About the Author

Robert Zarr, MD, MPH, FAAP, is a board-certified pediatrician at the Unity Health Care, Inc. in Washington, D.C., where he cares for a low-income and immigrant population in a setting with few resources. He leads D.C. Park Prescription (DC Park Rx), a program that helps train physicians to connect children to nature, has mapped hundreds of parks to help physicians and parents discover nearby nature, and is researching behavioral and attitudinal changes of both patients and health care providers. He has served as president of the American Academy of Pediatrics D.C. Chapter.

“WHY I PRESCRIBE NATURE” — In D.C., Pioneering Pediatricians Offer New Hope and Health Through Park Rx

What in the world is a doctor doing writing a prescription for Nature?  With our nation’s current epidemic of obesity, asthma, ADHD, and now Nature Deficit Disorder, it’s time that we doctors prescribe time outside, in Nature, for all our patients.

I have worked for the last 12 years as a primary care pediatrician at a community health center in Washington, DC, where I see firsthand how sick our children are and how they suffer from chronic disease.

Just the other day I saw Michael, a 15 year-old patient of mine.  His 24-hour activity and food diary revealed 5 hours of screen time on a school night (split between X-box and TV), 2 slices of pepperoni pizza and watermelon-flavored powdered beverage for breakfast, hamburger (without lettuce or tomato) for lunch, and 4 slices of pepperoni pizza plus watermelon-flavored powdered beverage for dinner.  Michael suffers from asthma, obesity, and Nature deficit.  This is typical of many adolescents.

robert zarr and son-800wi

Robert Zarr and son in a D.C. park

As a pediatrician, I have a responsibility to give advice and prescribe therapies that provide the greatest benefit with the least risk.

For example, if Mary, an infant of 11 months has a serious bacterial infection, I prescribe an antibiotic with the least side effects and narrowest spectrum to decrease the chance of creating resistant super bacteria.

Prescribing a park is very much like prescribing an antibiotic. First I have to make the right diagnosis.

Then I have to consider all the possible treatment options, taking into account a number of factors: risk benefit, cost (insurance status), readiness of patient or family to accept and adopt treatment modality, complexity of treatment, social context of patient, and the environmental impact.

Before I prescribe a park, I need to know if what I am prescribing is safe, clean, accessible, and has lots of different activity options that best match the interests of the patient/family and their schedule. With the help of several partner organizations and many volunteers, we have mapped all the green space in D.C.  We have rated all 350 parks for access, cleanliness, level of activity and safety, developed a searchable database by zip code, and linked the database to our Electronic Medical Records (EMR).

Since July 1, 2013, our “go live” date, we have dispensed over 400 Park Prescriptions (Park Rx).

Our patients, my colleagues, and I have embraced Park Rx with open arms because we are all ready for a positive approach to chronic disease that poses virtually no risk, but both prevents and treats our modern day plagues like obesity, asthma, and mental illness.

My colleague sent me an email a couple of weeks ago, and here is what she had to say, “Park Rx works!!!! I have a kid (whom) I saw last month and gave her the Parks Handout and she has been going there three times a week and has lost weight!!!”

I would be remiss, though, if I didn’t mention my ulterior motive.  I am not embarrassed to say that I want to save the planet.

Because our health is intimately linked to the health of our environment, we can’t have one without the other.  In order to protect and conserve the environment, we must first value it.  In order to value it, we must know it, and in order to know it we must touch, smell, breathe, and experience Nature.  By getting people outside in Nature, I find that much more happens than weight reduction, lower heart rate, and a sense of focus and well-being.

We start to understand and value trees, clean air, water, fauna and flora in a way we hadn’t before, and we feel committed.  We are creating the next generation of environmental stewards, conservationists, and activists.

Park Rx, therefore, serves two purposes: (1) to help create a healthier, happier society, and (2) to preserve and create more natural places through our next generation of environmental stewards, conservationists, and activists.  Giving children time in Nature to explore, especially through unstructured play, is essential to their overall development and well-being.

In the words of our First Lady, “Let’s move outside.”  I would add, “In Nature.”

Let us not forget about the all the Michaels out there who need our help in encouraging and motivating them to change their routines to include a better diet and more time moving outside.  There is no doubt that we can provide the tools to help them live healthier and happier lives.

__________

More Reading and Resources

PLAY OUTSIDE PRESCRIPTION

PARK RX: National Park Service, DC Park Prescription

C&NN’S GROW OUTSIDE! Tools & Resources for Pediatricians

PARADE MAGAZINE: Are Your Kids Vitamin N Deficient?

AMERICAN ACADEMY OF PEDIATRICS ISSUES NEW GUIDELINES FOR CHILDREN’S MEDIA USE

GROW OUTSIDE! Richard Louv’s Keynote Address to the American Academy of Pediatrics National Conference

TIME FOR YOUR VITAMIN “N”: Ten Great Ways Pediatricians and Other Health Professionals Can Promote Health and Wellness

VITAMIN “N” and the American Academy of Pediatrics

THE WHOLE CHILD: A Pediatrician Recommends the Nature Prescription

THE “VITAMIN N” PRESCRIPTION – Some Health Professionals Now Recommending Nature Time for Children and Adults

“SITTING IS THE NEW SMOKING” — What We Can Do About Killer Couches, Sedentary Schools, and the Pandemic of Inactivity

Rx FOR OUTDOOR ACTIVITY, National Environmental Education Foundation (NEEF); offers a patient brochure, prescription form, fact sheet and other valuable resources.

For information about research on health and nature experience see C&NN’s research summaries.

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Comments (11)

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  1. Sarah Milligan-Toffler says:

    Dr. Robert Zarr is the real deal. We can all learn from the “just do it” attitude he has taken to incorporating Park Prescriptions as part of his community health practice. I am so inspired by his wonderful work!

  2. CAPT Charles Higgins says:

    I’m deeply appreciative of this effort! As the Director of the National Park Service Office of Public Health, I too believe that nature is a powerful and inexpensive prescription. We’ve all come to accidentally accept a lesser state of health and wellness and it doesn’t have to be that way, all we need to do is reconnect with the planet we live on, it’s plants, animals and the people around us. These efforts are to commended, shared and supported. Way to go Dr Zarr!!

  3. Christie Hinnen says:

    Wonderful article, Robert! I forwarded it to a pediatrician friend here in Spokane. Very proud of you and what you are doing.

  4. I really enjoyed your article, and I shared it on my blog Mud On Your Feet (link below). I hope that is okay with you. Just let me know if it’s not. Thanks for your great work and have a great day!

    http://www.mudonyourfeet.blogspot.com/2013/11/why-i-prescribe-nature-by-robert-zarr-md.html

  5. Dr. Zarr is truly a “Nature Champion”! I had the great pleasure of doing a video interview of him where he describes more about his important work and why he does it: http://durablehuman.com/prescribing-nature-for-better-health/

  6. Anne Barton says:

    I appreciate Dr. Zarr’s efforts but wonder if he knows that one of the parks he has picked as healthy and known for being able to see deer (Rock Creek Park in the national Capital) is busy slaughtering those deer with sharpshooters and bait stations. This in spite of information that shows deer are not harming the park (exotic plants are doing that), an offer to share the cost of a non-violent alternative and a petition with more than 16,000 signatures from people who find the peaceful, restorative nature of Rock Creek Park has been destroyed. Violent solutions cannot be good for children’s health.

  7. I hope that you have checked into whether or not the groundskeepers of the parks are using pesticides, herbicides or fungicides (all chemicals) on the grounds of the parks. Glyphosate has been proven to be the mostly widely used and one of the most devastating to children and mothers of child-bearing age when it is found in Round-up. It is the combination of the active and inactive ingredients in this product that are very seriously effecting our children and pets.

    ConnFACT (CT Families Against Chemical Trespass

  8. Sean Nolan says:

    OK, this is just brilliant. Awesome, awesome stuff. Thank you Dr. Zarr! —S

  9. reader says:

    Thank you, Dr! You are restoring my faith in the allopathic medical community. I hope this is successful for you and your patients. And i hope it spreads to many more areas. Great work!

  10. Kelly says:

    Congratulations Dr. Zarr, this is amazing. Happy to know that there are doctors out there willing to think of alternatives outside pills. Very inspiring, I hope you have lots of success with Park RZ going forward.

  11. carol pfeifle says:

    Dear Dr. Zarr,
    You might want to check out the game “INGRESS” as a way to help motivate your patients to get out and move. It was partly created to get people out to walk their parks and neighbothood. It can only be played with a mobile phone , and YOU have to go out and spot virtual portals and interact with them. These portals are spots of interest or art or public transportation etc. The portals are added to the game (after approval) by the players. They get points and win badges. They get “keys” to the portal. they could show you the keys and then you would know they were out and about. Then you set a goal of so many keys per week or so many points. you can only get the points by getting out there. this is a bit like a geocashing game.

    thanks , Carol

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