Nature & Health is back on the agenda

Sarah Blaschke, PhD Candidate, University of Melbourne, Peter MacCallum Cancer Centre

Living Well Magazine Autumn 2015

Scientific literature now explores the impact of peoples’ contact with nature on health and wellbeing. In particular, the sectors of Population Health and Healthcare Design are investigating how to recruit nature as a healthcare resource.

A Timeless Topic
Nature’s impact on health and wellbeing is no doubt a timeless topic. It has been embedded into numerous healthcare philosophies from ancient times to recent history. In Egypt and Greece, as early as the fourth century B.C., nature was closely associated with medicine. The ancient healing centres, Asclepieia, paid great attention to the building’s relationship with the natural landscape and considered it important to the healing process.  Later, the enclosed courtyard gardens adjoining monasteries, hospitals and sanatoriums around the world were recognised as  restorative places. However, in the twentieth century, nature became an element to be conquered by man rather than valued and functionally maintained as a health-promoting asset. This brief epoch of modernisation saw nature’s rapid decline in Western living and healthcare environments.

Scientific Interest in Nature
Nature’s long-standing record of debate includes anecdotal stories, folklore and historic interpretations about its vital role for human health. Recent academic trends are digging deeper into this knowledge base. Scientific literature now explores the impact of peoples’ contact with nature on health and wellbeing. In particular, the sectors of Population Health and Healthcare Design are investigating how to recruit nature as a healthcare resource. This scientific uptake is unprecedented and exciting because it allows common knowledge to speak clearly and convincingly to our gatekeepers of change; healthcare providers, policy makers, developers and designers.

As a scientific study, Nature & Health is still “embryonic” and more work is needed to address exactly ‘how’ nature works and ‘what’ nature does for us. Nevertheless, many research disciplines are involved including public health, medical, psychological and sociological sciences as well as planning, design and environmental disciplines. There is recognition of a commonly understood phenomenon: that at the core of peoples’ interactions with nature lay valuable health benefits. Two noteworthy researchers in this domain are Prof. Emerita Clare Cooper Marcus who has written extensively on therapeutic garden design and Dr. Roger Ulrich who pioneered the field with his seminal research paper about the benefits of views to the outdoors from the hospital bed (1984).

Nature-Health Mechanisms
To date, the most commonly studied health outcomes related to nature are “mental restoration” and “stress reduction”. Two popular theories have developed to explain possible mechanisms underlying these nature-health benefits.

Attention Restoration Theory (ART) was developed by the researcher couple Rachel and Stephen Kaplan and springs from environmental psychology. ART is about how we perceive our environment and how we process information. According to the Kaplans, people have two types of attention. The first, focused attention, is required to deal with demanding situations such as crossing a busy street. Without rest, this restraining system can become exhausted and cause greater risk of becoming stressed. On the other hand, spontaneous or ‘soft’ attention is unlimited and is about scanning the environment rather than rapidly assessing impressions. Nature is thought to provide such soft stimuli.

Roger Ulrich’s Aesthetic Affective Theory stems from psycho-evolutionary theory and borrows from the Biophilia Hypothesis.

It states that humans have an inherited affection for living things and still possess the ability to assess an environment from a survival perspective within a fraction of a second. If the environment is judged as safe, one is able to relax. This means that our positive feelings may increase when we are in natural environments.

Alongside these theories, in the 1980s, studies began to emerge providing preliminary evidence about the general health claims and healthy by-products of contact with nature. These studies looked at the benefits of diverse uses of nature such as spending time in urban green spaces, outdoor school rooms, provision  of workplace indoor plants and even some more traditional practices such as Japanese forest bathing (Shinrin-yoku).

Nature in Healthcare
Australian researchers from Deakin University describe this trend in a publication titled ‘Healthy Nature Healthy People’: “In the context of the growing worldwide burden of disease, contact with nature may offer an affordable, accessible and equitable choice on tackling the imminent epidemic, with both preventive and restorative [public] health strategies”.

One starting point for investigating nature as a health-promoting strategy is the World Health Organisation’s broad definition of health from 1948, where health is not only related to the absence of disease but a state of complete physical, mental and social well-being. Today, health is often considered from a holistic perspective that includes all these areas of life and even extends to cultural and spiritual aspects. This has granted a closer look at what nature can contribute to healthcare settings and delivery, and has inspired a number of research projects.

These findings show positive association between nature exposure and health outcomes such as lowering physical discomfort during surgical procedures, reduced length of hospital stay, requiring less pain medication, improved psychological wellbeing, stress reduction and reduction in healthcare usage.

One more specialised niche in healthcare research now looks at how nature’s restorative qualities can be brought into cancer care environments. Supporting those affected by cancer has indeed become a healthcare priority and  requires low cost but high quality solutions, which need to maintain or even improve peoples’ quality of life for as long as possible. Some early stage research indicates potential for such nature-based interventions to enrich existing supportive care.

While research is underway, there is nothing to stop anyone getting outside and exploring the benefits for themselves. The abundant opportunities begin by simply opening the window!

Readings:

Kaplan, Stephen. “The restorative benefits of nature: Toward an integrative framework.” Journal of nvironmental psychology 15.3 (1995): 169-182.

Kellert, Stephen R. The Biophilia Hypothesis. Island Press, 1995.

Maller, Cecily, et al. “Healthy nature healthy people:‘contact with nature’as an upstream health promotion intervention for populations.” Health promotion international 21.1 (2006): 45-54.

Marcus, Clare Cooper, and Naomi A. Sachs. Therapeutic landscapes: an evidence-based approach to designing healing gardens and restorative outdoor spaces. John Wiley & Sons, 2013.

Melbourne tree scheme: www.melbourneurbanforestvisual.com.au

Ulrich, Roger S., et al. “Stress recovery during exposure to natural and urban environments.” Journal of environmental psychology 11.3 (1991): 201-230.