By Rachel Wormer, MPHCommunications Manager
5 min. read
Allyson Sutkowi-Hemstreet, PT, DPT, CCS shared a candid conversation with HPHC about the intersections of physical therapy, climate change, and the structural drivers of health — and why there are reasons to be hopeful about the future of climate-informed physical therapy.
Interviewer note: All views expressed belong to the interviewee in a personal capacity or HPHC and are not affiliated with other entities. This interview was minimally edited for length and clarity.
Rachel, HPHC: How did you first connect the dots between climate change and health, or what was your personal climate and health “aha moment?”
Allyson Sutkowi-Hemstreet: I worked in a somewhat rural community hospital in the northernmost part of the Napa Valley in California. That hospital houses a Heart and Vascular Institute, which serves patients from multiple rural counties, some of which are places that already have significant socioeconomic disparities.
Just within the same day, I would see a veteran who lives alone in a rural area or an agricultural worker who works out in the [winery] vines. I worked doing all clinical practice during the COVID-19 pandemic and during a number of years of extremely severe wildfire seasons. Those hot, fire-prone months seemed to get longer and longer. I would be trying to help mobilize and exercise people in the hospital with really serious heart and lung problems, like Chronic Obstructive Pulmonary Disease and heart failure.
Some days, there would literally be smoke in the hospital hallways because of local fires and such poor air quality. Environmental conditions directly and negatively impacted the health of many of my patients.
I saw so many patients who lost their homes to fires. They had lost their medical equipment. People with limited resources, physical disabilities, or mobility problems were in more danger when evacuation orders came out. You can image that caregiver support systems would often completely fall apart during disasters.
Beyond that, I saw people who didn’t have chronic conditions but had to work outdoors facing extreme heat. It was so dangerous for agriculture workers in the fields with limited access to shade and water and rest. Just listening to my patients, I heard how much those challenges were exacerbated for people with lower English proficiency or uncertain legal status.
In thinking about access to information, power, and the ability to advocate for safer working conditions, I kept seeing there were so many structural drivers that made it too hard for people to be healthy or manage chronic conditions. It struck me that people were just trying to work and feed their families, and doing so put their health at risk.
“I felt like with many of the people I worked with, we didn’t always contextualize these problems as, ‘This is climate change and this is happening. How are we going to handle this better?'”
Very few providers get training on health and climate change; that was not part of my education in physical therapy school. I felt really unprepared to navigate those issues in clinical practice.
Rachel, HPHC: One of your research interests is the intersection of climate change and health. How do you weave climate change education into your work? How do people respond?
Allyson Sutkowi-Hemstreet: In general, the students I teach are pretty receptive. That doesn’t feel like a very hard sell in the classroom. Many of my Doctor of Physical Therapy students are in their 20’s, and they’ve grown up with this heightened awareness of climate change.
“For me, in my teaching, I’m trying to integrate climate change content into what I already do. It’s quality improvement, basically, ‘Do what you know how to do or do it a little better, and consider these problems with a climate-change informed lens.’”
As physical therapy professionals, we need to help our patients become more savvy about heat, air quality, and environmental exposures. We need to think about access issues. From the student lens, that goes over pretty well.
Rachel, HPHC: What shifts have you noticed over time related to climate change awareness in physical therapy education?
Allyson Sutkowi-Hemstreet: Especially for people who have been practicing as physical therapists for a while or whose primary focus isn’t cardiopulmonary physical therapy, so like sports or orthopedics, I’m still trying to think about how to help those folks feel more engaged.
I hope in the future entry-level curriculum in physical therapy includes basic public health concepts and climate-aware practices to protect patient health in the short-term and long-term, and the dual benefits of active transport…I’m trying to make it relevant for physical therapists practicing in any setting.
We can also introduce this idea of: ‘Do you have a back-up plan for extreme weather events or natural disasters? What does your evacuation or caregiver back-up plan look like during a disaster?’
We know that a lot of folks with disabilities get left out of disaster mitigation planning. Accessibility needs aren’t always thought about. Some people in the physical therapy profession need a little initial help to draw some of those lines between climate, health, and rehabilitation.
It’s about helping climate change feel relevant. It’s best practice. Climate change-informed care is not really a part of our professional identity yet, but I hope we can continue nudging that forward.
Rachel, HPHC: You’re a Board-Certified Clinical Specialist in Cardiovascular and Pulmonary Physical Therapy, meaning you specialize in helping patients with heart and lung conditions. Let’s talk about the connection between climate change, health equity, and asthma.
Allyson Sutkowi-Hemstreet: When we think about climate change, we need to think about structural issues. Our country is segregated in housing, education, and often employment because of a long history of racist housing policies like redlining. Those structural implications directly impact people’s health. Asthma is a really clear-cut case. Racism is a risk factor for asthma, not race. Zip code and health should not be correlated, but they very much are in this country. We also have to start thinking more about housing quality and mold exposure. We need to have more nuanced conversations about pathophysiology.
There are complicated problems we’re not going to be able to solve with simplistic solutions. The solutions are also challenging. The solutions are not always going to come from one-on-one clinical encounters. I believe all healthcare professionals have a duty to support community health. It’s not enough to just keep seeing our patients without addressing structural drivers of health.
“People need to be engaged in that real-time data, like: ‘How do you feel knowing that in this zip code, the rate of having asthma is five times higher than over here? If that doesn’t sit right with you, then let’s find some ways for you to contribute to changing that reality.’”
These problems are not ones we can fix one-on-one in the clinic, so our professional identity needs to expand in its scope.
Rachel, HPHC: What are some of the hopes you have for physical therapy in addressing climate change from a clinical or health equity lens? What could that look like? What personally gives you hope?
Allyson Sutkowi-Hemstreet: Being more on the educational side of physical therapy is a hopeful act. I have so many fantastic colleagues who are helping students understand structural drivers of health and to really consider all of the factors. I’m encouraged by that. I feel really grateful to work with those folks across different institutions and geographic regions.
The other thing I’ve been really encouraged by is the transdisciplinary or interprofessional collaborations I’ve been involved in (such as an online course called Climate and Health for Healthcare Professions, the third course in the Healthcare Leadership for Climate Change Specialization via Coursera. We really need lots of different lenses to solve these very complex problems. Feeling like there are lots of people who are engaged and care about these issues, that’s a really hopeful thing for me.
I also hope that we’re turning a little bit of a corner culturally, although I know it doesn’t always feel like that right now, but I do think there’s more interest in partnering with and having people most directly impacted lead and to have a strong say in what climate change work should look like, and what health justice looks like. That gives me a little bit of hope too, although we still have lots of work to do to unpack how privilege shows up in climate work.
I believe new trainees should graduate with a basic understanding of structural and political drivers of health, climate change, and environmental contributors to health.
Rachel, HPHC: It feels like there might be energy to incorporate climate change into practice among students, and perhaps once they are practicing physical therapists, that energy can get lost. What’s your advice for keeping that energy going amid the realities of the healthcare system?
Allyson Sutkowi-Hemstreet: It’s a question I’m still wrangling with.
That’s part of why I feel having best practices [of climate change and structural drivers of health] as part of a professional identity matters. Then, it doesn’t matter where you are geographically, or the practice setting you’re working in. If that’s how you view the world and how you see your role in health, that matters a lot in terms of staying engaged in this work.
There are tons of people doing this work. If it’s your personal interest, there are many avenues for you to blend it with your professional interests, and it’s not a huge jump to do that.
“Community matters. For me, finding your people in this work helps make it a lot more sustainable.”
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Thank you to Allyson Sutkowi-Hemstreet for generously sharing her time and insights.
Meet Allyson: Allyson Sutkowi-Hemstreet (she/her) is a physical therapist with nine years of clinical practice in primarily acute settings and as a passionate educator. Allyson has a bachelor of arts in Psychology from the University of California, Berkeley, and a Doctor of Physical Therapy degree from Duke University. She is a Board-Certified Clinical Specialist in Cardiovascular and Pulmonary Physical Therapy and a former Duke Faculty Development resident. She is a Duke Teaching for Equity Fellow and a recipient of the Duke Doctor of Physical Therapy Diversity Award and the Helen Kaiser Alumni Award. She is a retired USA Women’s National Rugby Team player and a former USA Rugby Collegiate All-American.
In 2023, Allyson joined the University of Minnesota Medical School’s Division of Physical Therapy as an assistant professor. Her scholarly interests include diversity, equity, and inclusion (DEI) content in physical therapy education and health equity issues related to cardiovascular and pulmonary physical therapy, including perinatal health and climate change. Allyson is dedicated to teaching and learning, the humanities in higher education, and improving DEI and belonging in physical therapy. She loves to spend time outdoors with her wife and two children.
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