Scandinavian Journal of Occupational Therapy. 2014; 21: 161–165

ORIGINAL ARTICLE

How to contribute occupationally to ecological sustainability: A literature review

PETRA WAGMAN Jönköping University, School of Health Sciences, Sweden

Abstract Objective: Climate change is of great concern today, and is an important health issue. The changes are related to human occupations and, therefore, an occupational perspective can make important contributions to ecological sustainability. The aim of this scoping literature review was to explore and describe what has recently been written about how occupational therapy/ therapists/science can contribute to ecological sustainability and the prevention of more severe climate change. Methods: Publications were used as data. Searches were conducted in databases, journals, reference lists, and citations. Fourteen items, with content related to the contribution of occupational therapy/therapists/science to climate change and ecological sustainability; written in English; having an occupational therapist among the authors; and published between 2008 and 2013; were included. Results: The results revealed four different ways that occupational therapists/scientists can contribute: by adapting to prevent climate change and to existing changes; by cooperating with others; by exploring people’s occupational choices and the relationship between occupation and ecology; and by warning of the consequences of the changes. Conclusion: These ways of contributing can be used as a point of departure for further research on this important topic.

Key words: climate change, health and well-being, occupational science, occupational therapy, sustainable development

Introduction Climate change is a great challenge that threatens ecosystems and affects humans negatively (1,2) as it affects the prerequisites for health (3). The World Health Organization (2) has recognized the relationship between climate change and health, stating that “addressing climate change should therefore be viewed as much as an effort to improve human health and well-being as it is to protect the natural environment or economic development” (p 22). It suggested that health professionals should act as role models in the areas of climate change and health. Furthermore, the importance of multiple perspectives and of interdisciplinary research has been recognized in relation to climate change (4). Because climate changes are related to human occupations (1,2), the occupational perspective held by occupational therapists and occupational scientists is

important. Their knowledge would be useful for contributing to sustainable development that “meets the needs of the present without compromising the ability of future generations to meet their own needs” [(5), p 15] from an ecological point of view. Ecological sustainability has recently been highlighted by occupational therapy organizations, which have pointed out the importance of this perspective within occupational therapy. The World Federation of Occupational Therapists (WFOT) has recognized its importance (6,7) and has stated that occupational therapists should work towards environmental sustainability. The WFOT also encouraged use of the profession’s occupational knowledge to contribute to the issue and to collaborate with clients and communities, as well as evaluate models in relation to it. The need for new educational material, research, and research collaborations was also highlighted (6). Similarly, the Swedish Association

Correspondence: Petra Wagman, School of Health Sciences, Box 1026, SE-551 11 Jönköping, Sweden. E-mail: [email protected] (Received 18 April 2013; accepted 15 December 2013) ISSN 1103-8128 print/ISSN 1651-2014 online Ó 2014 Informa Healthcare DOI: 10.3109/11038128.2013.877068

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of Occupational Therapists (8) has emphasized the potential in occupational therapists’ competence, suggesting that they can enable clients to live in line with environmentally friendly values. However, further knowledge about how occupational therapists/scientists can contribute to ecological sustainability is important. A literature review would therefore be appropriate, considering that “its goal is to bring the reader up-to-date with current literature on a topic” [(9), p. 38]. The decision was taken to conduct a scoping literature review (10) aiming to explore and describe what is currently written about how occupational therapy/therapists/science can contribute to ecological sustainability and the prevention of climate change.

Table I. Journals selected for manual search. Journal American Journal of Occupational Therapy Asian Journal of Occupational Therapy Australian Occupational Therapy Journal British Journal of Occupational Therapy Canadian Journal of Occupational Therapy Hong Kong Journal of Occupational Therapy Journal of Occupational Science New Zealand Journal of Occupational Therapy Occupational Therapy in Health Care Occupational Therapy in Mental Health Occupational Therapy International OTJR Occupation Participation and Health

Material and methods Publications were used as data. The novelty of ecological sustainability within occupational therapy made it appropriate to include both articles (irrespective of whether published in scientific journals or not) and books/book chapters. Inclusion criteria were items published in 2008 to 2013, with content related to the contribution of occupational therapy/therapists/ science to climate change and ecological sustainability; written in English; and having an occupational therapist among the authors. Four ways of searching were conducted. First, searches were made in the electronic databases Academic Search Elite, Amed, Cinahl, and Medline. In these, occup* ther* OR occup* scien* were combined with a variety of search terms (climate, earth, ecolo*, environmental friendly, green, global crisis, global environmental change, mitigat*, pro-environmentally, recycl*, and sustain*). Thereafter, the reference lists of the included publications were scanned as well as their citations. Finally, journals were manually searched (Table I). The searches ended in November 2013. After inclusion, each item was read several times and a “data charting form” (10)” was used, consisting of year of publication, country, type of publication, and content regarding contribution to ecological sustainability and the prevention of climate change. When all data had been extracted, the contents in the charting form were analysed, compared, and sorted into themes. Results Fourteen items published between 2008 and 2013 met the criteria and were included. These were: nine articles, one book, and four book chapters. The authors were from Australia, Japan, New Zealand, Spain, Sweden, UK, and the US. The results revealed

Scandinavian Journal of Occupational Therapy

four ways to contribute: by adapting, cooperating, exploring, and warning. Adapting Adaptation was described in relation to not only making occupations more ecologically sustainable but also adapting to existing climate change; the potentials presented by adaptations as well as difficulties were described. Looking beyond occupational therapy’s traditional client groups, Wilcock (11) argued that occupational therapists can be advisers on how people could conduct occupational changes “suited to individuals to meet their needs yet to sustain resources and the ecology” (p 119). Blijlevens (12) argued against Pereira’s (13) thoughts (described below), highlighting occupational therapists’ potential for working with clients who need to adapt their occupations due to climate changes that have already occurred, exemplifying this with gardening in dry areas. Whittaker (14) also argued that occupational therapists can empower people so that they try to act in a sustainable way, and that they can use analysis to adapt occupational patterns to be more environmentally friendly. He suggested that if a client wishes, the intervention could include how to conduct the occupation in the most sustainable manner. However, he also problematized the occupational therapist’s role when a client is not interested in sustainability. Hocking and Kroksmark (15) described investigations conducted by the United Nations Environment Programme, which found that young people’s preferred sustainable choice differs between countries. This knowledge, they argued, would be useful to

Contributing occupationally to ecological sustainability occupational therapists when working with young clients wishing to live in an environmentally friendly manner. Furthermore, Ikiugu (16) described a conceptual framework including the enhancement of people’s awareness of their occupational impact on issues such as climate. Measurements for making people adapt their occupation in another direction were also developed (16,17) and investigated (17). It was suggested that these instruments can be included in an intervention led by an occupational therapist or scientist. However, Ikiugu also highlighted that these people need to have experience of the change themselves before doing it with clients (18). The benefits of reusing assistive devices, including recognition of the environment (19) and importance of adaptations among allied health professionals (20), was described. Finally, Aoyama et al. (21) recognized occupational therapists’ expertise in adaptations, but also the difference between adaptation to climate change and adaptations to disabilities. Cooperating The benefit of cooperation was mentioned both at the individual level, group level, and generally. It was proposed that occupational therapists should expand their client population, and that they would be useful as parts of “council sustainability teams or environmental charities” (14). Furthermore, one of the benefits of a gardening project including students in occupational therapy and people suffering from social exclusion was that it was “confronting the ecological crisis” [(22), p 358]. Hudson and Aoyama (23) also highlighted the potential of the occupational perspective as contributing to and complementing other sciences. Exploring This way of contributing – through exploring – an occupational perspective was proposed to facilitate an understanding of people’s occupational choices (21,23). The importance of exploration within the profession was also highlighted. Aoyama (24) argued that important knowledge can be gained by researching indigenous people and their occupations. Ikiugu (16), discussing climate change together with other occupational injustice issues, described that occupational knowledge is useful for exploring the rationale behind people’s occupational choices. According to him, this “could help us guide them so that they can find other ways of obtaining the same benefits” (p 97). Additionally, it was highlighted that occupational therapists can explore how people “perform and negotiate their daily activities in situations of ecological and social stress” [(23), p 546].

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Another way of exploration was described in relation to a gardening project including occupational therapy students. It was argued that: “While the students have participated in realitygrounded learning about occupational therapy, they also have understood the connection between human occupation and the ecological crisis.” [(22), p 358]. Warning Pereira (13) argued that climate changes, resulting in a warmer and drier climate which is negatively affecting occupations like gardening, can lead to occupational deprivation and affect people mentally. He described occupational therapists as “change agents” with the potential to warn about and highlight such issues at the societal level. Discussion The aim of this literature review was to explore and describe current literature on how occupational therapy/therapists/science can contribute to ecological sustainability and the prevention of climate change. The results of the literature searches, performed in multiple ways, comprised 14 items. This scarcity implies that the topic has not yet been fully recognized by occupational therapists. This is a limitation considering the relationship between occupation and ecological sustainability and the potential in the profession of occupational therapy. Ikiugu and McCollister (17) described this very nicely: “It could even be argued that most of the problems that trouble humanity are at some level a result of human occupational choices and performance patterns. This means that a professional/scientific discipline that understands human occupation is in a unique position to contribute meaningfully to the resolution of major global issues.” (p. 405). Four ways to contribute were identified in the results. One of these involves adapting to make an occupation more ecologically sustainable. Adaptations and strategies for doing preferred occupations in other ways, for different reasons, are familiar within occupational therapy. This knowledge is also appropriate in relation to climate change and ecological sustainability, and is in line with the publications from the professional organizations (6,8). Another perspective on adaptation was related to enabling clients to adapt to the effect of climate changes that have already occurred. However, rather than adaptations to changes caused by climate change, this author would like to argue that occupational therapists should prefer engagement in occupational adaptations that prevent it from becoming severe. It should be recognized, though, that the former may be necessary as well.

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One way occupational therapists already contribute is by conducting research related to extreme weather, which may become more common and severe (1), e.g. concerning the consequences of hurricanes from an occupational perspective (25,26). Finally, adaptation is perhaps even better when combined with one of the other ways of contributing, namely cooperating with, for instance, other professions. Exploring was also identified as a way to contribute. One way to do this practically could be to use some of the questions (“who”, “what”, “when”, “where”, “how”, and “why”), proposed to be asked when studying occupations (27). For example, the questions who and when can reveal whether an environmentally friendly occupation is conducted by certain groups or on certain occasions. Where could explore such things as the travel distance to the occupation. The how question, finally, may reveal for instance the amount of clothes put in a washing machine, and so on. The answers to these questions can be used to evaluate whether an occupation can be changed to be more environmentally friendly while remaining equally satisfying or effective. The latter may be an important promoter for environmentally friendly occupational patterns, and is also in line with Ikiugu (16). Finally, contribution through warning was another topic identified in the results. Showing the occupational consequences of ecological disasters is important, and this has been done by occupational therapists. Blakeney and Marshall (28) showed the importance of clean water, reporting on a study in which occupational therapists acted together with the population of a community affected by polluted water (although this was not caused by climate change). Their results showed that the participants faced several occupational injustices due to the polluted water (28). Taken together, the results show several ways in which the occupational perspective can contribute in relation to ecological sustainability. The four ways of contributing should be researched further, to explore their usefulness as well as occupational therapists’ perceptions of them and their value. However, not every topic described by the WFOT (6) and/or Swedish Association of Occupational Therapists (8) was mentioned in the items included. For instance, design for all in relation to recycling, as proposed by the Swedish Association of Occupational Therapists (8), was not identified in the results. This is a limitation because recycling has been identified as one of the occupations necessary for an ecologically sustainable society (29). Enabling people so that everyone can engage in such occupations is therefore relevant for occupational therapists to work with. Future research, investigating the degree to which occupational therapists are currently working with this and similar topics, would also be valuable.

Finally, there is a need to research whether ecological sustainability is sufficiently included in occupational therapy education. The need to educate occupational therapists more broadly has been emphasized by Thibeault (30), who recognized the lack of inclusion of issues like pollution in education and described it as important that students learn to ask themselves two important questions: “What are the social consequences of my professional decisions? What is their environmental cost?” (p 160). These questions are highly relevant. Methodological considerations This literature review is based on a limited number of items. Efforts were made to include all relevant publications by searching in different ways, but it cannot be ruled out that some might have been missed. Furthermore, no attempt was made to include unpublished material or material within networks or the like, which could be seen as a limitation. It should also be recognized that this review focuses solely on climate change and ecological sustainability, but could have linked to occupational justice more broadly. Finally, this author likely reflects a Western societal perspective. Conclusion This literature review aimed at exploring and describing what has been written about how occupational therapy/therapists/science can contribute to ecological sustainability and the prevention of climate change. Fourteen items published between 2008 and 2013 were included. The results identified four ways to contribute – by adapting, cooperating, exploring, and warning. These ways of contributing can be used as a point of departure for further research regarding this important topic. Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.

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How to contribute occupationally to ecological sustainability: a literature review.

Climate change is of great concern today, and is an important health issue. The changes are related to human occupations and, therefore, an occupation...
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