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Prescribing nature for health draws providers to Oakland, CA, conference


      Speakers and organizers of Exploring Nature and Health pose with a National Park Service mascot

Like many in the San Francisco Bay area, I recharge on weekends by hiking in forests or through the region’s wide-open spaces.

But I recall a particular time when I felt so overwhelmed by a reporting experience that the only antidote I could imagine was escaping to nature. While living in Turkey, I reported on a powerful earthquake that struck near Istanbul. I spent days listening to tales of survivors’ efforts to free loved ones from rubble, watched and listened as MASH unit medics tended the injured, and saw children whose parents had perished sit in numbed silence. After weeks of this, a fellow reporter and I, emotionally spent by serving as chroniclers of this tragic event, sought refuge on a grassy hillside on one of Istanbul’s neighboring islands.

In fact, there’s now a growing body of research showing the positive health effects of nature. At a recent conference in Oakland, CA, clinicians who prescribe nature to help buffer ACEs and toxic stress experienced by children and families shared findings from their own research and others. They were joined by representatives from partnering community-based groups. More than 150 people gathered for “Exploring Nature and Health,” on October 27 for an all day meeting presented by the Center for Nature and Health and Primary Care Clinic, UCSF Benioff Children’s Hospital.

As it happens, an early study in the 1980s was foundational in showing that nature has a buffering effect on people’s stress. A general surgeon, recounted presenter Dr. Nooshin Razani, reviewed the records of all of his gall bladder surgery patients and discovered they did better if they happened to be in a room facing a view of nature rather than a view of a brick wall.

How did he measure that? “What he was able to see is that the patients who were facing the wall had more post-op days, more negative comments to nursing staff and more analgesic use than the ones who had views of nature,” said Razani, who is a pediatrician at the UCSF Benioff Children’s Hospital in Oakland and the director of the hospital’s Center for Nature and Health.

Razani also highlighted some large studies that showed that over a person’s lifespan, there are clear benefits to living near or around nature. In one study, a population study of 40 million people in England under the age of 65 were classified according to levels of income and exposure to green space. They looked at mortality over a four-year-period and found that among those who had the lowest income, those who had greater exposure to green space had a 1.43 relative risk of mortality compared to a 1.93 relative risk among those who had little exposure to green space.  

Razani and her colleagues have done their own investigation of how their low-income patients have responded to prescriptions for nature. Since 2012, the Center for Nature and Health has worked with local park agencies in an effort to improve access for its pediatric patients and their families, according to a recent article in the journal PLOS One.The clinic enrolls families for monthly outings, which include providing transportation, food and activities. According to the article, by its third year, it had logged 1,000 park visits among its patients. 

A small randomized trial of 78 of their patients suggested that park visits were making inroads in reducing stress. Participants, which included children between the ages of four and 18, were followed over three months. Their parents were asked about how many park visits they made; their feelings of loneliness; gauged their physical activity, which was also measured by a pedometer; their stress levels, gauged by the 40-point Perceived Stress Scale; did cortisol saliva tests; and asked about their feelings about nature, which was measured by a validated tool.

 Overall, participants stress levels were reduced by 1.71 points with decreases associated with the number of park visits, according to the article.

How often do people need to be in nature? “In our work, we found the nature effect was small, but incremental and you need a daily dose,” Razani told the group.

Jose Gonzales, the founder and former executive director of Latino Outdoors, stressed to providers the necessity of gauging how safe people feel about going into a green space or nature. He recounts his very first so-called “heath walk” in Modesto with a group of Hmong, and noticed they had a park right across the street from where they lived.

“I asked them do you go there? ‘No, we want to go walking. We know walking is healthy for us. We love to do it.’ They gave me a dozen different reasons real and perceived threats: gang members, drug abuse.” So he asked them, what it would take for them to go to the park.

Their answer: “’If you come with us’,” he said. So that’s what he did. “The next day they wanted to walk an extra mile.”





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Laurie Udesky (ACEs Connection Staff) posted:

Thanks Cissy and Gail!

Thank you Daniel for providing these additional resources! Speakers did mention the benefits of hospital gardens gleaned from studies. I know the organizers of the all day event are going to post the powerpoint presentations from the Prescribing Nature for Health conference. I may be writing up an additional piece on some of the other research and experiences presented. Stay tuned.


It made me think of when my daughter was in kindergarten, first and second grade. She goes to a public charter school and kids come from 30 sending towns and cities that include among the richest and poorest in the area. Anyhow, one of the sending towns has a beautiful beach and ocean. One of the school field trips is to visit the beach, play in the sand and kids are able to go to their knees in the water (and with LOTS of parents and teachers on hand). Anyhow, it's great bonding for the kids and also, many of the kids have never been to the ocean. To see the kids playing in the sand, collecting shells, staring at the shore line, skipping the waves, getting splashed. Honestly, it's seared into my memory in the best way and the trip I went on happened a decade ago. I'll never forget it and I'd never thought of it in quite this way, as a nature and natural community building and healing event. If I had permission to share photos (I don't) I would. It's such a popular and fun event (and I admit I was a nervous nellie Mom and was pretty terrified to let my kid near water in a group setting at school. Despite my worrying, even I had bliss bath your writing helped me relive. I don't always get to read all of your stories but I appreciate how you blend research, interviews and add in some slices of your own experience. Cis

Thanks Cissy and Gail!

Thank you Daniel for providing these additional resources! Speakers did mention the benefits of hospital gardens gleaned from studies. I know the organizers of the all day event are going to post the powerpoint presentations from the Prescribing Nature for Health conference. I may be writing up an additional piece on some of the other research and experiences presented. Stay tuned.

Great story. It makes me want to go walk my dog at the park nearby and also reminds me how lucky I am to have nature so close. I also loved hearing more about your experiences living and working in Turkey. 

The connection between nature and health is very well established. The CDC used to have an office that spent a lot of time on this subject. Google for work done by Dr. Richard Jackson, Dr. Howard Frumkin, and Dr. Andy Dannenberg. Chris Kotchitsky currently with the CDC is an expert on the subject. Richard Louv books are out there that include the phrase, Nature Deficit Disorder. Here's another excellent article: https://www.scientificamerican...ature-that-nurtures/

Years ago, I attended a presentation in Atlanta by a doctor who was prescribing time in the garden to recovering patients. His name now escapes me but he was the only doctor I knew of at the time that saw the connections and was touting it. It may have been at Emory but I'm forgetting. Bottom line is to talk to your county health departments, your state health agencies, and your medical professionals and find out what if anything they are doing related to health and the environment.

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