Como citar este artículo en sucesivas ocasiones:
Bruggen van H. Reflections on the importance of celebrating the 15th ENOTHE meeting in Spain, A Coruña, in 2009. TOG (A Coruña) [revista en Internet]. 2008 [-fecha de la consulta-]; volumen 5 (num1): [10 p.]. Disponible en:
http://www.revistatog.com/num7  

Introduction

In 2009, the Barosso Commision will come to an end and the EU must decide upon its three high-level posts: President of the European Council (EC), Foreign Policy Chief and President of the Commission. A balance between nationality, geography, size, political affiliation and gender, although politically desirable, will be difficult to achieve.
Regarding the new Commission President all rumours had seemed to suggest that the current president, José Manuel Barroso, would be re-appointed.
What about the Spanish representation in the European parliament? Do you know the Spanish Commissioner? Which Spanish politicians are active in Europe? Are occupational therapists in Spain aware of Europe and its policies?

What is the theme of the European Year in 2008 and what in 2009?
How many Spanish occupational therapists are presenting or attending the European Congress in Hamburg in May 2008, how many Spanish occupational therapists lecturers and students are every year active in ENOTHE (European Network of Occupational Therapy in Higher Education)?

In this article the link between European policies and occupational therapy will be discussed and the opportunities occupational therapists could and should embrace for emerging new areas of practice  in their own countries.
Because occupational therapy in Spain is growing so fast, it is of utmost importance that the profession maintains and extends its popularity by developing new and a wide range of practices of good quality, continuous education as Masters in occupational therapy and occupational science and research. This development should go hand in hand with international developments and strengthen each other.
Therefore ENOTHE has chosen Spain, La Coruña, for its 15th ENOTHE meeting to discuss new strategic plans for occupational therapy and Europe and the theme of the European Year 2009, linking Education, Culture and Creativity.
European Policy with respect to Higher Education after 2010

By 2010 the European Higher Education Area (EHEA) should be a fact! (1). Will occupational therapy education be ready for it?
At least Spain was the first country that made a comparison between their national competences and the European Tuning competences in occupational therapy and even concluded that the European competences were of better use.
However accepting competences is one step, but implementing them at curriculum and in particularly at module level and using them for individual portfolio assessment is another thing to do.
The European Higher Education Area in  Occupational Therapy
As a follow up of the Bologna process, the TUNING methodology and recommendations done by UNESCO(2) the themes to be further addressed in occupational therapy education in the 21st century are:

1. Implement the three cycle degree system, quality assurance (peer review) and the recognition of degrees and study periods in all European countries

What is the situation in Spain as far as recognition and the three cycle system is concerned?

1. Until now only two out of eighteen occupational therapy programmes have WFOT recognition
2. Not one Spanish university has been peer reviewed in the subject of occupational therapy by ENOTHE
3. There is neither a master nor a doctorate programme in occupational therapy or occupational science
4. In OECD reports Spain is mentioned as one of the countries with the lowest rates of investment in research and development among developed countries (3)
1. Promote mobility of students, teachers and researchers across European Higher Occupational Therapy education
1. How many students, teachers and researchers are every year exchanged?
2. In which joint intensive programmes are Spanish teachers and students involved?
3. In which European research programmes are the Spanish OT researchers involved?
2. Major challenges to address within the occupational therapy education are relevance or the relation with the society, comparability and international cooperation

Higher education must address social needs (1,2), which could be defined as a social contract between higher education institutions and social and individual needs, because citizens make society. So, in that sense, the relevance of universities lies in building citizenship, and this must be done at a regional, national and international level.(2).

Meeting the basic conditions/relevance for occupational therapy education in Europe and Spain
An expert’s assessment of the application of ENOTHE for a Socrates grant stated:
“It is obvious that the societal demand is great for developing an academic based discipline as Occupational Therapy with impact on a European scale”
The TUNING methodology for developing curricula starts with analysing the context and the social needs for the occupational therapy education. With the paradigm shift from medical and impairment directed towards more social and participation directed (4) occupational therapy the target groups and social needs for occupational therapy (education) are rapidly changing and/or extending. “The problems of people with disabilities should not be seen as largely medical and thus marginal for the society at
large,” says Walter Wolf of the European Commission, DG Employment, Social Affairs and Equal Opportunities, “They should rather be viewed and addressed as questions relevant for the society as a whole and tackled only by fully integrating people with disabilities into it.”
Hereafter you find a small overview of facts, figures and policies about the social needs and the social agenda of Europe and Spain, which form the relevance for the occupational therapy education at European and Spanish level:

1. Some 16% of men and women aged 16-64 in the EU as a whole1 report having a long-standing health problem or disability (LSHPD= Long standing health problem or disability)
2. The EU-LFS (EU Labour Force Survey) indicates that fewer than 4% of those aged 16-24 reported being restricted in their ability to work, compared with 9% for those aged 25-54 and 21% for those aged 55-64.
3. In the EU as a whole, 63% of those aged 16-19 who were considerably restricted in their ability to work participated in education or training. This compared with 75% who were limited to some extent and 83% who were not restricted at all.
4. Of those aged 16-64 and strongly limited, 17% had incomes below this poverty line (20% men, 16% women) – compared with 15% for those limited to a lesser extent and 10% of those not limited at all. (5).

By 2010, the European Commission wants to see improvements in employment prospects, accessibility and independent living and disabled people should be involved in the decision-making process on the basis of the European principle: ‘Nothing about disabled people without disabled people’.(6).
One of the major challenges in Spain are the high number of immigrants, with repercussions  for employment and the labour market and with an enormous risk for occupational injustice and occupational deprivation. (7,8)
Spain has been boosted by the large figures of foreign immigrants, mostly from Latin America (38.75%), Eastern Europe (16.33%), North Africa (14.99%) and Sub-Saharan Africa (4.08%). Spain presents one of the highest immigration rates in the world (1.5% annually in 2005) and in 2006 9.27% of Spanish population were immigrants.(9).
These vulnerable and marginalised groups are not limited to: migrants and ethnic minorities (including Roma), but are also including people with disabilities, homeless people, ex-prisoners, drug addicts, people with alcohol problems, isolated older people and children.
The problems these groups experience are often translated into homelessness, unemployment, low or no education, and subsequently, their further exclusion from occupations, community and society at large.
Inclusion of vulnerable groups is one of the priorities of the European Social Protection Social Inclusion Process. In this context, Member States have committed to develop integrated and coordinated responses to the multiple disadvantages and the need of particular groups.
The European Union has a three-fold approach to overcoming discrimination and increasing the inclusion of vulnerable and marginalised groups – increasing access to mainstream services and opportunities, enforcing legislation to overcome discrimination and, where necessary, developing targeted approaches to respond to the specific needs of each group.
The European Union strives to increase the labour market participation of those disadvantaged groups and to promote their participation in social, cultural and political life. The precarious situation of Roma is tackled accordingly in all countries where they reside. A successful Roma integration campaign took place in Avilès, Spain (10).
Measures are implemented in favour of areas marked by exclusion – combating regional inequalities as in Galicia. Eliminating the barriers to education and training for all vulnerable groups and at all levels is as well a key issue of the European Union.
The main Spanish action will be one of solidarity towards greater social cohesion. A factor for improving all aspects of living together in society (active citizenship, employment, working conditions, promotion and protection of cultural diversity) and worldwide (good neighbourhoods, factor of credibility in foreign policies etc.). ICD (Inter Cultural Dialogue) will be a permanent process with a bottom-up flow of participation.
If occupational therapists in Spain and Europe want to contribute to the above mentioned actions, then they need to offer accessible services in the health care and in the community, providing occupational therapy, as well as health prevention and promotion through occupation and /or facilitating community development through engagement in occupations.
Besides individual client centred occupational therapy, new approaches need to be developed in practice and education to learn occupational therapists strategies for community development as effective partnering, capacity building through occupations, participatory action, environmental changing (including attitudes) and managing impact approach.(11)

Lifestyle changes
New problems such as the rise in obesity and an increasing number of factors impinging on mental health are affecting the health of Europeans.
Demographic trends mean longer and healthier lives and raise issues such as active ageing, lifestyle changes, intergenerational equity, the increasing importance of work/life balance in sustaining family life, the relationship between generations and new risks of poverty.
Research is needed to provide knowledge on the evolution of some key trends, such as in family life, the changing nature of work and of private life, the evolution of lifestyles, consumption patterns, values, attitudes and beliefs of contemporary societies, and their implications for people’s quality of life and health, including children, youth, disabled and the aged. 
The question of what role, Occupational Therapy will and can play in responding to changing social realities should be discussed in COTEC, ENOTHE and national associations. Increasing the knowledge about the social challenges from a occupational perspective and exploring best practice of occupational therapy service in Europe to meet those challenges will be one of the most important issues for the profession in the coming years.

Summary - European Year 2009 and The ENOTHE meeting in Coruna
To promote the integration of the most disadvantaged people, a comprehensive active inclusion strategy, entailing the provision of an adequate level of income support with a link to the labour market and a better access to services, is needed .
The problems of vulnerable groups are perpetuated through a vicious circle they are caught into, marked by lower education levels, unemployment, and subsequently, further exclusion from society. The degrees of the problem, as well as the responses to it, vary from one country to another and even from one region, like Galicia to another but it is recognised as a priority for the Union as a whole.
Lessons learnt from attempts to tackle the issue have proven that it can be successfully addressed only within the general framework of social protection and inclusion policies.
Spain’s Cohesion Policy (2007-2013) has set the following target indicators for 2013: rate of employment: 70% (57% female); expenditure on research and development (R+D): 2% of GDP (55% of which from private sector); Internet penetration in both small and medium sized enterprises (SMEs) to reach 99% and in households 65%; reduction of early school leaving to reach 15%. (12).
It is up to the initiative of the occupational therapists in Spain and in Europe to contribute to the Social Agenda and to make in a creative way use of the grants of for instance the European Social Fund and the Progress project funding to improve the position of the most disadvantaged groups.
Occupational therapists are looking forward to exchange in October 2009 in La Coruna best practices in emerging occupational therapy areas from the whole of Europe.

 

References

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