Physiotherapy and physiotherapy education – from an international to a global and value-based perspective

Even prior to the Covid-19 pandemic the world was changing faster than ever before and the direction has become vastly unclear. This leads to uncertainty in many aspects of the lives of individuals, societies, economies and nature. The global problems, such as the climate crisis and increasing social gaps, need to be addressed on both an individual and collective level with a multi-professional and transdisciplinary approach. Globalisation has brought completely new challenges for higher education and health care. Universities all over the world are rethinking their role considering the United Nation’s Agenda 2030 and the sustainable development goals [1] being the major future global issue, as a part of their core mission. Overall access to essential health services have improved but physiotherapy (PT) services coverage globally still needs increased availability. PT research, which provides the basis for knowledge development and PT practice, has been developed internationally with focus on evaluating physiotherapy interventions and treatment of individual patients. Let us preserve this strength but open our eyes to a broader, global and value-based perspective so that PT on a broad front can contribute to a better future.

PT did emerge and develop in an international context. The forerunner of PT, also called the Father of Swedish gymnastics, Per Henrik Ling (1776 − 1839) was one of the first to describe PT theory based on trends in natural romanticism and the enlightenment with the natural philosophy of living in harmony with oneself and nature. His health or movement cure spread to other European countries as early as in the middle of the nineteenth century as well as other countries beyond Europe [2]. World Confederation for Physiotherapy (WCPT), since 2020 World Physiotherapy, was founded 1951 with 11 member associations. World Physiotherapy is today the global voice for 121 physiotherapy member organisations representing 625,000 physiotherapists from all over the world. The vision of World Physiotherapy is to move physiotherapy forward, ensuring the recognition of the PT profession and its significant role in improving health and wellbeing globally by encouraging high standards of physiotherapy research, education and practice. Ever since the WCPT held its first international meeting on evidence-based physiotherapy in London, 2001, the importance of research-based PT practice and effects of PT interventions has been emphasised, and clinically oriented research has increased exponentially. The Physiotherapy Evidence Database PEDro provides access to over 49,000 randomised controlled trials, systematic reviews and evidence-based clinical practice guidelines relevant to physiotherapy. In 2020, over 3.8 million users from over 200 countries performed a PEDro search (https://pedro.org.au/).

Today, especially as we are in the midst of a global pandemic crisis, which is affecting the weakest in society the most, the importance of everyone's participation and efforts for a better future for all in line with the United Nation’s Sustainable Development Goals is obvious. The third goal: to ensure healthy lives and promote well-being for all at all ages is highly relevant in PT and commitment to improve global health is also shown in the mission of World Physiotherapy (https://world.physio/). Future changes of global health challenges concern physiotherapists in various clinical settings as well as PT researchers, teachers and students. The latest World Health Organisation statistics report [3] shows an increase in both life expectancy and healthy life expectancy by over 8% globally, meaning that the world population is not only living longer but also living healthier. Still, one of the most essential goals in the future is to promote health, healthy life style and well-being as the population ages and becomes more diverse. The ageing of the population will be coupled with an increase in non-communicable diseases as Parkinson's disease, stroke, heart diseases, cancer, diabetes, osteoarthritis, osteoporosis, dementia, falls and other age-related health problems, which will require new digital and preventive PT services. Additionally, climate change will make it more difficult for people in poor health to cope. Mental health problems have increased especially among young people, with underlying causes as climate anxiety, the competitive nature of society and the information flood created by digitalisation [4].

There are, besides the United Nation’s Agenda 2030 [1], several value-based frameworks, which provide ethical support in priorities when developing PT and PT education for an uncertain and unsafe future. The Ottawa charter [5] for health promotion points out the importance of providing prerequisites for health, healthy public policy, supportive physical and social environments, strong community actions, well developed personal skills and relevantly oriented health systems. The Shanghai Declaration [6], which message is that health also is a political issue, reminds us that political choices and commitments are crucial to ensure that all human beings can fulfil their potential in dignity and equality in a healthy environment.

Finally, I want to highlight the importance of working for democracy, human rights and solidarity, often cited as examples of European values. Another frame of reference that has proven to be valuable is the Nordic welfare society model: a democratic, open, safe and inclusive society with a public education and health care system that is financed by taxes and thus reduces social gaps.

PTs are one of the health care professions with knowledge and competencies to be in key position for taking ethical responsibility for the future and contribute to enable participatory society as well as a good life for everyone.