Growing Outdoors

For kids, the natural world can be a place of peace, health and inspiration—and can launch a lifetime passion for conservation.

• Richard Louv
• Conservation
• Sep 23, 2020

Wonder, delight, whimsy and discovery animate the faces of children exploring nature, whether by building a fairy house (top left) or rescuing a turtle from the road (bottom right). Even inspecting a few wildflowers (below) can yield quiet joy. (Above photos clockwise from top left: Leslie Alvis, The Jehoul Family, Mackenzie Rohrbaugh/Wild Sage Photo Co., Nichole Holze, Nakiesha D. Bridgers, Nakiesha D. Bridgers, Nakiesha D. Bridgers, Elizabeth Blank)

ON A WARM SUMMER AFTERNOON in Atascadero, California, Kathleen Lockyer and her seven-year-old daughter were in their backyard next to the Salinas River. The child was pounding an acorn with a stone when she suddenly looked up, seeming alarmed.

“Mama! What’s he saying?” she asked.

Lockyer’s stomach fluttered. Was someone watching them? Was her daughter hearing imaginary voices?

“Who are you hearing?" asked Lockyer, feeling uneasy.

“Him, that guy. Listen!” her daughter said. Baffled at her mom’s cluelessness, the little girl stood up and pointed toward the front yard. “That bird. So what’s he saying???”

Lockyer turned and heard the sharp metronomelike cheep-cheep-cheep alarm call of a bird. Her daughter, hearing it first, had been intuitively captivated—and curious. This backyard moment underscored what Lockyer, an occupational therapist, already knew: Connection to nature can be a doorway into a wider, deeper and even healing world—if we pay attention.

Increasingly, psychologists, health professionals, urban planners and others are, in fact, paying attention and incorporating the power of nature into their practices. Washington, D.C.-based pediatrician Robert Zarr, for example, founded Park Rx America, now a network of some 820 healthcare professionals from around the world who literally write prescriptions for nature. They’ll tell patients to “plant a garden,” “take a hike” or unplug from electronics and just “notice what’s in motion” outside. They’ve even created a database of parks or trails for outdoor opportunities in patients’ own neighborhoods.

Similarly, pediatrician Stephen Pont in Austin, Texas, prescribes nature as a “stealth health” intervention. In nature, children “can engage in health-improving activities without even realizing it,” he says. “Give kids a healthy snack and time outdoors in nature and many medical problems can be prevented or improved.” These problems range from attention-deficit/hyperactivity disorder to Vitamin D deficiency to cardiovascular and mood disorders. And though nature isn’t a panacea for everything that ails us, it’s one of the few prescriptions that act as both prevention and therapy.

As founding chair of the American Academy of Pediatrics (AAP) Section on Obesity, Pont is now encouraging AAP to establish a Nature and Child Health group for pediatricians interested in “increasing the amount of time that our patients spend in nature.” He bases this advice on common sense and hard science. “A growing evidence base is now documenting ... what we’ve always known—that we feel better after spending time in nature,” he says. 

Not long ago, it wasn’t easy to support the argument that the natural world can enhance physical, mental and social health and improve cognitive skills. In the early 2000s, when I was researching and writing Last Child in the Woods—a book about the benefits of nature and the problems with what I called nature-deficit disorder—I found only about 60 studies rigorous enough to cite. Then, in 2006, I co-founded the nonprofit Children & Nature Network, which now offers a free online research library with abstracts of more than 1,000 studies.

Ming Kuo was one of the early pioneers in the field. “When I got into this, it was just me and the tumbleweeds,” says Kuo, who heads the Landscape and Human Health Laboratory at the University of Illinois at Urbana–Champaign. Today, she says, “there’s been a noticeable uptick, maybe even a flood of research.”

In wide-open Wyoming, kids from Washington, D.C., enjoy a lakeside hike (above) and study wilderness first aid (below) through City Kids Wilderness Project, a D.C.-based program to help children exercise, explore, learn and bond in nature.

Nature proves its point

This growing number of studies suggests that nature connection can ease symptoms of depression and anxiety, help prevent or reduce obesity and myopia and boost the immune system—and those health benefits can lead to improved learning. Critical thinking and creativity are shaped not only by pedagogy but by health as well as environmental, economic and cultural conditions. For children and adults, connecting with the natural world can expand the senses, most importantly the sense of wonder.

In February 2019, Kuo and her colleagues, Michael Barnes and Catherine Jordan at the University of Minnesota, published a systematic review of nature-related education research in the journal Frontiers in Psychology. They conclude that greener schools—ones that, for example, offer a natural space for play and learning, take students on field trips to natural areas and bring nature into the classroom—reduce stress, boost cognitive functioning and may raise standardized test scores and graduation rates. “Report after report—from independent observers as well as participants themselves—indicate shifts in perseverance, problem solving, critical thinking, leadership, teamwork and resilience,” they write. Among the most recent findings:

• A 2019 study published in Health & Place found that time outdoors increases kids’ chances of experiencing moments of happiness. This study, involving more than 10,000 children using body-worn sensors, suggested that the odds of experiencing what the researchers called “happy moments” were 2.4 times larger in public spaces such as open fields and plazas than in commercial areas like malls.

• Another 2019 study in the same journal found that park prescriptions for low-income families lead to a significant increase in “resilience,” a balanced response to stress. 

• And researchers have found that for young adults, the more nature experienced over a 14-day period, the more life satisfaction they felt daily. In short, time in nature heals. 

Such research has fueled a powerful movement to connect children, families and communities to nature for both health and learning. Though barriers remain, parents, health care professionals and educators are increasingly aware of the benefits—and taking action. 

In the 1990s, for example, many school districts were cutting recess and favoring longer hours of desk-based learning and test taking. But in 2017, Education Week reported the creation of hundreds of new nature-based preschools within the decade. School gardens and natural schoolyards—such as those fostered through the National Wildlife Federation’s Schoolyard Habitats® program—are also gaining ground. And the threat of the coronavirus pandemic added incentive to create learning areas outdoors, where social distancing is easier than in classrooms.

Intent on the challenge of setting up a tent, middle-school kids from San Jose, California, (above) bond with nature and each other through a program supported by Latino Outdoors, which helps kids experience nature, often for the first time. Three curious kids (below) observe a baby snapping turtle at the Flying Deer Nature Center in East Chatham, New York. Its programs and camps help kids and families immerse themselves in nature.

Building equal access for all

The health and social benefits of nearby nature also have clear implications for conservation and the future of urban development. More than 50 studies point to nature-based play as key to developing pro-environmental behavior because it nurtures an emotional connection to the natural world. Research also suggests that healthy urban ecosystems can lead to more cohesive neighborhoods, reduced aggression, lower crime, better social bonding and less violence. 

That raises the very real question of equitable access to nature for all people. While the human need for nature connection is universal, equal access to nature is not. According to a new report released by the Center for American Progress based on an analysis from Conservation Science Partners, “people of color and low-income communities are more susceptible to developing immunocompromising illnesses such as asthma” because “they are more likely to live in polluted areas without sufficient tree cover and spaces to get outdoors.” 

The pandemic has underscored these problems. “Far from being an ‘equalizer,’ the pandemic has been an amplifier and magnifier of societal inequities,” says José González, founder of Latino Outdoors. Decisions to close or restrict access to parks, he adds, “will have a disproportionate toll on the communities that need it the most.” In addition, too many parks, from the local to the national, are, as Gonzalez puts it, perceived as “privileged spaces,” where people of color “may not feel welcome or safe.” 

This matters all the more because the health and educational benefits of natural environments appear to be particularly evident among children and communities under the most stress. In 2018, U.K. researchers Caoimhe Twohig-Bennett and Andy Peter Jones published a review of studies involving more than 290 million people of all ages from 20 different countries. Their analysis revealed that exposure to green space was linked to significant reductions in diastolic blood pressure, stress-related salivary cortisol, heart rate and diabetes. In addition, their survey indicated that green space exposure reduces the risk of preterm birth, premature death and high blood pressure—all of which disproportionately affect people of color.

While acknowledging the immense variability in access to safe outdoor spaces, it’s worth asking: How much of a dose of nature do we humans need? One 2019 study, published in Scientific Reports, found that a minimum of 120 minutes a week in parks, woodlands or beaches promotes physical and mental health. This two-hour threshold applied across genders, ages, ethnicities and economics—and also for people with long-term illnesses or disabilities. Ultimately, I’d argue the most useful dose is this: Some is better than none, and more is better than some.

Free play enlivens kids at the Flying Deer Nature Center in East Chatham, New York. “Through play,” says Program Director Josh Wood, “children learn to navigate the environment, gaining skills, confidence and a sense of well-being.”

Discovering our wild side

Moving beyond nature’s impact on health, researchers are beginning to study the relationship between humans and other animals. As I note in my recent book, Our Wild Calling, little is known about the impact of wild animals on human health or how, through a stronger bond, humans can prevent further destruction of wildlife.

This is the frontier that Lockyer and others are beginning to explore. For more than two decades, she has been helping kids with sensory processing disorder, in which the brain has difficulty processing information that comes in through the senses. Through her practice Rx Outside, Lockyer has come to believe that bird language illustrates how complicated the human auditory processing system is. 

“Bird language may have been the first [other than human] auditory language that our ancestors tuned into,” she says. “Listening to the many vocalizations birds use to describe different things happening in the environment may have helped our ancestors develop their own auditory processing capabilities, which they needed for survival.”

Lockyer also works with a group called 8 Shields, taking people into Northern California forests to learn “deep bird language,” listening to their vocalizations. Participants adopt a “sit spot” where they remain still long enough to truly listen to the sounds of nature—and to themselves.

The bird that Lockyer’s daughter heard turned out to be a California towhee agitated by a gray squirrel that crept close to its nest. By asking what “that guy” was saying, the girl was acknowledging a disturbance, possibly a nearby threat. In the past, such information might have been critical to physical safety, says Lockyer. Today, this form of alertness can help develop our neurological foundations and enhance our sense of being fully alive by making us more aware of our surroundings. “If a sound is not attached to sight or smell or given meaning, it never makes neurological sense,” she says. “We are designed to make sense of our world.” 

This truth can be applied to how we raise our children and care for the Earth. It’s also the core principle of all good research. “Developmentally,” Lockyer says, “the best response to a child who hears the alarm of a bird and asks, ‘What’s he saying?’ is, ‘I don’t know, let’s go find out!’”

NWF at Work

Connecting kids with nature

Give a kid a chance to explore outdoors—and you’ll see that child blossom. The National Wildlife Federation encourages such nature learning through its 9,000 certified Schoolyard Habitats® and 5,500 Eco-Schools USA, serving well over a million kids in the nation’s 25 largest school districts and beyond—by far the largest green-school programming in the United States. The Federation’s Ranger Rick® kids’ magazines, books and online programming teach kids about nature and show how they can make a difference in their own environment. NWF’s Garden for Wildlife™ programs teach young Butterfly Heroes™ how to help monarchs and other pollinators. And the Early Childhood Health Outdoors™ program is creating natural playscapes where kids can both learn and have fun—all gifts to future generations.

Richard Louv has authored several books about nature. His newest is Our Wild Calling: How Connecting with Animals Can Transform Our Lives—and Save Theirs.

Take a Walk in the Woods. Doctor’s Orders.

(THE NEW YORK TIMES, July 12, 2018)

“Forest bathing,” or immersing yourself in nature, is being embraced by doctors and others as a way to combat stress and improve health.

By Amitha Kalaichandran, M.D.

First we sat in a circle on the leafy ground, each sharing a moment in nature from our childhood that filled us with joy. Next our guide, Kiki, a newly trained forest therapist who insisted we call her by her first name, led us on a mindful — and very slow — walk through the forest.

“What do you hear, smell, see?” Kiki asked, encouraging us to use all five senses to become deeply “immersed” in the experience.

An older woman in the group told us that she was undergoing a difficult and stressful period in her life, and that being among the trees felt “healing.” Others mentioned that the activity reminded them of walks they took as part of Boy Scouts or commented on the sounds: insects, birds, the rustling of leaves. I noticed the bright green acorns that dotted the forest floor, which reminded me of my childhood collection of acorns and chestnuts. Admittedly, I was also worried that the early morning rain was fertile ground for vicious mosquitoes (West Nile!) and ticks (Lyme!).

We ended the two-hour forest walk with a tea ceremony, sipping a concoction of white pine needles steeped in hot water.I left feeling relaxed and more at peace, though with at least two dozen bites from mosquitoes that seemed immune to DEET.

Kiki had been trained according to standards set by the Association of Nature and Forest Therapy, a professional group that has certified more than 300 people across North America to be forest therapy guides, among them psychotherapists, nurses and six M.D.s. The sessions are modeled after the Japanese tradition of shinrin-yoku, or forest bathing.

Over the years, I’ve had physician mentors recommend Richard Louv’s books, “The Nature Principle” and “Last Child in the Woods,” which describe the benefits of time spent in the wilderness, from stimulating creativity to reducing stress. Florence Williams’s best-selling book, “The Nature Fix,” has a chapter dedicated to the benefits of forest therapy.And now, it appears that more North American doctors are starting to incorporate spending time in forests into their practice.

Some small studies, many conducted in Japan and Korea, suggest that spending time in nature, specifically in lush forests, might decrease stress and blood pressure (especially in middle-aged men), improve heart-rate variability and lower cortisol levels while boosting one’s mood. An analysis of studies from 2010 that focused on exercising in nature found improvements in self-esteem, particularly among younger participants. Overall effects on mood were heightened when there was a stream or other body of water nearby.

But other studies have shown mixed results. A cross-sectional study from Korea found no change in blood pressure with forest bathing, and a systematic review from 2010 found that while time in the forest may boost mood and energy, any effects on attention, blood pressure and cortisol may not be statistically significant. Another recent review from Australia underscored the challenges of drawing causal links to disease prevention, with the authors calling for robust randomized controlled trials.

Several theories have been proposed as to why spending time in forests might provide health benefits.Some have suggested that chemicals emitted from trees, so-called phytoncides, have a physiological effect on our stress levels. Others suggest that forest sounds — birds chirping, rustling leaves — have a physiologically calming effect. Yet evidence to support these theories is limited.

On a recent visit to Japan, I met with Dr. Hiroko Ochiai, a surgeon based at Tokyo Medical Center, and her husband, Toshiya Ochiai, who is currently the chief executive of the International Society of Nature and Forest Medicine. Dr. Ochiai is trained in forest therapy and currently conducts most of her sessions with volunteers within a forest in Nagano, about three hours from Tokyo, with the help of a local guide, and plans to offer forest therapy soon at one of Tokyo’s largest hospitals.

“I usually encourage participants to sit or lie down on the forest ground and listen to the sounds,” she says. “The hypersonic natural world can be soothing, and things are always moving even while we are still. It can be very calming.”

Last June the Northside Hospital Cancer Institute in Atlanta began to formally offer forest therapy as part of a pilot project in collaboration with the Chattahoochee Nature Center. Twelve patients with newly diagnosed cancers recently signed up for a session, according to Christy Andrews, the executive director of Cancer Support Community Atlanta.

“It was a four-hour session that seemed to have an impact on the patients,” she said. “I remember one participant telling me afterward that it was a way to ‘steer away from cancer,’ and the group became very cohesive. I think it helped reduce the isolation in a way that’s different from a regular support group.”

Dr. Suzanne Bartlett Hackenmiller, an obstetrician-gynecologist based in Cedar Falls, Iowa, began guiding patients in her practice through the Prairie Woods in Hiawatha Iowa, though she has also led groups in forests around Des Moines. She became a certified guide through the Association of Nature and Forest Therapy three years ago and tries to tailor her offerings based on the group she is leading.

“I generally get a sense of where people are at. For some, it’s best for me to stick to the science, but others may literally want to hug a tree. The traditional tea ceremony at the end might turn some people off, so I’m conscious of that and adjust accordingly,” she says.

In one exercise, she has participants close their eyes as she guides them through experiencing the different senses, imagining feeling their feet growing into the ground like roots of a tree, for instance, listening to nearby sounds and observing how far they may extend, or smelling the air. It’s similar in many ways to a guided meditation.

“I recently held a session where four out of the 20 participants were in wheelchairs, so I found a local park that had plenty of trees and a paved sidewalk so everyone could enjoy it,” she says.

At the University of California, San Francisco, Benioff Children’s Hospital in Oakland, Dr. Nooshin Razani, a pediatric infectious disease doctor and director of the Center for Nature and Health, has offered a similar program for the past four years. The “Shine” program, linked to the East Bay Regional Parks District, offers “ park prescriptions,” a movement that is growing in popularity, and aims to improve accessibility to nature for low income children.

One Saturday a month, Dr. Razani leads a group of up to 50 people through a lush forest of redwood trees and lakes on the outskirts of Oakland. The groups consist of patients ranging in age from a few months to 18 years, accompanied by at least one adult family member. A few of her medical colleagues — an orthopedic surgeon and primary care doctor — have also attended, and the Oakland-based pediatrics residency program at the medical centers invites doctors in training to join the group. Shine recently celebrated its 60th park outing.

“The accessibility part is huge for me. Many children don’t have access to green spaces in their community,” Dr. Razani says. “We also have evidence that supports the mental health aspects of spending time in forests, and for the resident doctors who participate, it’s a way to show them how children interact with nature based on the developmental stage. Sometimes the doctors’ need is just as much as the patients’.” In February, Dr. Razani published findings of a randomized trial that found that park visits — regardless of whether they were led by a guide or not — were associated with a decrease in stress three months after the visits.

A few hours after my own forest walk, the woman in our group who had mentioned her stress emailed me to say that she had checked her blood pressure afterward and noticed it was lower than usual. “It would be nice to see if there was a meaningful change from before, if they collected that information,” she wrote.

She had hit on one of the biggest issues around guided forest walks and forest therapy. Is it an evidence-based activity with proven clinical benefits?

The science is still lacking to prove it.But there is some evidence — as well as good old common sense — to suggest that spending time in nature is good for both the mind and body, whether done as a group or alone. It may be something we all need more of.

Amitha Kalaichandran, M.H.S., M.D., (@DrAmithaK) is a resident physician in pediatrics based in Ottawa, Canada.

Why living around nature could make you live longer

(The Washington Post, April 19, 2016)

This photo taken on October 18, 2008 shows the sun peeking through a canopy of trees on Skyline Drive in Shenandoah Park, Virginia. (KAREN BLEIER/AFP/Getty Images)

Living closer to nature is better for your health, new research suggests — and may even extend your life. 

A study just published in the journal Environmental Health Perspectives found that people who live in “greener” areas, with more vegetation around, have a lower risk of mortality. The health benefits are likely thanks to factors such as improved mental health, social engagement and physical activity that come with living near green spaces.

The research relied on data from a vast long-term Harvard study funded by the National Institutes of Health called the Nurses’ Health Study, which has collected health information biennially on more than 100,000 female registered nurses in the U.S. since 1976. The new paper analyzed participant data from between 2000 and 2008, taking note of any deaths that occurred and their causes. At the same time, the researchers used satellite data to assess the amount of green vegetation surrounding each participant’s home during the study period.

[How Earth itself has upped the stakes for the Paris climate accord] 

The researchers found that people living in the greenest places — that is, people who had the most vegetation within 800 feet of their homes — had a 12 percent lower rate of mortality from any non-accidental cause than people living in the least green places. Specifically, they found that the relationship was strongest for deaths related to respiratory disease, cancer and kidney disease. These results were the same regardless of the participants’ income, weight or smoking status and also did not significantly change between urban and suburban locations.

In statistical analyses, though, the researchers found that participants’ mental health, social engagement, level of physical activity and exposure to air pollution likely explained how the green spaces were making a difference.

This is all in line with the ways previous research has suggested greenness can affect health. Places with more vegetation are generally thought to be less polluted, and the presence of vegetation, itself, can help keep air cleaner. And green spaces like parks can help encourage people to get outside, exercise and engage with other people — all factors that can improve overall health. The effects on mental health may be somewhat less straightforward, but nonetheless important, as this study suggested.

“We were really surprised to find that the mental health pathway explained about 30 percent of the relationship between greenness and mortality,” said Peter James, the study’s lead author and a research associate at the Harvard T.H. Chan School of Public Health. 

There are several theories about how nature affects mental health, said Howard Frumkin, dean of the school of public health at the University of Washington, who was not involved with the new study. One of them is known as the “biophilia” hypothesis, which was proposed by renowned biologist and naturalist E.O. Wilson. This theory embodies the idea “that we evolved as a species embedded in nature over most of our existence as a species, and something about that nature contact still resonates with us,” Frumkin said. “Something about contact with nature is soothing and restorative and thereby good for mental health.”

It may also be that the social engagement that green spaces encourage can improve people’s mindsets as well. “Social connectedness is a predictor of good mental health, which is in turn a predictor of good physical health,” Frumkin said.

Still, much remains uncertain about the exact mechanisms by which exposure to nature can improve health, Frumkin noted. And scientists are still trying to figure out what type of contact with nature works best.

“Is a it a view out the window or do you need to get out and walk among the trees?” Frumkin said. “Does a bush do the trick or do you need a tree? Does it need to be in leaf during the summer, or does it work during the winter when it’s lost its leaves? There are lots of questions about the mechanisms and specifically about what form of nature contact offers benefit.”  

James and his team hope to continue exploring the finer details in future research. They’re interested in looking more closely at some of the specific causes of mortality revealed in this study, especially cancer, in order to examine not just how greenness is connected to deaths but to the overall incidence of disease.

“We also do want to explore this with other cohorts,” James added. While he and his team controlled for demographic factors in this study, it’s still worth pointing out that most of the participants were white, and since they were all registered nurses, the socioeconomic range within the group was somewhat narrow.

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James added that, while this study focused on greenness around the participants’ residences, it’s worth noting that most people spend a great deal of their time away from the home. So a good idea for future research would be to focus on a broader set of the spaces people interact with on a daily basis.

The challenge with all these ideas for future studies is that research on the health effects of greenness is difficult to get funded, Frumkin said, pointing out that even this study was “a piggyback onto an existing study that’s being funded for other reasons.” He feels that if more resources were afforded to the understanding of human interactions with nature, the health benefits could be immense.

“If we had a medication that did this — a medication that prolonged life, that addressed very different unconnected causes of disease, that did it at no cost and with no side effects — that would be the best medication of the decade,” Frumkin said. “But we don’t have a medication like that except for this ‘vitamin N’ — nature.”

You must turn back to the simple things...to the forest.

There is the start.

You must go in quest of yourself, and you will find yourself again only in the simple and forgotten things.

Why not go into the forest for a time, literally?

Sometimes a tree tells you more than can be read in a book.

  C. G. Jung Letters  8 Oct 1947                                                       

washingtonpost.com

Kids do not spend nearly enough time outside. Here’s how (and why) to change that.

by Collin O'Mara

THE WASHINGTON POST, May 29,2018 

As the weather turns warmer and the days are longer, many parents are looking forward to spending more quality time with the family. A great place to start is by taking your kids outdoors — a lot. As the parent of a 6-year old and a 10-month-old, I think a lot about how our family can provide experiences that help them reach their potential. As the head of the National Wildlife Federation, I am also focused on where children spend their time, and how it impacts their lives.

Here is a sobering statistic: The average American child spends five to eight hours a day in front of a digital screen, ofte

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Environ Health Perspect; DOI:10.1289/EHP2613

From Intuitive to Evidence Based: Developing the Science of Nature as a Public Health Resource

Nate Seltenrich

Doctors nationwide have already begun giving their patients “park prescriptions,” instructions to improve their health by spending more time outdoors. ^1,2,3 A growing body of evidence suggests that nature, whether the green leaves of a city park or the natural sounds of a back-country wilderness, may help us think better, feel better, and possibly even live longer. ^4,5,6 But as the authors of a new commentary in Environmental Health Perspectives posit, before nature can truly be tapped as a public health resource, many critical research questions remain to be answered.⁷

“The notion that nature contact is good for people is very intuitive,” says lead author Howard Frumkin, a professor of environmental and occupational health sciences at the University of Washington. Proof is another matter, however: “There are some basic elements of this science that are just developing,” he says. “There’s an ironic disconnect between how widely held this view is and how early we are in the scientific verification. It may be true that some exposures are very helpful, and others are of little help. Understanding the layers of truth to this is very important.”

What size and type of “dose,” for example, are required to achieve a health benefit? Do we need to be outside, or is peering through a window at a planted courtyard enough? How about watching nature on a screen? What is it about time with nature that helps us: cleaner air, room to roam, quiet contemplation? How, exactly, do the benefits accumulate: physiologically, psychologically, or in some combination? And do people of different cultures experience nature differently?

These are just a few of the questions raised by the commentary, an interdisciplinary effort from the University of Washington that draws upon environmental health, conservation biology, public policy, pediatrics, forestry, and psychology. The authors take a holistic perspective on a subject that is often expressed in simpler terms, such as the relationship between neighborhood green space and risk of type 2 diabetes, ⁸ or living near a park and level of physical activity,⁹ or views of landscaped spaces and relief from stress and mental fatigue.¹⁰ Although such linear, reductionist approaches in research are useful, they should be balanced by more complex systems-based thinking, the authors write.

Even more critically, as the examples above illustrate, the field also must work toward more standardized and reliable definitions of nature “exposure,” the authors note, writing, “Despite the centrality of exposure assessment in epidemiologic research, there is little agreement on how best to define nature contact for research purposes, let alone how to measure it.” ⁷

The implications of getting it right could reach even beyond human health, says study coauthor Josh Lawler, a professor of ecology at the University of Washington. A maturing evidence base could support policies that protect natural landscapes and biodiversity at the same time as human well-being. “Will the aspects of nature that give us these benefits, whether it is stress relief or more rapid healing or other psychological benefits … also provide benefits on the conservation and biodiversity side as well?” he asks.

Rooted in environmental health, the field is indeed growing more interdisciplinary—and for good reason, says Valentine Seymour, a Ph.D. candidate at University College London who authored a 2016 review of research into the relationship between nature and human health. ¹¹ “I found quite a lot of existing studies across a broad spectrum of disciplines, and there is a need to bring these together,” she says. “Examining the human–nature relationship from a single disciplinary perspective could lead to partial findings that neglect other important sources.” By contrast, adopting mixed-method approaches and what Seymour calls a “pragmatic outlook” accounting for real-world political, economic, and social forces should support the field’s continued growth.

Payam Dadvand, a senior researcher at the Barcelona Institute for Global Health who was not affiliated with the new commentary, agrees that an important goal going forward will be designing studies whose results can be readily translated into policy. “For example,” he says, “a ten-tree increase around a residential address gives X amount of benefit.”

Local governments in the Pacific Northwest are already clamoring for guidance in designing green infrastructure that can protect both water quality and human health, says coauthor Bobby Cochran, executive director of the Portland, Oregon–based nonprofit Willamette Partnership. ^12,13 “They are seeing the body of research out there that’s showing that there are benefits, and they are saying, ‘Great, tell me how best to direct my investment.’”

Nate Seltenrich covers science and the environment from Petaluma, California. His work has appeared in High Country News, Sierra, Yale Environment 360, Earth Island Journal, and other regional publications.

References

1. Seltenrich N. 2015. Just what the doctor ordered: using parks to improve children’s health. Environ Health Perspect 123(10):A254–A259, PMID: 26421416, 10.1289/ehp.123-A254.

2. Richards K. 2017. How nature heals: why East Bay doctors are prescribing the outdoors to people of color. East Bay Express, News & Opinion section, online edition. 18 May 2017. https://www.eastbayexpress.com/oakland/how-nature-heals-why-east-bay-doctors-are-prescribing-the-outdoors-to-people-of-color/Content?oid=6788567 [accessed 31 July 2017].

3. Melamed S. 2017. Philly doctors are now prescribing park visits to city kids. Philly.com, Health—Kids & Family section. 6 July 2017. http://www.philly.com/philly/health/kids-families/why-philly-doctors-are-prescribing-park-visits-to-city-kids-20170706.html [accessed 31 July 2017].

4. James P, Hart JE, Banay RF, Laden F. 2016. Exposure to greenness and mortality in a nationwide prospective cohort study of women. Environ Health Perspect 124(9):1344–1352, PMID: 27074702, 10.1289/ehp.1510363.

5. Hartig T, Mitchell R, de Vries S, Frumkin H. 2014. Nature and health. Annu Rev Public Health 35:207–228, PMID: 24387090, 10.1146/annurev-publhealth-032013-182443.

6. James P, Banay RF, Hart JE, Laden F. 2015. A review of the health benefits of greenness. Curr Epidemiol Rep 2(2):131–142, PMID: 26185745, 10.1007/s40471-015-0043-7.

7. Frumkin H, Bratman GN, Breslow SJ, Cochran B, Kahn PH Jr, Lawler JJ, et al. 2017. Nature contact and human health: a research agenda. Environ Health Perspect 125(7):075001, PMID: 28796634, 10.1289/EHP1663.

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Related EHP Article

Nature Contact and Human Health: A Research Agenda

Howard Frumkin, Gregory N. Bratman, Sara

Jo Breslow, Bobby Cochran, Peter H. Kahn Jr, Joshua J. Lawler,

Phillip S. Levin, Pooja S. Tandon, Usha Varanasi, Kathleen L. Wolf,

and Spencer A. Wood

‘Vitamin N’ is essential for children (and parents, too)

By Janet Eastman The Oregonian/OregonLive

April 30, 2016

 I hope you’re reading this review outside because the whole point of Richard Louv’s inspiring new book, “Vitamin N: The Essential Guide to a Nature-Rich Life: 500 Ways to Enrich the Health & Happiness of Your Family & Community” ($15.95, Algonquin Books), is getting us to spend more time in the natural world.  As the title implies, the book has a health emphasis. Louv cites studies that gardening, taking a walkabout or just sitting under a tree engages our brains, helps us focus and releases stress.  Kids who connect to the natural environment have less of a chance of having to battle obesity, drug use and risk-taking behavior, according to Bend pediatrician Mary Brown, who is quoted in the book.  The 304-page paperback offers 500 ways we can ease into the outdoors. Louv suggests children take parents or grandparents on an insect safari or become weather warriors who understand clouds as forecasting signs.  Other natural prescriptions are sure to delight tiny Thoreaus, from tossing seed bombs to a good old-fashioned roll down a grassy hill to making mud pies. It’s a world of look and touch (except maybe the exploration of animal scat).  Louv is the author of “Last Child in the Woods: Saving Our Children From Nature-Deficit Disorder,” and he co-founded the Children & Nature Network. He coaxes adults to transition from being helicopter parents to hummingbird parents who let little ones brave the wilderness while allowing time and space for purposeful as well as silly play.  Most of his ideas are free and freeing. As he notes, biodiversity exists in the Amazon rain forest but also in a backyard. There’s not much planning needed to execute his ideas, except creating a family G.O. (Go Outside) duffle bag with maps, water bottles, and maybe a snack.  As for cost, he’s a big advocate of visiting free public parks, playing with found objects and competing in a friendly game of Poohsticks in a stream of water.  Growing food doesn’t need to be pricey either. Little farms can sprout up in a reusable container or even a pair of old socks.  Most of Louv’s throw-caution-to-the-wind suggestions contribute to relaxing, creative, unplanned adventures.  But if you want to prepare for a wildlife experience, each paragraph-long idea comes with a guide, resource or website to learn more on the topic, such as family nature clubs, nature-focused camps and geocaching. He endorses using natural sign posts such as stars, shorelines and mountains along with compasses and maps to navigate. But he’s not a Luddite. If you must drag along a cellphone, let it record nature’s images and sounds to enjoy off the trail. This easy-to-flip-through book will no doubt inspire numerous adventures and outings led by little ones. 

We know that connecting with nature is good for us, but there are still many questions that need to be answered through more credible scientific research: What is the ideal “dose” of nature? What health conditions do these doses actually help with? Does duration and frequency of dose matter? How long do the benefits last? Does who you are and where you live impact how beneficial exposure to nature will be? And how does technology help or interfere with our connection to nature?

To get a better handle on the remaining unknowns, leading public health expert Dr. Howard Frumkin assembled a multi-disciplinary team at the University of Washington comprised of experts in epidemiology, environmental health, clinical medicine, psychology, ecology, landscape architecture, urban studies, and other disciplines, along with experts from the Nature Conservancy, Seattle Children’s Research Institute, U.S. Forest Service, Willamette Partnership, Stanford University’s Center for Conservation Biology, and the Natural Capital Project. Together, they crafted a creative, ambitious research agenda, which was just published in Environmental Health Perspectives.

According to Frumkin and the other co-authors, “nature contact offers considerable promise in addressing a range of health challenges, including many — such as obesity, cardiovascular disease, depression, and anxiety — that are public health priorities. Nature contact offers promise both as prevention and as treatment” at all stages of life.

Furthermore, exposure to nature is likely cheaper than “conventional medical interventions,” safe, practical, and doesn’t require a highly-trained professional to dispense treatments. Green spaces designed to provide health benefits of nature also offer many co-benefits: they provide wildlife habitat, store stormwater, or offer shade, for example.

While the benefits of nature are increasingly understood, the team found seven domains where further research is needed. Below are high-level summaries; for greater detail, read the research agenda.

Mechanistic Biomedical Studies: We need to better understand how nature exactly works its magic on us. While some scientists believe the mechanisms, or pathways of impact, on our minds and bodies have an evolutionary origin, meaning they are deep-rooted and associated with our innate biophilia, others posit there may be more precise pathways that are psychological, relate to our immune system, or are linked with increased social contact or improved air quality. We don’t know exactly the way nature exposure works its benefits on us.

Just in terms of psychological pathways, there are a diversity of theories: some argue that nature helps by relieving stress, while others focus on the way nature can relieve mental fatigue. Those are different things. And there could be multiple mechanisms happening at once, too. Frumkin and team argue that with more research “specific neural pathways” for these benefits will likely be discovered.

There is also some research suggesting exposure to nature boosts immune function; physical activity outdoors in a green space is better than in a gym; being in nature promotes the creation of social connections, which in turn provide health benefits; and trees and other green spaces, particularly in cities, reduce air pollution, creating health benefits.

But the research agenda notes that much more evidence-based research is needed to isolate the exact mechanisms through which nature exposure works its theorized benefits.

Exposure Science: Epidemiologists try to measure the “magnitude, frequency, and duration of exposure to an agent, along with the number and characteristics of the population exposed.” When “researching the environmental impacts on people,” research focuses on “pathogens, medications, toxic chemicals, and social circumstances, or salutary exposures such as nature.”

However, they argue that “standard approaches to exposure measurement” have limitations. “First they fail to capture variations in how people in how people experience nature, nuances that may be highly relevant. Suppose that one person sits in a car atop a seaside bluff and admires the view of the beach (while checking email on a smartphone), a second person walks barefoot along the shore, enjoying not only the view, but the feel of the sea breeze and the lapping waves, and a third person plunges in a for a swim. The designation ‘beach contact’ or a measure of ‘time on a beach’ would fall short of capturing the variation in their experience.”

As such, measuring the effects of various doses of nature becomes more complicated — someone paying close attention to all the details while on a forest path and really immersing themselves in the experience and another person simply walking through while looking at their smartphone will “likely ‘absorb’ differing levels of nature.”

Epidemiology of Health Benefits: Epidemiologists, who research the health and disease profiles of populations, conduct “true experiments, ‘natural experiments,’ and observational studies.” The bulk of research on nature contact and health have been observational studies, which Frumkin and his team argue are practical, can be conducted rapidly, and reduce costs of research, given they typically use data collected for other purposes. However, there are also built-in limits to the pre-existing data, and it’s hard to control bias in these studies.

True experiments, which are clinical trials, are the “gold standard” in science. Natural experiments, which “are study opportunities that arise through circumstances outside the investigator’s control” — like Roger Ulrich’s famous study of hospital patients, their views of trees, and recovery times — enable researchers to test hypotheses in realistic settings. More of these studies are needed.

The group also recommends nature and health researchers do a better job of tapping into existing large-scale research studies and data sets; finding new sources of big data, such as using Google Street View, webcams, and location-based data-collection apps like Mappiness; and investing in more advanced statistical analysis and advancing epidemiological research in general.

Diversity and Equity — The Role of Nature Contact: More research is needed to better understand “a) patterns of disproportionate exposure; b) cultural and contextual factors that affect nature preferences; c) differing patterns of benefit across different populations; and d) the possibility that improved access to nature may have unintended negative consequences on vulnerable populations.”

As has been explored by other researchers, low-income communities are more likely than not to also have limited access to nature and green space, which only exacerbates the negative health impacts of poverty, bad diets, lack of exercise, and crime.

African Americans, Frumkin and his team write, may also have different associations with trees, fields, and forests than other groups, due to the legacy of “forced labor, lynchings, and other violence.” 

And livelihoods play a role in creating different understandings of what’s restorative: “a rural farmer has quite different preferences regarding nature from those of an urban computer programmer.”

On the positive side: there is some research that argues that access to nature and green space may disproportionately help those in low-income communities who suffer from unequal access to many services, but, again, more study is needed.

Technological Nature: Modern technologies — the Web, smartphones, games, virtual reality (VR), the list goes on — are altering our relationship with nature. Kids, who spend more and more time glued to their screens, are particularly impacted. But there are also other kinds of technologies  — those that “mediate, simulate, promote, and/or augment the human experience of nature,” which must also be better understood. Computer desktop wallpaper of nature scenes, VR movies in which users go on safari in Africa, and location-based games like Pokemon Go may offer some of the benefits of nature exposure — and may be better than nothing — but more laboratory-based experiments are needed.

Economic and Policy Studies, including Co-benefits: The benefits of nature are increasingly being quantified. As such, policies are being promoted to increase the value of these benefits for communities and ecosystems. Frumkin and the co-authors propose looking to ecological and health economics for new models of evaluation and quantification of the benefits of nature as well as the avoided health care costs.

When the value of a new park is estimated, it’s important that policymakers don’t just look at improvements in real estate value or gains in stormwater credits, but also the real, quantifiable community health benefits. Furthermore, cost-benefit analyses rooted in benefits valuations can help guide limited public funds towards the most effective forms of green space investment.

We couldn’t agree more. It’s critical to answer: What policies and regulations can positively boost the health benefits of nature and which don’t do much at all? Many cities aim to provide a park within a five minute walking distance of every resident. Is this a worthy policy? Toronto just created a shade policy to help reduce the negative health impacts of heat in the summer. What metrics should be used to measure the success of such policies?

Implementation Science — Studies of What Works: “Research findings don’t necessarily translate into action.” This group wants to see more what “intervention studies are needed to determine what works in practice.”

As an example, they point to the U.S. Forest Service’s iTree software, which helps anyone with a computer understand the ecosystem service benefits of the trees they are planting. The researchers ask: “might further development of such tools incorporate additional mental and physical health benefits?”

While this research agenda is impressive and comprehensive, there are a few other unknowns important to include:

First, doctors are now prescribing time in the park. Do these treatments, which often combine increased activity, social interaction, and nature exposure work? Is the combination of exposure, social engagement, and exercise what is key?

Second, what is the impact of climate change on the nature and health connection? As nature becomes a more changeable, and often destructive force, in many places, do we need to differentiate between safe and unsafe nature spaces? Can an ocean that floods a community every year be considered restorative when it isn’t causing damage?

Lastly, there are landscape architecture educators and researchers, like William Sullivan, ASLA, and MaryCarol Hunter, ASLA, who seek to determine which forms and arrangements of landscape elements have the most benefits. Their forward-looking studies are critical: The next step is to translate proven health benefits from nature exposure into design principles planners, landscape architects and designers, and engineers can apply in their work. What designed landscape forms and elements act as pathways to the biggest benefits?