Putting the 'occupation' in Occupational Therapy and debating its role in Public Health

Guest post by Andrew Graham, Registered Occupational Therapist and PhD Candidate, Teesside University

Having recently made the move from NHS clinician into academia (I started my PhD at Teesside University in December 2017), I arrived in Belfast for the Royal College of Occupational Therapy Annual Conference with an appetite to hear new and interesting research in the profession.

In my welcome pack, I received a copy of the RCOT’s Strategic Intentions which represent the leadership response to the challenges of the changing landscape of health and social care. The principle that stood out for me was to ‘position the Profession, and our members, for the 21st century’.

With my background in amputee rehabilitation I have seen first-hand the impact of socio-economic inequalities and lifestyle trends on amputation rate in North East England. For example, the amount of amputations due to diabetes, and more shockingly intra-venous drug use, has spiked in the past 10 years or so. As an Occupational Therapist (OT), I view the person holistically and always try to take into account the social and psychological not just physical barriers they will need to overcome post amputation. My focus will always be on what the person needs and wants to do. The person’s meaningful activities (occupations).


The pledge tree

During the conference, we were asked to make a pledge about how we would do our part to ensure the new strategic intentions are met. The pledge tree seemed to have a recurring theme of ‘ensuring occupation is central to my work’.

My own pledge was to better explain ‘occupation’ and its meaning within occupational therapy to a range of audiences.

So, my attempt at articulating ‘occupation’? I’ll go with ‘doing things that we need to do and want to do (meaningful activities), which enable a sense of self-meaning and improved health and well-being.

I feel as a profession we are experts in using occupation as a goal (top down approach) and/or a means (bottom up approach) to ensure provision of high-quality, client centred services. Utilising the OT process from information gathering to evaluation we strive to enable growth, confidence and self-meaning.

Despite OTs generally being able to better define what they do and what the outcomes can be, it was a bit of a shock to see that the debate at the conference highlighted that the profession is still unsure about its stakeholders. The topic up for discussion was ‘This house believes that Occupational Therapy needs to be predominately based in public health, not in secondary or tertiary services’.

From my experience, this issue had been debated and answered years ago. My pre-registration training saw me working in the NHS, community mental health teams, a special needs school and a charity. The OTs all had a prominent and effective role in these sectors, so as intrigued as I was to hear the debate, I knew which way I would be voting!

For the purpose of this blog I’d like to highlight the case for OTs working in Public Health. A starting point would be the statement by the professional body, which points out that the Public Health Agenda has been of increasing importance and relevance for occupational therapists, who facilitate health promotion through working with people of all ages to enable their participation in meaningful occupations (RCOT 2004).

The evidence base is also pretty strong. A systematic review of Allied Health Professions and Health Promotion (Needle et al 2011) reviewed 28 studies related to occupational therapy and Public Health, and found related interventions in the areas of mental health, arthritis, pain and fatigue, pulmonary rehabilitation, stroke, drug and alcohol problems, and falls prevention.

Not only are OTs already working with people on aspects of Public Health and health promotion activity, but there is an expectation that this focus will form part of the delivery of all occupational therapy interventions in the future. For example, I remember reading about the ‘make every contact count’ campaign when working on an acute stroke ward and making sure I asked about smoking and drinking habits as part of my OT assessment.

So, it was with no surprise that the result swung against the motion at the conference. A particularly convincing rebuttal speech was given by Professor Diane Cox and Dr Jenny Preston, clearly showing the professions ability to address Public Health matters but also reach a wider audience through demonstrating outcomes in secondary and tertiary services.

Overall, I left the conference with a sense that the profession has strategically positioned itself to demonstrate that it is making a difference and will continue to make a difference to the health and well-being of people in the 21st century. It is time for OTs working in Public Health and other services to be proud. In my favourite quote of the conference….‘we are not the jack of all trades, rather we are the masters of human occupation’.


Andrew Graham is investigating ‘Sensory Discriminating Training for Phantom Limb Pain’, as a PhD candidate in the School of Health and Social Care at Teesside University.

Have we taken our eye off the ball?

Guest post by Andy Graham - specialty registrar in Public Health, County Durham

A couple of years ago I found myself in need of a dissertation topic for an MSc in Public Health – ‘make sure it’s something you are interested in’ was the advice. Simple I thought, I just need to weave football and beer into a research project! All joking aside though, I have become interested in the relationship between the two over the years. As a public health professional and former A&E nurse, I am well aware of the potential harms of excessive alcohol consumption. Also, as a fan who both attends matches and watches on TV, I have become increasingly aware at how visible this relationship has become. Of course, football and beer have long been associated, ever since Victorian landlords would set up teams, use the land out back for a pitch and, in the amateur days, employ the team as barmen in lieu of pay.

The Strawberry Pub, Newcastle, Phil Thirkell

But at the risk of sounding like my dad, when I ‘was a lad’, you either went to the match, where as a young working class man it was normal to have a pint with the lads, or you waited for Saturday night’s Match of the Day for your football fix. The pubs were open sporadically, had no TVs, and the football was rarely broadcast anyway. Fast forward a few years and we have football on satellite TV almost every night of the week and all day at weekends, most top flight football clubs sponsored at some level by an alcohol brand, marketing of alcohol, beer in particular, is rife and the norm appears to be drink beer and watch football with the lads in the pub. Opportunities to do both are far more common than when ‘I was a lad’, and not just within pubs, but within living rooms, where the cheaper alcohol deals of the supermarkets are very popular. As a dad myself I was disturbed by these developments, but hadn’t been able to quantify them.

I decided my dissertation would try to measure the amount of alcohol marketing that football TV viewers were exposed to. With the help of Jean Adams at Newcastle University, I planned the research. I chose six live broadcasts representing over 18 hours of footage, developed coding frameworks and watched 40 hours plus of coding footage to consider all the verbal and visual references.

The results shocked me:

• Over 2,000 visual images, 111 per hour on average, or around 2 per minute.

• 32 verbal references.

• 17 traditional advertisements, accounting for 1% broadcast time.

• Over 1,100 visual images in one alcohol sponsored Cup competition alone

The issue of traditional advertising commercials is interesting because the ‘voluntary’ codes of practice in place to regulate how alcohol is portrayed (should not appeal to youth, should not suggest social success, etc.) are most relevant to this type of advertising. Given that we know that quantity of alcohol marketing is more important than content, then the apparently unchecked stream of visual references in this research may be even more important, and we could argue that the current controls are completely inadequate because they are focused on content, rather than quantity.

I can’t help but feel that we have taken our eye off the ball – the globalisation of sports such as premier league football as a product, the satellite age, the endless thirst for profit and market share within corporations, the ‘self’ regulation that fails to control the exposure reported above, the relaxed licensing laws in this country, and the increase in type, availability, and affordability of alcohol. All of these things create a perfect storm in which alcohol and sporting idols become normalised as one and the same, and the brand becomes a member of the team. It feels as though the relationship between sport and alcohol has evolved towards its perfect and logical form.

I am disturbed to be one of a generation of football fans that has been manipulated in this way and that my children are also targets. And meanwhile, the alcohol industry has a seat at the policy making table through the Public Health Responsibility Deal. So we must ask the question: are we sleepwalking into a situation where drinking alcohol is so closely associated with the sporting heroes that children see on TV, that they are being actively normalised to become drinkers? No one seems to question this, but it is time someone did, and through public health advocacy it may just be up to us.