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Take a hike. Really. A new evidence-based nature prescription program catches on in Canada.

The Joule Innovation grant program offered funding, professional support and mentorship to physicians and medical learners making a difference in health care. This is part of a series of stories about the 2020 recipients and their innovations.

Growing up in suburban Toronto, Dr. Melissa Lem often felt most at home outdoors  — exploring the backyard garden, playing in her treehouse or climbing trees at the park.

“Nature was a place where I felt safe and where I could really connect.” — Dr. Melissa Lem, director, PaRx

As an adult, spending time in nature helped her cope with the stresses of residency and, later, the intense workload of rural family practice in northern BC.

But it wasn’t until Dr. Lem moved back to Toronto that she realized the correlation between nature and her own well-being.

“I remember sitting in my apartment and hearing the noise of the city and seeing skyscrapers out my window and thinking, ‘The work here is so much easier, so why do I feel stressed out?’” she recalls.

“And it dawned on me — I’m missing nature.”

Building a movement around nature and health

In 2010, Dr. Lem was one of the few physicians in Canada talking about how good nature was for people’s mental and physical health. She wrote blogs about the research evidence for several “green” organizations, including the David Suzuki Foundation, and was soon invited to speak at conferences and in the media.

At the same time, climate-related events such as storms, droughts and wildfires were having an increasingly negative impact on Canadians’ health. The stress related to these events, as well as uncertainty about the future of the planet, were contributing to a costly mental health epidemic.

Dr. Lem began hearing about a grassroots movement in the United States that encouraged physicians to prescribe “parks” to patients to improve their health. Dr. Lem thought about starting something similar in Canada.

After she moved to Vancouver in 2015, she connected with the BC Parks Foundation, which was also interested in developing a prescription initiative. Together, in November 2020, they launched PaRx — Canada’s first evidence-based nature prescription program.

In less than a year, the program has expanded to Ontario and Saskatchewan, and 900 licensed health care professionals — doctors, nurses, physiotherapists — have registered.

“We have the potential to improve patients’ health status, reduce costs to the health care system and grow a body of people who will be more engaged environmental advocates.”

Giving patients permission to prioritize nature

Dr. Lem has seen the value a nature prescription can add to a patient’s treatment plan.

Just before the launch of PaRx, she was treating a patient who had moved from Europe to BC during the pandemic. The woman, once an avid hiker, was struggling with her mental health and feeling disconnected in her new surroundings. Dr. Lem prescribed her an antidepressant and suggested other lifestyle changes, with minimal initial effect. Once the PaRx program was “live,” Dr. Lem wrote her a prescription for time spent in nature and was amazed at the result.

“Her words to me were ‘I’m shocked at the progress I’ve made,’” Dr. Lem recounts. “It could have been a combination of the medication and her time in nature, but she said, ‘I’m making it a priority to head out into green space every week, multiple times a week, and I’m feeling so much better.’”

In addition to anecdotal evidence, research suggests that spending time in nature can have a wide range of positive effects on human health — from reducing the burden of chronic disease to improving birth outcomes.

Dr. Lem and her son on Cortes Island, BC.

To achieve the greatest health benefits, PaRx recommends doctors prescribe at least two hours per week in a natural setting for at least 20 minutes at a time.

Prescribing nature can mean anything from planting a garden or taking a hike, to sitting on a flower-filled balcony in urban areas — whatever activity the patient finds meaningful and practical.

“When you give someone a prescription for nature, it allows them to say, ‘Hey, I actually need this for my health. I’d better do what my doctor says,’” explains Dr. Lem.

Creating a sustainable health system

With her $50,000 Joule Innovation grant, Dr. Lem is building an app that will incentivize and track the time people spend in nature. It will also allow her team to scale PaRx across Canada and create a CME-accredited online module to train doctors to effectively prescribe nature as a health remedy.

Dr. Lem’s ultimate goal for PaRx — one that reflects her role as president-elect of the Canadian Association of Physicians for the Environment — is to contribute to a sustainable health care system.

“We want to improve health on a population level, and by connecting people to nature, get them interested in helping out the planet in other ways.”

The 2020 Joule Innovation grant program provided $500,000 to support physician-led innovations in the areas of sustainable health care, physician health and wellness, health care solutions and access to care.

Read about the other innovations funded through the program:











About the author(s)

CMA Joule supports physicians and medical learners in the pursuit of clinical excellence. As a subsidiary of the Canadian Medical Association (CMA), we support the profession with continuing education and other learning opportunities as well as leading evidence-based clinical products and research.