Summary of International EPT Festival event: “Intersections of Health, Social, and Environmental Justice: A Canadian Perspective”
On November 8th, 2023 Justice-Centered Rehab members Erin Keough and Stephanie Molloy, and Grounded Physio founder Susan Czyzo came together to host a talk and discussion on the intersections of different justice areas, the environment, and healthcare, all while centering a Canadian perspective.
We started with using Mentimeter to see where all the attendees were coming from - professionally, in regards to background knowledge, and their current understanding of these topics. As we can see below, despite attendees not being sure about what environmental physiotherapy even is - they clearly have an understanding of what it can be:
Image ID: screenshot from Menti with the question "how comfortable are you with the idea of 'Environmental Physiotherapy'?" The responses are: Don't understand it at all = 11% , Not completely sure = 89% , understand it well = 0%
Image ID: screenshot from Menti with the question "What are ways that you think physiotherapy and the environment are linked? (10 responses).
Answers: "heat island and physical activity" , "medical waste!" , "exercise and physical activity outdoors with different communities" , "contributing to your or your clinics carbon footprint" , "physiotherapy clinics contribute to environmental waste (we need to be conscious of how we use material). How we promote physical activity outdoors" , "we are using products and taking part in systems that heavily impact the environment (ie up to 16+ disposable gloves a day) , "healing without drugs"
Image ID: screen shot from above continued. Answers: "humans and nature are connected! Physio is a way to help bring humans to nature in a safe and successful way" , "advocacy, accessibility for disability, environmental preservation" , "could be multiple ways"
The session started with an introduction to who we are and today’s topics, providing definitions for Health Justice, Social Justice, and Environmental Physiotherapy, in order to ensure we were all on the same page.
In regards to Environmental Physiotherapy there were a few key things to highlight, principally that this is “…an organic and fluid concept, grounded in planetary health” - it’s not just one thing! And even this definition is just a suggestion of what it can be.
Image ID: screenshots from our slide show. First one reading: What is Environmental Physiotherapy? Expanding away from: “The body as a machine” , Clinical environments, Environment as a person’s immediate surroundings, Search for cause, returning function to socially acceptable norms, Biomedical, biomechanical approach, Rehabilitation of individual human bodily functions, Humans being separate from the environment. Second slide continuing this idea reading: Embracing: Considering the role of, and addressing, social determinants of health, Our role in addressing access to healthcare and green spaces, Looking beyond the body of the person in front of you, “that it is not possible to think the one (human health, healthcare, physical therapy, etc.) without simultaneously thinking the other (environment, ecology, planetary health)., Integrating, indigenous knowledge on and approaches to planetary health, the role of the natural environment in health and how these tie in with problems of colonialism, social justice and health equity. …an organic and fluid concept, grounded in planetary health
Our presentation then moved onto discussion centered around three case studies: parks prescriptions, greening physiotherapy clinics, and wildfires across Canada. It was important to us to form this event not as a lecture or seminar, but centering collective and community knowledge and teaching each other as equals. So although we provided context for the event and discussion as the hosts, we involved all attendees as much as possible.
Parks Prescriptions
Our first case study was on parks prescriptions - a program across Canada (and available in different countries) where healthcare professionals can prescribe a pass to Parks Canada sites (parks, national historic sites, marine conservation areas). Participants were prompted to think about: What are the benefits of green space? What are the benefits of a parks prescription? What are the barriers to green space? What does the park's prescription not address?
The benefits included more access to greenspace, highlighting that greenspace and nature is good for the human mind and body, that it encourages mindfulness, relaxation, and symptom relief.
Barriers included
- Accessibility: the distance of parks from cities, no public transit to get there,
accessibility of the trails for disabled people, etc
- Urban planning: lack of parks in marginalized areas, lack of greenspace within cities,
lack of ways to get to city parks, why there is a need for a parks prescription to begin
with
- Contributing to structural problems: idea of greenspaces being a special thing outside
of cities, normalizing the idea that parks require a special trip or even a special health
intervention
- One participant mentioned research they saw saying we don’t need one great park
but many small ones
Then we discussed more the implications on physiotherapy practice.
- How can we train patients for reality? For broken sidewalks, tree roots, rocks, hole on
the path, especially in an acute setting where the goal is just to get them home
- How can adapted transport and community programs be integrated into our care and
advice?
- Can we bring nature indoors? Adding plants to hospitals etc
- Keeping in mind seasonal activities - what do we do in the cold winter?
Image ID: quote with trees in the background reading: “Ensuring we are following the patients goals and not our own, everyone has their own definition of nature and how they may want to access it” - quote from a participant
Greening Physiotherapy Clinics - Dockside Physio
Our second case study looking into the clinic Dockside Physio in British Columbia. This clinic is LEED (Leadership in Energy and Environmental Design) certified, and is a certified Green Leader through BC Green Business, among other things! This clinic strives to be more eco-friendly and reduce environmental waste by: promoting biking to the clinic (indoor bike storage, bike fittings), buying local products, using environmentally-friendly cleaning products & laundry, reducing and recycling single-use items, and using sustainable rehabilitation products.
This set the scene for engaging discussion on how to “green” physiotherapy and what that can look like in a variety of different settings.
For example in home care where you travel between patients home, as a physio you can ensure you plan your appointments as geographically close together as you can to avoid backtracking. We also discussed how usually in homecare employers compensate for gas usage, often provide transit passes, but provide no compensation for cyclists despite there still being wear & tear on their bikes.
We discussed using equipment, toys, and tools patients already have rather than encouraging them to buy something, or the possibility of renting equipment instead - because how often does a patient really need to use a Theraband for?
My favorite quote that stuck out to me from the discussion was this:
“The car you already have is the best car you can own”
Rather than buying something new, even if it is environmentally friendly, it's better for the environment to just use what you already have at home!
Wildfires in Canada
Our final case study looked at the wildfires that have been raging across Canada, this summer and for the past many years - however they are becoming larger every year. We emphasized the overlap between the areas with the wildfires and where Indigenous reserves and land is - and how minority populations disproportionately feel the effects of climate change.
This sparked a conversation on eco-anxiety and how we can be leaders for our patients. What can we do when it seems these climate catastrophes are getting worse year by year? Advocacy is a big part of this role, advocating for individual patients, for better policies, for local and national changes, and for continuing to treat the people in front of us.
One participant from outside Canada made a connection back to their country:
Image ID: quote with trees in the background reading: "Over here in my city in Nigeria, I think physiotherapy has a role to play especially in patient education, advocacy and policy-making." - quote from a participant
Another important point being, we “don’t want to undo all the hard work we did helping our clients get better, if the environment makes them sick again”.
Final thoughts