Eco-Social Occupational Therapy

The literature suggests that the occupational therapy paradigm must expand beyond individualistic, "person-centered" care to include a global environmental perspective. This "eco-social occupational therapy" connects ecology with occupational justice, recognizing that human health is inseparable from the health of our ecosystems. Within this framework, human activity and ecosystem services are linked through occupational performance, which acts as a mediator for human well-being. However, many modern human occupations are impacting the planet to such an extent that they are reducing the ability of ecosystem services to support that very well-being. To foster a more sustainable planet, practitioners are encouraged to explore "ecopations" and "eco-occupations," defined as daily activities where the doer accounts for the environment to promote balance between humans and the ecosystem.

Ethical Obligations & Intergenerational Justice

Advocating for sustainability is an ethical imperative, as overpopulation and environmental degradation directly threaten human health and well-being. The ability of future generations to exercise their occupational rights depends on the occupational duties fulfilled by practitioners and society today, requiring us to distinguish between legitimate and illegitimate occupational desires. Occupational stewardship can build robust connections and systems within a context, enabling resilience and supporting daily occupations even during ecological stress or natural disasters. Furthermore, moving from a consumerist, profit-driven health model toward a collectivist and altruistic vision of humanity is essential to ensure occupational justice.

Clinical Applications: Health, Mitigation, and Adaptation

Climate change is a clinical reality that results in occupational deprivation, psychometric illness, and decreased quality of life. Canadian occupational therapists report experiencing climate effects across personal, clinical, and professional levels, identifying an urgent need to address climate anxieties, disaster management, and sustainable equipment use. Clinical interventions like "Modified Instrumentalism in OT" (MIOT) have proven effective in facilitating positive occupational performance changes, moving clients from feelings of helplessness to empowerment. Additionally, OTs have a specific role in designing interventions for vulnerable populations, such as identifying heat-adaptive strategies for older adults to manage the impact of extreme heat on their daily lives. Eco-social entrepreneurship models, such as community horticulture, also offer powerful tools for mental health and social inclusion.

Overcoming Barriers in Practice and Education

While many OTPs demonstrate awareness and take actionable steps in their personal lives, they report uncertainty on how to integrate sustainability professionally due to institutional barriers and a lack of specific training. There is a clear call to incorporate concepts of sustainability, social equity, and environmental integrity into occupational therapy education and models of practice. By embedding environmental and sustainable reasoning into the curriculum, students can learn clinical reasoning through graded strategies and examine the ecological impacts of assumptions in person-centered care. Ultimately, by framing climate change from a health perspective, OTs can contribute to global efforts to combat the climate crisis by supporting engagement in sustainable occupations.

Conclusion

The evidence is clear: what is good for the environment is good for human health. By embracing our role as change agents, the occupational therapy profession can reaffirm its vision of human occupation toward a just ecological transition.

References

Foundational Theory & Professional Paradigms

• Aoyama (2012): Proposes that occupational performance mediates the relationship between ecosystem services and human well-being.

• Aoyama (2014): Introduces the ‘occupational cycle’ to illustrate how daily activities transform ecosystem services into health.

• Algado (2015): Introduces "eco-social occupational therapy," connecting ecology with occupational justice through initiatives with marginalized populations.

• Algado (2023): Argues for "occupational ecology" to study the inseparable links between human occupation and the ecological environment.

• Dennis (2015): Argues that OTPs are ethically obligated to use professional reasoning to create a sustainable and resilient future.

• Persson (2014): Explands on the concept of "ecopation"—the doer accounting for the environment—to promote global well-being.

• Taff (2023): Reframes the connections between climate, health, and occupation, calling for a shift from individualism to collectivism to address structural barriers.

• Ung (2020): Proposes that "eco-occupation" includes environmental, cultural, and economic dimensions of the "glocal" (global/local) balance.

• Whittaker (2012): Calls for the expansion of OT models to include the global ecosystem within the concept of "environment".

Clinical Practice, Adaptation & Mental Health

• Dieterle (2020): Links sustainability with health through "Environmentally Informed Occupational Therapy" (EIOT) and Lifestyle Redesign.

• Dutra (2018): Analyzes how environmental education programs can successfully change daily habits and encourage sustainable occupations.

• Fransson (2023): Supports the role of OTs in designing heat-adaptive strategies for older adults during extreme weather.

• Ikiugi (2011 & 2015): Investigates the "Modified Instrumentalism in OT" (MIOT) model, which empowers individuals to change occupational patterns to address global issues.

• Mansilla (2023): Discusses eco-social entrepreneurship and horticulture as models for mental health and social inclusion.

• Periera (2008): Describes how climate change can lead to occupational deprivation and "psychometric illness," particularly affecting leisure occupations like gardening.

• Wagman (2014b): Explores how the Model of Human Occupation (MOHO) can address sustainable development perspectives.

Advocacy, Ethics & Justice

• Drolet (2020): Presents an ethical framework for intergenerational justice, distinguishing between legitimate and illegitimate occupational desires.

• Garcia Diaz (2023): Argues that framing climate change as a health perspective allows OTs to combat lifestyle diseases and environmental degradation simultaneously.

• Lieb (2019): Positions OTPs as essential stakeholders because environmental degradation directly threatens occupational justice and quality of life.

• Pollard (2020): Emphasizes "occupational stewardship" as a way for individuals and groups to become change agents for sustainable, ethical occupation.

• Reagon (2020): Calls for OTs to address climate change through political engagement at both micro and macro levels.

• Rushford (2016): Links occupational justice to natural disasters, noting that marginalized populations are at the greatest risk.

• Turcotte (2020): Views the climate emergency as an opportunity to reaffirm the OT vision of human occupation toward a just ecological transition.

Professional Perspectives, Education & Scoping Reviews

• Chan (2020): Notes that while Canadian OTs value sustainability personally, they face significant institutional barriers to professional integration.

• Du (2024): Reports on an urgent need for OTs to address climate anxieties, disaster management, and environmentally friendly organizational approaches.

• Hess (2023): Suggests that OT students can learn clinical reasoning through graded strategies focused on environmental impacts.

• Hocking (2013): Reports on UN survey results regarding sustainability applications across diverse global contexts.

• Huss (2020): Argues that integrating sustainability into medical curricula is crucial for reducing healthcare waste and emissions.

• Lieb (2020 & 2022): Scoping reviews identifying that Western cultural values often impede climate action and calling for research into occupationally focused sustainability theories.

• Seville (2023): Surveys Australian OTs, finding that a lack of training and potential conflicts with client-centered practice are perceived barriers.

• Smith (2020): Summarizes the literature and presents theoretical models to support the inclusion of sustainability in OT curricula.

• Valderrama (2023): Highlights environmental education as a tool for training students with high ecological awareness.

• Wagman (2014a): Identifies four OT approaches to climate change: adaptation, cooperation, exploration, and warning.

• Wagman (2020): Describes how UN Sustainable Development Goals (SDGs) are integrated into OT curricula in Sweden.