Published On November 11, 2022
A growing body of evidence suggests that spending time in green spaces can have a range of beneficial effects—improving blood pressure as well as reducing anxiety, depression, rumination and neural activity in brain regions associated with mental illnesses. While the mechanisms are still coming into focus, such findings have, for physicians around the world, sparked interest in prescribing doses of nature.
One leader in “nature prescriptions” is Vancouver physician Melissa Lem, a clinical assistant professor of family practice at the University of British Columbia. She directs Canada’s first national nature prescription program, PaRx, which recently partnered with Parks Canada to enable doctors to prescribe national park passes to patients. Since she helped launch the initiative in 2020, the program has attracted some 6,000 physicians—more than 5% of the country’s practicing doctors.
Q: When did you start thinking about the health benefits of nature?
A: I started “self-medicating” as a child, I think—whenever I felt stressed, I would go to a natural place where I intuitively felt safe. When I moved back to downtown Toronto after working as a rural physician, I experienced nature deficit for the first time. I just felt my stress level increase.
Q: For the patient, what does a nature prescription look like?
A: Based on the latest evidence, our standard recommendation is that patients spend at least two hours a week in nature and at least 20 minutes during each visit. Health care practitioners can then collaborate to refine the prescription based on a patient’s interests and abilities as well as what nature is nearby. You can find nature in your community garden, backyard or in a city park. The research shows that patients see health benefits when they feel that they’ve had a meaningful nature experience.
Q: What’s been your own experience prescribing nature to patients?
A: The bulk of patients I would tend to write a formal prescription for are people with mental health concerns. It’s usually part of an overall treatment plan; we wouldn’t typically withhold medication and prescribe nature first, unless the symptoms are very mild. As with any prescription, the physician should check in and see how patients are doing as time goes on. That provides them with support and also shows them that it’s a serious recommendation.
I have to say I was initially a bit nervous about prescribing nature. I thought patients would see me as some out-of-touch, tree-hugging doctor. But every time I’ve prescribed it, patients nod their heads and say, “You’re right, I do feel better when I spend more time outdoors.” When a doctor formalizes that in a prescription, patients are more open to doing it. And there’s research about exercise prescriptions, showing that when something is written down, it increases a patient’s motivation to actually carry it out.
Q: What are the challenges for patients in filling a nature prescription?
A: One is transportation, especially for people who don’t live in nature-rich areas. Another issue is time. People are really busy. One good strategy is to substitute outdoor activities for things you typically do indoors. For instance, if you usually go to the gym, do your workout on a trail or in a park. Or if you’re going to meet friends at a restaurant, head outside for a picnic instead.
Making people feel comfortable and safe in nature is also important. Some people haven’t spent much time outdoors because it’s not part of the culture they grew up in. The British Columbia Parks Foundation runs an initiative called Healthy By Nature, which gets marginalized groups out into nature. We’re working on expanding this nationwide.
Q: What’s next for nature prescriptions?
A: There are currently two national nature prescription initiatives worldwide, one in the United States and one in Canada. Other countries have reached out to us for advice on launching something similar. This is a phenomenon I would love to see spread across the world, because prescribing nature isn’t only good for humans, it’s good for the planet. Research shows that people who are more connected to nature are more likely to engage in pro-environmental behaviors such as recycling and conserving energy. I like to think that every time I write a nature prescription, I’m doing something for the environment.
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