, and these
judges would accordingly deem this to be self-evidently ‘‘just.’’
Moreover, I am aware that my own perspective would be
deemed by many to be disrespectful, ethnocentric, and judge-
mental. This highlights the inherent problem of assessing injus-
tice: Who determines justice or injustice? From what
perspectives and values does one make this determination?
Moreover, when different perspectives exist, how might they
be reconciled? Is it possible, for example, to avoid cultural
imperialism without lapsing into cultural relativism? These
fundamental, and possibly irreconcilable, conundrums might
be addressed through attention to rights and to capabilities.
Advocating for a Focus on Rights
The previous example of the inherent difficulties in appraising
occupational injustices highlights the imperative to focus,
instead, on rights. If this conundrum is reframed in terms of
human rights, it is possible to exit the vortex of culturally
Canadian Journal of Occupational Therapy 84(1)
bound opinions and value-laden judgements and to identify
unambiguously whether the rights of these girls are being vio-
lated and whether an injustice exists.
Education is a human right that is not contingent upon
gender (Kallen, 2004). Human rights transcend cultural prac-
tices that conflict with fundamental human rights (Murumba,
1998); thus, respect for diversity cannot become a shield for
sexism (Okin, 1999). Of importance to the scenario outlined
above, from a human rights perspective, is not whether girls do
continue with their education but whether they have the equi-
table opportunity—the option—to do so. If they have the
freedom and opportunity to enact choices, and decide not to
continue their education, then no occupational injustice
exists.
An occupational injustice surely exists when the rights and
freedoms of an individual, community, or population to partic-
ipate in occupations that contribute positively to individual or
collective well-being are violated. The nature of the injustice—
marginalization, deprivation—is surely of less relevance than
the violation of those human rights to freedom and well-being
that are experienced and expressed through occupation. This
example exemplifies the important difference between the idea
of justice and that of rights. Hammell and Iwama (2012) argued
that because the notion of justice is vulnerable to charges of
moral relativism, the concept of rights offers a more focused
mandate for occupational therapists, because ‘‘rights state,
unequivocally what all people are entitled to expect (Nipperess
& Briskman, 2009; Young, 1990)’’ (p. 386).
Within the framework of human rights, philosophers
identify two main claims, or rights: to freedom and to well-
being (Kallen, 2004; Siegert, Ward, & Playford, 2010). Free-
dom describes ‘‘the right of every human being to participate
in the shaping of decisions affecting their own life and that of
their society’’ (Kallen, 2004, p. 15). Well-being is defined by
philosophers as the ability and conditions—the opportuni-
ties—to achieve one’s purposes by action (Kallen, 2004).
‘‘Because occupational engagement is integral to human
well-being, and because well-being is integral to human
rights,’’ Hammell and Iwama (2012, p. 392) contend that the
ability and opportunity to engage in occupations that contrib-
ute positively to individual and collective well-being is an
issue that concerns rights.
Occupational therapists have asserted that all people have
both a need and a right to engage in meaningful occupations
throughout their lives (American Occupational Therapy Asso-
ciation, 2011; World Federation of Occupational Therapists,
2006), and further, they have suggested that employing a cap-
abilities perspective might provide a helpful and relevant
approach through which occupational therapists might identify,
understand, and address the rights articulated in the World
Federation of Occupational Therapists’ (2006) Position State-
ment on Human Rights (Bailliard, 2016; Hammell, 2015, in
press). Venkatapuram (2011) observed that ‘‘the main advo-
cates of the capabilities approach have already done much over
the past three decades to argue that capabilities theory should
be a general theory of human well-being across all societies,
65
rich and poor, East and West’’ (p. 80). And it is the contention
of this paper that the capabilities approach could provide occu-
pational scientists and occupational therapists with a frame-
work through which to identify and address occupational
injustices—those inequitable circumstances that violate the
ability and opportunity of individuals and collectives to enact
their ‘‘occupational rights,’’ defined as ‘‘the right of all people
to engage in meaningful occupations that contribute positively
to their own well-being and the well-being of their commu-
nities’’ (Hammell, 2008, p. 62).
Advocating for a Focus on Capabilities
to Assess and Address Violations
of Occupational Rights
The capabilities approach was originally conceived by Sen
(1985, 1999, 2005) as a means to explore economic and human
development from a human rights perspective. Subsequently
embraced by many theorists (notably, Nussbaum, 2000, 2006,
2011) and used to inform many areas of human inquiry, it has
contributed a way to address the complex issues of health and
social care, and of disability, from a human rights perspective
(e.g., Biggeri, Bellanca, & Trani, 2011; Simon, Anand, Gray,
Rugkåsa, & Yeeles, 2013; Venkatapuram, 2011). In the early
years, the capabilities approach was viewed as constituting just
whatever had been expounded by either Sen or Nussbaum.
Nussbaum’s approach, for example, sought to prescribe the
capabilities to which all humans ostensibly aspired (for a cri-
tique, see Hammell, 2015; Stein & Stein, 2007). More recently,
the basic premise of the capabilities approach has been cited,
adopted, and adapted by many theorists and researchers in
accordance with their particular field of endeavour, including
occupational science and occupational therapy (see Bailliard,
2016; Hammell, 2015; Taff, Bakhshi, & Babulal, 2014; Town-
send, 2012).
The capabilities approach (Sen, 1999, 2005; Trani, Bakh-
shi, Noor, & Mashkoor, 2009) acknowledges the equal rights of
all people to choose what they wish to do and to be and
addresses their equitable opportunities—their rights—to do
so. Thus, the capabilities approach addresses occupational
rights (Stadnyk et al., 2010). If the example cited earlier is
examined from a capabilities perspective, it is recognized that
being female can result in restricted occupational opportunities,
choices, and participation (Bakhshi & Trani, n.d.) due to social
and cultural norms and expectations that violate the ‘‘capabil-
ities’’ of girls and women (Trani, Bakhshi, & Rolland, 2011)—
that is, their opportunities and rights to choose and to act—and
that these inequities are reproduced, for example, among dis-
abled people (Bakhshi & Trani, n.d.). Of particular importance
to occupational therapists is the recognition—inherent in the
capabilities approach—that ability is of little value without
opportunity.
A capabilities approach to understanding human rights
focuses attention not solely on the things that people do but
on the range of choices that are available to them, identifying
Revue canadienne d’ergothérapie
66
the social structures that can effectively constrain not just the
opportunities that are available to different people but also
the choices that people can envision and are equitably able to
make (Robeyns, 2005, Trani et al., 2009). Importantly, Froh-
lich and Abel (2014) explain that ‘‘people do not have equal
choices to act, and this lies at the basis of inequity in soci-
ety’’ (p. 210). The concept of choice is therefore not unpro-
blematic and within the capabilities approach is understood to
be a consequence of freedom and opportunity. Choices are
made within the confining repertoires of cultural templates—
or scripts—that shape the expectations and frame the life
possibilities available to a member of a culture (Goffman,
1959; Somers, 1994). Moreover, people who are oppressed
have an ‘‘an absence of choices’’ (hooks, 1984, p. 5). Thus,
the example of the Canadian girls’ inequitable educational
opportunities, sketched above, highlights ‘‘the importance
of understanding the socially structured and inequitable
shaping of choice’’ (Frohlich & Abel, 2014, p. 210; emphasis
added). The linkages between choices and actions, between
abilities and opportunities, are central to understanding
inequities and injustices.
Conclusion
This paper has sought to critique current conceptualizations of
occupational injustice and has highlighted some of the issues
that require significant scholarly attention and debate. The evi-
dence of this paper suggests that defining occupational injus-
tice in terms of violations of occupational rights might provide
an unambiguous and easily articulated concept with distinct
parameters, one that offers a clear mandate to occupational
therapists. Moreover, it is suggested that the capabilities
approach provides a well-defined framework through which
to identify and address violations of occupational rights and
to assert those human rights to freedom and well-being that are
experienced and expressed through occupation.
Acknowledgements
The first author extends sincere thanks to Isla Whittington (in Aoteroa/
New Zealand) and Alison Gerlach (in Canada) whose thought-
provoking conversations prompted this paper.
Key Messages
 Occupational injustice is frequently invoked by occupa-
tional therapists despite little scholarly attention to its def-
inition or parameters or to how it is assessed.
 Attending more closely to the role of occupation in the
expression of choice (freedom) and the experience of
well-being would facilitate a focus on occupational injus-
tice as a violation of human and occupational rights.
Canadian Journal of Occupational Therapy
Hammell and Beagan
 The capabilities approach provides a well-developed per-
spective from which occupational rights might be clearly
identified and violations addressed.
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This book’s focus of helping professionals and parents cope with
teaching learners with autism spectrum disorder is attempted by
eight contributing educators, each writing a chapter on a specific
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want/need. (The request for a desired behaviour is called a
mand.) ‘‘Learning to Learn’’ (chapter 3) deals with waiting for
the child to attend before beginning the task. In chapter 4, the use
of manual guidance is discussed. The remaining chapters focus
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Author Biographies
Karen R. Whalley Hammell, PhD, OT(C), DipCOT(UK), is
Honorary Professor, Department of Occupational Science and
Occupational Therapy, Faculty of Medicine, University of
British Columbia, Vancouver, BC, Canada.
Brenda Beagan, PhD, is Professor, School of Occupational
Therapy, Dalhousie University, Halifax, NS, Canada.
individualizing instruction, and writing meaningful goals. Each
chapter describes a case study and ends with a self-assessment
checklist to guide the reader in gaining insight into reasons his or
her current methods may not be working.
I feel the book was disjointed and somewhat difficult to
read. I found the content from one chapter did not build and
expand from a previous chapter, I would assume because of
the number of contributing authors. In addition, parents
might find the book overwhelming in terms of its contents,
detailed psychological theories, and scientific vocabulary.
Although it appears to have a clear goal to relate eight
essential strategies, I thought this book lacked practical
suggestions. However, its scientific content would be
valuable to professionals for reference and explanation of
current theory in regard to treatment of students with autism
spectrum disorder.
Beverly Franchuk