Occupational Therapy and informal work: reflections for practicing

Abstract

Introduction

Because of the growing number of informal workers in Brazil and with the implementation of the “Labor Reform”, it is important to understand the issue of informal work, pointing out challenges for professions dedicated to the care/attention to workers, such as Occupational Therapy.

Objective

To discuss the issue of informal work in contemporary times and to indicate possible consequences for the practice of Occupational Therapy.

Method

This is a theoretical article that conducts discussions based on legal documents, current statistical data, studies that trace the historical panorama of the informal economy, and classic studies of Occupational Therapy in the work field.

Results

Although interventions in Occupational Therapy and work have moved towards overcoming approaches strictly aimed at the return of motor functions, there are still practical challenges. In addition to the practices traditionally carried out, it is necessary to act considering that the deregulation of work results in consequences for the various areas of the workers' lives. It is necessary for professionals from the different pillars of social security to be committed, in addition to the health and social security network. The importance of practices aimed at exercising sociability, awareness, and information about rights in the sense of social transformation is pointed out.

Conclusion

Given the current situation, it is necessary to expand the performance of the profession in the field of work to include informal workers. One must understand the reality of these workers in the different devices that receive them and the economic/social issues involved in the development of this type of work.

Keywords:
Economics; Occupational Health; Occupational Therapy; Informal Sector; Employment, Precarious

Resumo

Introdução

Diante do crescente número de trabalhadores informais no Brasil e com a implementação da “Reforma Trabalhista”, é importante compreender a questão do trabalho informal, apontando desafios para profissões que se dedicam ao cuidado e atenção ao trabalhador, como a Terapia Ocupacional.

Objetivo

Discutir a questão do trabalho informal na contemporaneidade e indicar possíveis desdobramentos para a prática da Terapia Ocupacional.

Método

Trata-se de um artigo teórico que realizou discussões a partir de documentos legais, dados estatísticos atuais sobre o assunto, estudos que traçaram o panorama histórico da economia informal e estudos clássicos da Terapia Ocupacional no campo do trabalho.

Resultados

Apesar das intervenções em Terapia Ocupacional e trabalho terem caminhado para a superação de abordagens estritamente voltadas ao retorno das funções motoras, ainda existem desafios práticos colocados para a profissão. Para além das práticas tradicionalmente realizadas, aponta-se a necessidade de se atuar considerando que a desregulamentação do trabalho acarreta desdobramento para os diversos âmbitos da vida dos trabalhadores. Para que as atuações alcancem o trabalhador informal, é necessário o comprometimento dos profissionais inseridos em dispositivos de todos os pilares da seguridade social (saúde, previdência e assistência social) e do setor da educação. Aponta-se a importância das práticas voltadas ao exercício da sociabilidade, conscientização e informação sobre direitos no sentido da transformação social.

Conclusão

Diante da atual conjuntura, é necessário ampliar a atuação da profissão no campo do trabalho para contemplar os trabalhadores informais. Deve-se compreender a realidade desses trabalhadores, os diversos dispositivos que os recebem e as questões econômicas/sociais envolvidas no desenvolvimento desse tipo de trabalho.

Palavras-chave:
Economia; Saúde do Trabalhador; Terapia Ocupacional; Setor Informal; Emprego Precário

Introduction

Informality rates reached 41.4% of the total workforce in 2019 in Brazil, unprecedented numbers that will be part of the country's history. The Brazilian worker has been engaging in informal work, whether calling a self-employed worker/entrepreneur or performing any work activity without a formal relationship with a contractor (Silveira & Alvarenga, 2019).

The International Labor Organization (ILO) clarifies that the inequalities and vulnerabilities of developing countries are directly linked to the high number of informal workers in these places. Thus, the more formalized work, the greater the possibilities of reducing social inequality indices, since unregulated jobs are precarious due to the lack of social protection for them (Organização Internacional do Trabalho, 2002).

In Brazil, labor rights are established through formal employment contracts, most of the time, included in the Consolidation of Labor Laws (Consolidação das Leis Trabalhistas - CLT), the largest and most recognized system of labor rights in the country. Formal contracts seek to ensure that, even when performing a work activity that can be notoriously precarious¹, the worker has the right to access financial benefits and pension programs. However, the concept of informality at work will depend on the geographic location in which it is analyzed, an aspect that will be clarified in a later topic.

Regarding the advances in informality in Brazil, in 2017, the “Labor Reform” was implemented through Law number 13.467/2017. The law changes 201 points of the CLT (Brasil, 2017). According to Krein (2018, p. 78), the main purpose of implementing such changes was “to legalize practices that already exist in the labor market and to enable a new 'menu' of options for employers to manage the workforce following their needs”.

The Labor Reform was approved in the government of interim president Michel Temer, and contributes to the existence of atypical contracts, intensifying the precariousness of work. The approval of this law encourages informal work in Brazil. Another important point for the start of the precariousness of work was the dissolution of the former Ministry of Labor, in 2019, which weakened inspections of illegal work. In Brazil, there is the availability of “[...] a new range of open possibilities that mean cheaper ways of hiring employers and more vulnerable to workers” (Krein, 2018, p. 88).

Continuing with proposals that change employment contracts and modify rights, in 2019, the federal government announced Provisional Measure (Medida Provisória - MP) number 905/2019 (Brasil, 2019). The government speech stated that the MP had the objective of implementing a program that sought to encourage the hiring of young people between 18 and 29 years old, called “Green and Yellow” (Cavallini, 2019). In exchange for the contracts, the contracting companies would pay fewer taxes and labor charges. However, the rules that would guarantee the employability of young people were not clarified and the Provisional Measure interferes with rights such as working hours and unemployment insurance and removes the requirement for registration of some professions. After manifestations by the oppositions, the current president of the country revoked the MP, on March 30, 2020. The revocation does not invalidate the employment contracts signed during the MP's validity period; however, the MP cannot be applied to contracts made after April 20^th (Salati, 2020).

The approval of laws such as the Labor Reform and the implementation of provisional measures that restrict labor rights are presented as artifices of the current Brazilian administration to discourage formalized work and “cheap” workers. The justifications mentioned by government officials are based on the idea that offers more employment opportunities, the burden on labor rights must be reduced.

Given the above, we believe that new questions may be posed for the performance of professions dedicated to thinking about the resolution of the impacts of contemporary work on workers' lives, that is, their care and comprehensive care. It is necessary to discuss the direction of professional actions because of a situation full of reforms and strategies that circumvent labor legislation and provide opportunities for informal, precarious, and unfair jobs.

As occupational therapists, we point out that the work dimension permeates our profession in important ways and different ways. We emphasize that the profession's legislation allows it to intervene extensively in health, education, welfare, and social assistance devices. Therefore, we believe that carrying out such reflection based on this profession is a powerful trigger for thinking about contemporary professional practices aimed at workers.

Traditionally, the work of occupational therapists with workers takes place through insertion in the worker's health area, especially in the Unified Health System (Sistema Único de Saúde - SUS). Occupational therapists use specific knowledge and practices developed during the training process and form health teams to prevent diseases in the workplace, carrying out surveillance actions, health education, quality of life, and professional rehabilitation, privileging that activities are carried out following the worker's wishes and possibilities (Nascimento & Souza, 2018). However, we believe that the deregulation of work and its implications for workers are subject to several and new consequences for the practice of Occupational Therapy.

It is up to occupational therapists to intervene in and through all types and places of work, not just considering the formalized one. Therefore, we understand that professional practices aimed at comprehensive care for informal workers necessarily go beyond the context of the health sector and its devices. We understand that the scarcity of rights presented by contemporary work contracts, prolonged unemployment, and the various types of precariousness are aspects that justify the need to increase the range of Occupational Therapy activities in the work area. Occupational Therapy practices are dedicated to understanding people's lives and activities, intervening in and through them – in this case, the focus is on workers and informal work activities. The occupational therapist must make efforts to meet the daily or occupational needs of workers.

In order to justify the academic relevance and importance of the elaboration of this theoretical article, we carried out a search in all national Occupational Therapy journals: Cadernos Brasileiros de Terapia Ocupacional, Revista de Terapia Ocupacional of USP, Revista Interinstitucional Brasileira de Terapia Ocupacional and Revista Baiana de Terapia Ocupacional. We used the descriptors “occupational therapy” and “informal work”. The journal Cadernos Brasileiros de Terapia Ocupacional presented 01 article; the Revista de Terapia Ocupacional of USP, 08 articles. However, none of the studies from the searches actually deal with the theme of informal work, nor do they reflect on informality and its consequences.

Regarding the search in journals, it is important to emphasize that the system for scanning scientific journal sites does not have an evolved technology like in the indexed database systems, normally used in the preparation of systematic reviews. The search section of journal sites has limited refinement, which may justify the number of articles that return from the searches but do not relate to the descriptors. We did not perform a manual search on journal websites to systematize the literature on the subject, but rather to justify the need and scientific relevance of the study.

Given the above, the article aims to discuss the issue of informal work in contemporary times and indicate possible consequences of this issue for Occupational Therapy. For the theoretical discussion, we used legal documents, current statistical data on the subject, studies that trace the historical panorama of the informal economy, and classic studies of Occupational Therapy in the field of work.

Informal Work Over the Decades: Terminologies and Concepts

We will demonstrate here that the concept of informal work will directly depend on factors such as the region under investigation and the socio-historical processes to which it refers. Thus, it will depend on cultural and historical contexts, laws, and regulations of the place where the phenomenon is studied and even on the differences between the professional categories of informal workers that will be analyzed.

First, informal work must be understood regionally, that is, according to the understanding of each country or region, about what are formal employment contracts in that area. Only with an understanding of what “formality” is or what is considered “typical employment contracts” in a given region, it is possible to describe the informal work (Noronha, 2003).

Another important point for understanding the concept of informal work is to understand its transformation over the decades, based on historical processes. During the 1960s and 1970s, informal work was considered to belong to a so-called “informal sector” and that was directly linked to the group of illegal and criminal activities. There was a direct relationship between informality, groups in poverty, and marginality (Lima & Soares, 2002).

In the 1970s, neoliberalist justifications for the existence of informal work in the capitalist system were based on the explanation that this type of work was the result of a “residual unemployment” that had accidentally happened during the industrialization process, is strictly linked to a population considered as “industrial reserve army”. Such perspective had the hypothesis that this army would be absorbed by the formal work, as the industrialization processes were completed. In this historical moment, informal work was explained: “in terms of incomplete industrialization, underdevelopment, the result of urbanization that has not yet been completed industrialization” (Lima, 2013, p. 3).

With the issue of structural unemployment raised with greater emphasis from the 1990s onwards, the population previously referred to as “residual unemployment” or “industrial reserve army” was not fully incorporated into the formal capitalist system. Informal labor was not absorbed into the economic system; however, it was incorporated into capitalism, as it came to be used by large contractors as cheap labor. The capitalist system only works with informality, as this type of work helps to regulate the system.

New neoliberal responses were also put forward to justify the permanence of structural unemployment and informal work under capitalism. Such justifications were based on the idea that the informal worker has advantages: since he is free, he decides his future and, therefore, is responsible for his failures and his work opportunities:

Professional careers were disrupted, and jobs and qualifications disappeared. Requalification has become the watchword, with a new profile of the desirable worker: being flexible to new learning, being willing to assume different functional positions in the company, mobile, being able to be spatially dislocated according to needs, and entrepreneur, seeking solutions within the work process making it leaner and increasing productivity (Lima & Junior, 2018, p. 34).

With the enhancement of a new worker profile in modern society, informal work is no longer strictly linked to marginality. It starts to be articulated with positive ideas, through the concept of “self-employment” and “entrepreneurship”, concepts that try to disseminate the advantages of being “self-employed” and “owner of their own business”. Neoliberalism induces the thought that it is the worker's responsibility to leave the unemployment situation and that it is up to him to build his work opportunity. From this perspective, the “informal worker”, previously linked only to poverty, was replaced by a person who, theoretically, is independent of formal contracts and sees a certain advantage in this.

However, with such justification, there is a tendency to neglect the importance of social protection and workers' rights guaranteed through formal employment contracts. The Welfare State, understood as a political organization focused on providing access to basic services and rights and which proposes to provide care strategies mainly for those who have the least means necessary for survival, is now seen as unnecessary and Public policies adopt a new logic for action. Thus, the Government and its policies no longer have the objective of benefiting people in poverty, as they concentrate efforts on encouraging the population to obtain the means to take care of itself (Goldberg, 2014).

Unemployment, inequalities, precariousness, and poverty are now seen not only as issues that must be dealt with by the individual but also as a result of their individual “failure” (Lima & Junior, 2018, p. 34, quotes from the authors).

Having explained that the concepts of “formal” and “informal” are linked to issues of locality (what is formal and informal in each place in the world) and temporality/historical context (transformations in the idea of what is informal throughout the time), the possible theoretical implications of choosing to use concepts such as the informal sector, informal economy or informal work are now explained in studies on informality at work. Although they are sometimes used as synonyms in studies, these concepts are directed to different perspectives.

To simplify the discussion so that this text does not extend around definitions, we point out that the adjective informal can be used in three main ways: a) as an informal sector, which refers to informal activities within a sector and that is part of a production chain; b) informal economy, aimed at understanding informal work as an economic activity that is not taxed; and c) informal work, considered an activity that goes between the lawful and the unlawful, the regulation and non-regulation of public authorities, but legitimate. There is no consensus among researchers and scholars on this topic about the best term or concept to designate work activities considered informal (Pamplona, 2013).

However, based on the understanding that the population that worked informally was not simply residual, in 2002, the ILO stated that informality is part of the dynamics of capitalism and permanently replaced the term “informal sector” with “informal economy”, indicating the importance of using the latter over the former. Furthermore, it begins to understand the informality processes at work as a “new informality”². The new informality is put forward to assert that informality now integrates the capitalist economic system in an interdependent manner (Organização Internacional do Trabalho, 2002).

In this sense, the existence of a relationship of tension between informality and the capitalist economic system is pointed out, because, while capitalism is hostage to the cheap labor of informal work, the same system can despise this type of work activity. The contempt or valuation of informal work by the institutions that make up the system has an opportunist nature, as it will depend on how much the merchandise or service will benefit these institutions (Misse, 2006).

Thus, there are several options to understand the informal, whether linking it to social vulnerability, unemployment, legality, criminality, flexibility, and entrepreneurship, or even the absence of regulation or social rights. However, regardless of the concept and term used, the informal etymologically refers to something that has no form. The lack of consensus or precision when describing informal work situations by itself expresses the condition of people who work informally (Cerqueira, 2017).

Although other nomenclatures and perspectives are used that seek to alleviate the precarious and unequal effects that this employment relationship has historically carried, it is considered that encouraging work that lacks rights and social protection is to support activities that can offer significant damage to the lives of the workers involved. A survey developed by the Perseu Abramo Foundation points out that:

This discourse of such entrepreneurship is one more form of the precariousness of work. This happens to workers in the suburbs, who are far from commercial centers and need to deal with the job market without any rights. This entrepreneur's discourse is for the State not having responsibility for public employment and income policies (Rede Brasil Atual, 2019).

Given this problematization, promoting the liberalization and flexibilization of bonds, presenting them as an alternative to the structural unemployment that affects capitalism, a traditionally excluding system, is a risk not only to health but to all dimensions of workers' lives.

It is also important to add that the flexibilization of work associated with the use of information and communication technologies (ICT) has been helping to disseminate work carried out through digital platforms or “smartphone applications”, a process called by some authors as “labourization” or “platform capitalism”. It is a new guise for the problem of outsourcing and intermittency.

Although from the perspective of legislation, work on platforms is currently considered informal, it is clear that the absence of legislation on it is deliberate by the companies, which seek to be free from the costs of protective responsibilities related to workers' rights. This activity has characteristics that would justify obtaining rights, as companies determine who will work, how much and when they will be paid for the work, what will be done, and even a grading system for clients. These and other aspects of the activity demonstrate that app workers are, in fact, salaried workers in disguise. In addition to not having the right to employee benefits, workers do not have the financial conditions to defend themselves in court due to the great economic and political influence of the companies that command the platforms (Souza, 2020). Thus, it is a mistake to discuss informality and work without critically analyzing those involved and the relationships and links between them, a necessary analysis to understand whether formalization does not happen just because it does not interest the owners of capital. Many informalities are the result of successful strategies to circumvent labor legislation.

Occupational Therapy and Workers: from the Beginning to the Contemporary

The arrival of Occupational Therapy in Brazil - a profession that traditionally arises in the United States - was marked by influences from the characteristics of the profession's founders. However, the profession has changed over time and has built theories and models of action aimed at Brazilian social and cultural needs. The purpose of rescuing here a little of the history of the profession is to understand how issues of work and workers were perceived over the years in Occupational Therapy. We will demonstrate below that the very emergence of Occupational Therapy takes place in the care and attention of the worker and is transformed from historical events, facing challenges in contemporary times.

We explain here two classic perspectives that try to delve deeper into the history of Occupational Therapy. The first of them tells that Occupational Therapy began in the United States, in 1915, with the foundation of the first school to teach Occupational Therapy in Chicago. Afterward, the “National Society for the Promotion of Occupational Therapy” was founded in 1917. The researchers are dedicated to telling this story quote some founders of the profession, such as Danton, Slagle, Barton, Johnson, and Kidner, explaining the concern of these pioneers with the scientificization of the profession and with the recognition of Occupational Therapy (Monzeli, 2019).

The actions that culminated in the foundation of a school to teach Occupational Therapy and a National Society for Occupational Therapy were based on the physical consequences of the First World War. From that moment on, it is said that the actions in Occupational Therapy were aimed at war soldiers and were based on the valorization of techniques that restored bodily movements lost in combat. The objective was to provide a return to work and the insertion of soldiers in other functions, based on the strong influence of the positivist current (Pinto, 1990).

On the other hand, some authors say that the emergence of Occupational Therapy occurred from another perspective. This perspective on history comes mainly from feminist studies on Occupational Therapy, which point to women as protagonists in the history of the profession (such as Adams, Lathrop, and Slagle). However, due to a need to increase the scientific rigor of the profession, their ideas were downsized and replaced by those mentioned above. Based on ideas by Lathrop and Adams, developed at Hull House³ since 1908, Slagle initially helped to think about Occupational Therapy in a social, critical, and community way (Monzeli, 2019;Melo, 2015).

In Brazil, the first Occupational Therapy service was founded operated at the Hospital das Clínicas of the University of São Paulo and briefly treated injured workers who needed to recover physically to return to their productive activities. In this context, specific physical rehabilitation techniques were used (Lancman, 2004). With this context, we intend to point out that interventions aimed at work issues, for Occupational Therapy, date from the beginning of the profession, both in the world and in Brazil. The profession arises from work and to solve problems arising from work.

From the construction of movements for the democratization of health that took place in Brazil, mainly in the 1970s, called Health Reform, Occupational Therapy was one of the professions that changed its practices related to work issues. The Health Reform changed the practices of many professions, which were renewed, centered on a context that, at the time, was called worker's health (Gomez et al., 2018).

Workers' health, in general, emerged from reflections on collective health, carried out through Marxist currents that problematized working conditions and disseminated the importance of worrying - before intervening in the face of pathologies caused by work, as did the Occupational Medicine – with work environments and bonds, in the sense of preventing illnesses (Santana & Silva, 2008).

With the advent of the Unified Health System in Brazil, in 1990, the National Network for Comprehensive Care for Workers' Health (Rede Nacional de Atenção Integral à Saúde do Trabalhador - RENAST) emerged in 2002. RENAST became responsible mainly for surveillance, health promotion, and prevention of diseases, in work environments, in the Brazilian public health system (Brasil, 2009). Occupational therapists started to be inserted in the RENAST devices and the health teams; it was from this insertion that practices began to consider health as dependent on working conditions, understanding that one only changes along with the other (Lancman, 2004).

However, we point out here the important role of Occupational Therapy in the Brazilian Social Security system, since 1999, through the Professional Rehabilitation Program (Programa de Reabilitação Profissional - PRP) (Brasil, 1999)⁴. It is important to emphasize that occupational therapists do not carry out health practices in these spaces (Bregalda & Lopes 2013). Thus, it is clear that the profession's actions in the labor issues in Brazil have not been restricted to the health sector and its devices for a long time.

In the first decade of the 2000s, we indicated an emphasis on Occupational Therapy practices aimed at work and income generation groups, as well as cooperatives. The objective of these practices has been to provide the inclusion in the work of people with psychological distress, who do not have legislation to do so (Lussi et al., 2010), and the work of the occupational therapist is not based on specific health interventions, although there is the link between work generation groups and health devices.

Also the Occupational Therapy and professional actions aimed at understanding work and the worker, we can mention the contributions of the profession in the insertion of the homeless population into work or even in the search for more worthy trajectories of income supplementation, through provisions of the Unified Social Assistance System (Sistema Único de Assistência Social - SUAS) and educational institutions (Lopes et al., 2014). However, these devices are not specialized in understanding the environments, bonds, and working conditions, as they aim to offer programs, projects, services, and benefits to individuals and families in situations of social vulnerability, a situation that does not apply to all workers informal.

The practices mentioned above clearly demonstrate that the role of the profession with workers for a long time has not been restricted to those who specifically focused on the recovery of bodily movements and physical health. However, these have not been addressing the complexity of informal workers either.

We consider that, despite the health area having been, in Brazil and the world, very important for the consolidation of Occupational Therapy as a profession, we argue that the profession is both due to its diverse historical constitution and to the transformations that practices have undergone over the decades ‒ it is not strictly focused on the subjects' health needs. Occupational therapy is dedicated to understanding people's lives and daily lives, as well as the issues surrounding these dimensions, which permeate the various areas of knowledge. Thus, it can be characterized as a profession that strongly articulates the different areas of knowledge in its theoretical construction and, consequently, the different sectors in their professional practices.

However, Silva et al. (2016) analyzed the literature on Occupational Therapy and occupational health in national journals of the profession and pointed out that 27% of the articles specifically discuss repetitive strain injuries (RSI). This discovery reinforces the strong connection between the profession and discussions about physical illnesses, demonstrating that this relationship is still current. The other articles found (73%) in the cited study are divided into the discussion of themes such as worker health, ergonomics, mental health, professional rehabilitation, accidents, and the insertion of people with disabilities into work.

As occupational therapists, we emphasize the importance of professionals involved in the care and attention to workers to approach new work contexts to understand the doing, daily life, demands, and needs of contemporary workers. The current political moment in Brazil gives rise to such professional reflections, as the incidence of new types of employment contracts in the country has increased, while the government is disrupting the pillars of social security.

Occupational Therapy and Informal Work: Notes on Possible Paths

Given the historical trajectory presented, we question here whether it is possible to point out that Occupational Therapy practices, especially those cited as traditional and historical, have been sufficient to meet the demands of informal workers. We still question whether, currently, it is possible to know what these demands are. We understand that discussing these issues is essential for informal workers to benefit from activities in Occupational Therapy, and for occupational therapists to be able to expand their practices, especially those with workers as protagonists.

In 2015, COFFITO released Resolution number 459, which provides for the competencies of occupational therapists in Occupational Health, considering that the professional works in programs of inclusive strategies, prevention, protection, and health recovery. However, some research and practice professionals who focus on Occupational Therapy and understanding the world of work have focused their interventions on social inclusion.

In the context of transforming needs in mental health care, the creation of associations and cooperatives that promote social inclusion through work through the solidarity economy is encouraged. From this perspective, work is conceived as one of the rights of people with psychological distress. Work organized along the lines of self-management, one of the fundamental principles of the solidarity economy, contributes to the emancipation of people and collectives, including in the sense of awareness and struggle for their rights as workers (Morato & Lussi, 2015). However, the solidarity economy practices in which Occupational Therapy occupies an important place include, mainly, mental health users, and no other workers who are vulnerable to informal work.

Other practices that can be mentioned are those that seek to think and develop strategies that help make the life trajectory of populations with little access to fundamental rights more dignified. Regarding interventions, they are generally directed to the Unified Social Assistance System (Sistema Único de Assistência Social - SUAS), in which Occupational Therapy has operated since 1970 (although its practices have been recognized as important by the National Council for Social Assistance as of 2011) and to educational institutions (Lopes & Malfitano, 2016).

However, we point out that informal work is not only linked to the lives of people from classes considered poor or minority, even though these classes are those who experience the most precarious forms of informal work. Even though informal work is the result of material conditions that produce inequality provided by capitalism, it must also be considered that there is a subjective need that makes some workers opt for informal work over other links. These workers end up convinced that working for themselves has more social value than being employed, even if that means less legal protection. In addition, the low pay of some formal jobs leads workers to abandon opportunities that guarantee rights.

In short, we consider that the actions of the profession with workers historically constructed are currently broader and more intersectoral than those carried out in the early days of the profession in Brazil. However, these still do not necessarily contemplate the diversity and specificities of informal workers.

About the places of action and the necessary articulations in practices with a focus on deregulated work is linked to health, education, social security, and social assistance, but necessarily in an intersectoral manner and articulated with the Public Ministry of the Work, unions, associations, social movements and other devices that include the particularities of informal workers such as youth secretariats and coordinators in the case of young workers, for example.

Interventions can focus on processes of insertion and permanence in work; access/information/understanding about workers' rights; and in the construction of more dignified, fairer life projects/paths aimed at the individuals' desires (Souza, 2020). Practices can have an individual or collective focus, with the group strategy being widely used in the latter case. Thus, the interviews, techniques, assessments, and reassessments are intertwined with the articulations carried out in favor of the construction of life projects, “[...] listening, welcoming, dialogic encounter, social and network articulation” (Galheigo, 2020, p. 14)

Regarding the general practical actions that could be taken to start the construction of actions more focused on the specificities of informal workers in these devices, it is pointed out as important for the teams: a) getting closer to the places where this work takes place (from the scope private to public space); b) identify the types of informal work and their specificities; c) identify the different profiles of the populations involved in these activities; d) apprehend the trajectories/life stories of workers, seeking to understand the roots of their insertion and permanence in informal activities; e) identify with workers what their demands are, to provide greater well-being and more dignified life trajectories; f) identify the sectors and professions involved in meeting the demands of this population.

Such issues are fundamental so that, together with workers, it is possible to (re)think of new professional networks and actions, necessary in light of the current situation in Brazil. We understand that it is challenging to operationalize approaches to these workers, as informal work may not be linked to specific institutions or sectors. Approaching informal work is also approaching different physical environments, which can be closed shopping centers, public spaces – such as city streets – or even houses/rooms of workers who call themselves autonomous, liberal, or entrepreneurs.

It is important to point out the role of Higher Education Institutions in this approach, since, from the results of research on the subject, it is possible to obtain data that would help to (re)elaborate the network and new professional strategies/practices aimed at workers in contemporary Brazil, including informal ones. Ethnographic research, for example, as it can provide the researcher/professional with contact with real work experience, constitutes an interesting methodological framework to help think about the needs of workers. Understanding that the worker is a central actor in intervention processes in the field of work, it is necessary that, during these approximation researches, the experience, opinion, daily life, and way of life of the individuals must be respected and valued since they accompany and constitute the processes of illness at and through work (Jacques, 2003).

Faced with a new political, economic and social situation, we point out once again as necessary (re)thinking how the care network works for the worker, especially in the field of worker health, since conventional models do not have proven to be sufficient (Uchôa-de-Oliveira, 2020), especially to meet the demands of informal workers.

Practices that reach informal workers would only cease to be utopian based on community, political and critical approaches. The health, education, social assistance, and welfare teams must be prepared to understand work as a social determinant and to articulate across sectors to provide transformative actions to the detriment of palliatives, which continue to provide for the maintenance of inequalities and the exploitation of man for the work.

However, we highlight some challenges such as the lack of funding in general since the foundation of all networks and devices aimed at the needs of workers, as well as the little interest of political leaders in their functioning, something common in neoliberal governments. It is clarified that the existing experience and literature on Occupational Therapy and work should in no way be discarded. We affirm that the process of designing new theoretical approaches and possibilities for actions must include what has already been done and reported. We believe that theoretical principles and practices traditionally used are fundamental to help think about new demands.

Therefore, we understand that occupational therapists must carry out articulating, political and critical practices, understanding the importance of actions aimed at disseminating information in the field of work and law and helping in the process of awareness of workers inserted in the capitalist mode of production, always in the sense to favor social participation, the exercise of sociability, the construction of the identity of these workers and their understanding as a class.

Successive changes in legislation have not been finalized. We understand that these changes compromise the achievement of intersectoriality, a strategy that we consider to be the key point for professional practices in the work area (Barros et al., 2020). Changes continue to occur; in addition to thinking about new practices in the profession, we argue that the engagement and political articulation of professionals who work in the field of work is necessary, who must also think about the importance of the emancipation of informal workers. These are preliminary reflections on the subject that aim to support broader practices in the field of work and new research on the subject.

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  The precariousness concept developed by Vargas (2016) is used here. According to this perspective, precarious work activity is always precarious in something: social status of work and presence/absence of labor rights; objective work conditions such as the work environment and the instruments used; and subjective work conditions. As such, not every precarious work activity is necessarily informal work. However, based on this reflection, all informal work activity in Brazil is precarious. The absence of a formal employment relationship necessarily restricts workers' labor rights and social protection (precariousness in terms of social work conditions).
• 2
  The “new informality” incorporates into informal work the dynamics of globalized capitalism, both in developed countries and in those considered to be developing. This concept refers to "changes related to economic deregulation, the flexibilization of labor relations and the deterritorialization of production and the internationalization of markets, in which the relations between the formal economy and the informal economy form a continuum with imprecise borders" (Lima, 2013, p. 330, our translation).
• 3
  Hull House was created in Chicago in 1889 by Jane Addams and Ellen Gates Starr, who were socialists and social activists. The purpose of Hull House was to receive immigrants who arrived with difficulties from various parts of the European continent. This institution was focused on expanding women's social participation in different fields to strengthen a female political force (Melo, 2015; Jara, 2011). “The Hull House activists have held several strategic positions in public and private institutions with the aim of promoting social rights to all groups, especially marginalized groups subjected to controversial actions of the State - such as immigrants” (Melo, 2015, p. 27).
• 4
  The Professional Rehabilitation Program is promoted by the Brazilian Social Security Institute and aims to guide, insert, or reinsert workers in the labor market. Insertion begins when there is a stabilized and/or long-term labor restriction, caused by some type of illness (related or not to work activity) and works through some steps that are, above all, based on increasing the education of workers and on expansion of the range of possibilities in the labor market (Brasil, 1999).
• How to cite: Souza, M. B. C. A., & Lussi, I. A. O. (2022). Terapia Ocupacional e trabalho informal: reflexões para a prática. Cadernos Brasileiros de Terapia Ocupacional, 30, e2901. https://doi.org/10.1590/2526-8910.ctoAO21902901

Referências

• Barros, J. O., Daldon, M. T. B., Rocha, T. O., Sznelwar, L. I., & Lancman, S. (2020). Intersetorialidade em saúde e trabalho no contexto atual brasileiro: utopia da realidade? Interface, 24, 1-14. http://dx.doi.org/10.1590/Interface.190303
  » http://dx.doi.org/10.1590/Interface.190303
• Brasil. (1999, 06 de maio). Decreto-Lei nº 3048/1999, de 06 de maio de 1999. Regulamenta a Previdência Social brasileira e define as atribuições da Reabilitação Profissional. Diário Oficial [da] República Federativa do Brasil, Brasília. Recuperado em 09 de maio de 2020, de http://www.planalto.gov.br/ccivil_03/decreto/d3048.htm
  » http://www.planalto.gov.br/ccivil_03/decreto/d3048.htm
• Brasil. (2009, 11 de novembro). Portaria nº 2.728, de 11 de novembro de 2009. Dispõe sobre a Rede Nacional de Atenção Integral à Saúde do Trabalhador (Renast). Diário Oficial [da] República Federativa do Brasil, Brasília. Recuperado em 9 de maio de 2020, de http://bvsms.saude.gov.br/bvs/saudelegis/gm/2009/prt2728_11_11_2009.html
  » http://bvsms.saude.gov.br/bvs/saudelegis/gm/2009/prt2728_11_11_2009.html
• Brasil. (2017, 13 de julho). Lei nº 13.467, de 13 de julho de 2017. Altera a Consolidação das Leis do Trabalho (CLT), aprovada pelo Decreto-Lei nº 5.452, de 1º de maio de 1943, e as Leis nos 6.019, de 3 de janeiro de 1974, 8.036, de 11 de maio de 1990, e 8.212, de 24 de julho de 1991, a fim de adequar a legislação às novas relações de trabalho. Diário Oficial [da] República Federativa do Brasil, Brasília. Recuperado em 05 de maio de 2020, de https://legis.senado.leg.br/norma/17728053/publicacao/17728664
  » https://legis.senado.leg.br/norma/17728053/publicacao/17728664
• Brasil. (2019, 11 de novembro). Medida Provisória nº 905, de 11 de novembro de 2019 (Revogado pela Medida Provisória nº 955, de 2020). Diário Oficial [da] República Federativa do Brasil, Brasília. Recuperado em 05 de maio de 2020, de http://www.planalto.gov.br/ccivil_03/_ato2019-2022/2019/Mpv/mpv905.htm
  » http://www.planalto.gov.br/ccivil_03/_ato2019-2022/2019/Mpv/mpv905.htm
• Bregalda, M. M., & Lopes, R. E. (2013). A atuação dos terapeutas ocupacionais no Instituto Nacional do Seguro Social. In A. P. Simonelli & D. S. Rodrigues (Orgs.), Saúde e trabalho em debate: velhas questões, novas perspectivas (pp. 225-239). Brasília: Paralelo 15.
• Cavallini, M. (2019). Governo apresenta programa de estímulo ao emprego; veja ponto a ponto G1 Portal de Notícias. Recuperado em 05 de maio de 2020, de https://g1.globo.com/economia/noticia/2019/11/11/governo-apresenta-programa-de-estimulo-ao-emprego-veja-ponto-a-ponto.ghtml
  » https://g1.globo.com/economia/noticia/2019/11/11/governo-apresenta-programa-de-estimulo-ao-emprego-veja-ponto-a-ponto.ghtml
• Cerqueira, E. S. (2017). Considerações acerca do conceito de informalidade. Revista Produção Acadêmica, 3(1), 123-133.
• Galheigo, S. M. (2020). Terapia Ocupacional, cotidiano e a tessitura da vida: aportes teóricoconceituais para a construção de perspectivas críticas e emancipatórias. Cadernos Brasileiros de Terapia Ocupacional, 28(1), 5-25. http://dx.doi.org/10.4322/2526-8910.ctoAO2590
  » http://dx.doi.org/10.4322/2526-8910.ctoAO2590
• Goldberg, A. (2014). Contextos de vulnerabilidad social y situaciones de riesgo para la salud: tuberculosis en inmigrantes bolivianos que trabajan y viven en talleres textiles clandestinos de Buenos Aires. Cuadernos de Antropología Social, (39), 91-114. http://dx.doi.org/10.34096/cas.i39.1287
  » http://dx.doi.org/10.34096/cas.i39.1287
• Gomez, M. C., Vasconcellos, L. C. F., & Machado, J. M. H. (2018). Saúde do trabalhador: aspectos históricos, avanços e desafios no Sistema Único de Saúde. Ciência & Saúde Coletiva, 23(6), 1963-1970.
• Jacques, M. G. C. (2003). Abordagens teórico-metodológicas em saúde/doença mental & trabalho. Revista de Psicología Social, 15(1), 97-116.
• Krein, J. D. (2018). O desmonte dos direitos, as novas configurações do trabalho e o esvaziamento da ação coletiva Consequências da reforma trabalhista. Tempo Social: Revista de Sociologia da USP, 30(1), 77-104.
• Lancman, S. (2004). Saúde, trabalho e Terapia Ocupacional. São Paulo: Roca.
• Lima, J. C. (2013). A nova informalidade. In A. B. L. Ivo (Coord.), Dicionário temático Desenvolvimento e Questão Social: 81 problemáticas contemporâneas (pp. 330-336). São Paulo: Annablume.
• Lima, J. C., & Junior, A. M. (2018). Mobilidades diferenciadas e ilegalidades institucionalizadas: Tendências e contradições do trabalho na contemporaneidade. Tempo Social: Revista de Sociologia da USP, 30(1), 31-51
• Lima, J. C., & Soares, M. J. B. (2002). Trabalho flexível e o novo informal. Caderno CRH, 37(3), 163-180.
• Lopes, R. E., & Malfitano, A. P. S. (2016). Terapia Ocupacional Social: desenhos teóricos e contornos práticos São Paulo: EdUFSCar.
• Lopes, R. E., Malfitano, A. P. S., Silva, C. R., & Borba, P. L. O. (2014). Recursos e tecnologias em Terapia Ocupacional Social: ações com jovens pobres na cidade. Cadernos de Terapia Ocupacional da UFSCar, 22(3), 591-602. http://dx.doi.org/10.4322/cto.2014.081
  » http://dx.doi.org/10.4322/cto.2014.081
• Lussi, I. A. O., Matsukura, T. S., & Hahn, M. S. (2010). Reabilitação psicossocial: oficinas de geração de renda no contexto da saúde mental. O Mundo da Saúde, 34(2), 284-290.
• Melo, D. O. C. V. (2015). Em busca de um ethos: narrativas da fundação da Terapia Ocupacional em São Paulo (1956-1969) (Dissertação de mestrado). Universidade Federal de São Paulo, São Paulo.
• Misse, M. (2006). O Rio como um bazar: a conversão da ilegalidade em mercadorias políticas. In M. Misse (Org.), Crime e violência no Brasil contemporâneo: estudos de sociologia do crime e da violência urbana (pp. 211-228). Rio de Janeiro: Lumen Juris.
• Monzeli, G. A. (2019). Histórias da Terapia Ocupacional na América Latina: processos de criação dos primeiros programas de formação profissional (Tese de doutorado). Universidade Federal de São Carlos, São Carlos.
• Morato, G. G., & Lussi, A. O. I. (2015). Iniciativas de geração de trabalho e renda, economia solidária e Terapia Ocupacional: aproximações possíveis e construções necessárias. Cadernos de Terapia Ocupacional da UFSCar, 23(4), 733-745. http://dx.doi.org/10.4322/0104-4931.ctoAO0737
  » http://dx.doi.org/10.4322/0104-4931.ctoAO0737
• Nascimento, A. H. G., & Souza, M. B. C. A. (2018). Ergonomia e postos de trabalho: análise do ambiente de trabalho de professores da Universidade Federal da Paraíba de acordo com a NR17. Revista Interinstitucional Brasileira de Terapia Ocupacional, 2(3), 567-583.
• Noronha, E. G. (2003). “Informal”, ilegal, injusto: percepções do mercado de trabalho no Brasil. Revista Brasileira de Ciências Sociais, 18(53), 111-179.
• Organização Internacional do Trabalho – OIT. (2002). Decent Work and the informal economy. In Annals of 90th session International Labour Conference Geneva: ILO.
• Pamplona, J. B. (2013). Mercado de trabalho, informalidade e comércio ambulante em São Paulo. Revista Brasileira de Estudos de Populacao, 30(1), 225-24.
• Pinto, J. M. (1990). As correntes metodológicas em Terapia Ocupacional no Estado de São Paulo (1970 - 1985) (Dissertação de mestrado). Universidade Federal de São Carlos, São Carlos.
• Rede Brasil Atual. (2019). Não existe empreendedorismo, mas gestão da sobrevivência’, diz pesquisadora: São Paulo Recuperado em 20 de maio de 2020, de https://www.redebrasilatual.com.br/
  » https://www.redebrasilatual.com.br/
• Salati, P. (2020). MP do contrato Verde e Amarelo foi revogada: como fica a situação dos trabalhadores? G1 Portal de Notícias, publicado por “Economia”. Recuperado em 02 de junho de 2020, de https://g1.globo.com/economia/noticia/2020/04/23/mp-do-contrato-verde-e-amarelo-foi-revogada-como-fica-a-situacao-dos-trabalhadores.ghtml
  » https://g1.globo.com/economia/noticia/2020/04/23/mp-do-contrato-verde-e-amarelo-foi-revogada-como-fica-a-situacao-dos-trabalhadores.ghtml
• Santana, V. S., & Silva, J. M. (2008). Os 20 anos da saúde do trabalhador no Sistema Único de Saúde do Brasil: limites, avanços e desafios. Brasília: Ministério da Saúde.
• Silva, F. N. M., Vendrúsculo-Fangel, L. M., & Rodrigues, D. S. (2016). A Terapia Ocupacional e a saúde do trabalhador: panorama de produção bibliográfica. Cadernos de Terapia Ocupacional da UFSCar, 24(2), 351-361. http://dx.doi.org/10.4322/0104-4931.ctoAR0604
  » http://dx.doi.org/10.4322/0104-4931.ctoAR0604
• Silveira, D., & Alvarenga, D. (2019). Trabalho informal avança para 41,3% da população ocupada e atinge nível recorde, diz IBGE G1 Portal de Notícias, publicado por “Economia”. Recuperado em 02 maio de 2020, de https://g1.globo.com/economia/noticia/2019/08/30/trabalho-informal-avanca-para-413percent-da-populacao-ocupada-e-atinge-nivel--recorde-diz-ibge.ghtml
  » https://g1.globo.com/economia/noticia/2019/08/30/trabalho-informal-avanca-para-413percent-da-populacao-ocupada-e-atinge-nivel--recorde-diz-ibge.ghtml
• Souza, M. B. C. A. (2020). Juventudes trabalhadoras, uberização e precarização da vida: contribuições para o campo do trabalho e da Terapia Ocupacional (Tese de doutorado). Universidade Federal de São Carlos, São Carlos.
• Uchôa-de-Oliveira, F. M. (2020). Saúde do trabalhador e o aprofundamento da uberização do trabalho em tempos de pandemia? Revista Brasileira de Saúde Ocupacional, 45(e22), 1-8.
• Vargas, F. B. (2016). Trabalho, Emprego, Precariedade: dimensões conceituais em debate. Caderno CRH, 29(77), 313-331.

Edited by

Section editor

Prof. Dr. Nilson Rogerio Silva

Publication Dates

• Publication in this collection
  14 Jan 2022
• Date of issue
  2022

History

• Received
  11 Nov 2020
• Reviewed
  31 May 2021
• Accepted
  20 Aug 2021