This chapter explores the concept of occupational apartheid as something that emerges through the uneven distribution of resources among different groups of people and a consequent imbalance of power. This imbalance arises through human occupation, which is often associated with forms of territorial occupation to the exclusion of other inhabitants (Ch. 20). Over time those groups with more power develop systematic measures to protect and maintain these inequalities from a fear that their privileges could be lost or taken away by force. Occupational apartheid is considered through a number of examples, and a concluding section appraises human occupation as a facet of being that contains both positive and negative aspects. While the term itself has to be applied to specific occupational circumstances arising from the oppression of one group by another, none the less much of human culture and development has depended on the experience of situations that may with hindsight be recognized as occupational apartheid.

An understanding of occupation as ‘doing, being, becoming and belonging’ (Wilcock, 1999, Hammell, 2004 and Iwama, 2006) might seem inadequate where there are dominant and minority groups with distinct cultural experiences, for example in working with asylum seekers (Smith 2005; Chs 10, 15–20), and across classes and gender (Ch. 5). In any society it may become apparent from such differences that occupational therapists also need to understand occupation in a territorial or possessive sense. Communities and the institutions that serve them are often conceived in geographical terms, or as occupying positions within social strata.

In many instances the dominant group that determines the nature of the restriction does so to protect its interests and power. The restriction is based on the way the group in power defines itself; this becomes the qualification that determines occupational choice. In effect, the group in power takes steps to colonize aspects of occupation in order to define them as its territory – an example close to home might be the multidisciplinary conflicts that arise over professional boundaries, or in situations of domestic abuse (Cage 2007). Such restrictions are usually based on a fear of the excluded and an implicit recognition of the fact that power can be taken away, or laws and principles of exclusion can be subverted.

Forceful arguments may be made that a certain group defined by an arbitrary characteristic such as ethnic origin or class lacks the facility for certain occupations, but these are based on the implementation of restrictive measures to make the facility more difficult to obtain (Bush 2004). In other words the argument depends on crude manipulation of the evidence (Arendt, 1986 and Bush, 2004). Eventually, as the history of South African apartheid demonstrates, such a restriction is morally unsupportable but it is also evident that the legacy of apartheid continues not only in the wide social and economic disparities but in the less visible, internalized self-perceptions of people and communities that hold themselves to be superior or inferior to their peers on the basis of race and culture (Bush 2004).

Aptly, perhaps, given apartheid’s concern with gradations in skin colour, Card (2002, p. 6) describes such situations of continued oppressive contexts as ‘grey zones’. This term, taken from Primo Levi’s Holocaust experiences, refers to situations where people do what they have to do to survive and are even complicit in the perpetration of harm to others, without necessarily struggling against the oppression they experience. Card (2002) extends the concept of grey zones to allow them to refer to an accumulation of evil, which she defines as the product of wrongdoing and deliberate harm. These processes of accumulation may not be immediately clear, as discriminatory or disabling attitudes develop over time, for example through negligence or unscrupulousness. They manifest themselves in the abuses that human beings apply to each other, for example the development of racism as an associated cultural product of slavery, or the development of misogyny and its link to forms of domestic abuse (Bush, 2004 and Cage, 2007).

Occupational apartheid is not an accident of human activity. It is either the result of laws and restrictions created to discriminate and exclude (as in the apartheid era in South Africa, Israel, and many other states that have operated regulations directed against, for example, indigenous minorities such as the Ainu People in northern Japan (Siddle 1999)), or else is recognized to be an effect of laws and restrictions, assumptions and attitudes. The conditions these produce may or may not be the result intended, but they are tolerated through expediency and complicity. These grey zones are an aspect of all human societies. While there may be conditional elements that clearly serve dominant interests or perceptions, whether locally (as in 20th century Northern Ireland (Bardon 1992) and the southern states of the USA (Brogan 1990)) or globally (as in the relationship between the ‘developed’ and ‘developing’ world), inhabiting them involves the assumption of ‘grey’ attitudes concerned with the preservation of self (Card 2002).

Consequently there is, as Card (2002) admits, a great deal of complexity and ambiguity. Consider, for example, a therapist who witnesses institutional bad practice and is obliged to report this. If the institution condones the practice, the practitioner risks being discriminated against (Harding 1991). Often, people who have attempted to report malpractice among their colleagues have themselves become victims of institutional bullying or discrimination. Consequently there can be a reluctance to do so. People may be aware of what they should do but are also fearful of the possible consequences for themselves.

Mattingly and Fleming (1994) found that occupational therapy values have often been at odds with dominant medical practices. This was principally because occupational or real-life issues did not fit the reductionist paradigm sometimes offered in treatment plans. However, in order to retain their value with colleagues of other disciplines therapists learned to record those of their interventions that concurred with biomedical issues while continuing their own interventions – which were not recorded. Consequently, some occupational therapists developed an ‘underground practice’ (Mattingly & Fleming 1994, p. 296).

This conflict of interests is an illustration of the difficulty of balancing everyday decisions, such as those therapists make in practice, in favour of right and wrong. Codes of practice can become opposed or may pose dilemmas in the face of client needs. Kazez (2007) argues that the maintenance of consistently good behaviour is a moral challenge because the more we explore the cause and effect of our occupations the more complex the issues become, ‘there are no clear answers’ (p. 157). We can take our complicity for granted since, in an interconnected society, ‘everybody is responsible for everything’. This means that we are obliged to question our actions and probably to act on what we discover. Probably, because in that action we need both to be clear why we are acting in a certain way and to know that what we choose to do does not perpetrate some other negative effect. As Kazez (2007) frequently points out, this does not mean that we must do so without regard to our individual needs (Ch. 1).

This apparent political and moral complexity impacts on the occupational choices of daily functioning if, as human beings, we are to be concerned with making values of doing, being, becoming and belonging. Wilcock (1998) traces the evolution of occupation alongside human development, proposing that generally the separation of doing into categories of work and leisure emerged as societies grew in complexity, particularly with the development of agriculture and, later, industry. She argues that the development of capitalism created situations where the productive or occupational nature of humankind was turned against itself. Doing, being, becoming and belonging became subverted to mere subsistence in a wage economy and work became separated from leisure. Thus the political sense of occupation arises from a need for social justice, balance and equality in occupational opportunities. Whiteford (2005, p. 354–359) argues that to bring the political in a just and empowering way into everyday occupation requires a ‘Third Way’ perspective between the opposites of capitalism and socialism to bring about an ‘enabling state’. Such a state mobilizes resources to address disabling experiences, restrictions and barriers to everyday occupational functioning through measures that devolve power to communities.

If this is to happen, political power cannot belong only to politicians, captains of industry or religious leaders. If everybody is to be responsible for everything, people and communities must insist on their rights. However, such a situation does not produce equality, only equality of the right to compete (Gomberg 2007). The ‘enabling state’ is consequently an illusory notion, since, as Gomberg says (2007, p. 19), ‘the problems of competitive opportunity cannot be addressed by levelling the playing field’. Every state is unavoidably a disabling state (Graeber 2004). Every state will produce marginalizations and competition between different interest groups, or develop policies that cannot be applied equally to all its citizens. This is readily apparent when geographical location is considered with regard to access to health facilities (Ch. 10). In remote or sparsely populated areas it is difficult to provide the specialized facilities that may be available to city dwellers, even though there may be a right of access. The uneven distribution of resources (whether health facilities, transport and communication infrastructure or opportunities for work) generates inequalities and the development of discriminatory attitudes (Fraser 1997). These become hardened into behaviours such as racism and can become intellectualized by professionals in order to justify policy decisions on the basis that to give people access to certain facilities would be a waste of resources (Gomberg 2007, e.g. Manning 1964)

The term occupational apartheid was first coined in relation to the designation of certain occupations for certain racial groups in US society and the promotion of affirmative action as a measure to counter the difficulties black people had in obtaining higher-status positions (Steinberg, 1995 and Steinberg, 2003). The use of the term apartheid has been controversial in the occupational therapy community. Some of the people with whom we have corresponded regard the term as counterproductive. They feel that apartheid is too strong, emotional and politically charged a word to describe this process, or else that it should specifically relate to the political and ethnic divides of the late 20th century South African government. Others agree that there is a real and systemic problem that the term ‘occupational apartheid’ recognizes but are not comfortable with its identification by liberal white males from privileged backgrounds in former colonizing powers, who, not having experienced direct oppression, may be considered part of the problem, as for example Biko (1987) has commented.

We respect such criticism. However, having raised this argument, we feel that there are valid issues to explore and that if marginalizing forces are in evidence we should not be complicit but seek to challenge them as best we can. These issues apply as much to the circumstances in which we live as anywhere else; no one lives very far from disparities in equality, so our work on occupational apartheid continues. Access to occupational therapy training is a privilege (Ch. 5); the global distribution of occupational therapists and educational opportunities is very uneven (Ch. 7). This book represents our current position but we are still developing these ideas as we receive welcome critique from our colleagues.

Occupational apartheid (Kronenberg, 1999, Kronenberg and Pollard, 2005 and Kronenberg and Pollard, 2006) is a systematic and political process of marginalization and segregation leading to inequality and oppression. It is a relatively new term in occupational therapy but indicates an ancient phenomenon, evidenced in slavery and serfdom and the many situations where groups of people identify other groups which they deliberately and systematically subject to restricted occupations. Individuals can intentionally support conditions of occupational apartheid because it suits them, or they might think it is the right thing to do, or unintentionally through choosing not to know, or merely ignoring, how their choices and actions affect other groups of people. It is important to emphasize that occupational apartheid applies to the exclusion of groups, and conditions that affect individuals because they are members of excluded groups, rather than those exclusions applied between individuals, for example as a result of personal antipathy (Elelwani Ramugondo, personal communication, 2007). Occupational apartheid may set the systematic conditions for individual occupational circumstances but the extent to which these are operated between individuals depends on whether they observe them or not. For example, Wicks and Whiteford (2005) explore the history of barriers to occupational choice experienced by women. While they would not use the term occupational apartheid to describe these exclusions, it is arguable that it can be applied where overt restrictions are operated on the basis of sex or in situations of domestic violence in which the control of women by their partners is culturally sanctioned (Cage 2007).

In many countries street children are a social phenomenon whose existence and humanity is not only denied, but they are exploited by representatives of authority and even aid agencies, or else treated as vermin (Bonfim, 2005 and Kronenberg, 2005). Disabled people have also struggled for many years to be allowed to articulate their own voices, to assert themselves and their right to be different (Mason 2000). Occupational apartheid is, consequently, not just a product of the relationships we make and the way we articulate them; it is evident in the failure to express critiques of injustices, to speak up and act for ourselves or with others. This in itself can be the result of oppression, being made to fear the consequences, being afraid of upsetting a situation so as to make conditions worse or preventing others from escaping by drawing attention to an issue (Arendt 1986), and should not necessarily be a criticism. Sometimes, in order to survive, it is tactically necessary to be silent until the opportunity to speak out effectively can be found.

An important aspect of occupational apartheid is that the process produces attitudes that become culturally embedded. Consequently it is difficult, to follow on from the points that Card (2002) makes about ‘grey’ behaviours, to avoid being complicit in its operation and the maintenance of the many structures that support it. Gomberg (2007) suggests that, whereas previous discussions of injustice have concentrated on the distribution of resources, work towards equity should instead centre on contributive justice. This is essentially an Aristotelian notion of transformation through valuing the social aspect of giving to others over material gain. It is through such an enabling stance that occupational apartheid may be challenged.

Cultures of difference have evolved through the human occupational relationship with the environment and have themselves been instrumental in human evolution (Wilcock 1998). Human societies develop certain characteristics that reflect the need to maintain communities according to local conditions. Fernandez-Armesto (2000) describes how different civilizations emerged through the attempts of communities to live in various climates and topographies and the consequences of the effect the growing community had on the environment and resources around them. For example, living in a river delta facilitates cultivation on a replenishing supply of alluvial soil but requires a good deal of labour to maintain ditches and flood barriers to preserve crops. Increased need for labour increases the need for supplies to feed it and administrators to manage it but this increases the size of the community and makes bigger demands on the cultivators. Eventually an autocratic system emerges in which a clerical elite presides over the organization of agriculture and the engineering of flood management and repair.

The position of coastal communities, on the other hand, enables them to fish and to trade with inland and other coastal communities as goods find their way to the sea or to the interior. Trade creates opportunities for enterprise and cooperation, since in order to expand societies need to pool their resources. Through trade, complex societies emerged that were able to absorb influences, fables and knowledge from interactions with many others (Tacitus, 1959, Herodotus, 1972, Marcellinus, 1986, Wilcock, 1998 and Fernandez-Armesto, 2000). Although in the West some of the ancient societies that emerged may have had democratic features (Tacitus, 1959 and Aristotle, 1962), many of these communities dealt in human captives and maintained strictly segregated societies (Thucydides 1972). For example the Greek warrior nobility saw themselves as above those who obtained their livelihoods by craft and trade (Aristotle, 1962 and Herodotus, 1972).

The process of territorial occupation and exploitation is therefore associated with the development of individual occupations as components of social classes. As societies have developed these have necessarily become more diverse – the earliest literature in the British Isles from the warrior clans of the Celts describes a society primarily based on agriculture and feuding over land rights that clearly produced a nobility and a servant class (Taylor 2005). Through subsequent invasions and trade a wider range of occupations and roles gradually developed as different kinds of commodities were produced and new skills were required to supply them, market them and administer records of them. Sourcing goods also became increasingly important as societies became more complex. Because of their geographical position, however, sea-borne societies, such as the Greeks, Romans, Portuguese, Dutch and British, were able to spread their influence as their artefacts and ideas reached far beyond their borders and their increasing capacity for trade and exploitation brought wealth (Tacitus, 1959, Thucydides, 1972, Hobsbawm, 1969, Boxer, 1973a, Boxer, 1973b, Checkland and Checkland, 1989 and Fernandez-Armesto, 2000). The social, political and economic legacy of these empires remains in the imbalance of wealth between Western countries and much of the rest of the world and in many of the global economic and political structures, such as the British Commonwealth and patterns of trade (Ch. 7). They are also realized in many of our daily activities (Ch. 1). The British culture of tea drinking, with its combination of china, tea and sugar, would not have been possible without an empire. The wide dispersal of coffee, bananas, chillies, avocados, tomatoes and many other crops, which have become important elements of many national cuisines, is also due to the trading patterns of empire (David, 1973, Ortiz, 1977, Ortiz, 2002 and Heal and Allsop, 1986).

Inevitably the demand for labour in order to work in the mercantile ships that carried trade and the navies that protected them, to develop and maintain colonial administrations and to work in the great variety of supporting industries was very considerable. The process of territorial occupation, establishing land rights, conquest and the maintenance of the borders of empires and principalities has come, therefore, to require a plethora of supportive occupations, not only in military and administrative roles but also in supply of goods and services and even domestic settlement to further legitimize the colonies. These roles have further developed according to needs and opportunities created by changing social demands.

However, the same processes have also been destructive of roles and occupations. Just as through the successive invasions of Britain little is really known about pre-Roman society or pre-Saxon society, because these cultures were mostly obliterated (Whitelock, 1972 and Sowell, 1994), the colonial enterprises of European and other cultures have been immensely destructive to those they have overwhelmed and consumed (Fanon, 1986, Fanon, 1990, Fernando, 1991 and Gomberg, 2007). The Spanish and Portuguese incursions in South America (Boxer, 1973a, Parry, 1973 and Hemming, 1983) and of many European countries in Africa – in South Africa (Luthuli, 1963, Arendt, 1986 and Biko, 1987) and elsewhere such as the Congo (Ewans 2002), for example – were catastrophic events for the indigenous cultures and consequently whole ways of life were destroyed as people were subjugated, enslaved and killed through famine, disease and slaughter. Chapter 20

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