To reduce your stress your doctor might prescribe a walk in the woods. Careful, though. This type of medicine is definitely addictive.
A medicine cabinet includes a bottle that contains nature. Illustration by News Decoder. Photo on the medicine bottle of Comox Lake, British Columbia by Liana Hwang.
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Shortly after Melissa Lem, a Canadian family doctor, moved from northern British Columbia to Toronto, she found herself feeling edgier. She didn’t know why.
One day, as she stood at her apartment window with its view of concrete and glass skyscrapers, she realized she missed nature.
Although she’d always known intuitively that she felt better when she spent time outside, the experience prompted her to delve into the actual research. She was surprised to find hundreds of studies supporting nature’s positive effects on health conditions ranging from cancer to lung disease to ADHD.
“It was this a-ha moment,” she said. “I thought: ‘Wow! I’d never learned about this in medical school. I don’t hear any of my colleagues talking about this.’”
In 2020, she collaborated with the B.C. Parks Foundation to launch PaRx, Canada’s first nature prescription program.
Medicine not in pill form
I’m a family physician and delegate for the Alberta Medical Association, and I first found out about PaRx and the health benefits of nature in 2021 when a colleague asked me to help seek AMA endorsement of PaRx. In March 2022, after months of work from a team of local health professionals, Alberta became the fifth Canadian province to roll out the program.
By June 2022, it had expanded to every province. More than 12,000 health professionals have registered for the program which recommends prescribing time in nature, generally for at least two hours a week in 20-minute plus blocks, as part of lifestyle management and preventative care. To minimize barriers for patients, registered providers can prescribe free or discounted admission to gardens and national parks. I, too, am now registered with the program as a prescriber but am otherwise not associated with PaRx.
Lem said that the minimum recommended time is based on a study which found that the most efficient drop in cortisol, a stress hormone, occurs after 20 to 30 minutes. A second study found that spending at least two hours each week in nature was associated with better health and well-being.
Lem emphasized that people don’t need to scale mountains to benefit. “Something that really stood out to me was the fact that you didn’t need to move to experience the health benefits of nature,” she said. “There are measurable improvements in cortisol and heart rate variability just from sitting in a forest or park.”
Nor is it necessary to head into the remote wilderness. “Especially if we live in urban environments, we have to seek out and maybe redefine for ourselves what nature is,” she said. “We can find it in a community garden or a neighborhood park. It’s really self-defined. The benefits start to accrue when you personally feel like you’ve had a meaningful experience in nature.”
Won Sop Shin, former Minister of the Korea Forest Service, enjoys spending time among the trees. Photo provided by Won Sop Shin.
A worldwide movement for nature therapy
The PaRx program is the world’s second nature prescription program, following a similar initiative in the United States that was launched in 2013. With it, Canada joins a growing number of countries which have each embraced nature therapy in their own way.
In South Korea, forest therapy is part of national policy. Won Sop Shin, a professor and researcher in forest therapy and the former Korea Forest Service minister said that in the 1960s, much of the country was barren of trees. After 50 years of replanting and restoration, the government wanted to use forests to support the health and happiness of its citizens.
“The forest policies were changing from timber to the welfare of the people,” Shin said. During his term as minister from 2013 to 2017, he contributed to the Forest Welfare Promotion Act — legislation which established forest therapy centers as well as training for forest therapy professionals.
There are now more than 35 forest therapy centers and more than 1,500 licensed guides in South Korea. People access services at a therapy center by registering and paying a fee; for socially vulnerable patients, the government provides vouchers. Many centers are located in rural areas, but there are also urban centers as well.
One of the unique aspects of South Korea’s forest policy is that it provides forest programs throughout the life cycle. Children can attend forest education programs, and at the end of life, forest burials are available.
“Korea is a super aging society so we’re focusing more on senior citizens for forest therapy,” he said.
There are also programs for office workers and first responders. He encourages students at his university to use the campus forest to manage stress. Self-guided programs are available with instructions on stretching, breathing exercises and meditation.
The birth of forest bathing
Much of the research supporting the health benefits of nature comes from Japan, which introduced a national health program for shinrin-yoku, or forest bathing, more than 40 years ago.
“Some people study forests. Some people study medicine,” said Qing Li, a Tokyo-based physician and researcher, in an email exchange. “I study forest medicine to find out all the ways in which walking in the forest can improve our well-being.”
He is so convinced of the health benefits of nature that he takes medical students to practice shinrin-yoku every week.
Li discovered that part of the health effect of trees comes from phytoncides, the natural oils that protect trees from pests and give forests their particular smell. In one study, he found that when people slept in hotel rooms where Japanese cypress oil was diffused, they had lower levels of stress hormones and higher numbers and enhanced activity of natural killer cells, immune system cells that fight cancer and infection. Li said that interest in forest bathing is gaining momentum.
There are now 65 forest therapy bases in Japan, mostly publicly funded, and shinrin-yoku has been accepted as standard practice. Up to five million people visit the forest therapy centres each year, often meeting with a doctor for a check-up in the morning and then partaking in shinrin-yoku.
Nature therapy becomes a best seller.
In 2018, Li’s book, “Forest Bathing,” made it to the U.S. bestseller list and has since been translated into 26 languages. A growing number of people visit Japan each year to become certified in forest medicine and forest therapy, with the International Society of Nature and Forest Medicine holding its third annual training workshop beginning on 13 October 2023.
“’From a Feeling to a Science’ is a keyword to understand why shinrin-yoku is so popular in the world,” he said.
Lizzy Rhodes, a reflexologist in Dorset, England, said that she stumbled across the term on Facebook, and as she learned more about it, she decided to train to become a forest bathing guide through Nature and Therapy UK.
Lizzy Rhodes, who lives in the UK, is training to become a forest bathing guide. Photo courtesy of Lizzy Rhodes.
“I wouldn’t say that nature prescribing has taken off in the UK but certainly, social prescribing and alternatives to medication are beginning to be looked at,” Rhodes said. Doctors in the UK can prescribe community-based activities like gardening and woodworking, and Rhodes hopes to offer shinrin-yoku as an option.
Having already attended a three-day basic course where she experienced shinrin-yoku, Rhodes is working on the practical portion of her training — leading forest walks while receiving ongoing mentorship.
Getting lost in the sound of a stream
During each two and a half hour walk, she invites people to try activities such as standing barefoot on the ground, looking at leaves with a magnifying glass or using the five senses to experience the forest. Unlike many activities in nature which have a purpose or destination such as cycling or bird-watching, Rhodes says that forest bathing is about slowing down.
“The thing about shinrin-yoku is that it’s a really easy and healthy way to distract people positively from their worries,” she said. “Meditation and yoga are quite brilliant, but it’s hard work, whereas it’s easy to get lost in the wonder of a moss or the pattern of the leaves against the sky or the sound of a stream.”
She said it is about coming home to your body and using nature as a bit of a reflection. “The forest will reflect what you need it to, and sometimes that can be sorrow and it can be grief,” she said. “I think it offers non-verbal healing, which isn’t always necessarily comfortable but it’s healthy.”
At a time when climate change has been named the biggest threat to global public health, Rhodes says a key element of shinrin-yoku is reciprocity. At the end of each walk, she invites participants to express thanks to the forest in some way such as picking up litter.
“A lot of the feedback is that people never walk in the woods in the same way again because they’ve seen it through a different set of eyes,” she said. She thinks that directly experiencing nature inspires people to value and protect it.
Healthy body, healthy planet
Lem agrees that connecting people with nature is an effective way to promote planetary health. “There’s a shift in pro-environmental behaviours and values that happens when you spend time in nature,” she says.
She used to wonder if her energy would be better spent protesting fossil fuel expansion, but she realized there are many ways to contribute to planetary health.
She points to a framework developed by climate policy expert Ayana Elizabeth Johnson that helps people determine a climate action that would work best for them. “It’s in the middle of this Venn diagram where you think about what your skills and resources are, what brings you joy and then also what the Earth needs,” Lem said. “It just happened to work out that my passion intersected with where there was a gap.”
The World Health Organization recently recognized PaRx as a way to inspire protection and restoration of nature as the foundation of health, Lem said.
“I think we’ve managed to shift the conversation somewhat about how important nature is for our health,” she said. “Nature is where we were meant to be.”
Questions to consider:
- What are the reasons why Canada’s nature prescription program recommends 20-minute plus blocks for a total of 120 minutes each week?
- What are phytoncides, and what are some of their effects on human health?
- Using Ayana Elizabeth Johnson’s framework, what might be your ideal climate action?
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