Tone Dahl Michelsen, Ph.D. Associate Professor, Oslo Metropolitan University.
This article ("fagartikkel") has been peer-reviewed according to Fysioterapeuten's guidelines, and was accepted on 4 March 2021. No conflicts of interest stated.
Abstract
Introduction: Global environmental changes require the provision of sustainable health care and the decisive inclusion of sustainability considerations into all aspects of health care professional practice. In this article we illuminate how environmental sustainability might be positioned in physiotherapy and how environmental reasoning can inform future clinical reasoning in physiotherapy practice.
Main part: Environmental sustainability in physiotherapy relates to a two folded mandate of sustainable healthcare: to improve the sustainability of health care systems and services and contribute to the broader societal transition to sustainable futures. We suggest that measuring the environmental footprint of physiotherapy interventions should become a regular element of physiotherapy intervention research. This will enable the inclusion of an environmental layer to clinical reasoning in physiotherapy that we term environmental reasoning: The ability to include environmental sustainability considerations - based on relevant evidence of the environmental impact of physiotherapy services - into the collaborative clinical decision-making process shared by therapists and patients.
Conclusion: In this article we indicate a key pathway for introducing environmental sustainability into clinical decision-making via the measurement of physiotherapy intervention environmental footprint. This suggests an extensive research agenda with much to be explored, clarified and adapted as the physiotherapy profession makes first advances toward the inclusion and implementation of sustainability considerations.
Key words: environmental sustainability, clinical reasoning, physiotherapy.
Sammendrag
Betingelser for bærekraftig fysioterapi: Introduksjon av miljøresonnering i kliniske beslutninger i fysioterapi
Introduksjon: På grunn av globale miljøendringer trengs et bærekraftig helsevesen der hensynet til bærekraft gjennomsyrer alle deler av den helsefaglige praksisen. I denne artikkelen belyser vi hvordan bærekraft kan inkluderes i fysioterapi, og hvordan miljøresonnering knyttet til bærekraft kan inkluderes i fremtidens kliniske resonnering i fysioterapi.
Hoveddel: Miljømessig bærekraft i fysioterapi er knyttet til et todelt mandat for en bærekraftig helsetjeneste: å forbedre bærekraften i helsevesenets tjenester og systemer og bidra til den bredere samfunnsmessige overgangen til en bærekraftig fremtid. Vi foreslår at måling av miljømessige fotavtrykk integreres i all intervensjonsforskning innen fysioterapi. Dette vil legge til rette for et eksplisitt miljøfokus i klinisk resonnering; som vi betegner miljømessig resonnering: Evnen til å inkludere bærekraftshensyn - basert på relevant kunnskap om miljøpåvirkningen knyttet til fysioterapitjenester - i en klinisk beslutningsprosess, der både terapeut og pasient er medvirkende.
Avslutning: I denne artikkelen foreslås en konkret tilnærming for å innføre bærekraftstenkning i klinisk beslutningstaking gjennom måling av miljømessige fotavtrykk fra fysioterapiintervensjoner. Dette fordrer en forskningsagenda der mye må utforskes, avklares og tilpasses når fysioterapiprofesjonen tar viktige fremskritt mot inkludering og implementering av bærekraftshensyn.
Nøkkelord: miljømessig bærekraft, klinisk resonnering, fysioterapi
Introduction
Climate change, biodiversity loss, the disruption of biogeochemical cycles, air, water and plastic pollution and the widespread degradation of land and sea are fundamentally changing the environmental conditions that support human life on earth (1). The destruction of our global natural environment has been recognised as the largest threat to human health and flourishing in the 21st century and is already affecting the health of people around the world. Recognised health impacts expected to increase over the coming years include non-communicable disease, exposure to infectious and vector-borne disease, threats to human nutrition and food crops, as well as mental and physical trauma and injury due to extreme weather events, climate migration and other environment- and resource-related displacement and conflicts (2).
In light of the ubiquity and severity of todays interconnected environmental and health crises, it has been recognised that addressing them means working towards more sustainable futures and requires resolute action across all sectors of society, from multi-national endeavours to individual action in daily life. This is clearly stated in the UN Agenda 2030 Sustainable Development Goals (SDGs) explicit call for the 'mobilisation of all available resources, participation of all countries, all stakeholders and all people' and many other resonant publications (3).
For the health care professions, this represents a clear call for the inclusion of sustainability considerations into all aspects of professional practice,
