Occupational therapy and right to the city

Abstract

This essay aims to reflect on Occupational Therapy in guaranteeing the “right to the city” as a fundamental human and social right, directly involved in human occupations. We started this debate with collective occupations as determinants in the construction of the social space of cities. Then, we focus on the asymmetries of power and territorial inequalities, fruits of the commercialization of urban property, which imply injustices and deprivations in occupational involvement in the subject’s daily lives. We summarize theoretical and methodological possibilities, new and others already, that we bring to the field of urban studies and public urbanization policies. We defend that Occupational Therapy is an area of significant contributions to the defense and guarantee of the right to the city.

Keywords:
Occupational Therapy; Freedom of Movement; Urbanization; City Planning

Resumo

Este ensaio tem como objetivo apresentar reflexões sobre a terapia ocupacional na garantia do “direito à cidade” como um direito humano e social fundamental, diretamente relacionado com as ocupações humanas. Iniciamos este debate com as ocupações coletivas enquanto determinantes na construção do espaço social das cidades. Em seguida, focalizamos as assimetrias do poder e as desigualdades territoriais, frutos da mercantilização da propriedade urbana, que implicam injustiças e privações no envolvimento ocupacional no cotidiano dos sujeitos. Sumarizamos possibilidades teórico-metodológicas, novas e outras já conhecidas, que trazemos à luz das questões urbanas, e que aproximam a terapia ocupacional do campo dos estudos urbanos e das políticas públicas de urbanização. Defendemos que a terapia ocupacional é uma área de significativas contribuições na defesa e garantia do direito à cidade.

Palavras-chave:
Terapia ocupacional; Liberdade de Circulação; Urbanização; Planejamento de Cidades

Introduction

The field of urban studies is historically and traditionally produced by theoretical-methodological contributions from Architecture and Urbanism, Geography and Sociology (Correia, 2019b). However, it is a technical-epistemic space that is porous enough for the insertion of other areas that are interested in city life (Gehl & Svarre, 2018). Therefore, it is an object of analysis and complex understanding of reality, which should, in an emergent way, attend to the interdisciplinary action (Rolnik, 1995). Thus, this essay is important by “broadening the epistemic bases of occupational therapy” (Costa & Alves, 2017), proposing perspectives that guide the production of knowledge and practices in the area, based on urban issues and the right to the city.

Therefore, we started this debate with collective occupations as determinants in the construction of the social space of cities. Then, we focus on power asymmetries and socio-territorial inequalities, the result of the commodification of urban property, which implies injustices and deprivations in the daily occupational involvement of social subjects. Finally, we support the assertion that occupational therapy is an area of significant contributions in the defense and guarantee of the right to the city. Thus, we summarize a framework of possibilities that bring occupational therapy closer to the field of urban studies and public urbanization policies, which structure and streamline the city's issues and order the answers to face them.

There are different epistemic axes to understand the structure of the object of knowledge and intervention of occupational therapy, which expose a complex arena of narratives in disputes in the national and global scenario (Galheigo et al., 2018). Our position is of the object as the “occupational involvement, of individuals and collectives, in the activities of everyday life”. This involvement comprises the inseparable relationship of the subject with his environment and the temporal, everyday construction, structured through the carrying out of activities so that they can promote well-being and social participation (Law, 2002; Silva & Oliver, 2019; Sobel, 1993; Vessby & Kjellberg, 2010).

Given the breadth of studies on human occupation, here, we focus on those who propose a critical perspective, which, according to Galheigo (2012), comprises a complex reading of the phenomenon, considering the various historical, social, cultural, and political determinants, to avoid absolute truths and superficial analyses. In this sense, the construct “collective occupations” (Ramugondo & Kronenberg, 2015) shows a strong convergence with the objective of this debate, in particular, on the formation and dynamics of social space.

Therefore, our objective is to invite the category to a debate about a technical-epistemic perspective of occupational therapy in the field of urban issues, which values the understanding of everyday life in cities and promotes theories, processes, and technologies to outline practical actions and research in the area.

Human Occupations in the Production of Social Space in Cities

Historically, the western representation of “occupation” has been linked to the meaning of alienated work (Constantinidis, 2012). However, studies on human occupation have modified it over time (Reed et al., 2013), and, from more critical (Huff et al., 2020) and decolonizing (Simaan, 2020) historical perspectives, they have a centralized occupation in occupational therapy processes, as a historical, social and culturally constructed phenomenon. Thus, in these studies, occupation is understood as a dimension of human doing, which contributes to the understanding and explanation of human experience, through the inseparable relationship between subject-context/environment, and offering support for therapeutic-occupational practices.

In this sense, “human occupation” is not opposed to “activity”, much less “every day”, and designates an epistemic axis of studies (Hammell, 2009; Ramugondo et al., 2015). For this reason, occupation cannot be treated as an isolated concept, but as a category that exposes different mental/social representations and epistemic frames, built in the social, historical, cultural, and political processes that are related to the interests of the occupational therapy (Christiansen, 1994).

For these reasons, occupations contribute to the production and expression of identities, to the support of practical, material, and symbolic life, and the complex processes of inclusion and social participation (Galvaan, 2015). In this sense, we think of an occupational therapy that produces knowledge about strategies, processes, and technologies to promote, support, and facilitate the occupational involvement (Law, 2002) of subjects who face difficulties socially inserted in daily life activities, and who, therefore, may experience the absence of opportunities to exercise, with autonomy and interdependence, citizenship and well-being through their occupational capabilities. From this angle, the elements that make up the phenomenon of human occupation allow a reading of the complex reality of everyday life and the social fabric (Kantartzis & Molineux, 2017), which imply facilitators and barriers (Tolvett, 2016), for participation in the various spheres of life in the cities.

One of the perspectives that intersect the debate is the “collective occupations” (Ramugondo & Kronenberg, 2015). They comprise the collective involvement of subjects in occupations related to the production and dynamics of social space. Every subject can only be read within human life when signified by belonging to its community. Therefore, collective occupations are, in addition to occupational forms, the intention of getting involved collectively, comprising an act that implies strengths, roles, abilities, capacities, and meaning sharing in situations mutually identified for the cohesion and/or disjunction of the social fabric (Kantartzis & Molineux, 2017). Based on this reading, the city can be understood as a social fabric made up of occupations that provide collective involvement.

In urban studies, the city is a territorial dimension formed by the conditions of physical geography, and by the “human activities”¹ that people are collectively engaged in (Serpa, 2007). The city, in this conception, makes up the territorial immersion of collective action, and therefore, is manifested in structures and dimensions related to coexistence, sociability, leisure, work, mobility, among others (Rolnik, 1995). These manifestations are mediated and supported by structures and equipment, such as urban roads, means of transportation, buildings, lighting, parks and squares, urban furniture, among others. Thus, the city is an occupational dimension, that is, a social space produced by physical territoriality, which offers support for subjects to carry out activities, which, based on the sharing of their meanings, fulfill the function of structuring and dynamizing the processes of sociability, coexistence and social participation.

Therefore, we understand that awareness of the mechanisms of the urban issue that imply occupational involvement contributes to the governance power of subjects, increasing engagement in collective action and local transformations - it is about the cohesion of the social fabric. On the other hand, its disjunction comprises the occupational involvement that threatens social participation. According to Kantartzis & Molineux (2017), it makes it vulnerable and breaks with the networks of occupational opportunities, preventing subjects from being able to recognize the power of intentionality and collective exercise for local transformations.

However, opportunities for occupational involvement in cities is an arena of asymmetries and injustices, which capture social participation as one of the configurations of the “urban question” (Castells, 2006). This question comprises, according to the author, the socio-territorial inequalities, which translate, under many configurations and expressions in the daily life of cities, the effect of the commodification of urban land, taken as property in neoliberal society.

Power asymmetries and socio-territorial inequalities: the production of injustices and the deprivation of social rights in occupational involvement in the city

Brazilian cities are diverse and unequal. They are the result of the different processes of use and appropriation of territorial space and its (in)capacity for management and governance. They are processes that trace the Jesuit and exploratory colonization of Europeans back to the globalized political-economic dependence of current capitalism, which governs the development models of the cities (Castells, 2006). As Harvey (2012) and Léfèbvre (2001) argue, the urban issue also comprises a system of production operations and maintenance of social segregation that guides such models. They are centered on the interest and power of economic capital – which contributes to the fragmentation and precariousness of spaces, given the inversion of the use-value by the exchange value of the city. Likewise, Santos (2007) argues that this formation of the social space of cities, especially in Latin America, is governed by protocols of political and economic dependence imposed by the dominant countries; emphasizing the use of powers linked to economic capital to define the ordering of urban land, based on the unfair distribution of daily activities.

Under these considerations, we cannot fail to emphasize that Brazil is a diverse continental territory and that it has 5,570 municipalities (Instituto Brasileiro de Geografia e Estatística, 2010) that experience extreme political-economic-social inequalities. The difficulty that certain municipalities face in their local life problems reflects not only the insufficient administrative machinery but also the historical dispute and control of territories by majority economic interest groups, which violently mark government policies (Instituto de Pesquisa Econômica Aplicada, 2015). Such groups are related to criminal organizations and real estate speculation, both associated with or covered by the State. We observe in the favelas, in cities like Rio de Janeiro and São Paulo, the precarious housing conditions for the most vulnerable population, often managed by drug trafficking and the militia, which are consolidated as a local government, in the face of the absence of the State.

About this, Rolnik (2019) shows the category “work-housing” to trigger, overcome and explain one of the configurations of the urban issue related to the idea of “center-periphery”, as a simple dichotomous division of socio-territorial inequality. For the author, this category frames the trajectories of precarious habitability of the poorest in the social space of cities and the situations of violence to which they are subjected. The poorest people materialize their daily life in the city, based on what they do between their workplace and home. As the opportunities between one and the other are not always available and comparable, the poorest are subject to living the city in a precarious and limited way, on the "fringe" of urban centers, reducing their experiences of leisure, decent and healthy food, of quality and efficient urban structures, among others, to guarantee some proximity between working and living, mitigating pauperization and the time spent in orchestrating their activities. The public and political mechanisms to equalize such inequalities are the creation and implementation of models in local development but based on neoliberal logic, transform citizens into consumers.

In this sense, cities are intentionally designed to structure-activity distribution systems, conditioning occupational involvement in areas of interest to the capital (Serpa, 2007). On the one hand, it ensures that certain social groups remain in city spaces, such as in areas of social interest for the construction of housing projects. On the other hand, it reinforces the allocation of the poorest to areas with low infrastructure (Fernandes, 2005; Fernandes & Alfonsin, 2016; Santos, 2007), exposing them, as already exemplified, to the precarious habitability between “work-housing”. Such an inequity system reinforces the injustices of using and inhabiting the city, especially when it started to “modernize” and offer better structural and economic conditions, which is a contradiction, as Harvey (2012) argues, more whoever can pay for it will have freedom in the city. Therefore, they are issues that imply the emergence of a social protection system, via public policies, which, in the Brazilian case, is still insufficient.

However, even though the reality of Brazilian municipalities still shows socio-territorial inequalities, it is important to highlight that with the promulgation of the Federal Constitution of 1988, for the first time in the country, municipalities were named as federative entities of the union, and, therefore, they started to have autonomy and legal personality to legislate and execute public policies at the municipal level. This allowed, in addition to a less hierarchical relationship with the federal government, a management that was more attentive to the local reality and effective in responding to its demands. Thus, under the citizenship nature of the Constitution, resulting from the process of resuming political democracy in Brazil, the city came to be considered a fundamental social right and, therefore, the minimum (local) unit of democratic territorial management (Freitas & Bueno, 2018; Kirzner, 2006).

The right to the city and public urbanization policies

Based on a review of the history of Western European cities, Léfèbvre (2001) understood that the city is a historical product of human relationships. Thus, if they change, the city changes too. The author states that, with the consolidation of consumer culture and industrialization processes arising from the intensification of the capitalist system, the urban space has changed from a place of participation in social and community life to a place that commodifies the exchange of goods and places. For him, in resistance to the capitalist effects of the city, the right to the city, a term he used in his work, includes participation and its appropriation to “[…] places of meeting and exchange, to the rhythms of life and employment of time that allow for the full and full use of these moments and places” (Léfèbvre, 2001, p. 139). It is the “right to transformed urban life” (Léfèbvre, 2001), which would only be possible through a revolution in the capitalist mode of production, since this mode leads to social segregation, which, in this author's view, destroys cities and threatens urban life. Following the same theoretical perspective, David Harvey says that the right to the city is “[…] the right to change ourselves by changing the city” (Harvey, 2012, p. 74).

On the other hand, Trindade (2012) understands that such determinations imposed by the capitalist system are perhaps unlikely to change a “revolution” aimed at its “extinction”, focusing more on a perspective of reconfiguration of the capitalist system. Thus, the author highlights the importance of recent urban public policies, as devices for dissolving the asymmetries and injustices produced in the social space of the cities. In this way, the author does not ignore the importance of the philosophical reading of the right to the city, but he defends that it should support and guide the legal-institutional action, through the instruments of democratic management in the daily lives of cities.

Regarding these issues, Harvey (2012) states that the right to the city is the “[…] exercise of a collective power to shape the urbanization process” (Harvey, 2012, p. 74). Thus, the right to the city has been widely used by various social movements in Brazil to guide access to social rights in different dimensions of social life. The beginning of this agenda can be traced back to the 1960s, from the claims of the National Movement for Urban Reform – MNRU - Movimento Nacional pela Reforma Urbana (Saule Júnior & Uzzo, 2009). The organization of this movement managed to include in the Federal Constitution of 1988 two chapters on Urban Policy (chapters 182 and 183), which later culminated in the institution of the Statute of Cities (Brasil, 2001) and the creation of the Ministry of Cities, in 2003².

The City Statute aims to guide the guidelines and instruments for the ordering and development of the cities to promote well-being and citizenship and preserve the environment (Brasil, 2001). In addition to the concept of development as an exclusively economic process, the Statute proposes the concept of development as democratic management of the city, and, therefore, ensuring the condition and obligation of social participation in conducting its management instruments. To this end, the Statute defines the participatory master plan (PMP) as the basic instrument for planning and ordering the city, which must be implemented by the municipal public manager, based on the appointment of a management committee and the involvement of various social segments (Brasil, 2001). Such legislative instruments include, in urban management, the participation of various actors interested in this discussion, enabled by the National Conferences of Cities and the National Council of Cities - Conferências Nacionais das Cidades e do Conselho Nacional das Cidades³ (Cafrune, 2016; Secretaria Municipal de Direitos Humanos e Cidadania, 2015), which ensure the “exercise of collective power” as a right to the city.

Occupational Therapy Actions in the Interdisciplinary Field of Urban Issues

The city is a complex field that requires different epistemic lenses to compose readings of reality and the consequent interdisciplinary response to its demands related to guaranteeing the right to the city (Rolnik & Pinheiro, 2004). In this sense, we believe that an opportunity to identify and build a propositional place for occupational therapy in the field of studies and urban practices is to articulate the issues of the professional object with the macro-social issues of the social space of cities. Therefore, attention to the occupational involvement of people in the life of cities is an opportune way to remedy, as denounced by Gehl & Svarre (2018), the gaps in what people's daily activities reflect in urban space planning (Correia, 2017), and the production of well-being and social participation.

Given these considerations, we summarize here, some theoretical-methodological constructs, in which we assimilate the area of occupational therapy and the right to the city.

Approach of Occupational Therapy in Participatory Local Development Teaching (OT/PLDT)

The OT/PLDT approach (Correia, 2018b) aims to involve socially distinct groups in collective projects to make changes in the context of local life, fostering the management of the territory and the local power of its agents. It is structured in four procedures: I) immersion; II) mapping of perceptions of reality; III) round tables and; IV) collective life projects. The procedures offer clues for the creation and exploration of community teaching-learning strategies, in which local agents make decisions and collectively engage to modify negative aspects of their local context.

The experiences identified with the use of the OT/PLDT approach (Correia, 2018a, 2019a; Correia et al., 2016, 2018, 2017; Correia & Akerman, 2015) show an intimate relationship with the issues surrounding the production of social space and the right to the city, since the application of the approach has been used in contexts of reviews and creation of participatory master plans, valuing community processes, especially with populations historically separated from social participation in urban policies. The OT/PLDT approach was created in 2011, in the context of university extension projects, and is still being developed and validated in consulting projects for small and medium-sized municipalities in Brazil (Correia, 2017). Therefore, by promoting the social participation of local agents in the demands of their territories, the approach collaborates with the right to the city.

Cultural Accessibility

Since 2009, the Department of Occupational Therapy at the Federal University of Rio de Janeiro has offered the Specialization Post-graduate course in “Cultural Accessibility” to train multipliers of this agenda in all regions of Brazil (Dornelles et al., 2018). Supported by an aesthetic paradigm, Cultural Accessibility introduces a cognitive change in the way of understanding the structures, compositions, and dynamics of sociability and coexistence. Therefore, it interferes with the ways of producing culture in the city's social spaces (Correia, 2019b). Thus, actions, projects, and strategies in Cultural Accessibility, which, initially designed for cultural environments, expand to the city, and overflow access and participation for all people (Sarraf, 2018).

In this way, occupational therapy projects that take Cultural Accessibility as an aesthetic paradigm (Dorneles & Lopes, 2016) can develop knowledge and practices from Universal Design, Assistive Technology, Alternative and Augmentative Communication, Cultural Policies, Art, and Local Development. Actions can include accessibility to cultural facilities as devices for cultural enjoyment and, therefore, the population's right to experience the city, both in contexts of institutional cultural enjoyment, such as museums, theaters and in those of community-based and territorial cultural production such as cultural points, popular manifestations and festive events, among others, which are collective occupations that are part of the city's identity and memory (Correia, 2019b).

Assistive Technology

Occupational therapists have been working in the Assistive Technology (AT) area for a long time. However, we call attention to the need to overcome AT as an area dedicated exclusively to the clinical field of rehabilitation. Devices, methods, and resources in AT, designed from the demands of the occupational involvement of subjects in the life of cities, can collaborate with urban planning strategies and projects (Cassapian & Rechia, 2014; Cavalcanti et al., 2013; Ferreira et al., 2013; Gomes & Emmel, 2016) and, with this, equalize the socio-territorial inequalities experienced by groups historically neglected in urban policies, such as people with disabilities, the elderly, illiterate people, among others.

In this sense, occupational therapy can contribute to urban planning bodies such as secretariats, training technical staff, and in advising and educating the population with disabilities and without disabilities, the elderly, and, above all, in the planning, indication, and evaluation of AT devices for urban equipment, whether architectural, methodological or communicational.

In this sense, it is also proposed an expansion of occupational therapy models and approaches in the AT area that goes beyond the individualizing logic of assessments and prescriptions, and dimension them in collective contexts, developing protocols, manuals, and instruments, based on the notion of average accessibility for access and collective participation in public environments, as provided by the Brazilian Law of Inclusion (Brasil, 2015). For this, in addition to the architectural dimensions, the occupational therapists should know how to analyze the city's occupations, considering its methodological and communicational aspects, that is, how the city works, the establishment of its signs and strategies for functioning, and issuing information. Therefore, occupational therapists can be protagonists in elevating AT to the status of social rights and social technology by relating it to accessible urban policies and their effective implementation in city life.

Everyday urban mobility

Urban mobility is a human activity by nature and is essential to the subjects' way of life, as part of their daily lives (Balbim, 2016). This concept focuses on social issues and allows it to be inserted as an important element in occupational therapy practice (Gonçalves, 2020; Gonçalves & Malfitano, 2021). Everyday urban mobility is defined as:

[…] a social practice, defined by the meanings, impacts, and representations of displacements and daily movements of people and collectives through urban space. It occurs in everyday life, marked and influenced by the social position of the subjects, characterized as essential for their social participation and effective citizenship. It encompasses the social transformations related to the movement through the city and the meanings of displacements for the lives of people and groups, including their causes and consequences (Gonçalves, 2020, p. 319).

Gonçalves (2020) points out that the discussion of everyday urban mobility in occupational therapy can be based on four dimensions: I) specific objective of the intervention; II) form/instrument of assessment in occupational therapy; III) resource to practice to achieve the proposed objective and; IV) concept/reference to support the insertion of the profession in the discussion of public urban planning policies. Reflections on everyday urban mobility have proved fertile for us, as they refer to the defense of the right to the city by occupational therapy, and in the interdisciplinary debate on the subject (Gonçalves & Malfitano, 2020; Gonçalves et al., 2020; Vieira Filho et al., 2020).

Final Considerations

In addition to a setting or backdrop, the city is a field of issues that implies occupational involvement supported by territories of asymmetric opportunities, which generates ambiguous outcomes of justice and injustice, cohesion and disjunction, around the right to the city. Therefore, we believe that the city is an emerging field of study and interdisciplinary social practice for occupational therapy.

To capture this emergence, in this essay, we chose studies of human occupation as an epistemic axis, which brings together different theoretical and conceptual perspectives on human experience in the contexts/environments. This axis has helped us and has been helping, above all through the conceptual perspective of collective occupations, to articulate contributions from the disciplinary area with the macro-questions and tools of urban studies.

The social space of cities is where people produce and share their occupations, which are the maximum units of analysis and intervention in the complex and interdisciplinary reality, being a lens and communication system specific to the area. Thus, occupational therapy needs to weave closer relationships with theoretical-practical contributions from the Studies of Human Occupation, Sociology, Anthropology, Geography, Urbanism, Architecture and Social Public Policy, to broaden and signify its object of knowledge and collaborate with the confrontation of barriers that hinder the social participation of subjects in the city.

Finally, we hope that occupational therapists are interested in the life of cities, they can collaborate with studies and development of urban policies, and the search for practical solutions to local problems. The knowledge produced by interdisciplinary networks contributes more effectively and efficiently to the development of society and the production of means that guarantee the right to the city.

• 1
  Serpa (2007) and Rolnik (1995), use the expression human activity to define the city. However, the authors do not mention the theoretical framework that supports such understanding. This seems to be a gap in urban studies, as demonstrated by Gehl (2018). Anyway, this expression is close to our understanding of occupation, as already presented in this essay.
• 2
  From the current administration of the Federal Government, in 2019, the Ministry of the City was removed and demoted to the secretariat of the new Ministry of Regional Development, with an exclusively economic character.
• 3
  It is important to highlight that, since the beginning of the current presidential government, the City Councils and Committees, and other public policies were suspended. Several social movements for Urban Reform demand their return, as the Federal Constitution assures, but until the writing of this essay, the scenario is unfavorable.
• How to cite: Correia, R. L., & Gonçalves, M. V. (2021). Occupational therapy and right to the city. Cadernos Brasileiros de Terapia Ocupacional, 29, e2757. https://doi.org/10.1590/2526-8910.ctoARF2082

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Edited by

Section editor: Prof. Dr. Daniela Tavares Gontijo

Publication Dates

• Publication in this collection
  09 Aug 2021
• Date of issue
  2021

History

• Received
  17 Apr 2020
• Reviewed
  06 May 2020
• Reviewed
  10 Aug 2020
• Accepted
  29 Jan 2021