Greening the Curriculum: Exploring Sustainable Health Education for Physiotherapists (Part 2)

This is part 2 of 2 of a blog series on greening the curriculum. You can read part 1 by clicking here

Picture by Keira Burton

When incorporating SHE into physiotherapy curriculums the barriers we have highlighted must be addressed. Not all students and graduates thought it was a good idea, and those that did were often concerned about workload and relevance. One way to ensure relevance would be to use it as a theme throughout the degree when covering more traditional topics. For example: 

  • Orthopaedics & musculoskeletal care (MSK)
    Pathways have been developed to reduce the impact of MSK care on the environment [14]. 
  • Non-communicable diseases
    Links between air pollution and many health conditions exist, including COPD, asthma, hypertension, type 2 diabetes, and others [1, 2, 3, 10, 15, 17]. Management strategies for these conditions can have very different ecological impacts [6]. 
  • Neurology
    Links have been found between poor environmental conditions and certain diseases [8, 21]. This is a new area of research, so there is more to discover. 
  • 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 [7].  
  • 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 [11]. 
  • Communication about climate change
    Signposting to resources such as the Talking Climate Handbook [18] could improve confidence in talking about these issues – an important step in creating change [9]. 
  • Sustainable development goals (SDGs)
    These goals represent many population health issues, none of which happen in isolation and all of which affect health [16]. 

This approach would require no separate module, minimising workload and ensuring relevance. 

The other barrier – SHE not being a main priority in healthcare – must be addressed in several ways because it’s a complicated theme. Understanding the significant health impacts related to climate change may help students understand why SHE should be a priority. Using statements such as “Climate Change is the single biggest health threat facing humanity” [19, 20], will provide an evidence-based hook for engaging students in this subject. With so many impacts, how can this not be a priority? 

Infographic from Centres for Disease Control and Prevention

The concern that prioritising planetary health will negatively impact patient care must be addressed too. Patient care is paramount, but sustainability can also be a part of the equation [12]. If two treatments are likely to have similar outcomes for the patient, and one has less environmental impact, the “greener” one is the more appropriate [13]. Learning to factor this into clinical reasoning is an important skill.  

It was common thinking that HCPs had no time to prioritise sustainability due to understaffing and underfunding. For years the health service in the UK has focussed on reacting to negative events and less so on preventing them. Changing this would result in fewer incidents and less pressure on the health system eventually, but it requires investment and long-term thinking [4]. If HCPs have the confidence to advocate for this, it may help to create a healthier and more sustainable society. 

Picture by Markus Spiske

Key messages 

  • Physiotherapy students and physiotherapists have varied opinions on SHE. Some believe it should be encouraged, while others do not. 
  • Participants of this study were mainly concerned that SHE is not relevant to their practice as HCPs, that it would increase the workload for students and that it isn’t a priority in the healthcare setting. 
  • Addressing these concerns will be essential when universities incorporate SHE into their curriculums. Ideas have been explored here, although there are many other approaches [5]. Experimentation and conversation are always essential when investigating new ideas. 

Author information

Millie Kent, Physiotherapist, University of Nottingham graduate, Twitter @MillieKentPT. 


Ann Gates, Honorary Associate Professor University of Nottingham.
Fiona Moffatt, Associate Professor University of Nottingham.
Filip Maric, Associate Professor, UiT the Artic University of Norway.
Roger Kerry, Professor of Physiotherapy Education University of Nottingham. 

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