The Year Nature Became Mainstream Medicine

Author Aaron Reuben, administrating his own “nature cure.” Click to enlarge.

EJ Academy: The Year Nature Became Mainstream Medicine

By Aaron Reuben

Editor’s Note: This EJ Academy offers a unique contribution from a freelance writer who also happens to be a doctoral student in clinical psychology. Aaron Reuben shares his experience reporting and writing on “the nature cure” for Outside Magazine, which took second place in the student category for the Society of Environmental Journalists’ 2020 Annual Awards for Reporting on the Environment. Judges called it a “one-person tour-de-force … intimate writing with personal scenes, set among clear explanations.” Enjoy!

A few years ago I was presenting a study at the annual meeting of the American Public Health Association (a great place to find stories) when I caught the tail end of a physician’s talk on “nature-prescribing,” a new effort by a handful of clinicians to translate decades of scientific findings on nature and health into mainstream medical practice.

Dr. Robert Zarr, a pediatrician at Unity Health Care in Washington, D.C., had been following a trickle of scientific papers that had become a river, touting mental and physical health benefits for individuals spending time outdoors. Particularly helpful were natural areas like parks, gardens and wilderness. 

Zarr, like many of his colleagues, had grown despondent about modern medicine’s inability to slow the rise of obesity, diabetes, anxiety and depression, despite considerable expense to treat and prevent these diseases. 

 

Could time in nature be deployed

as a pre-pharmacological

or preventive intervention?

 

Could the fact that we are largely becoming an indoor nation have something to do with the problem? Could time in nature, once something we took as a matter of course, now be deployed as a pre-pharmacological or preventive intervention? 

These questions motivated Zarr to develop a novel prescribing program using digital parks databases, text and email reminders, and follow-up conversations to help encourage Americans to get outside. 

He wanted to help them to lower their blood pressure, shrink their waistlines and improve their mental health. As I quickly learned after conducting a few follow-up interviews, there were hundreds of care providers like Zarr around the country, each of whom was dissatisfied with their existing tools, convinced that nature exposure was somehow health-promoting and willing to try new ways to get people outside.

This struck me as a fascinating attempt to translate science into practice, one akin, in a small way, to the past successful efforts to convince people to stop smoking or start exercising. As a clinician myself, I also wondered if it worked.

 

Shoehorning journalism into my scientific training

A scientist and clinical psychologist-in-training, I have been telling science stories, on the side, as a freelance writer for many years. Without the benefit of formal training, I have shoehorned professional journalism into my career progression by striving to always have one active story or investigation in my workflow, regardless of how busy my other duties keep me. 

Whenever possible, I focus on stories that can inform my science or clinical care, illuminating new aspects of human health and behavior, and their possible connection to the environment.  

I reported this particular story while working as a full-time doctoral student, about midway through the slog of graduate study. When patients canceled last minute, I would use the newly spare time to call physicians. When I attended conferences in other states to present empirical studies, I would add extra days to meet patients or shadow doctor’s visits.

I knew that my ability to successfully tell a compelling story about nature prescribing would ultimately hinge on finding patients who had benefited from this new therapeutic approach. I crisscrossed the country over the course of a year, meeting with doctors and patients in urban Washington D.C., rural North Carolina and many parts between Wyoming, California and Washington State. 

In the process, I gained a firsthand appreciation for the size and span of the growing nature-health movement, which had mainstream advocates in all 50 states. Increasingly, it also had early support from large private foundations and public health institutions, including the National Institutes of Health. 

In my reporting, I met children healing from heart surgery, busy professionals recovering from burnout and senior citizens trying to maintain mobility, all coaxed outdoors by members of their healthcare team. 

 

A struggle doing justice to the topic

Usually, writing a story is easier when I have done more reporting. I have more examples to draw from, and more quotes and scenes to breathe life into the issue. I also understand the topic better. 

But for this story, I found that my hunt for the “perfect patient” had failed to turn up any one single case that was better than all the rest.  Instead, I had numerous compelling but rather too-complex stories to tell. 

 

Once I began writing I struggled

to balance doing justice to the size

and diversity of the movement.

 

Once I began writing I struggled to balance doing justice to the size and diversity of the movement while producing an accessible and well-paced story. In an ecosystem involving land trusts, hospital systems, parks departments and care providers from disciplines as diverse as physical therapy, cardiology, pediatrics, gerontology and clinical psychology, who should be left out? 

My terrific editor at Outside, Elizabeth Hightower, played a crucial role in helping me decide what to keep and what to cut. In the end, not surprisingly, we opted for fewer characters so that those we met would have more space to shine. 

Among others, I begrudgingly jettisoned a favorite mountain scene with an energetic former Navy doctor, who prescribed “air-side” time for staff on aircraft carriers who rarely saw the sun. 

Elizabeth also asked me to add a scene from one of the big conferences I had attended, something I always shy away from because, honestly, I find conferences tedious. But she, and the other senior editors at Outside, wanted readers to get a sense of what debates and controversies were brewing in the quickly evolving and messy field. 

That was the right call. I was lucky that the big conference that year, the SHIFT Festival on “public lands and public health,” had taken place under the backdrop of the Grand Teton mountains, offering plenty of color for a writer numbed to beige conference rooms and stale coffee.

 

Adding my own perspective

Finally, as a science writer, I tend to keep myself out of the story, but my editors asked for more of my own thinking in the piece, particularly towards the end. 

Though somewhat intimidated by the task, when I sat down to write these concluding paragraphs, I found that I did indeed have opinions, forged from hours spent listening to debates, reading empirical studies, watching doctors try to convince people to go outside and efforts of my own to generate behavior change in my patients. 

I knew as much about the topic as anyone, and there was a need for someone to look forward to what could come next, as well as to contextualize the movement within the larger history of public health and medicine.

After the story ran, I received immediate positive responses from prescribers and program leaders. Requests for participation from new patients, doctors, nurses and other clinicians accelerated overnight. The story seemed to hit a nerve with a significant number of readers. 

In an email that I cherish, Dr. David Sabgir, a cardiologist and founder of the international patient-outing initiative Walk with a Doc, wrote, "Your article could not be more highly regarded and important. It has created a lot of momentum." Emails like that are why I keep going.

Aaron Reuben is a doctoral candidate in Clinical Psychology at Duke University, where he studies environmental contributions to mental health, brain development and aging using international cohort studies. He has written about issues such as public health for The Atlantic, Wired, Mother Jones and other publications.

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* From the weekly news magazine SEJournal Online, Vol. 6, No. 21. Content from each new issue of SEJournal Online is available to the public via the SEJournal Online main page. Subscribe to the e-newsletter here. And see past issues of the SEJournal archived here.