WASHINGTON – When Annette Coen went for a health check-up in Washington state last summer, she and her doctor discussed concerns about her weight and asthma. Then her doctor prescribed a novel recipe: regular forest walks.
He gave Coen a one-year ticket to Washington’s state park system and told her to “walk, go camping, do what you have to do,” Coen, now 53, told the Thomson Reuters Foundation.
A year later, she said the park recipe was a “great experience” for her and her whole family. “I’ve lost 30 pounds since April this year … just on the go,” she said.
As the COVID-19 pandemic highlights the health benefits of spending more time outdoors, a growing fraction of the U.S. medical community is prescribing time outside in the same way as traditional medication.
The idea of writing out park or nature recipes has become particularly popular with paediatricians.
“It all came together” during the pandemic, said Maya Moody, president-elect of the Missouri chapter of the American Academy of Pediatrics, pointing to an increase in child anxiety and pediatric obesity since the coronavirus outbreak began.
With lockdowns keeping kids indoors, “we were 30, 50, 60-pound gains,” said Moody, who cares for around 3,000 low-income children in the St. Louis area.
In April of that year, she became one of a dozen or so pediatricians across the state who began offering natural prescriptions.
“When I give a prescription, it’s specific, just like an antibiotic. You use it for so many days and I say go to this park,” she explained.
Buy-in varied by age group, Moody noted, with younger children and their parents being more open to the approach, but teenagers expressing skepticism.
“Sixteen and 17 year olds look at me and say, ‘You want me to get off TikTok and get a real tick in the forest?’” She said.
But Moody said the fact that doctors and health professionals are now seriously investigating how something as simple as a walk in the park can help patients is exciting.
An AAP spokesman said the group was in the process of forming a nature regulations committee but declined to provide further details.
Natural recipes are still new so data on their effectiveness is limited, but a 2018 analysis by researchers at the University of East Anglia in the UK found that they “may have significant benefits”.
Much more research has been done on the general benefits of being outdoors – in one example, starting next month, a Welsh government-sponsored study will look into the benefits of treating hospital patients outdoors.
In more than 500 scientific studies over the past few years, researchers have linked spending time in nature to reduced anxiety, reduced risk of obesity, and even reduced all-cause mortality, said Maryland-based pediatrician Stacy Beller Stryer.
Stryer is also the Associate Medical Director at Park Rx America, an online platform that helps medical professionals write natural prescriptions.
Using the database of thousands of parks and public lots, prescribers can filter by activity, distance from the patient’s home, and facilities such as playgrounds.
“When (the patient) has decided where to go, does the prescriber discuss what to do – maybe walk the dog? And how often – maybe every Monday, Wednesday and Friday for 30 minutes? ”She said.
Writing an actual prescription for time in nature gives patients a useful extra boost, said Brent A. Bauer, director of research in integrative medicine and health at Mayo Clinic in Minnesota.
“More than half of my patients who receive a ‘prescription’ for time in nature do so successfully,” he said.
A census of park prescribing programs last year estimated there were more than 100 nationwide.
The Pittsburgh Parks Conservancy, in partnership with the UPMC Children’s Hospital of Pittsburgh, launched a pilot program in 2016 after a pediatric resident directed patients at a weight management clinic, said Kathryn Hunninen, a senior manager at the conservancy.
“He wanted to encourage patients to go outside but didn’t know where to send them,” she said.
“It started with a request from him to the parking system and developed from there.”
In a 2018 survey, more than 80% of staff at participating Pittsburgh clinics said they frequently recommend that patients visit parks.
Last year, Salt Lake County, Utah, offered park recipes to its employees “to improve or maintain physical and mental health while building sustainable health behaviors,” said Sarah Kinnison, who oversaw the program, in an email.
335 employees took part in the first year, and the county is running the program again this fall.
Access issues, financing
As doctors increasingly use outdoor time as a medical strategy, park prescribing programs are facing access issues.
In low-income neighborhoods, parks are on average four times smaller and more crowded than parks in high-income areas, according to a study published last year by the Trust for Public Land, a nonprofit that analyzed government data from 14,000 U.S. cities.
It also remains unclear how the programs can be kept financially sustainable. Currently, they rely on ad hoc funding, often cobbled together from grants, philanthropy, or as publicly funded pilot projects.
The associated costs aren’t particularly high, but they do exist, said Bradford S. Gentry, co-director of the Center for Business and the Environment at Yale University.
They could include the cost of parking passes, the salaries of community health workers and park workers to coordinate and run programs, and transportation to and from the green space, he said.
“If there are all of these (health) benefits, how can we move from grant funding or public funding to funding the health system?” asked Gentry, focusing on the interface between health and land protection.
“I haven’t found an answer yet.”
The U.S. Department of Health did not respond to a request for comment.
Gentry pointed to Oregon where work is being done to address the funding problem by calling for the repeal of certain federal regulations affecting Medicaid, the US government’s low-income health program.
Every five years states have the option to apply for such an exemption if they can demonstrate that it will result in better care and not cost extra money, said Lori Coyner, who was the state’s Medicaid director until July and is now in charge Medicaid Policy Advisor to the Oregon Health Department.
The state’s request for a waiver is due in December if it wants to demand more flexibility in how local organizations deal with health problems.
“We believe there is a real way to use some of those Medicaid dollars … to spend more time outdoors,” Coyner said.