NatureRx@UMD: A Review for Pursuing Green Space as a Health and Wellness Resource for the Body,Mind and Soul

Admiration for Nature Can Save Us

Our built environments are defined as the man-made structures and features that provide the setting and surroundings for humans to live, work, and play. These man-made spaces, created for human activity, include homes, buildings, streets, parks, transportation systems and other infrastructural elements. In the absence of the built environment, there is the natural environment. All naturally occurring components, living or non-living, encompass the natural environment. As such, the measurable and immeasurable interactions of species, climate and natural resources can impact human health, well-being and survival. Humans can and have impacted the natural environment through the overdevelopment of the built environment, the global climate systems, species eradication, and the exploitation of natural resources.

It is with this human impact on the natural environment and other non-human species that we must pause to recognize that our “admiration for nature can save us”, an adage from the esteemed novelist and confirmed naturalist, Alice Walker. ^1,2 Her quote resonates at multiple levels. First, Walker reminds us that by respecting nature, we can quite literally (try to) save ourselves from endangering Earth’s natural life. Second, we can understand her observation through interactions of species, climate and natural resources, which ultimately impacts the well-being and survival of humans for generations to come. Finally, Walker’s declaration provides an impetus for the promotion and protection of nature’s longevity and diversity. Guided by the prose of Alice Walker, we walk through this article by delving into the growing body of research emphasizing the salutogenic effects of nature and the restorative aspects of green environments on human behavior and life.

The benefits of human interaction with the natural environment have been demonstrated through both intervention and observational studies. Hundreds of these studies have found positive connections between time spent outdoors in natural settings and physical and mental health outcomes. ^{3 -6} Some of these physical health benefits include reduced high-density lipoprotein cholesterol; lowered diastolic blood pressure; and a diminished risk of type II diabetes, cardiovascular mortality, stroke, overweight/obesity, asthma hospitalizations and all-cause mortality. ^{7 -11} As a mediator to reduced risk of some adverse health outcomes, physical activity increases with both duration and frequency of green space visits. ³ Additionally, nature-based physical activity programming (e.g., hiking) has been determined to be an effective therapy for people with mental health conditions. ¹² Furthermore, interacting with nature has been shown to improve the cognition for children with attention deficits ¹³ as well as the mood and cognition in adults. ¹⁴ While the benefits to physical health, psychological well-being, and cognitive performance have been considered and noted more extensively, the social or spiritual benefits through interacting with nature cannot be underestimated. ^3,4 This area of research has brought about some promising results. The evidence of human interaction with the natural environment has been mounting with regard to the positive benefits on social cohesion, social interaction in adults and children, social empowerment, and interracial interaction. ^{4,15 -20} Moreover, a limited number of studies have found a positive association between time spent in green spaces with increased inspiration and spiritual well-being. ^{21 -23}

In Nature, Nothing Is Perfect and Everything Is Perfect

Mental health is a significant area of concern for college students. Student mental health issues, including stress, anxiety, depression and substance abuse, are precipitating a rise in suicides and suicidal ideation. ^{24 -26} According to the National Institute of Mental Health, the prevalence of serious suicidal thoughts and the prevalence of suicide attempts were highest among adults aged 18-25 years. Overall, suicide was the second leading cause of death among all adults in this age group. ²⁷ Many schools, such as Northwestern University, Kenyon College, and Florida International University, are responding by increasing the accessibility of counseling services aimed at prevention. Given the magnitude and severity of the challenge, however, additional efforts are needed to address this issue. While suicide and the accompanying comorbidities are complex medical issues, coping health behavior strategies through natural environment exposures may offer a viable supplement to comprehensive evidence-based treatment for mental health concerns on college campuses.

“In nature, nothing is perfect. Trees can be contorted, bent in weird ways and they’re still beautiful”, another Walker affirmation for these human-environment interactional complexities. ²⁸ To echo this quote in application, it is the hope that current standard protocols and clinical practices for treating student mental health on college campuses may be supported with holistic strategies. These additive strategies would be within the realm of utilizing green spaces for the alleviating benefits that are linked with them. If created, a program of these strategies must be curated to be both relevant and fitting for the college student lifestyle, given their mental health concerns. While a recent large study suggested that 120 minutes per week in nature was the minimum threshold for obtaining better health and higher psychological well-being, ²⁹ a previous scoping review indicated that as little as 10 minutes of leisure time experiencing nature can measurably improve the mental health and well-being of college-aged individuals. ³⁰ Though the results differ on the dose of nature required, the results clearly indicate a correlation of physiological and psychological health to various forms of green space exposure.

Evidence of physiological benefits are found in the form of biomarkers, as well as cardiac and neural activity. A 2013 study noted that, after an exposure of 20 minutes, subjects in highly built environments had over 6 times higher levels of the chronic stress biomarker (salivary alpha amylase) in comparison to highly natural environments. ³¹ Prior research has also indicated an inverse relationship between nature and cortisol levels, a biomarker hormone that modulates stress responses. In separate studies, cortisol levels were tested in subjects after assigned activities (e.g., walking) and routine activities typical to the subjects’ everyday routines. ^{31 -33} Both forms of activity saw reduced cortisol levels the more frequently subjects were exposed to natural environments. Prior studies also reported trends showing that, in addition to reducing cortisol levels, walking in forest settings could lower pulse rate values and blood pressure relative to walking in urban settings. Heart rate response patterns for those forest walking was often comparable to patterns that occur during meditation and yoga therapy. ^31,32 Bratman and colleagues determined that, after 90 minutes in nature, subjects experienced activity reduction in the brain’s subgenual prefrontal cortex (sgPFC). ³⁴ High activity in this area of the brain occurs when experiencing sadness and rumination (i.e., the prolonged focus on negative thoughts typically focused on one’s self). Ruminating is a risk factor for depression and other psychological illnesses. ^14,35 The body responds in several ways when struggling with mental health. This particular finding, along with other physiological correlations, supports the premise that time spent in nature serves as a restorative and regulatory aid for students who are coping with such hurdles. As such, research in a growing field called ecotherapy has shown a strong connection between nature exposure and the prevention or reduction of stress, anxiety and depression. ³⁶

Additionally, research continues to identify trends in subjective outlooks after spending time in natural environments. ¹¹ Several studies comparing effects of being in natural versus urban environments established that self-reported responses to natural environments were consistently more positive. Subjects have recounted a variety of experiences, such as feeling less stressed, diminished tension and anxiety, and general positive mood-state after spending a single period between 15 to 90 minutes in nature. The subjects even reported feeling soothed, more relaxed, and comfortable. ^32,34 Along with diminished sgPFC activity, self-reported reduced rumination was a concurrent trend. ¹⁴ In urban environments, subjects either did not report experiencing such benefit or they had increased negative affect. ^14,32,34 While there is not a single explanation for the shifts in subjective improvements in perceived experience and mood, these results across studies speak to the potential versatility of using natural experiences as a tool for a broader population.

The stressors, pressures, and moods in a college student’s lifestyle are extremely dynamic and multidimensional. Difficulty regulating can lead to these factors worsening or developing more serious, high-risk mental health states. The availability of university-provided clinical and counseling resources is valuable, providing the college population with support services from which they can seek evidence-based, multi-modal treatments if they experience depression, anxiety, and suicide ideation or attempts. ³⁷ Given the data presented here, time in nature may well be an effective complement to or component of those multi-modal treatment models. Mounting evidence shows that dedicated time in nature does not necessarily require prolonged intervals in order to begin creating a lift, whether in physiological health or subjective state. The diversity of effective experiences also implies that students may be able to personalize time in nature based on preferred activities, settings, and durations. While atypical, incorporating time in nature as a stress management, regulatory, and restorative tool for student mental health can be a beneficial and refreshing support in addition to existing resources. Moreover, it is arguable that time spent in nature and climate change awareness are positively related. As stated by the Trust for Public Land, “our awareness of climate change, and our gathering resolve to do something about it, has coincided with the largest indoor migration in human history.” ³⁸ Currently, the average American spends 90% of their life indoors, ³⁹ and it is not surprising that only 49% of Americans believe that climate change will impact their lives. ⁴⁰

Nature Is Always Dancing

Green spaces within, around, and created to enhance the natural environment can occur almost anywhere in rural, suburban or urban settings – including state parks, community gardens, the grounds of businesses, and on college campuses. On Earth Day 2019, a new initiative called NatureRx@UMD was launched at the University of Maryland at College Park (UMD). Modeled after NatureRx@Cornell, another movement emphasizing the natural environmental benefits interspersed throughout a campus, and born out of ParkRx America, “a non-profit organization whose mission is to decrease the burden of chronic disease, increase health and happiness, and foster environmental stewardship”, NatureRx@UMD is based on the premise that time spent in nature is therapeutic and contributes to personal well-being. ^41,42 ParkRx America, a reformulation of DC ParkRx, encourages healthcare providers to prescribe activity outdoors in nature and green spaces as a “a low-cost intervention that utilizes a known, generally trusted, and accessible resource – parks – to influence positive health outcomes” while also bridging the curative and preventative models of medicine and public heath, respectively. ⁴³ Therefore, NatureRx@UMD will serve as a living laboratory for the greater UMD community by emphasizing the ways in which the landscape of the campus arboretum can play a critical role in preventing or addressing mental health concerns among college students.

One component of NatureRx@UMD will involve prescribing therapies through health care providers at the UMD Health Center. For example, if a student is feeling overwhelmed with final exams and anxious, a prescription can be written to engage in an outdoor activity at a nearby green space in addition to other therapeutic options. Nature prescriptions will promote nature contact and improve the mental and physical health of college students through the activation of intrapersonal, interpersonal, and environmental processes. ⁴⁴ Other components of NatureRx@UMD will include a Communications Team and Student Club. Separate from the Steering Committee, which includes multiple UMD and non-UMD partners (e.g., UMD Memorial Chapel, ParkRx America, and Qi Circles), the Communications Team will create a campus-wide publicity plan for NatureRx@UMD and will manage and produce events (e.g., nature walks, nature safety presentations). ⁴⁵ The Student Club will be led and organized by students with the goal of teaching other students the best safety practices for outdoor activities and helping incorporate nature into students’ everyday routines. The Student Club will also work cooperatively with the Communications Teams to produce NatureRx@UMD events. Collectively, the Communications Team and Student Club may play an essential role in shifting social norms on campus to promote more interactions, inclusivity and equitable connections with nature. Finally, an essential component of this initiative is the creation of an undergraduate course focused on the mental and physical health benefits of time spent in natural environments, as well as, the human-to-nature salutogenic model.

In the next 3 decades, nearly three-quarters of the world’s population will reside in an urban environment. Both physical and mental urban health morbidities have expanded beyond traditional and conventional methods of treatment. Compounding these health issues are the choices humans make regarding built environment developments, which can have profound impacts on public health, sustainability, social cohesion, and community economic vitality. While urban life offers some advantages, there are often many disadvantages that warrant a need for the revitalization received from the natural environment. As Walker states, “nature is always dancing” and the benefits received from just a minimal amount of time in parks, gardens, or any natural space can serve as antidote for life’s challenges. ⁴⁶ For college students transitioning from adolescence to adulthood and for those who may experience an array of health and well-being issues, the gains from NatureRx@UMD are both promising and endless. Therefore, NatureRx@UMD, as described in this article, presents and supports the case that time spent in green spaces is both therapeutic and contributes to personal well-being.