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Occupational Justice A Conceptual Review
Occupational Justice A Conceptual Review
To cite this article: Evelyne Durocher , Barbara E. Gibson & Susan Rappolt (2014) Occupational
Justice: A Conceptual Review, Journal of Occupational Science, 21:4, 418-430, DOI:
10.1080/14427591.2013.775692
Evelyne Durocher, This paper, the first of two examining the concept of occupational justice,
Barbara E. Gibson presents the findings of a scoping review of how occupational justice and
& Susan Rappolt its associated concepts (occupational deprivation, marginalization, alienation,
imbalance or apartheid) have been conceptualized. Its purpose is to examine
potential avenues and barriers for development and application of these concepts.
The results indicate that perspectives on occupational justice emphasize
individuals’ unique sets of occupational needs and capacities within particular
environments. Based on the idea that participation in occupation can affect health,
occupational justice is underpinned by a belief in the right to engage in diverse and
meaningful occupations to meet people’s individual needs and develop their
potential. In the literature, barriers to engagement in meaningful occupation are
j Evelyne Durocher, PhD considered injustices. One impediment to enabling occupational justice in
candidate, OT Reg. (Ont.),
practice is the lack of conceptual clarity about occupational justice and its related
Graduate Department of
Rehabilitation Sciences and terms. Before an occupationally just perspective can be further developed and
the Joint Centre for Bioethics, utilised, the conceptual basis of occupational justice needs to be clarified and
University of Toronto,
Ontario, Canada models for occupationally just practice need to be further developed.
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perspectives to provide insights for future devel- partake; was not a review of a book or article; was
opments of occupational justice concepts in broad- written in English. Using these criteria, eight book
er multidisciplinary and theoretical realms chapters and 58 articles were included for full
(Durocher, Gibson, & Rappolt, 2013). First we review.
examine how the concept of occupational justice
emerged and outline how ideas of ‘occupational The third stage included hand searching key
justice’, ‘occupational injustice’ and frameworks of journals (those yielding more than three articles
occupational justice have been proposed in the in the initial search: American Journal of Occupa-
literature. The discussion will then consider tional Therapy, Australian Occupational Therapy
possible barriers and potential application of the Journal, British Journal of Occupational Therapy,
concept of occupational justice. Canadian Journal of Occupational Therapy and
Journal of Occupational Science) and the writings
Methods of key authors. The reference lists of literature
identified in stage two were also reviewed for key
A scoping review of the literature (Arksey & authors and recurrence of citations. Stage three
O’Malley, 2005) was undertaken to examine con- added a further 16 works, for a total of 19 book
cepts of occupational justice. Scoping methods chapters and 63 articles.
map ‘‘key concepts underpinning a research area’’,
particularly when ‘‘an area is complex or has not Finally in the fourth stage, additional inclusion/
been reviewed comprehensively before’’ (Mays, exclusion criteria were used to ensure that the
Roberts, & Popay, 2001, p. 194). Scoping reviews literature focused on the conceptualization and
explore the depth, breadth and nature of existing development of occupational justice. These addi-
research, draw conclusions about current research tional criteria required that each article or chapter
activity in the literature, and identify gaps where must not be limited to repeating information, or
evidence is not yet provided (Arksey & O’Malley, citing material, from another included article; and
2005). The methods for this study differed from must include conceptual and theoretical discus-
traditional scoping studies in that both empirical sion about the concept of, or concepts pertinent
and theoretical literature was analyzed. to, occupational justice (i.e. occupational injus-
tice). Literature was reviewed in its entirety,
The search was completed in four stages. In the and that which did not develop the theoretical
first stage, literature was identified by searching or conceptual discussion, such as works demon-
the following electronic databases for the phrase strating applications of occupational justice (or
‘occupational justice’: Ovid-MEDLINE, EMBASE, injustice) with minimal theoretical discussion,
AMED, Ovid-Healthstar, Pubmed, Scholar’s was excluded (69 items). Though we acknowl-
portal, Scopus, Web of Science, BIOSIS, and edge that applications of theoretical concepts can
CINAHL. This search yielded nine books or further theoretical discussions, a detailed exam-
book chapters and 105 articles. As with systematic ination of the applications of occupational justice
reviews (Higgins & Green, 2009), in the second was beyond the scope of this review. Consistent
stage, inclusion/exclusion criteria were applied to with scoping study methods (Arksey & O’Malley,
identified literature to ensure consistency in eval- 2005), the quality of the literature was not assessed
uating and identifying relevant works. Those as this could have excluded relevant discussion
criteria were applied through a review of the based on criteria that were not relevant to the
abstracts. If the abstract indicated clear relevance, purposes of this review.
the full article was reviewed. To be included, the
article had to meet each of the following criteria: The following questions were used to system-
discussed occupational justice or closely related atically review and extract information from the
concepts (i.e. occupational injustice); conceptua- identified literature: 1. How is ‘occupational
lized ‘occupation’ as all activities in which people justice’ conceptualized? 2. How are other terms
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and nations’’ (Wilcock & Townsend, 2009, justice in terms of how the former conceptualizes
p. 330). That necessitates fair allocation of humans as occupational beings having a unique
resources to enable the equitable distribution of set of occupational needs, abilities and resources.
rights and privileges that can result from partici- This work builds on Stadnyk’s (2008) earlier idea
pation in occupations, while recognizing the that the social structures can lay the determinants
unique occupational needs of individuals. Infrin- of occupational injustice.
gement of the freedom to participate in these
occupations is injustice (Wilcock & Townsend, What is occupational injustice?
2009). A number of conceptualizations of occupational
injustice have been described, helping to expli-
Occupational justice in relation to social justice cate the meaning of occupational justice by
Of the 13 articles and chapters reviewed, 8 elucidating how it can be violated. Five forms of
referred to the relationship between occupational occupational injustice are described in varying
justice and social justice, albeit all in a somewhat detail.
cursory and inconsistent fashion. Descriptions
of social justice broadly center on the social Occupational apartheid
nature of humans in the context of society and Occupational apartheid occurs in situations
social relationships, and span the equal worth of where opportunities for occupation are afforded
citizens, equitable rights, power and responsibil- to some individuals and restricted to others based
ities, as well as fair and ethical distribution of on personal characteristics such as race, disability,
resources and opportunities enabled by those gender, age, nationality, religion, social status,
resources (Stadnyk et al., 2010; Wilcock, 2005, sexuality and so on (Kronenberg & Pollard, 2005).
2006; Wilcock & Townsend, 2009; Whiteford & Occupational apartheid may result from occupa-
Townsend, 2011). These concepts are not com- tional restrictions at the economic, social, legal
prehensively discussed or linked by a coherent or religious level and be created through ‘‘unre-
theory of social justice. Occupational justice is sponsive, collusive, or exploitative policy mea-
differentiated from social justice, framed as the sures maintaining privilege over poverty’’ (p. 66).
belief that humans need the freedom to partici- Occupational apartheid could be considered
pate in meaningful occupations. Occupational formally institutionalized occupational injustice.
justice and social justice are described as having
in common concepts of equity (Wilcock & Occupational deprivation
Townsend, 2000) and the need for just govern- Occupational deprivation is the most prevalent
ance of society that upholds ‘‘fairness, empower- example of occupational injustice found in the
ment, and equitable access to resources, and reviewed literature. Drawing on Wilcock (1998),
sharing of rights and responsibilities’’ (Wilcock, Whiteford (2000) defined occupational depriva-
2005, p. 84). Debate about the ‘mutual exclusion’ tion as ‘‘a state of preclusion from engagement in
or ‘indistinguishable nature’ of occupational occupations of necessity and/or meaning due to
and social justice is, however, acknowledged factors that stand outside the immediate control
(Wilcock & Townsend, 2009). Stadnyk and col- of the individual’’ (p. 201). Whiteford (2000,
leagues (2010) tried to clarify that debate using 2010) and Wilcock (2006) both suggested that
Wilcock’s (2006) earlier view, distinguishing these external circumstances may include social,
occupational justice as complementary to social environmental, economic, geographic, historical,
justice. They suggested that occupational justice cultural, political or interpersonal factors. White-
extends notions of social justice by recognizing ford (2010) distinguished occupational depriva-
occupational rights, and through placing empha- tion from occupational disruption, a temporary
sis on the importance of enabling participation in condition that may be due, for example, to illness.
meaningful occupation. Stadnyk et al. (2010) also Occupational deprivation is argued to have a
distinguished occupational justice from social pervasive and long term effect on individuals
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(Whiteford 2012; Wilcock, 1998, 2006) and examination of the potentially highly detrimental
can also have significant health implications health effects of occupational alienation. Stadnyk
(Wilcock, 2006). et al. (2010) contended that situations where some
individuals are subject to deprivation or alienation
Occupational marginalization from highly valued and meaningful occupations
Occupational marginalization is explained as while others are privileged with the same (poten-
exclusion from participation in occupations based tially at the expense of those being alienated or
on ‘invisible’ norms and expectations about deprived) could lead to situations of occupational
who should participate in what occupations, apartheid.
how, when, where and why (Stadnyk et al.,
2010; Townsend & Wilcock, 2004). It is further Occupational imbalance
described as situations where individuals or At the individual level, occupational imbalance
groups may not be afforded the choice to partici- refers to excessive time spent occupied in one
pate in valued occupations, and may be relegated area of life at the expense of other areas (Stadnyk
to those that are less prestigious or allow little et al., 2010); for example, individuals spending
choice or control (Stadnyk et al., 2010), or an overabundance of time in paid employment at
opportunity for decision-making (Townsend & the expense of family time. Wilcock (2006)
Wilcock, 2004). Hammell (2008) added that further argued that occupational imbalance can
marginalization can be manifested through, or occur when the timing of occupations is out of
result in, social exclusion and limited access to alignment with personal or physiological needs or
opportunities and resources. Townsend and routines; for example working the night shift.
Wilcock (2004) distinguished occupational mar- At the societal level, occupational imbalance is
ginalization from occupational apartheid and described as situations where some individuals
occupational deprivation, arguing that occupa- are offered many opportunities for occupation
tional marginalization results from informal norms while others are afforded few, resulting in
and expectations within a sociocultural infrastruc- individuals being over, under, or even un-
ture. In other words, persons are not restricted occupied (Stadnyk et al., 2010; Townsend &
from participation in occupations because of Wilcock, 2004). All of these forms of occupa-
explicit laws, social policy or religious edicts, but tional imbalance can have detrimental effects
rather by habits, traditions and unexamined on health (Wilcock, 2006), with economic, poli-
expectations of behaviour. tical and cultural structures largely responsible
for situations of imbalance, particularly with
Occupational alienation respect to the distribution of paid employment
Occupational alienation is described as a ‘‘pro- (Townsend & Wilcock, 2004). Furthermore, if
longed experience of disconnectedness, isolation, those structures create or maintain situations of
emptiness, lack of a sense of identity, a limited occupational imbalance, the result could be seen
or confined expression of spirit, or a sense of as occupational apartheid. In situations of occu-
meaninglessness’’ (Townsend & Wilcock, 2004, pational imbalance, not only may occupations be
p. 80) and in relation to limited (or forced) unequally distributed, but also the rights, privi-
participation in occupations viewed as meaning- leges, benefits and rewards that are associated
less or purposeless (Stadnyk et al., 2010; Wilcock, with these occupations.
2006). Stadnyk et al. (2010) argued that mean-
ingful occupations may be mentally and spiritually The concepts of apartheid, deprivation, margin-
enriching and shape one’s identity. As such, alization, alienation and imbalance denote var-
participation in occupations that do not provide ious forms of exclusion from occupations as well
positive experiences can impede formation of as the imposition of unfavourable occupations,
positive identities and, they argued, is thus unjust. i.e., where individuals participate in occupations
Further injustice is implied in Wilcock’s (2006) they would not ordinarily choose. Occupational
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justice theorists argue that both prohibition from poverty, abuse, displacement and countless other
participation in occupations that are meaningful circumstances may indicate the need for a
and the obligation to participate in occupations response to injustice, but whether or not these
that are not willingly chosen or meaningful may and other injustices indicate the need for inter-
affect individual well-being. A difficulty with vention against occupational injustices requires
these concepts lies in the lack of conceptual deliberation. Closely linked to the forms of injus-
clarity regarding how to determine which occu- tice described in the literature is the concept of
pations should be prevented or compelled for occupational rights.
which individuals. For example, putting a child
to bed when he or she wishes to stay up and play What are occupational rights?
fits the definition of occupational injustice and In 2004, Townsend and Wilcock extended the
marginalization, yet most people would agree that concept of occupational justice by proposing four
the child’s general welfare supersedes his or her occupational rights, with each right linked to one
interest in staying up. Similarly, smoking cigar- of four forms of occupational injustice (listed in
ettes is linked with an increased risk of cardiac Table 1). The rights focus on enabling meaningful
and lung disease (Lloyd-Jones et al., 2009), and occupations, inclusion, autonomy and diverse
thus decreased health, yet some individuals who participation, but the authors do not explain the
smoke consider it a meaningful occupation from emergence of these four rights in their theorizing.
which they derive social benefit, opportunities These rights are also reflected in the work of
to develop social relationships and a sense of Whiteford and Townsend (2011).
belonging (Katainen, 2012). Is it injustice in the
form of occupational deprivation and/or aliena- In contrast, Hammell’s (2008) formulation of
tion to prevent individuals from smoking in social occupational rights as ‘‘the right of all people to
situations that occur in public places where they engage in meaningful occupations that contribute
might most wish to express their individuality? positively to their own well-being and the well-
being of their communities’’ (p. 61), is very
While both of these examples outline situations similar to previous descriptions of occupational
that meet the definitions of occupational injus- justice proposed by Wilcock, Townsend and
tice, it could be argued that these injustices are Stadnyk. While Hammell briefly acknowledged
outweighed by other moral and health concerns. Townsend and Wilcock’s (2004) definition, she
The more nuanced argument may be less about did not explicitly differentiate her use of the term
defining and identifying occupational injustices from theirs, nor did she comment on their
than whether or not the injustice obligates a definitions. The use of different terms for similar
response. Certainly situations of slavery, war, meanings and the same terms for different
*Injustices noted are examples only. They are not categorically limited consequences of restricted rights.
(Townsend, E. & Wilcock, A. #2004, Canadian Journal of Occupational Therapy, 71(2), p. 80. Reproduced with permission)
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meanings impedes the development, uptake and Townsend, 2011). Both frameworks are described
application of the ideas. below.
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Figure 1: Framework Exploring the Creation and Outcomes of Occupational Justices and Injustices
(Stadnyk et al., 2010, p. 335; From Christiansen, Charles; Townsend, Elizabeth. Introduction to occupation:
The art and science of living, 2nd ed. #2010. Printed and electronically reproduced by permission of Pearson
Education, Inc., Upper Saddle River, New Jersey, USA)
(Stadnyk et al., 2010, p. 336; From Christiansen, Charles; Townsend, Elizabeth. Introduction to occupation:
The art and science of living, 2nd ed. #2010. Printed and electronically reproduced by permission of Pearson
Education, Inc., Upper Saddle River, New Jersey, USA)
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align such that occupational rights are respected, useful to occupational therapists approaching
occupational justice is enabled and individuals are situations of injustice. While helpful, a more
afforded opportunities to participate in chosen generalized analytical approach is needed to
meaningful occupations. If, on the other hand, guide practices across contexts and individual
structural and contextual factors lead to circum- situations. The only identified framework that
stances where participation in occupation is attempts to do so is Whiteford and Townsend’s
hindered, occupational rights are violated and Participatory Occupational Justice Framework
occupational injustice may arise. Occupational out- (2011), discussed below.
comes pertain to individuals or social groups and
may be positive or negative. The authors described Participatory Occupational Justice Framework
that ‘‘occupational injustices are thus socially struc- Whiteford and Townsend’s (2011) framework is
tured, socially formed conditions that give rise to the only one attempting to apply concepts of
stressful occupational experiences’’ (p. 338). occupational justice to practice. It is described as a
conceptual tool for doing justice for individua-
In part three of the framework, Stadnyk et al. lized and population-based practice situations
(2010) outlined four underlying beliefs and four (p. 65), which aims to ‘‘strengthen occupational
principles. The beliefs are based on values and therapists’ and other professionals’ abilities to
assumptions about humans, including that parti- consistently raise consciousness of, articulate,
cipation in ‘‘occupations [takes place] in social and defend, both philosophically and theoreti-
conditions that determine health and quality cally, a transformative vision of a more occupa-
of life’’ (p. 340) and are informed by theories tionally just world’’ (p. 66). The framework is
from various fields of study such as occupational structured according to six processes that ‘‘profile
science, occupational therapy, philosophy, science, six key enablement skills that are markers of
and anthropology. The four beliefs are that hu- collaborative partnerships informed by a vision of
mans are occupational beings, that they participate occupational justice’’ (p. 72). These processes
in occupations as autonomous agents, that parti- are intended to enable collaboration and are set
cipation in occupation is both interdependent within a practice and systems context, which is
and contextual, and finally, that participation in further embedded in a local, regional, national and
occupation is a determinant of health and quality global context. The six processes can be com-
of life (Stadnyk et al., 2010). pleted in any order and ‘‘raise consciousness of
occupational injustice; Engage collaboratively
The four principles ‘‘outline rights, responsibil- with partners; Mediate agreement on a plan;
ities, and freedoms of enablement’’ and ‘‘derive Strategize resource funding; Support implementa-
from a recognition that individuals have occupa- tion and continuous evaluation; Inspire advocacy
tional needs, strengths, and potentials that for sustainability or closure’’ (Whiteford & Town-
affect health and quality of life’’ (Stadnyk et al., send, 2011, pp. 7374). Each step contains a list of
2010, p. 343). They include claims about guiding questions aiming to stimulate critical
‘‘empowerment through occupation; . . . inclusive reflection about situations of potential occupa-
classification of occupations; . . . enablement of tional injustice. It is not clear how the authors
occupational potential; . . . [and] diversity, inclu- identified and defined the six enablement skills
sion and shared advantage in occupational parti- after which the processes are modeled. Similarly,
cipation’’ (Stadnyk et al., 2010, pp. 343347). while the authors briefly described the two levels
While the principles appear to be derived from of context in which the processes are set, how they
beliefs, the discussion does not make clear how delineated these two levels of context is unclear.
they were developed or if they are informed by
theoretical or empirical work. Stadnyk (2008) In summary, occupational justice is a concept that
attempted to apply this framework to a specific denotes individual and population rights to
scenario in order to exemplify how it might be unique occupational habits, needs and wishes,
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and recognizes that these are based on individual more robust models to bridge occupational justice
capacities and circumstances. However, its poten- theory to practice.
tial to inform practice and policy would be
enhanced with greater clarity, consensus and gui- The literature is replete with descriptions of
dance in its application. Below we briefly expand ideas, principles and concepts related to occupa-
on the problems with applying the principles of tional justice (e.g. occupational injustice, occupa-
occupational justice and point to possible future tional rights, occupational marginalization etc.),
directions for development. yet there is no clear or consistent definition of the
concept. Arguably the abundance of related terms
may, with refinement, contribute to the delinea-
Discussion: Current State of Development
of Occupational Justice and Future tion of subtle nuances of occupational justice and
Directions injustice; at the same time, however, with many
terms there is the risk that the overall concept
Though its origins are in occupational science, loses focus and becomes difficult to understand.
Whiteford and Townsend (2011) also linked In the literature to date, efforts to increase the
occupational justice to occupational therapy, depth of understanding have been sacrificed for a
stating that ‘‘occupational justice is occupational focus on delineating the applicable breadth of the
therapy’s implied social vision’’ (p. 69). That concept.
position is supported by the WFOT Position
Statement on Human Rights (2006), which out- Hammell (2008) argued that too many terms
lines that one of the challenges faced by occupa- ‘‘which are culturally specific and lacking in
tional therapists is in ‘‘accepting professional distinct parameters may serve to muddy rather
responsibility to identify and address occupa- than elucidate [the] theoretical waters’’ (p. 62),
tional injustices and limit the impact of such and the same critique may hold for others
injustices experienced by individuals’’ (p. 2). This attempting to apply the concept of occupational
position statement thus asserts occupational jus- justice to the alleviation of pressing social issues
tice as a responsibility of occupational therapists, such as racism or poverty. Hammell’s proposed
while not excluding the possibility that others solution, however, was to suggest yet another
might be informed by and contribute to the achie- overarching term, ‘occupational rights’, related to
vement of occupational justice. Stadnyk (2008) human rights. It is not clear however if this
also took this stance; but suggested that while addresses the issue and it may raise others. For
occupational justice is closely aligned with the example, should understandings of occupational
core tenets of occupational therapy and has justice be centrally focussed on rights? What
potential to guide occupational therapy practice, would this leave out? Is the term occupational
barriers remain for practicing clinicians. If these rights any more useful than the term occupational
barriers are present for occupational therapists justice? Moreover, the definition of occupa-
whose global body has embraced this approach, tional rights suggested by Hammell does not
similar barriers may also be faced by occupational align with other descriptions of occupational
scientists or other professions or approaches. This rights in the literature (Townsend & Wilcock,
review has demonstrated that some of the barriers 2004) and appears very similar to definitions of
to the realization of the potential applications occupational justice. As such, would it also
of the concept of occupation justice include that require related terms such as occupational in-
proposed definitions of occupational justice and justice and its variants? Other than her criticism
related terms lack conceptual clarity, have not of the overabundance of terms related to occupa-
been developed with reference to other bodies of tional justice, Hammell (2008) did not provide a
scholarly work, and are not supported by empiri- clear rationale for her preference of the term
cal evidence. Additionally, there is a need for occupational rights.
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Additionally, as has been noted, the number of therapy practice is Whiteford and Townsend’s
scholars contributing to this literature is small, (2011) Participatory Occupational Justice Frame-
where 11 of the 13 works were authored by work. While a depth of information is provided,
combinations of only four theorists; three addi- some of the concepts may remain intangible. For
tional authors contributed the final two papers. example, the framework is described as ‘‘a con-
Perhaps the lack of conceptual clarity and the ceptual tool for doing justice’’ (p. 65). This is a
resulting hindrance in understanding discourages rather vague and imposing claim that may hinder
additional scholarship in the field? This lack of efforts to engage with the framework. Additionally,
understanding may also hinder further develop- while the questions guiding the six processes are
ment of ideas of occupational justice and occupa- very detailed and would likely prove to be helpful
tional rights and related practice models. in guiding critical reflection about situations of
occupationally injustice, these processes are set in
We acknowledge that occupational justice is a two levels of context that are only briefly and very
rich and complex concept and as such, a succinct generally described. A set of questions for each of
definition may not be possible. What we are the two levels of context, similar to those posed for
suggesting, however, is that a carefully worked each of the processes, would facilitate answering
through conceptualization would delineate clearly questions for the six processes as it would help to
the relationship between occupational justice delineate the boundaries and resources in the
and social justice, acknowledging the diverse context, thus further guiding its practical applica-
approaches to social justice and making unambig- tion. As well, examples applying the framework to
uous which approaches to social justice are tangible individualized and population based
aligned. (We discuss this idea in more detail in practice situations would help to model how the
the second article in this series). Furthermore, if framework can be used.
a breadth of related terms is needed to capture
the complexity of occupational justice, then the Finally, in the discussion of their framework,
relationships between these terms and concepts Whiteford and Townsend (2011) mentioned the
has to be mapped out and developed in more use of the model by diverse professions and their
detail. Increased clarification would render con- potential application of concepts of occupational
cepts of occupational justice more accessible, thus justice several times. Although there is reason
facilitating its application to achieve occupation- to engage different disciplines and the broader
ally just policies and practices. Additionally, an healthcare community, with the exception of
increased understanding could stimulate further Wilcock (2006), work towards that end has not
work and interdisciplinary collaboration between yet been delineated. While great strides have been
occupational scientists and other disciplines. made in the development of theories and models
since the inception of concepts of occupational
With respect to current theories and models of justice, more is needed to bridge the gaps between
concepts of occupational justice and the work and
occupational justice, while Stadnyk (2008) help-
practice of occupational science, occupational
fully provided one example of the application of
therapy and the various other professions and
core tenets of the Evolving Theory of Occupa-
disciplines working to address health injustices
tional Justice to a scenario involving the care of
and social disadvantage.
older adults, more examples would further an
understanding of the theory and help to illustrate
its application. More importantly, however, such Conclusions
examples should be used to complement a general
guideline of how the application of this model The concept of occupational justice has become
can inform practice across different situations. more prevalent in the literature and has potential
Such a guideline has yet to be developed. The to inform social change. Occupational justice
only framework attempting to guide occupational is linked to the concept of social justice but
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