The relative shortage of content

Given the relative novelty of environmental and sustainability perspectives as an explicit feature in entry-level physiotherapy education curricula and a relative scarcity of research linking environmental and sustainability concerns with physiotherapy in an explicit manner, one of the challenges is to decide what should be integrated into curricula in terms of content. To address this issue, we have tried to point to various possible directions for inquiry and education throughout the EPT Agenda 2023 that could be drawn upon as potential starting points. This includes, e.g. drawing on the rapidly growing bodies of work across overlapping, interdisciplinary fields like global and planetary health, environmental medicine, sustainable healthcare and education, environmental Medicine, OneHealth, as well as physiotherapy in occupational health and medicine, and animal physiotherapy, and more. In addition to these, there is also an extensive range of materials on existing strategies and policies like the SDGs, including readily available material for teaching (with) them. Not least, a significant amount of resources has developed across local and indigenous knowledge systems, philosophy, the social sciences and the humanities, all of which have long thought about and sought to improve our relationship with the environment, highlighted problems in our thinking that have contributed to our current situation and investigated novel futures. Because this combines to an extensive amount of resources, we have only been able to provide a modest and indicative selection in the ‘Resources and References’ section of this Agenda, but hope it will be helpful.

Once again, it should also be clear that we are aware that many of our colleagues working in physiotherapy education are already integrating sustainability and environmental perspectives into their courses and curricula. As outlined in the 'Proposal for ongoing collaboration' section of this Agenda, we hope to draw on these efforts to support and inspire other colleagues around the world to develop their unique approaches to sustainability and environmental physiotherapy education.

Just as in the case of the so-called basic sciences of anatomy, and physiology, which have played a central role in the history of the physiotherapy profession so far, there is also an amount of basic knowledge, e.g. about environment, ecology, or climate, that needs to be considered prior to more specialised application to healthcare and physiotherapy. Considering this raises another interesting issue relating to the increasing efforts to integrate teaching about sustainability, climate change, environmental degradation, the SDGs, and even eco-anxiety into secondary school education around the world (Berger, 2019; Graham-McLay, 2020; The World’s Largest Lesson). When more of this basic knowledge becomes general knowledge held by students before entering tertiary education, it will enable us to be more particular about what needs to be included into physiotherapy education and what prior knowledge we can build on. This might also help further clarify our specific role and contribution as physiotherapists in, e.g. achieving the SDGs versus our roles as members of society in general, or in other specific capacities, as much as discussing to what extent this distinction is or should be treated as categorical, interwoven, or otherwise.

Continuing on this discussion, we suggest that even talking about what to include and exclude in the curricula with physiotherapy students, what is general knowledge already taught in schools, what the specific aspects relevant to physiotherapy are, and how these should be approached could equally already mean achieving the aim of the EPT Agenda 2023 in itself. It would represent an approach to beginning the conversation and the development of the subject field, but doing so in partnership with our students. That integrating students into curriculum development and its challenges in this manner might be a particularly pertinent approach is also echoed in current calls for more participatory approaches in teaching and learning (Peseta & Bell, 2020). Literature in sustainable healthcare education equally seems to support such strategies (Walpole et al., 2017; Walpole & Mortimer, 2017). We believe that the potential discussions concerning environmental physiotherapy in this regard provide an especially amenable forum for doing so, precisely because environmental physiotherapy is an underexplored field that is yet to be developed collaboratively, thus turning yet another apparent challenge into an exciting strength and opportunity.

We hope that refraining from prescribing specific content in an overly rigid manner throughout the EPT Agenda 2023 will also support the development of as many locally diversified approaches to achieving its primary aim as possible. Taking an environmental, or planetary perspective must inherently imply acknowledging, thinking and acting in accordance with the diversity of national, regional, and local contexts. What might be particularly relevant to one ecosystem, or possible in one culture or society, might not be the same as in another, even in a neighbouring one. Respecting and acknowledging this geo-regional diversity is at the core of effective ‘glocal’ solutions (Sudmann & Breivik, 2018). It is also echoed in, and we would argue, a pertinent extension and implementation of the World Physiotherapy statement on diversity and inclusion (WCPT, 2019). Practice, research and education in sustainability and environmental physiotherapy therefore inherently calls for highly diverse, non-standardised, glocal approaches that will need to be nurtured as they emerge, rather than limited by the a priori imposition of overly rigid, predefined parameters. Yet again, we therefore believe that starting from what seems like a relative shortage of content effectively constitutes an outstanding strength and opportunity.

Finally, the EPT Agenda 2023 provides a timeframe of four years for participating institutions to envision their very own, glocal approaches and achieve its aim. We hope and believe that this should be ample time for doing so because the aim of this Agenda is to begin the explicit integration of sustainability and environmental perspectives into entry-level physiotherapy curricula, rather than develop and deliver comprehensive and highly polished novel content. As has been argued about planetary health, as well as sustainable and regenerative development, we have to approach our aim with the full awareness that we are embarking on ‘a continuous learning journey that will need many adjustments of course and constant redesign to adjust answers and solutions to changing conditions’ (Wahl, 2018).