Let Nature Be Thy Medicine: A Socioecological Exploration of Green Prescribing in the UK

Abstract

Prescribing nature-based health interventions (green prescribing)-such as therapeutic horticulture or conservation activities-is an emerging transdisciplinary strategy focussed on reducing noncommunicable diseases. However, little is known about the practice of, and socioecological constraints/opportunities associated with, green prescribing in the UK. Furthermore, the distribution of green prescribing has yet to be comprehensively mapped. In this study, we conducted a socioecological exploration of green prescribing. We deployed online questionnaires to collect data from general practitioners (GPs) and nature-based organisations (NBOs) around the UK and conducted spatial analyses. Our results indicate that GPs and NBOs perceive and express some common and distinct constraints to green prescribing. This highlights the need to promote cross-disciplinary communication pathways. Greenspace presence and abundance within close proximity (100 and 250 m) to GP surgeries (but not greenness-as a proxy for vegetation cover) and NBO presence within 5 km were associated with higher levels of green prescribing provision. Lower levels of deprivation were associated with higher frequency of NBOs. This suggests that the availability of greenspaces and NBOs could be important for green prescribing provision, but there could be greater opportunities in less deprived areas. Important foci for future research should be to establish transdisciplinary collaborative pathways, efficient infrastructure management and a common vocabulary in green prescribing-with the overall aim of reducing inequalities and enhancing planetary health.

Keywords: biodiversity; green prescriptions; greenspace; mental health; nature connectedness; nature-based interventions; noncommunicable diseases; planetary health; upstream health interventions; urban nature.

Figure A1

Green prescribing questionnaire for GPs.

Figure A2

Green prescribing questionnaire for NBOs.

Figure 1

Green prescribing web scrape search method for nature-based organisations. Search terms are shown on the left, and a count breakdown of UK counties per country on the right.

Figure 2

Example of buffer zones created around each point file containing attribute data (spatial information and questionnaire responses) for GPs and nature-based organisations in the UK.

Figure 3

Example of Lower Super Output Areas (LSOAs) (boundaries) with Index of Multiple Deprivation (IMD) scores using ‘categorised’ symbology in QGIS.

Figure 4

Example of buffer zones around GP surgeries with a visual representation of the Normalised Difference Vegetation Index (NDVI). The mean values within these buffers was calculated and exported for further analysis. The whole of the UK was overlaid with the NASA Landsat 8 tiles to facilitate NDVI calculations.

Figure 5

Provision of nature-based health interventions (green prescriptions) in the UK based on the questionnaire responses. This figure shows the location and distribution of responses to the question “Does your GP surgery provide green prescriptions?” (or a similar question for nature-based organisations).

Figure 6

Waffle charts showing what GPs consider to be the key constraints to green prescribing. These charts show proportions with actual response counts and corresponding percentages below. The proportions are presented in descending order (i.e., of response frequency) from top left to bottom right.

Figure 7

Waffle charts showing what nature-based organisations consider to be the key constraints to green prescribing. These charts show proportions with actual response counts and corresponding percentages below. The proportions are presented in descending order (i.e., of response frequency) from top left to bottom right.

Figure 8

UK map of counties showing count (n = 714) and distribution of nature-based organisations which currently (or have the potential to) provide green prescribing activities (inlets show counts/distribution for individual activities). The quantitative differences in values are presented using graduated symbology and an appropriate colour ramp. This was processed in QGIS.

Figure 9

Boxplot showing differences in greenspace abundance within the 100 m buffer zone around GP surgeries that did (green) and did not (red) prescribe nature-based interventions. The maximum number within 100 m of any practice was n = 4. The violin plots show kernel density estimation, i.e., representing the distribution shape of the data and the points have a small amount of random variation (jitter) to reduce over-plotting.

Figure 10

Box and violin plot showing differences in greenspace abundance within the 250 m buffer zone around GP surgeries that did (green) and did not (red) prescribe nature-based interventions.

Figure 11

Boxplots showing mean NDVI scores for each buffer zone (50 m–1000 m) around GP surgeries that either did prescribe nature-based interventions (GRx = Yes) or did not (GRx = No).

Figure 12

Output of X² results: The frequencies of nature-based organisations (NBOs) were significantly different between areas with different levels of deprivation (based on UK IMD quintile scores), where 1 = least deprived and 5 = most deprived. Note, n = 53 NBO records contained zero IMD data.

Figure 13

Output of X² results: the frequencies of NBOs were significantly different between areas with low and high levels of deprivation (based on converting UK IMD quintile scores into low- and high-deprivation categories).