The economics of nature’s healing touch: A systematic review and conceptual framework of green space, pharmaceutical prescriptions, and healthcare expenditure associations

Abstract

Green spaces play a crucial role in promoting sustainable and healthy lives. Recent evidence shows that green space also may reduce the need for healthcare, prescription medications, and associated costs. This systematic review provides the first comprehensive assessment of the available literature examining green space exposure and its associations with healthcare prescriptions and expenditures. We applied Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to search MEDLINE, Scopus, and Web of Science for observational studies published in English through May 6, 2023. A quality assessment of the included studies was conducted using the Office of Health Assessment and Translation (OHAT) tool, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) assessment was used to evaluate the overall quality of evidence. Our search retrieved 26 studies that met the inclusion criteria and were included in our review. Among these, 20 studies (77% of the total) showed beneficial associations of green space exposure with healthcare prescriptions or expenditures. However, most studies had risks of bias, and the overall strength of evidence for both outcomes was limited. Based on our findings and related bodies of literature, we present a conceptual framework to explain the possible associations and complex mechanisms underlying green space and healthcare outcomes. The framework differs from existing green space and health models by including upstream factors related to healthcare access (i.e., rurality and socioeconomic status), which may flip the direction of associations. Additional research with lower risks of bias is necessary to validate this framework and better understand the potential for green space to reduce healthcare prescriptions and expenditures.

Nature-based allied health: current practice, challenges and opportunities

“…There is increasing evidence that supports the health benefits of exposure to nature [1][2][3][4][5][6][7][8][9][10][11][12][13], and engaging in nature-based activities [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Allied health professionals (AHPs) can play an important role in improving people's access to and use of nature, by working with individual patients/clients, communities and from a broader public health perspective, including advocacy for and input into the design of public natural environments.…”

“…While there has been a shift away from healthcare settings in nature, there has been an increase in research into the benefits of exposure to nature (e.g. green [1][2][3][4][5][6][7][8][9][10][11][12][13] and blue spaces [2,10,13]), and nature-based activities to improve health and wellbeing [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Allied health professionals are well placed to integrate NBAs -by encompassing outdoor and indoor nature-based activities which may be recommended or directly engaged in with the patient/ client, and advocacy for or the provision of improvements to natural spaces -into their practice.…”