Health promotion within the context of climate change in Nepal and Sweden: Social Workers’ Discourses

The nexus between social work and health promotion work in the context of climate change demands increased attention. This study focuses on discourses on health promotion within the context of climate change among social workers in Nepal and Sweden. An integrated socio- cognitive theory served as a conceptual framework to analyze social workers’ understanding about climate change and health, the ways they could intervene towards health promotion, and the facilitators and hindrances that influence their efforts on health promotion work. Ethical approval was provided by the Swedish Ethical Review Authority Board (diary number 2024-04330-01). Data collection was done through a total of 16 semi-structured interviews, 8 each from social workers in Nepal and Sweden online between October 2024- February 2025. ATLAS.ti v. 25 was used for data storage and analysis. A critical discourse analysis building on Van Dijk’s socio-cognitive approach reveals that social workers’ knowledge, beliefs, skills and ideological (anthropocentric and anthropogenic) discourses were central in describing negative implications of climate change focusing mostly on human health. The study also shows that social workers’ skills and attitude discourses were integral to facilitating health promotion work by positively correlating with higher efficacy beliefs and presenting a wider range of interventions, from counseling, advocacy and policymaking to protecting vulnerable populations. Additionally, socio-institutional impediments attributing to a) climate agenda not being a priority, b) lack of climate education and practice, c) ambiguous role/identity and d) lack of legal recognition (Nepali context) posed significant barriers to health promotion work. A comparative analysis shows that social workers in Nepal had a significant awareness to their biophysical environment and shed light on the need to understand and protect vulnerable populations. In Sweden, social workers were concerned with addressing mental health challenges like eco-anxiety with a focus on organizational and behavioral change. The study concludes by highlighting an urgent need for transformative social work education and practice that a) presents climate change and health as an integral part of the social work profession, b) broadens the concept of health to both living and non- living species and the planet (“One Health”), c) builds upon existing social workers’ skills, and d) embraces “eco-centric” ideals to meet the demands posed by the biggest health challenge of the century.