Advancing an environmentally responsible physiotherapy

A recent study from the US showed that in 2013 the health care sector was ‘responsible for significant fractions of national air pollution emissions and impacts, including acid rain (12%), greenhouse gas emissions (10%), smog formation (10%), criteria air pollutants (9%), stratospheric ozone depletion (1%), and carcinogenic and non-carcinogenic air toxins (1–2%)’ (Eckelman and Sherman, 2016). 

‘The impact of human activities on our planet’s natural systems has been intensifying rapidly in the past several decades, leading to disruption and transformation of most natural systems. These disruptions in the atmosphere, oceans, and across the terrestrial land surface are not only driving species to extinction, they pose serious threats to human health and wellbeing. Characterising and addressing these threats requires a paradigm shift’ (Myers, 2017).

Resources and references

On this page you will a range of existing resources and reference that could inspire environmental physiotherapy and environmental physiotherapy education in the broadest sense. We draw especially on resources and references currently less endemic to physiotherapy so far, including sustainable healthcare, planetary health, the UN SDGs, and many more. We hope this will provide you with some interesting starting points for further exploration and development.

Sustainable healthcare and planetary health centres and networks

Centre for Sustainable Healthcare, Oxford, UK: The Centre for Sustainable Healthcare is renowned for its work on sustainable healthcare research and practice and provides strategic input and consultancy to internation, national and local programmes.

Centre for Sustainable Healthcare Education SHE, UiO University of Oslo, Norway: SHE is a Centre for Excellence in Education at the Faculty of Medicine that will educate students to become change agents for the sustainable healthcare in both the global and local contexts, and will provide them with competencies to make sustainable evidence-based decisions.

Centre for Sustainable Health Systems – Redefining sustainable healthcare, Canada: The Centre for Sustainable Health Systems is a research and innovation lab, a training shop, and a network of allies and partners working on the transition to truly sustainable and social health care.

inVIVO Planetary Health: A collaborative network for planetary health with the mission ‘To transform personal and planetary health through awareness, attitudes and actions, and a deeper understanding of how all systems are interconnected and interdependent’.

Planetary Health Alliance: The Planetary Health Alliance is a consortium of over 200 universities, non-governmental organizations, research institutes, and government entities from around the world committed to understanding and addressing global environmental change and its health impacts.

Planetary Health Platform, University of Sydney, Australia. The Planetary Health Platform fosters understanding of how natural systems support civilisation health, drives research, education and leadership on the relationships between ecological, economic and social change and the health and wellbeing of future generations.

Sustainable Development Unit, UK: The Sustainable Development Unit (SDU) help organisations across health and care embed and promote sustainable development in order to reduce emissions, save money and improve the health of people and communities.

Sustainable Healthcare training tools

Canadian Association of Physicians for the Environment (2019). Climate Change Toolkit for Health Professionals.

Nicholas, K. (2018). Climate Change We Can Fix It World Cafe: A 3 hour activity where students analyze, compare, and present climate solutions proposed and now underway from governments, non-governmental organizations, businesses, scientists, citizens, and more.

Climate for Health (2019). Moving Forward Toolkit. The Climate for Health: Moving Forward Toolkit provides guidance and tools to reduce energy use, to build resilient clinics and health departments, and advocate for climate solutions that prioritize health and equity. The website also provides a range of other helpful resources.

EcoAmerica (2016). Let’s talk health and climate: Communication guidance for health professionals. Climate for Health, Washington, DC.

Harvard University (2019). The Health Effects of Climate Change: Learn how global warming impacts human health, and the wayswe can diminish those impacts. A free online course by Harvard University’s Global Health Institute.

International Federation of Medical Students’ Associations (2016). Climate and Health Training Manual. Enabling students and young professionals to understand and act upon climate change using a health narrative. Developed by IFMSA, with the support of World Health Organisation (WHO).

NurSusTOOLKIT for Sustainability Literacy and Competency (SLC in nurse education.) International Erasmus+ Project seeking to enhance the availability of an evidence-based learning offer in Sustainability Literacy and Competency (SLC) in nurse education.

One UN Climate Change Learning Partnership: The One UN Climate Change Learning Partnership (UN CC:Learn) is a joint initiative of more than 30 multilateral organizations helping countries to achieve climate change action both through general climate literacy and applied skills development. UN CC:Learn provides strategic advice and quality learning resources to help people, governments and businesses to understand, adapt, and build resilience to climate change.

Rehr, R.C., & Perkowitz, R.M., ecoAmerica (2019). Moving Forward Toolkit: A Guide for Health Professionals to Build Momentum on Climate Action. Washington, DC. Retrieved February 16, 2020.

The Canadian Coalition for Green Healthcare: Green Hospital Scorecard: The Green Hospital Scorecard (GHS) is the only comprehensive health care benchmarking tool in Canada measuring energy conservation, water conservation, waste management and recycling, corporate commitment and pollution prevention.

US National Institute of Environmental health Sciences: Climate Change and Human Health Lesson Plans. Climate and Health learning modules for a variety of student audiences that explore the health impacts of climate change both in the United States and globally.

Inspiration from indigenous knowledges, philosophy, the social sciences and humanities

Barnhardt, R., & Kawagley, A.O. (2008). Indigenous Knowledge Systems and Alaska Native Ways of Knowing. 36(1), 8-23. doi:10.1525/aeq.2005.36.1.008

Haraway, D. (2003). The Companion Species Manifesto: Dogs, People, and Significant Otherness. Prickly Paradigm Press, Chicago.

Hill, R., et al. (2020). Working with indigenous, local and scientific knowledge in assessments of nature and nature’s linkages with people. Current Opinion in Environmental Sustainability, 43, pp. 8–20. doi:10.1016/j.cosust.2019.12.006

Jonas, H. (1984). The imperative of responsibility. In search for an ethics for the technological age. Chicago: University of Chicago Press.

Kawagley, A.O., Barnhardt, R. (2008). Education Indigenous to Place: Western Science Meets Native Reality. Alaska Native Knowledge Network, Alaska University, Fairbanks.

Kropotkin, P. (1993). Mutual Aid: A Factor of Evolution. London: Freedom Press.

Morton, T. (2017). Humankind: Solidarity with nonhuman people. London: Verso Books.

Næss, A. (1989). Ecology, community and lifestyle. Cambridge: Cambridge University Press.

Nicholls, D. (2018). New Materialism and Physiotherapy. In: Manipulating practices: A critical physiotherapy reader (Edited by Gibson, B.E., Nicholls, D.A., Setchell, J., Groven, K.S.). Oslo: Cappelen Damm Akademisk.

Nicholls, D. (2020). What’s real is immaterial: What are we doing with new materialism? Aporia, 11(2), 4-14. doi:10.18192/aporia.v11i2.4594

O’Gorman, E., et al. (2019). Teaching the Environmental Humanities: International Perspectives and Practices. Environmental Humanities, 11(2): 427–460. doi:10.1215/22011919-7754545

Redvers, N. (2018). The Value of Global Indigenous Knowledge in Planetary Health. Challenges, 9, 30. doi:10.3390/challe9020030

Surrales, A., & Hierro, P.G. (eds.)(2005). The Land Within: Indigenous Territory and the Perception of Environment. Copenhagen: Centralrtykkeriet Skive A/S.

Tuhiwai Smith, L. (2001). Decolonizing methodologies: Research and Indigenous peoples. Dunedin: University of Otago Press.

UNESCO (2017). Local Knowledge, Global Goals. UNESCO: Paris, 48 pp. Retrieved February 24, 2020. See also UNESCO Local and Indigenous Knowledge.

Articles on sustainable healthcare education

Alvarez-Nieto, C., Richardson, J., Parra-Anguita, G., Linares-Abad, M., Huss, N., Grande-Gascon, M.L., Grose, J., Huynen, M., Lopez-Medina, I.M. (2018). Developoing digital educational materials for nursing and sustainability: The results of an observational study, 60, pp. 139-146. doi:10.1016/j.nedt.2017.10.008

Barna, S., Goodman, B., Mortimer, F. (2012). The health effects of climate change: What does a nurse need to know? Nurse Education Today, 32(7), pp. 765-771. doi:10.1016/j.nedt.2012.05.012

Hackett, F., Got, T., Kitching, G.T., MacQueen, K., Cohen, A. (2020). Training Canadian doctors for the health challenges of climate change. Lancet Planetary Health, 4(1), PE2-E3. doi:10.1016/S2542-51961930242-6

Madden, D., McLean, M., & Horton, G. (2018). Preparing medical graduates for the health effects of climate change: an Australasian collaboration. The Medical Journal of Australia, 208(7), 291-293. doi:10.5694/mja17.01172

Maxwell, J.; Blashki, G. (2016). Teaching about climate change in medical education: an opportunity. Journal of Public Health Research, 5, pp. 673. doi:10.4081/jphr.2016.673

Musaeus, P., Wellbery, C., Walpole, S., Rother, H.A., Vyas, A., Leedham-Green, K. (2018). E-collaborating for environmentally sustainable health curricula. In: Climate literacy and innovations in climate change education. Berlin: Springer: 151–167.

Thompson, T., Walpole, S., Braithwaite, I., Inman, A. Barna, S., Mortimer, F. (2014). Learning objectives for sustainable healthcare. The Lancet, 384(9958), pp. 1924-1925. doi:10.1016/S0140-67361462274-1

Walpole, S., Barna, S., Richardson, J., & Rother, H. (2019). Sustainable healthcare education: integrating planetary health into clinical education. The Lancet Planetary Health, 3(1), e6. doi:10.1016/S2542-51961830246-8

Walpole, S. Mortimer, F. (2017). Evaluation of a collaborative project to develop sustainable healthcare education in eight UK medical schools. Public Health, 150, pp. 134-148. doi:10.1016/j.puhe.2017.05.014

Walpole, S., Mortimer, F., Inman, A., Braithwaite, I., Thompson, T. (2015). Exploring emerging learning needs: a UK-wide consultation on environmental sustainability learning objectives for medical education. International Journal of Medical Education, 6, pp. 191-200. doi:10.5116/ijme.5643.62cd

Walpole, S., et al. (2017). Building an environmentally accountable medical curriculum through international collaboration. Medical Teacher, 39(10), 1040-1050. doi:10.1080/0142159X.2017.1342031

SDG teaching tools and resources

TEACH SDGs: Volunteer organisation with the goal to actively support and enhance the work of the United Nations’ efforts within K-12 classrooms by connecting with global educators dedicated to responding to a call to action within education to meet the Sustainable Development Goals, pointing to open and accessible resources, lessons plans, and global projects directly aligned to the Sustainable Development Goals. See also their comprehensive ‘Responding to a Call to Action: How do you #TeachSDGs?’ blogpost.

The World’s Largest Lesson in collaboration with UNICEF: A UNICEF project looking to integrate ‘A lesson about the #GlobalGoals for Sustainable Development in every school on the planet’. Free materials available on the website.

UN DESA Department of Economic and Social Affairs, Division for Sustainable Development Goals: Sustainable Development Goals Knowledge Platform

UNESCO What is Education for Sustainable Development? Retrieved February 20, 2020.

UNESCO (2018). Education for Sustainable Development and the SDGs: Learning to Act, Learning to Achieve. Policy Brief: Advancing ESD Policy. UNESCO Global Action Programme on Education for Sustainable Development. Retrieved February 20, 2020.

UNESCO (2017). Education for Sustainable Development Goals: learning objectives.

UNESCO and Gaia Education:

Other references cited in the EPT Agenda 2023

Maric, F., Nicholls, D., Mostert, K., Culpan, J., Stone, O., van Wijchen, J., Kennedy, M., Long, I., Bundtzen, T. (2020). The Environmental Physiotherapy Agenda 2023. Oslo: Environmental Physiotherapy Association (EPA). ISBN: 978-82-303-4491-0

Association of Clinical Psychologists UK (2019). Practitioner psychologists and the trauma of climate change. An open letter demanding immediate and effective action. Association of Clinical Psychologists (ACP-UK). Retrieved March 1, 2020.

Battiste, M. (2019). Decolonizing Education: Nourishing the Learning Spirit. UBC Press. Vancouver, BC, Canada.

Battiste, M., Bell, L., Findlay, L.M. (2002). Decolonializing education in Canadian universities: An interdisciplinary, international, indigenous research project. Canadian Journal of Native Education, 26(2): 82-95.

Benda, W., McGibbon, N.H., & Grant, K.L. (2004). Improvements in Muscle Symmetry in Children with Cerebral Palsy After Equine-Assisted Therapy (Hippotherapy). The Journal of Alternative and Complementary Medicine, 9(6), 817-825. doi:10.1089/107555303771952163

Berger, M. (2019). Italy’s government becomes first to mandate climate change education in schools. The Washington Post. Retrieved November, 6 2019.

Boshoff, N. (2009). Neo-colonialism and research collaboration in Central Africa. Scientometrics 81, 413. doi:10.1007/s11192-008-2211-8

Boucaut, R. & McPhee, B, (2013). Physiotherapists in occupational health — the Australian experience. Physical Therapy Reviews, 18(5), 327-335, doi:10.1179/1743288X13Y.0000000091

Climate Health Action (2019). US Call to Action on Climate, Health, and Equity. Climate Health Action: A Policy Action Agenda. Climate Health Action (CHA). Retrieved March 1, 2020.

Dahdouh-Guebas, F., Ahimbisibwe, J., Van Moll, R., Koedam, N. (2003), Neo-colonial science by the most industrialised upon the least developed countries in peer-reviewed publishing, Scientometrics, 56(3): 329–343. doi:10.1023/A:1022374703178

Deighton, B. (2019). Q&A: Most SDGs ‘going into reverse’ – UN expert group member. SciDevNet: Bringing science and development together through news and analysis. Retrieved February 14, 2020.

Eckelman, M.J., Sherman, J. (2016). Environmental Impacts of the U.S. Health Care System and Effects on Public Health. PloS One, 11: e0157014. doi:10.1371/journal.pone.0157014

Enfield, G.H. & O’Hara, S.L. (1999). Degradation, Drought, and Dissent: An Environmental History of Colonial Michoacán, West Central Mexico, Annals of the Association of American Geographers, 89(3): 402-419, doi:10.1111/0004-5608.00155

European Commission (2019). Communication from the Commission to the European Parliament, the European Council, the Council, the European Economic and Social Committee and the Committe of the Regions: The European Green Deal. COM/2019/640 final. Brussels, 11.12.2019.

Foo, R. (2016). The role of physiotherapy in climate change mitigation. Physiotherapy, 102(3), e5. doi:10.1016/

Gill, S.R., & Benatar, S.R. (2019) Reflections on the political economy of planetary health. Review of International Political Economy, 27(1), 167-190. doi:10.1080/09692290.2019.1607769

Gorski, P.C. (2008). Good intentions are not enough: a decolonizing intercultural education. Intercultural education, 19(6): 515-525. doi:10.1080/14675980802568319

Graham-McLay, C. (2020). New Zealand schools to teach students about climate crisis, activism and ‘eco anxiety’. The Guardian. 13 Jan 2020. Retrieved from

Guterres, A. (2020). Remarks to the General Assembly on the Secretary-General’s priorities for 2020. Retrieved 16 Feb 2020.

Haines, A., & Scheelbeek, P. (2020). European Green Deal: a major opportunity for health improvement. The Lancet, Online First. Retrieved February 20, 2020. doi:10.1016/S0140-67362030109-4

Horton, R. (2020). A “super-year” for the environment. Lancet Planetary Health, 4(1), PE1. doi:10.1016/S2542-51962030007-3

International Association of Physical Therapists in Animal Physiotherapy (2020). WCPT Network for animal physical therapy practice ( Retrieved February 16, 2020.

International Federation of Physical Therapists working in Occupational Health and Ergonomics (2019). Subgroup of WCPT. Retrieved February 12, 2020.

International Federation of Medical Students’ Associations (2018). Statement on Draft WHO global strategy on health, environment and climate change. Sixty-fifth session of the WHO Regional Committee for the Eastern Mediterranean. 2018, Retrieved: December 16, 2019.

Jones, L.E. (2009a). Physiotherapy and the Earth’s global climate: a need for cultural change. Physiotherapy Research International, 14(2): 73–76. doi:10.1002/pri.441

Jones, L.E. (2009b). Thinking vertically about carbon emissions. InMotion, Septmber 2013: The Green Issue. Australian Physiotherapy Association (APA).

Legard C, Green M, Tucker Y, van Daalen K (2019). Climate change is impacting population health and our future patients: remaining silent is not an option – The BMJ. Opinion. (Sept 26) 2019. Retrieved: October 16, 2019.

Karliner, J., Slotterback, S., Boyd, R., Ashby, B., Steele, K. (2019). Health Care’s Climate Footprint: How the Health Sector Contributes to the Global Climate Crisis and Opportunities for Action. Health Care without Harm, Climate-smart healthcare series Green Paper Number One, produced in collaboration with ARUP. Reston, VA. Retrieved: February 15, 2020.

Maric, F. & Nicholls, D. (2019) A call for a new environmental physiotherapy – An Editorial, Physiotherapy Theory and Practice, 35:10, 905-907. doi:10.1080/09593985.2019.1632006

McGowan, E., Stokes, E. (2019). Leadership in physiotherapy: experiences of leaders of physiotherapy professional organisations. BMJ Leader 2019; 3(4): 115-122. doi:10.1136/leader-2019-000185

Myers, S. (2017). Planetary health: protecting human health on a rapidly changing planet. The Lancet, 390, 2860- 2868. doi:10.1016/S0140-67361732846-5

Nagtegaal, L.W., de Bruin, R.E. (1994). The French connection and other neo-colonial patterns in the global network of science. Research Evaluation, 4(2): 119–127. doi:10.1093/rev/4.2.119

Nazar, M.; Kendall, K., Day, L., & Nazar, H. (2015). Decolonising medical curricula through diversity education: Lessons from students. Medical Teacher, 37:4, 385-393, doi:10.3109/0142159X.2014.947938

Nordling, L. (2018). How decolonization could reshape South African science: A generation of black scientists is gearing up to transform the research landscape. Nature, 554: 159-162.

Nursing and Midwifery Council (2019). Standards of proficiency for midwives – NMC, London, UK. Retrieved December 12, 2019.

Oluwatoyin Onabola, C. (2019). Planetary Health as a Central Context to the Sustainable Development Goals (SDGs). Journal of Environmental Health and Sustainable Development, 4 (3), 798-801. doi:10.18502/jehsd.v4i3.1495

Peseta, T. & Bell, A. (2020). Seeing institutionally: a rationale for ‘teach the University’ in student and staff partnerships. Higher Education Research & Development, 39:1, 99-112. doi:10.1080/07294360.2019.1676200

Planetary Health Alliance (2020). Clinicians for Planetary Health. Planetary Health Alliance (PHA). Retrieved March 1, 2020.

Pongsiri, MJ., Bickersteth, S., Colón, C., DeFries, R., Dhaliwal, M., Georgeson, L., Haines, A., Linou, N., Murray, V., Naeem, S., Small, R., Ungvari, J. (2019). Planetary Health: From concept to decisive action. Lancet Planteray Health, 3(10): PE402-404. doi:10.1016/S2542-51961930190-1

Pradyumna, A. (2018). Planetary Health and Food Systems: Insights from global SDGs. Lancet Planetary Health, 2(10): PE417-E418. doi:10.1016/S2542-51961830202-X

Psychologists for Social Change (2019). Manifesto 2019. Psychologists for Social Change (PSC). Retrieved March 1, 2020.

Royal College of Occupational Therapists (2019). Learning and development standards for pre-registration education – RCOT, London, UK. Retrieved January 12, 2020.

Rees, W.E. (2010). Globalization and Extended Eco-footprints: Neo-colonialism and (Un)sustainability. In (2010). Democracy, Ecological Integrity and International Law (pp. 467-489). Cambridge Scholars Publishing.

Rice, M.B., Thurston, G.D., Balmes, J.R., Pinkerton, K.E. (2014). Climate Change. A Global Threat to Cardiopulmonary Health. American Journal of Respiratory and Critical Care Medicine, 189(5), 512-519. doi:10.1164/rccm.201310-1924PP

Roe, D. (2019). Biodiversity loss—more than an environmental emergency. The Lancet Planterary Health, 3(7): PE287-289. doi:10.1016/S2542-51961930113-5

Sachs, W. (1992). The Development Dictionary – a guide to knowledge as power. Zed Books Ltd., London, UK.

Sachs, W. (2015). Planet dialectics: Explorations in environment and development. Zed Books Ltd., London, UK.

Saravanan, V. (2004). Colonialism and coffee plantations: Decline of environment and tribals in Madras Presidency during the nineteenth century. The Indian Economic & Social History Review, 41(4), 465–488. doi:10.1177/001946460404100405

Spencer, C., & Gee, K. (2009). The roots and branches of environmental psychology. The Psychologist, 22, 180-183. The British Psychological Society. Retrieved January 11, 2020.

Steffen, et al. (2015). Planetary Boundaries: Guiding human development on a changing planet. Science, 347(6223), 1259855. doi:10.1126/science.1259855

Stigmar, K.; Ekdahl, C., Borgquist, L., & Grahn, B. (2014). How do physiotherapists perceive their role in work ability assessments? A prospective focus group study. Primary Health Care Research and Development, 15(3), 268-276. doi:10.1017/S1463423613000170

Sudmann, T.T. (2018). Equine-facilitated physiotherapy – devised encounters with daring and compassion. In: Manipulating practices: A critical physiotherapy reader. Oslo: Cappelen Damm Akademisk.

Sudmann, T.T., & Breivik, J.-K. (2018). Editorial: special issue on community work and going glocal in Scandinavian Welfare States. Community Development Journal, 53(3), pp. 407–423. doi:10.1093/cdj/bsy018

Thomas, E. (2020). A physiotherapy clinic on Vancouver Island blazes a trail in eco-friendly clinic design: Blogpost by Evan Thomas from Dockside Physiotherapy. Environmental Physiotherapy Association (EPA), Oslo, Norway. Retrieved January 28, 2020.

United Nations (2015). Transforming Our World, the 2030 Agenda for Sustainable Development. General Assembly Resolution. A/RES/70/1. New York: United Nations Publishing.

United Nations (2019). Harmony with Nature: Report of the Secretary General. A/74/236. New York: United Nations Publishing.

Wahl, D.C. (2018). What if? — Scaling-out regenerative development glocally: Building educational ecosystems of collaboration to improve planetary health. The Medium. Retrieved February 19, 2020.

Watts, N., Amann, M., Arnell, N., Ayeb-Karlsson, S., Belesova, K., et al. (2019). The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate. The Lancet, 394(10211), pp.1836-1878. doi:10.1186/s13063-018-3129-y

World Federation of Occupational Therapists (2012). Position Statement: Environmental Sustainability, Sustainable Practice within Occupational Therapy (WFOT). Retrieved November 28, 2019.

World Physiotherapy (2019). WCPT Policy Statement: Diversity and Inclusion. Retrieved 24 February 2020.

Whitmee, S., Haines, A., Beyrer, C., et al. (2015). Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health. Lancet; 386: 1973-2028; doi:10.1016/S0140-67361560901-1

Willow, A.J. (2014). The new politics of environmental degradation: un/expected landscapes of disempowerment and vulnerability. Journal of Political Ecology, 21(1): 237-257. doi:10.2458/v21i1.21135

WONCA (2017). WONCA Statement on Planetary Health and Sustainable Development Goals. World Organisation of Family Doctors (WONCA). Retrieved February 19, 2020.