Around the World

Around the World


Nature-based initiatives, projects and interventions in other countries

The World Health Organisation (WHO) estimate that one in six people globally (15-20%) have one or more mental health issues. WHO places mental disorders among the leading causes of ill-health and disability worldwide and claims that one in four people in the world will be affected by mental or neurological disorders at some point in their lives. With this growing crisis in mental health and increasing evidence supporting the health benefits of exposure to nature, governments and organisations around the world are investing in research and nature interventions to treat mental health issues and support mental well-being.

Japan

In 1982, the Japanese government introduced the concept of ‘shinrin yoku’, or ‘forest bathing’, urging citizens to make use of the country’s 3,000 wooded miles for therapy. Since then, Japan has been at the forefront of scientific investigation into the links between forests and human health. Research has been led by Dr Qing Li, who has been conducting experiments since the 1990s and is now one of the world’s leading experts on the health benefits of forests. Having discovered that spending time in forest environments reduced concentrations of cortisol, lowered pulse rate and blood pressure, increased parasympathetic nerve activity and lowered sympathetic nerve energy, he founded the Forest Therapy Study Group in 2004, with the specific aim of discovering exactly what it is about forests that make us feel so much better; he is now the vice-president and secretary general of the International Society of Nature and Forest Medicine, and conducts his cutting-edge research from his laboratory at the Nippon Medical School in Tokyo. 

Between 2004 and 2012 the Japanese government invested $4 million in developing shinrin yoku as a national health programme, and there are currently 62 certified forest-therapy bases in Japan, all of which have been proved to have particular health-promoting properties. Between 2.5 and 5 million people walk the forest trails every year, and shinrin yoku has become standard practice in Japan as a way to manage stress and treat associated issues of depression and anxiety. The Japanese government continues to invest heavily in both research and practice, and is committed to expanding its number of designated forest therapy sites to 100 within the next 10 years.

For a review of some of the latest research in Japan, see:
Song, C., Ikei, H., & Miyazaki, Y. (2016). Physiological effects of nature therapy: A review of the research in Japan. International Journal of Environmental Research and Public Health, 13, 781.

USA

The concept of a ‘nature prescription’ is gaining momentum in a number of states across America, with many doctors now sending their patients to parks for a variety of physical and mental health issues, including diabetes, obesity, depression, anxiety and asthma. Dr Daphne Miller, a physician and associate clinical professor at the University of California, San Francisco, is one of a growing number of doctors who are no longer simply advising their patients to spend more time in nature, but are now writing formal prescriptions such as the following:

Drug: Exercise in Glen Canyon Park
Dose: 45 minutes of walking
Directions: Monday, Wednesday, Friday, and Saturday at 7:00 am
Refill: Unlimited

Dr Miller has been a champion of nature prescriptions for over a decade, and believes there is ‘no other health-promoting activity that’s more worthy of our time’. She looks forward to a time, in the not-too-distant future, when ‘nature exposure’ will become a critical piece of data collected at the start of every medical encounter, joining blood pressure, temperature, and pulse as the newest ‘vital sign’.

In 2017, Park Rx America (PRA) was established in Washington, D.C., by paediatrician Dr Robert Zarr, with a mission to ‘decrease the burden of chronic disease, increase health and happiness, and foster environmental stewardship, by virtue of prescribing Nature during the routine delivery of healthcare’. The organisation has expanded rapidly in its first year, and there are currently doctors in 13 states, delivering nature prescriptions and receiving individual analysis from PRA of their patients’ park visits. Enthusiasm for Park Rx America is evident with over 8000 parks in 27 states now signed up to the database and ready to participate in the project.

Throughout America there are numerous medicine-nature collaborations, some funded by private hospitals, some by insurance companies, and some by government agencies, including the National Park Service and the Centres for Disease Control and Prevention. Nature-based interventions to treat specific mental health problems are becoming increasingly popular, as both mental health professionals and policy makers become aware of their efficacy and cost-effectiveness. For example, the Green Road Project, which opened in 2016, treats veterans for PTSD and traumatic brain injury, and there are a number of schools such as SOAR Academy in North Carolina, which offer specific nature-based adventures and experiences to treat young people with diagnoses of ADHD and autism.

Nature initiatives promoting mental wellbeing and serving non-clinical populations are also thriving in America. In 2012, the Association of Nature and Forest Therapy Guides and Programs (ANFT) was founded by M. Amos Clifford. ANFT’s mission is to ‘develop and disseminate the practice of forest therapy, leading to its widespread acceptance and integration into health and wellness practices and programs and eco-activism’. Drawing on ‘the latest medical research, new developments in the field of nature connection, and ancient traditions of mindfulness and wellness promotion’, it now considers itself ‘the global leader for forest therapy’, and to date has trained over 600 guides, who are currently conducting forest therapy walks and workshops in 46 countries across six continents.

Nature Sacred is a network of community projects across the States that has been creating small green spaces of ‘refuge, respite and renewal’ for over 25 years. Each ‘sacred place’ is intended to reconnect people with nature, restoring minds and enabling its visitors to regain perspective and find balance.

Kids in Parks is another nature-health partnership, which began in North Carolina but is expanding nationwide. The programme uses paediatricians’ offices as ‘trailheads’ with the goal of getting kids and parents off the couch and into the woods, and there are currently 55 trails in five states.

Australia

Healthy Parks Healthy People originated in Australia and is now a global movement that harnesses the power of parks and public lands in contributing to a healthy civil society. The idea began with Parks Victoria, Australia, and came to global prominence at the first Healthy Parks Healthy People Congress in 2010, which brought together 1,200 participants from 37 nations to explore the many ways nature and parks significantly contribute to our health and wellbeing. Its mission is to unlock the power of nature and parks for their preventative and restorative health and wellbeing benefits, while conserving biodiversity. The movement has played an important role in promoting the health benefits of exposure to nature across Australia, with the Government now taking significant steps to ensure parks become increasingly relevant, respected and valued in the daily lives of all people. For example, in its Public Health and Wellbeing Plan 2015-2019, the Victorian Government highlights that interacting with nature contributes to a reduction in chronic disease risk factors and improves the mental health of Victorians, and estimates that Victoria’s parks may contribute up to $200 million in avoided health care costs. Already visitors to Victoria’s parks annually undertake 37 million short walks, and make a further 54 million visits for other recreation activities such as exercise, camping, playing with children, and wildlife observation. However, the Government recognises that there are still many barriers that prevent some people in the community from accessing parks and gaining health benefits, and are working hard to increase the number of visits made by people from culturally diverse communities, people with disabilities and people from lower socio-economic backgrounds.

Parks Victoria has inspired many new initiatives and projects to make use of nature-health links, and established partnerships with a large number of diverse organisations throughout Australia, for example, BrainLink, which supports people affected by brain disorders such as stroke or acquired brain injury, AMAZE that works with people on the autism spectrum, the Werribee Park Program which uses parks to increase community cohesion and improve mental and physical wellbeing of refugees and migrants, and Four Wheel Drive Victoria that builds self-esteem of young people at risk of detention.

In 2014, Australia hosted the World’s Parks Congress in Sydney, which takes place every ten years, and at this event, attended by over 6000 participants, representing 160 countries, the contributions of parks to human health and wellbeing was one of its major themes. In his address, Dr Jonathon Patz, MD MPH, President of the International Association for Ecology and Health, said,

 ‘as a medical doctor and public health scientist, it is my professional opinion that conservation biologists can actually save more lives, promote more wellbeing and prevent more illness than the health sector’. 

For a significant and comprehensive review of the Australian and international literature on the links between mental health and wellbeing and contact with nature, see the report by Townsend and Weerasuriya from Deakin University, Victoria, commissioned by beyondblue: the national depression initiative, 

Beyond Blue to Green: The benefits of contact with nature for mental health and well-being.

South Korea

In South Korea, forest-bathing, known in Korean as ‘salim yok’, is taken extremely seriously by the government and by the Korean population. In 2014, the government invested $140 million dollars in establishing a National Forest Healing Centre, and in 2015 the Law on Forest Welfare Promotion was enacted by the National Assembly. Currently, a $100 million forest healing complex is being built adjacent to the country’s iconic Sobaeksan National Park, complete with aquatic centre, addiction treatment centre, ‘barefoot garden’, herb garden, open-air decks, suspension bridge and 50km of trails.

The Korean Forest Service aims to develop ‘a green welfare state’, and plans to open 34 official healing forests over the next two years to add to the three currently in existence, meaning that most major towns will have access to one.

There is also a plan to train a further 500 forest healing instructors, a profession with high status in Korea which requires a graduate level qualification. 82% of Koreans already visit forests more than once a year, and the frequency of their visits is rapidly increasing as the evidence grows for the health benefits of engaging with nature. The Forest Service now regularly takes blood pressure and heart rate variability measures and is assembling a large database that will be used to work out indivduals’ ‘necessary dose’; for example, is one walk a week in the woods enough to maintain low blood pressure, and how frequently do we need to ‘top up’?

Korea is embracing forest kindergartens, forest pre-natal classes and forest classes for bullies, and forests are being used as places to overcome addictions, and treat a variety of mental health issues, including symptoms of PTSD amongst firefighters, and anxiety related to so many aspects of modern urban living.

City parks are also being used to support mental wellbeing, for example, in one of Seoul’s big parks, Bukhansan, a digital detox programme runs for pre-teens.

Finland

Finland’s reputation as one of happiest nations in the world (ranked number one out of 156 countries in 2018 World Happiness Report) is often assumed to be due to its low-income disparity, but it may also, at least in part, be due to nature: Finland is the most forested country in Europe and most Finns regularly access its lakes, forests and coasts to conduct national obsessions of fishing, mushrooming, berry picking, lake swimming and Nordic skiing. In fact, according to large national surveys, over 95% of Finns regularly spend time engaged in outdoor activities (on average 2-3 times a week): 58% of Finns go berry picking, 35% cross-country-skiing, and 70% hike regularly, with dog walking, cycling and long-distance ice-skating all popular pursuits. However, as the Finns are moving into urban environments, they are reporting increased levels of stress and depression, and health experts are now trying to work out precisely how much time is needed outdoors to stay healthy and sane. The Finnish Government invested $16 million in a series of studies, called the Green Health and Research Project, to investigate the benefits of natural environments available to city dwellers, for example managed city parks and gardens. The results showed that just 15-45 minutes in a city park, even one with pavements, crowds and some street noise, were enough to improve mood, vitality and feelings of restoration. The research further concluded that five hours a month is the lowest amount of time to gain health benefits from nature, but the more the better. Following this project, ‘five-hours-a-month’ is establishing itself as a recommended ‘minimum dose’ in Finland to stave off depression, and the Finnish Government is already recognising the huge savings for the national health-care system.

In 2010, Korpela, an environmental psychology professor and expert in the restorative and well-being effects of natural and urban environments, created a couple of ‘power trails’: well-signed self-guided nature walks, that maximise nature’s beneficial effects with recommended exercises such as listening to nature’s sounds, feeling plants, and consciously breathing in the air. Hikers have no requirement for a certified ranger or a big healing forest, just water, views and strategic instructions. They are hugely popular in Finland, with research demonstrating physiological and psychological benefits for over 80% of participants, and there are now several similar trails across northern Europe.

Sweden

The Alnarp Rehabilitation Garden has been delivering its highly successful horticultural therapy programmes for over 15 years. It is funded by the Swedish Government and uses plant cultivation and garden settings as a healing strategy for people with severe work-related stress, who are often on long-term sick leave. The standard treatment programme runs for 12 weeks, with participants attending for 12 hours a week. Sixty percent of Alnarp’s patients return to work after one year, higher than in any other therapy, and the model is being replicated elsewhere, and now being trialled with traumatised refugees and stroke patients.

The Swedes have a long history of believing that nature is essential to healthy children, and were one of the first countries to develop the concept of nature schools in the 1950s. Sweden is often considered a world leader when it comes to outdoor learning and has a master’s programme in Outdoor Environmental Education and Outdoor Life at Linköping University, which is the only programme of its kind in the world that is geared directly toward schools.

Singapore

Singapore spends $150 million per year ‘to develop scenery’ (0.6% of its national budget). As the third densest country in the world, its government has recognised the potential negative impact on mental health of living in urban environments and taken radical steps to reduce some of the harmful effects of city living. With an understanding that city dwellers are more stressed and depressed (extensive reviews of medical literature show a 21% increase in anxiety disorders, a 39% increase in mood disorders, and a double risk of schizophrenia in city dwellers), Singapore has embraced greenery in every aspect of its planning, with integrated parks and gardens in its shopping centres, hospitals and office blocks. Architects and developers are encouraged to include green walls, roof parks and vertical gardens into corporate and residential towers, with government grants to help fund the projects. As a result, Singapore is now considered one of the top ‘biophilic’ cities in the world, with its percentage of green space actually increasing, even as its population grows. The government considers access to green space a priority for its citizens, and its large botanical gardens (an Ionesco Heritage Site) is open 16 hours a day and free to visitors. It has set itself the ambitious goal of having 80% of people living within 400m of green space, and it is already at 70%. A new hospital close to the city centre is an excellent example of a simple biophilic design, which has invested in the known health benefits of nature: many of its rooms face inner luxuriant garden courtyards, dense with trees and shrubs, specifically chosen to attract birds and butterflies; plants are draped over balconies and there’s a huge pond, a medicinal garden, a walking path, and an organic vegetable garden on the roof.

New Zealand

The New Zealand Government was the first to use the term ‘green prescription’, introducing the concept in the 1990s as a response to increasing obesity rates. It consists of a health professional’s written advice to a patient to become more physically active outdoors, and has been highly successful in New Zealand, with the term now spreading to other countries to describe a non-medical referral option for GPs and other health professionals.

The Green Prescription Active Families initiative focuses particularly on young people, and has seen over 1000 children, young people and their families referred to its programme, with the latest survey (2016) showing that 87% of participating families noticed positive changes in their child, including more energy, increased confidence and better sleep.

In New Zealand’s capital city, Wellington, the government has created a natural place of awe for everyone to enjoy, by designating and signposting a public snorkel trail, close to the city centre, where you can jump in the water, swim around, and encounter octopuses, butterfish and seahorses.

Canada

Canada has a number of initiatives promoting the physical and mental health benefits of natural environments. Since 2012, thousands of Canadians have joined the David Suzuki Foundation’s annual 30 x 30 Nature Challenge, pledging to spend 30 minutes in nature every day during the month of May.

Mood Walks is another successful project, led by the Canadian Mental Health Association, and promotes physical activity in nature, or “green exercise,” as a way to improve both physical and mental wellbeing.
Share by: