Next time you visit your GP expecting to leave with a prescription for meds, you might be in for a surprise. Instead of the usual printout, you might find yourself clutching a (sometimes literally) green alternative, prescribing an agreed activity outside – a weekly group walk, perhaps, or involvement in a local conservation project. The idea, say advocates, is to shift the focus of prescriptions from illness to wellness, getting more people better and potentially saving the NHS from financial ruin.
So-called “green prescriptions” have long been the norm in New Zealand, as well as in some parts of Australia and the United States, and they’re becoming increasingly popular over here. “Studies on life expectancy show that lack of exercise is now second only to smoking in causing premature deaths,” says Dr Tim Ballard, vice chair of the Royal College of GPs, who adds that mounting evidence points to the health benefits of being out and about in green spaces – less tension, stress and depression; lower blood pressure; improved immune system responses; lower levels of obesity; and milder ADHD symptoms in children, just to name a few. In fact, simply spending more time outside – instead of staring at a TV screen or computer monitor, for instance – equates to an overall increase in physical activity. “So while, unlike in New Zealand, there are no plans for a nationalised scheme for green prescriptions, I think GPs will be more likely to link their patients to them in 2016,” he predicts.
The cost saving could be considerable. Natural England found that for every £1 spent on establishing healthy walking schemes, the NHS could save £7.18 in the cost of treating conditions such as heart disease, stroke and diabetes. Meanwhile, a recent Response for Nature report by the RSPB and other charities recommended that by 2018, one per cent of the public-health budget should be invested in the preventative and restorative value of nature to provide cost-effective health solutions.
But surely GPs have long been telling people to “take a hike”, as it were, to improve both their physical and mental health? “Indeed, I recently came across a 150-year-old edition of Dr Roth’s The Prevention and Cure of many Chronic Diseases by Movements, which basically tells people to forget their tablets and get moving,” says Dr Ballard, adding that in more recent years, there can hardly be a GP in the land who hasn’t systematically given advice around getting off the bus a stop early or walking upstairs instead of taking the lift.
There have been more centralised attempts, too, notably the recent NICE-accredited Exercise Referral Scheme. “But just as patients often don’t take the informal advice, evidence also found that after 12 weeks on the scheme, people were virtually back to where they started, and after six months, they were completely back to square one,” says Dr William Bird, strategic health advisor for Natural England, who believes a large part of the problem is that many people simply don’t like gyms. “Then came the Let’s Get Moving scheme and that failed, too, probably because it was too rigid.”
So what’s different now? “The big change – and I’ve been pushing for this a lot – is making exercise fun and sociable, as well as using it as a means to an end,” he explains. “So encouraging someone to go for a walk in a green space, which ends with having a pint in the pub or a cup of tea, makes the activity far more appealing. You’re talking to your mates, you’re out in the countryside and you’re having a good time. It’s all about trying to get exercise to be part of a fun life, not an add-on.”
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