Nature and Health Beyond Exposure: Pluriversalism and Relationship (Introduction to the Special Issue)

Introduction

For many, within and beyond academia, it has become increasingly clear (perhaps to the point of saturation) that massive biodiversity loss, ecological disruption, erosion of place-based cultures, food-systems instability, mounting chronic disease, and a deepening mental health crisis collectively signal a deeper, intertwining planetary health emergency. Transformative and justice-oriented responses are, therefore, urgently and unequivocally needed (Gupta et al., 2024; Santos, O’Riordan, de Sousa, and Pedersen, 2026). But how do we move beyond despair and mobilize?

The nature and health field has a significant role in this context, offering a healing paradigm supported by hundreds of empirical studies. Even as it grapples with power dynamics and epistemological and generalizability limitations, the field continues to expand conceptually and methodologically, demonstrating that nonhuman nature underpins human physical, psychological, and cultural health across historical, political, and geographic contexts (Gallegos-Riofrío, Arab, Carrasco-Torrontegui, and Gould, 2022).1 This positive narrative is a powerful catalyst: it informs public policy and planning and advances scientific efforts to understand human–nonhuman interactions across multiple levels, even as the field continues its frank and necessary expansion (e.g., Bratman & Olvera-Álvarez, 2022; Frumkin et al., 2017; LoTemplio et al., 2023). In the aftermath of a global pandemic that revealed the costs of isolation, disconnection, and collective grief (Tomasso et al., 2021), the field is well-positioned to catalyze a global dialogue on relational, interdependent, and life-affirming futures. Reimagining how humans live and interact with the rest of the living world is central to this Special Issue (SI) and depends on acknowledging both the universal and the localized, historical, and culturally specific dimensions of these relationships.

In this spirit, this introduction, and the collection as a whole, invites the field to engage the pluriverse (Escobar, 2020): a planet composed of many worlds, and to embrace not only diverse perspectives but also distinct ways of knowing and experiencing the world. These include ethnocognitive modes of perception and reasoning, the world-making force of language, and the semiosis that underlies life itself. For instance, the contemporary and widely accepted notion of “spending time in nature for health” becomes almost paradoxical when viewed through the lens of Indigenous Peoples, for whom human–nature relations are continuous and inseparable (e.g., De Castro, 2019; Zent and Zent, 2022). Healing, in this view, does not stem from nature as an external agent but emerges from reciprocal relations; for instance, where the human recognizes the plant’s sacredness and the plant, in turn, offers its medicine through a relationship of acknowledgement and respect. And at the microbiological level—a reality to which we are seldom attuned—where does the “I” end and where do the forest, the desert, the mountain, the prairie, or even the small patch of grass breaking through concrete begin?

A productive dialogue requires the willingness to sit with such tensions. The invitation aligns with a broader paradigmatic shift increasingly recognized within Western academic institutions, yet grounded in intellectual, cultural, and political traditions long cultivated at the margins, the relational turn (Gallegos-Riofrio, Zent, Gould, 2022; West, Haider, Hertz, Mancilla Garcia, and Moore, 2024). These traditions, emerging from Indigenous, decolonial, community-based, and relational scholarship, have advanced transformations in subtle and radical ways, challenging dominant frameworks and are now expanding the epistemic horizons of the nature and health field.

In the Bolivian Altiplano, the Aymaras conceived the uywaña or mutual nurturing (i.e., mutual care), rather than domestication, as life reproduces itself (Carrasco-Torrontegui, 2025). This is one of several streams that inspired our SI. We sought work that reimagined the nature and health field through lenses of reciprocity and interdependence, challenging dominant extractive and utilitarian paradigms and instead honoring nature as a being, a partner, and a whole—as articulated in many Indigenous and relational worldviews (e.g., Mother Earth as Andean Pachamama, Celtic Danu, Hindu Bhūmi Devī, Akan Asase Yaa, or Lakota Ina Maka) (Gallegos-Riofrio, Arab, Carrasco-Torrontegui, Gould, 2022). This stage is animated by the biological, ecological, and planetary processes that sustain life and the symbolic and cultural fabrics through which societies conceptualize things and define boundary “objects” or “entities.” It is our hope that these standard conceptualized boundaries might become less objectified through new lenses for interacting with nonhuman nature, which could emerge through this call for papers.

Fulfilling this invitation in its entirety is, of course, a long-term endeavor; perhaps a project evaluated in decades. Yet it can be said with confidence that the works gathered in this SI represent important steps toward a more pluriversal nature and health field. The unifying theme across this collection is a shared inquiry into how relationships with the nonhuman world—rooted in lived experience, cultural meaning, ecological interaction, evolutionary history, and historical depth—reveal, challenge, and transform our sense of emplacement within a multiscale planetary proscenium. This introduction advances a relational, pluriversal framing of nature and health scholarship, which acknowledges different epistemological and cultural traditions, and highlights the need to move beyond the human–nature divide as a central orientation for the field’s next methodological and intervention phase.

Situating This SI Within a Transforming Field

Ecopsychology has published a number of themed issues over the years that engage nature, well-being, and public health (e.g., Frumkin and Jackson, 2014). The set we refer to here—SI I, II, and now III—constitutes a more recent Nature and Health special-issue series aligned with the Nature and Health Alliance (NHA), which has emerged as an organizing hub for research, practice, and field-building in this domain. The inaugural Nature and Health SI, edited by Bratman and Olvera-Álvarez (2022), offered a thoughtful examination of the field’s contours, including its shortcomings and the urgent need for greater justice, inclusivity, and attention to inequity. Their introduction articulated, with exceptional clarity, many of the concerns that align with those raised in a 2022 assessment of the field, which demonstrated that research on nature’s mental health effects has been conducted largely within Western contexts, drawing on populations and conceptual frameworks that are far from globally representative (Gallegos-Riofrio, Arab, Carrasco-Torrontegui, Gould, 2022).2 As they noted, the field’s growth must be accompanied by an expansion in the diversity of locations, methods, populations, and perspectives it encompasses.

SI I also foregrounded the structural inequities that shape access to nature, particularly in urban environments. Drawing on scholarship documenting both the cobenefits and the limitations of green infrastructure, the editors highlighted how environmental burdens such as the urban heat island effect and air pollution disproportionately affect marginalized communities. They further underscored how racism and discrimination create persistent barriers to greenspace access for Black, Indigenous, and other people of color. In this sense, SI I extended and deepened concerns that the 2022 assessment had earlier articulated as a chronic deficiency of diversity and pluralism—manifestations of enduring structural and epistemic exclusions in the field. Together, these efforts offer complementary diagnoses of a shared systemic challenge.

Importantly, SI I broadened the field geographically and conceptually by featuring contributions from Latin America and other underrepresented contexts in nature–health research. Stanley’s (2022) narrative essay traced the enduring power of childhood landscapes in shaping the ecological self, drawing on Indigenous wisdom and ecopsychology to illuminate how identity remains rooted in place across the lifespan. Calderón Moya-Méndez, Ganzevoort, Lenders, and van den Born (2022) examined “visions of nature” among residents of Lima, Peru. These authors reveal images of human–nonhuman nature relationships (from practical stewardship to ecocentric responsibility) that complicate simplistic anthropocentric/ecocentric dichotomies and expand understanding of relational values in both urban and extraurban settings. Garza-Terán, Tapia Fonllem, Fraijo-Sing, and Moreno-Barahona (2022) evaluated a two-day immersion in the Sonoran Desert, adding a desert biome to a literature dominated by green and blue spaces. These studies, like many from the Global South, were constrained by conceptual tools inherited from Western frameworks, yet they nonetheless signaled a meaningful movement toward diversifying the field.

Building on the foundations laid by SI I—and responding to other tensions and challenges—Nature and Health SI II took a different approach. SI II retrospectively examined how other now-conventional health behaviors evolved from kernels of scientific research and diffusion by respected authorities to enter mainstream practice. Maddock and Razani traced the parallels that exist between the current status of nature and health as a public health prerogative vis-à-vis the decades-long evolution of shared awareness and, eventually, official guidance around smoking, nutrition, and later physical health (Maddock and Razani, 2024). After those paradigms, the solidifying research base in support of nature exposure today still lags in formal recognition by national health agencies. This may be in part due to popular perception that nature protection falls under the operative domain of the Department of the Interior, while the CDC and the Department of Health and Human Services are tasked with protecting health. Overcoming that bureaucratic divide is monumental. Promotion of an integrative, equitable nature-health campaign demands an interdepartmental charge, with the result that there continues to be no single unified administrative authority on this issue.

Maddock and Razani further made clear that widespread acknowledgment of nature contact as a salutogenic practice requires concrete steps to move the discipline forward from a growing national conversation toward structured actionable work, for example, establishment of named policy bureaus within government, collection of surveillance data, and regular scientific conferences. National and state governmental bureaus, funders, insurers, prescribers of physical and mental care, and nonprofit community health agencies, urban planners and educators, and not just dispersed cross-disciplinary researchers, all must realize their roles as adjunct public health practitioners to realize this leap forward. Maturation of this discipline into a legitimate sphere of policymaking will otherwise not occur, despite ever-increasing epidemiological evidence of the impact nature exposure has on health and wellness outcomes across cultural and demographic strata.

In contrast to this disciplinary scene-setting, this current SI showcases a range of reflective and practical experiments that are centered on interventions summoning active and mindful activities in nature by their program participants. Exercises to strengthen awareness in nature deliberately seek to minimize the “otherness” that perceptually arises between participant and context, emphasizing instead the relational bonds between them. The process of sharpening one’s “nature EQ” opens program participants to possibilities of deeper levels of change rooted in an admission of mutuality between nonhuman and human nature. We found this sentiment common to nearly all pilot programs, where individuals interacting with nonhuman nature felt they had a mutual obligation to and with the rest of the living world, whether designed to address emotional malaise, stress, or social isolation, whether launched for college students, trauma-afflicted individuals, black men, or travelers abroad. As an example, medical students participating in an experimental training course, which promoted spending time in [nonhuman] nature to reduce accumulating practitioner stress, felt better equipped and more likely to write nature prescriptions for patients once they themselves experienced the internalized benefits of contact outside built environments. Awareness in nonhuman nature, openness to it, and dependence on nonhuman nature became the precondition for change in these programs, be they emotional, behavioral, or empathic shifts.

“Nature immersion” at this deep level of awareness also appears to cultivate a sense of environmental responsibility manifested as pro-environmental attitudes and behaviors (PEB). Perhaps this PEB response comes from a newly found sense of nature-based kinship, dependency, mutuality, or the opposite emotional reaction of tenuousness, impermanence, and potential loss of nature as a nurturing presence. Several contributors to this collection observed nature as being an active coparticipant—cofacilitator, even—in the process of human emotional and sensory change. Such awareness transforms the historic notion of nature as the grand canvas or landscape, both figurative and literal, on which human activity plays out toward that of the protagonist. Not just the balletic stage but the principal partner in a pas de deux. The designers of nonhuman nature interventions featured in this SI converge on a singular emotional response noted among program participants that collected data fail to convey: that of reciprocity, an emotion that transcends nature connectivity as a form of mutual reliance. Furthermore, research might consider how to gauge the long-term effectiveness of nature interventions that transmit a sense of human–nonhuman nature reciprocity and in what conditions such sentiment is most likely to be sustained.

As a collection, SI III expresses an emerging realization that nature—the living continuum of which humans are a part and which also exceeds us—is not merely agentic in conferring health benefits. Rather, positive health outcomes arise through relationship: through the ways humans engage with, respond to, and are met by the rest of the living world. Often explained in terms of the human biophilic response, human health depends on stable planetary health to make us whole. Nowhere is this more urgent than in nature-deficient urban contexts where relational nonhuman nature contact finds few enabling conditions to flourish. Programmatic interventions such as those described here demonstrate that the individual nonhuman nature experience demands intentional cultivation, precisely because our urbanized society has restricted biodiversity from our routine societal existence. Nature has come to be treated as a destination rather than a home—both a place and a way of being. Recasting home in this fuller sense, in ways that invite pluralistic responses and meaningful public engagement, underscores the central policy-advisement role of applied researchers working to expand relational opportunities with the rest of the planet. Such opportunities take root in functional, well-balanced ecosystems that stand in stark contrast to the ecological disruptions of most contemporary cities.

The emergence of the Nature and Health Alliance (NHA) reflects a growing recognition that advancing the nature and health field requires coordinated, transdisciplinary efforts. Its early development, including strategic planning processes initiated in 2023, introduced a rotating leadership model designed to ensure diverse regional perspectives and support a more inclusive national agenda. The establishment of the NHA is strengthening collaboration across the United States and expanding internationally, broadening the field’s conceptual and methodological horizons. Within this broader trajectory, the 2025 Nature and Health Conference, at which this SI was launched, represented an important milestone. Notably, a group of scholars within the Alliance is currently developing a renewed research agenda for the field, building on and extending the influential agenda previously articulated by Frumkin and colleagues (Frumkin et al., 2017).

The Alliance has also emphasized the need for justice, inclusivity, and meaningful engagement with communities historically underserved in nature–health research and practice. From the perspective of this SI, meeting this need requires moving beyond the long-standing emphasis on equitable access and health benefits of nature to cultivating forms of agency grounded in reciprocity and relational responsibility—an orientation that foregrounds not only what “nature” offers humans but also what people can offer the nonhuman world. We see this work, which we hope will be amplified through the NHA platform, as a key forum for advancing the transformative potential of the nature and health field and for catalyzing collaborative efforts aligned with a pluriversal and justice-oriented vision.

What This Collection Brings to the Field

This SI brings together contributions that illuminate the field from multiple vantage points. We received articles from academics, practitioners, and community builders from different parts of the world and from diverse disciplinary backgrounds. Taken together, these pieces do not fall along with clear categorical lines; instead, they present a set of interwoven elements that emerge across the collection, including conceptual analyses, empirical work, community-based interventions (with one centering historically underrepresented voices), narrative accounts, and practitioner reflections. What links them is not a single theoretical framework but a shared orientation toward relationality and plurality.

We are honored to introduce a collection of ten articles that attest that the nature and health field is dynamic and evolving fast. But before, and aligning with the spirit of this collection, we briefly situate ourselves. As editors, we come to this work from distinct disciplinary, cultural, and lived perspectives. Carlos Andres Gallegos-Riofrío approach this work as an Ecuadorian, Andean, Spanish speaker, and transdisciplinary scholar working at the intersections of planetary health, agroecology, and Indigenous Knowledge Systems, with two decades of embodied experience collaborating with rural and historically underserved communities; and Linda Powers Tomasso, as a US Government policy-maker turned academic, connects environmental sustainability to public health and cultural antecedents to downstream nature exposure. Her personal journey of physical therapy in outdoor nature after paralysis in early adulthood orients her to the instrumental value of nature for health recovery.

We acknowledge the perspectives that informed how we engaged these pieces and wove this introduction together. Hence, we sought to create a more dialogic and relational editorial process: we invited authors to share one or two key insights they hoped readers would carry forward—reflections capturing the heart of their contribution (in Italic below). We received responses from all contributors, individually or collectively, and we integrate their insights here, in their own terms, alongside our interpretations and uplifting the thoughtful work of the reviewers. These layers form a collective narrative.

We have organized these ten articles in a way that first foregrounds the theoretical foundations of this perspective through two conceptual framings: Saltonstall’s (2026) Feeling the Ache of Earth and Usha Varanasi’s and Kathleen Wolf’s Cultivating Reciprocity, which together pose a relational balancing act between nonhuman nature, human health provisioning, and the recognition of their shared fragility (Varanasi and Wolf, 2026). The third piece, Taylor Berrett’s (2026) Making the Natural Personal, is a compelling and eye-opening commentary that explores how the interpersonal scale can serve as a doorway into deeper forms of human–nonhuman relationality.

This first block’s orientation demonstrates that “nature and health” cannot be reduced to exposure effects or universal mechanisms alone. Instead, they invite us to approach the field as a relational, culturally situated, and historically entangled domain of inquiry, where health emerges from exchanges, responsibilities, memories, and embodied experiences, all interacting complexly and not solely from environments or interventions.

We follow with two articles that present two sides of the same coin: co-opting nature as a source of stress reduction by and for medical practitioners. The first article by Stryer, Chen, Zarr, and Maddock (2026), Health Care Provider Behaviors and Characteristics that Are Associated with Issuing Nature Prescriptions, investigates through survey research the reinforcements and barriers underpinning the likelihood of medical doctors to prescribe nature contact as a form of patient treatment. The second article, Cassie Eno and Jack Phillips’ Healing in Nature: A Retreat-based Course for Fourth Year Medical Students, anticipates the stress inherent in the medical profession for providers, not patients (Eno and Phillips, 2026). The effectiveness of a nature-based pilot intervention designed for current medical students is presented with participant feedback.

Four articles then discuss and analyze the outcomes of ad hoc nature immersion programs designed for specific participant groups. The first, Nature from my perspective, collaborates with the “Boyz in the Woods” organization to look at nature outings from the perspective of black men. The second, Out of the Clinic and into the Woods, considers the effectiveness of outdoor rock climbing in California for individuals with PTSD. The third, Development and Impact of a College Peer-Based Outdoor Wellness Program, regards a peer-led outdoor wellness intervention to improve the mental health of college students. Finally, Act with Nature intervention supporting planetary wellbeing, links the intentional cultivation of pro-environmental attitudes to future tendencies to activate pro-environmental behaviors.

This final selection, Where the Rocks Grow: A Photovoice Exploration of Student Study Abroad Experiences Through Deep Ecology by Brown (2026), is a qualitative study of a group of study abroad college-aged students and their attitudes which emerge from intensive environmental immersion in the context of Norwegian friluftsliv. The use of in-situ photovoice enhances this research.

Conclusions and Pathways Forward

Across diverse cultural, disciplinary, and ecological contexts, relationships between people and the nonhuman world continue to shape and reshape how we understand health, healing, belonging, and—perhaps more fundamentally—ourselves. These relationships remind us that we are not isolated entities but participants in what Maturana and Varela (2012) describe as autopoietic networks: dynamic, self-creating systems whose identities emerge through continuous interactions with their environments. In this sense, conceptual entities such as health and nature, ultimately expressions of relationships, illuminate our place within the larger flow of interconnections that sustain life and through which life continually recreates itself.3

Together, the articles in our collection underscore that the future of nature and health scholarship lies not in narrowing our lens but in deepening and pluralizing it: embracing methodological diversity, honoring community authority, and acknowledging that health is fundamentally relational. By situating each contribution on the vast planetary proscenium, we all are part, this SI aims to broaden the conversation about what it means to live, heal, and thrive within an interconnected world.

Building on this theme and shared inquiry about relationships with the nonhuman world, the articles collectively gesture toward questions that the field must continue to engage: How do different communities, geographies, and histories understand and enact relationships with the nonhuman world? In what ways do these relationships support human and ecological health, and how do structural inequities, epistemological blind spots, and ongoing forms of exclusion diminish these supportive relational dimensions? What concepts, methods, and practices are required for the nature and health field to more fully reflect the world’s cultural, ecological, and ontological diversity?