Historical and Philosophical Perspectives of Occupational Therapy's Role in Health Promotion

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SECTION I Foundations and Key Concepts

Chapter 1
Historical and Philosophical Perspectives

of Occupational Therapy’s Role in Health
Promotion
S. Maggie Reitz
In 1991, occupational therapy was identified as “the only health profession that had fully
embraced the concepts of: health promotion and prevention, community-based care and the
individual as centre to the process”
by Steven Lewis, former leader of the national New Democratic Party in Canada as part of his
remarks as the keynote speaker at the 1991 Canadian Association of Occupational Therapist
(CAOT) Conference (as cited by Green, Lertvilai, & Bribrieso 2001, ¶ 2).
Learning Objectives
This chapter is designed to enable the reader to:
• Articulate humans’ evolutionary, cross-cultural • Describe the historical roots, documents, and
use of occupations to promote healing and literature of occupational therapy’s role in health
prevent disease and disability. promotion and their potential use to support
• Discuss the historical development of occupa- and enhance current health promotion inter-
tional therapy as a caring health profession that ventions and innovative evidenced-based health
has emphasized prevention, health promotion, promotion practice.
and wellbeing since its inception.
K e y Te r m s
Client Moral treatment Shell shock
Disability prevention Prevention Wellness
Health promotion
Introduction perspective will enable the reader to link current

practice with philosophical tenets and historical
After a brief review of early historical views on heal- interventions and policies to establish a foundation
ing, health, and the use of occupations, this chapter for today’s health promotion interventions.
traces the profession’s roots in the philosophy and
delivery of preventive and health promotion services.
Official documents and activities within the American Historical and Cultural Views
Occupational Therapy Association (AOTA) related to
health promotion and prevention will be presented.
of Health and Healing
This review focuses on health-promotion activities Many cultures around the world have developed similar
within the United States as influenced by both beliefs regarding health, wellbeing, and occupational
domestic and international activities. This historical engagement. While historical reviews often focus on
1
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2 SECTION I Foundations and Key Concepts
Greek and Roman contributions, other civilizations

have contributed to the development and evolution of
the medical and healing arts. Travel and exploration, as
well as war, have facilitated the sharing of this knowl-
edge between cultures. Ancient beliefs have influenced
health-care practices through the years and continue to
inform current developments. Tai chi is an excellent
example of this type of continued impact. Being knowl-
edgeable about healing and health beliefs that span time
and cultures is important as the profession of occupa-
tional therapy seeks to provide culturally competent
care. The following brief review provides a glimpse into
humans’ rich history of engaging in healing and health-
promotion occupations.
Greek mythology provides an early view of the Greeks’
beliefs regarding health and healing. Asclepius, the son of
Apollo, was the god of medicine (Anderson, Anderson, &
Glanze, 1998). According to mythology, Asclepius was the
father of Panacea, the goddess of healing, and Hygeia, the
goddess of health (Lasker & The Committee on Medicine
and Public Health 1997). Hygeia is depicted with her
father in Figure 1-1. It is now believed the myth of Aescu-
lapius may have arisen as a result of the efforts of one
or more individuals with exceptional healing abilities.
Humans attributed divine status to those abilities and
the legendary Aesculapius was then worshipped through-
out the ancient Mediterranean area (National Library of
Medicine [NLM], 2004a).
Throughout human history, healers have been
afforded a special place in society. However, in some
societies those who practiced medicine were more Figure 1-1 Asclepius and Hygeia in allegorical setting.
highly respected than those interested in prevention and
Courtesy of the National Library of Medicine.
health promotion. This division between health promo-
tion and healing and the overshadowing of prevention
and maintenance by medicine was described by Plato
The dichotomy between healing and prevention
(Friedland, 1998, p. 374):
does not appear in early writings from Persia, China,
In the . . . therapeutic arts, the corrective portion is and India. According to early Islamic writings:
more apparent but less important, while the regulative
Medicine is a science from which one learns the states of
portion is largely hidden, but far more essential. . . .
the human body with respect to what is healthy and what
[Hence] there is grave danger lest “prevention” and
is not, in order to preserve good health when it exists and
“maintenance,” the real work of the art, be overlooked,
restore it when it is lacking. (Ibn Sina, the opening to the
and attention exclusively be devoted to the correction
Qanun fi al-tibb, cited by Savage-Smith, 1994)
of the diseases already there.
In the famous Chinese medical text Nei Chang
While this division was aptly described by Plato
(Canon of Medicine), which dates back to 2600 BC, the
in his world, a slightly different view was held by
Yellow Emperor, Yu Hsiung, describes both prevention
the indigenous people of the Americas. They had an
and treatment (Lyons & Petrucelli, 1987). The impor-
appreciation of the link between rubbish and illness
tance of balance and the connection of humans to
and believed prevention was of great value. The
the physical and spiritual world were at the center of
medicine of the South American Indian primarily
Chinese healing and prevention activities “in the last
focused on hygiene, “as such medicine ought to be,
three centuries B.C.” (Sivin, 1995, p. 5):
it being of greater daily importance to preserve
health than to cure disease” (Spruce as cited by Since ancient times [it has been understood that] pen-
Vogel, 1970, p. 261). etration by [the ch’i of] heaven is the basis of life,
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Chapter 1 Historical and Philosophical Perspectives of Occupational Therapy’s Role in Health Promotion 3
which depends on [the universal ch’i of] yin and yang. This historical review of examples supports the con-
The ch’i [of everything] in the midst of heaven and tinued development and evolution of health promotion
earth and in the six directions, from the nine provinces as well as the need to study the effectiveness of blend-
and nine body orifices to the five visceral systems and ing preventive care with medical and rehabilitative
the twelve joints, is penetrated by the ch’i of heaven. approaches. Knowledge of history also helps practi-
(Huang-ti nei ching t’ai su, cited by Sivin, 1995, p. 15) tioners better understand potential areas of tension
The Chinese people and government are proud of between disciplines, as well as cultural differences in
their historical contributions to medicine and health. approaches to health and wellbeing.
According to the Wudang Taoist Internal Alchemy
(2005), recent additions to a famous temple complex
that dates back to AD 140 include sculptures represent- Historical Use of Occupation
ing historical figures in Chinese medicine (Fig. 1-2). to Heal and Promote Wellbeing
Further evidence of the importance of understanding
The historical actions, beliefs, and practices of humans
and offering acute and preventive care is found in
through the ages also provide an important backdrop
examining long-held practices in India. Ayurveda, the
from which to view the potential to enhance health and
science of life, originated in India about 5000 BC and
wellbeing through engagement in occupation. The use
was later documented by Charak:
of occupation to promote health and wellbeing through
Ayurveda has been reported as one of the oldest sys- prevention of disease, injury, and social injustice has
tems of health care dealing with both the preventive and been substantially documented. Examining lessons
curative aspects of life in a most comprehensive way from the past is time well spent when crafting solutions
and presents a close similarity to the WHO’s [World for the present, since “we cannot accurately and profes-
Health Organization] concept of health propounded in sionally comprehend the present or look at the future
the modern era. (Department of Ayurveda, 2004, ¶ 1). intelligently until we become acquainted with and study
the past” (Stattel, 1977, p. 650). Content Box 1-1 out-
lines other benefits of knowing the history of one’s
Content Box 1-1
Practical Benefits of an Awareness

of Historical Influences on the
Practice of Occupational Therapy
in Health Promotion
• Supports the role of occupational therapy in health
promotion through the realization that foundational
philosophical beliefs and principles can be traced
to the early 1900s.
• Enhances awareness of the unique history of
occupation-based interventions for prevention
and health promotion, which increases the com-
fort level of occupational therapists and occupa-
tional therapy assistants in this role.
• Encourages the examination of the historical
influence of sociopolitical factors on the evolution
of the profession and its ongoing contributions to
provide solutions to societal problems.
• Strengthens society’s view of occupational thera-
pists as educated professionals through demonstra-
tion of an appreciation and synthesis of the liberal
arts aspect of occupational therapy education.
• Fosters competence to facilitate interdisciplinary
Figure 1-2 Sculpture of ancient Chinese physicians from the
Taiqing Temple Complex, Laoshan Mountain, People’s Republic cooperation and respect via increased ability to
of China. articulate an understanding of the rich traditions
of occupation-based service delivery.
Photography by S. Maggie Reitz.
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profession and the political and sociocultural influences European colonists, this society understood the impor-
on that history through time. tance of a lifestyle that balanced the needs of the
History provides a rich description of humans’ engage- human and nonhuman worlds. This lifestyle included a
ment in occupation for subsistence, self-expression, heal- respect for earth, animals, and humans as well as a
ing, and aesthetics (AOTA, 1979d; MacDonald, 1976; deep sense of responsibility for self and others. Ancient
Pizzi, Scaffa, & Reitz 2006). Through the ages, many sacred sites, often including cave paintings and rock
cultures have used occupations to promote healing. A engravings, represent beliefs regarding origin, attach-
variety of early philosopher-scientists as well as healers ment to the land, and personal and group identity
in Egypt, Rome, Greece, and Persia promoted the use of (Barunga, 1975; Edwards, 1975; Peterson, 1975). The
occupation as a healing agent. Pythagoras and Thales, aboriginal view of social responsibility encompassed
both early Greek philosopher-scientists, used music as a the health and welfare of humans and animals in both
treatment modality (MacDonald, 1976), as did Ibn Sina, the present and the future. The active process of aborig-
a Persian physician, known in the west as Avicenna inal “Dreaming” embodies values such as prudence
(Ahmed, 1990; Licht, 1948). Aristotle, the pupil of Plato, and social responsibility, which were practiced through
viewed praxis or “desirable and satisfying activity or spiritual, learning, and teaching occupations:
action” as leading to eudaimonia, the “well-being of the
Dreaming is the tracks you are responsible for. You
soul” (Friedland, 1998, p. 374).
grow up, then you have to maintain it spiritually. You’ve
Physical occupations were often prescribed. The
got to maintain it through not over-using it; you’ve got
Egyptians recommended physical activity and boat
to do ceremonies for the different animals; you’ve got to
trips on the Nile (Punwar, 2000) as well as music and
do ceremonies for human beings; and as you grow
games (Dunton, 1954). The Chinese prescribed exer-
and as you get older you learn your responsibilities to
cise to restore wellbeing (Lyons & Petrucelli, 1987)
that area. As you grow older still, and as you marry
and promote health (Levin, 1937). Gymnastics were
into different families, to take on the responsibility of
described by Zhuangzi in fourth-century BC China as a
other people, and as your children have children you
preventive technique to ensure successful aging and
take on the responsibilities of other Dreamings—their
longevity and became “well established as a form of
Dreamings, the children’s Dreamings, which might go
therapy around the third and second centuries B.C.”
on a different way from yours. (Bowden & Bunbury,
(Despeux, 1989, p. 241). Hippocrates recommended
1990, p. 33)
other physically challenging occupations, such as
wrestling and riding that required linking the mind and Dreaming is consistent with the aboriginal descrip-
body during treatment (MacDonald, 1976). tion of knowledge as the true aboriginal currency and
In addition to the use of occupations, early public the belief that learning is a lifelong process (Bowden &
health actions and the importance of occupational bal- Bunbury, 1990). To learn more about the ancient and
ance were appreciated as being linked to health and modern culture of the Australian aboriginal people,
wellbeing. Hippocrates encouraged physicians to con- including symbolism in aboriginal art (see Fig. 1-3),
sider the influence of air and water quality in a specific visit http://www.aboriginalart.com.au.
geographical area as well as the occupations of the Indigenous people of North America share this
population—both healthy and unhealthy. He encour- appreciation for nature, the land, and a desire to live in
aged an examination of “the mode of life of the inhab- harmony with the physical world (Kavasch & Baar,
itants, whether they were heavy drinkers, taking lunch, 1999; National Museum of American Indians [NMAI],
and inactive, or athletic, industrious, eating much, and 2005). They also have long shared a belief in the con-
drinking” (cited by Lasker & the Committee on Medi- nection of dreams, visions, and rituals to health
cine and Public Health, 1997, p. 12). Pythagoras was (Kavasch & Baar, 1999). Some healing practices have
thought to have “promoted health through a special involved occupations such as music, drumming, and,
vegetarian diet” (NLM, 2004b, ¶ 1). Other historical for the Navajo, sand painting. However, sand painting
figures were proponents of a balanced lifestyle, includ- that can now be purchased as art is not the same in
ing the 13th-century Byzantine writer Actuarius, also either form or function as the sand painting that is cre-
known as John the Actuary (Licht, 1948). In addition, ated for healing purposes. Physically active occupa-
in the fifth century, a neurologist named Caelius Aure- tions such as endurance games and footraces were
lianus encouraged patients to become involved in their believed to enhance the power of other healing prac-
rehabilitation efforts (MacDonald, 1976). tices (Kavasch & Baar, 1999).
Australian aborigines have long recognized the The Wampanoag Indians have lived in eastern
interdependence of human health and welfare with that Massachusetts and the surrounding islands for over
of the land (Chambers, 2002). Prior to the arrival of 12,000 years (Kavasch & Baar, 1999). This group
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Emu
W
itc
h et
Digging stick ty
gr
na
u b
an
Go
C
up of people
oo
Gro
lam
rs
o
a
n
ce
Spe
Sit
Pla e
Honey ant
Child
Adult
garoo
“7”
ra
Kan
wir
me
lki
oo
W
ns
i
si
Boomerang
ra
h
B us
Bu
sh
pl u m
Figure 1-3 Dreamtime symbols used in aboriginal art.

Courtesy of Aboriginal Australia Art & Culture Centre, http://www.aboriginalart.com.au/site_map.html.
shared food-gathering and cultivation knowledge with Bernardino Ramazzini, an 18th-century Italian phy-
the Pilgrims, thus helping the Pilgrims survive. For sician (NLM, 2005) and a professor at Padua, “stressed
several hundred years, this group has played Wamp- the importance of prevention rather than treatment”
anoag Fireball, a dangerous medicine game that resem- (MacDonald, 1976, p. 5). These early proponents of
bles soccer with a flaming ball. In this game, men— occupation, the importance of client-centered care, and
usually young men—channel their strength to enhance the influence of context planted seeds that would later
the healing of a friend or a loved one. The passion and take root in the era of moral treatment and the philosophy
energy expended and the wounds sustained in this of the new discipline of occupational therapy.
game are believed to minimize the impact of one’s
illness (Kavasch & Baar, 1999).
Other early medical writers and educators consid- Select Historical Milestones in
ered less dangerous occupations to be useful for both Health Promotion and Prevention
the maintenance of health and illness prevention.
Cornelius Celsus, who lived from 25 BC to AD 50 Within Occupational Therapy
(University of Texas Medical Branch, 2005), encour- in the United States
aged the use of occupations such as “sailing, hunting,
handling of arms, ball games, running, and walking” to The Birth of the Profession
maintain health (MacDonald, 1976, p. 4). He also The era of moral treatment established the foundat-
encouraged matching occupations to the needs and ion of ideas that would later be embraced by the
temperament of each person. founders of occupational therapy. Moral treatment is
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a “nineteenth-century humanitarian approach to treat- performing self-inoculation through occupation. The case
ment for individuals with mental illness that centered of Barton, one of the founders of occupational therapy in
around productive, creative, and recreational occupa- the United States, is perhaps the most familiar example
tions” (Spear & Crepeau, 2003, p. 1031; the history of for occupational therapy practitioners. Isabel Newton,
this approach is discussed in more detail in Chapter 4, also a founder of occupational therapy in the United
which addresses public health). The beliefs and suc- States (Licht, 1967; Neuhas, 1968) and who later
cesses of moral treatment were compatible with the became Barton’s wife, described Barton’s use of occupa-
visions and optimism of the leaders of various social tion to heal his paralysis. Physicians were so impressed
reform movements in the United States and became the with his results that referrals soon followed (Peloquin,
catalyst for the profession’s development in the early 1991a). Beers, who was hospitalized in several mental
1900s. Educational reformers, mental hygienists, and institutions over a 5-year period at the beginning of the
leaders in the arts-and-crafts movement shared a phi- 20th century, credits his self-selected engagement in the
losophy stressing the importance and meaning of work occupations of drawing, writing, and reading as con-
and occupation and the resultant potential impact on tributing to his recovery (Peloquin, 1991a). Dunton
learning and health (Breines, 1986). Harold Bell believed patients such as Barton and Beers, who success-
Wright eloquently described the importance of occupa- fully used occupations to aid in their recovery, should be
tion by stating, “Occupation is the very life of life” acknowledged as contributing to the development of the
(cited by Dunton, 1915, title page). profession (Dunton, 1915; Peloquin, 1991a).
These ideas and values have supported occupa- Sir Winston Churchill, prime minister of Great
tional therapy practitioners’ engagement in health Britain during World War II, began painting at the age
promotion activities through the years, both with of 40, providing another example of self-inoculation:
individuals and with populations. Those committed to
Winston found hours of pleasure and occupation in
the arts-and-crafts movement “saw activity as a means
painting—where problems of perspective and colour,
to improve society—‘to socialize less accepted mem-
light and shade, gave him respite from dark worries,
bers of society such as the disabled, mentally ill,
heavy burdens, and the clatter of political strife. And
impoverished’ ” (Schemm, 1964, p. 639, as cited by
I believe this compelling occupation played a part in
Friedland, 1998, p. 375). While occupation was pre-
renewing the source of the great inner strength that
scribed to ill individuals, the power of occupation
was his, enabling him to confront storms, ride out
to promote the overall wellbeing of society was also
depression, and rise above the rough passages of his
recognized early in the profession’s development:
political life. (Mary Soames, Winston Churchill’s
“Although they spoke of occupation as curative, it was
daughter, Foreword, 2002, pp. vii–viii)
not in relation to medical or psychiatric conditions but
rather to the human condition” and to use it as a tool Pursuing a variety of occupations provided balance
to maximize human potential for the good of society and perspective to his complex life of military, politi-
(Friedland, 1998, p. 375). cal, and public service. Churchill’s leadership during
In addition to those who advocated occupation to World War II was instrumental in preventing the inva-
address societal problems, others wrote about the sion of Britain and the expansion of Hitler’s Germany,
preventive qualities of occupation. Dunton proposed which were critical in turning the tide of the war. In
that occupation could be used as a preventive agent: recognition of his efforts, Churchill received honorary
“Another purpose of occupation may be to give the U.S. citizenship (Frenz, 1969) and was identified as
patient a hobby which may serve as a safety valve and one of the 100 most important people of the century
render the recurrence of an attack less likely” (Dunton, (Keegan, 2003). He also received a Nobel Prize for
1915, p. 25). In addition, Dunton also believed that Literature (British Broadcasting Corporation [BBC],
occupation could be a powerful tool for well individu- 2005; Frenz, 1969). An excellent resource summariz-
als, and his work supports the profession’s use of occu- ing his contributions is listed in the table of website
pation for health maintenance (Peloquin, 1991b). resources at the end of this chapter.
Self-Inoculation Through Occupation The Military and the Use of Occupation
MacDonald noted that “the occupational therapist of Military leaders have long recognized the benefits
early history was the ‘doctor’ himself” (1976, p. 2). of using occupation to improve their armies. These
However, through time, it appears that individuals and occupations primarily included physical activities for
communities have self-prescribed occupation both to conditioning and prevention of injury (Kavasch &
heal and prevent illness. Sir Winston Churchill, Clifford Baar, 1999; Levin, 1937) and included entertainment
Beers, and George Barton are examples of individuals to prevent boredom and maintain morale such as has
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been provided by the United Service Organizations deafening sound of shells and grenades exploding. Later
[USO] since 1941 (USO, 2005). it was understood that the symptoms were caused by the
However, occupation does not appear to have been horrific living conditions endured during trench warfare,
used for rehabilitation of soldiers until World Wars which included spending weeks at a time in rat-infested,
I and II. Rehabilitation is not primary prevention; it corpse-laden, and flooded trenches. These conditions are
falls under the categories of secondary and tertiary pre- detailed in an exhibit at the NLM (2004c).
vention. The rehabilitation efforts described below In 1918, Dunton became president of the National
were aimed at the individual needs of soldiers but were Society for the Promotion of Occupational Therapy at
also part of a broader societal intervention through gov- the group’s second annual meeting. At that meeting, he
ernmental policy and programs, which can be consid- shared the Europeans’ success in using occupation to
ered a form of population-based health promotion. treat shell shock and stressed the need for the United
“During World War I, it was found in Germany, States to prepare well-trained occupational workers
France, and England that much could be done to recon- for the eventual war effort (Peloquin, 1991b). Within
dition the wounded by means of occupation” (Dunton, months, the United States entered World War I, and
1954, p. 5). Early in World War I, before the United recruitment and education for reconstruction aids began
States entered the conflict, leaders in countries already (Dunton, 1954; Peloquin, 1991b; Willard & Cox, 1979).
involved were concerned about the prospect of large Recovering soldiers in World Wars I and II received
numbers of wounded and their need for rehabilitation instructions in basket weaving, woodwork, and other
(Willard & Cox, 1979). The previous system of pension- occupations to facilitate their recovery from physical in-
ing injured veterans for life was not going to be econom- juries and from psychosocial dysfunction caused by the
ically feasible. Thus, there was great interest in ensuring horrors of war (McDaniel, 1968). Figures 1-4 and 1-5
the self-sufficiency of these soldiers (Christensen, 1991). show examples of occupational therapy workshops in a
At the onset of World War I, British physicians began U.S. Army hospital in France during World War I.
to see a cluster of symptoms that became known as shell The exhibit at the NLM mentioned earlier traces
shock. These symptoms included “partial paralysis, shell shock from World War I to the Vietnam War,
convulsive movements, blindness, terrifying dreams when the syndrome was “labeled Post-Traumatic
and flashbacks, and amnesia” (NLM, 2004c, ¶ 1). At Stress Disorder, a disorder now recognized by the
first, these symptoms were blamed on exposure to the American Psychiatric Association” (NLM, 2004c).
Figure 1-4 Service

provision at U.S. Army
Base Hospital No. 9,
Chateauroux, France.
Courtesy of the National Library
of Medicine (A02826).
1193_Ch01_001-021.qxd 6/8/09 5:30 PM Page 8
Figure 1-5 Base Hospital

No. 9. Chateauroux, France,
woodwork.
Courtesy of National Library of
Medicine Collection. Appears as
Figure 24 in “Occupational
therapists before World War II
(1917–40)” by M. L. McDaniel
in Army Medical Specialist
Corps (pp. 69–97). Washington,
DC: Office of Surgeon General,
Department of the Army.
As often happens, knowledge gained in war can later and “experimental projects were carried out in the
be used to favorably affect the health and wellbeing of quest for new occupations to be offered to incapaci-
nonmilitary populations. tated individuals” (Barton, 1968, p. 342). An example
of one of the many “experiments” conducted in the gar-
Early Community and Prevention Practice den area was growing calabash with the expectation
Barton’s establishment of Consolation House in 1914 is that patients could turn them into pipes. The philoso-
the earliest example of community-based occupational phy of George Barton and Consolation House can best
therapy practice within the United States (Scaffa, 2001; be expressed through his words:
Scaffa & Brownson, 2005). The doors of Consolation
I am going to raise the cry that it is time for humanity
House opened on March 7, 1914, after extensive alter-
to cease regarding the hospital as a door closing upon
ations. In an article commemorating AOTA’s 50th anniver-
a life which is past, and to regard it henceforth as a
sary, Barton’s wife, Isabel, described the alterations and
door opening upon a life which is to come. I do not
the dedication of the Consolation House (Barton, 1968).
mean heaven. I mean a job, as better job, or a job done
The alterations included a 6-foot tub, which Barton
better than it was before. (Barton, 1968, pp. 342–43)
installed against the advice of the plumber. After many
months at a sanatorium, Barton desired the opportunity Consolation House was the model for the present-day
to “stretch out” while bathing. The parlor of the house University of Southern California (USC), Department of
was turned into an office that housed books related to Occupational Science and Occupational Therapy’s Cen-
occupational therapy as well as a glass case exhibiting ter for Occupation and Lifestyle Redesign (Gourley,
patients’ craft work. The décor of Consolation House 2000; Krieger, 2001). The center was established in
was heavily influenced by the arts-and-crafts movement 1999 (USC, 2004) in a renovated 1894 Victorian man-
of the early 1900s (Krieger, 2001). sion (Krieger, 2001) and is used for community-based
The first floor of an old red barn on the property was practice, education, and research. Workshops modeled
converted into a workshop, and the second floor after Barton’s program and the Hull House’s work with
became a studio. Barton acquired a vacant lot adjacent immigrants are geared primarily for the local Latino
to the house and subdivided it into three sections: a community (Krieger, 2001).
vegetable garden, a grass lawn, and an area containing In the United States, occupational therapy’s early
flowering shrubbery and a hammock. The house pro- work in prevention focused on the prevention of infec-
vided tools for engaging in a variety of occupations, tious disease such as tuberculosis (TB). Diaz (1932)
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described her efforts to organize a preventorium in advantage of being in the community as an opportunity
Puerto Rico for children of parents with TB, with the to minimize adverse health conditions and prevent
goal of decreasing the children’s risk of contracting the future illness in other family or community members,
disease. The board of directors of an association to pre- thereby joining the public health team.
vent TB among children contacted Diaz to organize The use of occupation to promote normal develop-
a new facility to house and care for 50 children ment was also recognized early in the profession’s evo-
between the ages of 2 and 10. Diaz performed a variety lution. Manual, recreational, and musical occupations
of administrative functions, including the development were recommended for use with children in the 1940s:
of a daily regimen of habit training and occupations
Activities used with children should be chosen primar-
that included “marching, sun-baths, singing, folk danc-
ily for their therapeutic value, but at the same time the
ing, rest in bed, story telling, calisthenics, outdoor
possibilities for a normal development of the child
games, daily prayers, personal habits . . . academic
should be considered and activities of positive value
classes, and some craft work” (Diaz, 1932, p. 200).
should be chosen to encourage this development.
Within a 1-year period, the progress of the children was
(Gleave, 1954, p. 163)
reported as “remarkable. They entered the institution in
very bad condition: undernourished, unhealthy, and
with little or no discipline. They were returned quite Visionary Leaders and Modern Milestones
different” (Diaz, 1932, p. 201). in Health Promotion
Shaffer, a psychologist, presented a paper at the 21st Occupation was also seen as a preventive tool for the
annual meeting of the AOTA on recreation for preven- hospitalized patient. Fay and Kellogg (1954) described
tion and therapy for social maladjustments. He argued one of the roles of occupational therapy as “the pre-
that access to healthy play would facilitate children’s vention of the establishment of invalid habits by giving
development and prevent criminal habits and mental opportunity for establishing or maintaining good
illness. He was concerned about the then-current prac- work habits.” The benefits of engaging occupational
tice of sheltering children from vigorous activity. Play, therapy were identified as improvement in circulation,
he believed, “properly engaged in, is habit training for decrease in fatigue, “good sleep, good appetite, and
the more serious problems of adult living” (Shaffer, good posture” (p. 118).
1938, p. 98). Team play was also viewed as beneficial, Although these were important efforts, they were
with the child learning how to “subordinate his desires falling short of the full potential that the profession
to the common good and to develop loyalty to a of occupational therapy had to offer. This was readily
purpose or a task undertaken. Thus he is learning apparent to visionaries such as Wiemer. Wiemer repeat-
the important secrets of a good adjustment to life” edly stressed her concern (1972) that the profession was
(Shaffer, 1938, p. 98). viewing its role in prevention in a too limited, “elemen-
Prevention was mentioned intermittently in the tary” manner and that the description of the role appeared
literature in the 1940s both within Canada and the to be mere technical responses rather than professional-
United States. Dr. Howland, the first president of level problem-solving. Wiemer encouraged the profession
the Canadian Association of Occupational Therapists, to expand efforts across the preventive-health continuum.
identified prevention as one of five forms of occupa- Figure 1-6 displays Wiemer’s Preventive Health Contin-
tional therapy (Friedland, 1998). In 1947, the director uum functions matched to the three levels of prevention—
of the Philadelphia Committee for the Prevention of primary, secondary, and tertiary.
Blindness discussed the need for interdisciplinary col- In Wiemer’s view, the appropriate role of occupa-
laboration to prevent blindness through combating its tional therapy should encompass
three primary causes: venereal disease, now referred to
the clear exercise of that expertise unique to occupational
as sexually transmitted infection; glaucoma; and acci-
therapy, needed by society, and unavailable from other
dents (Carpenter, 1947). Carpenter believed occupa-
sources, exerting all components of occupational ther-
tional therapists, due to their interactions with families,
apy’s armamentarium impinging upon prevention rather
had a key role in the early screening of visual problems
than selected options from it, with imaginative action to
in children and their parents (Reitz, 1992). Specifically,
supplement and complement efforts of other disciplines
occupational therapists were encouraged to look for
[italics are original author’s]. (Wiemer, 1972, p. 5)
and intervene when symptoms of congenital syphilis or
ineffective home remedies for injured eyes were pre- Wiemer also noted that this role would require a
sent, or if they heard reports of family members or change in philosophy. Occupational therapists would
neighbors seeing colored rings around lights at night. need to broaden their perspective regarding who they
Occupational therapists were also encouraged to take were responsible for—switching their focus from
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assuming responsibility for patients treated to persons Also in the 1980s, articles appeared in the occupa-
they do not treat (Wiemer, 1972). This statement also tional therapy literature regarding the potential role of
holds true for current practice, as the profession largely occupational therapy in workplace injury prevention.
remains reimbursement driven. The profession has Allen (1986) reviewed two programs addressing the
renewed its commitment to improve the health and impact of repetitive work injury on workers and
wellbeing of society, which will be demonstrated employers. The first was a seven-session program deliv-
through examples and discussions of official docu- ered to bank employees and consisting of recommen-
ments in the next section of this chapter. dations to modify the work environment and work
The 1980s saw the publication of numerous articles habits for efficiency and effectiveness. The second was
regarding prevention and health promotion. The director a luncheon lecture program for university employees
of AOTA’s Practice Division presented current trends that and addressed “modifying life-style, posture, equip-
were impacting the practice of the profession. Woven ment, desk arrangement, and work organization”
through this discussion was support for the prediction (Allen, 1986, p. 766).
that “wellness and prevention concepts will become Schwartz (1989) described the role of occupational
increasingly accepted for philosophical and economical therapy in industrial accident and injury prevention.
reasons” (Bair, 1982, p. 704). Articles describing pro- Many areas of expertise required for competence in this
gram outcome studies were published, providing data for role were identified, including knowledge of the business
evidence-based practice and ideas for future research. world (i.e., labor relations, corporate and industrial man-
Two of these studies were conducted with children— agement, economics), biological science (i.e., neuro-
one with preschoolers in the United States (George, sciences, kinesiology, pathology), social science, and
Braun, & Walker, 1982) and one with infants in Israel education. Schwartz predicted “an explosive demand for
(Parush, Lapidot, Edelstein, & Tamir, 1987). Both studies prevention services. Whether called ‘wellness, risk man-
concluded that structured occupation-based programs agement, and cost containment,’ or something else, it is
developed by occupational therapists can enhance the going to become economically and legally imperative
development of age-appropriate skills. In addition, a that employees act to prevent accidents and injuries”
study was conducted with healthy older adults to deter- (1989, p. 6). This prediction was partially realized within
mine the effectiveness of occupational therapy interven- the following decade, as the author increasingly saw
tion on self-care independence and quality of life retail employees wearing protective gear, though often
(Kirchman, Reichenbach, & Giambalvo, 1982). Results incorrectly and inconsistently.
suggest that the intervention had a positive impact on The AOTA’s backpack awareness campaign (AOTA,
social resources, life satisfaction, and general affect. 2004; Gourley, 2001a, 2001b) is another example of
Prevention/Health Promotion
Primary Prevention Secondary Prevention Tertiary Prevention
Promotion Protection Identification Correction Accommodation
Education in Interception Locating illness, Treatment of Adaptation of

support of of agents and preventing illness and person with illness
good health conditions advancement disability • Changing
• Health • Isolation of disease • Treatment and environment
education • Immunization • Multiphasic rehabilitation • Altering
• Eradication of • Accident screening of acute, customs
taboos and prevention • Consultancy chronic, or • Interpreting
cultural habits evaluations degenerative medical facts
• Training in • Physical exams disease • Counseling
hygiene and • Diagnostic families
activities to workups
promote health
Figure 1-6 Wiemer’s Preventive Health Continuum matched to the three levels of prevention.
Developed from Wiemer (1972), by Reitz (1984, 2004) with permission.
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occupational therapy’s potential for preventing injury. Official Documents and Activities
These preventive initiatives demonstrate the potential
for occupational therapy to be involved in primary pre- of AOTA Related to Health
vention at the level of the individual, the classroom, or Promotion and Prevention
the educational institution.
In the late 1990s, Wilcock and Townsend, as was Examples of practitioners’ use of occupation in
earlier the case for Wiemer, articulated a vision for community-based practice and prevention from the
occupational therapy to contribute to the health and profession’s inception through the mid-20th century in
wellbeing at a societal level (Townsend, 1999; Wilcock, the United States were provided above. The ability of
1998; Wilcock & Townsend, 2000). In 2000, Wilcock humans to maximize their health through engagement
described the impact of occupational science on her in occupations was discussed repeatedly in the litera-
philosophy and work (Wilcock, 2000). The interna- ture during this time period (Brunyate, 1967; Finn,
tional team of Townsend and Wilcock introduced the 1972, 1977; Jaffe, 1986; Johnson, 1986a, 1986b; Reilly,
constructs of occupational justice, occupational injus- 1962; West, 1967, 1969; Wiemer, 1972), including in
tice, and other terminology to provide a language for several Eleanor Clarke Slagle lectures (Table 1-1). The
occupational therapy assistants and occupational thera- discussion will now turn to an examination of official
pists to use as they examined broader societal and AOTA documents and activities, including the vision-
global issues through the lens of occupation. These ary leadership of Brunyate (née Wiemer) and others. A
ideas are introduced and defined in the context of pop- timeline of these key events appears in Table 1-2.
ulation health in Chapter 6 and are also addressed dur-
ing a discussion of occupational justice in Chapter 8. Report of the Task Force on Social Issues
Toward the end of the 1990s, a milestone in the pro- In the 1970s, the AOTA established a task force “to iden-
fession’s history was reached with the publication of tify major changes occurring within the social system
the USC Well Elderly Study in the prestigious Journal and the health care systems in order to evaluate the
of the American Medical Association (Clark et al., directions and contributions of occupational therapy”
1997). This study investigated the effectiveness of the (AOTA, 1972, p. 332). Ten trends (shown in Content
USC Well Elderly program. Results indicated that Box 1-3) were identified as possible influencing factors
“preventive occupational therapy greatly enhances the on changes in health care in the next decade. Two of
health and quality of life of independent-living adults. these trends included
This landmark study reaffirmed foundational principles
of occupational science and occupational therapy” 1. national health insurance and legislation, and
(Mandel, Jackson, Nelson, & Clark, 1999, p. xi). The 2. new attitudes toward health care.
program was based on fundamental beliefs of the occu- Echoing Plato, the task force stressed that preventive
pational therapy profession (see Content Box 1-2) as approaches were as necessary as medical approaches.
well as theoretical perspectives from the academic The task force also described alternatives for the future of
discipline of occupational science. A complete descrip- occupational therapy. Occupational therapy services
tion is available through an AOTA publication (Mandel were described using the five functions identified in
et al., 1999). Wiemer’s (1972) preventive health care continuum (i.e.,
promotion, protection, identification, correction, and
accommodation).
Content Box 1-2 In 1979, Wiemer criticized the simplistic nature
of the services described in the task force report,
Core Ideas From Occupational Ther- believing they fell short of the true potential of occu-
apy That Framed Lifestyle Redesign pational therapy:
• Occupation is life itself.
• Occupation can create new visions of possible My prior plea for attention to occupation regrettably
selves. resulted in action tangential to my point. In quoting my
• Occupation has a curative effect on physical and thoughts, the Task Force on Social Issues suggested:
mental health and on a sense of order and routine. “for example,
• Occupation has a place in prevention. a. One of the highest accident rates occur in the home,
From Lifestyle redesign: Implementing the well elderly study (p. 13) by therefore occupational therapists might participate
D. R. Mandel, J. M. Jackson, R. Zemke, L. Nelson, & F. A. Clark, in public education programs to help people become
1999, Bethesda, MD: American Occupational Therapy Association.
With permission. Copyright © 1999 by American Occupational
aware of the dangers of slippery rugs, slippery
Therapy Association. floors, and other hazards.
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Table 1–1 Eleanor Clarke Slagle Lectures With Health Promotion Themes and Constructs
Year Lecturer Title Themes
1961 Mary Reilly Occupational Therapy Can Be Humans can impact their own health and wellbe-
One of the Greatest Ideas of ing through engagement in meaningful occupations.
20th-Century Medicine
1967 Wilma L. West Professional Responsibility The role of current occupational therapy should
in Time of Change be broadened from the medical model by prepar-
ing practitioners to serve society by being health
agents.
1969 Lela A. Llorens Facilitating Growth & Occupational therapy can promote healthy growth
Development: and development.
The Promise of Occupational
Therapy
1971 Geraldine L. Finn The Occupational Therapist The need for and issues that must be addressed
in Prevention Programs to develop occupational therapy’s role in preven-
tion programs.
1972 Jerry A. Johnson Occupational Therapy: Occupation can be used to impact individual and
A Model for the Future society’s need for health. Profession needs to
predict changes in society so its practitioners can
be prepared to make contributions to the ever-
changing world.
1980 Carolyn Manville Occupational Therapists Practitioners need to be prepared to enter different
Baum Put Care in the Health arenas in health care, other than acute care.
System Examples include public health, hospital-based
community outreach, and embedding prevention
within curative programs.
1984 Elnora M. Gilfoyle Transformation of a A paradigm shift is occurring with the society and
Profession the profession. The profession needs to continue
to decrease its reliance on the patriarchal medical
model and develop its potential to impact the
wellbeing of individuals and society.
1990 Susan B. Fine Resilience and Human Occupation can be used as a tool to facilitate
Adaptability: Who Rises resilience and wellbeing in the face of traumatic
Above Adversity? life events.
1994 Ann P. Grady Building Inclusive Community: Promoting inclusion in communities of choice for
A Challenge for Occupational individuals at the local and global level promotes
Therapy adaptation, participation, and wellbeing for indi-
viduals with and without disabilities.
1996 David L. Nelson Why the Profession of Engaging in meaningful occupation can promote
Occupational Therapy health and quality of life.
Will Flourish in the
21st Century
2004 Ruth Zemke Time, Space, and the Importance of temporal rhythms, and their
Kaleidoscopes of Occupation interactions with space, place, and culture to
human health.
2006 Betty R. Hasselkus The World of Everyday Engagement in everyday occupations can promote
Occupation: Real People, health and wellbeing. The detrimental impact
Real Lives of limits to occupational engagement.
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Table 1–2 Selection of Key Highlights in AOTA’s Historical Involvement in Health Promotion
and Disease Prevention
Year Event Reference
1915 Dunton proposes that occupation can be a preventative agent. (Dunton, 1915)
1932 American Journal of Occupational Therapy (AJOT) publishes (Diaz, 1932)
an article titled “Organizing a Preventorium for Children.”
1947 AJOT publishes an article on prevention of blindness. (Carpenter, 1947)
1961 Reilly proposes that humans can impact their health through (Reilly, 1962, p. 1)
occupation: “Man, through the use of his hands as they are
energized by mind and will, can influence the state of his
own health.”
1968 Revised AOTA definition includes the phrase “to promote (Willard & Spackman, 1971, p. 1)
and maintain health, to prevent disability.”
1972 AOTA Task Force established “to delineate a model of practice (Jaffe, 1986, p. 11)
for prevention and health maintenance programs.”
1977 AOTA Representative Assembly (RA) passed Resolution (Jaffe, 1986)
No. 521-77, Preventive Health Care Services.
1978 AOTA RA approved “the Philosophical Base of Occupational (AOTA, 1979c, p. 785)
Therapy,” which included the phrase (occupation) “may be
used to prevent and mediate dysfunction.”
1978 AOTA RA convened a special session; the result was the (AOTA, 1979b)
monograph Occupational Therapy 2001: AD.
1986 First AJOT special issue on health promotion. (AOTA, 1986)
1988 AOTA appoints first health promotion/wellness program (A. Morris, personal communication,
manager. July 1989)
1989 AOTA RA approved the position paper “Occupational Therapy (AOTA, 1989a)
in the Promotion of Health and Prevention of Disease
and Disability.”
1989 AOTA representatives participate in the meeting of the U.S. (AOTA, 1989b)
“Year 2000 Health Objectives Consortium.”
2000 AOTA RA approved “Occupational Therapy in the Promotion (Brownson Scaffa, 2001)
of Health and the Prevention of Disease and Disability.”
2007 AOTA RA approved AOTA’s Statement on Stress and Stress (Stallings-Sahler, 2007)
Disorders.
2007 AOTA RA approved “Occupational Therapy Services in the (Scaffa et al., 2008)
Promotion of Health and the Prevention of Disease and
Disability.”
Modified from The historical and philosophical bases for occupational therapy’s role in health promotion, presentation by S. M.
Reitz at the 10th International Congress of the World Federation of Occupational Therapists, Melbourne, Australia, April 3, 1990.
b. Adolescents have a high accident rate, and parents various types of occupation, or lack of it, and the fact of
and adolescents might be warned of the dangers of the fall or driving accident; facts indicating, for exam-
permitting or encouraging adolescents to drive high ple, the relationship between boredom, carelessness,
speed cars, . . .” and falling, or between fast driving and the nature of the
Any parent, spouse, sibling, or TV commercial can do occupational experiences of teenagers. (Wiemer, 1979,
that! We need to show causal relationships between pp. 44–45)
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Content Box 1-3 AOTA Official Statements on Prevention

and Health Promotion
Ten Trends Identified by AOTA Task The AOTA has published four statements on the profes-
Force That May Have an Impact on sion’s role in health promotion. The first was titled
Health Care in the 1970s “Role of the Occupational Therapist in the Promotion
• National health insurance and legislation
of Health and Prevention of Disabilities” (AOTA,
• Changing attitudes toward health care 1979a). The second, “Occupational Therapy in the
• Changing educational patterns Promotion of Health Care and the Prevention of Dis-
• Change in educational consumer ease and Disability,” followed 10 years later (AOTA,
• Changing patterns of work-leisure 1989a). The next most recent version was titled “Occu-
• Changes in housing and living patterns, styles of
life, and living conditions
pational Therapy in the Promotion of Health and the
• Technology and daily living Prevention of Disease and Disability Statement”
• The feminist movement (Brownson & Scaffa, 2001). The most recent version is
• Technology changes affecting career patterns and titled “Occupational Therapy Services in the Promo-
places of living tion of Health and the Prevention of Disease and Dis-
• Transmission of knowledge
ability” (Scaffa, Van Slyke, Brownson, & American
From “Report of the task force on social issues,” by J. A. Johnson, Occupational Therapy Association, 2008).
Chairman, Task Force, 1972, American Journal of Occupational An evolution in the profession’s knowledge and
Therapy, 26, pp. 333–37. With permission. Copyright © 1972 by
American Occupational Therapy Association. application of prevention and health promotion can be
traced by reviewing the aforementioned documents.
The introductory section of the first document (AOTA,
The profession has begun to answer Wiemer’s chal- 1979a) included two significant quotations. The first of
lenge with a return to occupation-based practice and these was the oft-quoted World Health Organization
the implementation of broader initiatives such as the (WHO) definition of health, which is “the complete
USC Well Elderly program, which provides evidence state of physical, mental, and social wellbeing, and not
for practice. Continued progress is needed in idea just the absence of disease or infirmity” (WHO, 1947,
formation and interventions at the broader policy and p. 29). The second is Reilly’s famous statement that
population levels. “man, through the use of his hands as they are ener-
gized by mind and will, can influence the state of his
American Journal of Occupational Therapy own health” (Reilly, 1962, p. 1). This two-page role
Special Issue statement was the first AOTA document to be adopted
This first-ever special issue on health promotion of the by the Representative Assembly on prevention and
American Journal of Occupational Therapy included health promotion and thus institutionalized the vision
articles on a variety of subjects related to health pro- of its leadership (Brunyate, 1967; Finn, 1972, 1977;
motion (AOTA, 1986). Topics included educational Reilly 1962; West, 1967, 1969; Wiemer, 1972). The
needs, potential role, cost and benefits of program- second version of the document was reduced to a one-
ming, and the best practice examples of that time. page, five-paragraph document that focused on defin-
The guest editor of the issue defined terminology, the ing and differentiating between the terms health
need for outcome measures, and other issues in health promotion and wellness (AOTA, 1989a). The term
promotion. wellness was increasingly being used by both lay and
health professionals during this time.
2000 Health Consortium The third version (Brownson & Scaffa, 2001) contin-
In 1989, two AOTA representatives (Anne Long Morris ued to define wellness, health promotion, and three levels
and Evelyn Jaffe) participated in a meeting of the 2000 of prevention (i.e., primary, secondary, and tertiary), and
Health Objectives Consortium sponsored by the Insti- the WHO definition of health. New terms that have
tute of Medicine and U.S. Public Health Service emerged within the discipline, such as lifestyle redesign,
(AOTA, 1989b). This meeting was one of many activi- also were defined. Readers were introduced to the U.S.
ties in the development of the health objectives for national health agenda through a description of Healthy
Healthy People 2000: National Health Promotion and People 2000 and Healthy People 2010. In addition, this
Disease Prevention Objectives (U.S. Department of version provides examples of individual-level, group-
Health and Human Services [USDHHS], 1990). More level, organizational-level, community/societal-level, and
details regarding other U.S. governmental health- governmental/policy-level occupation-based interven-
promotion initiatives, including Healthy People 2010: tions. This list of interventions was a resource for occu-
Understanding and Improving Health (USDHHS, pational therapists and occupational therapy assistants
2000), appear in Chapter 4. considering such work.
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The current 10-page statement (Scaffa et al., 2008) intervention process that facilitates engagement in occu-
continues to define health promotion and the three levels pation to support participation in life” (AOTA, 2002,
of prevention and builds on the foundation of the earlier p. 609). This document provides the structure to support
works. The new version provides detailed examples of health promotion interventions at multiple levels, includ-
occupational therapy strategies at each level of preven- ing context, performance patterns, and performance
tion. In addition, it expands the discussion of the role of areas (i.e., education, work, play, leisure, and social par-
occupational therapy practitioners at the level of the in- ticipation). Although individuals are the focus of inter-
dividual, community, population, and organization as vention approaches outlined in the tables located in the
well as at the governmental and policy levels. A new fea- Framework’s appendix, the document defines the terms
ture, case studies, is used to provide details regarding the client and prevention more broadly than the individual
assessment and intervention process in occupational level. See Table 1-3 for these and related definitions
therapy health promotion practice. The current statement (i.e., health promotion, disability prevention, and
includes a discussion of the profession’s unique contri- wellness). The use of these definitions and language
bution in this area (see Content Box 1-4). that is consistent with the World Health Organization’s
International Classification of Functioning, Disability
Occupational Therapy Practice Framework: and Health (ICF) (WHO, 2001) helps the profession
Domain and Process (Framework) make the shift to the new health system paradigm as
The capacity for the profession to contribute to health described by Baum and Law (1997) in Table 1-4.
promotion and to disease and disability prevention is
supported by the document Framework (AOTA, 2008). Centennial Vision
The Framework was developed in order to “more clearly In 2003, the AOTA board of directors “endorsed the
articulate occupational therapy’s unique focus on occu- development of a Centennial Vision to act as a road
pation and daily life activities and the application of an map for the future of the profession” (Christiansen,
2004, p. 10). This effort is reminiscent of the work of
the 1970 Task Force on Social Issues (AOTA, 1972),
discussed earlier in this chapter and the long-range
Content Box 1-4 planning as advocated by Bair (1982). The goal of this
2-year process was to develop a plan that would
Occupational Therapy’s Unique
Contribution to Health Promotion ensure that individuals, policymakers, populations,
and society value and promote occupational therapy’s
and Disease/Disability Prevention practice of enabling people to prevent and overcome
• Evaluate occupational capabilities, values, and obstacles to participation in the activities they value, to
performance prevent health related issues, improve their physical
• Provide education regarding occupational role
performance and balance and mental health, secure well-being, and enjoy a
• Reduce risk factors and symptoms through higher quality of life. (Christiansen, 2004, p. 10)
engagement in occupation
• Provide skill development training in the context of The first step in the development of the Centennial
everyday occupations Vision was a scenario-building process that took place in
• Provide self-management training to prevent October 2004 (Brachtesende, 2004). Various AOTA lead-
illness and manage health ers and a small number of international representatives
• Modify environments for healthy and safe occupa- were invited to participate in this early stage of the Cen-
tional performance
• Consult and collaborate with health care profession- tennial Vision development. From this process, four pos-
als, organizations, communities, and policymakers sible scenarios were developed. Details regarding each
regarding the occupational perspective of health scenario and the anticipated trends impacting the profes-
promotion and disease or disability prevention sion are available on the AOTA website. It is expected
• Promote the development and maintenance of that the Centennial Vision effort will expand the current
mental functioning abilities through engagement
in productive and meaningful activities and rela- view of the profession’s role in fostering healthier indi-
tionships (adapted from USDHHS, 1999, p. 4) viduals, families, communities, and society.
• Provide training in adaptation to change and in
coping with adversity to promote mental health
(adapted from USDHHS, 1999, p. 4) Conclusion
From “Occupational therapy in the promotion of health and the preven- The historical use of occupation by many cultures to
tion of disease and disability statement,” by C. A. Brownson & M. E. heal, promote health, and prevent injury and disease has
Scaffa, 2001, American Journal of Occupational Therapy, 55, pp.
656–60. With permission. Copyright © 2001 by American Occupational been well chronicled. Occupational therapy’s many and
Therapy Association. varied contributions to health promotion and disease
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Table 1–3 Select Health Promotion Terms and Definitions From the AOTA Frameworks
Term Definition
Client The entity that receives occupational therapy services. Clients may include (1) individu-
als and other persons relevant to the individual’s life, including family, caregivers, teach-
ers, employers and others who also may help or be served indirectly; (2) organizations
such as business, industries, or agencies; and (3) populations within a community
(Moyers & Dale, 2007 cited by AOTA, 2008, p. 669).
Disability prevention An intervention approach designed to address clients with or without a disability who
are at risk for occupational performance problems. This approach is designed to prevent
the occurrence or evolution of barriers to performance in context. Interventions may be
directed at client, context, or activity variables (adapted from Dunn et al., 1998 cited by
AOTA, 2008, p. 659).
Health promotion Creating the conditions necessary for health at individual, structural, social, and environ-
mental levels through an understanding of the determinants of health: peace, shelter,
education, food, income, a stable ecosystem, sustainable resources, social justice, and
equity (Trentham & Cockburn 2005, cited by AOTA, 2008, p. 671).
Prevention Promoting a healthy lifestyle at the individual, group, organizational, community
(societal), governmental/policy level (adapted from Brownson & Scaffa, 2001 AOTA,
2002, p. 633 and AOTA, 2008, p.674).
Wellness Wellness is more than a lack of disease symptoms. It is a state of mental and physical
balance and fitness (adapted from Taber’s Cyclopedic Medical Dictionary, 1997, in AOTA,
2002, p. 628 and AOTA, 2008, p. 676).
Compiled from Occupational therapy practice framework: Domain and process, by the American Occupational Therapy Association,
2002, Bethesda, MD: Author; Occupational therapy practice framework: Domain and process (2d ed.), by the American Occupational
Therapy Association, 2008, Bethesda, MD: Author. Copyright © 2002, 2008 by American Occupational Therapy Association.
Table 1–4 A Changing Health System Paradigm
Area Old Medical Model

The Model Sociopolitical (community) model Planned or managed health
The Focus Focus on illness Focus on wellness
Acute care outcomes Wellbeing, function, and life satisfaction
Individual Individual within the environment
Deficiency Capability
Survival Functional ability, quality of life
Professionally controlled Personal responsibility, flexible choice
Dependence Interdependence, participation
Treatment Treatment, prevention
The System Institution centered Community centered
Single facility Network system
Competitive focus Collaborative focus
Fragmented service Coordinated service
From Table 1 in “Occupational therapy practice: Focusing on occupational performance,” by C. M. Baum and M. Law, 1997,
American Journal of Occupational Therapy, 51, p. 281. Copyright © 1997 by American Occupational Therapy Association.
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and disability prevention are extensively documented. “prescribing” occupations for healing and health? Or
This historical information was reviewed as a founda- might it result in further separation from the potential
tion for future efforts in health promotion and preven- to serve society and eradicate occupational injustices?
tion of disease and disability. 3. Review AOTA’s Centennial Vision home page
Interdisciplinary efforts are essential to maximize (http://www.aota.org/nonmembers/area16/index.asp)
the benefits of occupational therapists and occupa- and the four possible future scenarios. What do you
tional therapy assistants on the health of individuals, see as occupational therapy’s possible contributions
families, communities, and populations. Health pro- to society’s wellbeing for one of these four scenarios?
motion is performed by a variety of trained individu-
als; it is not unique to a specific profession. The need
for the profession to work collaboratively with other ◗ Research Questions
disciplines was recognized decades ago. It was 1. By way of a document analysis, how does the
believed the profession’s expertise and historical con- frequency of articles on issues of occupational
cerns for health and service can best be actualized and social justice in the American Journal of
through interdisciplinary collaboration (MacDonald, Occupational Therapy compare to other interna-
1976). These collaborative efforts can result in more tional journals?
efficacious outcomes that include occupation as a rec- 2. How does the development of interest in the pre-
ognized, legitimate tool. ventive aspects of occupation in the United States
There is much for U.S. occupational therapy practi- compare to other countries in South America,
tioners to learn through involvement with the interna- Southeast Asia, and Europe?
tional occupational therapy community. Knowledge can
be gained through exposure to international literature
(e.g., Occupational Therapy without Borders: Learning ◗ Occupational Engagement
from the Spirit of Survivors [Kronenberg, Algado, &
Pollard, 2005], British Journal of Occupational Therapy, Assignments to Enhance
Israeli Journal of Occupational Therapy, Journal of Appreciation of the Historical
Occupational Science, South African Journal of Occupa- Role of Occupational Therapy
tional Therapy), websites (e.g., Australian Association of
Occupational Therapists, Canadian Association of Occu- in Health Promotion
pational Therapists, European Network of Occupational 1. Select five objects that you would put in a time
Therapy in Higher Education, World Federation of Occu- capsule (to be opened in 50 years) to capture the
pational Therapists), and by attending international con- current state of occupational therapy health
ferences. Although countries have differing political and promotion practice. Explain your selections.
economic ideologies, they share many common health 2. Develop a 15-minute skit that depicts time travel-
promotion and prevention concerns. As a profession, occu- ers’ observations and reflections of occupational
pational therapy has much to contribute to the global health therapy interventions directed toward health and
and wellbeing of citizens and populations through kno wellbeing in at least two different time periods.
wledge of the healing and preventive qualities of occupa- 3. Develop a presentation that portrays the leaders in
tion. Innovative health-promoting strategies are likely to occupational therapy from any period in time and
emerge through international and interdisciplinary collab- highlights the impact of then-current political and
oration, maximizing the contributions of all involved. social contexts on their professional activities.
◗ For Discussion and Review References

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SECTION I Foundations and Key Concepts

Historical and Philosophical Perspectives

Introduction perspective will enable the reader to link current

2 SECTION I Foundations and Key Concepts

Greek and Roman contributions, other civilizations

Content Box 1-1

Practical Benefits of an Awareness

4 SECTION I Foundations and Key Concepts

Figure 1-3 Dreamtime symbols used in aboriginal art.

6 SECTION I Foundations and Key Concepts

Figure 1-4 Service

8 SECTION I Foundations and Key Concepts

Figure 1-5 Base Hospital

10 SECTION I Foundations and Key Concepts

Primary Prevention Secondary Prevention Tertiary Prevention

Promotion Protection Identification Correction Accommodation

Education in Interception Locating illness, Treatment of Adaptation of

12 SECTION I Foundations and Key Concepts

Year Lecturer Title Themes

14 SECTION I Foundations and Key Concepts

Content Box 1-3 AOTA Official Statements on Prevention

16 SECTION I Foundations and Key Concepts

Table 1–4 A Changing Health System Paradigm

Area Old Medical Model

◗ For Discussion and Review References

18 SECTION I Foundations and Key Concepts

20 SECTION I Foundations and Key Concepts

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