Environmental sustainability and occupational therapy practice, revisited.
I received an email from a colleague who has been an advocate and published author on this topic asking me if I had the opportunity to revisit my thoughts on sustainability and occupational therapy.
In fact I have continued to think about this, so I thought I would document my response here.
Thanks for reaching out. I have previously and still believe that the study of climate change itself should remain within the purview of climate scientists. It seems to me that when it is co-opted by distal groups (including occupational therapy) that the issue tends to be used to promote a political social justice agenda. I continue to object to that because I don't know that occupational therapy can advance climate science itself and I find that the proposed actions advance very specific political ideologies and constricts the intellectual diversity within the profession.
I disagree with the conflation of climate science with local political movements - such that in the AOTA policy it states that it is the role of occupational therapy practitioners "...to increase individual, organizational, and community awareness and action related to sustainable occupational choices which threaten human, animal, and environmental well being, and the importance of making occupational choices that preserve natural and built environmental/ecological resources in the United States."
I am uncertain if it is the scope or role of occupational therapy practitioners to dictate lifestyle choices to others. Certainly that is not a core construct of the profession. What would stop any occupational therapist with any particular belief system from telling service recipients how they should be conducting themselves? From a practical perspective, the social contract of occupational therapy is to assist people with returning to independence or occupational role functioning in rather traditionally defined areas of personal care, productivity, and recreation or leisure skills. That is encoded into our licensing laws, our billing systems, and our identity. I understand that some individuals may wish that occupational therapy was not embedded within such a medical and Westernized model of care, but in fact it is in the United States. In short, Medicare won't pay for OTs to promote climate justice - and that makes these political white papers a little out of step with the realities of everyday practitioners. I don't say that with any disrespect toward anyone's interests or beliefs. It is simply factual.
From a scientific standpoint, it is also difficult to understand why any occupational therapists' actions should be limited to what is happening in the United States. There seems to be compelling evidence that negative environmental consequences are driven by the sum of planetary activity. If China produces more than twice the CO2 than the United States, why would we exclude action in that direction? If the US comprises 10-15% of the global total of carbon emissions, how effective will restricting action in the United States be? Do we advance or constrict quality of life by advising populations of individuals in the United States that they need to find alternatives to disposable consumerism - or do we spend our time instead helping them learn how to put on their pants after a stroke, or learn how to write legibly if they have fine motor delays? I have spent 35 years in practice, mostly in areas of significant rural and urban poverty. It has never crossed my mind to tell my patients that recycling will help them improve their lives - particularly when much more immediate concerns consume their thoughts and constrict their opportunities.
As a final point, I struggle with the idea that in order to achieve climate justice that it is important to prioritize the experiences of those who are labeled as marginalized groups. As an example, the position paper suggests that we are to "recognize the impact of climate change on marginalized and high-risk populations who are disproportionately affected, and in many cases unable to make sustainable occupational choices..." The proposed actions for occupational therapy practitioners are to promote sustainable lifestyle choices, to address social/economic/environmental/spiritual determinants of health, to advocate for sustainable health care, and to be advocates for legislation that promotes the climate justice agenda. It is unclear to me how any of these actions does anything other than promote a singular political approach to the concern. Co-opting a scientific construct into sociopolitical terms and identity-based activism seems counterintuitive to generating consensus around an action.
I really don't begrudge anyone's interest in this topic. I consider myself a conservationist although I don't agree with nearly any of the above methodologies for solving pollution problems. I still just don't see this as a function for the occupational therapy profession to be dabbling in - particularly when the profession is losing ground in so many practical areas to other health care professions. As we generate white papers on social justice and climate change and reproductive health, physical therapy is taking over our jobs in many settings. That does not mean that social justice or climate change or reproductive health are not important - in fact they are - but when a small profession like occupational therapy has constricted resources and a defined scope of practice it seems imprudent to be making forays into these other areas.
AOTA (2022). Professional Policy: Sustainability and climate change. https://www.aota.org/practice/practice-essentials/aota-official-documents
Dennis, Carol; Dorsey, Julie; and Gitlow, Lynn (2015). A call for sustainable practice in occupational therapy. Canadian Journal of Occupational Therapy, 82(3) 160-168. doi:10.1177/0008417414566925
Lieb, Lisa C. (2022). Occupational Therapy in an Ecological Context: Ethics and Practice. AJOT, 76(3), https://doi.org/10.5014/ajot.2022.049148
Wood, Peter (2011). Critiquing sustainability. The Chronicle of Higher Education,