That was the title of my first assignment as part of my module Understanding Economic and Social Inequalities and Exclusion. It is not a small question, and if I am honest, at the start it felt quite overwhelming. But as I worked through the module, and built on my earlier presentation exploring occupational deprivation, it became something much more real and connected to practice.
Before I go any further, I want to take a moment to unpick some of the language, because these are terms that can feel quite academic but actually describe things we see every day in occupational therapy.
Neoliberalism is often used to describe a way of organising society that places a strong focus on individual responsibility and economic productivity, where paid work becomes one of the main ways people are seen as contributing (Harvey, 2007; Brown, 2015). Within this way of thinking, value is closely tied to employment, and participation is often judged by whether someone is working, or able to work.
Occupational exclusion, on the other hand, is something we are very familiar with in occupational therapy. It is when people are unable to engage in meaningful occupations because of barriers outside of their control. These barriers might be environmental, social, political, or attitudinal, but the key point is that exclusion is not about the individual, it is about the context around them (Whiteford, 2000; Townsend and Wilcock, 2004).
What my assignment explored was how these two things connect. More specifically, how a focus on productivity and paid work can contribute to the exclusion of disabled people from meaningful participation in everyday life.
This built directly on my earlier presentation in the module, where I explored occupational deprivation and how inequality shows up in occupational therapy. That presentation was a real starting point for me, because it made me think differently about the people we work with. Many of them are not just managing their health or disability, they are also navigating systems that create additional barriers, whether that is through inaccessible environments, inflexible services, or assumptions about what they can and cannot do.
When I moved into writing the assignment, I began to look more closely at how wider systems, particularly welfare policy, define contribution. What became really clear is that contribution is often reduced to paid employment. If you are working, you are seen as contributing. If you are not, questions start to be asked. This reflects wider policy narratives that prioritise reducing economic inactivity and increasing labour market participation (Department for Work and Pensions, 2023).
But this does not reflect the reality of people’s lives.
In occupational therapy, we understand that occupation is much broader than work. It includes everything people need, want, and have to do. Managing health, maintaining relationships, caring for others, engaging in communities, and finding ways to cope with daily life are all meaningful occupations (Wilcock and Hocking, 2015). These are central to people’s wellbeing, yet they are often invisible within systems that prioritise economic productivity.
This is where the idea of occupational exclusion becomes particularly important. When systems only value certain types of participation, particularly paid work, they risk excluding people whose lives do not fit within that narrow definition. This is not because those individuals lack contribution, but because the system does not recognise it. Occupational justice perspectives highlight that people have a right to engage in meaningful occupations that support their health, well-being, and sense of belonging (Hammell, 2017).
This module has helped me to see more clearly that inequality is not just something that exists, it is something that is produced. It is shaped by policies, by how we measure success, and by what we choose to value. When we bring this back into occupational therapy, it shifts the questions we ask. Instead of asking why someone is not participating, we begin to ask what is getting in the way. We start to see that what looks like non-participation is often the result of structural barriers rather than individual limitations (Oliver, 1990).
This has also been a personal learning experience. There have been times in my own life where I have experienced restrictions on my participation, not because of what I am able to do, but because of the environment around me. Systems that did not flex, expectations that did not match my reality, and barriers that limited my choices. That is occupational exclusion, and it is something that changes how you see both practice and policy once you have experienced it.
What I am taking from this first semester is not just knowledge, but a deeper understanding of the role occupational therapy has in challenging inequality. It is not only about supporting individuals to engage in meaningful occupation, but also about recognising and questioning the systems that create exclusion in the first place. If we are not doing that, there is a risk that we adapt people to fit systems, rather than advocating for systems to change.
This assignment, and the module as a whole, has felt like a starting point. It has helped me connect theory, practice, and lived experience in a way that feels meaningful. More than anything, it has reinforced that understanding inequality is not separate from occupational therapy. It is central to it.
References
Brown, W. (2015) Undoing the demos: Neoliberalism’s stealth revolution. New York: Zone Books.
Department for Work and Pensions (2023) Transforming support: The health and disability White Paper. Available at: https://www.gov.uk/government/publications/transforming-support-the-health-and-disability-white-paper (Accessed: 29 March 2026).
Hammell, K.W. (2017) ‘Critical reflections on occupational justice: Toward a rights-based approach to occupational opportunities’, Canadian Journal of Occupational Therapy, 84(1), pp. 47–57.
Harvey, D. (2007) A brief history of neoliberalism. Oxford: Oxford University Press.
Oliver, M. (1990) The individual and social models of disability. Available at: https://disability-studies.leeds.ac.uk/wp-content/uploads/sites/40/library/Oliver-in-soc-dis.pdf (Accessed: 29 March 2026).
Townsend, E. and Wilcock, A.A. (2004) ‘Occupational justice and client-centred practice: A dialogue in progress’, Canadian Journal of Occupational Therapy, 71(2), pp. 75–87.
Whiteford, G. (2000) ‘Occupational deprivation: Global challenge in the new millennium’, British Journal of Occupational Therapy, 63(5), pp. 200–204.
Wilcock, A.A. and Hocking, C. (2015) An occupational perspective of health. 3rd edn. Thorofare, NJ: Slack Incorporated.