83 Physical therapies are everywhere

Many physiotherapists will be anxious about letting go of their professional identity and primary source of income and may be quite resistant to change for all of the reasons discussed in the last chapter. But there are examples we can draw on from other areas of contemporary society that suggest their work could morph and transform in a very positive sense while the physical therapies re-establish their vitality. One such example comes from food culture.

Food culture is now a vast global industry that has exploded in the Internet age. It has brought the work of chefs, film-makers, journalists, authors, and social media influencers to the public’s attention like never before. And it has fuelled support infrastructures like building and interior design, logistics and supply chains, innovations and technologies, tourism, and popular culture. It has become a competitive sport, a popular pastime, and an arm of the entertainment industry. It asks fundamental questions about water and food sovereignty, the value of legislation and behaviour change, the psychology of pleasure and the morality of indulgence, the power of coercive marketing and language, the climate costs of enjoying tomatoes in winter, and the downstream impact of lifestyle illnesses like obesity and diabetes. As well as offering more granular advice, meal plans for lactose intolerant children, new ways to prepare quinoa, and ten uses for a sous-vide.

There are many reasons for the explosion of food culture around the world: television and the Internet, the neoliberal emphasis on personal choice and consumption, the masculinisation of cooking, and so on. But one of the main drivers has been the seemingly strange behaviour of the chefs themselves. These people demonstrate their prowess, not by regulating their practice and restricting access to their skills and knowledge, but by their generosity and largesse. Celebrity chefs not only do all of the work of devising new ways to cook, they design new recipes, and teach you all of their techniques. They explain their ethos and influences, and share their passion for food. And then they give it all away. Over and over again.

One might think that this would mean people stop buying cookery books because surely all of the world’s recipes are known by now? And surely, it has oversaturated people and dulled the allure of food in their eyes? Apparently not. In fact, the effect has been the reverse. Cookery books and magazines are some of the market’s biggest sellers, and most newspapers carry food sections. Millions of people subscribe to food YouTube channels and Instagram feeds, and streaming media are full of food programmes. The diffusion of food culture into the life-world seems to have only fuelled people’s desire to become better cooks, bakers and cup-cake decorators, bread makers, wine connoisseurs and coffee aficionados, restauranteurs, and food tourists.

But, at the same time as we have seen an explosion of interest in food culture, a small group of registered nutritionists have also been plying their trade. In New Zealand, a country with a population of just over five million people, there are only around 400 registered nutritionists. This means that there is one registered nutritionist for every 12,500 New Zealanders (comparable with the number of physiotherapists). Their work mostly involves treating people within the health sector, advising on diets for people with complex co-morbidities, and those recovering from metabolic disorders, debility and surgery. By law, they are the only people who can do this.

Is their claim to being nutrition experts justifiable today? Does their university qualification rightly elevate them above the many other forms of knowledge now circulating in world food culture? Does their affinity with biomedicine justify the legal protection and financial security they get from being state employees? Does it blinker their practice? Does their work require them to be registered nutritionists? Given their relative size, can nutritionists claim to ‘own’ any aspect of food culture today? Their work is important, but it represents only a tiny speck in the vast cosmos of modern-day food culture. The physical therapies are, in many ways, similar ^[1]. So, what I am suggesting here is that we now need to reverse the course that the profession has taken over the last century and give up our quest for power, prestige, and autonomy, so that the knowledge and skills we have acquired over the last century become just as ubiquitous as cooking.

As I mentioned earlier, some people may argue that we need to contain the physical therapies within a professional enclosure in order to protect the public from harm. Certainly, there are some aspects of physiotherapy that are risky and require special skills, but here again comparisons with food culture are worth making because badly stored and prepared food can kill people perhaps just as easily as a therapeutic procedure. And no-one would suggest that everyone who cooks a chicken casserole should become a registered chef. It would not be possible anyway because people know that the intensity of food will always exceed the capacity of society to govern it. The physical therapies could, and I would argue should, now be seen the same way.