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Biodiversity and Physiotherapy

Original Editor - Robin Tacchetti based on the course by Jessica Stanhope
Top Contributors - Robin Tacchetti, Wanda van Niekerk, Lucinda hampton, Kim Jackson, Jess Bell, Tarina van der Stockt, Ewa Jaraczewska and Olajumoke Ogunleye


Biodiversity

Multicellular biodiversity of the Earth.

The term biodiversity refers to every living thing including humans, animals, plants and bacteria. [1] Some areas of the world are more biodiverse than others including, South Africa, Brazil, Mexico, the southwestern US and Madagascar.  Rich biodiverse areas can be threatened by pollution, population growth and climate change.  These threats can lead to species extinction, which decreases biodiversity. Scientific estimates say that it is possible that half of the species on earth could be extinct by the next century. To preserve biodiversity and protect endangered species, conservation efforts are necessary.[2]

Ecosystem

An ecosystem is a specific environment where a community of living organisms interact and live. Ecosystems can vary in size from very small to very large.[2] "Humans are an integral part of ecosystems."[3] Whether directly or indirectly, every factor within an ecosystem depends on every other factor. For example, the weather will affect which plants grow, which then affects which animals will eat those plants. Animals that do not eat those plants will have to adapt, move to another ecosystem, or die.[2]

Ecosystem Services/Ecosystem Functions

Ecosystem services are the benefits people derive from their ecosystems. While the ecosystem services framework effectively highlights nature's benefits to people, its focus on human utility can misrepresent ecological roles and overlook species without direct economic value. In contrast, the ecosystem functions framework offers a more holistic alternative by accurately describing ecological processes, avoiding ethical pitfalls, and supporting more inclusive conservation efforts.[4]

Ecosystem Services are categorising the essential benefits human populations derive from natural ecosystems into four distinct functions:[5]

  • Provisioning Services (PS): The resources and material goods people obtain from ecosystems, such as fresh water, food, raw materials, and other essential products.
  • Supporting Services (SS): Sustain core ecological mechanisms, such as habitat provision and nutrient cycling, necessary for all other services.[3][6]
  • Regulating Services (RS): The benefits people obtain from the regulation of ecosystem processes, including climate regulation, erosion control, air quality maintenance, water purification and regulation of human diseases.
  • Cultural Ecosystem Services (CES): Offer non-material benefits that enrich human life, such as aesthetic enjoyment, artistic inspiration, recreational opportunities, and cognitive development.[3]

Ecosystem functions:

Ecosystem function identifies the action of the “objects of community ecology on the flow of matter and energy” [4]

Human Well-Being

Ecosystem services are crucial to human well-being, because they are important in influencing sustainability.[7] Five different factors encompass human well-being:[3][8]

  1. Basic material needs for a good life
  2. Health
  3. Good social relations
  4. Personal security
  5. Freedom and choice

Each factor supports the others either positively or negatively. Change in one facet will bring about change in another. Human well-being is particularly affected by the availability of ecosystem services. A higher supply of service allows for increased well-being whereas a lower supply decreases well-being. Increased and varied services impart communities with resource options in the face of social upheaval or natural disasters. In contrast, poorly managed ecosystems, have an increased risk of being vulnerable to drought, crop failure, flood or disease.[3] The chart below gives a synopsis of the different ecosystem services and how they relate to well-being.

Millennium Ecosystem Assessment

The demand by humans for ecosystem services is growing quickly. However, human action is concurrently altering the capacity of these systems to provide services. The Millennium Ecosystem Assessment (MA) was created in 2001 by a partnership of governments, private sectors, non-governmental organisations and scientists. It's goal was to provide options for conserving the ecosystem while meeting human needs, as according to MA, approximately 60% of ecosystem services globally are experiencing degradation, with regulating and cultural services particularly affected at a rate of 70%.[9]

Questions the MA is designed to answer include:

  • “What are the current conditions and trends of ecosystems and their associated human well-being?
  • What are the plausible future changes in ecosystems and in the supply of and demand for ecosystem services and the consequent changes in health, livelihood, security, and other constituents of well-being?
  • What can we do to enhance well-being and conserve ecosystems? What are the strengths and weaknesses of response options, actions, and processes that can be considered to realize or avoid specific futures?
  • What are the most robust findings and key uncertainties that affect the provision of ecosystem services (including the consequent changes in health, livelihood, and security) and other management decisions and policy formulations?
  • What tools and methodologies developed and used in the Millennium Ecosystem Assessment can strengthen capacity to assess ecosystems, the services they provide, their impacts on human well-being, and the implications of response options?"[3]

In the following chart, Millennium Ecosystem Assessment has shown the relationship between human well-being, biodiversity and ecosystems and how they can be altered.

Urban Lifestyles

Research shows that urban lifestyles have more immune-mediated diseases than pre-modern lifestyles.[10] One factor researchers believe is causing the increase in immune-related diseases is the lack of biodiversity in urban communities. City living decreases microbial communities via consumption of processed food, use of antibiotics and urban pollution. This microbial imbalance has an association with immune-mediated diseases.[11][12]

Green Space Exposure

Noosa national Park, green space.

Through urbanisation, we have removed green spaces and destroyed ecosystems. Introducing new green spaces in an urban area and protecting existing ones are important because of the association to human health benefits. Research has shown that there is a wide range of health benefits associated with green space exposure:

  • Reduction in: cancer, diabetes, decreased blood pressure and cardiovascular disease.[6]
  • Improvement in: mental health, allergies[13]
  • Short term exposure: reduces stress and depressive symptoms, decreases fatigue, increases self-reported positive emotions and improves self-esteem, mood, perceived mental and physical health
  • Access to natural environments tends to enhance outdoor physical activity thereby reducing obesity and type 2 diabetes
  • Long-term exposure: (residing in) reduced respiratory, cardiovascular and cancer mortality; improved respiratory and mental health[13][12]
[14]
[15]

Physical Therapy Implications

Outdoor Gym

Biodiversity and ecosystems have implications on physiotherapists (PTs) in various ways. As discussed above, exposure to green spaces has many health benefits. As PTs, we can educate our patients on the health benefits of outdoor exposure. When discussing these benefits, PTs should inquire about any barriers the patient might have to get outdoors. Together, they can brainstorm ideas on how to add green space exposure to their normal routine. In addition, PTs can provide therapy in green space environments such as a park or an outdoor area near the clinic.[6] Should there be no green space associated with the hospital/clinic, PTs should advocate for it.  

PTs can advocate not only in their local area, but on a national or international level to improve health, ecological and social challenges. One international organisation seeking to do just that is The Environmental Physiotherapy Association. This network of students, academics and clinicians aims to advance environmental responsibility across physiotherapy practice, education and research. Environmental stewardship is a novel concept for most PTs, but with some education and understanding of how we can initiate change, PTs have an important role to play regarding the interrelation of environment and human health.[16]

Resources

References

  1. ↑ Sarkar S. Origin of the Term Biodiversity. BioScience, 2021; 71(9):893.
  2. ↑ 2.0 2.1 2.2 National Geographic. Biodiversity. Available from https://www.nationalgeographic.org/encyclopedia/biodiversity/ (2019)
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Alcamo J. Ecosystems and human well-being: a framework for assessment. (2003)
  4. ↑ 4.0 4.1 Ferraro KM, Ferraro AL, Lundgren E, Sommer NR. The use and abuse of ecosystem service concepts and terms. Biological Conservation. 2025 Aug 1;308:111218.
  5. ↑ Gui Y, Ma Y, Chen Y, Zhou C, Xiao T. Ecosystem services in UNESCO World Heritage sites: a review of research trends and future directions. npj Heritage Science. 2026 Feb 23;14(1):115.
  6. ↑ 6.0 6.1 6.2 Stanhope, J. Biodiversity and Physiotherapy Course. Plus. 2022
  7. ↑ Wang B, Zhang Q, Cui F. Scientific research on ecosystem services and human well-being: A bibliometric analysis. Ecological Indicators 2021;125.
  8. ↑ Tamnes CK, Bekkhus M, Eilertsen M, Nes RB, Prydz MB, Ystrom E, Aksnes ER, Andersen SN, Ask H, Ayorech Z, Baier T. The nature of the relation between mental well-being and ill-being. Nature human behaviour. 2025 Dec;9(12):2431-40.
  9. ↑ Liao HY, Zhao C. Ecosystem degradation. InData-Driven Earth Observation for Disaster Management 2026 Jan 1 (pp. 303-325). Elsevier.
  10. ↑ Manurung MD, Heieis GA, König M, Azimi S, Ndao M, Veldhuizen T, Hoving D, Hoekstra PT, Kruize YC, Wammes LJ, Menafra R. Systems analysis unravels a common rural-urban gradient in immunological profile, function, and metabolic dependencies. Science advances. 2025 Apr 30;11(18):eadu0419.
  11. ↑ Roslund MI, Puhakka R, Grönroos M, Nurminen N, Oikarinen S, Gazali AM, Cinek O, Kramná L, Siter N, Vari HK, Soininen L. Biodiversity intervention enhances immune regulation and health-associated commensal microbiota among daycare children. Science advances. 2020 Oct 1;6(42):eaba2578
  12. ↑ 12.0 12.1 Oestreicher JS, Buse C, Brisbois B, Patrick R, Jenkins A, Kingsley J, Távora R, Fatorelli L. Where ecosystems, people and health meet: Academic traditons and emerging fields for research and practce. Sustentabilidade em Debate (Sustainability in Debate). 2018;9:45-65.
  13. ↑ 13.0 13.1 Aerts R, Honnay O, Van Nieuwenhuyse A. Biodiversity and human health: mechanisms and evidence of the positive health effects of diversity in nature and green spaces. British medical bulletin. 2018 Sep 1;127(1):5-22.
  14. ↑ Jebel Musa.Health Benefits of Urban Green Spaces. Available from: https://www.youtube.com/watch?v=aFBjxaKxw8g [last accessed 15 February 2022]
  15. ↑ Greenlife Matters. Green spaces - good for people, the community and the country. Available from: https://www.youtube.com/watch?v=ac78Fyn4CxY [last accessed 15 February 2022]
  16. ↑ Maric F, Griech SF, Davenport TE. Advancing environmental stewardship in physical therapy: Connect, learn, act. Cardiopulmonary Physical Therapy Journal. 2022 Jan 1;33(1):2-4.
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