Global Health Trends: The Rise of Nature-Based Interventions
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Nature-Based Health Interventions (NBIs) are about mindfully connecting patients with the outdoors to promote mental and/or physical health. It can be performed individually or in a group situation. There is evidence that inequalities in health are lower in greener communities, meaning that providing effective nature-based interventions that (re)connect people to nature can be an important way to help to reduce health inequalities.[1]
Nature–based health and wellbeing treatment or prevention aim to change the behavior in individuals or groups with specific physical, mental or social health and wellbeing issues. The nature-based therapy improves patients' self-esteem and decreases depression; improves motivation and social interaction; reduces healthcare consumption including use of medicines particularly antibiotics where not required; increases mental well-being, and engagement, and can give participants a sense of meaningfulness. Spending time in green space for example, doing things like growing food or flowers, exercising outdoors or being around animals can benefit both mental and physical wellbeing. NBIs activities are becoming increasingly recognised across disciplines from city planning to medicine (health promotion). These interventions may be broadly categorized into those that change the environment in which people live, work, learn, recreate or heal (for example, the provision of gardens in hospitals or parks in cities) and those that change behavior (for example, engaging people through organized programmes or other activities). A range of factors (such as socioeconomic variation) that will inevitably influence the extent to which these interventions succeed. Social factors, such as acceptability of the intervention to local communities, are also likely to have an important influence on the uptake of nature–based health interventions. Finally, an individual’s age, gender and other factors will play a role. Recognition of the possibilities with NBIs is innovation, development of therapeutic gardens for different client groups (e.g., war veterans) and the use of nature experience to support the acquisition of mindfulness meditation techniques be also helpful.[1]
Nature-Based Interventions Play A Positive Role In Promoting Good Health
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There are many pressing public health and environmental challenges associated with modern living, with rapidly growing levels of chronic, non–communicable physical and mental health conditions and global recognition of serious health risks posed by stressful living conditions. Engagement with nature is a common pursuit in cities and it is becoming increasingly recognized as a means to alleviate many of these challenges. Evidence now points to benefits for physical health (e.g., lower prevalence of high blood pressure and allergies), mental health (e.g., lower prevalence of depression and anxiety) and social wellbeing outcomes for people who spend time in nature. Moreover, there is evidence that the magnitude of such benefits can increase with the dose of nature. It is thus of significant concern that urbanization and the challenges of modern life are leading to reduced engagement with the natural environment.[2]
Nature–based health interventions (NBIs) can facilitate change through a somewhat structured promotion of nature–based experiences. For example, environmental manipulations where green and blue spaces are incorporated into cities can have positive outcomes associated with the management of habitats and flow of ecosystem services to people, but there is also a growing body of evidence highlighting the potential of green space for the treatment and prevention of physical, mental and social health and wellbeing challenges. This recognition that experiences of nature can provide benefits for people represents a major shift in public health thinking for both the prevention and the treatment of health issues, beyond considering nature solely as a risk–factor, through the transmission of insect–borne diseases. Many governments, non–government organisations, public and private stakeholders are now beginning to consider these potential benefits in their policy and planning frameworks. Indeed, across the world, many NBIs are being implemented. These include, for example, minimum area targets for public green space and ‘nature prescriptions’, where doctors or other health practitioners prescribe nature–based experiences for patients living with specific health conditions. However, despite this growing movement, there is a dearth of guidance as to what NBIs are available and what specific health outcomes they might achieve and for whom. This can only limit the potential leveraging of natural settings to improve health and wellbeing outcomes for individuals and communities, potentially leading to inefficient and ill–targeted investment decisions.[2]
Intended Health Outcomes[3]
Reduce pain stress, and agitation potentially leading to improved mental health, quality of life and wellbeing. Improve air quality, mental wellbeing thus enhances creativity and productivity. To encourage outdoor leisure, engagement with nature, increase neighborhood walkability and physical activity, enhanced social cohesion, and quality of life outcomes. For resident’s attention restoration, in part by improving the view from people’s homes. Indirect health benefits include reduced heat island effects. Provide place of learning, attention restoration, overall improvement in health.
Reduce blood pressure, improve healing times, reduce depression, increase resilience and other mental health benefits. Prevention or treatment of obesity, cancer and diabetes. Address social and psychological issues through positive human–nature interactions, building self–esteem and fostering social connections. Treatment modalities include the natural world in relationships of mutual healing and growth, and as such are a form of applied ecopsychology Enhance child health and development through environments that promote varied playing opportunities, improved attention and learning. Provide alternative and improved learning environment. Improve nutrition, social connections and psychological benefits e.g., confidence, team work skills. Increase awareness, engagement, use and experience of natural environments and mental wellbeing of general population[3]
The Global Take On Nature-Based Interventions Concept For Health
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For centuries, approaches to human health have utilized the benefits of engaging with nature, from plant-based medicines to the beneficial properties of ‘fresh air’ and biodiverse environments. Today, differing models of healthcare systems worldwide re-engage with this concept in different ways. This includes preventative approaches, such as using immersive forest experiences for stress relief through to specialized gardens to aid surgery out-patient recovery. In addition, the adoption of nature-based interventions as non-clinical responses to medical conditions has gained momentum particularly in Western societies. Most recently, the COVID-19 lockdowns have seen a sustained revival in the public health benefits of visiting local green spaces.[4]
Use Of Nature-Based Interventions-Current Situation-WHO
The public health approaches across the globe need to shift from reactive treatment to proactive preventative measures. There has been increased international acknowledgement of the need for urban environments to integrate greenspaces into people’s lives to support public health. 'Nature in all the SDG Goals' shows how nature-based solutions can contribute to achieving all the Sustainable Development Goals and deliver sustainable development for everyone. The National Health Services in many countries are moving to a preventative model of care within the community focused on the upstream determinants of health (social, economic and environmental). This includes increased recognition for community-led interventions and the role of the natural environment in supporting health and wellbeing. Furthermore, as demand for access to public green space increased during the COVID-19 pandemic, there was increased attention to the public health and wellbeing value of these urban landscapes. In the past two decades, there has been increased international uptake in nature-based interventions, from large-scale health initiatives such as Canada’s 30x30 nature challenge through to the revised focus on healing gardens in Sweden. The 30x30 nature challenge aims to reconnect residents with their local natural environments for 30 minutes a day for 30 days. In the USA, Public Health policy has begun to consider ways to improve wellbeing and health through access to nature. [4]
Current ‘green prescriptions ‘ use of nature within an intervention has been turned into a whole sector within Western medicine. Putting the patient at the center of the decision and creating opportunities for innovation in non-clinical treatment has seen the evolution of ‘green prescriptions’ (other names include; GRX, nature prescriptions, park prescriptions, nature-based intervention). Green prescriptions are theorized to be successful due to three elements; mobilizing restoration through nature, positive social contact and facilitating meaningful activity. An intervention aims to increase the participant’s connection to nature as a pathway to improve wellbeing.
The increased attention into ‘dose response’ of nature frameworks creates recommendations on how much, how frequently and what quality of environment people require to gain the associated health outcomes. One may needs a better understanding of these dynamics to ascertain what types or characteristics of greenspaces need to be incorporated into urban spaces design and nature-based interventions.[4]
A number of NBIs can be used to improve population health and wellbeing, and to address specific physical, mental and social health issues. The identified interventions broadly fall into two categories: those that change the environment, and those that change behaviors. The selection of an intervention will require the consideration of a range of factors, including cost, likely benefit, accessibility (including availability and social acceptability) and the capacity of the organization to deliver it. Most importantly, however, the needs of the community or the individual and the goals of the intervention must be considered. To integrate nature–based health interventions into public health and planning policy, is a strong evidence for their effectiveness and thus evaluation should be carefully built into new interventions.
References
1. Bragg, R., & Atkins, G. (2016). A review of nature-based interventions for mental health care. Natural England Commissioned Reports, 204
2. Bragg, R., & Leck, C. (2017). Good practice in social prescribing for mental health: The role of nature-based interventions (Issue 228)
3. Buck, D. (2016). Gardens and health: Implications for policy and practice. https://www.kingsfund.org.uk/publications/gardens-and-health
4. Batman, D. C. (2012). Hippocrates: “Walking is man’s best medicine!”. Occupational Medicine, 62(5), 320–322