Many programs came to a screeching halt during the COVID-19 lockdown. Nature PHL, a Philadelphia-based initiative that counsels patients on the health benefits of outdoor activity, was no exception, says Barbara Rolnick, a pediatrician at the Children’s Hospital of Philadelphia primary care location in Roxborough.
During the pandemic lockdown, green spaces had “caution tape around them” and funding slowed, she said. At the same time, she saw children’s health take a nosedive.
There was “a surge in suicidal kids and not enough people to manage it. Kids were showing up in the ER, in crisis … it was a disaster,” she said. “And we said, ‘We have to restart this. We need this more than ever.’”
The initiative rebranded in 2022 as Prescribe Outside, a cross-sector program that connects families in Philadelphia with nature to improve their physical and mental health. Funded mostly by the Pennsylvania Department of Conservation and Natural Resources, the network hosts free programs throughout the city that include nature-based crafts, hiking and other outdoor activities.
Prescribe Outside’s network consists of health providers at Children’s Hospital of Philadelphia (CHOP), land stewards at Awbury Arboretum, educators at Let’s Go Outdoors, as well as researchers at Temple University and the U.S. Department of Agriculture’s Forest Service.
It is set to host programs in Blue Bell Park, The Farm at Awbury and Houston Meadow this month. Prescribe Outside’s upcoming Walk with CHOP event in Cobbs Creek Park will take place on Dec. 13 from noon to 1:30 p.m., and participants will receive free gloves and hats. All events are free and open to the public.
The program also trains pediatric and family health providers at six of CHOP’s primary care locations, including in Chestnut Hill, to write nature prescriptions for patients, Project Manager Grace Parker said.
Also known as “green prescriptions,” providers recommend patients spend time in nature rather than provide medication. The practice of prescribing time in nature has taken off in New Zealand, the United Kingdom, Japan, and recently, the United States.
Studies show that spending time in nature can lead to a range of health benefits including as improved cognition, focus, and mood, and a healthier heart and lungs.
Prescribe Outside has written an estimated 500 nature prescriptions a year since its launch, referring patients to its list of programs based on their needs, Parker said.
Families tend to be more motivated to go outside if they join established programs versus plan their own outings, Prescribe Outside found through focus groups.
“You want to have a program that people could join into, rather than deciding everything on their own,” she said.
Apart from improving their mood and health, Prescribe Outside participants reported feeling more connected to their family members, according to Prescribe Outside’s research.
Rolnick recalled seeing one family grow closer after attending Prescribe Outside programs at Pennypack Park. The family now does its own outdoor adventures on weekends, and she’s seen a significant improvement in their overall mood.
“They’re not in a crisis. But there’s a difference between functioning and doing okay and actually feeling good,” Rolnick added. “So, I feel like this is sort of the secret sauce that people need to be adding to their life to go from just doing okay to feeling good.”
A public health necessity versus luxury
Rolnick and Megan Hood, a physician assistant at CHOP, said the healthcare industry is becoming more aware about the benefits of connecting with nature, thanks to growing research, the rise in nature prescription programs, and the impact of the COVID-19 lockdown.
But more medical professionals should treat it as a public health necessity rather than benefit, like they do with exercise and eating healthy, they said.
The amount of time American children spend playing outdoors has declined by 50% over a generation, University of Michigan researchers found in a 2023 study. In the meantime, kids in the United States are spending more of their days on screens.
“We see nine-month-olds who are already addicted to tablets,” Rolnick said.
This trend is negatively impacting people’s health in various ways, such as a reduction in exercise and increased levels of depression and anxiety.
The American Academy of Pediatrics recommends that kids six and older get at least an hour of exercise a day for a healthy lifestyle. But there’s no recommended time set for outdoor activity, Rolnick said.
Hood said spending time in nature should be recommended by all health departments, not just by primary care providers.
“It’s not just the pediatrician’s job to talk about nature and being outside,” she said.
An equity issue
Another core mission of Prescribe Outside is to tackle health disparities in Philadelphia and ensure families have equal access to safe green spaces. Low-income neighborhoods have nearly half of the park space per capita as their higher income counterparts, according to a 2022 study.
In Prescribe Outside surveys, some children and families report feeling unsafe going to public green spaces on their own. Other residents attributed their lack of outdoor time to financial constraints, transportation difficulties and other issues.
“If you live in the suburbs and you have access to all these things, it almost seems like, ‘Why do you need a prescription for that? Why can’t you just go outside?’” Parker said. “It’s just not the reality for a lot of kids and families within the city who might have to take two bus transfers to get somewhere where they feel like they can just spend some time and relax.”
Prescribe Outside plans to hire a nature prescription coordinator in 2026 to help families customize their nature prescription plans and manage those obstacles.
In the future, the program is hoping to expand regionally so its model and research will be adopted in other areas, Parker said. Their PA Children’s Outdoor Bill of Rights, which states that every child in Pennsylvania should have safe and regular access to outdoor experiences, was endorsed by Gov. Josh Shapiro and Lieutenant Gov. Austin Davis in October.
“We’re hoping that by providing free programs and by working with healthcare providers to really frame this as something that’s not just nice to do, but actually impacts you, mentally and physically, that it will become more of a priority for people to connect with nature in an increasingly digital world,” Parker said.
Abby Weiss is an environmental reporter for the Local and a Report for America corps member. She can be reached at abby@chestnuthilllocal.com.
