On August 6th, 2024, the Canadian Coalition for Green Health Care's Project Manager, Autumn Sypus sat down with Giovanna Boniface, one of the Coalition’s growing cadre of volunteer advisors, to learn more about sustainability in occupational therapy.
Giovanna Boniface is an Occupational Therapist (OT) with over 27 years of experience, where she specializes in a community-based practice focusing on severe and catastrophic injuries. In addition to community practice, her career includes roles with Worksafe BC and the Insurance Corporation of BC. She has also held leadership positions within the occupational therapy community, both provincially and nationally. Her most current role was the President of the Canadian Association of Occupational Therapists (2020-2022). Additionally, as a clinical assistant professor at UBC, Giovanna has co-led climate change-related research projects within the Master of Occupational Therapy program, with several research initiatives completed and new ones underway.
In 2022, Giovanna and her husband (also an occupational therapist) co-founded the Occupational Therapy Climate Action Network (OT CAN) to accelerate the pace and scale of climate action of the occupational therapy community. OT-CAN envisions a global occupational therapy community that is empowered to make change.
Read below to learn about how Giovanna advocates for integrating sustainability into health care through systemic changes, addressing barriers like regulatory frameworks, financial constraints, and resistance to change, while highlighting facilitators such as individual commitment, Indigenous wisdom, and emerging technologies.
Q 1: What inspires you to be involved in making OT more sustainable?
It’s a deep commitment to the well-being of everything on this planet, not just people. I believe we’re often too focused on human needs, and we need to broaden our perspective to consider the well-being of all living and nonliving things. This has become a driving purpose - to help shift this worldview and be more balanced in our approach with nature.
Occupational therapists (and all in health care) have a role to play, not only in mitigation but adaptation and in building resilience in our communities. In both occupational therapy and health care more broadly, there are universal themes that should guide us, including reducing waste, conserving, reducing consumption and minimizing emissions. While the specific actions may differ across professions, the underlying goals are all the same.
What else keeps me going is a personal and family commitment to this broader vision of well-being. We need to think about biodiversity, ecosystems, the mountains and rivers that support life. Not enough people are thinking like that quite yet. I believe we can do it, but we need to embrace a commitment to sustainability in everything we do and hold all things as equal.
This is not about saving the planet. It's about saving humanity. The planet is going to be here long after any of us. It's all about our ability to be on this planet.
Q 2: What do you believe is the most significant change health care should undertake?
I believe health care should undertake a fundamental paradigm shift in worldview—from a human-centred, ego-centric approach to an eco-centric view.
Think about the planet and the resources, we just take, take, take. What do we do in return? If we thought about everything as equal, would we still behave in this way? In occupational therapy theoretical frameworks, our models reinforce a human-centric approach with no explicit consideration of nature, animals, insects, plants, etc. What if instead of humans at the top of the pyramid, we viewed everything as equal with all things balanced in a circle?
While this broader shift in thinking may seem idealistic, it is crucial. Health care is driven by people, and if we adopt this perspective, it could underpin our decisions and actions.
In addition to mitigation activities such as reducing carbon emissions and improving energy efficiency in facilities, we need to take urgent action in adaptation and community resilience building - preparing for climate-related challenges including heat waves, fires, smoke-related climatic events and rising sea levels.
Another important shift is through prevention, just as we promote preventive measures, like fall prevention, we need to embrace prevention as a core principle in addressing climate impacts. By investing upstream, we can mitigate the consequences of environmental changes before they become critical issues. Education and advocacy are key in making this shift happen.
Q 3: What are the biggest barriers to this change?
I'm going to say it again, worldview. We tend to be human-centred and don’t think beyond ourselves, making it difficult to prioritize sustainability.
One of the biggest barriers at the high level is the lack of regulatory and policy frameworks focused on climate change. Without clear mandates or guidelines, people won’t necessarily take action on their own. Assuming people will do the right thing is not realistic.
Budgets are also a barrier. In health care, most resources are allocated to immediate needs like patient care, making it hard to invest in sustainability measures such as energy-efficient buildings or greener operations.
We’ve talked to dozens of occupational therapists, many indicating sustainability is not even on the radar due to other more pressing issues. For example, departmental budgets, lack of beds for patients and other common health care challenges.
Technological barriers also play a role. Much of the adaptive equipment prescribed by occupational therapists is made from plastic and oil-based products, often sourced overseas, with a resultant large embodied carbon footprint. There are few sustainable alternatives (e.g. recycled materials or locally made items) limiting options for more eco-friendly choices. Additionally, this comes with a resistance or inability to change within organizations due to long-standing procedures or formal procurement requirements.
There's also the issue that people think green costs more, which is not true in a lot of cases. If we consider change and risk over time, choosing sustainable options can be cheaper in the long run.
The health care system already struggles with the status quo, and introducing environmental considerations may feel like an added burden to many. In the end, these barriers—worldview, lack of regulation, financial constraints, technological limitations, resistance to change, and prioritization of immediate concerns—make it challenging to drive sustainability in health care.
Q 4: What are the facilitators to this change?
Some key facilitators that I’m seeing include the growing movement of individuals who are committed to making change. While change at the policy level is what would really be a driving lever for change, I would never underestimate the impact of desire and action among individuals and grassroots groups to push for sustainability..
Another facilitator is the influence and knowledge from Indigenous communities, who have lived in balance with the land and all things for generations before us. There’s a noticeable trend of leaning into Indigenous wisdom and nature-based solutions to inform sustainable practices in some fields. However, the integration does not seem to be permeating health care to the same extent.
I also see potential in emerging technologies and innovations that offer promise, though they aren’t yet fully realized in health care.
Ultimately, the most powerful facilitator is people. We are the cause of these problems, and change in our actions is a must.
Q 5: What are the facilitators to this change, specifically in OT?
OT’s work with people and their occupations, encompassing all the things that they need and want to do in their life. This focus on occupation is a major lever for sustainability because what people do in their day-to-day lives has a direct impact on greenhouse gas emissions, adaptation and resilience. People sometimes say, “Individual effort is a tiny drop in the bucket” but it is individuals that turn into collectives that then turn into a movement. It's the collective efforts of individuals that drive larger shifts in behaviour.
Beyond making their practices more energy-efficient and reducing carbon use, OTs can help individuals prepare for sustainable lifestyles. They can use every opportunity to engage in conversations, influence behaviour, and model sustainability in their own practices. OTs can start having conversations about adopting sustainable lifestyles, integrating sustainability into conversations we are already having. To me, that is where we have a significant opportunity for impact.
For instance, working with someone who is recovering from a broken leg, an occupational therapist could discuss not just their return to driving but also alternative forms of transportation with a smaller carbon footprint. This opens up opportunities to introduce the idea of a sustainable return to the occupation the person needs and wants to do. For example, education about active transportation and health could be embedded into this scenario. Of course, it's important to be realistic—suggesting the purchase of an electric car isn’t feasible for everyone, and each person has a different context to be considered.
- end of interview-
Giovanna highlights how integrating sustainability into occupational therapy and health care requires a fundamental shift from a human-centered to an eco-centric worldview. By embracing this broader perspective, addressing systemic barriers, and leveraging emerging technologies and individual commitment, health care professionals can play a crucial role in fostering environmental stewardship and resilience.
If you have questions about sustainability and the part OTs can play, feel free to reach out to Giovanna at info@ot4climate.com.
Learn more about sustainability in occupational therapy at https://ot4climate.com/.
Looking to get started on greening your office space? Check out the Green Office Toolkit at https://greenhealthcare.ca/green-office-toolkit/.
