From Socks to Social Justice: Questioning Occupational Therapy’s Shift Toward Universalism

Every profession needs a vision. Vision statements chart the future, express values, and signal where a field aspires to go. Occupational therapy has long embraced this idea. Yet visionary language, when untethered from the realities of practice, can obscure more than it clarifies. This tension is increasingly visible in the language of AOTA’s Vision 2030.

Vision 2030 declares that occupational therapy "maximizes health, well-being, and quality of life for ALL people, populations, and communities." The capitalization of "ALL" signals more than inclusivity. It implies universality—if not absolutism—shifting the vision from aspirational to morally directive. But does this align with occupational therapy as it exists and has historically been practiced?

Consider daily occupational therapy work. Hospital-based therapists arrive at 7 a.m. to help patients regain basic life functions: dressing, sitting up, toileting. In schools, therapists assist students with handwriting, mobility, and classroom participation. These tasks are fundamental, not trivial. They reflect the dignity inherent in daily occupations. They are also specific and context-bound. These therapists are not universal agents of social change—nor should they be. Their work is personal, grounded, and vital.

Historically, this specificity defined occupational therapy. Earlier definitions focused clearly on enabling individuals to engage in meaningful occupations, especially when illness, injury, or disability disrupted daily life. Over time, however, clarity has eroded. The Occupational Therapy Practice Framework (OTPF), while still acknowledging context and individuality, has incrementally expanded the profession’s scope. Populations, communities, and social contexts have moved from background considerations to foreground priorities. This shift, gradual but steady, reflects an ideological drift away from the profession’s clinical and therapeutic center of gravity.

Vision 2030 brings this drift into sharp relief. Previous visions, such as the Centennial Vision and Vision 2025, expanded occupational therapy’s scope but retained balance. They emphasized societal impact and inclusivity without abandoning focus on science, evidence, and individual participation. Vision 2030 breaks with this pattern. Its call to serve “ALL people, populations, and communities,” without qualification, is not merely ambitious—it is transformative. It recasts occupational therapy from a therapeutic service grounded in individual needs to a profession with universal obligations.

This raises serious concerns. In regulated, resource-limited systems, universal rhetoric is not only impractical—it may be harmful. Service delivery remains constrained by scope of practice, payer rules, resource availability, and ethical obligations. Absolutist language risks creating confusion for practitioners, patients, regulators, and the public. More critically, it may alienate occupational therapists whose work remains rooted in the concrete realities of function and participation.

The issue is not whether occupational therapy should serve diverse populations or reduce barriers. It should and always has. The issue is whether defining the profession as universally responsible for “ALL people” reflects reality—or imposes an ideological vision disconnected from daily practice.

Vision statements should inspire, but they must also be honest. They should motivate without distorting. Occupational therapy’s strength lies in its ability to enable participation where life happens—in homes, schools, workplaces, and communities. Helping someone who has had a stroke put on socks, assisting a child to write their name, enabling a person to return to work or play—these moments are not small. They are everything.

Before embracing universalism, the profession must ask: is this truly occupational therapy’s place? Participation is always contextual. At its best, occupational therapy enables engagement where life happens — not in lofty social justice rhetoric, but in the concrete realities of everyday living.

If the profession’s vision no longer reflects this, why should practitioners feel connected to it—or compelled to belong to the organizations promoting it?

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