Career: Research Faculty/PhD Student | University of Melbourne School of Medicine | Melbourne, Australia
The Understanding of Human Occupations: Implications for Public Health
Understanding human occupations is the cornerstone of Occupational Therapy (OT) and Occupational Science. The word occupation has been used in different contexts, with different meanings and applications. In the field of OT, the process of defining this concept has changed significantly over time and still continues to undergo theoretical development. Through empirical evidence and propositions made in different historical periods, OT has gained a quite distinct interpretation of occupation.
This understanding has allowed the profession to integrate different key elements into various models used clinically, and it has enabled the development of unique methods to measure and address occupations through the different life stages.
As Occupational Therapy approaches its centenary, it becomes more evident that occupations are crucial in human development, having a seminal role in shaping people’s psychology, motor, language, sensory and social skills. Developed countries, especially the ones who lead in research, on the issue have emphasized the importance the OT vision has on health programs.
For this reason, the presence of young OTs in schools, hospitals, and local health care departments has increased dramatically over the last two decades; these professionals are now not only integrated as a fundamental part of transdisciplinary teams, but they are also changing the dynamics through which major goals are achieved.
In recent years, as aging becomes one of the major public health challenges, OTs have been more and more involved with the treatment of clients who are experiencing decline of occupational performance, loss of friends, partners and work. In this context, being aware of what clients are confronting through evaluation is pivotal.
A clear example of how this plays out in public health is the constant progress being made in the area of cognitive evaluation. Deficits in cognition can be determinant in people’s occupations. Each year, more people are living with chronic deficits due to impairment in cognitive functions. In stroke, for example, mild deficits can generate serious complications, such as the loss of work, depression, and overall occupational disengagement. It has also been found that up to 49% of this population experiences what is known as mild stroke or transient ischemic attack, representing 200,000 to 500,000 new cases each year in the U.S. alone. These individuals present with symptoms that are extremely complex and diverse, though not clearly evident, often due to the condition being undiagnosed. Ironically, though, when studying these symptoms with the right measures, cognitive impairments are highly prevalent in these conditions, with up to 65% of this subgroup exhibiting some sort of cognitive dysfunction.
When considering this reality, a substantial number of people, not only stroke survivors, but others with different conditions, are living their lives with some degree of cognitive impairment. Evidence describing this condition can be found in investigations of people with brain injury, Alzheimer’s disease, spinal cord injury, Parkinson’s disease, psychiatric disorders, autism, multiple sclerosis, and cancer.
What is common and is of real concern about these groups from a public health and OT perspective is that they all present some degree of functional dependence, with negative effects in numerous activities of daily living, such as productivity, leisure, and social participation.
Because of the importance cognition plays in planning and carrying out everyday activities, researchers have put a high priority on improving the current evaluation methods for this area. Occupational therapists assess clients’ cognitive abilities in order to determine their capacity to perform the occupations that are important to them in a safe and efficient manner. Hence, knowing what cognitive components are affected will be decisive for the treatment approach and future performance.
By classifying and systemizing information, OT professionals have been able to find problems and work toward goals more efficiently. This is a core component of public health and epidemiology, and it is precisely the contribution OT can add to public health: understanding the nature of occupations and how occupational deficits can be measured, so that not only OTs but also other professionals are more successful at promoting activity, preserving health, functionality, and participation.