Human health is increasingly shaped by the environments in which people live, work, learn, receive care and age. In the twenty-first century, these environments are predominantly urban and built. Cities concentrate education, healthcare, innovation, economic opportunity and social interaction; at the same time, they also concentrate many environmental determinants of disease, including air pollution, noise, heat islands, sedentary lifestyles, psychosocial stress, social isolation, biodiversity loss and reduced daily contact with natural environments [1,2,3].
This transition requires a broader understanding of environmental medicine. The discipline cannot be limited to the identification and mitigation of harmful exposures. It must also investigate, protect and intentionally promote salutogenic exposures: environmental conditions that support physiological regulation, psychological restoration, immune resilience, social connection, physical activity and healthy behaviour. Within this framework, nature should not be understood only as scenery, amenity or recreation. It should be recognized as a positive determinant of health and as a measurable component of prevention and care [2,3].
Nature prescriptions are emerging internationally as a relevant interface between clinical practice, public health, environmental psychology, urban planning, green infrastructure and ecological health. The term refers to structured recommendations, often initiated by healthcare professionals or allied health and community professionals, for regular, meaningful and safe contact with natural environments as part of health promotion, prevention or care pathways [4,5,6]. Nature prescriptions may include walking in parks, spending time in urban forests, visiting blue spaces, engaging in community gardening, participating in nature-based social prescribing activities, practising mindful contact with nearby green areas, or integrating repeated nature exposure into daily routines.
The terminology deserves precision. In the peer-reviewed literature, “nature prescriptions” is widely used to identify the intervention or programme category, while “nature prescribing” is commonly used to describe the clinical, public-health and implementation process. The expression “natural prescription” appears in some contexts, but it is less specific and may be confused with general non-pharmacological or natural-product interventions. For this reason, this editorial uses “nature prescriptions” in the title and throughout the text when referring to the intervention field, while retaining “prescribing” only when describing the act or process of recommending nature exposure.
The scientific rationale for nature prescriptions rests on converging bodies of evidence. The biophilia hypothesis proposed that human beings possess an evolved tendency to affiliate with life and life-like processes [7]. Stress Reduction Theory suggests that certain natural environments may support rapid psychophysiological recovery from stress through affective and autonomic pathways [8]. Attention Restoration Theory proposes that natural environments can restore directed attention by engaging effortless forms of attention and reducing cognitive fatigue [9]. These theories do not imply that nature is universally therapeutic in every context or for every individual. Rather, they provide biologically and psychologically plausible models for understanding why the loss of everyday contact with natural systems may contribute to the burden of urban disease.
More specific evidence on nature prescription programmes is developing. Kondo et al. reviewed the evidence base for nature prescription programmes and identified the need for stronger evaluation of clinical, behavioural and implementation outcomes [4]. A systematic review and meta-analysis published in The Lancet Planetary Health reported that nature prescription interventions were associated with improvements in blood pressure, depression and anxiety scores, and physical activity, while also noting limitations related to study quality, heterogeneity, risk of bias and the need for more rigorous trial designs [5]. A recent scoping review of nature prescriptions offered by healthcare providers similarly highlighted the promise of the field, but emphasized that prescription content, provider training, implementation pathways and outcome measures remain insufficiently standardized [6].
Nature prescriptions are no longer only a theoretical concept. They are becoming an international public-health and healthcare implementation practice.
In Canada, PaRx, led by the BC Parks Foundation, is described as Canada’s national nature prescription programme and equips healthcare professionals to prescribe time outdoors as part of everyday care [10]. In Scotland, RSPB Scotland developed Nature Prescriptions in collaboration with NHS partners, beginning with the Shetland pilot and later expanding to other areas [11]. In England, green social prescribing is part of NHS personalised care and supports people to engage in nature-based interventions and activities to improve mental and physical health, usually through social prescribing link workers and community referral pathways [12]. In the United States, ParkRx initiatives and Park Rx America provide resources for healthcare professionals and community partners to connect patients with parks and natural areas through structured nature prescriptions [13]. In Italy, Nature Prescriptions Italy is positioned as an AIB-led framework, with the Italian Academy of Biophilia (AIB) providing the national reference in biophilia, biophilic design, environmental psychology, education, consulting and scientific outreach for human-nature reconnection [14]. The principal international models and initiatives related to nature prescriptions are summarised in Table 1.
Table 1.
Principal international models and initiatives related to nature prescriptions.
Epidemiological evidence has consistently associated green-space exposure with multiple health outcomes, although effect sizes, mechanisms and causal certainty vary across studies. Reviews by the World Health Organization Regional Office for Europe have linked urban green spaces with benefits for mental health, cardiovascular health, obesity, pregnancy outcomes, physical activity, social cohesion and mitigation of heat, air pollution and noise [2,3]. A systematic review and meta-analysis by Twohig-Bennett and Jones found that higher green-space exposure was associated with lower salivary cortisol, heart rate and diastolic blood pressure, as well as lower risk of type 2 diabetes, cardiovascular mortality, all-cause mortality and preterm birth [15]. White et al. reported that spending at least 120 min per week in nature was associated with higher probabilities of self-reported good health and high well-being [16]. Hunter et al. found that 20–30 min of nature exposure were associated with efficient reductions in salivary cortisol in daily life [17].
This caution is essential. Nature prescriptions should not be presented as substitutes for pharmacological treatment, psychotherapy, rehabilitation, surgery or specialist care when these are clinically indicated. They should never encourage patients to discontinue prescribed medication without medical supervision. Their correct position is complementary and preventive. Nature prescriptions may support self-regulation, physical activity, sleep, mood, social connection, adherence to healthier routines and reduction of selected environmental stressors. In some circumstances, regular nature exposure may contribute to a lower burden of risk factors that influence medication need, but any medication-related outcome must be assessed clinically and cautiously.
The urban-policy implication is direct: if nature is to be prescribed equitably, access to nature must be available, safe, inclusive and of sufficient quality. WHO Europe has recommended that urban residents should have access to public green spaces of at least 0.5–1 hectare within 300 m of their homes, corresponding approximately to a five-minute walk [3]. A health impact assessment of 978 European cities estimated that compliance with this recommendation could prevent up to 42,968 natural-cause deaths annually, equal to approximately 2.3% of all natural-cause deaths in the study population [18]. These findings transform green-space access from an urban-design preference into a public-health benchmark. Operational tools such as the 3-30-300 rule can support communication and monitoring, provided they complement local epidemiological assessment and equity analysis [19].
However, nature prescriptions cannot be reduced to parks alone. In dense cities, ageing societies and healthcare settings, many people experience limited mobility, safety concerns, time poverty, disability, hospitalization or lack of nearby green space. For these populations, the built environment becomes part of the prescription infrastructure. Homes, condominiums, schools, workplaces, hospitals and care facilities can either interrupt or restore daily contact with nature. This is where the fields of healthy buildings, green building and biophilic design become directly relevant to environmental medicine.
Green Building Council Italia (GBC Italia) contributes to this discussion because the health value of nature prescriptions depends not only on clinical advice, but also on the quality of the built environments that make nature contact possible. Buildings are not neutral containers of health. They shape exposure to daylight, views, air quality, acoustics, temperature, movement, social contact, vegetation, biodiversity and restorative micro-experiences. A nature-prescription strategy that ignores the built environment risks becoming inequitable, because it asks individuals to seek nature while leaving unchanged the places where they spend most of their time.
For this reason, a mature model of nature prescriptions should include both outdoor and built-environment pathways. Outdoor pathways include parks, forests, urban greenways, waterfronts, schoolyards, community gardens and peri-urban landscapes. Built-environment pathways include indoor vegetation, views of nature, accessible balconies and terraces, green roofs, therapeutic gardens, healing gardens in hospitals, green courtyards, condominium gardens, biophilic workplaces, nature-based schools and care environments designed to support restoration, orientation, daylight exposure and social connection [20,21,22,23,24,25].
The expression “indoor nature prescriptions” should be used with precision. It should not imply that indoor vegetation is equivalent to biodiverse outdoor ecosystems. Rather, it identifies a complementary and pragmatic strategy: when outdoor nature access is limited, clinically and environmentally informed recommendations may include repeated exposure to indoor and semi-outdoor nature elements, provided that safety, maintenance, allergens, humidity, mould risk, accessibility and psychological meaning are considered. In this sense, indoor and building-integrated nature should be understood as part of a continuum, not as a replacement for outdoor green and blue infrastructure.
Evidence from healthcare design supports the relevance of this continuum. Ulrich’s classic study found that surgical patients with a view of trees had shorter postoperative hospital stays and used fewer strong analgesics than patients with a view of a brick wall [8]. Subsequent research on healthcare environments has examined the effects of gardens, daylight, views, noise reduction and environmental design on stress, pain, satisfaction and recovery [20,21]. Although the evidence base varies by intervention type and setting, the overall direction is clear: the physical environment can influence clinical experience and selected health-related outcomes.
The same principle applies beyond hospitals. In schools, workplaces and residential settings, contact with daylight, vegetation, natural materials, views and opportunities for outdoor micro-breaks may support attention, stress regulation, comfort and perceived well-being [22,23,24,25]. Biophilic design translates this knowledge into spatial strategies that reconnect people with direct, indirect and symbolic forms of nature [25]. These strategies should not be used as decorative claims. They require measurable goals, appropriate maintenance, environmental quality control and alignment with broader public-health objectives.
A nature-prescription framework for environmental medicine should therefore operate across five levels. First, it should identify the person: age, clinical condition, mobility, psychological state, culture, preferences, risk factors and safety needs. Second, it should identify the exposure: type of nature, dose, frequency, duration, sensory qualities, biodiversity, accessibility, thermal comfort, air quality and social context. Third, it should identify the setting: home, school, workplace, hospital, neighbourhood, park, waterfront, forest, garden, terrace or indoor environment. Fourth, it should identify the pathway: self-directed prescription, healthcare-provider recommendation, social prescribing, community referral, rehabilitation programme, workplace health programme or urban public-health intervention. Fifth, it should measure outcomes: mental health, perceived stress, sleep, physical activity, blood pressure, adherence, medication-related outcomes where appropriate, healthcare utilization, social connection, equity, feasibility, safety and cost-effectiveness.
Several safeguards are necessary. Nature prescriptions should be tailored and risk-aware. Heat exposure, air-pollution peaks, allergens, vector-borne risks, falls, unsafe spaces, ecological anxiety, social isolation and mobility limitations must be considered. In the built environment, additional risks include poor plant maintenance, excessive humidity, mould, inappropriate species selection, inadequate ventilation and misleading health claims. Prescribing nature must not shift responsibility from public institutions to individuals. A patient cannot realistically follow a prescription for nature if the surrounding neighbourhood is unsafe, overheated, polluted, inaccessible or devoid of green space.
Italy has a specific opportunity to develop a scientifically robust and culturally appropriate model. The country combines dense historic cities, climatic vulnerability, ageing populations, strong healthcare traditions, architectural heritage, biodiversity, urban inequalities and growing interest in One Health and Planetary Health. A national approach to nature prescriptions should therefore integrate medical responsibility, environmental psychology, biophilic design, green-building expertise, urban planning, landscape architecture, public health and community-based implementation.
Within this perspective, the Italian Society of Environmental Medicine (SIMA) can provide the scientific and public-health framework required to position nature prescriptions within prevention, environmental risk assessment and clinical prudence. The Italian Academy of Biophilia (AIB) can contribute expertise in biophilia, biophilic design, environmental psychology and human-nature connection. Green Building Council Italia (GBC Italia) can support the translation of health-oriented nature access into the built environment, healthy buildings and sustainability standards. Healthy Habits Academy can contribute to behaviour-change approaches and lifestyle implementation. The integration of these perspectives is essential because nature prescriptions are not only clinical acts; they are systems interventions.
The deeper implication is that environmental medicine must move from a defensive paradigm to a regenerative one. Reducing pollution, heat, noise and toxic exposures remains indispensable. Yet health also requires the active creation of environments that support recovery, attention, movement, immune resilience, social connection and meaning. Nature is one of these environments. It is not a universal cure, and it should not be romanticized. But the evidence is strong enough to justify structured, cautious and measurable implementation.
Nature prescriptions should therefore be understood as a bridge: between clinical care and public health; between urban policy and individual prevention; between green infrastructure and healthy buildings; between biophilia and environmental medicine; between human health and ecosystem health. Their future will depend not on generic claims that nature is good, but on rigorous answers to practical questions: how much nature, what type of nature, for whom, under which environmental conditions, through which professional pathway, with which safeguards, and with which measurable outcomes? This position is aligned with the One Health perspective recently advanced in the International Journal of Environmental Medicine (IJEM), which framed nature as medicine in response to global environmental and health challenges [26].
If health is increasingly urban and built, then access to nature must become part of the right to healthy environments. Prescribing nature is not a nostalgic return to the past. It is an evidence-informed environmental medicine strategy for the century of cities, climate stress and chronic disease.
Funding
This editorial received no external funding.
Conflicts of Interest
A.M. is President of the Italian Society of Environmental Medicine (SIMA), Vice-President of the Italian Academy of Biophilia (AIB), affiliated with the University of Milan and Green Building Council Italia (GBC Italia), and serves as Editor-in-Chief of the International Journal of Environmental Medicine (IJEM). F.C. is President of Green Building Council Italia (GBC Italia). D.M. is affiliated with the Italian Society of Environmental Medicine (SIMA) and Healthy Habits Academy. D.G. is affiliated with the Italian Society of Environmental Medicine (SIMA) and the Italian Academy of Biophilia (AIB). R.W. is an Editorial Board Member of the International Journal of Environmental Medicine (IJEM), President of the Italian Academy of Biophilia (AIB), and affiliated with the Italian Society of Environmental Medicine (SIMA). The authors declare no other conflicts of interest.
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