From Green Space to Green Prescriptions: Challenges and Opportunities for Research and Practice

Research on the healthy and restorative effects of green space has been rapidly expanding over the past decades, and the field is fast moving toward maturity (van den Berg and van den Berg, 2014; Capaldi et al., 2015). Findings converge in showing that regular contact with green space can enhance well-being and alleviate stress, and may even mitigate income-related health inequalities regarding chronic diseases and life expectancy (Mitchell and Popham, 2008). In response to these insights, there has been a surge of initiatives to (re)connect people with nature, especially those without the ability or opportunity to engage with green space as part of their usual lifestyle. Many of these initiatives have focused on “bringing nature to people” by greening of places in people’s nearby environment, such as schoolyards, urban public spaces, hospitals, classrooms, and offices (Wolch et al., 2014; van den Berg et al., 2016). Other initiatives have aimed at “bringing people to nature” by encouraging and facilitating adults and children to actively participate in nature-based activities (Bragg and Atkins, 2016). These activities range from health promotion programs and projects for the general population, like green gyms or community gardening, to more therapeutic interventions for individuals with a defined need, like care farms, walk-and-talk coaching, or horticultural therapy. Nature-based activities are increasingly gaining momentum as a cost-effective, easy-to-do, lowrisk, and enjoyable preventive and therapeutic intervention that is particularly beneficial for people who do not have the ability or opportunity to engage with nature as part of their usual lifestyle (Allen and Balfour, 2014). For example, a calculation of the social return on investment of a health walks program in Glasgow revealed a cost-benefit ratio of £8 for every £1 invested (Carrick, 2013). It therefore seems important that this type of intervention becomes more routinely integrated into everyday health care practice. In particular, general practitioners and other primary health professionals have been targeted as key actors who can support such integration by writing more “green prescriptions” (Hine et al., 2008; Patel et al., 2011; Nisbet and Lem, 2015). However, although objective data are scarce, the overall impression in most countries is that referral rates tend to be very low (Maas and Verheij, 2007; Allen and Balfour, 2014). Therefore, a key question is: what is needed to make health professionals write more green prescriptions?