Physical therapists (PTs) and physical therapist assistants (PTAs) are likely familiar with the health burden of noncommunicable diseases (NCDs), and many will even say that the physical therapy profession has a role in addressing that burden. But as 5 APTA Catherine Worthingham fellows would point out, saying that PTs and PTAs have a role is not the same as living out that role—and if the profession wants to achieve the latter, it has a lot of work to do.
Marilyn Moffat, PT, DPT, PhD, DSc (hon), FAPTA, laid out the breadth of the NCD problem by way of a set of grim statistics, including a World Health Organization (WHO) estimate that 88% of US deaths are attributable to NCDs. Moffat said that although death rates associated with some of the 4 major types of NCDs—cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes—are trending down, the drops largely are related to drugs and surgical interventions and not in preventive lifestyle changes.
Julie Fritz, PT, PhD, FAPTA, used Moffat's statistics as a springboard to talk about how NCDs affect different parts of society, pointing out that in certain locations, life expectancy is actually declining. "That's an inflection point that's worthy of note by all of us," Fritz said. "If you're poor, it really matters."
The drivers, however, are less about socioeconomic factors and more about health behaviors, Fritz said. And while she believes changing those behaviors "is in our wheelhouse collectively as health care providers," in her opinion, PTs are "playing a very small role in being part of the solution to this situation."
"We have to consider more upstream factors and think about care as a continuum," Fritz said. "The real goal is the well-being of the patient in a broader sense." But according to Fritz, PTs are doing little to approach the issue from this more proactive perspective; instead, "we just think more people ought to show up, and we're waiting for them," she said.
The profession's slowness in making this shift isn't necessarily due to a lack of information or unclear policy directives, according to Lisa Saladin, PT, PhD, FAPTA. Saladin pointed to several resources, including the WHO global action plan on NCDs, that show not just the need for action but also the possibilities for the PT's role in reducing risk factors. But PTs can't go it alone, she added, saying that "we need to increase our level of partnerships."
If any PTs or PTAs feel hesitant about taking on a more prominent role in the fight against NCDs, they shouldn't, according to Saladin. She cited 4 separate APTA positions, as well as the association's public policy priorities, as support for the physical therapy profession to step up to the plate. Without that action, she added, the policies don't amount to much. "We can talk the talk, and we can understand what our role should be," she said, but that doesn't necessarily mean the profession is acting on that understanding.
So how does the profession shift to action? Gail Jensen, PT, PhD, FAPTA, said it begins with PTs and PTAs understanding that a "fundamental commitment to social justice" is "a part of who we are" as a profession. Jensen said that action won't happen until the profession fully embraces its ethical professional identity.
Jensen said that the profession need look no further than its own code of ethics to understand its obligation to address NCDs—specifically, by way of Principle 8 of the code, which states that "Physical therapists shall participate in efforts to meet the health needs of people locally, nationally, or globally." That statement, linked to the core value of social responsibility, makes it clear that PTs and PTAs need to assume a role.
But it's not simply about acting—it's about acting with a goal in mind, Jensen said, and that's an idea that brings its own challenges. "Do we really understand what it is to have a just health care system?" she asked.
Karen Paschal, PT, DPT, MS, FAPTA, rounded out the presentations by focusing on how education "across our lifetimes as physical therapists" could spark a more active professional role in addressing NCDs. But bringing education up to speed first will require an examination of priorities, Paschal asserted. She challenged the audience by asking them, "How many of you have hired applicants who say 'I want to help prevent NCDs?'"
Paschal said that change needs to take place in 3 major areas of educational focus. First, education around rehabilitation needs to provide more than an understanding of the role of NCDs—it needs to address what the PT and PTA can do. "Although we may give that [concept] language, we do not give that action in physical therapy," she said.
Second, the profession needs to take an honest look at its education efforts around collaboration, including some of the underlying assumptions that color the profession's concept of what collaboration is. Paschal said that, too often, collaboration is understood as equivalent to an orchestral concerto, where "we dream of being the soloist accompanied by the orchestra." Taking up a real role in prevention of NCDs will require a much more humble attitude, she told the audience.
Third, risk factors for NCDs need to be well-understood by PTs and PTAs, who in turn are ready to address those factors. "We need to change our orientation from rehabilitation and toward health prevention and promotion," Paschal said.
In closing her portion of the discussion, Paschal may have summed up the crux of the entire presentation: "We need simply to think bigger."