Environmental Physiotherapy Agenda 2023

The time is now!

The Environmental Physiotherapy Agenda 2023 (EPT Agenda 2023) is a global call to action built around a single aim relevant to physical therapy or physiotherapy education (1). This aim of the agenda is:

To ensure that every student beginning entry-level physiotherapy education from 2020 onwards will have education regarding the relationship between the environment, human health and functioning, and how this pertains to physiotherapy as part of their programme.

Current international agendas like the UN Sustainable Development Goals, the EU Green Deal, and extensive research across healthcare are highlighting the inextricable relationship between the environment, human health and functioning, as well as the urgent need for decisive, corresponding action across all sectors of society (EC, 2019; Haines & Scheelbeek, 2020; Myers, 2017; Roe, 2019; UN, 2015). Firmly aligning with these calls to action and the extensive evidence in their support, the purpose of the EPT Agenda 2023 is to elicit a strong commitment to immediate action across the physiotherapy profession in light of the largest health threat that humanity has faced to date (Watts et al., 2019).

We believe that integrating environmental and sustainability perspectives into entry-level physiotherapy education is the single most effective action we can take as a profession at this moment to ensure a maximum contribution to planetary health, both now and in the future.

Within future uncertainty, we discover hope driving to action, support advocacy and applaudall we share this commitment. Resonating with the recent EU Green Deal, we believe that the physiotherapy profession is exceptionally well placed to turn this ‘urgent challenge into a unique opportunity’ and provide considerable help in the global efforts to ‘protect the health and wellbeing of citizens from environment-related risks and impacts’ (EC, 2019; Haines & Scheelbeek, 2020).

In recognition of the fact that integration of new content into physiotherapy curricula requires some thought and time, and in light of the average length of entry-level programmes around the world lying around four years, the EPT Agenda 2023 is set out as a four-year plan. This means that physiotherapy education institutions would have enough time to reach all students that have begun their training in 2020.

It is not our intention to prescribe the exact content or methods that should be integrated and implemented by participating physiotherapy education institutions to achieve the aim of the EPT Agenda 2023. Building on the quickly growing literature across fields including sustainable healthcare, sustainable healthcare education, global health, planetary health and others, we can however, provide some tentative directions throughout this Agenda and hope that this will be of value for further discussion, development and implementation.

Concerning content, we assume that achieving the aim of the EPT Agenda 2023 will mean that participating institutions around the world would integrate at least some amount of education on any of thematic elements in the following list into entry-level physiotherapy education between the years of 2020-2023. All of these concern slightly different, but nonetheless overlapping aspects of the relationship between human health, functioning and our planetary environment:

  • The positive contributions of the environment to human health and flourishing;
  • Basic understandings of modern-day environmental degradation and climate change;
  • The negative impacts of climate change and environmental degradation on human health and functioning in relation to physiotherapy globally, and as they apply to the national, regional and local context of each respective physiotherapy education institution;
  • A basic understanding of the philosophical, historical, cultural, social, political and economic conditions leading and relating to our current health and environmental crises;
  • Some critical engagement with fundamental concepts like nature, environment, sustainability, development, social and environmental justice and the intersection and interaction of these and other related terms and issues;
  • A basic overview and understanding of current policies and strategies for mitigation and adaptation to climate change and environmental degradation (e.g. the UN Sustainable Development Goals, the WHO Global Strategy on Health, Environment and Climate Change, the EU Green Deal and others), as well as some of their conceptual and practical challenges;
  • A basic overview of relevant work across other healthcare professions (e.g. medicine, nursing, occupational therapy and psychology) engaging with environmental issues and other related interdisciplinary developments across sustainable healthcare, planetary health, One Health and related fields;
  • A basic understanding of the environmental history of physiotherapy, i.e. its historical relation to ‘nature’ via the therapeutic use of natural elements and low-carbon modalities like touch, communication and movement, as well as its past and current use of natural resources;
  • Basic insights into how the environment is implicitly and explicitly addressed and engaged with, in aspects of physiotherapy (including also speciality fields like occupational health and ergonomics, animal physiotherapy, and others);
  • A basic understanding of how existing environmental challenges, policies and strategies relate to, can be implemented, and further developed in physiotherapy, and how novel approaches might be envisioned to address challenges and opportunities unique to physiotherapy.

Concerning means and methods, the literature across education in general, but also physiotherapy education and sustainable healthcare education more specifically suggest four general approaches which are likely to be relevant to entry-level physiotherapy education:

  • Interweaving environmental physiotherapy content with existing curriculum content;
  • The development of standalone environmental physiotherapy workshops, seminars, lectures, and similar;
  • A combination of face-to-face and digital education in environmental physiotherapy;
  • A practical, learning-by-doing approach where environmental physiotherapy is interwoven in clinical education and student practice.

Existing research thus far suggests that interweaving sustainable healthcare education with existing curriculum content is a particularly feasible and beneficial approach (Walpole, Barna, Richardson & Rother, 2019; Hackett et al., 2020). This is both because healthcare education curricula are already very dense and this poses considerable challenges to change or addition, and because one of the core aspects that need to be illustrated and understood is how the environment is already implied in all of physiotherapy practice, research, and education. In other words, it is to show and understand the inseparable relationship between health and environment in all aspects of physiotherapy, healthcare and beyond. In the following section, we, therefore, provide two examples of how environmental and sustainability perspectives might be interwoven with common physiotherapy curriculum content.

Though not the main focus of this Agenda, but for the same reasons - the inseparable relationship between health/care and the environment - we also strongly recommend that physiotherapy research and education institutions begin seeking and providing support for diverse research involving environmental and sustainability perspectives in physiotherapy at all levels of professional education. A stronger research base is urgently needed to enhance our understanding of the situation we are facing and to inform the best ways to take action at this time.

We also recommend and hope that more national and international professional physiotherapy organisations will put environmental and sustainability perspectives on their respective agendas and discuss how physiotherapy might best contribute to the adaptation to and mitigation of the today’s global environmental challenges.

We also wish to highlight that the aim of this Agenda is not just something that we need to do because it is urgent, but it is also something we can achieve, if we work together. According to the recent, 2019 report of The Lancet Countdown on health and climate change the role and responsibility of the healthcare professions is clear and essential. It consists in ‘ensuring that the health of a child born today is not defined by a changing climate’ by ‘com­municating the health risks of climate change and driving the implementation of a robust response which will improve human health and wellbeing’ (Watts et al., 2019). In light of this responsibility and our proven capacity to take action, we firmly believe that our profession is in an exceptional place to make a significant contribution to planetary health through the integration of environmental and sustainability perspectives into entry-level physiotherapy education. Considering the additional urgency of the matter, what we know for sure is that the time is now!

Signed, the Executive Committee of the Environmental Physiotherapy Association (EPA), 18 February 2020:
Dr Filip Maric (Founder and Executive Chair EPA, Oslo, NO)
Prof David Nicholls (AUT University, Auckland, NZ)
A/Prof Karien Mostert (University of Pretoria, SA)
Joost van Wijchen (Senior Lecturer, HAN University of Applied Sciences, Nijmegen, NL)
Dr Jane Culpan (QMU University Edinburgh, Scotland, UK)
Dr Olivia Stone (University of Otago, Christchurch, NZ)
Marion Kennedy (PhD cand, University of Otago, Dunedin, NZ)
Issie Long (PT student, Cardiff University, Wales, UK)
Thies Bundtzen (PT student, Saxion University of Applied Sciences, Enschede, NL)


(1) We use the terms ‘physiotherapy’ and ‘physiotherapy education’ throughout the remainder of the EPT Agenda 2023. Following global conventions and the recent name change of the World Confederation for Physical Therapy (WCPT) to ‘World Physiotherapy’, we understand and use these terms in reference to both physiotherapy and physical therapy. See also: WCPT Name change for global physical therapy body.