The original green prescriptions
Green prescriptions are prescriptions to spend time in green space, right? Not necessarily. A “green prescription” was a term first coined in New Zealand in the 1990s to describe a written prescriptions for physical activity made by a healthcare professional and was written on a green prescription pad – hence the name. The concept was later expanded to include diet prescriptions, and the current Green Prescriptions Program in New Zealand now includes additional support to patients, with subsidised access to exercise facilities, and follow-up phone calls and face-to-face meetings, as well as community support groups (see https://www.tewhatuora.govt.nz/health-services-and-programmes/green-prescriptions).
Jessica Stanhope (PhD)
Chief Medical Scientist, Rheumatology Unit, The Queen Elizabeth Hospital, SA Health & Lecturer in Physiotherapy,The University of Adelaide
Jess leads the Environmental Allied Health Group at The University of Adelaide and is on the Executive Committee of the Environmental Physiotherapy Association.
The confusion
From 2014, the term “green prescriptions” has also been used to refer to nature-based prescriptions. It is of course okay for a term to have more than one meaning, although this does create challenges, and the need for more clarification in communication. For example, we observed that there were a number of journal articles discussing the evidence regarding health effects of nature-based prescriptions that erroneously cited studies of written prescriptions for physical activity and/or diet, because ‘green prescriptions’ had been used to describe both. We recently highlighted this problem with respect to a systematic review of “green prescriptions” looking specifically at nature-based prescriptions (Stanhope and Weinstein 2025), where almost 20% of the studies included in the systematic review had nothing to do with nature exposure, and were instead consistent with the original definition of “green prescriptions”.
The error was perpetuated when the mis-cited papers were re-cited incorrectly. I have had several discussions with researchers, educators and clinicians who stated there was evidence for health effects of nature-based prescriptions, particularly for outcomes like weight loss and increases in physical activity, where the evidence they were referring to had nothing at all to do with nature-based prescriptions. While all consumers of research evidence should read and critique the articles they read in full, it is clear that this is not occurring – even in systematic reviews where the protocols stipulate that the papers need to be screened for relevance, critiqued, and data extracted in a transparent and repeatable manner.
Photo by John Arano on Unsplash
How the term is being used
In response to this confusion, we undertook a scoping review of all articles using the term “green prescriptions” to elucidate how this term was being used, and whether there were geographic, temporal and/or disciplinary differences in its use (Stanhope and Weinstein, 2023). We found that the term “green prescriptions” was still used predominantly to refer to written physical activity and/or diet prescriptions, not nature-based prescriptions (as originally intended), independent of geographic location. This original use was also prominent in journals classified as being medical or health sciences focused.
(Mis-)use of the term to refer to nature-based prescriptions was most prevalent in non-health journals (e.g. those covering the environmental sciences), despite the fact that people in these disciplines do not actually write prescriptions. As such, the term “green prescriptions” mainly retains its original meaning for health professionals making prescriptions. To avoid confusion and misinterpretation of the evidence base (including the potential to recommend inappropriate treatments), we therefore recommended that the term “green prescription” be reserved for use in its original meaning, and that the term “nature-based prescriptions” be used for prescriptions that recommend engaging with nature.
Take home messages
The issue of ambiguous terminology is not specific to the problem of “green prescriptions”, and tends to occur in multidisciplinary fields, as we have seen with this example. Clear communication between disciplines is critical to ensure a shared understanding of what is being discussed.
As consumers of research, we have a responsibility to carefully and thoroughly read relevant articles, paying close attention to the details of the interventions or exposures investigated.
As communicators of science, we clinicians, researchers and educators need to be clear about what we mean when we use potentially ambiguous terms like “green prescriptions”. We have suggested that separating the use of the term into “green prescriptions” (keeping its original meaning) and “nature-based prescriptions” (for nature exposures) may help in promoting clarity, safety, and health (Stanhope and Weinstein, 2023). This point is particularly important in the context of artificial intelligence, where people are using artificial intelligence to quickly and easily synthesise the evidence on a topic, where the distinction between the two forms of green prescriptions may be less clear; further perpetuating the problem.
References
Header image by Red Reyes on Unsplash
Stanhope, J., & Weinstein, P. (2023). What are green prescriptions? A scoping review. Journal of Primary Health Care, 15(2), 155–161. https://doi.org/10.1071/HC23007
Stanhope, J., & Weinstein, P. (2025). Conflating “green prescriptions” and “nature prescriptions”. Environmental Research, 269, 120873. https://doi.org/10.1016/j.envres.2025.120873
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