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The podcast discusses green prescribing, where healthcare providers recommend time in nature for improved health. It originated in New Zealand in the late 1990s and involves structured nature activities tailored to individual needs. Benefits include stress reduction and better well-being. However, barriers like unequal access and lack of practitioner training exist. Evidence supports its effectiveness, especially in improving mental and physical health. It also promotes environmental stewardship and climate-conscious healthcare. Dr. Smith shares experiences of prescribing nature to patients, emphasizing its role in prevention and community resilience. Implementing green prescribing requires cultural humility and equitable, patient-centered care. Welcome to the Prescribing Nature Pod. I'm your host, Erin. And I'm your co-host, Nisi. Today, we're exploring an approach to health that has been gaining a lot of attention lately, green prescribing, which basically means spending time in nature to support health. Hmm, green prescribing. I feel like it might sound unusual to some people. Right, because when you think of medicine and prescriptions, most of us picture pills or creams. Exactly. Not necessarily spending time in nature. So, what exactly is green prescribing? Green prescribing, sometimes also called nature-based social prescribing, is the practice of health providers recommending structured time in nature to improve health outcomes. The idea actually started in New Zealand in the late 1990s. Back then, doctors began writing prescriptions not for medication, but for lifestyle changes to improve health, usually focused on physical activity or better nutrition. That's fascinating. So, just to be clear, green prescribing isn't just about spending more time outdoors. It's a personalized, evidence-based approach to improving health, right? Absolutely. Activities in green prescribing are quite concrete. Things like guided park walks, community gardening, forest bathing sessions, or even joining local conservation projects. The point is that people are matched with nature-based activities that fit their needs, rather than being told to just get outside. And you might wonder, what's the justification for prescribing these kind of activities in the first place? Well, we know there's real context behind this. Modern life has shifted overwhelmingly indoors, and that shift matters. Reduced everyday contact with nature has been linked to higher stress, greater risk of chronic disease, and increased social isolation. And when people disconnect from nature, they also lose those built-in opportunities for physical activity, mental restoration, and social well-being. That's exactly right. Green prescribing helps bridge that gap by reconnecting people with nature in ways that support physical, mental, and social well-being. But it also faces real barriers. Access to safe green spaces is unequal. Transportation can limit participation. Funding is inconsistent. And many practitioners still lack the training or awareness needed to confidently integrate nature-based options into care. These gaps mean the benefits of nature still aren't shared equitably. How these barriers show up for different communities is an important part of the story, especially when we think about climate impacts and social inequities. From a public health perspective, I think this is where things start to feel even more layered. Climate change is making these gaps wider. It disrupts ecosystems and land-based activities that support well-being, especially for Indigenous communities, whose relationship with land are relational, cultural, and reciprocal. And immigrants and newcomers often participate less in outdoor recreation because of social and economic barriers, but it can reduce settlement satisfaction and overall well-being. So, what does nature-based prescribing look like in real life? How do doctors actually turn this idea into a prescription that patients follow? To help us answer that, we're thrilled to have Dr. Smith with us here today, a family physician who's been practicing green prescribing for several years. She has been working with patients experiencing stress, burnout, and early chronic disease, and has seen firsthand how time and nature can complement traditional medical care. Dr. Smith, welcome. What made you start prescribing nature to your patients? Thanks, Erin and Nisi. I'll be honest, I was initially skeptical, and so were many of my colleagues, but I started to feel more convinced after learning about programs like PARX, Prescription for Parks, a Canadian initiative where primary care providers partner with local parks to prescribe time and nature. I see so many patients dealing with stress, anxiety, and early-stage chronic conditions where traditional medications alone just aren't enough. So, the idea of green prescribing felt like it could fill a real gap in care. What gap in health care were you hoping to address? Prevention. We're very good at treating disease once it's advanced, but we're not always strong at upstream interventions, things that support well-being before a crisis hits. So, how does this translate into real recommendations? What are you actually writing or guiding people toward? Yeah, it's actually pretty specific and measurable. A green prescription might look like spend 20 to 30 minutes in a local park three times a week for eight weeks, and we always tailor it to the person. For some people, it's gardening. For others, it might be a guided nature walk, conservation volunteering, or structured park-based activities. I use it most often with patients dealing with mild to moderate depression, anxiety, stress-related conditions, early cardiometabolic risk factors, and even social isolation. Could you share a real example of what that looks like in practice? Sure. One patient I worked with, let's call her Jane, came in feeling really low and burned out. Medication was an option, but we also added a structured park prescription. After a few weeks, she was sleeping better, had more energy, and felt more connected. It didn't replace her other treatments, but it complemented them really well. Wow, hearing that firsthand really brings it to life. Dissy, from the research side, what do we know about how well this actually works? Now, that's the big question, and I'd say the evidence is pretty encouraging. Systematic reviews of randomized control trials show improvements in psychological well-being, physical activity, cardiometabolic health, and even inflammation markers. Importantly, these benefits hold up when compared to control groups, which really strengthens the case that this isn't just a placebo effect. That's exactly it. As a clinician, it matters a lot that this isn't just observational work. We're seeing positive effects in control trials, too, which really strengthens the case for using it in practice. There's another perspective that adds even more to this picture. In pediatrics, when clinics partner directly with parks, park prescriptions have been linked to improve resilience and reduce stress among children and families facing socioeconomic barriers. Dr. Smith, how does that line up with what you've seen in your own practice? Yeah. In my experience, what really makes this such a powerful intervention is that patients generally enjoy it. When something feels accessible and meaningful, people are simply more likely to stick with it. Wow, that's great to hear. There's a broader ripple effect here that often gets overlooked. Feeling connected to nature is strongly linked to pro-environmental behavior. The more people feel connected, the more they're likely to support environmental protection. It's a reminder that green prescribing isn't just about individual well-being. It can also strengthen community-level stewardship. Of course, this isn't without its challenges. Weather is a big one, especially in Canada. And time constraints in primary care can make it tough, too. Access matters as well. Not everyone has a safe or nearby green space. Right. Research shows that barriers such as time, distance, lack of social support, and even the lack of interest tend to affect younger urban populations more, while rural residents may face fewer access barriers but face other structural challenges. And for many immigrants, social and economic barriers can limit participation in outdoor recreation. And beyond access, there's a deeper layer we need to acknowledge. Indigenous perspectives remind us that the land isn't just a backdrop. It's an active healer. Land-based healing emphasizes relational, reciprocal, culturally grounded connections. Which means equitable implementation really requires cultural humility, recognition of sovereignty, and genuine community collaboration. And there's yet another perspective that really broadens how we think about green prescribing. Beyond individual and community-level equity, it also intersects with climate-conscious health care. Green prescribing is a low-carbon approach. It doesn't require manufacturing, shipping, or disposal. And it shifts our focus toward prevention rather than treatment. And by reducing stress and strengthening resilience, nature-based interventions may help communities cope with climate-related stressors such as heat waves, wildfire smoke, and environmental disasters. So Dr. Smith, from your perspective, does this feel like climate-conscious medicine? Absolutely. When I prescribe time and nature, I'm not just thinking about one individual patient. I'm thinking about prevention, community connection, and long-term resilience. When people feel better in their local parks, they're more likely to value them. And when communities value green spaces, they're more likely to protect them. It becomes a positive feedback loop, a healthier environment supporting healthier people, and healthier people supporting their environment. That's such a compelling way to think about it. Health and environment reinforcing each other. So to wrap up, Dr. Smith, what would you say to clinicians who are still feeling a bit skeptical? I'd say start small. You don't need to overhaul your entire practice overnight. Begin by asking patients about their relationship with nature. Suggest something specific and measurable, and then follow up. And most importantly, listen. For some patients, especially Indigenous patients, land already plays a healing role. For others, there may be barriers we need to acknowledge like transportation, safety, or cultural relevance. Green prescribing only works when it's equitable and patient-centered. And what about the patients who may be curious, but unsure of where to start? You don't need expensive gear or access to wilderness. It can be a neighborhood park, a community garden, or even just sitting underneath a tree. The consistency matters more than the intensity. So before we close, let's pull together a few key takeaways from everything we've talked about today. Green and nature prescriptions represent a promising evidence-based strategy to improve mental and physical health. Exactly. But making them work in practice requires clear definitions, equitable access, cross-sector collaboration, and culturally grounded approaches. And as climate change intensifies and chronic disease continues to rise, reconnecting people with nature may be more than a wellness trend. It might be one of the simplest preventative tools we have. Sometimes the most powerful medicine is already growing around us. Thank you for listening to the podcast today. Don't forget to subscribe wherever you get your podcasts. Our next episode will be out next Monday. Stay tuned.