Is there room for physiotherapists in the public health world?

Hello, and welcome to my blog! I'm the Public Health (resident) Physio, and I am here to discuss all things public and population health.

Physiotherapists are often known as the musculoskeletal specialists, the movement therapists, and the clinicians who are most focused on physical health - #movementismedicine

However, as a resident physiotherapist who is still early on in my career in the non-hospital public sector, I can certainly say that a large portion of my time - if not the majority of it - is dedicated to addressing non-physical determinants of health. For those reading who aren't familiar with the most frequently cited determinants of health, they are as follows [1]:

• Income and social protection

• Education

• Unemployment and job insecurity

• Working life conditions

• Food insecurity

• Housing, basic amenities and the environment

• Early childhood development

• Social inclusion and non-discrimination

• Structural conflict

• Access to affordable health services of decent quality

I'd like to highlight two significant cases that not only make me progressively frustrated with how gravely our social system is failing us, but emphasize how physiotherapists are key stakeholders in systems navigation, collaborative care, and advocacy.

Case 1 - Neurodegenerative Disease A patient was referred to me for physiotherapy to cope with a progressive neurological condition. They cannot work, but are married to a person with a good salary and therefore qualify for exactly zero social support.

• No ODSP

• No Ontario works

• Limited PSW support

• No respite care

• No free equipment

• No housing subsidy

• No home modification subsidies

They need more support than a physiotherapist can provide. As we move through an exercise program, a common theme of discussion returns - the need for emotional support and fear of the future. On my spare time, I put together a list of all the resources I could find from funding, group support, community health referrals, mental health support, group exercise programs for individuals with neurodegenerative diseases, and even spoke to the physicians in my workplace and got them on a waitlist for when they have space for new patients. As you can see, my resourcefulness and knowledge of the healthcare and social system is thorough, but my capacity in my role is extremely limited. Our system is not made for this type of person, but it should be. As the person who sits 5 feet away from this patient on a weekly basis and hears their stories, passes tissues to wipe away tears, and offers words of encouragement while navigating our broken system, I can't help but feel that I could play a valuable role in policy and advocacy discussions. I don't have an MPH, but I do work in the "trenches" and see the person behind a policy maker's statistic.

Case 2 - Brain Injury A patient with a tragic health history was transferred onto my caseload from a locum therapist. They spent a long time in a coma after a brain injury with many comorbid conditions and received exactly no rehabilitation thereafter. They were discharged home with no support, no outpatient services, no in home services - nothing. This individual was burdened by just about every social determinant of health you can imagine, and many were of no fault of their own, but were a result of a tragic upbringing and falling into a life that no person should have to endure. As we made marginal improvements from when they started their outpatient care many months prior, I quickly noticed that this individual was so beyond the need of a physiotherapist. They were in need of basically everything and everyone, but had access to basically nothing and nobody. The medical team was there, but there was no social support for him beyond the most basic, shameful housing. Again, I sifted through resources, considering the dire need for much more intensive care, and realized that there are no facilities in my region who could appropriately serve this individual, and no social programs that could adequately serve a person like this. If I - the person who saw this patient just two days before they passed away - had the opportunity to sit at a table where I could give people like this a voice, I know that there is much more I could do to prevent such grim outcomes for current and future generations.

Physiotherapists hear hundreds, if not thousands of stories per year. We physically, emotionally, and mentally touch the lives of people all over the world who come from fortunate and unfortunate circumstances. We see them in their environments and attempt to address unmet needs with the limited scope we have. While an MPH, MPP, or MSc is certainly valuable for public health professions, I'd argue that moreso are clinical degrees. I'll leave you with a few questions:

1. If physiotherapists are considered "preventive" in nature, why are we waiting until people fall through the cracks to treat them?

2. If physiotherapists are "primary care providers", why don't we have a seat at policy tables, with people who are discussing primary care funding?

If we give physiotherapists a seat at the policy and advocacy tables, the chance to tell stories we were told firsthand from real people, and bring to light true hardships that cannot be understood from an excel sheet, imagine the good we could do.

Until next time,

The Public Health (resident) Physio

References:

1. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1