Sustainability in occupational therapy practice, education and scholarship

Occupational therapy practitioners recognise the importance of the environmental context on occupational performance and subsequently on human health and well-being. Greta Thunberg’s recent appeals to international leaders for climate justice centre on addressing uncomfortable and unpopular truths about sustainability. These issues have simmered into a perception of climate crisis at the beginning of this year as Australian bushfires, in addition to their devastation on human and animal life, have affected air quality around the southern hemisphere, while the impact of human activity on warming and acidity in the oceans poses a threat to millions living in arctic and low-lying regions (WMO, 2019, 2020). While Thunberg has spoken truth to power, figures such as Bank of England governor Mark Carney have also warned corporations to take heed of the effects of climate change as the biggest threat to the global economy.

Doubts about the science of global warming can mostly be traced back to corporate, political or media misrepresentation of the arguments (Supran & Oreskes, 2017). The link between climate change and effects such as flooding and increased precipitation cannot be ascertained easily because of current deficiencies in science or its resources (Kundzewicz et al., 2014), not because the science itself is ‘wrong’. There is a need for the science community, engineers, citizens and governments and even occupational therapists to choose the ‘precautionary principle’ and do ‘the right things’ rather than wait for the evidence (Kundzewicz et al., 2014, p. 230).

Climate change is not the only dimension of sustainability, which concerns the use of resources and land as well as equity and balance in life experience. The UN sustainability goals relate to the pressing effects of climate change on primary human concerns anticipated in the next few decades (https://www.un.org/sustainabledevelopment/sustainable-development-goals/), but also to inequity, poverty and injustice. Vulnerable and disenfranchised people are most exposed to disaster, 11% of the world population live in areas at risk from flooding – one of the most significant being Bangladesh, (Kundzewicz et al., 2014). With over half the world’s population living in urban areas (UN, 2018) there are multiple public health concerns arising from air and noise pollution, lack of access to natural environments and the risk of epidemics. Many people who are exposed to disasters lack adequate insurance and so the true costs are not detectable by financial systems (Hillier, 2018).

Concern about environmental influence on occupational performance, health, and well-being makes sustainability a core topic for occupational therapy practitioners. Meaningful occupational participation has to take account of sustainability and threats to the environment arising from every aspect of human activity in connection with planetary resources. The contribution of unsustainable lifestyles to climate change and resulting threat to health and well-being means that sustainability has to be part of the occupational therapy scope of practice (UCL-Lancet Commission, 2009; Stancliffe, 2014; Wilcock, 2006).

Ikiugu (2008) illustrated ways in which individuals could account for their environmental impact through every aspect of their daily occupation. Persson and Erlandsson (2014) identified an ethical element of this connection through ‘ecopation’, a term which refers to the doer accounting for the environment in the relationship between occupation and eco-systems. Rushford and Thomas (2016) advanced a principle of ‘occupational stewardship’ to advocate a justice-oriented approach to promoting occupation for health without compromising the ecology. The concept of ecopation addresses Thunberg’s uncomfortable truth that factors such as pollution, weather events, desertification and environmental change are significant factors in public health, life expectancy and life quality and result from human activity.

Contributors to this special edition of the WFOT Bulletin were invited to explore how the incorporation of sustainability into practice, scholarship, and education following the publication of the WFOT Guiding principles for sustainability in occupational therapy practice, education and scholarship (WFOT, 2018). Amongst the contributions are articles which discuss how, although the issues are global, the practice of change must be adopted at an individual and group level, as illustrated by the case study by Whitney Lucas Molitor et al in this issue; Camille Dierterle examines how the principles of Lifestyle Redesign can motivate individual change and be incorporated into education; Wagman et al demonstrate how UN sustainability goals can be incorporated into the occupational therapy undergraduate curriculum.

If the crisis is planetary in scale, at least part of its mitigation and the promotion of sustainable ethical occupation may rest in working with individuals and groups with justice related concepts such as occupational stewardship and ecopation. In navigating the stormy and intemperate times ahead occupational therapy may offer practical and achievable interventions through which everyone can participate in change.