SOME OF US think aging is bad policy. Having said that, here’s some good news: spending more time in nature can make aging easier, perhaps even salutary. Think of it as nature-assisted aging. When I asked older adults how nature had or was assisting their own aging, their answers were revealing. One man said: “I don’t feel old when I am in the natural world. My relationship with it allows me, or so it seems, to reconnect with an earlier time; it brings out the excitement and enthusiasm I had as a youngster, as though those days of fishing, searching for bugs and bird nests were just the other day. I know my body is getting old, but as long as I remain connected to nature, I don’t feel old.”
Others said that spending time in nature gave them needed perspective on time passing. “The time dimension of the natural world (billions of years) helps you cope with your mortality,” said a scientist. Another woman wrote: “I don’t quite have the ability to scramble up a tree like I once did, nor the inclination to build forts in the gathered cornstalks of the farmer’s field behind my house, nor play in snow forts till our clothing froze solid and our skin hurt. When I think of those things, I can feel what I felt then, again, with fondness and some melancholy. The difference is I can consciously reflect on those experiences and place value on them because I see how defining they were in determining who I became. I appreciate things differently, with more intention.”
Of course, as we move deeper into old age, our nature experiences change. “As I get older, I tend more toward the quiet and simple experiences in nature,” writes a North Carolina woman. “Even with swimming in the ocean, I used to Scuba dive and spear fish. Now, I am very content, just swimming and sightseeing by swimming on my side or on my back. Don’t need all the equipment, or maintenance, to see and feel and experience the richness of it all. I also savor the experiences more, really appreciating that they are there for the taking, and that I have the senses and abilities to access them.”
Similarly, an artist who had moved to rural New England said: “Catching trout on the river is less important to me now. I’m thrilled and satisfied just seeing a fish rise, or seeing a great blue heron pass close overhead, seeing an annoyed beaver flap his tail at a fisherman or even having to stop fishing for a canoeist passing through.” And a woman who plants urban forests said simply and optimistically, “I feel befriended and supported by the natural world, and the role it plays in my potential longevity.”
Active engagement is not forever, unfortunately. An inability to take part physically in the outside world means indirect association with nature becomes even more important. More geriatric studies are needed, but existing research confirms that elderly residents in retirement apartments report greater satisfaction and stronger feelings of well-being if they have a garden view.1 Other studies show benefits do increase if elders can get outside and into a garden. In 1994, a study divided eighty institutionalized seniors into two groups. One group received horticultural therapy —gardening time —and the other did not. They tested the groups three times over a six-month period and found predictable emotional and mental improvement at the midpoint, which dropped if therapy was withdrawn.2
Another perk of hands-on gardening is increased pinch and grip strength and improved dexterity. Kansas State University researchers Candice Shoemaker, Mark Haub, and Sin-Ae Park noted these benefits and others in a study published in 2009 in the journal Hort-Science.3 In 2000, researchers reported that patients with Alzheimer’s disease showed improved group interaction, reduced agitation, and less wandering if they could be outside in a garden at different times of the day and experience changing light levels. This apparently allowed their brains to provide structure in minds otherwise confused.4 And a 2006 Australian study of 2,805 men and women aged sixty years and older, who were initially free of cognitive impairment and followed for sixteen years, found that daily gardening was associated with a 36 percent reduction in the risk of developing dementia.5
At the primal level, how we age depends on the health of mitochondria. “They were once small bacteria swimming in the sea. But about 1 billion years ago, they joined up with other bacteria for energy, and this created life as we see it all around us,” explains the physician William Bird, one of the UK’s leading voices for connecting people to nature.
Today, almost every plant and animal uses mitochondria to transform air and nutrients into energy. Every cell in our bodies contains some two hundred to three hundred mitochondria. These are our cellular power plants. They’re also engaged in other processes, including cell differentiation, cell growth, and cell death. The mitochondria are happily employed until their lives are overwhelmed by free radicals —atoms or molecules that with a single unpaired electron in an outer shell are released as the mitochondria produce energy. According to the free-radical theory of aging, organisms age as cells accumulate free radicals, which can set off chain reactions that can lead to cancers and degenerative diseases, including cardiovascular disease, arthritis, diabetes, lung disease.
“All of these diseases are related to the aging process associated with mitochondrial dysfunction,” says Bird. Toxins and obesity create more free radicals, as do stress and sedentary behavior. At the chemical level, antioxidants keep free radicals under control. Negative stress can tip the balance to the radicals. “Children who have been subjected to stress such as child abuse show premature aging later in life. Stress gives them a disadvantage by increasing the risk of chronic diseases such as diabetes later and also shortens their lives,” he adds.
A minor industry now produces food and drink additives to increase antioxidants although research has suggested that some of these supplements may be toxic in high concentrations and not much is known about long-term impact. What does work then? “The more exercise someone does, the more the cell releases antioxidants to protect it,” he says. “So a child who plays outside in a natural green space will reduce the chance of developing chronic diseases later in life.” The balancing act continues throughout our lifetimes. Bird recommends exercise, as do most physicians. Also, considering the emerging literature on green exercise, he suggests that outdoor activity may have added antioxidant properties. If Bird is right, our personal and public policies about aging need some fresh air. So, it’s time to take our mitochondria for a walk in the woods.
Or better yet, time for aging boomers to take children for a walk. Our generation still remembers a time when it was considered normal for children to get their hands muddy and their feet wet, to lie in the grass and watch the clouds move. There’s no better form of green exercise than passing along to the next generation the gifts of nature that we received.
Just as the nature experience’s impact on intelligence holds implications for education—perhaps especially higher education, which will be discussed later —its role in shaping physical and mental health recommends a new approach to health care. How then might the Nature Principle, which holds that a reconnection to the natural world is fundamental to human well-being, be applied to the health care system?
In 2009, Janet Ady of the U.S. Fish and Wildlife Service stood before a crowd of grassroots leaders working to connect people to nature and held up an outsized pharmacy bottle. Within the bottle was a physician’s “prescription” —one that would be as appropriate for adults as it would be for children. It read: “Directions: Use daily, outdoors in nature. Go on a nature walk, watch birds, and observe trees. Practice respectful outdoor behavior in solitude or take with friends and family. Refill: Unlimited. Expires: Never.”6 Gimmicky? Sure. But effective —a direct illustration of how the medical industry’s attitude, as well as our attitudes about exercise and wellness, could be reshaped to incorporate vitamin N.
Within the health professions, interest in the nature prescription is growing. Healing gardens on hospital grounds are already popular. The provision of these restorative nature spaces has become specialized, with ailment-specific gardens being designed by landscape architects for patients with cancer; patients requiring physical rehabilitation; those with Alzheimer’s disease and other forms of dementia; and people suffering from depression and burnout.
Daphne Miller, a general practitioner in the Noe Valley neighborhood in San Francisco, California, envisions nature prescriptions as part of the burgeoning field of integrated medicine. In these medical practices, physicians offer the typical services, but also recommend to their patients other health modalities, including herbal medicine, biofeedback, homeopathy, acupuncture, and mindfulness. “Nature is another tool in our toolbox,” says Miller, who, in addition to her medical practice, is associate clinical professor in the Department of Family and Community Medicine, University of California - San Francisco. She also believes that park rangers can, in effect, become health care providers. This epiphany, as she calls it, came to her at a conference held at Yosemite National Park, as she listened to a ranger preach the gospel of nature’s impact on health and well-being—having witnessed its transformative effect on visitors to Yellowstone.
Miller recalls that, as he spoke, she realized “this guy is a health practitioner.” She wondered: why not, with training, “anoint these rangers as health paraprofessionals —as paramedicals —to help people use nature as a conduit for health?”
In addition to park rangers, who else might be on a list of potential nature paramedicals? Farmers, ranchers, camp counselors, nature guides, park docents, clergy, teachers, nutritionists, architects, urban planners, builders. The list could go on. Why not establish a certificate in nature health, or continuing education credits? Individuals from a variety of professions and avocations might learn about practical applications appropriate to their discipline, plus receive more generalized training. In addition, health care professionals might earn such a certificate.
Colleges and universities could offer additional courses for certification in a variety of established arenas, under the watchful eye of state or national public health organizations. Businesses could offer this training, too. So could the National Wildlife Federation, the National Recreation and Park Association, the National Environmental Health Association, to name a few possibilities. Such nature paramedicals might be trained to teach about the general impact of the natural world on health; about practical applications of outdoor fitness, including exercise regimens specific to, say, nature trails; stress reduction; improving mental health through nature experience; how to make changes in the home or yard to encourage natural fitness; and so on. Potential nature therapies might also include adventure therapy for combating family disconnection, for improving body image in women and men, for the treatment of eating disorders, for aging. Other possibilities: special training in nature fitness for children, the elderly, or people with disabilities. Most of this could be done in concert with health care providers, but some of it could be offered independently.
This approach is attractive because there would be no need to wait for the great ship of mainstream medicine to turn, although physicians and other health care professionals may be more accepting of such ideas than one might expect. One reason is peak petroleum—that inevitable moment when the scarcity of oil becomes permanent. Filling our cars’ gas tanks will be only part of the challenge. Howard Frumkin, dean of the University of Washington’s School of Public Health, points out that the production of many of our most basic medications —aspirin, for example —is entirely dependent on petroleum-based molecules. While many synthetic alternatives will be available, FDA approval could lag behind need. Because of the impact of peak petroleum on supplies, packaging, transportation, and nearly every other aspect of health care, dramatic drop-offs could occur in the rates of cancer screening, renal dialysis, prenatal care, and physical therapy. Because of the recession and rising gas prices, that effect has probably already begun. After Frumkin published a paper on this topic in the Journal of the American Medical Association, he reported one oncologist’s comment that “some of his patients were choosing to forgo appropriate chemotherapy in favor of surgery because they couldn’t handle the cost of frequent fill-ups for numerous visits to the medical center.” Also, like Australia’s Glenn Albrecht, Frumkin worries about the indirect impact on mental health, as our petroleum-based way of life is disrupted.
Even without the peak petroleum issue, an aging population presents threats and opportunities to health care. “As the U.S. population ages, proportionately fewer medical practitioners, particularly in primary care, will be available,” Miller contends. “That means our definition for a medical practitioner and where we obtain health care will change.” Physicians are increasingly open to the other healing professions. “When you use that term, ‘healing professions,’ most people think of acupuncture, massage,” she says. But the term could stretch. Miller also believes that patients are primed for the nature prescription. One of her patients told her, “I have a StairMaster right in my own basement, but honestly it’s been there for years gathering dust and making me feel guilty. I started walking the three-mile trail in the park near my house, then I got serious about exercising. I do it now rain or shine. I love the fresh air. The best part is that I get a great workout and don’t even mind sweating.”
Miller has heard enough repetition of, and variations on, that patient’s story that she has “started to make formal ‘park prescriptions,’” she reported in a commentary for the Washington Post.7 “The prescribing instructions are considerably more detailed than ones you might get with a medication or a typical exercise prescription (e.g., ‘walk 40 minutes five times a week’). They include the location of a local green space, the name of a specific trail and, when possible, exact mileage.” She is not the only health care professional handing out nature prescriptions. In 2010, the National Environmental Education Foundation (NEEF), working with the American Academy of Pediatrics, launched a training program for pediatricians, focused on prescribing outdoor activities. “I’ve begun hearing about doctors around the country who are medicating their patients with nature in order to prevent (or treat) health problems ranging from heart disease to attention-deficit disorder,” says Miller. Among them is cardiologist Eleanor Kennedy, who worked with local funders and the National Park Service’s Rivers, Trails, and Conservation Assistance Program to create a Medical Mile, a walking and running path along a downtown stretch of the Arkansas River. Nearby is a new, natural play space designed primarily by parents and children, which includes grassy hills for rolling down, tunnels for crawling, and wetlands. Kennedy told Miller, “If my patients feel that they can get outdoors, they are more likely to be consistent about exercise.”
In 2009, the city of Santa Fe, New Mexico, in an effort to fight the high rate of diabetes there, launched its Prescription Trails program, which is partially funded by the Centers for Disease Control and Prevention. Besides trail time, physicians can refer their patients to a trail guide. “All these insurance companies focus on prevention, but no one thinks of the free public land resources that we have at our disposal,” said Michael Suk, an orthopedic surgeon and former health adviser to the National Park Service (NPS). The Golden Gate National Recreation Area plans to create a prescription tool kit for doctors, “possibly in partnership with a large health organization such as Kaiser Permanente,” Miller reports. She believes “it’s not too much of a stretch to think of our national park system as an integral part of our health care system; the NPS is already offering wellness services that are free and accessible to all, regardless of preexisting conditions.” In 2010, a similar pilot program in Portland, Oregon, began pairing physicians with park professionals, who will record whether the outdoor “prescriptions” are fulfilled; the park prescription program will be part of a longitudinal study to measure the effect on health.
“Woodland therapy” and “care farming,” a partnership among farmers, health care providers, and health care consumers to care for people and land, are taking root in several countries. In Norway, general practitioners can prescribe their patients a stay in a care farm. In the Netherlands, six hundred health farms are integrated into the health service.8 In 2006, a group called the Forest Therapy Executive Committee, made up of researchers and others, began to give forests across Japan the official designations of Forest Therapy Base or Forest Therapy Road. The designations are based on scientific evidence. As of 2008, thirty-one bases and four roads had been designated, and Chiba University’s Yoshifumi Miyazaki hopes that over the next decade that number will reach one hundred. The forest therapy bases—typically a forest and walking path —are managed by local governments and independently observed by Japan’s Forest Agency and the Health, Labor, and Welfare Ministry. People who visit the therapy bases and roads can take part in guided walks with experts in forest medicine; they can also enroll in other health classes, such as dietary management and hydrotherapy, and receive medical checkups. Some Japanese companies now send their employees to these forest therapy bases —presumably to increase their productivity. The therapy forests also bring tourists to local economies. And in the UK, a growing “green care” movement encourages therapeutic green exercise activities, therapeutic horticulture, animal-assisted therapies, ecotherapy, and care farming. “Nature’s Capital,” a 2008 report issued by the National Trust in Great Britain, calls for local funding for green exercise and “wellbeing prescriptions,” adding: “There are potentially very significant cost savings for Primary Care Trusts in more widely recognizing green exercise as a clinically valid treatment option for mental and physical ill health. It has been estimated that a 10 percent increase in adult physical activity would benefit the UK by £500 million a year, saving 6,000 lives.” The trust also cites a government report that anticipates an estimated 60 percent of the UK populace is likely to be obese by 2050.9
Do you see a pattern forming here? In England and Scotland, efforts are afoot to build a Natural Health Service as a supplement to the National Health Service (NHS). William Bird of Natural England explains: “This service will represent the green open spaces surrounding health centers and hospitals including parks, community gardens, allotments and trees in the street.” Plans are also being made to create a National Health Service Forest, “in which 1.3 million trees will be planted, one for each NHS employee, to cool the urban heat of our island, provide shade, reduce stress, and increase activity.”
The cumulative effect of such thinking could eventually lead to natural health care reform at the national level in the United States and around the world. Daphne Miller and other health care professionals are ready to quicken the pace. “Don’t be surprised if, at your next visit to the doctor, you are handed a trail map and itinerary along with your lab slip,” she says. “In fact, if you are not offered one, you should demand it.”
To transform the health care system will require more than institutional change. It will demand rigorous research and a philosophical evolution that goes beyond what we usually call preventive care. That shift, toward natural fitness, can happen organizationally—as well as at the level of the individual, in our social and family networks, and in the living environments we create for the young and the old.