“Do No Harm” – Reflections About Physiotherapy and the United Nations Sustainable Development Goals.

As a healthcare professional how can I contribute to global sustainability? Here are my reflections. 

On my first day of my first clinical rotation as a student physiotherapist I was presented with an experience which has stayed with me over my years of practice. One of the physiotherapists in the clinic had called in sick and my clinical educator said they were glad to see me and promptly gave me the caseload of their absent colleague.  I must have looked a little terrified because my clinical instructor then told me, “You’ll be fine. Just do no harm and they won’t know the difference.

This experience has stayed with me serving me with a constant reminder to always do better, that just because someone “won’t know the difference” doesn’t mean they deserve anything short of my best. My interpretation of this lesson has led me to come to the conclusion that there is a difference between a novice therapist and a poor therapist; the first recognizes their weaknesses and can strive to strengthen them, the second does not.

This lesson applies to many different areas of life. Ultimately we can choose to step-up and lead for the betterment of all or stand aside and hope no one will notice. Where better to apply this lesson than to the idea of sustainability?  But how could I, a single person, have any effect on global sustainability?

One of the first places I looked to find out more were the courses on Physioplus which focus on environmental sustainability which introduced me to the United Nation’s (UN) Sustainable Development Goals (SDGs).

Sustainable Development Goals (SDGs)

The news today is full of stories about climate change, extreme weather events, pandemic illness, food scarcity, and social unrest. All huge global issues that the SDGs are attempting to address and reverse. The SDGs are a guide to peace and prosperity for current and future generations. The scale of these issues can feel overwhelming and seemingly impossible for an individual to make any difference in grand scheme of things but remember do not harm, it’s time to step up and lead.

“Sustainable development is about all of us, not just some of us. And it’s about taking the health of future generations as seriously as we take our own.” Horton, R and Lo, S (2018).

Physiotherapy is a profession built on hope and measured expectations. We walk that fine line between an overeager cheerleader promising the impossible and an overbearing coach pushing to the breaking point. We exist in a place in healthcare where we can devote time to each patient to answer their questions, gain their trust to place hands on them to promote their unique more perfect movement, guide them to control their pain with decreased dependence on medication, and teach them how to be their new best. Some would say physiotherapists help people make their bodies sustainable.

Sustainable Development Goal 3 and Physiotherapy

Goal number 3 is known as The Health Goal. The goal is about ensuring health and well-being for all people through optimising function and maintaining good health across the life span. This is in essence the focus of rehabilitation and goes without saying that by strengthening rehabilitation availability worldwide could greatly improve the quality of life and wellbeing of countless people. An article published in The Lancet in 2020 by Cieza et al found that based on 2019 global burden data, 2.4 billion people globally would have benefited from rehabilitation during that single calendar year.

It is an exciting time to be a rehabilitation professional, as there is renewed focus to strengthen and promote rehabilitation within global health systems. The nature of physiotherapy practice is cost-effective, highly ethical, and evidence-based, and entry-level physiotherapy education should align with these trends to prepare new therapists to make global change collectively through local actions. Health-focused practice should be a priority and developed into a clinical competency.

Sustainability Development Goal 13 and Physiotherapy

Goal number 13 addresses climate change and how it impacts every industry and ecosystem. When measuring climate change, an organization’s carbon footprint is taken into consideration.

“…if the global healthcare were a country, it would be the fifth-largest emitter of greenhouse gas emissions of the world” Karliner et al, 2020.

When looking at the carbon footprint of hospitals, physiotherapy can offset some greenhouse gas emissions by shortening a patient’s length of stay. With proper rehabilitation and preventative care, physiotherapy can postpone or remove the need for surgical interventions, which have a large carbon footprint.

Compared to other healthcare professionals Physiotherapy has a lower carbon footprint. We do not rely on energy-intensive diagnostic testing, our interventions require fewer supplies with their related supply chain carbon footprint, we can decrease the use of NSAIDs for pain management which can have a far-reaching effect on water pollution in addition to greenhouse gas emissions. For these carbon footprint alterations to make a difference there must be a paradigm shift in healthcare, one where physiotherapists take the lead in making healthcare more sustainable.

How Environmentally Friendly Is Physiotherapy Practice?

The Environmental Physiotherapy Movement

There is a movement within our profession advocating for physiotherapy to become more environmentally conscious. It pushes to advocate for the health of our planet in addition to the health of mankind because without one we cannot have the other. This movement points to the industrialization of our healthcare system, the norm of treating patients in hospital centres in simulated environments while considering the human body in isolation from the world it inhabits.

Environmental physiotherapy encourages the expansion of our practice to consider broader global health implications such as pollution and social issues that have effects on long-term wellbeing and health. Intervening at a more holistic inclusive level has been shown to have a more powerful effect on outcomes than behavioral approaches on the individual level.

This is best described by Nicholls (2019) who explains that as a respiratory physiotherapist it wouldn’t make sense for them to work effectively as a clinician without having a view on the interplay between the air we breath and the gas exchange in our lungs. But they go further than this by exploring the wider symbolic and spiritual meaning of air and breath and how this influences both interventions and patient outcomes.

 How can I not be interested in designer face-masks, and the creative conversion of oxygen, air and breath in works of art; or be concerned for cities like Delhi, where levels of carbon monoxide were 25 times the WHO recommended level at times last year? – Nicholls (2019).

This expanded view of healthcare will give physiotherapy more opportunities to improve the wellbeing and overall health of both mankind and the planet. Changing the way our profession practices will require new models of healthcare and new training for therapists at all levels of practice. It will require seeing beyond human needs to those of the planet as a whole, and seeing how our human activities affect our entire interconnected world.

Step-up and Lead

Maric and Nicholls (2021) suggest we start with audits of physiotherapy’s contribution to environmental degradation at a clinic, community, and national through our member organisations. Physiotherapy schools can begin implementing environmental physiotherapy, environmental ethics, and social justice courses into their programs. Professional organizations and leaders can be tasked with developing and coordinating sustainability plans and how to implement them into our practice.  One person, standing up as a leader, could begin here to start making a change for the better. It will take all of us working together, but it can begin with one.