Well Connected

Connection to the Natural World via Therapeutic Landscapes

© Elizabeth R Mackenzie, PhD

The art of healing comes from nature, not from the physician.
Therefore the physician must start from nature, with an open mind. – Paracelsus

Daoist Landscape Arts

Many cultures throughout history have understood the connection between nature and healing. People intuitively – or perhaps instinctively – gravitate to natural settings when seeking peace, comfort, solace, and regeneration. Now, researchers are beginning to explore the myriad ways in which nature can be healing for both individuals and communities.

Urban garden and farm programs may have the potential to play a key role in public health promotion, particularly in underserved communities. Gardens have many therapeutic dimensions. They may function as tools for remediation of blighted neighborhoods, sources of sustenance and empowerment, and oases of sanity and serenity in an otherwise hostile and forbidding terrain. The literature discusses such benefits as obesity prevention, improved nutrition, increased physical activity, building social capital, community empowerment, collective efficacy, jobs training, food security, violence prevention stress reduction, and environmental stewardship (Brown and Jameton 2000). A cadre of researchers has begun to explore the critical importance of salutogenic environments or therapeutic landscapes to human health using innovative and interdisciplinary approaches (Thompson, Aspinall and Bell 2010).

Physical Health Promotion

The benefit of urban farms and gardens as sources of good nutrition has been well documented. Persons who participate in community gardens consume more fruits and vegetables (Alaimo et al. 2008). Children and youth exposed to garden-based nutrition education programs show an increased willingness to eat fruits and vegetables (Robinson-O’Brien et al. 2009; McAleese and Rankin 2007). Sustainable agriculture, with an emphasis on smaller, local farms – particularly in the urban and peri-urban environment – can have a significant impact on food systems and health disparities (Story et al. 2009). Since improved nutrition is correlated with a myriad of health benefits, including obesity and diabetes prevention (Lombard et al. 2006) that aspect alone is a strong argument supporting the public health benefits of urban gardens and farms. Furthermore, gardening and farming activities provide a significant level of physical activity in a safe environment, an important consideration for built environments that do not support outdoor physical activity (due to crime, violence or traffic).

Mental Health Promotion

Evidence suggests that participating in a garden or farm program can reduce psychological stress, enhance mood and promote self-esteem. In fact, the field of horticultural therapy is dedicated to documenting and promoting the therapeutic dimension of gardening, and numerous horticultural projects have been implemented in institutional settings for the express purpose of therapy and rehabilitation (e.g., hospitals, nursing homes, schools, and prisons) (Matsuo and Relf 1995).

Emerging clinical evidence points to the therapeutic potential of gardens and green space. A prospective study of therapeutic horticulture was found to significantly decrease depression in a population of clinically depressed adults (N-18) (Gonzales et al 2010). Another study found that gardening reduced the effects of acute stress in 30 adults (using measures of salivary cortisol and self-reported mood) (Van den Berg and Custers 2010). Additional new research findings suggest that “green exercise” (physical activity in natural settings) results in significantly improved mood and higher self-esteem (Barton and Pretty 2010; Pretty et al. 2005). Barton and Pretty (2010) conducted a meta-analysis with a total of 1252 participants and found that exercising in nature resulted in statistically significant increases in both mood (p<0.00001) and self-esteem (p<0.00001). The authors conclude that “green space is important for mental health and regular engagement is linked with longevity and decreased risk of mental ill-health” (Barton and Pretty 2010).

Community Health Promotion

At the community level, health promotion benefits of gardens and farms include increased community cohesion (Wakefield et al 2007), community empowerment and civic pride (Twiss et al 2003), social well-being (McCormack et al 2010) and collective efficacy (Teig et al 2009). Some evidence suggests that community gardens can also have a meaningful impact on the overall food/nutritional environment of low-income (inner city) populations (Cyzman et al 2009; McCormack et al 2010).

Conclusion: The Healing Power of Nature (Vis medicatrix naturae)

The word “paradise” is derived from an Old Persian word for a walled garden.  Such oases have historically been associated with healing both mind and body, and centers of healing included medicinal herb gardens until recent times.  The need for places of natural beauty where people can go to restore themselves has never been greater. As the population of urban areas continues to increase, it is crucial for health policy and urban planning to come together to ensure sufficient green space in cities to support human health in a way that contributes to body-mind-spirit coherence. Hippocrates, the father of modern medicine, notes that nature itself has the power to heal, referenced by the Latin phrase, vis medicatrix naturae.  Let us remember this ancient wisdom as we consider ways to improve the health of populations in the 21st century.

Bibliography of Works Cited

Alaimo, Packnett, Miles and Kruger (2008) “Fruit and Vegetable Intake among Urban Community Gardeners” Journal of Nutrition Education and Behavior 40(2):94-101.

Barton and Pretty, (2010) “What is the best dose of nature and green exercise from improving mental health? A multi-study analysis” in Environmental Science and Technology 44 (10): 3947-3955.

Brown and Jameton, (2000) “Public Health Implications of Urban Agriculture” in Journal of Public Health Policy, v. 21, n. 1, pp. 20-39.

Cyzman, Wierenga and Sielawa (2009) “Pioneering Healthier Communities, West Michigan: A Community Response to the Food Environment” in Health Promotion Practice v. 10, n. 2, 146S-155S.

Gonzales , Hartig, Patil, Martinsen and Kirkevold (2010) “Therapeutic horticulture in clinical depression: a prospective study of active components” Journal of Advanced Nursing [e-publication in advance of printing] doi:10.1111/j.1365-2648.2010.05383.x

Lombard, Forster-Cox, Smeal, and O’Neill (2006) “Diabetes on the Navajo nation: what role can gardening and agriculture extension play to reduce it?” Rural and Remote Health, 6:640 (online)

Matsuo and Relf (1995) Horticulture in Human Life, Culture, and Environment, A National Symposium (proceedings), Acta Horticulturae, IHC, Proceedings Number 391.

McAleese and Rankin 2007) “Garden-based nutrition education affects fruit and vegetable consumption in sixth-grade adolescents” in Journal of the American Dietetic Association 107(4):662-5.

McCormack, Laska, Larson, and Story (2010) “Review of Nutritional Implications of Farmers’ Markets and Community Gardens: A Call for Evaluation and Research Efforts” in Journal of the American Dietetic Association 110:399-408.

Pretty, Peacock, Sellens, and Griffin (2005). “The mental and physical health outcomes of green exercise” in International Journal of Environmental Health Research, 15(5):319-37.

Robinson-O’Brien, Story, and Heim (2009) “Impact of garden-based youth nutrition intervention programs: a review” Journal of the American Dietetic Association 109(2):273-80.

Story, Hamm and Wallinga (2009) “Food Systems and Public Health: Linkages to Achieve Healthier Diets and Healthier Communities” Journal of Hunger and Environmental Nutrition 4:219-224.

Teig, Amulya, Bardwell, Buchenau et al (2009) “Collective efficacy in Denver Colorado: Strengthening neighborhoods and health through community gardens” in Health & Place, 15: 1115-1122.

Thompson, Aspinall and Bell (2010) Innovative Approaches to Researching Landscape and Health. London: Routledge.

Twiss, Dickinson, Duma, et al (2003) “Community Gardens: Lessons Learned from California Healthy Cities and Communities” in American Journal of Public Health, 93(9):1435-1438.

Van den Berg and Custers (2010) “Gardening promotes neuroendocrine and affective restoration from stress” in Journal of Health Psychology, [e-publication ahead of print]

Wakefield, Yeudeall, Taron, Reynold and Skinner (2007), “Growing urban health: Community gardening in South-East Toronto” in Health Promotion International, 22:2 (92-101).

Elizabeth Mackenzie, PhD a lecturer in the Health and Societies Program at the University of Pennsylvania, Associate Fellow of the Center for Public Health Initiatives, and an Associate Fellow of the Institute on Aging. Currently teaching humanistic and holistic medicine and a consultant for eMindful, Inc., www.eMindful.com, an on-line wellness resource, she is the author of “Healing the Social Body: a Holistic Approach to Public Health Policy”, numerous journal articles, and several book chapters. She is also co-editor of “Complementary and Alternative Medicine for Older Adults”, a collection of articles on holistic approaches to healthy aging. Her most recent article, “The Role of Mindfulness in Health Care Reform” was published in Explore: the Journal of Science and Healing. In addition, Dr. Mackenzie is a Reiki practitioner, a long-time student of yoga, and Qigong, and section editor for All Things Healing, www.AllThingsHealing.com

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