For over a decade, debates in occupational therapy have extended into the profession's theoretical foundations as well as epistemological underpinnings thereof A series of proposals have emerged from around the world that aim to link the definition of occupational therapy, its knowledge and practices to contemporary social, political, cultural and economic conditions. Contributing to this is the increasing precariousness of the global social life, the economic crises of many social systems, and the deterioration of the ecological environment. The current paper critically reflects on the historical conditions that shape the institution of occupational therapy, particularly in the regions of South America and Africa. This involves a political, ethical, and epistemological rethinking of the foundations that underpin identities, knowledge and practices of occupational therapy and their effects on society. These foundations may favour processes of exclusion and ahistorical and individualist views of human occupation, as opposed to social perspectives expressed in collective occupations and human rights promoting practices. The authors propose to problematise the construction of a professional identity, knowledge and practices of occupational therapy, emphasising the need for a liberating discipline, committed to and acting alongside people and communities who are in situations of social exclusion. This implies the necessary positioning of occupational therapy within social transformation. Key words: Southern, critical, epistemologies, human occupation, human rights