Letter to the Editor
A growing disconnection from nature. Urgent call to action for a nature prescription global health alliance
Creciente desconexión de la naturaleza. Urge una alianza de salud global para la prescripción de naturaleza
Juan Antonio Ortega-Garcíaa,b,
, Concepción Martínez-Gómeza,c, Albert Bacha,d, Laura Benitez-Rodrígueza,e, Rebeca Ramisa,f, en representación de la Alianza GRSIA
Corresponding author
a Alianza Global para Renaturalizar la Salud de la Infancia y Adolescencia (GRSIA), Comité Salud Medioambiental, Asociación Española de Pediatría, Spain
b Unidad de Salud Medioambiental Pediátrica PEHSU-Murcia, Environment & Human Health Lab, IMIB-Arrixaca, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
c Contaminación Marina, Instituto Español de Oceanografía (IEO-CSIC), Centro Oceanográfico de Murcia, San Pedro del Pinatar, Murcia, Spain
d Environment & Human Health (EH2) Lab, Centro de Ciència y Tecnología Forestal de Catalunya, Solsona, Lleida, Spain
e SEO BirdLife, Sociedad Española de Ornitología, Spain
f Area de Epidemiología Ambiental y del Cáncer, Instituto de Salud Carlos III, Madrid, Spain
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Urge una alianza de salud global para la prescripción de naturaleza" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1706 "Ancho" => 2508 "Tamanyo" => 523667 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0105" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Goals of the GRSIA for reintroducing contact with nature in cities.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">At present, the time children can spend playing out of doors is considerably less compared to their parents when they were children. Today, young individuals can have 4000 Instagram followers, but no one to play outside with. The lack of direct contact with people, animals, plants and landscapes, exacerbated by the COVID-19 pandemic, has been substituted by a growing supply of virtual reality options that attempt to simulate nature. The body of evidence supporting the benefits of contact with nature (CN) is ever growing and diverse, including exposure to plants, animals and immersive nature experiences (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> There are many elements of nature whose positive effects on health have yet to be discovered. Our aim was two-fold: first, to report key findings regarding the connection with nature of school-aged children in Spain, and to introduce the Alianza Global para Renaturalizar la Salud de la Infancia y la Adolescencia (GRSIA, Global Alliance to Reintroduce Nature in Child and Adolescent Health).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">In 2015, 74% of the population of the European Union and 80% of the population in Latin America lived in cities, and 20%–21% in suburbs, with greater poverty and fewer green spaces. Most of today’s youth have barely had any experiences in the fields, the woods or the sea… The young spend an increasing amount of time indoors and have nature deprivation. The Committee on Environmental Health (CEH) of the Asociación Española de Pediatría (AEP, Spanish Association of Pediatrics) has identified nature deprivation as one of the key challenges in child health in Europe and Latin America.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> What dose of nature should children receive? Although the CN needs may vary, children should spend at least 1 or 2<span class="elsevierStyleHsp" style=""></span>h a day (>1<span class="elsevierStyleHsp" style=""></span>h) in the nearest green or blue space to satisfy the requirements for healthy development. If this dose is not achieved, they are considered nature deprived. Still, the beneficial effects can be perceived from small doses of 2<span class="elsevierStyleHsp" style=""></span>h a week.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Healthier cities that meet the 3−30–300 rule (3 trees visible from every home, 30% of tree canopy cover in every neighbourhood and a maximum distance of 300<span class="elsevierStyleHsp" style=""></span>m to the nearest green space) can help achieve this goal. Contact with nature is essential in the first years of life, and the sooner it starts, the greater the benefits. In 2022 we started to study the level of contact with nature of school-aged children (N<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3500 children aged 7–17 years), and we already know that only 1–2 out of 4 plays outdoors daily in contact with nature. In their parents’ generation, the ratio was 3 out of 4. Twenty-five percent of children and adolescents barely goes spend time out of doors once or twice a month, and only 25% goes to urban parks or natural spaces daily. These are unpublished data of the research project on environmental health (EH) trends in children and adolescents (file FFIS-DF-2022-36) funded by the Sociedad de Pediatría Sureste de España (Society of Paediatrics of Southeast Spain). Some of the risks and problems associated with nature deprivation have reached epidemic proportions in children and adolescents. Historically, the artificial separation of humanity from the rest of living beings on planet Earth and its non-living components (a sunset or sunrise, a view of mountains …) has hindered the incorporation of CN as a key element in the health of humans and the planet Earth.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Recent studies on the global burden of diseases evinced that the main causes of death and of years of chronic poor health are 100% preventable and associated with the deterioration and pollution of ecosystems.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> As physicians, we should prescribe nature more frequently and explore these aspects in our offices, asking about the number, type and duration of experiences in nature and promoting a relationship with nature as a means to improve health and counteract or reduce the effects of exposure to environmental pollutants.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The GRSIA is a collaborative network founded at the initiative of the CSMA that involves institutions, businesses, corporations, community-based organizations and excellence centres that chose to work together through the development of partnerships to root the health of the young into biodiversity and the health of the planet in cities in a series of shared goals (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Through a structured exchange of knowledge, the creation of new capabilities and a global multidisciplinary collaborative approach, we promote transformational leadership in EH. We aspire to become an international referent in “nature prescribing” to foster self-care, lead by example and inspire change in individuals. Partnerships between scientific societies, official institutions and the community give rise to more resilient health care systems, promoting mechanisms for adaptation to climate change and adding nature-based interventions to the portfolio of health care services.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1706 "Ancho" => 2508 "Tamanyo" => 523667 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0105" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Goals of the GRSIA for reintroducing contact with nature in cities.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0110" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Decrease in overall mortality (by 3.5% per 10% increase in green spaces) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Increased happiness and wellbeing \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Increase in sociability \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Decrease in aggressive behaviours and hyperactivity, improvement in attention \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Decreased anxiety and depression \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Decreased stress and inflammatory markers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Improved sleep \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lower cardiovascular risk \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Improved motor development (coordination/balance) and cognitive development \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Improved academic performance and reading test scores \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Decrease in consumption of alcohol and other drugs \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Improved obstetric outcomes and birth weights \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Decrease in child overweight and obesity \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Decreased risk of diabetes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Improved motor, social and communication skills in patients with neurodevelopmental disorders (foetal alcohol syndrome, autism spectrum disorder…) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Improved health-related quality of life in cancer survivors \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Decreased risk and increased overall survival for some types of cancer \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Improved immunity (increased NK activity, expression of anticancer peptides and immunoglobulin A in mucosae) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Improved visual acuity \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Improvement in lung function and asthma symptoms \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Increased level of physical activity \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Increased levels of vitamin D \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Improvement in acute and chronic pain control \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Quicker recovery after surgery \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reduction in medical visits and in the use of medication \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3594101.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Health effects associated with contact with nature in scientific studies.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a>.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nature contact and human health: a research agenda" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. 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