To help the UK reduce future pressures on the NHS and recover from the Covid-19 pandemic, the government has announced a two-year green prescribing pilot which will be established at four rural and urban locations. The £4 million green prescribing strategy is led by the Department for Environment, Food and Rural Affairs (Defra) and will focus on areas hit the hardest by Covid-19. The government also announced plans to scale up the project to other locations.
Here is what green prescribing is and why it matters.
What is green prescribing?
Historically, green prescribing has referred to the use of physical activity as part of a patient’s health management plan (Green Prescriptions, 2016). More recently, green prescribing has referred to the use of nature-based activities for improving the physical and mental health of individuals (Robinson & Breed, 2019). This practice is part of social prescribing which allows healthcare providers to refer patients to local, non-clinical services (What Is Social Prescribing?, 2017) . Common activities used in green prescribing include walking and cycling in nature, conservation activities, horticulture and meditation (Robinson & Breed, 2019).
Why should nature be prescribed?
Greater access to green space is connected to better health and wellbeing. Doing activities in green spaces or simply spending time in nature is beneficial in different ways. For example, going for a walk at their local park can help patients manage their weight and prevent chronic non-communicable diseases such as diabetes and hypertension (Improving Access to Greenspace. A New Review for 2020, 2020). Green spaces also promote a sense of being connected to nature as well as encouraging social connections with others. These connections are good for our mental health and wellbeing, helping us experience lower levels of stress, fatigue and anxiety, among other benefits (Improving Access to Greenspace. A New Review for 2020, 2020).
Interacting with green spaces is particularly beneficial for vulnerable populations. Those with greater access to green space experience lower levels of health inequalities linked to income deprivation (Mitchell & Popham, 2008). Research also shows that equitable access to green spaces in England alone could save the NHS £2.1 billion every year (An Estimate of the Economic and Health Value and Cost Effectiveness of the Expanded WHI Scheme 2009, 2009).
Our recent experience with Covid-19 has demonstrated the need for greater access to green space - as these areas have been havens for communities during these hard times - as well as ensuring a more sustainable health system through a decrease in demand for services. Green prescribing can tackle both these issues.
An example from New Zealand
New Zealand has been using green prescriptions for encouraging patients to be active outdoors for decades. The scheme is implemented at the primary care level where a physician or nurse generally assesses the needs of patients and provide tangible recommendations in a prescription. A referral is also shared between the practice and regional sports trusts. Follow up work is carried out by these local trusts to facilitate and encourage patient access to activities (Hamlin et al., 2016). Research in the country shows that green prescribing is among the most cost-effective strategies for promoting healthy behaviours and physical activity (Garrett et al., 2011). Findings also show that patients taking part in green prescribing in New Zealand are more likely to meet current physical activity guidelines when compared to those not engaged in green prescribing (Hamlin et al., 2016).
Expanding support networks in the UK
The UK has taken a number of steps toward establishing better primary care services, including expanding the provision of social and green prescribing.
The NHS’ long term plan establishes its priorities for the next 10 years. Among these priorities is the development of Integrated Care Systems (ICSs) in the UK. ICSs bring together the NHS itself and local organisations to improve the level of care and overall health of communities. A major aspect of improving community health is founded on the expansion of non-clinical services to the population, given the many physical and mental health benefits that these services can offer. By 2021 it is expected that the NHS will gain 1,000 new social prescribers within the country’s primary care networks, whose jobs entail facilitating patient access to green and social prescribing services. Under the current long-term plan, the aim is that 900,000 people will be able to access personalised care by 2023-24 with the help of social prescribers.
Other efforts such as walking and cycling pilots being rolled out by the Department of Transport also aim to strengthen the preventive care offers of the NHS. These pilots will help GPs prescribe cycling activities when recommended. It also facilitates access to activities by connecting patients to training services, cycling groups as well as available bicycles and ensuring patients have access to safe cycling routes in good quality green spaces.
More information is needed to understand in detail how the new green prescribing pilot being launched by Defra works in conjunction with other initiatives and the NHS’ long-term plan.
A Dose of Nature: Addressing chronic health conditions by using the environment. (2014). University of Exerter, NERC.
An estimate of the economic and health value and cost effectiveness of the expanded WHI scheme 2009. (2009). Natural England.
Garrett, S., Elley, C. R., Rose, S. B., O’Dea, D., Lawton, B. A., & Dowell, A. C. (2011). Are physical activity interventions in primary care and the community cost-effective? A systematic review of the evidence. British Journal of General Practice, 61(584), e125–e133. https://doi.org/10.3399/bjgp11X561249
Green Prescriptions. (2016). Ministry of Health NZ. https://www.health.govt.nz/our-work/preventative-health-wellness/physica...
Hamlin, M. J., Yule, E., Elliot, C. A., Stoner, L., & Kathiravel, Y. (2016). Long-term effectiveness of the New Zealand Green Prescription primary health care exercise initiative. Public Health, 140, 102–108. https://doi.org/10.1016/j.puhe.2016.07.014
Improving access to greenspace. A new review for 2020. (2020). Public Health England.
Mitchell, R., & Popham, F. (2008). Effect of exposure to natural environment on health inequalities: An observational population study. The Lancet, 372(9650), 1655–1660. https://doi.org/10.1016/S0140-6736(08)61689-X
Robinson, J. M., & Breed, M. F. (2019). Green Prescriptions and Their Co-Benefits: Integrative Strategies for Public and Environmental Health. Challenges, 10(1), 9. https://doi.org/10.3390/challe10010009
What is social prescribing? (2017, February 2). The King’s Fund. https://www.kingsfund.org.uk/publications/social-prescribing