When I told some of my peers that I was doing my dissertation on environmental sustainability in physiotherapy, I got lots of comments like “But… why?” or “Wow that’s very niche!” With a degree with such a high workload already, why would you add sustainability to the curriculum? We didn’t choose to do an environmental sciences degree, and physiotherapists are burnt out already.
I understand these ideas, but once I started reading the blogs from the Environmental Physiotherapy Association (EPA), I was hooked. I found it strange that the World Health Organisation called climate change “the single biggest threat facing humanity” and yet I hadn’t heard anything about this during my healthcare course.
These blogs, and further research, made me realise how the health impacts of climate change affect us in so many ways, and how sustainability is relevant to many areas of physiotherapy. Examples I have found include:
Orthopaedics & musculoskeletal care (MSK)
Pathways have been developed to reduce the impact of MSK care on the environment (Palstam et al., 2022).
Non-communicable diseases
Links between air pollution and many health conditions exist, including COPD, asthma, hypertension, type 2 diabetes, and others (Committee on the Medical Effects of Air Pollutants, 2010; Hansel et al., 2015; Kelly & Maynard, 2018; Maynard, 2022; Tiotiu et al., 2020; Vallianou et al., 2021).
Neurology
Links have been found between poor environmental conditions and certain diseases (Louis et al., 2023; Zammit et al., 2021). This is a new area of research, so there is more to discover.
Sustainable Development Goals (SDGs)
These goals represent many population health issues, none of which happen in isolation and all of which affect health (United Nations, 2015).
Biopsychosocial model (BPS)
Understanding that every aspect of a person’s experience happens within their environment is important but often missed. This links to access to green spaces and population health issues such as poor housing (Lehman et al., 2017).
Communicable diseases
The origin of diseases that put many people in hospital, can be traced back to our relationship with the planet and other animals (Mishra et al., 2021).
Communication about climate change
Signposting to resources such as the Talking Climate Handbook (Webster & Marshall, 2019) could improve confidence in talking about these issues – an important step in creating change (Maibach, 2021).
Millie Kent
PT, BSc (Hons), University of Nottingham
Millie is a new-graduate Physiotherapist in England, who has recently received her registration. She is interested in musculoskeletal and neurological physiotherapy and the power of physical activity to improve function and wellbeing. In her spare time, she enjoys running, wild swimming and yoga.
These are just some ways that link nicely into the topics already covered by current physiotherapy degrees. I’m sure there are many others too.
However, we cannot forget the concerns that my peers had, because new ways of working are more likely to be adopted when the opinions of all the stakeholders are involved (Fagiewicz et al., 2021).
This is where the idea for my dissertation came from. I did a questionnaire exploring the opinions of physiotherapy students and graduates on this topic, the full paper is available here. All students and graduates from the University of Nottingham could participate, as my research aimed to inform curriculum development here. 34 students and 11 graduates responded. I analysed the results descriptively and some of the main findings were:
Twenty-eight (62%) of participants believed sustainability topics should be included in physiotherapy education. The remaining seventeen (38%) did not.
Thirty participants had positive initial reactions to SHE (interested, excited, pleased, relieved), five had negative reactions (boring, frazzled, not interested, neutral), and eighteen mentioned being confused by the concept.
Three main barriers to implementation were identified
(1) Belief that planetary health is not relevant to clinical practice.
(2) Concern that it would increase the workload for students.
(3) Belief that there are bigger priorities to learn about in healthcare.
If students learned about the health impacts of climate change alongside expected topics (as previously explained) the barrier of relevance & and confusion would not be an issue, because the links to current practice would be explicit. Using it as a theme would also give a broader understanding of how the environment affects every aspect of life, and therefore every part of physiotherapy. This approach would also minimise the workload, which was another concern highlighted by the questionnaire.
The other barrier of sustainability not being a priority in healthcare is complex. Understaffing and underfunding are massive issues, and the care of the patient is always paramount, leaving little time to think about much else. Changing these underlying issues requires a change in strategy at a national level, to focus more on the prevention of incidents, rather than constantly reacting (Hewitt, 2023). However, this would require significant investment, leaving many health professionals feeling helpless to make a change. If they were given the tools and confidence to advocate for changes, it may help to create a healthier and more sustainable society (Maibach et al., 2021).
Another idea was that sustainability and patient care contradict each other. Sterilising equipment and essential single-use plastics are sometimes necessary to ensure everyone’s safety. But there are also examples where resources are being used unnecessarily, for example, non-sterile gloves (Flores & Wrigley, 2019), and unnecessary procedures (Born et al., 2022). Furthermore, some treatments with similar patient outcomes have different environmental impacts (Jeswani & Azapagic, 2019), and learning to factor this into clinical reasoning is increasingly important (Mortimer et al., 2018). Finally, there are many examples of interventions being beneficial for people and the environment. Examples include active transport, healthy eating, and access to insulated housing (GOV.UK, 2022). This demonstrates that patient care could even be improved by advocating for a more sustainable health system.
In conclusion, students and graduates have varied opinions on learning about sustainability in physiotherapy courses, and this must be respected. I have described some of my ideas of how to overcome the barriers identified by the survey, but there are many ways to go about this, as seen in the EPA blogs. Experimentation and conversation are always essential when investigating innovative ideas (Maibach, 2021).
References
Header image by Leeloo Thefirst
Born, K., Levinson, W., & De Freitas, L. (2022). Reducing harm from overuse of healthcare. BMJ, 379. https://doi.org/10.1136/BMJ.O2787
Committee on the Medical Effects of Air Pollutants. (2010). The Mortality Effects of Long-Term Exposure to Particulate Air Pollution in the United Kingdom.
Fagiewicz, K., Churski, P., Herodowicz, T., Kaczmarek, P., Lupa, P., Morawska-Jancelewicz, J., & Mizgajski, A. (2021). Cocreation for Climate Change—Needs for Actions to Vitalize Drivers and Diminish Barriers. Weather, Climate, and Society, 13(3), 555–570. https://doi.org/10.1175/WCAS-D-20-0114.1
Flores, A., & Wrigley, M. J. (2019). Use of non-sterile gloves in healthcare; an evaluation of healthcare workers’ perception of risk and decision making.
GOV.UK. (2022). Climate and health: applying All Our Health. https://www.gov.uk/government/publications/climate-change-applying-all-our-health/climate-and-health-applying-all-our-health
Hansel, N. N., McCormack, M. C., & Kim, V. (2015). The Effects of Air Pollution and Temperature on COPD, 13(3), 372–379. https://doi.org/10.3109/15412555.2015.1089846
Hewitt, P. (2023). The Hewitt Review An independent review of integrated care systems.
Jeswani, H. K., & Azapagic, A. (2019). Life cycle environmental impacts of inhalers. Journal of Cleaner Production, 237, 117733. https://doi.org/10.1016/J.JCLEPRO.2019.117733
Kelly, F., & Maynard, R. (2018). The Effects of Long-Term Exposure to Ambient Air Pollution on Cardiovascular Morbidity: Mechanistic Evidence A report by the Committee on the Medical Effects of Air Pollutants.
Lehman, B. J., David, D. M., & Gruber, J. A. (2017). Rethinking the biopsychosocial model of health: Understanding health as a dynamic system. Social and Personality Psychology Compass, 11(8). https://doi.org/10.1111/SPC3.12328
Louis, S., Carlson, A. K., Suresh, A., Rim, J., Mays, M. A., Ontaneda, D., & Dhawan, A. (2023). Impacts of Climate Change and Air Pollution on Neurologic Health, Disease, and Practice. Neurology, 100(10), 474–483. https://doi.org/10.1212/WNL.0000000000201630
Maibach, E. (2021). Recognition and Commitment Every major public health victory of the last century has had effective communication at its heart.
Maibach, E., Frumkin, H., & Ahdoot, S. (2021). Health Professionals and the Climate Crisis: Trusted Voices, Essential Roles. World Medical & Health Policy, 13(1), 137–145. https://doi.org/10.1002/WMH3.421
Maynard, R. (2022). Cognitive decline, dementia and air pollution: a report by the Committee on the Medical Effects of Air Pollutants.
Mishra, J., Mishra, P., & Arora, N. K. (2021). Linkages between environmental issues and zoonotic diseases: with reference to COVID-19 pandemic. Environmental Sustainability 2021 4:3, 4(3), 455–467. https://doi.org/10.1007/S42398-021-00165-X
Mortimer, F., Isherwood, J., Wilkinson, A., & Vaux, E. (2018). Sustainability in quality improvement: redefining value. Future Healthcare Journal, 5(2), 88. https://doi.org/10.7861/FUTUREHOSP.5-2-88
Palstam, A., Sehdev, S., Barna, S., Andersson, M., & Liebenberg, N. (2022). Sustainability in physiotherapy and rehabilitation. https://doi.org/10.1016/j.mporth.2022.07.005
Tiotiu, A. I., Novakova, P., Nedeva, D., Chong-Neto, H. J., Novakova, S., Steiropoulos, P., & Kowal, K. (2020). Impact of Air Pollution on Asthma Outcomes. International Journal of Environmental Research and Public Health 2020, Vol. 17, Page 6212, 17(17), 6212. https://doi.org/10.3390/IJERPH17176212
United Nations. (2015). THE 17 GOALS | Sustainable Development. https://sdgs.un.org/goals
Vallianou, N. G., Geladari, E. V., Kounatidis, D., Geladari, C. V., Stratigou, T., Dourakis, S. P., Andreadis, E. A., & Dalamaga, M. (2021). Diabetes mellitus in the era of climate change. Diabetes & Metabolism, 47(4), 101205. https://doi.org/10.1016/J.DIABET.2020.10.003
Webster, R., & Marshall, G. (2019). The #Talking Climate Handbook. How to have conversations about climate change in your daily life.
Zammit, C., Torzhenskaya, N., Ozarkar, P. D., & Calleja Agius, J. (2021). Neurological disorders vis-à-vis climate change. Early Human Development, 155, 105217. https://doi.org/10.1016/J.EARLHUMDEV.2020.105217