672171

research-article2016
OTJXXX10.1177/1539449216672171OTJR: Occupation, Participation and HealthGupta

Article

OTJR: Occupation, Participation and

Mapping the Evolving Ideas of

Health
2016, Vol. 36(4) 179­–194
© The Author(s) 2016
Occupational Justice: A Critical Analysis Reprints and permissions:
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DOI: 10.1177/1539449216672171
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Jyothi Gupta1

Abstract
The values of occupational therapy are grounded in justice, and its origins in activism and advocacy. Enabling individuals to
participate in meaningful occupations to enhance health and well-being was the genesis of the profession that answered a call
to justice. Occupational science brought focus to understand humans as occupational beings and made justice more visible
in the discourse. A systematic mapping review was undertaken to deconstruct how notions of occupational justice (OJ) have
been woven in the literature. The ideas of OJ were dominant in 40 out of the 120 articles that met the study’s inclusion
criteria. OJ was represented mainly in the context of disadvantaged groups and dissonance in practice. For OJ to influence
policy, the focus on the individuals’ experiences of occupational injustices must be seen as transacting with systems and
policies that contribute to participation inequities in groups and populations.

Keywords
occupational justice, context, justice-oriented practice, practice dissonance

Introduction exploring population health and the relationship of occupa-

The origins of occupational therapy (OT), rooted in justice,
activism, and advocacy, focused on opportunities to engage
in everyday occupations to confer dignity, respect, and mean-
ing to marginalized persons in society (Cage, 2007; Frank,
2012). Influential social reform movements, such as the Art
and Crafts Movement, Settlement House Movement,
Education Reform, and Mental Hygiene Movement provided
the social and political context for the profession’s birth
(Friedland, 2003). During the “Moral Treatment” era that
emerged in the 18th century and was prominent for much of
the 19th century, brutal mistreatment and neglect of psychi-
atric patients in asylums was replaced with activities believed
to promote healing (Gordon, 2009). In the United States and
Canada, OT emerged in psychiatric institutions where arts,
crafts, and other activities provided daily structure and
appeared to alleviate symptoms in patients (Friedland, 1998).
Occupations, in particular crafts, were used in community
settings to help individuals experiencing poverty, unemploy-
ment, and homelessness, as well as with new immigrants to
develop self-esteem, identity, and/or skills (Friedland, 2003).
The social vision of OT aligns with the aims of social jus-
tice (SJ) and promotes occupational enablement and partici-
pation in society for all individuals regardless of their different
potentials and abilities (Townsend, 1993). The implicit links
between justice and occupation became explicit when the
term occupational justice (OJ) was introduced to the profes-
sion’s lexicon in the mid-1990s by two theoreticians who
coined the concept by merging their two overlapping areas of
research (Townsend & Wilcock, 2004). Ann Wilcock was
tion and social determinants of health, and Elizabeth
Townsend was studying “societal and practice determinants”
(Wilcock & Townsend, 2014, p. 542) that constrained occu-
pational therapists from enabling justice in practice. Their
exploratory theory of OJ proposes that “occupations highlight
the reality of justice in everyday life” and illustrates how
social determinants disparately influence occupational expe-
riences (Wilcock & Townsend, 2014, p. 542).
The motivation for justice-oriented work in OT stems
from the belief that occupation is a determinant of individual
and population health and well-being, and is therefore a basic
human right (Wilcock, 2006). In addition, Whiteford and
Townsend (2011) mentioned that complex interactions of
structural and contextual factors create conditions of occupa-
tional injustice for certain individuals, groups, or popula-
tions. There have been suggestions that a justice-oriented
approach and the application of concepts and theories of OJ
would contribute to OT’s aim of enabling participation and
promoting social inclusion (Whiteford & Pereira, 2012;
Whiteford & Townsend, 2011). A recent scoping review of
13 theoretical publications provided a synthesis and critique
of the OJ literature, concluding that resolution of conceptual
1
A.T. Still University, Mesa, AZ, USA
Corresponding Author:
Jyothi Gupta, Department of Occupational Therapy, Arizona School of
Health Sciences, A.T. Still University, 5850 E. Still Circle, Mesa, AZ 85206,
USA.
Email: jgupta@atsu.edu
180 OTJR: Occupation, Participation and Health 36(4)
CINAHL MEDLINE OT SEARCH
1980-2014 1980-2014 1980-2014
115 Citation(s) 81 Citation(s) 55 Citation(s)
260 TOTAL HITS
Inclusion/Exclusion
Criteria Applied
Duplicates Removed
Article Title and Abstract Screened
120 Articles Retrieved
Articles Assigned OJ Code
57 Articles Included in Mapping Review
Figure 1.  Literature selection process.
Note. OJ = occupational justice.
inconsistencies and the development of practice models were
required to enable OJ to be applied in practice (Durocher,
Gibson, & Rappolt, 2014a; Durocher, Rappolt, & Gibson,
2014b). The Participatory Occupational Justice Framework
(POJF) is one framework that outlines concrete steps for
therapists to analyze and address everyday justice issues for
individuals and populations (Whiteford & Townsend, 2011).
In the POJF, occupations are both the means and ends of OT
intervention, and the ultimate outcome of OT is viewed as
participation and social inclusion for all members in a
society.
OJ has had rapid uptake in the professional community.
The previously mentioned scoping review excluded empiri-
cal work and examined four theoretical articles and nine
book chapters (Durocher, Gibson, & Rappolt, 2014a). A
mapping review, initiated in 2011 (Gupta & Garber, 2016),
examined exclusively peer-reviewed journal publications
that included both theoretical and applied studies. The spe-
cific research questions of that mapping review were as
follows:
Research Question 1: How have justice-related concepts
been presented in the peer-reviewed literature?
Research Question 2: How have these concepts been
reported to be applied in practice?
The results revealed a discord in the profession’s history, val-
ues, and current practice, and identified contextual factors
that put certain groups at risk for social exclusion, occupa-
tional injustices, and compromised health.
A focus on the peer-reviewed literature means that many
seminal articles, particularly influential book chapters
(Kronenberg & Pollard, 2005; Stadnyk, Townsend, & Wilcock,
SOC INDEX
1980-2014
9 Citation(s)
140
63 Articles Excluded 40 Articles Assigned Primary Code OJ
After Full Text Screen During Data Extraction 17 Articles Assigned Secondary Code OJ
2010; Whiteford & Townsend, 2011), were not included in this
review. Nonetheless, the author contends that a review of the
peer-reviewed literature provides important insights into the
current state of the application of scholarship in the field.
Method
A mapping review aims to evaluate the state of a body of
knowledge or evidence for specific areas or topics
(Evidence for Policy and Practice Information and
Co-Ordinating Centre [EPPIC], 2010). Grant and Booth
(2009) described this type of review as “a valuable tool in
offering policymakers, practitioners and researchers an
explicit and transparent means of identifying narrower
policy and practice-relevant review questions” (p. 97).
Mapping reviews allow researchers to construct a descrip-
tive map of the literature, to conduct an in-depth review of
the research, to gain an understanding of the state of affairs
pertaining to scholarship of a particular concept or topic,
and to identify gaps in the literature as well as directions
for future study (Grant & Booth, 2009). The source of evi-
dence for policy and practice can be statistical, narrative,
or conceptual data (EPPIC, 2010). In this study, the “data”
used to construct a descriptive map were the peer-reviewed
OJ literature published between 1980 and 2014.
Figure 1 describes the literature selection process. A wide
net was cast with paired search terms “social justice AND
occupational therapy” as well as “occupational justice AND
occupational therapy.” The search was conducted on
CINAHL, Medline, SocINDEX, and OT Search databases.
Inclusion criteria was English-language, peer-reviewed arti-
cles published between 1980 and 2014, which used justice-
related terms in keywords, abstracts, or text.
Gupta 181
Table 1.  Deductive and Inductive Justice-Related Codes and
Categories.
Code
categories Code subcategories
OJ Alienation; Deprivation; Imbalance; Marginalization;
Apartheid; Rights; OJ theory (nonspecific)
SJ Human rights; Justice terminology—Dignity,
respect, equity, equality, rights, disparities;
Accessibility; Poverty; Racism; Oppression;
Power; Privilege; Contextual factors; Health
disparities
VP Ethics; Client centered; Health; Well-being;
Participation; Inclusion; Medical model; Cultural
competence
PE Political practice; Social vision; Community; Social
change; Practice paradigm; Education
Note. OJ = occupational justice; SJ = social justice; VP = values of the
profession; PE = practice environment.
Table 1 shows the list of terms used to code and catego-
rize both manifest and latent content related to justice in this
literature (Graneheim & Lundman, 2004). The data analysis
followed the steps of familiarization, indexing, charting,
mapping, and interpretation (Ritchie & Spencer, 2004).
A systematic and iterative process was undertaken to
manage the mapping and synthesis of articles. The articles
were assigned a primary code (P) of OJ if OJ or related con-
cepts were in the title, keywords, or abstract (see Table 1). A
secondary code (S) of OJ was assigned if the concept was
mentioned in the body of the article (see Table 1). The chart-
ing process involved adding supporting content from the
article for each code and coding category, which allowed for
chunking of material, identification of themes, and synthesis
of the literature across coding categories and articles.
Results
Descriptive Analysis
The results of the descriptive analysis are shown in Figures 2
and 3. What is captured in Figure 2 is the yield of articles that
coded for OJ, which amounted to 47%, and the remaining
articles that coded for SJ, which amounted to 53%. The sub-
set of 47% of OJ articles represented a total of 57 articles; a
P of OJ was assigned to 33% (n = 40) and an S of OJ was
assigned to 14% (n = 17). The appendix lists and summarizes
the key elements and concepts of all 57 articles included in
this mapping review.
A graphic representation of the distribution of the actual
number of articles across descriptive categories is shown in
Figure 3. Nearly 47% of the total articles were empirical and
53% were conceptual or theoretical. SJ was coded in 40% of
the articles, values of the profession (VP) in 61% of the arti-
cles, and practice environment (PE) in 18% of the articles. In
addition, 66% of the articles addressed the occupational
injustices disadvantaged and/or vulnerable groups such as
immigrants, refugees, persons with physical or mental dis-
ability, vulnerable adults, indigenous people, transgender
persons, unemployed people, and homeless persons.
Although most articles reported multiple forms of injustice,
occupational deprivation was the dominant form and repre-
sented in 30% (n = 12) of the articles.
Qualitative Analysis: OJ Themes
The qualitative data analysis followed the steps of familiar-
ization, indexing, charting, mapping, and interpretation pro-
posed by Ritchie and Spencer (2004). This process resulted
in three major themes: conceptual elements of OJ, disso-
nance in practice as occupational injustice, and enabling
participation and social inclusion.
Conceptual elements of OJ.  Of the 57 articles, 30 discussed
the theoretical or conceptual elements of OJ. OJ was pre-
sented as either professional terminology, a concept, an
approach, a framework, or a theory. Townsend and Wilcock
brought together OT’s core values and beliefs about occupa-
tion, health, and ideas about justice, and introduced OJ and
related terminology into the profession’s lexicon (Townsend
& Wilcock, 2004; Wilcock & Townsend, 2000). They artic-
ulated various manifestations of occupational injustice as
occupational deprivation, occupational marginalization,
occupational imbalance, and occupational alienation.
Townsend and Wilcock (2004) also proposed the idea of
occupational rights as the right to “experience occupations
as meaningful and enriching; develop through participation
for health and social inclusion; exert individual or popula-
tion autonomy through choice in occupations; and benefit
from fair privileges for diverse participation in occupations”
(p. 80). In addition, these authors presented OJ as comple-
mentary to and extending SJ, with the main difference
between SJ and OJ being OJ’s focus on humans as occupa-
tional beings, on the differing abilities of individuals to
engage in daily occupations, and on the enablement of occu-
pational participation (Townsend & Wilcock, 2004; Wilcock
& Townsend, 2000).
Interestingly, Kautzmann (2009) examined practitioners’
views, and found therapists were split in their preference for
the terms occupational justice and social justice. Positive
responses to OJ were related to its focus on the profession’s
area of concern—occupation. In contrast, reasons for prefer-
ring SJ included the alignment between SJ and the profes-
sion’s origin, the view that SJ has greater interdisciplinary
understanding, and an argument that OJ was “another case
of occupational therapists attempting to show their exclusiv-
ity and attempting to assert ownership of an idea by placing
the word occupational in front of the existing concept”
(Kautzmann, 2009, p. 98).
182 OTJR: Occupation, Participation and Health 36(4)

Figure 2.  Distribution of articles in the literature.

Note. SJ = social justice; OJ = occupational justice; OJ-P = primary code; OJ-S = secondary code.

Figure 3.  Articles distribution based on descriptive categories.

Note. Series 1 = total articles in category; Series 2 = primary articles; Series 3 = secondary articles. Y-axis = number of articles; X-axis = descriptive
category key: 1 = empirical; 2 = conceptual; 3 = OJ; 4 = SJ; 5 = VP; 6 = PE. OJ = occupational justice; SJ = social justice; VP = values of the profession; PE
= practice environment.

Townsend and Wilcock (2004) suggested that different
forms of occupational injustice are not mutually exclusive
and may be experienced concurrently. Articles varied in how
much they focused on one or other forms of OJ or injustice
(Blakeney & Marshall, 2009; Burchett & Matheson, 2010;
Guptill, 2012; Mpofu & Hocking, 2013). Guptill (2012)
reported that musicians with injury experienced marginaliza-
tion owing to attitudinal barriers, occupational deprivation
due to injury and/or disability, and alienation due to loss of
social and occupational identity. In another study by
Blakeney & Marshall (2009), residents of a coal mining area
with water pollution issues reported that they had no choice
or control over their occupational lives, that they could no
longer fish, swim or engage in water-related activities, and
that they had to spend enormous time to access clean water
for laundry or cooking (Blakeney & Marshall, 2009). Their
analysis suggested residents experienced occupational alien-
ation, deprivation, and imbalance.
Occupational deprivation was highlighted in 30% of arti-
cles (n = 12). Whiteford (2000) noted that OJ occurs when
individuals are unable to engage in meaningful and necessary
occupations for extended periods of time owing to factors
outside of their control. Whiteford framed occupational depri-
vation as a consequence of social conditions that deprive cer-
tain groups from engaging in occupations that are meaningful,
necessary, and expected by society. A number of articles high-
lighted social policies that were seen to restrict the ability of
professional immigrants (Mpofu & Hocking, 2013) and asy-
lum seekers (Burchett & Matheson, 2010) from participating
in meaningful productive occupations. Occupational depriva-
tion was also suggested in studies of individuals who expe-
rienced chronic unemployment (Aldrich & Dickie, 2013);
Gupta 183
individuals unable to obtain work owing to their disability
(Jakobsen, 2004); prisoners of war (Cockburn, 2005); ethnic,
religious, and cultural minority groups; refugees/asylum
seekers; women; and child laborers negatively impacted by
global economic trends and civil unrest (Whiteford, 2000).
Occupational injustice was described in studies as mani-
festing in the denial of rights to participation for certain seg-
ments of society (Nilsson & Townsend, 2010). Denial of
occupational rights due to cultural imperialism, marginaliza-
tion, and exploitation was reported to negatively impact the
well-being of various vulnerable groups (Hammell, 2008).
Occupational rights were also highlighted in relation to
socially constructed barriers that deprived indigenous people
of their culture, land rights, and occupational heritage
(Fiddler & Peerla, 2009; Zeldenryk & Yalmambirra, 2006).
Occupational marginalization was described by Townsend
and Wilcock (2004) as operating “invisibly,” and as “a major
force of injustice being normative standardization of expecta-
tions about how, when, and where people ‘should’ participate”
(p. 81). In an example of occupational marginalization, social
beliefs and attitudes were seen to portray men with spinal cord
injuries as asexual, infantile, and dependent, and thereby cre-
ated barriers to occupations related to sexuality (Sakellariou &
Simo Algado, 2006). In another study, transgender persons
were reported to experience marginalization when forced “to
engage in particular occupations in order to survive or thrive
in a gender-normative world that otherwise demanded of them
that they live a partial existence” (Beagan et al., 2012, p. 237).
Townsend and Wilcock (2004) described occupational
alienation as “prolonged experiences of disconnectedness,
isolation, emptiness, lack of a sense of identity, a limited or
confined expression of spirit, or a sense of meaninglessness”
related to a lack of occupational choices (p. 80). Articles that
discussed alienation did so in different contexts. For instance,
Guptill (2012) discussed occupational alienation as the expe-
rience of professional musicians who had sustained injury
and could no longer pursue their occupation of choice.
Jakobsen (2004) described individuals with disability who
were unemployed to experience alienation. Water pollution
due to mining practices was reported as the context of occu-
pational alienation, when residents do not have choice or
control of their occupational lives due to contaminated water
(Blakeney & Marshall, 2009).
The concept of occupational apartheid appeared in one
article that discussed restrictions from professional work of
highly qualified immigrants such as medical doctors whose
credentials were not recognized by the host country (Mpofu
& Hocking, 2013). The article drew on Kronenberg and
Pollard’s (2005) conceptualization of occupational apart-
heid, defined as the state of being occupationally deprived or
marginalized due to social segregation, and being treated as
unworthy compared with other members in society.
Dissonance in practice as occupational injustice.  Another major
theme was dissonance in practice as occupational injustice.
Townsend and Wilcock (2004) noted that tensions between
professional values, and values in practice settings indi-
rectly promote occupational injustices. Some of the historic
premises of OT such as advocacy, activism (Frank, 2012),
and aims to serve societally marginalized groups (Cock-
burn, 2005) were identified as causing dissonance when not
enabled by practice contexts. Occupational injustice was
also identified when dissonance occurred through lack of
client centeredness (Riegel & Eglseder, 2009), lack of cul-
turally responsive services (Gerlach, Wilson, & Hopkirk,
2012), or not meeting the occupational needs of clients
(Paul-Ward, 2009).
Occupational injustice was also associated with limited
resources and the rationing of services. The constraints of
biomedical PEs and health care funding were highlighted in
a number of studies as barriers to client-centered practice
(Arthanat, Simmons, & Favreau, 2012; Du Toit, Böning, &
Van Der Merwe, 2014). For example, attitudinal barriers and
the availability of funding were reported to impact the qual-
ity of service and the usability of prescribed assistive devices
(Arthanat et al., 2012), as well as the resettlement and social
integration of refugees with disability (Mirza, 2012).
Injustices were reported with respect to indigenous health
care service delivery, including inadequate culturally respon-
sive care and therapists’ silence and inaction in the face of
systemic problems that negatively impacted quality of ser-
vices (Gerlach, Wilson, & Hopkirk, 2010). The latter study
recommended infusing diversity in personnel, perspectives,
and practice as a way to change practice. Galvin, Wilding,
and Whiteford (2011) further demonstrated incongruence
between the profession’s vision and the reality of practice
when they reported that therapists in their study believed that
ideas of human rights and OJ, which arguably align with the
vision of OT, interfered with the provision of quality hospi-
tal-based care. Bridging OJ theory to occupation-based prac-
tice was suggested by Riegel and Eglseder (2009) as a means
to improve quality of care and client-centered practice in bio-
medical settings.
A number of studies called for a paradigm change to
include more community-based practices as a means of
aligning practice with OJ (Al Heresh, Bryant, & Holm, 2013;
Arthanat et al., 2012; Blakeney & Marshall, 2009; Paul-
Ward, 2009). A focus on occupation-based practice was also
suggested (Guajardo & Pollard, 2010; Pettican & Bryant,
2007). For instance, injustices in health services for individ-
uals with dementia were reported in medically dominated
health care environments, and an occupational perspective in
practice was recommended as a means to alleviate injustices
(O’Sullivan & Hocking, 2013). The occupation of volunteer-
ing was reported to positively impact the well-being, social
ties, and identity for individuals with mental illness (Farrell
& Bryant, 2009). One article highlighted how acts of justice
in everyday practice can create opportunities for occupa-
tional fulfillment in community-based settings (Al Heresh
et al., 2013). In summary, a number of articles suggested that
184 OTJR: Occupation, Participation and Health 36(4)
client-centered, occupation-based, and/or community-based
practice could promote OJ.
Enabling participation and social inclusion.  A theme that arose
in a number of articles was focus on enabling participation
and social inclusion as a means of promoting OJ. In their
article about citizenship, Yeung, Passmore, and Packer
(2008) found that young adults with disabilities reported a
desire for citizenship, to contribute to society, to live with
dignity, and to respect and pursue their life goals, but instead
reported experiences of isolation and loneliness. In another
article, persons with mental health issues were reported to be
vulnerable to imbalance, deprivation, compromised well-
being, and social exclusion emanating from a “restricted
range of occupations” in which they could participate (Dorer,
Harries, & Marston, 2009, p. 521). The analysis by Häggb-
lom-Kronlöf and Sonn (2006) identified that very elderly
people experienced occupational injustices of alienation,
deprivation, and/or marginalization in terms of limited occu-
pational interests and choices. In a study by VanLeit, Starrett,
and Crowe (2006), homeless women and children were
reported to experience restricted participation in social life
and occupational injustices. In two studies, refugees were
reported to have encountered challenges to social integration
in the resettlement process (Mirza, 2012; Suleman & Whit-
eford, 2013). Bailliard (2013) furthermore reported that with
the ever-present threat of deportation, immigrants often live
in fear and experience deprivation, exploitation, and oppres-
sive conditions in their daily life, and that this impacts their
well-being and participation in society. Many of these stud-
ies alluded to community practice to enhance participation
and social inclusion, and ultimately OJ.
Societal beliefs and attitudes were highlighted as shaping
the expectations, value, and worth placed on different occupa-
tions. Rudman and Molke (2009) linked employment to OJ,
arguing that employment is a productive occupation that con-
fers social membership and is viewed as necessary and
required in adulthood. Gupta (2012), however, found that
despite legislation prohibiting discrimination, motivated
workers with a disability encountered attitudinal issues and
experienced workplace occupational injustices. Relatedly, van
Niekerk (2009) reported that individuals with mental illness
experienced injustices when they were unable to participate in
work, which was an important facilitator in their recovery. In a
study by Burchett and Matheson (2010), asylum seekers
restricted from engaging in paid employment reported loss of
identity and roles, and feelings of social exclusion. These are
instances of occupational injustice due to an inability to meet
societal expectation of participation in work.
Overemphasis on productive occupations was also
reported as an issue of OJ. In a study by Mirza (2012), reset-
tlement policies were seen to emphasize self-sufficiency and
employment such that support services staff focused exclu-
sively on either work or welfare, and ignored other occupa-
tional interests, and social integration of refugees with
disabilities. Finally, the focus of a think tank of scholars in
2012 was to highlight the benefits and need for an occupa-
tional lens to critically evaluate and address workplace ineq-
uities, pointing to participation and social inclusion as issues
of OJ (Shaw et al., 2012).
The studies reported above demonstrate contextual barri-
ers to social inclusion and participation in meaningful occu-
pations that contribute to occupational injustices. These
barriers frequently included factors which challenge people
to accept or resist individual experiences of injustice.
Whiteford (2000) highlighted how social phenomena such as
human displacement, mass migration, poverty, and exploita-
tion of children are matters of justice beyond the control of
individuals and that need to be considered when looking at
issues of social inclusion. Guajardo and Pollard (2010)
argued that a broad understanding of social perspectives,
inclusive of political, social, and economic systems, is
required to address occupational injustices and promote
social change through community- and occupation-based
practice. Rudman (2013) went so far as to question whether
occupational scientists are perpetuating injustices by their
continued focus on individuals to the exclusion of consider-
ation of how social structures differentially distribute power
and possibilities for achieving occupational potential.
In summary, the findings of this mapping review revealed
dissonance in practice largely owing to a disconnect with
core professional values. Community- and occupation-based
practice was seen as the means to enhance participation and
social inclusion, and ultimately OJ.
Discussion
A premise of OJ is a belief that engagement in meaningful
and purposeful occupation is fundamental to the health and
well-being of individuals and society (Townsend & Wilcock,
2004; Whiteford & Townsend, 2011; Wilcock & Townsend,
2014). By extension, when humans as occupational beings
are restricted or deprived from engagement and participation
in occupational opportunities, some have argued that they
are being denied certain aspects of their basic humanity
(Gupta & Garber, 2016).
Although it is clear from the mapping review that justice
is both implicit and explicit in the profession’s origin, phi-
losophy, and values, the results revealed both challenges and
inconsistencies in the way the concept of OJ has been opera-
tionalized in practice. Occupational injustice was frequently
identified with practice that was not client-centered, occupa-
tion-based, or community-oriented. What follows is a critical
analysis of the reported barriers to the promotion of OJ in
practice that appear to fall under two broad categories:
aspects of practice contexts that do not align with OJ and
conceptual clarity in the articulations of OJ.
Sponsorship by medicine that brought status and legiti-
macy to OT has been attributed with distancing the profes-
sion from the original values and ideals of the social reform
Gupta 185
movements that inspired its birth (Reed & Peters, 2006).
Practice today in the United States is largely reimbursement-
driven and in medical contexts, which may not promote the
profession’s espoused values, beliefs, and conceptual models
(Gupta & Taff, 2015). Gupta and Garber (2016) suggested
that therapists in certain biomedical settings, where interven-
tions are focused on enhancing the functioning of body sys-
tems, are often conceptually removed from everyday
occupations in which their clients participate, the social con-
texts and systems in which these occupations naturally occur,
and notions of well-being and human rights. OT intervention
primarily aims to enhance function and occupational perfor-
mance (Gupta & Taff, 2015). Wilcock (1999) has challenged
occupational therapists to go beyond “doing” to incorporate
the “being” and “becoming” dimensions of occupation in
practice, which are dimensions of well-being. Doble and
Santha (2008) have also suggested that occupational thera-
pists go beyond occupational performance, and recom-
mended that occupational well-being be considered as an OT
outcome. Hammell (2004) has proposed that meaningfulness
of occupation is derived from doing, being, belonging, and
becoming, and that meaning is essential for well-being and
life satisfaction. She also noted the importance of the social
dimensions of occupation, such as belonging, connected-
ness, and interdependence, to well-being.
“Individualizing” Justice
Concepts of OJ emphasize individuals’ rights to engage in
occupations and place less focus on what ensues from occu-
pational engagement. The literature is inconsistent in identi-
fying the outcomes of OJ, which are reported to span from
occupational performance and engagement, to health, well-
being, participation, and social inclusion (Stadnyk et al.,
2010). Each of these is a very complex and multidimensional
construct, and the relationship to OJ has not yet been devel-
oped in a differentiated fashion, suggesting the need for fur-
ther work in this regard. Furthermore, Hammell (2012)
suggested that an unexamined assumption in OT is the “belief
that occupational engagement always contributes positively
to life’s meaning, and the assumption that occupations invari-
ably contribute positively to health” (p. 14). There is, how-
ever, a dark side to occupational engagement. For instance,
occupations related to harmful substance addictions (Kiepek
& Magalhães, 2011), or imbalanced engagement of meaning-
ful and health-promoting occupations (Guptill, 2012), can
also negatively impact health and well-being.
One critique of OJ is its view of “injustice as a state of
being or outcome” (Frank, Muriithi, & Austin, 2015, p. 16).
Accordingly, most of the studies in the review described
experiences of injustices. For instance, professional musi-
cians were reported to experience occupational deprivation,
marginalization, or alienation as a result of occupational
imbalance or over-engagement in their music-related occu-
pations (Guptill, 2012). The analysis by Blakeney and
Marshall (2009) highlighted that residents of an area with
water contamination experienced occupational injustice
resulting from social and political factors outside of their
control and choice. One might argue that occupational depri-
vation subsequent to excess engagement in a meaningful
occupation of choice is perhaps not comparable with that due
to social conditions outside of one’s control and choice.
From the perspective of parity, perhaps the root cause of the
occupational injustice is irrelevant, and what is of impor-
tance is the fact that they are restricted from full participation
in social life (World Health Organization [WHO], 2001).
Many cases of occupational injustice identified in the
review were reported to relate to attitudinal barriers, whereby
certain groups were judged and excluded, and denied access
to resources and opportunities (Burchett & Matheson, 2010;
Sakellariou & Simo Algado, 2006). The reviewed articles
highlighted that the root causes of occupational injustice
often lie in the social and political context and that as such
addressing individual experiences of occupational injustices
requires explicit consideration of the context. Attitudinal
barriers, policies, and systemic structures described in the
literature need to be recognized. The end goal of OJ may be
social inclusion and full participation, but achieving this goal
requires advocacy for social contexts and policies that reduce
inequities and differential opportunities for participation.
Human development and well-being are dependent on access
to resources and opportunities in the social environment that
impact life chances in profound ways.
Although Whiteford and Townsend (2011) characterized
OJ as essentially a population issue that is a consequence of
social systems, the literature included in this mapping review
is focused to a great extent on OJ as individual experiences
of injustices. This is problematic from a policy perspective,
as the metrics of policies are concerned with averages and
aggregate numbers. The development and application of
social policies are based on principles of universality where
everyone benefits from the policy or selectivity that restricts
eligibility to specific criteria (Béland, Blomqvist, Andersen,
Palme, & Waddan, 2014). For example, Temporary
Assistance for Needy Families, a federal legislation in the
United States that exemplifies selectivity, determines wel-
fare assistance eligibility based on aggregate data (Center on
Budget and Policy Priorities, 2015). In recent years, policies
based on universality even in countries known for their gen-
erosity have declined (Béland et al., 2014). Concurrently,
eligibility criteria have tightened for policies based on selec-
tivity (Center on Budget and Policy Priorities, 2015). Policies
are designed to benefit aggregates, and the benefits of poli-
cies have differential impact on different individuals of the
aggregate. In light of these considerations, it is proposed that
the focus of OTs who want to address OJ needs to be broader
and more conscious of how individual experiences of occu-
pation shape and are shaped by the root causes of occupa-
tional injustice, including policies that support or limit
participation and social inclusion. Rudman (2014), Frank
186 OTJR: Occupation, Participation and Health 36(4)
(2014), and Townsend (2012) have all argued that research-
ers in occupational science and OT could advance the con-
cept of OJ with consciousness raising to understand how
policies and other environmental forces shape and are shaped
by individual and collective participation in occupations.
Calls have been made for a deeper and more nuanced
understanding of social and systemic influences on occupa-
tion for a critical and socially responsible science (Angell,
2014; Frank, 2012; Rudman, 2013). The Framework of
Occupational Justice (FOJ; Stadnyk et al., 2010) identifies
structural and contextual factors in relationship to OJ.
Townsend (2012) recently noted that the FOJ demonstrated
“how the inter-relationships of structural factors and contex-
tual factors support or restrict occupational outcomes and
occupational rights, dis-ease and injustices” (p. 13). However,
a critique of the FOJ has been that “individuals are portrayed
as affected by or subjected to environmental determinants in
a mechanistic fashion that does not account for their role in
the well-being, freedom, and justice of others” (Bailliard,
2016, p. 7).
This literature review captured different forms of occupa-
tional injustices that resulted from either attitudinal barriers
which is classified as a contextual factor (WHO, 2001) or
policies that differentially enabled participation for some
groups such as asylum seekers. Therapists who experienced
dissonance in practice also did so owing to organizational
values and systemic barriers to OJ practice that were contex-
tual in nature. Contextualizing OJ may therefore help develop
intervention strategies at the social systems level to reduce or
better yet eliminate the root sources of injustices.
OJ, Health, and Well-Being
Social determinants of health have been shown to contribute
to health inequities between different social groups, on the
basis of class, race, income, or other social variables (Marmot
& Wilkinson, 2005). Social determinants that put people at
risk for poor health are also the risk factors reported for occu-
pational injustice. Vulnerable groups identified in this review
included those experiencing poverty, homelessness, unem-
ployment, and lack of access to education, work, or other
social goods.
Hofrichter (2003) suggested that “eliminating health ineq-
uities is important as a matter of SJ as health is an asset and
resource critical to human development” (p. xvii-xxi). The
primary moral concern of justice is individual well-being, and
health inequalities matter insofar as they are a subset of well-
being (Sreenivasan, 2014) and in light of health as an “impor-
tant component and cause of well-being” (Hausman, 2007, p.
46). It is this link between health and well-being that makes
health “a meta-capability which is an overarching capabil-
ity to achieve a cluster of basic capabilities to be and do
things that make up a minimally good human life in the con-
temporary world” (Venkatapuram, 2012, p. 20, emphasis
added). These articulations of health and well-being from
health justice scholars conceptually demarcate health from
well-being. It is critical for OJ scholars to make similar dis-
tinctions to situate OJ in the broader health justice discourse.
Townsend (2012) has written about the compatibility of
OJ with Nussbaum’s (2003) capabilities perspective of jus-
tice in their shared concern for the doings and beings of peo-
ple. Although there appears to be some resonance between
capabilities approach (CA) and OJ, a deeper conceptual
comparative analysis is needed to identify points of congru-
ence and deviation. Bailliard (2016) advocated adopting
Sen’s (1999) CA, as a philosophical basis for conceptualiz-
ing OJ, because the goal of CA is to promote the capability to
be healthy and live a good life. Bailliard argues that this
would help the profession articulate the rationale for OJ, that
is, the need for occupational participation as a means to
improve health and well-being.
Despite these arguments, there are differences between
current formulations of OJ and CA that need to be recon-
ciled. The CA notes that freedoms (opportunities) are depen-
dent on social and economic arrangements that include
education, housing, health care, and so on (Sen, 1999).
Poverty, political tyranny, systematic social deprivation, and
poor economic opportunities are named unfreedoms that
impact human development (Sen, 1999). Moreover, the CA
is situated in and heavily influenced by dominant egalitarian
SJ distributive paradigms. The literature on OJ in its efforts
to distinguish OJ from SJ appears to distance itself from the
social, and in doing so the social contexts of OJ are in the
background, and the individual experience of occupational
injustice is foregrounded.
If OJ is to be the means of addressing inequity and envi-
sioning a more occupationally just world, rigorous and
empirical evidence of occupations’ influence on health, well-
being, social inclusion, and participation is critical.
Limitations
The study is limited in that gray literature and book chapters
were excluded from the mapping review. This is mediated by
the inclusion of relevant gray literature in the “Introduction”
and “Discussion” sections.
Conclusion
The articles in this review have presented occupational injus-
tices as complex, multifaceted, and multidimensional.
Practice dissonance was associated with therapists’ inability
to practice from an OJ perspective, which was associated
with promoting participation and social inclusion through
occupation-based, client-centered, and community-based
practice.
OJ and related terminology requires further conceptual
development and empirical evidence to demonstrate the
mechanisms by which occupation is a determinant of health
and by extension well-being. Well-being as a metaconcept
Gupta 187
is inclusive of health, participation, and social inclusion,
and might provide a way to align OJ with SJ discourse out-
side of the profession. The profession-centric concept of OJ
must be framed as part of the larger interdisciplinary dis-
course if its utility is to move beyond the profession.
Finally, if OJ is to evolve as a unique and influential
Appendix
Literature Chart of Primary and Secondary Articles.
Articles included in mapping review
Primary OJ articles
  1. Aldrich, R. M., & Dickie, V. A. (2013). “It’s hard
to plan your day when you have no money”:
Discouraged workers’ occupational possibilities and
the need to reconceptualize routine. Work: A journal
of Prevention, Assessment & Rehabilitation, 45(1), 5-15.
  2. Al Heresh, R., Bryant, W., & Holm, M. (2013).
Community-based rehabilitation in Jordan:
Challenges to achieving occupational justice.
Disability & Rehabilitation, 35(21), 1848-1852.
  3. Arthanat, S., Simmons, C. D., & Favreau, M.
(2012). Exploring occupational justice in consumer
perspectives on assistive technology. Canadian
Journal of Occupational Therapy, 79(5), 309-319.
  4. Bailliard, A. (2013). Laying low: Fear and injustice
for Latino migrants to Smalltown, USA. Journal of
Occupational Science, 20(4), 342-356.
  5. Beagan, B. L., De Souza, L., Godbout, C., Hamilton,
L., MacLeod, J., Paynter, E., & Tobin, A. (2012).
This is the biggest thing you’ll ever do in your
life: Exploring the occupations of transgendered
people. Journal of Occupational Science, 19(3), 226-
240.
  6. Carlsson, C. (2009). The 2008 Frances Rutherford
Lecture: Taking a stand for inclusion: Seeing
beyond impairment! New Zealand Journal of
Occupational Therapy, 56(1), 4-11.
  7. Cockburn, L. (2005). Reflections on . . . Canadian
occupational therapists’ contributions to prisoners
of war in World War II. Canadian Journal of
Occupational Therapy, 72(3), 183-188.
  8. Dorer, G., Harries, P., & Marston, L. (2009).
Measuring social inclusion: A staff survey of mental
health service users’ participation in community
occupations. British Journal of Occupational Therapy,
72(12), 520-530.
  9. Durocher, E., Gibson, B. E., & Rappolt, S. (2014a).
Occupational justice: A conceptual review. Journal
of Occupational Science, 21(4), 418-430.
concept that can inform policy to promote justice-oriented
social change, then the focus on the occupational experi-
ences of individuals must be seen as transacting with, and
rooted in, systems and policies that contribute to occupa-
tional inequities in engagement and participation of groups
and populations.
Distribution of code
categories
R OJ SJ VP PE Key ideas/concepts
X X X X Employment as an occupational determinant;
Unemployment and deprivation as individual
and social issue
X X X Human displacement creates vulnerable
refugees; Community-based practice creating
opportunities for occupational fulfillment;
Views of justice from developed countries are
utopian ideals
X X X Impairment-focused paradigm to independence-
focused community practice; Practice
constraints to client-centered practice;
Sociopolitical influences on resource
availability; Attitudinal barriers to participation
for individuals with disabilities
X X X X Contextual barriers and systems SJ and policy-
context; Immigrants living in fear, experience
oppression and discrimination; OJ critique and
occupational perspective on public policy
X X X Coerced to fit cultural norms as injustice for
transgendered persons; Marginalization owing
to attitudinal barriers
X X Roots of OT in SJ and OJ; Going beyond
impairment for students with disability;
Promoting inclusion and full participation
X X Historical roots of OT in justice; Occupational
deprivation in prisoners of war
X X X X Restricted range of occupations for individuals
with mental health issues; Attitudinal barriers
negatively impact social inclusion and well-
being
X Critique of OJ as a concept for lack of
conceptual clarity; Barriers to use OJ in
practice
(continued)
188 OTJR: Occupation, Participation and Health 36(4)
Appendix (continued)
Articles included in mapping review
10. Durocher, E., Rappolt, B. E., & Gibson, S.
Durocher, E., Rappolt, S., & Gibson, B. E. (2014b).
Occupational justice: Future directions. Journal of
Occupational Science, 21(4), 431-442.
11. Du Toit, Sanetta H. J., Böning, W., & Van, D. M.
(2014). Dignity and respect: Facilitating meaningful
occupation for SeSotho elders. Scandinavian Journal
of Occupational Therapy, 21(2), 125-135.
12. Fiddler, A., & Peerla, D. (2009). The
Kitchenuhmaykoosib Inninuwug and the struggle
for the right to say no. Journal of Occupational
Science, 16(1), 10-11.
13. Frank, G. (2012). Occupational therapy/
occupational science/occupational justice: Moral
commitments and global assemblages. Journal of
Occupational Science, 19(1), 25-35.
14. Galvin, D., Wilding, C., & Whiteford, G. (2011).
Utopian visions/dystopian realities: Exploring
practice and taking action to enable human rights
and occupational justice in a hospital context.
Australian Occupational Therapy Journal, 58(5),
378-385.
15. Gupta, J. (2012). An issue of occupational (In)
justice: A case study. Disability Studies Quarterly,
32(3).
16. Guptill, C. (2012). Injured professional musicians
and the complex relationship between occupation
and health. Journal of Occupational Science, 19(3),
258-270.
17. Hammell, K. (2008). Reflections on . . . well-
being and occupational rights. Canadian Journal of
Occupational Therapy, 75(1), 61-64.
18. Hansen, A. M. W. (2013). Bridging theory and
practice: Occupational justice and service learning.
Work, 45(1), 41-58.
19. Holthe, T., Thorsen, K., & Josephsson, S. (2007).
Occupational patterns of people with dementia
in residential care: An ethnographic study.
Scandinavian Journal of Occupational Therapy, 14(2),
96-107
20. Jakobsen, K. (2004). If work doesn’t work: How to
enable occupational justice. Journal of Occupational
Science, 11(3), 125-134.
21. Kautzmann, L. (2009). What you told us about
occupational justice. Occupational Therapy in Mental
Health, 25(1), 97-99.
Distribution of code
categories
R OJ SJ VP PE Key ideas/concepts
X X Occupation and health relationship; OJ ties
to inform health care services and improve
practice; Bioethics potential to inform OJ;
Collaborate with other disciplines about OJ
X X X X Practice is compatible with justice when it is
client centered, culturally appropriate, and
human dignity and respect are upheld when
clients’ choice respected
X X Indigenous people; Cultural imperialism; Rights
to autonomy and cultural practices
X X X Occupational science & OT share history and
moral philosophy; Critique of occupation as a
right to occupation and need for infusing larger
context and interdisciplinary frameworks
through collaboration
X X X X Dissonance between human rights and practice;
Ideal and reality of human rights and practice;
Relevance of rights and justice in everyday
practice
X X Individual with disability; OJ—Workplace
injustices, social exclusion; Attitudinal barriers
to integration
X X Individuals’ experiences of OJ marginalization—
Attitudinal barriers judging musicians as
frivolous; Deprivation due to injury and
perhaps disability; Alienation—Loss of social
identity and occupation
X X X OT allegiance to occupational rights; Link
between human rights and well-being; OT’s
emphasis on health and inadequate concern
for well-being
X X X Serving underserved communities;
Contextualizing OJ with concrete examples;
Transforms learning from knowing OJ to
understanding OJ
X X X Elderly with dementia lack of occupational
choices and forced activities; Challenge to
client-centered approach in practice
X X Paid work is a key to social identity;
Unemployment of people with disabilities
contributes to deprivation, alienation, and
imbalance
X X X Professional understanding and view of OJ as
a term no consensus; OJ seen as a way to
validate the profession but adds to confusion;
Preference for SJ
(continued)
Gupta 189
Appendix (continued)
Articles included in mapping review
22. Mirza, M. (2012). Occupational upheaval during
resettlement and migration: Findings of global
ethnography with refugees with disabilities. OTJR:
Occupation, Participation & Health, 32(Suppl),
S6-S14.
23. Mpofu, C., & Hocking, C. (2013). Not made here:
Occupational deprivation of non-English speaking
background immigrant health professionals in New
Zealand. Journal of Occupational Science, 20(2),
131-145.
24. Nilsson, I., & Townsend, E. (2010). Occupational
justice: Bridging theory and practice. Scandinavian
Journal of Occupational Therapy, 17(1), 57-63.
25. O’Sullivan, G., & Hocking, C. (2013). Translating
action research into practice: Seeking occupational
justice for people with dementia. OTJR: Occupation,
Participation & Health, 33(3), 168-176.
26. Paul-Ward, A. (2009). Social and occupational
justice barriers in the transition from foster care
to independent adulthood. American Journal of
Occupational Therapy, 63(1), 81-88.
27. Riegel, S. K., & Eglseder, K. (2009). Occupational
justice as a quality indicator for occupational
therapy services. Occupational Therapy in Health
Care, 23(4), 288-301.
28. Rudman, D. L. (2013). Enacting the critical
potential of occupational science: Problematizing
the “individualizing of occupation.” Journal of
Occupational Science, 20(4), 298-313.
29. Sakellariou, D., & Simo Algado, S. (2006). If not
the disability, then what? Barriers to reclaiming
sexuality following spinal cord injury. Sexuality and
Disability, 24(2), 101-111.
30. Shaw, L., Jacobs, K., Rudman, D., Magalhaes, L., Huot,
S., Prodinger, B., . . . Suto, M. (2012). Directions for
advancing the study of work transitions in the 21st
century. Work: A journal of Prevention, Assessment &
Rehabilitation, 41(4), 369-377.
31. Smith, D., & Hilton, C. (2008). An occupational
justice perspective of domestic violence against
women with disabilities. Journal of Occupational
Science, 15(3), 166-172.
32. Suleman, A., & Whiteford, G. E. (2013).
Understanding occupational transitions in forced
migration: The importance of life skills in early
refugee resettlement. Journal of Occupational
Science, 20 (2), 201-210.
33. Townsend, E. (2003). Reflections on power and
justice in enabling occupation. Canadian Journal of
Occupational Therapy, 70(2), 74-87.
34. Townsend, E. A. (2012). Boundaries and bridges
to adult mental health: Critical occupational
and capabilities perspectives of justice. Journal of
Occupational Science, 19(1), 8-24.
Distribution of code
categories
R OJ SJ VP PE Key ideas/concepts
X X Refugees with disabilities lack of supportive
services; Emphasis on self-sufficiency and
work; Attitudinal barriers enhance OJ—
Deprivation, challenge social inclusion and
integration
X X Professional immigrants experience OJ—
Deprivation and apartheid, social exclusion,
attitudinal barriers, and social policies
X X X Roots of OT in SJ; OJ and SJ inform practice;
Participation restriction as a human rights
issue
X X X X People with dementia experience health services
injustices; Need for occupational perspective
and OT practice paradigm change
X X X X X SJ—Systemic barriers for children in foster care;
Need for social change advocacy; Community
practice conducive to client-centered practice
and OJ
X X X Bridging OJ theory to practice promotes quality
OT programs that is client-centered
X X X Critical stance on individualizing of occupation;
Politics of occupation must be considered;
Power relations need to be traversed;
Dominant ways oppress others
X X X Informing practice to take OJ perspective;
Beliefs and attitudes about sexuality and sexual
identity of individuals with a disability
X Broad application of OJ lens to workplace
issues; OJ lens to critical questions of injustices
and inequities in work
X X Women with disabilities experiencing domestic
violence experience poor health and well-
being; Empowerment as strategy to address OJ
X Enablement in resettlement of refugees through
life skills training enhances social inclusion and
promotes OJ
X X X Justice and client-centered practice; Negotiating
power in PEs
X X Persons with mental health issues experience
OJ—Exclusion from participation; OJ
and Nussbaum’s Capabilities Approach
compatibility
(continued)
190 OTJR: Occupation, Participation and Health 36(4)
Appendix (continued)
Articles included in mapping review
35. Townsend, E., & Wilcock, A. A. (2004).
Occupational justice and client-centred practice:
A dialogue in progress. Canadian Journal of
Occupational Therapy, 71(2), 75-87.
36. Whittaker, B. (2012). Sustainable global wellbeing:
A proposed expansion of the occupational therapy
paradigm. British Journal of Occupational Therapy,
75(9), 436-439.
37. Whiteford, G. (2000). Occupational deprivation:
Global challenge in the new millennium. British
Journal of Occupational Therapy, 63(5), 200-204.
38. Wilcock, A. A., & Townsend, E. (2000).
Occupational terminology interactive dialogue.
Journal of Occupational Science, 7, 84-86.
39. VanLeit, B., Starrett, R., & Crowe, T. (2006).
Occupational concerns of women who are
homeless and have children: An occupational
justice critique. Occupational Therapy in Health Care,
20(3-4), 47-62. doi:10.1300/J003v20n03_04
40. Zeldenryk, L., & Yalmambirra. (2006). Viewpoint
occupational deprivation: A consequence of
Australia’s policy of assimilation. Australian
Occupational Therapy Journal, 53(1), 43-46.
Secondary OJ articles
41. Blakeney, A. B., & Marshall, A. (2009). Water
quality, health, and human occupations. American
Journal of Occupational Therapy, 63(1), 46-57.
42. Beck, A. J., & Barnes, K. J. (2007). Reciprocal
service-learning: Texas border head start
and master of occupational therapy students.
Occupational Therapy in Health Care, 21(1-2), 7-22.
43. Burchett, N., & Matheson, R. (2010). The need for
belonging: The impact of restrictions on working
on the well-being of an asylum seeker. Journal of
Occupational Science, 17(2), 85-91.
44. Cage, A. (2007). Occupational therapy with
women and children survivors of domestic
violence: Are we fulfilling our activist heritage?
A review of the literature. The British Journal of
Occupational Therapy, 70(5), 192-198.
45. Farrell, C., & Bryant, W. (2009). Voluntary work
for adults with mental health problems: A route
to inclusion? A review of the literature. The British
Journal of Occupational Therapy, 72(4), 163-173.
46. Gerlach, A., Wilson, L. H., & Hopkirk, J. (2010).
Occupational therapy and indigenous peoples:
Partnerships for change. WFOT Bulletin, 61, 52-55.
Distribution of code
categories
R OJ SJ VP PE Key ideas/concepts
X Seminal article on naming OJ and proposing
exploratory theory; Various forms of justice—
Terminology and definitions; PE constrains
client-centered practice implicitly promoting
injustices
X X OT paradigm expansion to environmental
sustainability; OJ linked to environmental
justice
X X Paradigm shift in practice needed; Influences of
technology and economy on a global scale;
Vulnerable at risk for deprivation; Global
societal issues: unemployment, civil unrest,
migration
X Various forms of justice—Terminology and
definitions
X X X X Homeless women and children marginalized;
Social issues such as employment, poverty,
education, transportation, and housing
contribute to OJ
X X X Indigenous people experiences of cultural
imperialism and policy of assimilation;
Occupational and cultural deprivation
X X X Environmental injustice leads to OJ—Poor
water quality and occupational imbalance,
marginalization, deprivation; Alienation;
Community practice
X X X Involving students in underserved communities
to broaden understanding of injustices,
enablement, and mutual responsibility
X X X Immigrants and refugees loss of identity and
roles; Legislative restrictions to participation
contribute to OJ
X X Critical role for OT to work with individuals
experiencing domestic violence; Lack of
training and education; Need to develop
critical consciousness of contextual and social
issues
X X Individuals with mental illness benefit by
volunteering as it provides roles, identity,
and social ties to community; Enhance social
inclusion
X X Indigenous injustices in health care; OT
complicit in perpetuating injustices by its
silence; Enhance diversity in personnel and
practice beliefs
(continued)
Gupta 191
Appendix (continued)
Articles included in mapping review
47. Gossett, A., Mirza, M., Barnds, A. K., & Feidt,
D. (2009). Beyond access: A case study on the
intersection between accessibility, sustainability,
and universal design. Disability and Rehabilitation:
Assistive Technology, 4(6), 439-450.
48. Guajardo, A., & Pollard, N. (2010). Occupational
therapy perspectives from the southern
hemisphere. British Journal of Occupational Therapy,
73(6), 241-242.
49. Häggblom-Kronlöf, G., & Sonn, U. (2006). Interests
that occupy 86-year-old persons living at home:
Associations with functional ability, self-rated health
and sociodemographic characteristics. Australian
Occupational Therapy Journal, 53(3), 196-204.
50. Jakobsen, K. (2004). If work doesn’t work: How to
enable occupational justice. Journal of Occupational
Science, 11(3), 125-134.
51. Pettican, A., & Bryant, W. (2007). Sustaining a
focus on occupation in community mental health
practice. The British Journal of Occupational Therapy,
70(4), 140-146.
52. Polgar, J. (2011). Enabling community mobility is
an opportunity to practice social occupational
therapy. Canadian Journal of Occupational Therapy,
78(2), 67-71.
53. Rudman, D. (2006). Positive aging and its implications
for occupational possibilities in later life. Canadian
Journal of Occupational Therapy, 73(3), 188-192.
54. Rudman, D. L., & Molke, D. (2009). Forever
productive: The discursive shaping of later life
workers in contemporary Canadian newspapers.
Work: A journal of Prevention, Assessment &
Rehabilitation, 32(4), 377-389.
55. Thomas, Y. (2009). Inspiration: moving forward
when you do not see the steps. New Zealand
Journal of Occupational Therapy, 56(1), 12-18.
56. van Niekerk, L. (2009). Participation in work: A
source of wellness for people with psychiatric
disability. Work: A journal of Prevention, Assessment
& Rehabilitation, 32(4), 455-465.
57. Yeung, P. H., Passmore, A. E., & Packer, T. L.
(2008). Active citizens or passive recipients: How
Australian young adults with cerebral palsy define
citizenship. Journal of Intellectual and Developmental
Disability, 33(1), 65-75.
Note. R= rights; OJ = occupational justice; SJ = social justice; VP = values of the profession; PE = practice environment; X = OJ nonspecific.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, author-
ship, and/or publication of this article.
Distribution of code
categories
R OJ SJ VP PE Key ideas/concepts
X X X Enhancing sustainability and accessibility for
individuals with disabilities; Complexities
involved in translating Universal Design into
practice
X X Social OT perspective from Latin American
therapists for social change; Culturally
responsive and occupation-based practice
required understanding of political, economic,
and social influences on occupation
X X X Alienation and marginalization of the very old;
Impact on well-being; Occupational interests
at this life stage
X X X Systemic and attitudinal barriers to individuals
with disability and employment; SJ and social
policy
X X Community mental health practice; Policies
impact client-centered and occupation-based
practice creating tension and dissonance
X X Community mobility as a justice issue;
Profession’s role in advocating for justice by
addressing barriers to community mobility
X X X Occupational equities and positive aging; Social,
political, and cultural influences on discourse;
Macro issues; and Aging
X X Critical discourse analysis of occupational
injustices and productive occupations and
aging
X X Decolonize the profession from medical model
and focus on occupational enablement,
diversity, and participation
X X X Individuals with mental illness and importance
of work as OJ to promote recovery and
participation
X X X Perception of social participation and citizenship
experiences of individuals with disability;
Promoting social inclusion as OT role and
outcome
References
Aldrich, R. M., & Dickie, V. A. (2013). “It’s hard to plan your day
when you have no money”: Discouraged workers’ occupational
possibilities and the need to reconceptualize routine. Work: A
journal of Prevention, Assessment & Rehabilitation, 45, 5-15.
Al Heresh, R., Bryant, W., & Holm, M. (2013). Community-
based rehabilitation in Jordan: Challenges to achieving
192 OTJR: Occupation, Participation and Health 36(4)
occupational justice. Disability and Rehabilitation, 35,
1848-1852.
Angell, A. M. (2014). Occupation-centered analysis of social dif-
ference: Contributions to a socially responsive occupational
science. Journal of Occupational Science, 21, 104-116.
Arthanat, S., Simmons, C. D., & Favreau, M. (2012). Exploring occu-
pational justice in consumer perspectives on assistive technol-
ogy. Canadian Journal of Occupational Therapy, 79, 309-319.
Bailliard, A. (2013). Laying low: Fear and injustice for Latino
migrants to Smalltown, USA. Journal of Occupational Science,
20, 342-356.
Bailliard, A. (2016). Justice, difference, and the capability to func-
tion. Journal of Occupational Science, 23, 3-16.
Beagan, B. L., De Souza, L., Godbout, C., Hamilton, L., MacLeod, J.,
Paynter, E., & Tobin, A. (2012). “This is the biggest thing you’ll
ever do in your life”: Exploring the occupations of transgendered
people. Journal of Occupational Science, 19, 226-240.
Béland, D., Blomqvist, P., Andersen, J. G., Palme, J., & Waddan,
A. (2014). The universal decline of universality? Social pol-
icy change in Canada, Denmark, Sweden and the UK. Social
Policy & Administration, 48, 739-756.
Blakeney, A. B., & Marshall, A. (2009). Water quality, health,
and human occupations. American Journal of Occupational
Therapy, 63, 46-57.
Burchett, N., & Matheson, R. (2010). The need for belonging: The
impact of restrictions on working on the well-being of an asy-
lum seeker. Journal of Occupational Science, 17, 85-91.
Cage, A. (2007). Occupational therapy with women and children
survivors of domestic violence: Are we fulfilling our activ-
ist heritage? A review of the literature. The British Journal of
Occupational Therapy, 70, 192-198.
Center on Budget and Policy Priorities. (2015). Policy basics: An
introduction to TANF. Retrieved from http://www.cbpp.org/
sites/default/files/atoms/files/7-22-10tanf2.pdf
Cockburn, L. (2005). Reflections on . . . Canadian occupational
therapists’ contributions to prisoners of war in World War II.
Canadian Journal of Occupational Therapy, 72, 183-188.
Doble, S. E., & Santha, J. C. (2008). Occupational well-being:
Rethinking occupational therapy outcomes. Canadian Journal
of Occupational Therapy, 75, 184-190.
Dorer, G., Harries, P., & Marston, L. (2009). Measuring social
inclusion: A staff survey of mental health service users’ par-
ticipation in community occupations. The British Journal of
Occupational Therapy, 72, 520-530.
Durocher, E., Gibson, B. E., & Rappolt, S. (2014a). Occupational
justice: A conceptual review. Journal of Occupational Science,
21, 418-430.
Durocher, E., Rappolt, S., & Gibson, B. E. (2014b). Occupational
justice: Future directions. Journal of Occupational Science, 21,
431-442.
Du Toit, S. H., Böning, W., & Van Der Merwe, T. R. (2014). Dignity
and respect: Facilitating meaningful occupation for SeSotho
elders. Scandinavian Journal of Occupational Therapy, 21,
125-135.
Evidence for Policy and Practice Information and Co-Ordinating
Centre. (2010). EPPI-centre methods for conducting sys-
tematic reviews. Retrieved from http://eppi.ioe.ac.uk/cms/
Portals/0/PDF%20reviews%20and%20summaries/Methods.
pdf?ver=2012-03-13-084040-433
Farrell, C., & Bryant, W. (2009). Voluntary work for adults with
mental health problems: A route to inclusion? A review of the
literature. The British Journal of Occupational Therapy, 72,
163-173.
Fiddler, A., & Peerla, D. (2009). The Kitchenuhmaykoosib
Inninuwug and the struggle for the right to say no. Journal of
Occupational Science, 16(1), 10-11.
Frank, G. (2012). Occupational therapy/occupational science/occu-
pational justice: Moral commitments and global assemblages.
Journal of Occupational Science, 19, 25-35.
Frank, G. (2014). Occupation for population health: an apprecia-
tion. Journal of Occupational Science, 21(1), 77-80.
Frank, G., & Muriithi, B. A. K. (2015). Theorising social trans-
formation in occupational science: The American Civil Rights
Movement and South African Struggle against Apartheid
as “occupational reconstructions.” South African Journal of
Occupational Therapy, 45, 11-19.
Friedland, J. (1998). Occupational therapy and rehabilitation: An
awkward alliance. American Journal of Occupational Therapy,
52, 373-380.
Friedland, J. (2003). Why crafts? Influences on the development
of occupational therapy in Canada from 1890 to 1930. The
Canadian Journal of Occupational Therapy, 70, 204-213.
Galvin, D., Wilding, C., & Whiteford, G. (2011). Utopian
visions/dystopian realities: Exploring practice and taking
action to enable human rights and occupational justice in a
hospital context. Australian Occupational Therapy Journal,
58, 378-385.
Gerlach, A., Wilson, L. H., & Hopkirk, J. (2010). Occupational
therapy and indigenous peoples: Partnerships for change.
WFOT Bulletin, 61, 52-55.
Gordon, D. (2009). The history of occupational therapy. In E.
Blesedell Crepeau, E. Cohn, & B. Boyt Schell (Eds.), Willard &
Spackman’s occupational therapy (pp. 202-215). Philadelphia,
PA: Lippincott Williams & Wilkins.
Graneheim, U. H., & Lundman, B. (2004). Qualitative content
analysis in nursing research: Concepts, procedures and mea-
sures to achieve trustworthiness. Nurse Education Today, 24,
105-112.
Grant, M. J., & Booth, A. (2009). A typology of reviews: An analy-
sis of 14 review types and associated methodologies. Health
Information and Libraries Journal, 26, 91-108.
Guajardo, A., & Pollard, N. (2010). Occupational therapy perspec-
tives from the southern hemisphere. The British Journal of
Occupational Therapy, 73, 241-242.
Gupta, J. (2012). An issue of occupational (In)justice: A case study.
Disability Studies Quarterly, 32(3).
Gupta, J., & Garber, T. (2016). A systematic mapping review of
notions of justice in occupational therapy. In N. Pollard & D.
Sakellariou (Eds.), Occupational therapy without borders (3rd
ed.). Elsevier.
Gupta, J., & Taff, S. D. (2015). The illusion of client-centred
practice. Scandinavian Journal of Occupational Therapy, 22,
244-251.
Guptill, C. (2012). Injured professional musicians and the com-
plex relationship between occupation and health. Journal of
Occupational Science, 19, 258-270.
Häggblom-Kronlöf, G., & Sonn, U. (2006). Interests that occupy
86-year-old persons living at home: Associations with functional
Gupta 193
ability, self-rated health and sociodemographic characteristics.
Australian Occupational Therapy Journal, 53, 196-204.
Hammell, K. W. (2004). Dimensions of meaning in the occupations
of daily life. Canadian Journal of Occupational Therapy, 71,
296-305.
Hammell, K. W. (2008). Reflections on . . . well-being and occupa-
tional rights. Canadian Journal of Occupational Therapy, 75,
61-64.
Hammell, K. W. (2012). Exposing the emperor: Meditations on cre-
dulity and occupational therapy. Occupational Therapy Now,
14(6), 13-17.
Hausman, D. M. (2007). What’s wrong with health inequalities?
Journal of Political Philosophy, 15, 46-66.
Hofrichter, R. (Ed.). (2003). Health and social justice: Politics,
ideology, and inequity in the distribution of disease. San
Francisco, CA: Jossey-Bass.
Jakobsen, K. (2004). If work doesn’t work: How to enable
occupational justice. Journal of Occupational Science, 11,
125-134.
Kautzmann, L. (2009). What you told us about occupational justice.
Occupational Therapy in Mental Health, 25, 97-99.
Kiepek, N., & Magalhães, L. (2011). Addictions and impulse-
control disorders as occupation: A selected literature
review and synthesis. Journal of Occupational Science, 18,
254-276.
Kronenberg, F., & Pollard, N. (2005). Overcoming occupational
apartheid: A preliminary exploration of the political nature
of occupational therapy. In F. Kronenberg, S. Simo Algado,
& N. Pollard (Eds.), Occupational therapy without borders:
Learning from the spirit of survivors (pp. 58-86). Edinburgh,
Scotland: Elsevier.
Marmot, M., & Wilkinson, R. (Eds.). (2005). Social determinants
of health. Oxford, UK: Oxford University Press.
Mirza, M. (2012). Occupational upheaval during resettlement and
migration: Findings of global ethnography with refugees with
disabilities. OTJR: Occupation, Participation and Health,
32(Suppl), S6-S14.
Mpofu, C., & Hocking, C. (2013). Not made here: Occupational
deprivation of non-English speaking background immigrant
health professionals in New Zealand. Journal of Occupational
Science, 20, 131-145.
Nilsson, I., & Townsend, E. (2010). Occupational justice: Bridging
theory and practice. Scandinavian Journal of Occupational
Therapy, 17, 57-63.
Nussbaum, M. C. (2003). Capabilities as fundamental entitle-
ments: Sen and social justice. Feminist Economics, 9(2-3),
33-59.
O’Sullivan, G., & Hocking, C. (2013). Translating action research
into practice: Seeking occupational justice for people with
dementia. OTJR: Occupation, Participation and Health, 33,
168-176.
Paul-Ward, A. (2009). Social and occupational justice barriers
in the transition from foster care to independent adulthood.
American Journal of Occupational Therapy, 63, 81-88.
Pettican, A., & Bryant, W. (2007). Sustaining a focus on occupation
in community mental health practice. The British Journal of
Occupational Therapy, 70, 140-146.
Reed, K. L., & Peters, C. (2006). Occupational therapy values and
beliefs, Part II: The great depression and war years, 1930–1949.
OT Practice, 11(18), 17-22.
Riegel, S. K., & Eglseder, K. (2009). Occupational justice as a qual-
ity indicator for occupational therapy services. Occupational
Therapy in Health Care, 23, 288-301.
Ritchie, J., & Spencer, L. (2004). Qualitative data analysis for applied
policy research. In A. Bryman & R. G. Burgess (Eds.), Analyzing
qualitative data. (pp. 172-194). London, England: Routledge.
Rudman, D. L. (2013). Enacting the critical potential of occupa-
tional science: Problematizing the “individualizing of occupa-
tion.” Journal of Occupational Science, 20, 298-313.
Rudman, D. L., & Molke, D. (2009). Forever productive: The dis-
cursive shaping of later life workers in contemporary Canadian
newspapers. Work: A Journal of Prevention, Assessment &
Rehabilitation, 32, 377-389.
Rudman, D. L. (2014). Embracing and enacting an ‘occupational
imagination’: Occupational science as transformative. Journal
of Occupational Science, 21(4), 373-388.
Sakellariou, D., & Simo Algado, S. (2006). If not the disability,
then what? Barriers to reclaiming sexuality following spinal
cord injury. Sexuality and Disability, 24, 101-111.
Sen, A. (1999). Development as freedom. Oxford, UK: Oxford
University Press.
Shaw, L., Jacobs, K., Rudman, D., Magalhaes, L., Huot, S.,
Prodinger, B., . . . Suto, M. (2012). Directions for advancing the
study of work transitions in the 21st century. Work: A Journal
of Prevention, Assessment & Rehabilitation, 41, 369-377.
Sreenivasan, G. (2014). Justice, inequality, and health. In E. N.
Zalta (Ed.), The Stanford encyclopedia of philosophy (Fall
2014 Edition). Retrieved from http://plato.stanford.edu/
archives/fall2014/entries/justice-inequality-health/
Stadnyk, R., Townsend, E., & Wilcock, A. (2010). Occupational jus-
tice. In C. H. Christiansen & E. Townsend (Eds.), Introduction
to occupation: The art and science of living (2nd ed., pp. 329-
358). Upper Saddle River, NJ: Pearson Education.
Suleman, A., & Whiteford, G. E. (2013). Understanding occupa-
tional transitions in forced migration: The importance of life
skills in early refugee resettlement. Journal of Occupational
Science, 20, 201-210.
Townsend, E. (1993). Muriel driver memorial lecture: Occupational
therapy’s social vision. Canadian Journal of Occupational
Therapy, 60, 174-184.
Townsend, E., & Wilcock, A. A. (2004). Occupational justice
and client-centred practice: A dialogue in progress. Canadian
Journal of Occupational Therapy, 71, 75-87.
Townsend, E., A. (2012). Boundaries and bridges to adult mental
health: Critical occupational and capabilities perspectives of
justice. Journal of Occupational Science, 19(1), 8-24.
VanLeit, B., Starrett, R., & Crowe, T. (2006). Occupational con-
cerns of women who are homeless and have children: An occu-
pational justice critique. Occupational Therapy in Health Care
20(3/4), 47-62. doi:10.1300/J003v20n03_04
van Niekerk, L. (2009). Participation in work: A source of well-
ness for people with psychiatric disability. Work: A Journal of
Prevention, Assessment & Rehabilitation, 32, 455-465.
Venkatapuram, S. (2012). Health justice: An argument from the
capabilities approach. Cambridge, UK: Polity Press.
Whiteford, G. (2000). Occupational deprivation: Global challenge
in the new millennium. The British Journal of Occupational
Therapy, 63, 200-204.
Whiteford, G., & Townsend, E. (2011). Participatory Occupational
Justice Framework (POJF): Enabling occupational participation
194 OTJR: Occupation, Participation and Health 36(4)
and inclusion. In F. Kronenberg, N. Pollard, & D. Sakellariou
(Eds.), Occupational therapy without borders: Volume 2:
Towards an ecology of occupation-based practices (pp. 65-84).
Toronto, Ontario, Canada: Elsevier Churchill Livingstone.
Whiteford, G. E., & Pereira, R. P. (2012). Occupation, inclusion
and participation. In G. E. Whiteford & C. Hocking (Eds.),
Occupational science: Society, inclusion & participation
(pp. 187-207). Hoboken, NJ: Blackwell Publishing.
Wilcock, A. A. (2006). An occupational perspective of health.
Thorofare, NJ: Slack Incorporated.
Wilcock, A. A. (1999). Reflections on doing, being and becoming.
Australian Occupational Therapy Journal, 46(1), 1-11.
Wilcock, A. A., & Townsend, E. (2000). Occupational terminol-
ogy interactive dialogue. Journal of Occupational Science, 7,
84-86.
Wilcock, A. A., & Townsend, E. (2014). Occupational justice. In
B. A. Boyt Shell, G. Gillen, & M. E. Scaffa (Eds.), Willard and
Spackman’s occupational therapy (pp. 541-552). Philadelphia,
PA: Lippincott Williams & Wilkins.
World Health Organization. (2001). International classification of
functioning, disability and health. Retrieved from http://www.
who.int/classifications/icf/en/
Yeung, P. H., Passmore, A. E., & Packer, T. L. (2008). Active citi-
zens or passive recipients: How Australian young adults with
cerebral palsy define citizenship. Journal of Intellectual &
Developmental Disability, 33, 65-75.
Zeldenryk, L., & Yalmambirra (2006). Viewpoint Occupational
deprivation: A consequence of Australia’s policy of assimi-
lation. Australian Occupational Therapy Journal, 53(1),
43-46.