Dan Bloomfield: Sometimes patients could use a dose of nature, but how could it be prescribed?

This blog is part of a series on sustainable healthcare, which looks at health, sustainability, and the interplay between the two. The blog is coordinated by the Centre for Sustainable Healthcare and shares ideas from experts across the healthcare field.

Doctors generally understand that exercise is good for you. They also realise that isolation is harmful. The more surgeries I visit, the more I find that there is also a common acceptance within general practice that being outdoors in a wild or natural setting is “a good thing.” When they are stressed, need a break or a stretch of the legs, or want to wind down at the weekends, doctors are as likely as anyone else to head outdoors. Add a social element, and/or some aerobic physical activity, and—with suitable patients in mind—GPs become quite keen to suggest that a “dose of nature” is needed.

This follows a considerable amount of evidence. We know that when people spend time in forests there is a benefit in terms of hypertension and immune function (Mao et al, 2012; Li, 2010). We know that being outdoors reduces the experience of pain (Diette et al, 2003). We also know that populations that live closer to green spaces have a lower prevalence of disease, after controlling for a range of socio-economic factors (Maas et al, 2009). There is good evidence that if people exercise in, garden among, walk in, or simply view nature they exhibit greater feelings of revitalisation (Coon et al, 2011), relief from stress (van den Berg and Custers, 2011), and an enhanced ability to direct and restore attention (Berman et al, 2008).

As the landscape of commissioned services changes in this country, many doctors are also aware that a referral to a suitable voluntary sector project results in additional patient benefits, compared with general practitioner care alone, in managing psychosocial problems (Grant et al, 2000). This is particularly the case when the referral process is mediated by a dedicated person (Grayer et al, 2008).

In Cornwall there is a project underway to develop “Green Prescriptions,” so that it is easier for doctors to make available a dose of nature. They are not “true” prescriptions, of course. Nonetheless, by forming partnerships with those who manage environmental assets in the county and who are willing and able to receive patients, by providing funding to cover the gap until such services are commissioned, and by ensuring a high quality service that allows a patient whose situation with regard to their health is considered in need of such activity, a doctor is able to direct a patient towards making some potentially important lifestyle changes.

This project, called “A Dose of Nature,” is itself a partnership between academics, GP surgeries, and environmental organisations. Because it is funded by a Knowledge Exchange Fellowship from the Natural Environmental Research Council, the aim of the project is to develop a coherent approach across the county—spanning different sectors—so that questions and issues are addressed reciprocally. The project works with NHS Kernow, the Health and Wellbeing Board, and the Local Nature Partnership, as well as the University of Exeter Medical School and its biosciences department. So far five pilot schemes are in development, and the intention is to apply the model across Cornwall and beyond in due course.

To find out more about “A Dose of Nature,” contact me at d.bloomfield@exeter.ac.uk

Dan Bloomfield is a NERC knowledge exchange fellow at the University of Exeter. He also works as a psychotherapist in private practice.

Competing interests: I declare that I have read and understood the BMJ policy on declaration of interests and I have no relevant interests to declare.