People & Culture
The family physician advocates for outdoor time with the PaRx nature prescription program
She’s a passionate advocate for the health benefits of time spent in nature, and in 2020 B.C.-based family physician and environmental advocate Melissa Lem turned her beliefs into action when she founded PaRx. Launched through the B.C. Parks Foundation, PaRx encourages healthcare providers to prescribe time in nature to improve patient health. Just two years on, PaRx operates in eight provinces and boasts more than 6,000 registered prescribers. In January, the program signed an agreement with Parks Canada, allowing doctors to prescribe a Parks Canada Discovery Pass to patients through the PaRx program. Dr. Lem spoke with Canadian Geographic about the positive effects of getting outdoors, and how she believes PaRx is part of a greater movement toward climate action.
When I actually moved from where my first job was in northern B.C. as a rural family physician back to downtown Toronto, where I was born, and then really felt a major deficit myself. So I still remember the moment I was standing in my apartment, looking out at concrete and glass and a little square of sky where I can see the CN Tower and hearing the streetcars rumble by beneath and thinking, Why do I feel so stressed? You know, my work in northern BC was much more stressful; I was a new grad, running an emergency department, delivering babies in the middle of the night. But I loved the work. I think part of the reason why I loved the work was because I could go for a hike immediately after work in the mountains. My commute to and from work was past the hospital garden where I could take wild raspberries and look at the moisture rising over the mountains. Whereas when I moved back to Toronto, it was suddenly back in an urban environment where I didn’t have that stress relieving effect anyway.
Staring out at the concrete and glass, I realized my feeling of stress was related to missing nature. As a physician, I practise evidence-based medicine, and this intuitive sense I had about the health benefits of nature didn’t exist unless it was enshrined in research. And so I sat down at my computer and did a literature review. Study after study popped up showing how good nature is for humans across both mental and physical health. Though I hadn’t learned about this in medical school, I realized I needed to make it my mission to spread the word about the health benefits of nature to my patients and my community. Everything snowballed from there.
Ten or 12 years ago when I started this journey, this health-nature link really wasn’t talked about very much in Canada. And I thought, I’m one person. Just one family doctor. How am I supposed to make this happen? I knew I needed to team up with an organization that was parks- and nature-based that had the vision could make something happen on a national scale. That was the B.C. Parks Foundation.
In 2019, I connected with the B.C. Parks Foundation just as they were starting to develop their health and nature program. They were interested in launching a nature prescription program. There was no concerted movement in Canada to connect people to nature for health benefits until we launched PaRx. Any licensed healthcare professional can be a prescriber. We’ve learned that a written prescription is better than verbal advice in motivating people to make a lifestyle change. We prescribe patients two hours of nature time per week — 20-plus minutes at a time. Receiving that written prescription also gives patients permission to prioritize time outside.
Hearing from patients and colleagues about how much nature has done for them is very rewarding. So many patients and friends have said to me, “Oh, by the way, I took a walk in a park yesterday and I thought about you and your program” or friends tell me they make it a priority now to get outside every single day with their kids because of this program. So I think it has a ripple effect beyond individual patients I see in my office.
Before founding PaRx, I used to tell my patients about how a healthy diet, adequate exercise and good sleep were key components of a healthy lifestyle. But given the massive body of evidence behind the health benefits of nature, I think it’s accurate to say that nature time — outdoor time — needs to be non-negotiable. It’s just as essential to our health as the other three factors. When we launched PaRx, we called nature time the fourth pillar of health, and I see it as non-negotiable as diet, exercise and sleep in keeping us healthy.
We’re working to change people’s concept of what nature is. Connecting with nature doesn’t have to be on the side of a mountain or in the back woods. You can get benefits of nature time in a park, on the corner of two streets in your neighbourhood, in your garden or even by spending time indoors with plants. But, that said, we also have to reduce barriers to nature access. Our new collaboration with Parks Canada is a major way to reduce barriers since prescribers can now provide a Parks Canada Discovery Pass to patients. Another barrier is transportation, and we are meeting with transit organizations to work on how to make nature access easier.
Connecting to nature was something that was so important for me as a child growing up in a majority white neighbourhood to feel a sense of belonging and connectedness. It was, like I said, over a decade ago when I first started speaking about, writing about and advocating for the nature of connection. And that was enough for a very long time. But though I had been advocating for a nature-health connection for a long time, it wasn’t until after my son was born in 2014 that I started educating myself about climate change. While I was nursing, I read Naomi Klein’s This Changes Everything, and it propelled me into the world of climate activism. I started thinking about what kind of world my son would grow up in and realized that these beautiful green spaces I’ve loved my whole life are threatened by climate change.
Wanting to communicate ideas to the general public is something I’ve always done. I was a reporter for the Varsity, the student newspaper, at university. And when I moved back to Toronto, I appeared on a national TV lifestyle show called Steven and Chris for several years and wrote articles for the CBC. Being able to tell stories and communicate information, which is something that I’ve been doing for years, has been really effective in my work in health and climate activism. I feel that I can use my skills to share my passion for climate action.
The fact that we now have over 6,000 registered nature prescribers — five per cent of practicing physicians in Canada — speaks to how much our message resonates. Something that keeps me going is that PaRx is changing the discourse — both within Canada and internationally — about how good nature is for us. And research shows that people who connect with nature are more likely to engage in pro-environmental behaviors: they tend to recycle more, conserve more energy and engage in climate action. These are small steps that move us toward a society that prioritizes planetary health. And so it’s not just some fluffy thing that’s going to make people feel better — it’s also part of the movement for climate action.
You form connections with other people who care about the same things and who are working together, and then you see the winds that your action has created and you celebrate those winds. That builds optimism and energy for the future, because this is a marathon. Climate change is not going to be solved in the next two years or five years. This is something that we have to be working on for a long time.
I love the way my brain calms down when I’m in nature. There are so many different obligations I have, but when I go outside, I’m not really thinking about them. My son is just, you know, joyfully skipping or exploring bicycle trails. Being in nature is a time for our family to disconnect, slow down and spend time with each other. And it’s so beautiful, too — seeing the colours change in the fall, the new fresh green in the springtime, seeing the snow. When that happens in Vancouver, it’s kind of magical.
We are working to extend the program across the country. My dream is to see the program extended across the country from coast to coast to coast. We obviously want more healthcare providers to sign up. And we’re planning to launch a nature prescription app that will incentivize and track users’ connection to nature. We’re also working with some international trials that will look into how effective native prescriptions are to improve people’s health — we’re really excited to contribute to the scientific knowledge behind how nature is good for health and how we can make native prescriptions more effective. So there’s lots coming down the line. We won’t just rest on our laurels. We want to keep contributing.
This story is from the July/August 2022 Issue
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