Greening healthcare: practicing as if the natural environment really mattered.

OBJECTIVE: The natural world's role in human well-being is an essential, yet often forgotten, aspect of healthcare. Of particular importance are the benefits one can derive through interaction with natural environments. While health is an obvious goal of allopathic medicine, many healthcare settings are neither nurturing nor healing. Reincorporating the natural world into the design of settings in which medicine is practiced is one way to complement conventional healing modalities and move healthcare toward being more "green." This article discusses the breadth of existing knowledge available on the positive aspects of interaction with nature and provides a comprehensive theoretical perspective for future research. DATA SOURCES: Computerized searches were conducted using MEDLINE, PsycINFO, the Social and Scientific Science Indices, Dissertation Abstracts, Lexus-Nexus, the University of Michigan library, and the Internet. Searches were conducted from June 2001 through March 2002. STUDY SELECTION: Keywords used included health, well-being stress, attention, nature, garden, landscape, restorative, and healing. The literature, published between 1960 and 2001, came from various disciplines, including medicine, public health, nursing psychology, natural resources, history, and landscape architecture. Four components of well-being were used as a framework for literature selection: physical psychological-emotional social, and spiritual. DATA EXTRACTION: Articles were qualitatively reviewed to extract theories, hypotheses, and experimental evidence. DATA SYNTHESIS: Interaction with nature positively affects multiple dimensions of human health. Physiological effects of stress on the autonomic nervous system are lessened. Psychologically, deficits in attention can be restored or minimized, and people report feeling greater satisfaction with a variety of aspects of life. The presence of the natural world promotes social health by encouraging positive social interaction and lessening the frequency of aggressive behavior. Spiritual well-being is enhanced through the experience of greater interconnectedness, which occurs when interacting with the natural world.
CONCLUSIONS: The literature reviewed provides evidence to support the intuitive belief that interaction with the natural world is a vital part of biopsychosocial-spiritual well-being. Incorporating the natural world into healthcare could provide health benefits and improve the design of healthcare facilities. Applied more broadly to society, this knowledge may change the way we approach public health, guard and manage natural resources, and design environments for human use.