Ch. 15 – Occupation in Illness Prevention
Occupation in illness prevention is defined as the application
of medical, epidemiological, behavioral, social, and
occupational science to prolong quality of life for all people
by preventing physiological, psychological, social, and
occupational illness, accidents and disability through
occupation-focused advocacy, meditation and programs to
enable people to do, be, belong, and become according to
their natural health needs
Ch. 15 – Occupation in Illness Prevention
Occupational illness may manifest in a medically recognized
disorder and may require occupational resolution rather than,
or as well as a medical prescription
Occupation as a means of illness prevention often appears
to be disregarded, despite the many sources of information
that make it clear that ill-health and disability could be
reduced, and in some cases prevented, according to what
people do or do not do
Common understanding of occupation’s effects on health is
skewed toward the exploration of physical illness that is a
prime focus of mainstream medicine
Ch. 15 – Occupation in Illness Prevention
Preventing Illness:
Prevention is the action of stopping something from happening or arising
Disease prevention is the name given to action usually emanating from
the health sector about risk factors and risk behaviors
It is commonly referred as preventive medicine
It is often performed by general medical practitioners who use
population-based studies as a foundation for advice to protect individuals
In developing countries, it is best known for methods, such as
immunization, vaccination, screening, quarantine, improved sanitation,
and encouraging of breastfeeding
Ch. 15 – Occupation in Illness Prevention
World health organizations focus on:
Prevention of illness such as cancer, HIV/AIDS, sexually transmitted
disease, tuberculosis, obesity-related disorders, noncommunicable
disorders, and mental illness
Prevention of work-related illness or accidents
Prevention of behaviors, such as suicide, drug, alcohol, or other
substance abuse
Prevention of school drop outs, bulling, and cruelty to or abuse of
children
Prevention of teen pregnancies or child sex abuse
Prevention of family, sexual, and youth violence, juvenile delinquency, or
gang behavior
Prevention of poverty
Prevention of terrorism
Prevention of pollution and ecological degradation
Ch. 15 – Occupation in Illness Prevention
Public health is very complex:
For example: There is no research why people (especially youth) take up
bad habits, such as smoking
Instead efforts are placed on shocking people about the health hazards
(TV commercials, radio and other social media announcements, graphic
photographs, and so forth)
Questions about what other forms of occupation it replaces,
supplements, or enhances are disregarded
Things which are mostly blamed (not without merit!) are:
Peer pressure
Greed of multinational tobacco companies
Advertising
Ch. 15 – Occupation in Illness Prevention
To take more holistic approach from an occupational
perspective requires consideration of what basic needs are
fulfilled by taking up bad habits in the first place
What occupational needs are not met to make it necessary
or possible to ignore health warnings?
There should be changes in social, political, and economic
pressures on tobacco entrepreneurs and on lifestyles and
occupations across the board, to reduce the harmful habits
(such as smoking)
Ch. 15 – Occupation in Illness Prevention
Because prevention appears a less immediate need than
treatment of an existing problem, it is often overlooked, put
aside, and forgotten despite the life-saving and remedial
successes of early public health initiatives
Sir William Osler (1849-1919) stated:
“… that it was in the field of prevention of disease that modern medicine
attained its greatest achievements. Our life is no longer shortened by
diseases such as leprosy, plague, smallpox, and rabies. Our life
expectation is about twice as long as it was half a century ago.”
Ch. 15 – Occupation in Illness Prevention
McKeown pointed out that:
Noncommunicable diseases are a response to conditions that have
arisen in the last few centuries
These changes are acting on a genetic constitution suited to the
lifestyles of at least 100,000 years ago
Most of the noncommunicable diseases appeared in the past century
McKeown stated:
“Living conditions have changed profoundly since industrialization, in
ways that might be expected to prejudice both physical and mental
health: increased size and density of populations; transfer from rural to
urban life; reduction of fiber and increase of fat, sugar and salt in the
diet; increased use of tobacco, alcohol and illicit drugs; reduction of
physical exercise; changes in patterns of reproduction, with fewer and
later pregnancies.”
Ch. 15 – Occupation in Illness Prevention
Recent Considerations:
In 1921, Adolf Mayer presented ideas about occupation as a mean to
prevent illness while, at the same time, promoting health
He claimed that occupation requires people’s active interaction with the
environment and reality in a way that maintains and balance them,
because the mind and body work in unison
He recognized that activity un tune with natural rhythms has a positive
effect on human functioning, and that there is a need to strive for
balance in the various types of occupation
Ch. 15 – Occupation in Illness Prevention
In the 1960s, Wilma West proposed that occupational therapists
should:
Function as health agents with responsibility to help ensure normal growth
and development
Encourage occupation focused programs aimed toward maintaining optimum
health rather than intermittent treatment of acute disease and disability
Consider more fully the socio-economic and cultural as well as biological
causes of disease as dysfunction
Develop a health model of practice with the assumption that health care
would be as concerned with prevention as with rehabilitation
Find more effective methods to ensure and enrich development of physical,
mental, emotional, social, and vocational abilities
Make a timely translation from a long time focus on activities of daily living for
the disabled to advocacy of the balanced regimen of age appropriate, work
play activities for man in the pre-disease/disability phase
Revisit their underlying philosophy and facilitate a broader application of
existing knowledge about the effects of activity, or its absence, on health
Ch. 15 – Occupation in Illness Prevention
Occupation-Focused Prevention of Illness and Disability:
People are occupational beings and much illness can be prevented,
naturally, through what people do day by day throughout life
Through informed and wise choice of occupation, people can influence
the state of their own and others’ health, reduce illness and disability
directly or indirectly
People can meet their biological needs and potentials across 24-hour
active-rest continuum throughout life
Occupations known to lead to illness should be replaced by illnessprevention occupations that are socio-culturally valued and afford
individual and lollective meaning and purpose
Ch. 15 – Occupation in Illness Prevention
For occupations to be illness preventive, they need to
provide opportunity for growth and development according to
human biological capacity
They need to meet the prerequisites and the physiological
requirements for physical, mental, and social exercise
They should result in the well-working of each human
organism as a whole
Ch. 15 – Occupation in Illness Prevention
Is Occupation-Focused Prevention of Illness and Disability
Necessary?
Chronic diseases are now the major cause of death and disability
worldwide. Noncommunicable conditions, including cardiovascular
diseases (CVD), diabetes, obesity, cancer, and respiratory diseases,
now account for 59% of the 57 million deaths and 46% of the global
burden of disease
The impact of illness or premature death can be associated
with ongoing, unresolved stress from occupational
imbalance, depravation, or alienation
This may result from paid employment, corporate
occupations, or sociopolitical initiatives
Those can be risk factors in themselves or result in the
development of health risk behaviors
Ch. 15 – Occupation in Illness Prevention
They may lead to early health disorders, such as:
Boredom
Burnouts
Depression
Decreased fitness, brain, or liver function
Increase blood pressure
Changes in sleep patterns
Changes in body weight patterns
Changes in emotional state
Ultimately to disease, disability, and/or death
Ch. 15 – Occupation in Illness Prevention
Poverty is a great Threat:
Lack of work occupation often leads to poverty, which is accompanied by
hunger, disease, and illiteracy, as well as by addiction, violence, and
depression
Poverty includes living and working in risky and unhealthy conditions
(such as polluted environment)
Poverty can lead to feelings of loneliness, powerlessness,
voicelessness, anxiety, and fear for the future
Ch. 15 – Occupation in Illness Prevention
Urbanization:
Living in bigger cities allowed people to meet others with similar interests
Cities appear to be less healthy places to live in than rural environments
Doing things, becoming fulfilled, and being with others is so important
that those left behind in rural communities can experience occupational
depravation
However, there is a downside: The centralization of businesses and
other paid employment leaves many people without sense of community
and people can suffer from isolation, loneliness, boredom, and alienation
It is easier to be unknown in a crowds of big cities than in a
smaller rural communities where people are more readily
observed and involved
Ch. 15 – Occupation in Illness Prevention
People living outside urban centers are exposed to:
Long and tiring travel for work or services
Increased incidences of road accidents
Increased suicide rates among rural youth
Increased alcohol use
Feeling “burn up”
Necessity for younger population to “go to town”
Increased depression rates
Ch. 15 – Occupation in Illness Prevention
Increased drug Abuse and Civil and Domestic Violence:
Substance abuse and violence are unhealthy occupational behaviors
They are learned occupations from:
○ Families
○ Community
○ Media
○ Peer pressures, and so forth
The youth appear particularly at risk due to their developmental
stages
For some young people an adventurous or rebellious nature or
those who are easily led risky behaviors provide a means of
forgetting failure and fighting back with established norms
Ch. 15 – Occupation in Illness Prevention
Decrease of Physical Occupations:
Physical doing has altered throughout time as a result of
accelerating changes in societies across the world
Most people in postmodern cultures are no longer required to
undertake either sustained or substantial physical exercise
through what they do
People undertake physical exercises at will rather than for
necessity
Vigorous physical activity was part of everyday life for most
people, at home, at work, and in transit between them
Ch. 15 – Occupation in Illness Prevention
As recent as 1850, human muscles provided up to 1/3 of the
energy used by physical occupations - today the figure is
less than 1%
The human body is becoming redundant as a source of
energy in the workplace (with physical activity having
become) largely a recreational option rather than a survival
necessity
Ch. 15 – Occupation in Illness Prevention
Physical inactivity is a major health related concern
It declines with age from as early as adolescence
Many studies have found differences between groups
according to:
Age
Gender
Ethnicity
Sociocultural status
Education
Employment
Ch. 15 – Occupation in Illness Prevention
An overload of sedentary occupation (physical inactivity)
contributes significantly to the global burden of chronic
disease
It is estimated to cause 2 million deaths worldwide annually
Throughout the world about 10-16% of cases of breast
cancer, colon cancers, and diabetes are directly linked to
sedentary lifestyle
In addition, 22% of ischemic heart disease is linked to
sedentary lifestyle as well
Sedentary lifestyle is as strong a risk factor as increased
blood pressure, smoking, and high levels of cholesterol
Adults who are inactive are twice as likely to die from
cardiovascular disease than those who are very active
Ch. 15 – Occupation in Illness Prevention
The WHO provided the following facts:
Appropriate regular physical activity is a major component in preventing
the growing global burden of chronic disease
At lease 60% of the global population fails to achieve the minimum
recommended 30 minutes of moderate intensity physical activity a day
The risk of getting a cardiovascular disease increases by 1.5 times in
people who do not follow minimum physical activity recommendations
Inactivity greatly contributes to medical costs – by an estimated $75
billion in the USA in 2000 alone
Increasing physical activity is a societal, not just an individual problem,
and demands a population-based, multi-disciplinary, and culturally
relevant approach
Ch. 15 – Occupation in Illness Prevention
Approaches to Occupation-Focused Prevention of Illness
and Disability:
The terms primary, secondary, and tertiary prevention are used
to differentiate different stages of the preventive process:
○ Primary prevention is about preventing the occurrence of the illness
or injury
○ Secondary prevention is about early detection or arrest
○ Tertiary prevention is about the reduction of chronicity or possible
relapse
Ch. 15 – Occupation in Illness Prevention
It has been found that occupations of a physical nature lower
the risk of
Breast cancer
Lower blood pressure
Reduce body fat
Improve glucose metabolism
Benefit musculoskeletal conditions (such as low back pain)
Reduce osteoporosis
Reduce incidents of falls among elders
Ch. 15 – Occupation in Illness Prevention
In addition, occupations of a physical nature can reduce:
Depression
Anxiety
Stress
Provide social health
Provide economic benefits
They have a beneficial effect on social interaction throughout
life
They can provide enjoyment, reduce violence, increase
productivity, create healthier environments, and reduce
health care costs
Ch. 15 – Occupation in Illness Prevention
Too much physical exercises can be detrimental to health as
too little
It can lead to atrophy of body tissue and organs
Over-exercising has been linked to the overproduction of
free radicals, which could be linked with many lifestyle
disorders and even sudden death during exercise
Athletes experiencing some form of breakdown of health at
the time of major competition is not uncommon
The stress of over-training can cause depression and
decrease immune function
Moderate, rather than strenuous, exercise is now often
recommended
Ch. 15 – Occupation in Illness Prevention
Health is more likely to be maintain if individual have the
skills and recourses to cope effectively with the diversity of
life’s challenges
Patterns of doing acquired early in life establish the function
for health or illness, are often manipulated subconsciously,
and are difficult to overturn
From childhood people should be involved in occupations
that:
Fulfill occupational natures and needs rather then being add-on
requirements
Provide for basic requirements
Provide meaning, purpose, and a sense of belonging
Provide opportunities to develop and grow
Ch. 15 – Occupation in Illness Prevention
Considering illness from the perspective of occupational
imbalance, depravation, alienation, and a lack of
opportunities to develop potential, as well as boredom,
burnouts, or sleep disturbance are useful ways to explore
prevention of illness with an occupational lens
Ch. 15 – Occupation in Illness Prevention
This includes identification of occupational factors that lead
to:
Stress related and mental illness
Ineffective parenting, child exploitation or depravation, and food abuse
Child cruelty and abuse, family and sexual violence, juvenile
delinquency, teen pregnancies
Bulling
School dropout, street living, suicide, aggression, substance abuse
Work related alienation, dissatisfaction, illness, welfare fraud
Exclusion from work or chosen occupations that ensure active aging
Terrorism or gang behavior
Pollution or ecological degradation
Ch. 15 – Occupation in Illness Prevention
Bird and Fremont noted differences in men’s and women’s
activities in relation to illness
They hypothesized that although women live longer, they
experience more sickness than men because of
occupational and social role variance
Those include the combined effect of:
Less paid work and lower remuneration
More time expended in household labor
More time expended in child care and helping others
Fewer hours of leisure and sleep
Mostly holding less prestigious roles than men
Ch. 15 – Occupation in Illness Prevention
Bird and Fremont concluded that women would
experience better health than men if gender roles
were more alike because, when gender
differences are controlled, being a man is
associated with poorer health than being a woman
Chapter 15 explored occupation as a means of preventing illness and the priority issues for
occupation-focused prevention of illness and disability (OPID): poverty, urbanization, drug
abuse, civil and domestic violence, and decreased levels of physical activity. The discussion will
assist students to become clearer about the negative as well as the positive health consequences
of occupation. It will enable a clearer vision about preventing illness and disability through
increased understanding of and action toward what people want, need, or have to do; what it
means to them; or the physical, mental, and social health outcomes.
Wilcock, A. A., & Hocking, C. (2015). An occupational perspective of health (3rd ed.).
Thorofare, NJ: SLACK Incorporated.
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