Making sustainability in occupational therapy visible by relating to the Agenda 2030 goals – A case description of a Swedish university

ABSTRACT

Occupational therapy has a lot to contribute to sustainable development considering the discipline’s occupational focus and knowledge. This has been recognised by researchers and professional associations, but there is still a scarcity of research explicitly mentioning sustainability. Relevant contributions may be identified by relating education and research to the Agenda 2030 sustainable development goals. The aim of this article was to describe explicit and implicit inclusion of sustainable development and Agenda 2030 goals in occupational therapy education and research at one Swedish university. Current course syllabi and study guides, as well as research over the past five-year period, were examined and related to sustainability. The results showed that although only a few courses and articles were explicitly related to sustainable development, more course and research content became relevant when this content was compared with the sustainable development goals. It can be concluded that sustainability was more extensively addressed than first visible, but further studies including more universities are warranted.

KEYWORDS:

• Climate change
• ecological sustainability
• education
• health and wellbeing
• occupational justice
• research
• social sustainability
• sustainable development

Introduction

The struggle to achieve sustainable development (SD) can be considered the most important challenge of our time. According to the Brundtland report (United Nations, 1987), SD includes development that ‘meets the needs of the present without compromising the ability of future generations to meet their own needs’ (p. 15). Within occupational therapy, there is deep knowledge related to human occupations and occupational adaptations. Many aspects that relate to unsustainability, such as climate changes (IPCC, 2014), consumption and production (United Nations Environment Programme (UNEP), 2015), are also related to human occupation. Thus, occupational therapists can provide important contributions to sustainable development. Considering that climate changes pose severe threats to health with negative implications especially for the poor and vulnerable (World Health Organization, 2009, 2018), the relationship between ecology and occupational justice (Simó Algado & Townsend, 2015) is clear and so is the relevance of sustainable development for occupational therapy.

The importance of addressing SD within occupational therapy has been recognised over the years (Aoyama, 2014; Dennis, Dorsey, & Gitlow, 2015; Ikiugu, 2008; Ikiugu & McCollister, 2011; Whittaker, 2012; Wilcock, 2006). The terms ‘ecopation’ (Persson & Erlandsson, 2002; Persson & Erlandsson, 2014) and ‘eco-social occupational therapy’ (Simó Algado & Townsend, 2015) have also been proposed. A statement related to SD (World Federation of Occupational Therapists, 2012) as well as a guide to research and education (World Federation of Occupational Therapists, 2018) have been published by the WFOT. In the latter, occupational therapists are recommended to include sustainability in their work, education and research (World Federation of Occupational Therapists, 2018) and encouraged ‘to widen their scope of practice to include a ‘well’ population to promote sustainable occupational lifestyles and adaptation to the adverse effects of climate change’ (p.41). Similarly, the Swedish Association of Occupational Therapists highlights the importance of SD and gives examples of how occupational therapists may contribute to this (Förbundet Sveriges Arbetsterapeuter [The Swedish Association of Occupational Therapists], 2012; Sveriges Arbetsterapeuter [The Swedish Association of Occupational Therapy], 2017).

So far, empirical occupational therapy projects related to sustainable development seem scarcely described. Garden projects have focused on both social and ecological aspects of sustainability (Coetzee, 2016; Simó, 2011), and empirical research related to water and sanitation (Blakeney & Marshall, 2009; Wrisdale, Mokoena, Mudau, & Geere, 2017) as well as to food (Hyett, Kenny, & Dickson-Swift, 2017) have been described. When searching for it in occupational therapy articles, SD is also less explicitly addressed than could be assumed given its relevance. However, the multitude of aspects related to SD is clearly shown by the Agenda 2030 (United Nations, 2015), launched a few years ago by the United Nation and described as ‘a plan of action for people, planet and prosperity’ (p. 5). The Agenda includes 17 sustainable development goals (SDGs) to be met by 2030. The goals (Table 1) range from ‘end[ing] poverty in all its forms everywhere’ (SDG 1) to ‘strengthen[ing] the means of implementation and revitaliz[ing] the global partnership for sustainable development’ (SDG 17) and are described as goals which are ‘integrated and indivisible and balance the three dimensions of sustainable development: the economic, social and environmental’ (United Nations, 2015, p. 5).

Table 1. The focus of the different sustainable development goals in Agenda 2030 and how they are addressed in education/research.

Goal number	Focus	Addressed in education, Bachelor/Master	Addressed in research Yes
1	Poverty	Bachelor/Master	Yes
2	Hunger
3	Health/wellbeing	Bachelor/Master	Yes
4	Education	Bachelor	Yes
5	Gender equality	Bachelor/Master	Yes
6	Water and sanitation		Yes
7	Energy
8	Work and economic growth	Bachelor	Yes
9	Infrastructure
10	Inequalities	Bachelor/Master	Yes
11	Cities and community	Bachelor	Yes
12	Consumption/production	Bachelor/Master
13	Climate	Bachelor/Master	Yes
14	Below water
15	On land
16	Peace and justice	Bachelor
17	Partnerships

Explicitly relating occupational therapy education and research to the SDGs (United Nations, 2015) would make the education and research conducted by occupational therapists in relation to SD more visible both within the profession and externally. The knowledge gained from such endeavors would contribute to showing the current state of education and research as well as potential gaps, which is important as the WFOT has encouraged the alignment of work to the SDGs (World Federation of Occupational Therapists, 2018). Therefore, the aim of this article was to describe the explicit and implicit inclusion of sustainable development and the Agenda 2030 goals in occupational therapy education and research at one Swedish university.

Method

A descriptive approach was chosen. Data on course content and research output was collected in several ways. Firstly, each of the intended learning outcomes (ILOs) in the course syllabi of the bachelor’s and master’s programmes during the academic year 2019–2020 were examined by the first and last author in order to investigate whether they explicitly mentioned SD and/or whether it was considered relevant in relation to the SDGs. Thereafter, study guides were examined for content and the results were exemplified and described. In parallel, occupational therapy researchers at the department were asked to contribute with descriptions of research they had been involved in the last five years and relate this to relevant SDGs. These were discussed until all agreed that the relevant SDGs had been chosen.

Results

Sustainability in education

Aspects related to sustainability are addressed in many courses, although few course syllabi (two at the bachelor and two at the master level) explicitly mention sustainable development in their ILOs. At the bachelor level, six of the eleven mandatory courses and eight of the twelve elective courses include SD. The ILOs relate to nine of the SDGs (Table 1), namely numbers 1, 3, 4, 5, 8, 10, 12, 13 and 16. Of the six courses given at the master level, four have ILOs of relevance for SD, related to six of the SDGs (numbers 1, 3, 5, 10, 12 and 13).

Examples of the content in education related to sustainable development

The students encounter issues related to SD from semester one of the undergraduate programme all the way through completion of their master’s degree, as shown by several examples. In their first semester (undergraduate), the students have several course segments related to SD. One of these is explicitly related to this topic and, after an introductory lecture about SD and occupations, their task is to relate their own occupational patterns to SD and Agenda 2030. Finally, they present and discuss similarities and differences as well as opportunities to change the occupation to have less negative impact while keeping its value. Another module is related to human rights from national and international perspectives and the students focus on various aspects related to SDGs 1, 3, 5, 8, 10, 11 and 16.

In the second year, the students chose 2–4 elective courses that together comprise 6 credits. Several of these are related to SD and one is explicitly focused on everyday occupations from a sustainability perspective. During the third year, the students can choose elective courses. Two of these, work rehabilitation and ageing from a health-promotive perspective, are given at the department. Both address issues related to SD, and for example the ageing course includes a case seminar related to social inclusion (SDG 10). As a point of departure, the students get a case describing an activity group, which includes issues related to gender equality (SDG 5) as no men attend, to public transport (SDG 11), and to health (SDG 3), and the students are asked what could be done regarding these issues.

In the master’s programme, content related to sustainable health and development is included in several courses. For example, one work theme in one course is named ‘Sustainable health and sustainable development.’ During this, the students reflect on sustainable health and sustainable development in relation to occupation, based on literature. They choose an area of interest, reflect on their choice and why they consider this important, and prepare and conduct a seminar discussion. This is progressed in other courses that also include equality and equity, with an additional emphasis on sustainable health locally/globally.

Sustainability in research the last five years

Many articles related to sustainable development were identified in the research published over the last five years including occupational therapists at the department. Their content was related to nine of the SDGs (numbers 1, 3, 4, 5, 6, 8, 10, 11 and 13), as seen in Table 1.

Two articles were explicitly related to SD and concerned climate change (i.e. SDG 13) in relation to occupational therapy (Wagman, 2014a, 2014b). The first of these was a literature review about the contribution to ecological sustainability and climate change from occupational therapy/science. The results showed that occupational therapy can contribute through the adaptation of occupations to make them more environmentally friendly as well as in relation to current climate changes, cooperation with other relevant partners, exploration of occupational choices and warnings from an occupational perspective (Wagman, 2014a). The second article (Wagman, 2014b) was an opinion paper positing that the Model of Human Occupation (Kielhofner, 2008) could be useful in relation to climate changes as well (Wagman, 2014b).

The results also showed several articles of relevance to various SDGs conducted in projects related specifically to children and young people, to adults or to people in older age.

Research has been conducted on the participation of children and young people in various aspects of life (Lygnegård, Almqvist, Granlund, & Huus, 2018; Lygnegård, Augustine, Granlund, Kåreholt, & Huus, 2018) using the Children and Youth version of the International Classification of Functioning, Disability and Health (Lygnegård, 2018), demonstrating that this classification can be a useful tool in documenting young people’s mental health in everyday life activities (SDG 3). Moreover, an interdisciplinary approach is crucial in designing interventions to increase participation in and outside school activities (SDGs 4 and 10), and, related to SDG 3, it is not a diagnosis per se that primarily affects participation but rather factors such as sibling support and family atmosphere. Other research projects are related to children with disabilities (Lygnegård, Donohue, Bornman, Granlund, & Huus, 2013), children’s rights, and basic and special needs in low-and middle-income countries (SDGs 1 and 10) (Huus, Granlund, Bornman, & Lygnegård, 2015). How children’s voices are emphasised, and what rights, according to the UN Convention on the Rights of the Child, the children themselves think that they have, as well as the rights their primary caregivers think they have, have also been researched (Huus, Dada, Bornman, & Lygnegård, 2016), which relates to SDGs 1, 3, 4 and 5. Findings illustrate that proxy ratings regarding children’s needs are in focus rather than the children’s own voices (SDG 10).

When it comes to research involving adults, an ongoing longitudinal multi-center study (Lindmark et al., 2019), related to SDGs 3, 4 and 8, aims to explore health-promoting factors for a sustainable working life among higher education students in the fields of health care and social work, during their education as well as for a time period after completion of their studies. Occupational balance is another topic researched at the department. It has often been related to health and wellbeing (i.e. SDG 3), (e.g. Gunnarsson, Wagman, Hedin, & Håkansson, 2018; Wagman & Håkansson, 2014). However, occupational balance has also been researched in relation to organisational factors at workplaces (Borgh, Eek, Wagman, & Håkansson, 2018), i.e. SDG 8, as well as in relation to cohabiting men and women (Håkansson, Milevi, Eek, Oudin, & Wagman, 2019; Wagman, Nordin, Alfredsson, Westerholm, & Fransson, 2017), which is relevant for SDG 5. Finally, the need to address occupational balance from an interpersonal perspective has been highlighted (Wagman & Håkansson, 2019) and problematised from an equality perspective (SDG 5 and 10), as it is possible to enhance one person’s occupational balance at the expense of another person’s balance. In another project, people from other EU countries who are begging in Sweden in order to sustain themselves and their families were interviewed about health (Wagman, Björklund, Johansson, & Fristedt, 2018), i.e. SDG 3, and their everyday life abroad (Wagman, Johansson, & Fristedt, 2018). The results showed poverty (SDG 1), lack of water and sanitation (SDG 6), and issues related to inequalities (SDG 10). The participants also described their desire to work instead and how difficult it was to secure gainful employment (Wagman, Johansson, et al., 2018), i.e. SDG 8.

Research involving asylum-seekers and refugees is also part of the ongoing research from perspectives relating to the need for work and how to stay healthy (SDGs 3, 8 and 10). This is exemplified in an article describing the need for change in the asylum centers incorporating the perspective of asylum-seekers (Morville & Jessen-Winge, 2019), and a publication on the refugee perspective toward the health-care system (Niemenen, Green, & Morville, 2019). Furthermore, an ongoing project relates to the need to decrease inequality and develop sustainable solutions regarding the employment challenges that refugees experience in the Swedish society (A-L. Morville, personal communication September 2019).

Other studies related to SDG 3 have been published on: wheelchair users’ satisfaction with their prescribed wheelchairs and wheelchair service in Croatia (Štefanac, Grabovac, & Fristedt, 2018), what is important for people in palliative care (Von Post & Wagman, 2018) and the categorisation of daily occupations by adolescents as an aspect of health (Widmark & Fristedt, 2019). Research taking a professional rather than a personal perspective on occupational therapist students’ views on addressing sexual health (SDG 3 and partly SDG 5) has also been conducted (Areskoug Josefsson & Fristedt, 2019). Another area is related to work, where research has been conducted regarding employers’ perceptions of work ability (Jansson, Björklund, Perseius, & Gunnarsson, 2015) and the impact of mental health problems (Jansson & Gunnarsson, 2018), as well as on rehabilitation during sick leave due to mental health problems with the purpose of promoting sustainable participation in working life (Jansson, Gunnarsson, Björklund, Brudin, & Perseius, 2015; Jansson, Perseius, Gunnarsson, & Björklund, 2014), which are all related to SDGs 3 and 8. Moreover, paid work has been problematised more generally, related to SDGs 3 and 8, and the potential of basic income to decrease poverty and enhance health has been discussed (Jansson, 2019).

Work is also a topic in research projects related to older people and prolonged employment. The welfare sector’s need for voluntary care, due to the growing number of older persons, contradicts the need for employees to work beyond their retirement age. This entails a gender inequality (SDG 5), since voluntary care is more common among women. As a result, women also get lower retirement pensions (Björklund, Brushammar, Bjursell, Nystedt, & Nilsson, 2018). Moreover, prolonged employment after retirement age is not self-evident for every employee who wants or needs to, since this possibility is most often reserved for the highly educated (Bjursell, Nystedt, Björklund, & Sternäng, 2017), i.e. SDG 10. For those without possibilities for prolonged employment with their original employer, staffing agencies offer jobs for retirees, but often for lower pay than before (Björklund et al., 2018), which relates to SDGs 8 and 10.

Research on older persons and ageing is also common at the department, exemplified by articles describing health-promoting programmes for senior citizens (Johansson & Björklund, 2016; Johansson, Ericsson, Boström, Björklund Carlstedt, & Fristedt, 2018), which is related to SDG 3. In an ongoing project, the aim is to evaluate an occupation-focused health-promotion project (SDG 3) for people aged 75 years or older that have increased risk for mental illness and activity limitations, i.e. SDG 10 (A Johansson, personal communication September 2019). Another project (Johansson & Fristedt, 2019) relates to occupation and occupational adaptation among migrant women from the Western Balkans as foreign-born persons are at greater risk for ill-health (SDG 10). The results showed that the women felt inactive and avoided social occupations due to limited language abilities and that this affected their wellbeing (SDG 3). Using a mixed methods approach (RCT and qualitative interviews), mobile geriatric teams (MGTs) have been evaluated based on cost-effectiveness and from a user’s perspective. The MGT intervention intends to support health (SDG 3), but the team also works to improve the care of ‘the most sick older adults’ at risk of becoming marginalised when the ordinary care system fails to sufficiently acknowledge or address their needs (Fristedt, Nystedt, & Skogar, 2019), i.e. SDG 10. One project focuses on elderly with hip fractures with the aim of decreasing deteriorations in health and wellbeing (SDG 3) that are often associated with the sequelae of a hip fracture (Röpke, Lund, Thrane, & Morville, 2019).

Community mobility in later life that enables access to activity arenas for participation and thereby influences health (SDGs 3 and 11) remains a topic of interest (Fristedt, Dahl, Wretstrand, Björklund, & Falkmer, 2014; Fristedt, Kammerlind, Ernsth Bravell, & Fransson, 2016; Kammerlind, Fristedt, Ernsth Bravell, & Fransson, 2014). Community mobility may be influenced by gender, and thus one article also takes a gender perspective (Fristedt et al., 2014) in line with SDG 5.

Discussion

This paper aimed at describing the explicit and implicit inclusion of sustainable development and the Agenda 2030 goals (United Nations, 2015) in occupational therapy education, at our department as well as in research involving our researchers, in order to provide an example. The results showed that although few courses and articles explicitly described SD, and none the SDGs (United Nations, 2015), there were many ILOs and articles that could be related to these, showing that the topic is more extensively addressed than perhaps would have been guessed beforehand. In fact, it can be discussed whether the topic is even addressed more extensively in education than is shown by the formal documents (course syllabi and study guides). Although no ILOs for the clinical placement and the thesis course were directly related to SD, some students may include aspects of relevance to some of the SDGs. Moreover, during the present examination, we also recognised another fact related to sustainability, as some of our internationalisation work is conducted remotely through the Internet, which is a way to make it more sustainable from an ecological point of view. Similarly, our master’s programme is web-based, which limits the travel needed. Explicitly addressing such kinds of ‘own’ sustainability efforts, as well as potential areas for improvement in these, could provide valuable knowledge, as the importance of more sustainable practices has been highlighted (Dennis et al., 2015). Clearly addressing sustainable development in occupational therapy education could also be considered a quality aspect.

As the present description solely relates to one Swedish university, no knowledge exists about how common the content is within occupational therapy in general, and further studies are warranted. However, our university is probably not unique, and most of the research involving ‘our’ researchers was conducted in national/international collaborations.

Taken together though, there may be a lot of education practices and research related to SD that could be disseminated if more universities were to implement a similar procedure. Continuous reflection about course content and research in relation to SD, and explicitly marking this content and research in relation to the SDGs in Agenda 2030 (United Nations, 2015), would be a way of showing, both to the profession and to the outside world, what is being conducted. This would be valuable, as the profession’s contribution to SD has not yet been fully recognised. Such a procedure would also be in line with the recommendation from WFOT to align our work with the SDGs (World Federation of Occupational Therapists, 2018).

However, it seems that it is mostly the ecological and environmental aspects of sustainability that are addressed in education and research and there is clearly more to be done. Another thing to consider is that although several of the SDGs were identified as relevant (ten in education and eight in research), the respective course syllabi and research projects focused on only one or a few of them at a time. According to the United Nations (2015), the SDGs and associated targets are ‘integrated and indivisible’ (p. 5), potentially implying that it would be better if SD was addressed on a broader scale. On the other hand, the broadness of sustainability makes the concept difficult to grasp as a coherent whole, and focusing on some aspects, while realising their interdependence with others, may be fruitful for occupational therapy. The importance of recognising the interdependency of the goals is even further emphasised considering that none of our ILOs/research seemed related to SDGs such as ‘below water’ and ‘on land’ (SDGs 14-15) and those aspects are of course invaluable for the other SDGs. However, there was no analysis conducted regarding the potential impact of the research on aspects related to sustainable development as this was beyond the aim of this paper. This is a limitation in that improvement in one SDG, such as health or working environment, may affect other SDGs such as climate change. Taken together, though, a continuous awareness of the goals, and working toward them in occupational therapy practice, would contribute to a more sustainable future.

Methodological considerations

The present article has both limitations and strengths that need to be taken into consideration. Firstly, it should be recognised that most of the content had not originally been described as related to either sustainable development or to the Agenda 2030 (United Nations, 2015). The authors, however, are all working as lecturers in the programmes, which adds face validity to the findings regarding education. Similarly, the authors of the articles agreed with the relevance of the identified SDG(s), which is a strength. However, it should be recognised that not all of the primary authors of the articles were affiliated with our department/university.

Conclusion

Sustainable development seems quite extensively addressed in education and research at our university when relating it to the goals in Agenda 2030, and is thus more visible than what is shown by the explicit use of the concept. Knowledge about how and to which goals occupational therapy education and research are related is a way to show the current state of the profession. It is also a way of showing the relevance of occupational therapy in the struggle toward a future that includes sustainable development. However, further studies including more universities are warranted.

Disclosure statement

No potential conflict of interest was reported by the author(s).