As part of my Master’s in Inequality and Society, I recently watched the video “Why Participatory Social Policy Now?” which explored the growing recognition that people and communities should actively shape the policies that affect their lives, rather than simply being passive recipients of them. The discussion particularly focused on participation, lived experience and the importance of redistributing power within policy development.
The video can be viewed here: https://youtu.be/IP4MvILhUPU?si=VOORCcCiQ-jA5JeB
What made the discussion feel even more real to me was that one of the contributors spoke about their lived experience of seeking asylum in Middlesbrough, which is where I live. Hearing somebody talk about these experiences within the context of my own community brought an immediacy and humanity to the discussion that felt difficult to ignore. It reminded me that social policy is never abstract. It directly shapes people’s everyday lives, opportunities and occupations.
Watching the video left me reflecting on what participatory social policy means for occupational therapy and, perhaps more importantly, what participation itself means as an occupation.
Social policy shapes nearly every aspect of everyday life. It influences access to healthcare, housing, education, welfare systems, transport, employment and community participation. In many ways, policy structures the opportunities people have to engage in occupations that are meaningful to them. Occupational opportunities are not created equally, but are shaped by wider social, political and economic structures (Galvaan, 2012). Yet historically, policy decisions have often been developed by professionals, governments and institutions without the meaningful involvement of the people most affected by them (Beresford, 2016).
Participatory social policy challenges this traditional top-down approach. Instead, it argues that citizens, communities, and people with lived experience should be directly involved in shaping social policy, services, and systems (Beresford & Carr, 2018). This shift is not simply about consultation. It is about power, inclusion and recognising lived experience as expertise.
As occupational therapists, this should feel familiar.
Occupational therapy has long emphasised the importance of participation, autonomy, inclusion and engagement in meaningful occupations (Wilcock & Hocking, 2015). However, occupational participation is often discussed in relation to self-care, productivity and leisure, rather than civic or political participation. Watching the video made me think about policy engagement itself as an occupation.
Activities such as campaigning, advocacy, attending meetings, co-production, storytelling, protesting, participating in consultations, engaging in community action and influencing policy can all be understood as meaningful occupations through which people express identity, exercise agency, and shape the world around them.
This feels particularly important within disability movements. The phrase “nothing about us without us” reflects the principle that disabled people should be centrally involved in decisions affecting their lives. Historically, disabled people have often experienced exclusion from decision-making spaces despite being directly affected by policy outcomes (Charlton, 1998).
From an occupational therapy perspective, this can be understood through the lens of occupational justice. Occupational justice recognises that social, political and economic structures influence people’s opportunities to engage in meaningful occupations (Townsend & Wilcock, 2004). When people are excluded from shaping the systems that govern their lives, this may also represent a form of occupational injustice.
Participatory social policy has important implications for occupational therapy practice.
Occupational therapists already support many forms of participation, including self-advocacy, community engagement, peer support, access to services, communication and reducing barriers to inclusion. Participatory social policy also made me reflect on civic and political participation as an area where people accessing occupational therapy may, at times, require support to engage fully. This may include support for accessing consultations, community forums, advocacy opportunities, campaigning spaces, or other forms of civic engagement that are meaningful to them and connected to shaping the systems that affect their everyday lives.
This also connects closely to ideas around co-production within health and social care. True participation is not simply asking people for feedback after decisions have already been made. Arnstein’s classic “Ladder of Citizen Participation” argued that many forms of participation are tokenistic because they do not involve genuine power-sharing (Arnstein, 1969). This remains highly relevant today.
Meaningful participatory approaches require organisations to consider the barriers that prevent people from fully engaging. These barriers may include inaccessible environments, digital exclusion, fatigue, poverty, communication barriers, discrimination, power imbalances or assumptions about whose knowledge is valued.
Occupational therapists have an important role in addressing these barriers because participation is central to the profession’s philosophy. This includes recognising that occupational choices and opportunities are influenced by structural inequalities and social conditions rather than by individual capability alone (Galvaan, 2012). The video also made me reflect on how occupational therapy sometimes focuses heavily on helping individuals adapt to systems rather than supporting people and communities in challenging and reshaping those systems. Participatory social policy invites us to think more critically about the profession’s role within wider social and political structures.
If occupational therapy genuinely values participation, inclusion, and occupational justice, then supporting people in participating in policy and decision-making processes should matter to the profession.
Because participation is not only about doing occupations within society.
It is also about having the opportunity to shape the society in which those occupations occur.
References
Arnstein, S.R. (1969) ‘A ladder of citizen participation’, Journal of the American Institute of Planners, 35(4), pp. 216–224.
Beresford, P. (2016) All Our Welfare: Towards Participatory Social Policy. Bristol: Policy Press.
Beresford, P. and Carr, S. (2018) Social Policy First Hand: An International Introduction to Participatory Social Welfare. Bristol: Policy Press.
Charlton, J.I. (1998) Nothing About Us Without Us: Disability Oppression and Empowerment. Berkeley, CA: University of California Press.
Galvaan, R. (2012) ‘Occupational choice: The significance of socio-economic and political factors’, in Kronenberg, F., Pollard, N. and Sakellariou, D. (eds.) Occupational Therapies Without Borders: Towards an Ecology of Occupation-Based Practices. 2nd edn. Edinburgh: Elsevier, pp. 152–162.
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.
Wilcock, A.A. and Hocking, C. (2015) An Occupational Perspective of Health. 3rd edn. Thorofare, NJ: SLACK Incorporated.
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