News Nature as Preventive Health Infrastructure

Executive Summary

A growing body of interdisciplinary research demonstrates that regular exposure to natural environments significantly improves mental, physical, and emotional health across our lifespans. Long-term exposure to residential greenness and nature-based experiences is associated with reduced physiological stress, improved cognitive function, and enhanced emotional regulation. These benefits are particularly relevant in modern urbanized societies, where screen-based work, traffic, noise, and constant cognitive demands contribute to chronic stress, mental fatigue, and declining executive function.

Clinical researchers, educators, and healthcare providers increasingly recognize nature exposure as a low-cost, scalable, and equitable public health intervention. Evidence from population-scale studies, stress-reduction theory, and attention restoration theory explains the mechanisms by which nature environments support human health. These findings are now being operationalized through clinical “nature prescriptions,” nature-based education (NbE), and intentionally designed landscapes that provide accessible and therapeutic outdoor experiences.

Landscape architects play a critical role in translating this research into built environments. Through the design of parks, trails, schoolyards, interpretive landscapes, and green infrastructure, designers create the physical settings that enable nature-based health and education outcomes. This white paper synthesizes current research, clinical applications, and educational frameworks and highlights the role of landscape architecture in advancing public health through nature-based design.

1. The Science of Nature and Human Health

Clinical psychologists, public health researchers, and environmental scientists agree that regular exposure to nature produces measurable benefits to mental and physical health. Large-scale epidemiological research, including studies of more than 400,000 participants in the UK Biobank, has demonstrated associations between residential greenness and reduced mortality, lower stress biomarkers, and improved mental health outcomes (Twohig-Bennett & Jones, 2018; UK Biobank, 2020).

Nature exposure is increasingly recognized as a cost-effective preventive health strategy, particularly in comparison to pharmacological or reactive clinical interventions. These benefits are supported by two foundational theoretical frameworks: Stress Reduction Theory and Attention Restoration Theory.

2. Theoretical Foundations

2.1 Stress Reduction Theory

Ulrich’s Stress Reduction Theory proposes that natural environments elicit an innate physiological response that reduces stress and promotes recovery (Ulrich et al., 1991). Exposure to natural settings activates the parasympathetic nervous system—often described as the “rest-and-digest” response—while reducing sympathetic nervous system arousal associated with the “fight-or-flight” response.

Observed physiological outcomes include:

• Lowered cortisol levels
• Reduced blood pressure and heart rate
• Decreased muscle tension
• Faster recovery following acute stress

These responses have been consistently observed in both passive (viewing nature) and active (walking, gardening) forms of engagement.

2.2 Attention Restoration Theory

Kaplan and Kaplan’s Attention Restoration Theory explains how nature environments restore depleted cognitive resources (Kaplan & Kaplan, 1989). Modern life requires prolonged directed attention—focused, effortful cognitive control—leading to mental fatigue, irritability, and diminished executive functioning.

Natural environments support restoration by engaging involuntary attention, allowing directed attention to recover. Research has shown that nature exposure can:

• Improve emotional regulation
• Enhance focus and reduce rumination
• Increase resilience to cognitive and emotional stress

3. Clinical Applications: Nature Prescriptions

Healthcare providers are increasingly translating this research into clinical practice through the use of “nature prescriptions.” Physicians prescribe specific, measurable nature-based activities—such as walking in parks, gardening, or time in green spaces—as complementary interventions for stress, anxiety, hypertension, and attention-related conditions.

Organizations such as Park Rx America provide clinical guidance and tools to support physicians in issuing structured nature prescriptions, often specifying:

• Location (park or green space)
• Activity type
• Frequency
• Duration

These efforts are supported by organizations including the American Heart Association, Cornell Health, and the Pew Charitable Trusts.

In Scotland, healthcare providers have prescribed nature-based activities—including birdwatching, walking, gardening, and outdoor creative play—for over a decade, demonstrating institutional adoption of nature as a therapeutic modality (NHS Scotland, 2019).

4. Nature-Based Education and Child Development

Nature-Based Education (NbE) research demonstrates that outdoor natural environments provide exceptional contexts for learning, development, and emotional growth, particularly in early childhood. Forests, gardens, beaches, schoolyards, and other open-air environments support experiential learning, sensory engagement, and opportunities for awe and curiosity that are difficult to replicate indoors.

Stanford University researchers have concluded that early childhood nature-based education positively influences cognitive, emotional, and social development. The North American Association for Environmental Education (NAAEE) defines early childhood environmental education as a holistic approach encompassing knowledge of the natural world, emotional connection, dispositions, and practical skills (NAAEE, 2016).

NbE has been associated with:

• Improved attention and self-regulation
• Enhanced social interaction and cooperation
• Increased environmental stewardship
• Greater equity in learning opportunities

5. The Role of Landscape Architecture in Health and Education

Landscape architects serve as essential collaborators in transforming research and policy into tangible, equitable environments. Working alongside researchers, educators, healthcare professionals, and municipalities, landscape architects design spaces that enable restorative, educational, and therapeutic experiences for people of all ages and abilities.

Key landscape typologies that support nature-based health outcomes include:

• Regional and neighborhood parks
• Schoolyards and outdoor classrooms
• Trails and greenways
• Interpretive nature experiences
• Open space networks and access pathways

Through intentional design, these environments can address accessibility, cultural inclusion, safety, and sensory engagement—ensuring that nature-based benefits are available to diverse populations.

6. Interpretive Landscapes and Case Studies

6.1 Pleasant Park, Apex, North Carolina

At Pleasant Park in Apex, North Carolina, landscape architects curated a nature-based educational experience that integrates interpretive signage, natural play elements, and immersive landscapes. The design encourages creativity, exploration, and learning through direct engagement with natural systems.

6.2 River Cane Wetland Park, Raleigh, North Carolina

River Cane Wetland Park in Raleigh, North Carolina, was designed to provide immersive nature experiences while demonstrating ecological principles. The park includes:

• Interpretive play features
• Nature trails
• A pollinator meadow
• A food forest

These elements offer didactic lessons in ecology, sustainability, and environmental stewardship while supporting physical activity, stress reduction, and community wellness.

7. Conclusion and Call to Action

The evidence is clear: nature-based experiences function as preventive health infrastructure. Integrating nature into healthcare, education, and community design offers a scalable, cost-effective strategy to improve public health, enhance learning outcomes, and build resilience in the face of modern stressors.

Landscape architects, healthcare providers, educators, and policymakers must continue to collaborate to:

• Expand equitable access to nature
• Integrate nature-based prescriptions into healthcare systems
• Support nature-based education initiatives
• Invest in public and private infrastructure that promotes human and ecological health

By designing with nature, we design for human well-being.

References

Kaplan, R., & Kaplan, S. (1989). The experience of nature: A psychological perspective. Cambridge University Press.

NAAEE. (2016). Guidelines for Excellence: Early Childhood Environmental Education Programs. North American Association for Environmental Education.

NHS Scotland. (2019). Green prescriptions and nature-based interventions; www.thinkhealththinknature.scot.nhs.uk/what-is-a-green-prescription/

Twohig-Bennett, C., & Jones, A. (2018). The Health Benefits of the Great Outdoors: A Systematic Review and Meta-Analysis of Greenspace Exposure and Health Outcomes.

Ulrich, R. S., Simons, R. F., Losito, B. D., Fiorito, E., Miles, M. A., & Zelson, M. (1991). Stress Recovery During Exposure to Natural and Urban Environments, Journal of Environmental Psychology., September, 1991

UK Biobank. (2020 & 2025). Outdoor physical activity, residential green spaces and the risk of dementia in the UK Biobank cohort, article in Communications Medicine, 2025 by Benjamin Kroger, Hui-Xin Wang, Orjan Ekblom, Jing Wu, Hugo Westerlund, Mika Kivimaki & Rui Wang.