There is every reason to be seriously concerned and even frightened about the future of life and health on the world today. Soil erosion and degradation, loss of biodiversity, global warming, pollution, deforestation, ocean acidification and all the other closely intertwined environmental crises of our time are painting a dire picture for the future. It is not surprising then that this situation evokes all sorts of emotions and reactions that span the spectrum from getting frantically active on the one hand, to being completely stifled and unable to act on the other.

An undoubtedly very tempting reaction, or approach to action, is to look for something like the holy grail of environmental sustainability. The one best and biggest solution that will resolve every problem we are currently facing. The true and therefore right thing to do. It is an approach that is historically very familiar to the healthcare professions, physiotherapy included. The search for that one pill to heal them all. The one gold-standard treatment that will resolve all back problems. The one way to rehab anterior-cruciate ligament injuries that will guarantee succes and a swift, championship-winning return to sports, just as much as the one hamstring exercise not to do at any cost, the one way not to lift your shopping bags from the car, and the list goes. 

Thankfully we now have a growing understanding that one size rarely fits all after all. That the holy grail approach has not produced the results we have hoped for seems to suggest that we have to take to people, places, and things in a different, much more nuanced way. This includes, for example, acknowledging the complexity of who or what we are facing, our lack of knowledge, the individual, social, cultural, biological, psychological, environmental (you name it) context and circumstances of a person, condition, phenomenon or else. 

Current research and developments in the treatment of chronic pain seem to be taking to this in strides and appear to be quite successful in pushing this kind of thinking into mainstream physiotherapy. So we might actually be in quite a good place to apply this more open and multiple approach to seeking solutions and taking action as we try to think about what an environmentally aware and responsible physiotherapy might be and do.

Considerably easing our finding of some kind of first response is the fact that there is no shortage of very concrete suggestions for taking action out there which, at least theoretically, should be relatively easy to transfer and implement in physiotherapy practice, research and education. These suggestions can be gleaned either from outside or within the healthcare sector, and given the intimate relationship between health and today’s environmental crises, one will also quickly find that the suggested action steps converge on many points. Project Drawdown alone lists 80 solutions, most of them directly or indirectly relating to healthcare. To name but a few collated in another recently published, interactive perspective on health and care in today’s climate crisis, possible actions to be taken by healthcare systems and healthcare professionals include:

Improving climate (or simply, environmental change) resilience of healthcare systems;

Developing interventions aimed at reducing the health impacts of climate change, or protecting people from them;

‘Greening’ the healthcare ector, i.e. reducing the carbon footprint of healthcare services, research and education;

Increasing health professional education on the relationship between health and the environment;

Educating clients about the inseparable relationship and co-benefits of environmentally sustainable and healthy lifestyles;

Advocating for policy and legislation aimed at improving environmental sustainability;

Personal actions modelling healthy and environmentally sustainable lifestyle (which, like other more incremental and bottom-up approaches, are effective and will likely stay very relevant in the future despite all reservations), and many more…

So on the one hand we are not short of options, but on the other also in an incredibly exciting moment in which the field is still widely open with regard to more specific ways that we might implement some of the existing approaches and novel ways for doing so that are still more specific to physiotherapy, as a profession, and as individual practitioners, clinicians, teachers, etc. 

An additional point of interest might be made by using our last blogpost as an example. In this blogpost (as well as an email distributed to members) we suggested that one way to take action could be to prompt the WCPT to acknowledge the earnestness and importance of the matter by including environmental thinking (environmental sustainability, etc.) in the 2021 WCPT Congress in Dubai. Building on the idea that accelerating social learning about environmental issues and solutions through media coverage, public fora, informal conversations, etc. is one important environmental action, we still think that featuring environmental thinking at a profession-wide level (incl. the next WCPT Congress) is crucial.

But as has been rightly pointed out by some of our members, the same suggestion is also environmentally counterproductive at the same time, and for a number of reasons that only begin with the environmental costs of international travel. So our suggestion to take action in this one way additionally highlights that there likely no one environmental action that comes without its own environmental problems, though their magnitude might certainly differ (Buddhist thought might have some interesting insights to offer on the impossibility of entirely avoiding harm, including to the environment). And this in turn underscores the main point of this blogpost: 

There are and must be

more ways than one 

to be, think and act environmentally. 

Depending on how we think about it, we could say that there already are, or at least could be 7.5billion different solutions. And we probably need every single one of those (of us that is). From the perspective of a nascent professional association looking to increase environmental awareness and responsibility in physiotherapy this is hugely exciting. If starting an association could be one way to increase conversation on all things environment within physiotherapy and featuring this kind of thinking and questioning at the largest international physiotherapy conference another, then what other ways might there be to be, think and act environmentally that physiotherapists might be in a particularly good position to champion? What other environmental solutions will physiotherapists contribute to the 7.5 billion already (waiting to get) out there? 

Whatever we do though, it might be worth keeping in mind that we don’t necessarily have to come up with the one perfect environmental action, but that it’s much more a matter of individually and collectively taking, exploring and refining all sorts of different approaches.

Filip Maric (PhD)
Filip Maric is a physiotherapist and researcher interested in practical philosophy, ethics, environmental physiotherapy, planetary health and sea kayaking.