What is the contribution of occupational therapy to face the effects of the centrality of labor on the time and lives of workers?

Workers’ health has developed from occupational health, while at the same time criticizing its concepts, methods, and practices^{c 1}. What remains common is the occupation, understood as work, that may explain the illness and health production of the workers involved.

While occupational health is applied in the private world of companies and institutions, workers’ health has public¹,², comprehensive nature and is aligned with the premises of the Unified Health System (SUS). Workers’ health implies a form of engagement, driven by “a commitment to changing the intricate health situation of the working population [...] its fundamental pillar, which involves political, legal, and technical action as well as ethical positioning”²(p. 24). However, given the countless institutional, organizational, and political obstacles that hinder public action to protect workers, it can be seen as a civilizational utopia³.

In any case, work - as a determinant and locus for understanding health problems and as an object of transformation through prevention and surveillance actions - is central to professionals in the field⁴,⁵, both in practice and in research.

Nevertheless, the possibility of intervening to increase the power to act that workers⁴, and that health and safety professionals themselves, including those in companies, have to build prevention in workplaces, seems to be diminishing in the face of the managerialist phenomenon that underpins both the processes of intensification at work and those of control and limitation of workers’ autonomy, and is therefore associated with the growth of violence in professional relationships⁶.

Well, what seems to be at stake in this model of management based on pressure or targets is the control and exploitation of time, the various types of time, needed to do the job, and also for its effectiveness and quality, which gives meaning to what is done at work⁷,⁸. By suppressing learning time, exchanges between peers, etc., management only considers one type of time that interests it: that of production. In this deadlock, the way out for workers, to give new meaning to their work and to protect their health, depends on a new “ecology of working times”⁸(p. 22). After all, “times” have different values and functions for each person and group. It seems fundamental to be able to act to “temporalize time”, in other words, for everyone to be able to create their own time, giving meaning to what they do and integrating both external and internal demands into the work activity, and favoring the construction of health⁸ (p. 24).

For most workers, including those in management, lack of time is a common variable that must be experienced by everyone, at all levels. Although “white collar” workers may have more autonomy to make decisions, organizational demands and internal and external interactions can constrain and limit their autonomy, as well as their time availability, also putting their health at risk⁹. Now, if time “vanishes into thin air”, if it “slips out of our hands”, how can we do what we are always supposed to do on an urgent basis? What’s the point of working without the necessary time?

Similarly, we see the extension of working hours, through overtime, which takes away workers’ free time and invades their personal and family lives, causing various health impacts.

Also serious is the situation of workers with precarious contracts, legitimized by the labor reform, who have little wiggle room when defining their working and living hours¹⁰. Nothing is more common than for an app worker to work for more than 12 hours non-stop.

The alarming increase in mental health problems in various sectors of the economy is linked to the current managerialism, which takes away people’s time and limits their operational leeway⁸, including in their private lives.

Now, if we go back to the definition of health proposed by Dejours¹¹in the 1980s, according to which people’s health depends on the possibility of building a personal project in which work plays a central role, it is worth questioning whether it is currently possible to maintain work as a positive factor in building health.

If the impediments to intervention at work seem evident, why not also consider other spaces, other activities of workers, other occupations for the construction of their personal project and their health? It is important to verify the influence of work, and the time spent in other spheres of life, to have as an object a system of activities, not just centered on work⁸. A recent study of health professionals showed better health indicators among those who engaged in other activities or occupations outside of work¹².

However, interventions aimed at assistance and professional rehabilitation, in general, even when designed in a comprehensive way, take little account of the development of other forms of occupation in the process, even for workers who must retire due to disabilities, for example. The principle followed is to “retrain workers” for the labor market. The economic logic predominates, with reinsertion being the main solution to be adopted. Only the “occupation” of work is considered.

Why are other occupations that human beings engage in not considered? As far as health is concerned, shouldn’t the search for a better balance between people’s various “occupations” become the object of health care actions, forming part of workers’ individual projects?

It would appear that occupations that are significant^d but do not necessarily produce economic value do not have the same importance in today’s society.

In this sense, occupational therapy (OT) must be called upon, a discipline whose adjective originated in the name occupation does not exclusively mean “work”, which studies the relationship between human occupations with a view to people’s development and health¹³.

The perspectives and contributions of occupational therapy

For OT, individuals engage in occupations (those they want to do and those they need to do), characterized as all the activities we engage in throughout our days and, consequently, throughout our lives¹³. It is understood that occupations are fundamental to the formation of identity and the promotion of structure in people’s lives. To this end, it is worth highlighting the term «occupation”, which refers to life activities that can be carried out individually, as a family, or in communities, to fill (occupy) time and bring meaning and purpose to life¹⁴.

These occupations change in their characteristics and/or intensity throughout life. They change with the passing of stages, determined by life cycles - which are directly influenced by chronological age - or by events that alter or add occupational roles to the individual’s journey.

Occupational roles correspond to the “set of behaviors expected by society and shaped by culture and context; they may be further conceptualized and defined by a person, group, or population”¹⁵(p. 12). It is an aspect of occupational identity, as it defines what people, groups, or a given population believe they are, based on their occupational experiences and future prospects¹³.

Some occupational roles are associated with specific activities and occupations, such as student, mother, father, wife, husband, child, worker, among others. It is common for us to play several occupational roles simultaneously at certain times in our lives. Occupational roles or sets of roles are socially expected at different stages throughout life. Each occupational role is made up of a set of occupations, which are formed or structured into activities, which in turn are subdivided into tasks. We can therefore say that the occupational roles we play at any given time partly define our routine and make up the set of activities that determine our habits.

Thinking about the balance of these roles - and consequently of occupations - would mean thinking about better health and well-being conditions, as proposed by Adolf Meyer in 1922, i.e. a balanced distribution between work, rest, leisure, and sleep is fundamental for men and women to participate more effectively in the world¹⁴. This is the foundation of OT, for which the notion of occupation is central, as it refers to what one does, gives meaning to life, and favors recognition by others¹⁴.

Among occupations, work stands out as the main occupation expected by society to be carried out in adulthood, which ensures purpose and social participation. From the perspective of OT, work can be understood as an occupation, paid or unpaid^e, that involves the development, production, delivery, or management of objects or services¹³.

Although working - in capitalist society - is the main occupation in the adult life cycle, associated with personal fulfillment¹⁵, it is not the only occupation performed in this cycle and should ideally be balanced with the other occupations we need or want to perform: leisure, physical activity^f, health management, activities of daily living or instrumental activities of daily living, rest and sleep, education, and social participation (Table 1).

Table 1
Occupational categories

Occupations	Contexts	Performance patterns	Performance skills	Client factors
Activities of daily living Instrumental activities of daily living Health management Rest and sleep Education Work Leisure Social participation	Environmental factors Personal factors	Habits Routines Roles Rituals	Motor skills Process skills Social interaction skills	Values, beliefs, and spirituality Body functions Body structure

To have well-being, pleasure, and health, we need to perform meaningful activities. However, the criterion for the significance of an occupation in a person’s life is singular, unique, and individual. In the case of adults, this meaningful activity may or may not be work, which may just be an occupation to be performed (due to financial need, for example), albeit an unwanted one.

The start of a new occupational role in life can change the importance of the roles played previously and consequently of the occupations, as well as the time spent and the person’s engagement in each occupation. A person, for example, who used to work as their main occupation, after having a child, may change it, temporarily or permanently, to look after their child to the detriment of spending their time on their professional career.

Nevertheless, in general, societies value work differently from other occupations, and it takes up more time in the lives of workers^g. From the point of view of social demands, people’s need for acceptance, belonging, or recognition, there is an imbalance between occupations and roles.

Also, sometimes the impossibility of ending participation in work or its impacts means that people don’t participate effectively in another occupation. Let’s consider the case of an elderly person who wants to exercise their occupational role as a grandparent and needs, due to the economic conditions imposed, to continue working. Or someone who has dedicated themselves excessively to work, to the detriment of their social participation, when their work activities come to an end (retirement, for example) may find themselves living in loneliness because, throughout their adult life, they have not cultivated social relationships outside the professional environment.

OT practices make it possible to analyze the occupations in which people are engaged, check their suitability, distribution, significance, balance, or imbalance and correlate them with health and well-being processes. They can thus analyze the imbalance that the work occupation has caused in a person’s life and its consequences, and help them in their search for greater personal agency and balance^h.

In view of the significant increase in mental health problems, it is essential to put workers who are ill at work in front of the “mirror of their occupations”, so that they can reflect on their power to act now and in the future, seek more balance in their various occupations, and build a life project in search of health and well-being¹¹.

Final comments

OT questions and relativizes the supremacy of work over other occupations, since it recognizes the importance of balance in the various occupations and roles as a determining factor in health and development.

Finally, we hope to contribute to the question, which has not been explored in depth in the field of workers’ health, about the weight of the centrality of work to the detriment of other occupations that are essential for living, and how this affects workers. The current social debate around the six-day working week is due to the perception of part of the workers group that work is invading their lives.

References

• ¹ Mendes R, Dias EC. Da medicina do trabalho à saúde do trabalhador. Rev Saude Publica. 1991 Oct;25(5):341-9. https://doi.org/10.1590/S0034-89101991000500003
  » https://doi.org/10.1590/S0034-89101991000500003
• ² Minayo-Gomez C, Thedim-Costa SM. A construção do campo da saúde do trabalhador: percurso e dilemas. Cad Saude Publica. 1997;13 Supl. 2:S21-32. https://doi.org/10.1590/S0102-311X1997000600003
  » https://doi.org/10.1590/S0102-311X1997000600003
• ³ Vasconcelos LC. Saúde do trabalhador como direito humano viabilizando uma utopia civilizatória. In: Oliveira MHB, Vasconcellos LCF, Vianna MB, organizadores. Direitos humanos e saúde: refletindo sobre as dores e esperança. São Paulo: Hucitec; 2024. p. 151-65.
• ⁴ Jackson Filho JM, Pina JA, Vilela RG, Souza KR. Desafios para a intervenção em saúde do trabalhador. Rev Bras Saude Ocup. 2018;43 Supl.1:e13s. https://doi.org/10.1590/2317-6369ap0141218
  » https://doi.org/10.1590/2317-6369ap0141218
• ⁵ Jackson-Filho JM. Perspectivas da nova segurança. Rev Bras Saude Ocup. 2022;47:e22. https://doi.org/10.1590/2317-6369ed222pt2022v47e22
  » https://doi.org/10.1590/2317-6369ed222pt2022v47e22
• ⁶ Metzger JL, Maugeri S, Benedetto-Meyer M. Predomínio da gestão e violência simbólica. Rev Bras Saude Ocup. 2012;37(126):225-42. https://doi.org/10.1590/S0303-76572012000200005
  » https://doi.org/10.1590/S0303-76572012000200005
• ⁷ Miraglia M, Russo SD, Bouville G. The hazards of performance management: an investigation into its effects on employee absenteeism and presenteeism. Hum Relat. 1 set 2024. https://doi.org/10.1177/00187267241274619
  » https://doi.org/10.1177/00187267241274619
• ⁸ Gaudart C, Volkoff S. Le travail pressé: pour une écologie des temps du travail. Paris: Les Petits Matins; 2022.
• ⁹ Väänänen A, Toivanen M. The challenge of tied autonomy for traditional work stress models. Work Stress. 2018;32(1):1-5. https://doi.org/10.1080/02678373.2017.1415999
  » https://doi.org/10.1080/02678373.2017.1415999
• ¹⁰ Cordeiro R, Assunção AA. Saúde e trabalho: novos tempos, novos paradigmas. Cad Saude Publica. 2024 Feb;40(2):e00176323. https://doi.org/10.1590/0102-311xen176323
  » https://doi.org/10.1590/0102-311xen176323
• ¹¹ Dejours C. Por um novo conceito de saúde. Rev Bras Saude Ocup. 1986;14(54):7-11.
• ¹² Rocha SV, Cardoso JP, Correia RA, Silva NN, Araújo TM. Atividades de lazer e transtornos mentais comuns entre médicos de municípios baianos. Rev Bras Saude Ocup. 2024;49:e14. https://doi.org/10.1590/2317-6369/15122pt2024v49e14
  » https://doi.org/10.1590/2317-6369/15122pt2024v49e14
• ¹³ Gomes M, Teixeira L, Ribeiro J. Enquadramento da prática de terapia ocupacional: domínio & processo. 4a ed. American Occupational Therapy Association; 2021.
• ¹⁴ American Occupational Therapy Association (AOTA) Occupational Therapy Practice Framework: Domain and Process - Forth Edition. American Journal of Occupational Therapy, 2020, 74(sup. 2): 1-87.
• ¹⁵ Kielhofner G. Modelo de ocupación humana: teoría y aplicación. 3a ed. Buenos Aires: Médica Panamericana; 2004.

• Data availability:
  The authors declare that all the data supporting this discussion has been published in the text itself.
• Presentation at a scientific event:
  The authors declare that the study has not been presented at a scientific event.
• c
  In Brazil, the field of workers’ health is distinct from occupational health; what is not common in other countries.
• d
  These are occupations that have meaning for people, that relate to their goals, interests, and needs, and that contribute to their development and well-being. These can be basic self-care tasks as well as leisure, work, study, and social activities.
• e
  For OT, a voluntary activity is considered “work”.
• f
  In the original, play is mentioned.
• g
  It is assumed that, throughout history, people’s relationship with work has changed: if, in ancient times, people worked to survive, later they began to work to live and, nowadays, people live to work. This can be explained by a certain “ideology of work”, influenced by significant changes in social, economic, technological, and production relations.
• h
  In the ongoing research - Work as an occupation, its meaning and impact on people’s lives - the Occupational Analysis Tool (OAT) is being developed, the purpose of which is to propose a representation of the time distribution spent by people in their occupations over a period of days.
• Funding:
  The authors declare that the work was not subsidized.

Edited by

• Editor-in-chief:
  Leila Posenato Garcia

Data availability

The authors declare that all the data supporting this discussion has been published in the text itself.

Publication Dates

• Publication in this collection
  15 Sept 2025
• Date of issue
  2025

History

• Received
  14 Apr 2025
• Reviewed
  21 May 2025
• Accepted
  23 May 2025