Stakeholders need to leverage research, shared language, partnerships to propel park prescriptionsPark Prescriptions is a grassroots movement in which health care professionals prescribe patients time in parks to improve their physical and mental health. The parks prescription movement is both growing and global. However, the movement largely lacks coherence because its practitioners and stakeholders span unrelated fields—health care providers, public health, exercise professionals, recreational professionals, and community members—and different disciplines, such as medicine and parks and recreation. This article provides an historical perspective, literature review, and critical analysis of park prescriptions to support interdisciplinary discussion and a unified research agenda to propel the park prescriptions movement. Situated in the field of parks and recreation, a key goal of the paper is building a bridge between health care professionals and parks and recreation professionals through the growing park prescriptions movement.
Methodologically, this study is a literature review in which parks and recreational researchers cited relevant research from several disciplines to provide (1) an historical perspective on the park prescription movement, (2) empirical evidence of the success of park prescriptions, and (3) critiques of park prescriptions and recommendations for the future.
Medical professionals often see nature prescriptions as a recent health care trend. In the historical section, however, the literature review identified historical antecedents of physicians prescribing nature in ancient Greece (Hippocrates), Rome (Galen), and India (Susruta) and later with 19<sup>th</sup> century Victorian philanthropists and medical professionals. Over the past fifty years, the movement has grown with non-medical prescriptions for food, books, and physical activity; social prescriptions that link primary care to community programs; grassroots collaborations among insurance providers, medical practitioners, non-profits, professional organizations, and municipalities; and, more recently, the prescription trails, green time, Exercise is Medicine, Children & Nature Network, Vitamin N, Recreation RX, and Nature RX movements. Next, this 2019 review characterizes the evidence base of park prescriptions as mixed and somewhat limited. Research is more anecdotal than experimental, focused on adults (not children), emphasizes physical health over mental health, and often neglects patients’ motivation and behavioral change while privileging health outcomes. In the critical analysis section, the review addresses some healthcare providers’ skepticism towards park prescriptions, tensions between preventative park prescriptions treating immediate medical issues, doubts about patients’ compliance and motivation to change their behavior, and physicians lacking the specialized knowledge of parks and recreational professionals to steer patients towards appropriate activities and support their physical activity. Based on these critiques, the review calls for more randomized controlled trials to provide medical professionals with the types of evidence they find most valuable, stronger collaborations between medical professionals and parks and recreation professionals, and a focus on shared language to build a coherent, cross-sectional movement and encourage public use of nature prescriptions.
Overall, the study calls for national support of park prescriptions based on cross-sector collaborations and interdisciplinary alliances. In the authors’ view, many stakeholders have similar goals but have not leveraged each other in ways that benefit a broader movement to normalize non-medical prescriptions for more nature time and outdoor activity. Medical professionals and parks and recreation professionals crossing departmental, disciplinary, and professional lines could potentially make park prescriptions an accepted medical treatment while demonstrating the park and recreation field’s contributions to health and well-being. Finally, they argue that the parks prescription movement might model itself on the pharmaceutical industry to shift perceptions of nature-based interventions—that is, by focusing on a specific health treatment, conducting extensive research, having a shared language between professions, developing lobbying efforts for insurance practices, facilitating high-level partnerships, promoting a cohesive marketing campaign, and utilizing trained park prescription representatives and approved programs.
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