Nature is good for us: Why I prescribe outside

Posted on Oct 1, 2021 in Wellness Committee | 0 comments

Nature is good for us:

Why I prescribe outside

A silver lining of the pandemic is that many of us have been forced to spend more time outside; we haven’t been able to do anything else!  I have been able to ditch my car and more safely pedal the 3.5 miles on pedestrian friendly streets to work.  One morning last spring, I was reflecting on how good the ride outside made me feel when I walked in to see Mr. T., a 68-year-old with several significant behavioral and medical problems.

Before I could say a thing, he jumped in as if in mid-conversation. “Dr Hass, I can’t thank you enough.  I swear that prescription you gave me mid- Covid lockdown saved my life!”  Nodding, I tried to hide the fact I didn’t recognize him and assumed he was talking about an antibiotic or some other medicine. 

“I was so depressed and isolated”, he said.  “You gave me a prescription to ride my bike to the marina and watch the sunset.  I have been watching that sunset almost every day until I got sick last week.  And the prescription is still on the fridge!  I can’t thank you enough!”

I have been giving out “old school” paper prescriptions for about 2 years now where I prescribe non-pharmaceutical  things that have been proven to make people healthier.  Apparently, I had given him one to get outside and take in the natural beauty of the sunset.

“Thank you, Mr. T.  that means a lot to me.”  I said, “Your feedback really helps!”

I had heard that nature can make people happier and healthier, but embarrassingly, revealing my bias, I envisioned it primarily for more “outdoorsy” people like me, whatever that means.  Also, I assumed it would just a slight bump in the happiness quotient.  Mr. T had shown me that I had underestimated both the impact of getting outside and who could be helped.

I became determined to dig a little deeper to understand the health benefits so I could do more with these prescriptions.

While much of the research has been done in the USA, Japan is where the science has been most readily embraced.  Starting with research on blood pressure and stress hormone levels in the early 2000’s, there is now a medical specialty in Forest Bathing and more than 25% of Japanese partake in the activity.  There are nearly 100 officially sanctioned forest where the benefits have been demonstrated and with guides to help visitors the get the most from their time in the forest. A measure of the Japanese commitment to health through nature is that the director of the ministry of forestry is a social scientist not a botanist.  Trees are seen more as a health resource than an extractable resource

What are the benefits?  Lower blood pressure, heart rate and stress, improved mood and immune function, better sleep and increased creativity.  There are surprising social benefits, too.   During early forest bathing experiments, Dr Qing Li found that after a couple hours in the woods, blood pressure went down an average of 5 points. The effects didn’t end once people left the trees; stress hormones were measurably lower for a week. After 3 days with 2 hours of forest bathing, markers of immune health showed improvement that last 7 days (researchers at the GGSC confirmed this finding in Yosemite!). And of course, almost all the people would say they just felt better, too!

What is forest bathing? It is essentially taking it all in – with all our senses.  In fact, looked at individually, all our senses have a role in nature’s restorative power.

Dr Qing Li’s group found that when people slept overnight breathing in essential oil from the sacred Japanese cedar tree, they reported better sleep and had lower stress hormone levels.  Since then, researchers at Vanderbilt have demonstrated nurses report less stress if this same oil is infused in their hospital workplace.

Sound researcher Joshua Smyth at Penn State has documented decreased the tension in our nervous system as measured by heart rate variability when people listen to songbirds.  It increases with rumble of cars and roar of airplanes.   Researchers with the Nation Park Service found their parks “look” worse when people hear man-made sounds and thus, view noise pollution as an important issue for the parks.  Man-made noise can be more than an irritant. Research in Bonn Germany found that kids at schools subject to a lot of airplane noise have a tougher time learning than those in control schools across town.

We are primarily visual creatures, so it is not surprising that simply looking at beautiful natural scenes makes us feel good.  A heart surgeon at Vanderbilt suspected it did more than that.  Looking at it closely, he found that his patients whose hospital room faced the forest healed faster than those who faced the parking garage. I never knew why hospitals are full of nature scene until I researched for this project.  Strange that this bit of data reached the architects, but not the doctors!

So why is the natural world good for us? The Biophilia Theory suggested that since we evolved in nature, our senses and body rhythms are best suited for that environment. According to biologist E. O. Wilson, there is an “innate emotional affiliation with other living organisms” that makes us calm and comfortable in nature.  The sounds, smells, sights are our evolutionary “happy place” where we can rest and rejuvenate.  We are deeply tied to a world from where have strayed, despite the comforts and safety of the modern world, there is a price to pay for urban living.

Other scientists espouse the Attention Restoration Theory, Rachel Kaplan at Michigan says the “soft fascination” with the beauty of the natural world along with its subtle mysteriousness draws us in.  It is “enticing but not demanding”.  fMRI data by her student Stephen Kaplan showed that looking at nature pictures let the hard-working executive function parts of the brain recover compared to looking at urban landscapes.

Emotion scientists like the GGCS’s own Dacher Keltner believe there is something else going on as well: awe.  It’s that feeling we get from seeing something vast, wonderous that challenges our comprehension; with it our jaw drops, and we get goose bumps as we say, “Awe-some.”  But more than that happens, we have the same physiological effects that are seen as we forest bathing where heart rate and blood pressure drop.  The “awe walks” the Dr Keltner recommends where one slows down and looks for the beauty as opposed to racing along are essentially a way to forest bathe.  Beyond the physiological there are pro-social effects of awe: less concern for self, increased generosity and more cooperation.  This might be why research suggests there is less violence when trees are incorporated into low income housing developments.

So, what do I prescribe now?  Researchers from Finland suggest that 5 hours a month is the minimum to have lasting effects (leave the technology behind or at least in your pocket).  It doesn’t have to be the forest; water, even urban parks, can be healing, too.   For those with the resources, I prescribe breaks to a quiet cabin or tent of at least 3 days once or twice a year.  I also recommend house plants for home and office, microbreaks of stopping work to look out the window or a nature video for one minute and a couple short 5-minute walks even if it is in an urban environment.

But how in our busy lives? Well, the pandemic has helped with that.  Many of us have taken our physical activities and social activities outside.  Skip the gym and coffee house.   A walk with a friend outside is a Greater Good “three-fer”: exercise, friendship and nature all at once.

We should also be thinking beyond of selves.  Access to the natural world is far from equitably distributed.  While access to green space is foundational in public health and urban planning, my country, the USA, is far behind, Japan, Korea, Singapore, and many European countries in efforts to integrate this idea into our society.  Yet through efforts of hard-working citizens, vets can get outdoor therapy for PTSD.  The SHINE program in the Bay Area is one of several park-healthcare collaboratives that get kids out of their tough city lives to nature once a week.  We should all be inspired by these efforts and find ways to advocate for green access as best we can.

We see the effects of this lack of access every day.  Last week, I was taking care of Ms. S, a 58-year-old woman with mental health and mobility issues complicated by poor social support.  She came to the hospital with abdominal pain.  Sitting down and talking to her I could see her mood and isolation were her biggest issues.  Notes in her medical record recommend psychiatric care and medications, but now I start with a different approach.  “What brings you joy, Ms. S?”, I asked.

“Well, I loved my flower boxes I had outside my apartment” she said.   “I planted herbs and flowers.  Tending the plants made me feel good, but the manager said it was a fire hazard and I have hardly been outside since they hauled them away.” Her comments are in line with data on the benefits of touch – hands or feet in the dirt – and wellbeing. There is also a large body of research on the positive social and health benefits of gardening.

Before she went home, our team gave her resources about community gardens and I gave a prescription to bus to Redwood Park and the lake.  While that felt insufficient, at least she felt buoyed that our health care team felt her garden was as important to her health as she did.

This is a lesson we all should learn from Ms. S: don’t underestimate the benefits of engaging with nature.  Researchers repeatedly found we tend to discount the wellbeing boost we get from nature. Coming out of this long public health crisis we all should cherish all the good we can.   I have tried to make this cognitive shift:  every episode outside is an opportunity to access the healing power of nature.  I try to see each tree as an incredible living being and forests, the shoreline and even my neighborhood park as sacred sites for communing with the wonderous natural world and restoring my body and mind.  And when I watch the sun set, I think of what it did for Mr. T.

Leif R. Hass, MD
Summit, Wellness Chair