In Boston’s Leading Hospitals, Nature Is Part of the Therapy

Spaulding Rehabilitation Hospital, roof terrace designed by Hoerr Schaudt Landscape Architects / Steinkamp Photography

In the 1908s, Roger Ulrich discovered hospital patients recover faster and request less pain medication when they have views of nature. Spaulding Rehabilitation Hospital, built on a former brownfield in Charleston’s Navy Yard, and MGH’s Yawkey Outpatient Center, both in Boston, seem to be guided by this essential finding.

At Spaulding, patients recovering from traumatic injury are rejuvenated by good medical care, but also sunlight, garden terraces, and views of the surrounding Charles, Mystic, and Chelsea Rivers. The hospital landscape is a multi-functional therapeutic space where therapists aid patients in the air and sun. In a tour of the 132-bed facility at the 2017 Greenbuild, Jeffrey Keilman, an architect with Perkins + Will and Sean Sanger, ASLA, principal at landscape architecture firm Copley Wolff Design Group explained how the facility heals, but is also one of the most sustainable and resilient hospitals in the country.

Spaulding picked this brownfield site in part because rehabilitating it would help tell the story of resilience to its patients. If a toxic place can become a place of healing, then a broken person can return to health stronger as well.

The LEED Gold-certified hospital — designed by Perkins + Will, with Copley Wolff Design Group and Hoerr Schaudt Landscape Architects — has all the usual green building features, but its the extra, humane elements that make it something special — the custom-made sinks so that a patient in a wheel chair can more easily wash their hands; the tall wall of windows in the main rehabilitation room that offer views of the river; the light and views every patient enjoys from their rooms; the garden terraces with horticultural therapy spaces, as well as the gardens just for staff; and the multi-functional therapeutic landscape.

Spaulding Rehabilitation Center, designed by Perkins + Will / Anton Grassl/Esto
Spaulding Rehabilitation Center, designed by Perkins + Will / Anton Grassl/Esto
Spaulding Rehabilitation Center employee terrace, designed by Hoerr Schaudt Landscape Architects / Anton Grassl/Esto

The landscape — which was ingeniously designed by Copley Wolff Design Group to significantly reduce the impact of flooding in a 500-year storm event — is both for patients and the public. Like the building, the landscape has small but thoughtful features that exemplify patient-centered design.

For example, there are small brass sculptures of animals spread throughout. While these can be enjoyed by visitors and the public, they are really there for patients recovering from traumatic brain injuries who search for them in scavenger hunts in order to rebuild cognitive abilities and memory.

Starfish at Spaulding Rehabilitation Hospital, designed by Copley Wolff Design Group / Copley Wolff Design Group

A multi-functional space for physical therapy was designed for “active use.” Patients and caregivers didn’t just want “a space for respite and solitude. They wanted a space for activity, so they can get mentally and physically ready to re-enter society,” explained Sanger.

The space offers a “beginner’s walk,” with a slight grade and handrails. Throughout, there are benches, so patients can take a break.

Therapeutic landscape at Spaulding Rehabilitation Hospital, designed by Copley Wolff Design Group / Luke O’Neill

Sculptural rock forms on poles are actually therapeutic tools for building upper body strength.

Therapeutic landscape at Spaulding Rehabilitation Hospital, designed by Copley Wolff Design Group/ Luke O’Neill

Amid the gardens, there is also a ramp for teaching patients how to use a wheelchair.

Therapeutic landscape at Spaulding Rehabilitation Hospital, designed by Copley Wolff Design Group/ Luke O’Neill

In warmer months, the hospital puts recumbent bikes on the waterfront harbor walk. Rails along the walk were specially designed so people in wheelchairs can use them to pull themselves up.

Our tour then moved over to MGH’s Yawkey Outpatient Center, where cancer and other patients are treated in downtown Boston in a maze of co-joined buildings. Here was a therapeutic landscape that feels like the opposite of the one at Spaulding: a small but impactful place of respite and restoration.

As you enter the roof garden, which was added later after the building had been built, the broad trees and gorgeous views of the Charles River momentarily awe. The space is a welcome surprise in the midst of the vast hospital complex.

Yawkey Outpatient Center garden / Boston’s Hidden Sacred Spaces

Designed by Robert Adams, ASLA, principal at Halvorson Design Group, the garden is well-loved by adults and children undergoing cancer treatment.

The enclosed entry pavilion, with expansive glass windows, is open year round. Cancer patients often have a terrible, metallic taste in their mouth, so any metal fittings were painted over so as to not remind them. A journal is available for patients to write in. A giant urn is filled with rocks. Patients take the rocks to keep as touchstones; and survivors often bring back stones from their journeys, replenishing the urn, which has a “most sacred” duty, Adams said.

Yawkey Outpatient Center garden / Anton Grassl/Esto

And the garden itself, with its simple shade-covered walking loop, benches facing the river, and sculptures, is open in warm months. “You’ll often see patients with their IV in tow walking the loop.”

Yawkey Outpatient Center garden / Anton Grassl/Esto
Yawkey Outpatient Center garden / Anton Grassl/Esto

For Adams, the only wrinkle is the garden has become so popular staff can no longer easily access. Before, staff were eating lunch there and visiting often. This is a sign that “staff need open spaces, too.” As author Clare Cooper Marcus described in a recent interview, over-worked and stressed doctors and nurses means more deadly medical errors. Just a 15-minute break for these critical workers outdoors can help boost their cognition and lower stress.

Why aren’t more hospitals creating restorative spaces not only for patients but also for their staff? Spaulding and Yawkey, two of the best hospitals in the country, offer models for how to bring nature into healthcare environments that other facilities can learn from.

Do Views of Indoor Plants Improve Health and Well-Being?

Perkins + Will office, with plants installed for this research project / Micah Lipscomb

Do views of indoor plants have similar health benefits as views of nature or direct experience in natural environments? The benefits of nature exposure to human health are well documented.  However, little is known about the psychological benefits of exposure to nature indoors. We studied this topic in a research project at Perkins + Will’s Atlanta office.

The office’s nearly identical floor plans set the stage for a controlled experiment where a floor was filled with 129 plants for two weeks and then participants were tested for psychological well-being and objective memory task performance.

Office floor plan with plant layout / Micah Lipscomb and Kimberly Rollings

A crossover study was conducted where participants on another floor were also given the same tests without plants. The plants were then moved to the other floor, so that each participant was surveyed with and without the plants.

Data on perceived psychological distress (PERI) and memory task performance (digit span backwards) were collected during each study period from 63 employees. Light levels, cloudy days, self-reported physical and psychological health, and participant demographics were also documented.

Statistical analyses indicated that the plants only marginally improved the psychological health of participants. For the memory task performance, the participants actually performed better without the presence of plants than with the plants.

Survey results for psychological well being (PERI) of participants / Micah Lipscomb and Kimberly Rollings
Survey results for memory task performance (Digit Span Backwards) of participants / Micah Lipscomb and Kimberly Rollings

There are several possible reasons the plants did not have a substantial influence on the psychological health or short term memory of the participants. In an office, there are many factors that effect worker’s psychological well-being and task performance, and plants may go unnoticed in this setting.

One study participant observed that there was initial excitement about the plants among participants, but after a few days, the plants seemed to fade into the background, somewhat like furniture. This comment is consistent with previous studies that find participants may habituate to the presence of the plants; their beneficial effects may be relatively strong in only an initial period after their introduction into the setting.

The abundant natural light and views of nature in the office may have distracted from the influence of the indoor plants. Indoor plants would likely have a greater impact in a windowless basement without views of nature and daylight, like Milton’s desk in Office Space.

Milton from Office Space / YouTube

Previous studies have shown the greatest impact from plants in settings with less visual stimuli. The participants in our study had higher levels of reported psychological health than typical, so the influence of plants might be lower with these settings.

In other words, the presence of plants might benefit those who work in poorer quality environments and/or those with poorer quality psychological or physical health than participants in this study. A much larger sample size is likely needed to detect smaller anticipated beneficial effects of indoor plants when compared to effects of direct exposure to nature.

The experience of engaging with nature (in the form of an indoor plant) may be different when the participant is working on an activity at a desk as opposed to being engaged with the experience with movement. A potted plant on a desk does not compare to the rich sensory experience of being in nature. It is not surprising the health benefits documented in outdoor environments may not translate to an indoor setting.

While the results did not align with our hypothesis, further study is needed on the influence of plants in an indoor setting.

This guest post is by Micah Lipscomb, ASLA, senior landscape architect at Perkins + Will and Kimberly Rollings, assistant professor, School of Architecture, University of Notre Dame.

Best Books of 2017

Drawdown / Penguin Press

Whether you are looking for a unique book to give as a gift or just one for yourself to delve into, we have some options. Here’s THE DIRT‘s top 10 books of 2017, our picks for the best on the environment, cities, and landscape:

Drawdown: The Most Comprehensive Plan Ever Proposed to Reverse Global Warming (Penguin Press, 2017)
Author and environmental activist Paul Hawken assembled hundreds of experts around the world to rank the potential positive impacts of 100 substantive climate solutions. One of the most accessible and informative books on climate change, Drawdown makes clear the vital role of landscape architecture, architecture, and urban planning in finding a way to reduce greenhouse gas emissions. Hawken and his coalition consider complete streets and bicycle infrastructure, walkable cities, green roofs, composting systems, and net-zero buildings as critically important. Other top solutions — like educating girls in developing countries and silvopasture — will cause you to think more about the relationships between population, agriculture, and sustainability.

Be Seated (Applied Research and Design Publishing, 2017)
In his new book, Laurie Olin, FASLA, founder of the landscape architecture firm OLIN and this year’s Vincent Scully Prize winner, brings to life his deep interest in outdoor seating. As he describes: “My interest in public outdoor seating in parks and plazas revolves around two poles: one is related to the fascination that Emerson and other philosophers have shown regarding aspects of the quotidian in our lives and experience, its pressures and benefits; the other is the utility of public seating in guiding our conduct as citizens.” Scattered throughout are evocative sketches and water-colors and well-curated images. If you enjoy trying to figure out what makes a public space great, you’ll love this book.

The Color of Law: A Forgotten History of How Our Government Segregated America (Liveright, 2017)
Richard Rothstein, an authority on housing policy, “explodes the myth that America’s cities came to be racially divided through de facto segregation―that is, through individual prejudices, income differences, or the actions of private institutions like banks and real estate agencies. Rather, The Color of Law incontrovertibly makes clear that it was de jure segregation―the laws and policy decisions passed by local, state, and federal governments―that actually promoted the discriminatory patterns that continue to this day.” As American cities continue to address the legacy of segregation while also dealing with widespread gentrification, this new look at urban history is invaluable.

Extreme Cities: The Peril and Promise of Urban Life in the Age of Climate Change (Verso, 2017)
Ashley Dawson, a professor of English at the City University of New York, argues that mega-cities, which are most often found on coasts, are “ground zero for climate change,” given they are home to our largest populations, highly vulnerable, and also contribute the most to greenhouse gas emissions. Reviewing Extreme Cities, author McKenzie Wark writes: “Dawson shows how social movements have combined action on disaster relief with forms of equitable common life to produce models for radical adaptation from which we can all learn. This is a brilliant summation of what we know and what we can do to build a new kind of city in the ruins of the old.”

Handbook of Biophilic City Planning & Design (Island Press, 2017)
University of Virginia professor Tim Beatley’s new book presents everything he has discovered on what he calls “biophilic urban planning and design” — strategies that both boost biodiversity and foster deeper human connections with nature in cities. He brings together the established science, the important case studies, and innovative code and design practices from around the world in one place. Even if you think you already know a lot about how best to incorporate nature into cities, there will be some interesting new facets in this book for you to explore. (Read the full review).

Movement and Meaning: The Landscapes of Hoerr Schaudt (The Monacelli Press, 2017)
This book highlights the depth of work created by landscape architects Doug Hoerr, FASLA, and the late Peter Schaudt, FASLA. From private gardens to lush civic spaces, Movement and Meaning chronicles the major works by the Chicago-based studio, from inception to final installation. The sheer variety of images, drawings, and photography make this book an absorbing overview. (Read the full review).

The New Landscape Declaration: A Call to Action for the Twenty-First Century (Rare Bird Books, 2017)
Last year, on the eve of its 50th anniversary, the Landscape Architecture Foundation (LAF) brought together 700 landscape architects, designers, and planners in a symposium in Philadelphia to forge a New Landscape Declaration. LAF now offers in handy book form 33 speeches that “reflect on the last half-century and present bold ideas for the what the discipline should achieve in the future.” Those ideas are meant to “underscore the need to diversify, innovate, and create a bold culture of leadership, advocacy, and activism.” (Read more about the declaration and symposium).

Paradoxes of Green: Landscapes of a City-State (University of California Press, 2017)
This new book by Gareth Doherty, ASLA, director of the masters in landscape architecture program at Harvard University Graduate School of Design, is a successful hybrid of landscape writing and ethnography focused on the island nation of Bahrain. It presents a portrait of Bahrainis’ rich and evolving relationship with their landscape as well as a model for future studies. (Read the full review).

Transmaterial Next: A Catalog of Materials That Define Our Future (Princeton Architectural Press, 2017)
While we have all experienced the effects of the information technology revolution now underway, we may be less aware of the impact of the new “materials revolution,” argues University of Minnesota professor Blaine Brownell in his new book. Building materials are being transformed to respond to our planetary environmental crisis, lower costs and boost efficiency, and provide new media for creative expression. Given the serious problems facing the Earth, the scale of the ambition is heartening. (Read the full review).

Wise Trees (Harry N. Abrams, 2017)
Landscape photographers Diane Cook and Len Jenshel offer gorgeous full-page photographs of 50-plus wise, old trees, which are accompanied by a brief story about the spiritual and cultural life inspired by each of these natural wonders. With the help of grants from the Expedition Council of the National Geographic Society, the photographers spent two years traveling across five continents to capture these historic specimens.

Also, worth knowing: buying these books through THE DIRT or ASLA’s online bookstore benefits ASLA educational programs. And if you are based near Washington, D.C. we also recommend checking out the National Building Museum’s fantastic book store.

Interview with Mikyoung Kim on How to Design for Our Hybridized Lives

Mikyoung Kim, FASLA / Chris Baker

Mikyoung Kim, FASLA, is an award-winning landscape architect and founder of Mikyoung Kim Design.

Interview conducted at the ASLA 2017 Annual Meeting in Los Angeles.

A recent study found 85 percent of parents allow their children under the age of six to use technology at home, despite concerns that too much time with phones, tablets, and computers cuts into their time playing outside. Another study found one-third of all children worldwide spend less than 30 minutes a day outside and half spend less than an hour a day outside, which is lower than the average amount a prison inmate spends outdoors. Meanwhile, childhood obesity rates throughout the developed world have skyrocketed. Now one in five children in the U.S. are obese. What can landscape architects do to combat these trends?

We all spend too much time on our digital toys! When I see a group of teens walking down the street together and texting other friends, I have to admit I feel confused. But lately I’ve been trying to be more optimistic about the role of technology in our lives. I think it’s clear that technology has some benefits for kids—they have access to information quickly and they can connect easily to a wider group of friends. With my son, he’s able to find really obscure musical composition events for teens in Boston in a way he wouldn’t have been able to do before. So, there are real benefits with technology.

Do phones disconnect us from the natural world? Probably, I think. There are lots of studies that say, yes, it does. But I don’t want to be too nostalgic. I think we have to accept that the world has changed. We live a hybridized life.

Just recently, we went to see the redwoods in Northern California, Max had no desire to pull out his phone when we were hiking even though on the car ride there he was texting with friends. It’s really about how compelling a place is.

Young people these days are very nimble. They’re able to toggle between two worlds and use technology to help them better understand the world that they inhabit. As landscape architects, we must embrace the fact that people live in both digital and analog worlds.

But there’s clearly a connection between childhood obesity and technology. As landscape architects, we can help municipalities and cities plan their neighborhoods better because it’s the daily rituals that really matter.

Instead of focusing on large centralized parks, it’s important for us to also advocate for a more atomized green neighborhood plan where kids can walk through a pocket park, a neighborhood park, every day, or even twice a day.

For the Chicago Botanic Garden, you designed the five-acre Regenstein Learning Campus, which features grass-covered mounds, a waterway channel, willow tunnels, nature play, and discovery gardens. How do you define nature play? And how do you design a space that will really encourage it?

The Chicago Botanic Gardens is an amazing place for families and kids. When we first started working on the project, the Botanic Garden was interested in creating a place that went beyond just visual beauty and encouraged multi-sensory engagement. They wanted to create gardens that encourage kids to touch things; places where the leaves rustle in a way that really encourages listening. Through this process of engagement in a multi-sensory garden, children learn something about natural processes.

ASLA 2017 Professional General Design Honor Award. Chicago Botanic Garden: The Regenstein Learning Campus. Mikyoung Kim Design and Jacobs Ryan Associates / Kate Joyce

As I’ve said, I think “nature” is a pretty loaded word. I’m not sure that anything near Chicago is really “natural” anymore. Instead, what we did was to try to capture and abstract natural systems.

Programming was also very important to the Botanic Garden. We engaged the community to create complex and layered programming for visitors of all ages; from toddlers to seniors. We also worked closely with the design team to create an integrated inside/outside classroom experience.

You have said that your design for the campus also encouraged “inquiry-focused learning.” Can you explain what that is? And why it was important to encourage?

I’ve been interested in this since the beginning of my practice. How do we teach kids through hands-on learning?

We work with kids to understand how we can make playgrounds and landscapes that move away from the homogeneity of off-the-shelf playground equipment, and encourage hands-on learning- this encourages kids to ask questions.

We’re interested in etching deep memories. I’m very opportunistic about creating these places for children-especially in the city — you have to be. We work with families and try to find these moments — in pocket parks or pop up parks.

I am not necessarily concerned about kids and their interaction or lack of interaction with the natural world, but more with the kind of digital and analog worlds we’re making for them. For example, the homogeneity of playgrounds is a real issue. You can go to Omaha or Boston and see the same play equipment. The games they play have answers already defined by some adult somewhere. Even with Legos. When I was a kid, you would spill out like a whole bunch of Legos and then create your own world. Now you know you’re making a boat at the end. And kids love it. I know they do, but I really feel, as a landscape architect, that we need to create places that highlight open ended experiences, places that encourage children to be inquisitive and creative.

Having said that, all we can do as landscape architects is to strive to create environments that engender inquiry. “Imagination” should be a verb, right?

Maybe the answer is that we should try to create landscapes that are more open-ended, that allow for the imagination to thrive for children and adults. Adults need to play as well; they need to be able to find different interpretations in the landscapes we create.

You said the land forms you designed applied the “concept of the dignity of risk,” which is such an interesting phrase. Can you explain what you mean? And why is it important to incorporate that into designed nature play areas?

Too much of our built environment is designed from a place of fear. I understand there are concerns with litigation, but this is an idea that our client emphasized at the Chicago Botanic Garden.

We discussed different ways of bringing kids up to various elevations as a way of encouraging discovery play– we studied tree houses and land forms which would allow kids to move up and down and run around.

ASLA 2017 Professional General Design Honor Award. Chicago Botanic Garden: The Regenstein Learning Campus. Mikyoung Kim Design and Jacobs Ryan Associates / Kate Joyce

The only constraint the Botanic Garden had was that the landscape had to be accessible to all kids. In all of our work, we’re trying to create landscapes that allow for kids to understand the range of what their body can do but also challenge them to discover new things.

You brought nature play indoors, too, at the Crown Sky Garden at the Ann & Robert H. Lurie Children’s Hospital in Chicago. You transformed 11,000 square feet space on their 11th floor into an interactive engaging healing garden for ailing and recovering children and their families. The space is designed to offer access to light and plants, reduce stress and boost physical activity, while offering a safe space for children with compromised immune systems. How did you design the space to protect patients’ immune systems?

We met with families, caregivers, and patients for days and just tried to understand what was important to them. The difference between this garden and some of the other healing gardens we’ve designed is that this was the only garden they had. Within this singular garden, we had to pack in a lot of aspiration and hope.

Working on these healthcare projects, I’ve learned to be a better listener. I remember that as we were working through this project, President Obama talked about the empathy deficit. I think as a landscape architect I always strive to be more empathetic and really hear people’s stories — and learn how that can help me better understand their aspirations and needs.

We had to make a decision while we were working on this project, as all these requirements emerged. Each time we said — “Well, we want water. We want to hear the sound of trickling water” — they would present evidence that if we did that, a certain population at the hospital could contract Legionnaires’ disease. We decided we wanted a garden that was accessible to everybody.

When I interview patients, I’ll go to their bedside and meet them. It’s the most fragile patients, especially in pediatric hospitals, who need these gardens the most. So, the last thing we wanted is a sign that said, “patients with these kinds of immune deficiencies are not allowed in the garden.”

We had to put aside our preconceived notions of what healing gardens are and really start to abstract nature in order to create this indoor experience for these families and patients.

ASLA 2013 Professional General Design Honor Award. The Crown Sky Garden: Ann & Robert H. Lurie Children’s Hospital of Chicago. Mikyoung Kim Design / George Heinrich Photography

At the Crown Sky Garden, it was the client who actually saw in us the possibility of merging our arts background and our ability to creatively innovate with materials with our interest with kids. We learned we had a way of transforming the landscape that’s artistic, but also compassionate.

ASLA 2013 Professional General Design Honor Award. The Crown Sky Garden: Ann & Robert H. Lurie Children’s Hospital of Chicago. Mikyoung Kim Design / George Heinrich Photography

With ubiquitous technology increasingly winning the competition for attention, how does nature play need to evolve, or perhaps co-evolve with technology? Do landscapes need to be designed to be resilient to technological or cultural change?

Kids find their own hybrid definition of digital and analog play. They’re able to easily text friends in the car while playing some video game and then go into the park and put the phone in their pocket and run around and climb a tree. I don’t think one necessarily precludes the other.

We need green spaces that are more accessible, but what’s more important today than ever before is creating something compelling in a park that will draw kids there. I have yet to see technology in the landscape advanced enough to compete with technology a teen has in their phone.

However, merging technologies into the landscape itself so that our landscapes become a large video game is something I don’t buy. Our technology is just not advanced enough. Kids are incredibly smart. They’ll look at that and say, “Well, that’s lame,” you know?

Throughout our design process at the Crown Sky Garden, we worked closely with different constituents. We worked with families and patients and brought two options. We brought an option that used more natural materials, and then we brought in a design that had more innovative materials — materials people hadn’t seen before — more contemporary materials built in innovative ways. I’d say 99-percent of kids were drawn to those. They said, “Cool, that’s amazing. I’ve never seen that before.”

ASLA 2013 Professional General Design Honor Award. The Crown Sky Garden: Ann & Robert H. Lurie Children’s Hospital of Chicago. Mikyoung Kim Design / George Heinrich Photography

Innovative materials draw kids. They ask a lot of questions: “What is this? How is it made?” They really wanted something that was more open-ended and unique — something that was beautiful, interesting, strange, and vibrant. Maybe there is something to this.

Lastly, you’re known for your truly-innovative explorations with materials. For example, you’ve created wave forms out of stone for the Alexander Art Plaza in West Palm Beach. And you have sculpted metal in many of your projects. You seem to enjoy transforming the properties of materials. Nothing appears static. What is your creative process for approaching materials?

Like kids these days, we approach the process in a hybrid fashion. We use both analog and digital tools. Personally, I love technology. It’s really transformed the kind of landscapes we can make. It’s allowed us to inhabit our landscapes in ways that I could never do when I started my practice. I love being able to walk through the landscapes we make in Rhino.

Alexander Art Plaza in West Palm Beach. Mikyoung Kim Design / Robin Hill
Alexander Art Plaza in West Palm Beach. Mikyoung Kim Design / Mark La Rosa

But then I’m also a little suspicious of those beautiful but singular perspectives that have emerged from these rendering technologies; that’s not how our perception works. In one minute, our eye can see 3,000 different perspectives. In singular perspectives, we tend to pick the hero shot and neglect the shots that don’t look at great. For us, we use walk-throughs to say, “well, this spot doesn’t look so great. Let’s try to work on it further.” The fluidity and kinetic qualities that you talked about in some of our work comes from this technology.

We’ve been talking about community engagement and being empathetic. For us an empathetic community allows for us to find new ways of designing. it just helps make our work richer.

And meeting with people also builds trust. It builds trust between us and our client groups. Our clients often have very high expectations — they are patients in a hospital, developers who are building very high-end developments, etc. Through our process, they enter a shared design space with us; one that is a collective experience that hopefully yields a unique landscape in the end.

Urgent Biophilia: Connecting with Nature After a Disaster

Rarely have I worked on a project that I feel is quite as timely and potentially impactful as the Beach 41st Street Garden. With images of Texas, Florida, and the Caribbean fresh in our minds, this story of how nature has helped one Queens, New York, community heal following Hurricane Sandy is incredibly relevant.

When we finished shooting this past spring, it was months before the name Harvey had been uttered on a weather forecast. But by the time September had arrived, and with it a new wave of destructive storms, we at TKF felt a renewed sense of urgency to shine a light on what we had learned through our work in Queens post-Sandy.

When Sandy’s storm surge engulfed the Rockaways, the devastation was intense. You get a visceral sense of what the residents of Beach 41st Street, a New York City housing residence, lived through in the voice of Celeste Grimes, one of the resident gardeners we interviewed for the film. She described it in apocalyptic terms.

In 2014, TKF chose the Beach 41 Street garden as a site to receive one of only six grants awarded to clusters of cross-disciplinary research teams to study how healing green spaces help individuals and communities recover following various kinds of trauma.

The team that applied for funding on behalf of the Beach 41 Street project included social scientists Lindsay Campbell and Erika Svendsen of the US Forest Service; Keith Tidball, Director of the Cornell Cooperative Extension Disaster Education Network at Cornell University, Craig Desmond of Ecotone Building, and landscape architect Victoria Marshall, ASLA.

The team collaborated on a plan that would enable residents to revive the gardens and space; a healing exercise intended to meet what researchers understand is a desire innate in people to connect with nature, particularly in times of deep distress and trauma caused by nature.

For years now, social scientists, civic ecologists, horticultural therapists — among others — have been gathering evidence of the innate connection between people and nature, terming it biophilia. Expanding on that concept, Keith Tidball originated the term “urgent biophilia” to describe the intense need that arises post-disaster to connect with nature.

What the research team saw happening at the Beach 41st Street garden — between the gardeners and community and green space — was a living enactment of urgent biophilia. As they worked to restore the gardens, they were at the same time restoring themselves.

What we often miss in the media is the full scope of the damage that remains in the aftermath of the immediate aftermath of a storm. We know that recovery extends far beyond reconstruction and restoration.

But if our communities are to heal fully following natural disasters like Sandy, Harvey, Irma, Maria — and the countless future storms that are sure to arise in the coming weeks, months and years, we can’t ignore our green infrastructures. They are, without a doubt, essential to our well-being.

This guest post is by film maker Alden E. Stoner, who is also a board member of the nonprofit TKF Foundation.

Interview with Clare Cooper Marcus on the Healing Power of Nature

Clare Cooper Marcus

Clare Cooper Marcus is Professor Emerita of Architecture and Landscape Architecture at University of California, Berkeley. Most recently, she is the author of Therapeutic Landscapes: An Evidence-Based Approach to Designing Healing Gardens and Restorative Outdoor Spaces, co-authored with Naomi Sachs, ASLA; and Iona Dreaming: The Healing Power of Place.

This interview was conducted at the ASLA 2017 Annual Meeting in Los Angeles.

In your book Therapeutic Landscapes: An Evidence-Based Approach to Design Healing Gardens and Restorative Outdoor Spaces, co-authored with Naomi Sachs, ASLA, you argue we’re returning to the wisdom of the ancient Greeks, who understood the healing power of nature and mind-body connection. Why has it taken so long to rediscover these essential understandings?

While the understanding was not entirely lost, the medical world needed proof. They were not interested in aesthetic arguments that gardens are “nice” and people appreciate “green views.” Those didn’t cut it.

The whole start of the healing gardens and therapeutic landscapes movements was Roger Ulrich’s famous study, The View from the Window, published in 1984 in the prestigious magazine Science. With access to medical records of people recovering from gall bladder surgery – some with a view to trees, some who could only see a brick wall – data showed that those with a view to trees called the nurse less often, asked for fewer high-dose pain killers, and went home a little sooner than those who viewed a wall. This study offered proof of the benefits of nature, using empirical data the medical world could understand and appreciate. Healthcare facilities took note and said, essentially: “Oh, I see. Trees outside windows and gardens around a hospital are not just cosmetic niceties, they can also affect the bottom line!”

There’s now an understanding that access to nature, sunlight, fresh air, and interactions with nature can reduce healthcare costs and patient recovery times. What has driven the explosive growth in therapeutic landscapes in hospitals and other care facilities? Has it been the financial benefits? Or are there other reasons?

There are certainly studies now that show if people have certain conditions and then have access to nature, they may call for fewer pain killers. That’s certainly significant. Studies of Alzheimer’s facilities where residents have access to a garden have shown that there is less need to prescribe drugs to reduce agitation or deal with insomnia.

Yes, the financial benefits have been important in encouraging the growth of therapeutic landscapes. But marketing is also important. It would be rare to find a senior retirement facility or hospice where a garden is not an attractive element, appealing to family members or to prospective staff.

Many hospitals are now providing gardens and that is good. However, in their marketing, some use the term “healing garden” as a buzz word. Sadly, in some cases I see in the trade magazines, there’s a photo of a chaise lounge on a roof with two potted plants, and it’s labeled a “ healing garden.” Some of us in the field are beginning to say perhaps there’s a need for a certification of healing gardens, although, just how that would work is very complicated.

There’s also been important recent research on the significance of access to outdoor space for the staff. Hospital staff work long shifts often under very stressful circumstances. Here’s a shocking number: more than a quarter of a million avoidable deaths occur in U.S. hospitals every year due to medical errors. This is just a speculative question, but could access to nature for hospital staff on their break times result in lowering stress and result in fewer medical errors?  I doubt this could ever be proved as there are too many variables. But there is research where staff are saying, “Oh, yes, we want to have access to gardens.”

Hospital staff typically have window-less break rooms with no outdoor access. Also, did you know that the average lunch break for a nurse in an American hospital is just 38 minutes? So, even if there is a garden, and it’s at a distance, they’re not going to go there because they don’t have time. A trend now at hospitals who are aware of this is to put smaller gardens close to break rooms, so that staff can at least get outside for 10 or 15 minutes. That’s very important. Research has shown that is long enough for a significant reduction in levels of stress.

Roof garden for staff only, Great Ormond Street Hospital for Children, London, England. It is increasingly recognized that hospital staff often feel burnt-out and stressed and need a quiet garden space of their own, away from patients and visitors. The wooden arches are in memory of two nurses from this hospital who died in the 7/7 terrorist attacks in London. / Clare Cooper Marcus

What are the key elements of a well-designed therapeutic landscape? What separates a great one from an OK one? Can you provide a few examples?

Oh – where to begin! It’s not rocket science, and some might argue its not vastly different from just a beautiful, well-designed garden. But there are many elements that are critical and are over-looked by even the most experienced landscape architects. First, it needs to be predominantly green; I would say about 70 percent green 30 percent hardscape. If it flips the other way, you’ve got a plaza; you don’t have a garden. The garden needs to be green, lush, and have all-season vegetation to the extent that it’s possible, depending on the location. It needs to be colorful and appeal to all the senses – smell, sound, touch, even taste – not just the visual.

The garden should serve the most vulnerable users. So, if this is, say, an acute care hospital, the most vulnerable users might be someone pulling an I.V. pole or using crutches. Pathway surfaces, non-glare elements, universal design – all are critical. A user may be someone who’s so weak they can only walk from the entry to the first bench. A person who is frail needs upright seating with arms and a back to help them get up – no slumped seating in the ubiquitous Adirondack chair!

A successful garden needs to be easily accessible and visible from a well-used interior space – foyer or waiting area in a hospital, day room or dining area in a senior facility. There should be a hierarchy of pathways for people to exercise who have varying degrees of energy. There must be adequate shade in an entry patio or under trees or a shade structure — an obvious thing but often overlooked. A lot of people are on medications — chemo, HIV-AID medication, psychiatric drugs — where they have to stay out of the sun. If there’s no shade, people aren’t going to go out there. We are seeing more and more patient-specific gardens – for those with cancer, PTSD, dementia, mental health problems, children with disabilities. In those cases it is critical that the designer works with the clinical staff and the maintenance staff in a participatory process.

So what separates a great one from a merely decent one? If the garden just had some greenery, paths, and a few benches, it wouldn’t be really therapeutic. Here are a few very good examples, in no particular order:

The Olson Family Garden at St. Louis Children’s Hospital is an 8,000-square-foot roof garden on the eighth floor. It has lush plantings, fairly large trees, and winding paths where children love to run, disappear, and appear again. There are five different water features. It has elements that intrigue children without turning it into a playground: stepping stones across water, telescopes so you can look out over St. Louis, cubby windows, a kaleidoscope, a sundial. It also appeals to adults and care givers with many semi-private places and a variety of moveable seating. It’s used by everybody and is well publicized within the hospital. The garden was designed by Herb Schaal, FASLA, with AECOM. It cost $1.9 million and was paid for by a local philanthropic family, who also gave an endowment for maintenance, so it always looks beautiful.

Olson Family Garden, St Louis Children’s Hospital, St Louis, Missouri. A roof garden popular with visitors, children and staff where children find plenty to engage them – stepping stones, water features, cubby windows, telescopes – and adults appreciate an oasis in complete contrast to the hospital interior with choices of semi-private places and moveable seating. / Clare Cooper Marcus

Another great example is the garden of the Oregon Burn Unit in Portland, Oregon, designed by landscape architect Brian Bainnson, ASLA, Quatrefoil. The reason this one works so well is Bainnson worked closely with the clinical staff at the Burn Unit to find out what patients and staff would need outdoors. He incorporated lush, beautiful, all-season planting.

Garden of the Oregon Burn Unit, Portland, Oregon. A garden designed with crucial input from the clinical staff. It has all-season colorful plant materials, shade structures essential for patients with burns and skin grafts, and varying surfaces for those learning to walk again. / Clare Cooper Marcus

A third example is the Living Garden at The Family Life Center in Grand Rapids, Michigan, an Alzheimer’s care center designed by landscape architect Martha Tyson, ASLA, who understood the literature on Alzheimer’s and dementia. She worked with the staff. The garden completely recognizes the main issue of these patients, which is lack of spatial cognition. I has a simple figure-eight path with destination points, so patients can’t get lost. There’s one exit and entry to the garden. No plants are toxic.

The Living Garden at the Family Life Center, Grand Rapids, Michigan. A garden designed for those with Alzheimer’s disease and other forms of dementia. To avoid confusion for those with limited spatial cognition there is one way to enter and exit the garden, an arched entry, a simple figure-of-eight path, a gazebo destination point were staff program events. Lush, layered planting around the garden boundaries disguises walls and fences – essential as those with dementia sometimes try to “elope.” / Martha Tyson via Landscape Architecture Magazine
The Living Garden at the Family Life Center, Grand Rapids, Michigan. / Clare Cooper Marcus

In Japan and South Korea, there are efforts to expand the use of forest bathing to improve health and well-being and also to fight addiction to new technologies. South Korea is creating a network of national forest healing centers. What do you see as the value of forest bathing? What will it take for this practice to take off in the U.S.?

The evidence from research in Japan is that breathing the air in these forests, particularly those of Hinoki cypress, lowers stress levels, blood pressure, and pulse rates. I think it has definite value, but we also know that walking in any kind of forest or non-urban green area has positive effects on health.

We’re really at a stage of infancy in this work in the U.S., but I do see a lot of media attention.

It’s funny, but the U.S. is often at the forefront with technological innovations, but rarely with social innovations – at least involving nature and play environments. Forest kindergartens have been popular in Germany and Denmark for decades; they are just catching on here. Adventure playgrounds have been around in western Europe since the 1940s; there have never been more than two or three in the U.S. (one is in Berkeley!). The Netherlands spearheaded the notion of the woonerf , or a street shared equally by vehicles and pedestrians; the idea spread across the developed world. But hardly at all in this country, largely, I would guess, because of resistance from transportation engineers.

However, in the realm of healing gardens in healthcare, the U.S. is at the forefront. It’s sad to see that in my own country of origin – Britain – famous for its gardens, those within hospitals are often poor or non-existent.

In a recent study, the Nature Conservancy estimates that, despite all the high-profile tree-planting campaigns, Americans city currently lose around 4 million trees a year. But just planting more trees in cities could reduce healthcare costs by decreasing the impact of air pollution, namely ozone and particulate matter. Other studies have found correlations between lifespan, sense of well-being, and proximity to trees. Unfortunately, however, even most arborists aren’t familiar with many of the health benefits of trees. Why aren’t the health benefits more widely understood?

Yes – there is a lot of valid research linking trees and health. Like so much material in this field of health and design, the studies produced in academic or semi-academic journals don’t filter out to people in practice. This is why it isn’t well-understood by people out in the field running tree planting programs in cities. I would not expect the people pruning trees in the street to know this. But the people in charge of trees for the city should.

There just needs to be more coverage of this information transferred from academic writing into more popular writing and hence the need for journalists and new messengers rather than new messages.

Some innovative doctors are now prescribing time in the park for a variety of conditions, testing to see if exposure to nature or a particular exercise in nature helps. What will it take for the mainstream medical profession to buy into this approach? What will it take for parks to be considered an essential part of our healthcare system by healthcare providers and insurers?

I see more and more references to the idea of providing prescriptions for people to go to parks. I believe in Washington, D.C. doctors can be provided with a list of available parks, so they can give those to their patients. For it to catch on, it will take a while, as with forest bathing and these other innovative things. It’s going to be some time before there’s research to show to the medical profession — proof that prescribing time in the park for someone with condition X improves that condition. But parks and their links to health have long been part of the landscape architecture profession going back to Olmsted.

Some hospitals being built or rebuilt are not only putting therapeutic gardens within the hospital confines but also putting a park or garden at the entry that is open to the general public. They’re providing green space for the city as a whole within their site.

Some examples include University Hospitals’ Schneider Healing Garden, Cleveland, Ohio; and Good Samaritan Medical Center’s Stenzel Healing Garden in Portland, Oregon.

Some re-built hospitals are specifically orienting patient rooms towards an adjacent park. These include The Royal Children’s Hospital in Melbourne, Australia, and Alder Hey Children’s Hospital in Liverpool, England.

Alder Hey Children’s Hospital, Liverpool, England / © Parry Family Charitable Foundation

This will continue as more hospitals recognize how important access to greenery is. Providing green space within the hospital or adjacent is relatively inexpensive compared with the cost of a new MRI machine.

Lastly, to recover from your own serious illness, you immersed yourself in nature for six months in the remote Scottish island Iona and then you wrote a book about it. You said nature there mirrored your soul and had a profound healing effect. Can you talk about that experience? How can we find those magical places? And how do you know you’ve found yours?

I found mine by serendipity and intuition. I don’t think you can go out and search for such a place or know that it has certain characteristics. When you find this place, it’s probably not your home, probably somewhere you found by chance. It may be somewhere a little different, a little distant, maybe a place you go now on weekends or maybe once a year.

In the mid-80s, I went to live with my children at Findhorn, an innovative, intentional community in Scotland from the 60s that still exists and flourishes today. They own a retreat house on the island of Iona on the other side of Scotland, and, once I had been there, I knew that the island was my healing place.

After two diagnoses of cancer shortly after retirement from academia, I went on retreat and lived alone there for six months and began to write. I now go back every year and have done so for 18 consecutive years.

All I can say is, when you find such a place, it feels as though you have come home. Not home as in a house. Home as something much deeper on a spiritual, psychological level, a place that resonates with something deep inside you.

Iona / Clare Cooper Marcus

I’ve met people who’ve come to Iona for the first time and stepping ashore they find themselves in tears. For other people, it feels like they have at last come home, yet they have absolutely no familial roots with Scotland or Britain. There is no logical reason; its not an issue of logic or reason. It occurs to numbers of visitors to this island, but that doesn’t mean to say you have to go to this particular place. You might find your place through a dream, or coming by chance across a mention in a book, or some other unexpected event.

Follow your heart; it knows. No one can give you a formula.

Visions of a Renewed Los Angeles River (Part 2)

CalEnviroScreen of Los Angeles River area / LA River Index

As revitalization efforts reach a new stage on major sections of the Los Angeles River, including the creation of a new park at Taylor Yard, an old railroad station, a team of architects, landscape architects, and civil engineers are building off of the approved 2007 Los Angeles River revitalization master plan and 1996 county master plan guiding city, county, and Army Corps of Engineers work. The team comprised of Gehry Partners, OLIN, and Geosyntec  — who are now working “pro-bono” and claim to have volunteered $3 million in time — is undertaking a multi-year, “data-driven” research effort to better understand the trade-offs involved in greening the concrete culverts that now define the Los Angeles River in much of its 51-mile span. Mayor Eric Garcetti and the non-profit River LA, formerly known as the Los Angeles River Revitalization Corporation, have lent support to Gehry’s new planning effort.

At a session at the ASLA Annual Meeting in Los Angeles, civil engineer Mark Hanna, Geosyntec, explained that the Los Angeles River is highly variable in its outflow, which makes it dangerous. In 2007, some 48,000 acre feet of water flowed out of the mouth of the river, while just two earlier, there had been 950,000 acre feet. “The variation is extreme.”

Along the course of the channelized river, there are different zones designed by the Army Corps of Engineers to move water rapidly through or hold it. “The channel morphs — there are culverts and also reservoirs. There are narrow box culverts and wider trapezoidal ones. There is a ‘soft bottom reach.’ And then the river widens out as it reaches the estuary by the sea.”

However, Hanna cautioned, even with all the engineering, there are still flood risks. The Los Angeles River was originally channeled because it used to meander and spread wide across the flat flood plain, damaging properties and even claiming more than a hundred lives. The current system has been designed to handle the 100-year storm in most parts, but there are still around 3,300 homes at risk if that level of storm hits the city.

While there are plans underway to return more ecological function to the river zone, there are more calls to make the actual concrete culverts green. “There’s 2,000 acres of open space that is now hot and unwelcoming.”

The problem is any greenery added to the culverts “create friction and therefore slows water down.” Hanna said replacing all the culverts with natural systems would in turn require widening the river by five times, an impossibility given communities now line the concrete channel. Greening the culverts without widening could then in effect create a major flood risk.

“Just adding trees to the banks would reduce flood capacity by 60 percent; turf, grasses and shrubs along the bottom of the culvert would reduce by 45 percent; just grasses, 25 percent; trees in the middle band alone, 20 percent; and grass along the middle stretch, 5 percent,” explained Hanna.

For Richard Jackson, former head of environmental health for Centers for Disease Control and Prevention, and professor at University of California at Los Angeles, adding more green is the goal, but not at the cost of future flood deaths. Still, he wants to see a revitalized river become a positive change agent, instead of a contributor to health problems, as it is now.

Using California’s EnviroScreen, a tool he helped develop, he found those communities “most at risk of severe health problems are near the river.” High levels of asthma and obesity are co-located along the river because many of the communities near the river lack parks, access to healthy foods, and are also near pollutant-spewing highways and freeways.

Richard Roark, ASLA, a partner at landscape architecture firm OLIN, also wants to see a new Los Angeles River creating a healthy environment for both people and wildlife. “If restoring the ecological function of the Los Angeles River costs $100 million a mile, at a total cost of $5 billion, think about what it could be preventing in terms of healthcare costs.” Indeed, Jackson estimated the total public health costs of a poor environment in Los Angeles to be around $25 billion.

Roark called for using “designed ecologies” to improve the quality of life for the communities near the river, by creating fresh air and cleaner water and wildlife habitat. But he cautioned that “we can’t think about restoring the river to its original form; we can’t free it. Within the urban matrix, we have to control it.” Roark also called for a green infrastructure network in the neighborhoods surrounding the river and its primary tributaries.

When landscape architects in the audience questioned why the team didn’t look more closely at distributed options that could make greening the entire river a viable option — including more upland green infrastructure, including reforestation; using structural soils to slow down and store water; or building underground channels to convey water — Hanna cautioned that the models show these systems would help with regular storm events, but not the 100 year storm the culverts are designed to handle.

Still, many of the landscape architects called for much bolder thinking and a renewed effort, given the LA River now functions as “a giant urinal.”

View the team’s full analysis at LA River Index.

Love and Fear in Los Angeles

Graphic by Margaret Gerhart

Sometimes things happen that make you question everything.

Two weeks ago, I walked along 103rd Street toward the corner of Grape in Watts with several community advocates and a selection committee from the California Natural Resources Agency. Viviana Franco and Maria De Leon from From Lot to Spot, the non-profit who applied for an urban greening grant, led us past Jordan High School and the Jordan Downs public housing development that is under redevelopment.

We described our proposal to the Agency, pointing out the portions of sidewalk to replace with shade trees and planting. Viviana had us meet in the beloved Heart of Watts community garden they installed a year ago, and showed us the parkway plantings and new concrete that brought patches of life and pride amid the crumbling curbs. As we walked, we talked about which trees would best shade people walking by and cool the apartment homes, which have no air conditioning. We noted the phone lines overhead, and the weeds and litter underfoot. We discussed native species and biodiversity. And maintenance.

A young man in a white suit and several teenage girls passed by on their way to school. Otherwise the sidewalk was empty.

Our group included John Jones from Council District 15, Haleemah Henderson of Watts Labor Community Action Committee, Amada Valle from the Heart of Watts garden, and Watts Gang Taskforce member Pinkus Crowther. We stopped at the corner of Grape at a large fenced lot where Mudtown Farms Agriculture Park will soon be. A few scraggly trees and one large one lined the fence opposite us on 102nd Street.

The light was red where Grape Street dead-ended into 103rd. A line of cars gathered. One driver leaned out his window to complain, laughing, to John about a new sign reading “No Right on Red.” John told him, “The community asked for it.”

Pinkus and I talked about the huge change trees could bring to the street.

“I just hope they don’t come cut their branches,” he said. “We plant trees and as soon as they start growing, they cut the branches so the police can see.” He turned to John, “Do you know if the police came to cut the trees yet?”

“Not yet, but they need to,” John said. He pointed across the lot at the big tree. “That big one. That’s where one of the toughest gangs in LA hangs out. The police need to cut it so they can see who is there.”

As we walked back towards the Heart of Watts, I said to Pinkus, “I know nothing of the situation here. But how do we balance immediate security with providing the very thing that can improve social cohesion, reduce criminal behavior, improve self-esteem, and build a community? Because we know trees and gardens can do that.”

“I don’t know,” he responded. I don’t know either.

This is where the tension lies. Which approach would you choose: fear, or love?

The night after I walked through Watts for the first time, my son’s best friend was killed there, on the same street I had walked on the day before. He and two friends went to a birthday party meant to bring youth from different communities together. They left the party without a ride, were attacked by a group of men, and beaten until he lay unconscious against an alley wall. One of the men pointed a gun at his friends. They ran for their lives. Two gunshots sounded. They returned to their friend, called 911, and tried to stop his bleeding. He died while they watched over him.

His friends are devastated. My eyes ache from crying. I cannot imagine the pain his family is going through. We all loved him. I will miss his kind smile and gentle nature and the days and weeks he spent with us. I will miss the unconditional love and support he gave my son during our own family struggles.

I’m grieving the only way I know how, by writing. As I grieve, I cannot help thinking about that tree as a symbol of the lives that are lost in places like Watts.

Trees provide the air we breathe. They cool our homes and our cities, protecting us from deadly heat waves. They absorb rainwater and protect us from floods. Planting more trees may even prevent senseless deaths like our dear one’s.

Drs. Frances Kuo and William Sullivan, ASLA compared Chicago public housing projects and found that trees and grass in the courtyard correlated with a greater sense of community, greater feeling of safety, less aggressive and violent behavior, and less impulsivity and irritability. A study with their colleague Dr. Andrea Faber Taylor found greater self-discipline (and fewer pregnancies) in teenage girls who lived in housing where trees and grass were. These studies illuminate the power of nature to improve mental health — to reduce the stresses and irritability that can lead to violence.

The systems so many (cities, school districts, housing developments, detention centers) have in place now — security cameras, security fencing, security guards, Crime Prevention through Environmental Design (CPTED), helicopter policing, reducing growth of trees and shrubs so people cannot hide behind them — these are based on fear. Fear of somebody doing something if we don’t control our environment.

This is the same fear felt by parents who keep their children inside and over-scheduled after the freer attitudes of the 60s and 70s when so many of us roamed our neighborhoods and creeks and parks by ourselves.

But what about design born of love? Love lets us imagine the best for all of our communities. Tree-lined, clean streets with safe sidewalks, public plazas and gardens for people to gather, public restrooms and parks where families feel safe. Shaded bus stops with benches and green schools with playgrounds open to the community at all hours. Jane Jacobs summed up a safe neighborhood with four words: eyes on the street.

I grew up in a neighborhood like this in the 70s. When our classmate was brutally murdered while walking home from school, our schools and parents taught us to walk in groups and know our neighbors, not to stay inside and hide. I lived in a neighborhood riddled with crack in the 80s, where gunshots went off regularly, few dared to walk after midnight, and our roommate was held at gunpoint at the corner deli. I’ve lived in a lot of situations in between, and I’ve known love and fear in all of them.

We need to overhaul the racist lending, housing, and justice systems that paved the way to where Watts and neighborhoods like it are today. Instead of the fear-based approach that led to barren projects surrounded by crumbling streets and punitive law enforcement, people deserve to be treated with compassion, humanity, and dignity. These communities need empathetic justice, medical and mental health care, education, job training, decent shelter, clean water, healthy food, and purpose.

People also need a respite from stress, a sense of community, self-esteem, beauty, and hope. These are things trees and gardens provide. Our children and teenagers, who are drowning in anxiety, need and deserve relief.

There are non-profits all over the city working for environmental justice. WORKS is a non-profit developer building affordable and sustainable residences with mental health services in LA’s disadvantaged neighborhoods. The Trust for Public Land in LA has created 10 parks in the last eight years, including Watts Serenity Park, which opened in 2015. From Lot to Spot sees a more humane and beautiful Watts through planting street trees and community gardens. The Watts Labor Community Action Committee is leading the effort to build Mudtown Farms Agriculture Park.

We need to support these efforts, and others like them, by advocating for funds, programs, and services to help build healthier, safer communities without displacing people — to work towards social and environmental justice. Fear has had its chance, and it isn’t working. Let’s try more love.

This guest post is by Claire Latané, ASLA, LEED AP, SITES AP, fellow in innovation and leadership, Landscape Architecture Foundation (LAF), and senior associate, Studio-MLA.

What We Still Don’t Know about the Health Benefits of Nature

ASLA 2017 Professional General Design Award of Excellence. Klyde Warren Park, Dallas, OJB Landscape Architecture / Gary Zonkovic Photography

We know that connecting with nature is good for us, but there are still many questions that need to be answered through more credible scientific research: What is the ideal “dose” of nature? What health conditions do these doses actually help with? Does duration and frequency of dose matter? How long do the benefits last? Does who you are and where you live impact how beneficial exposure to nature will be? And how does technology help or interfere with our connection to nature?

To get a better handle on the remaining unknowns, leading public health expert Dr. Howard Frumkin assembled a multi-disciplinary team at the University of Washington comprised of experts in epidemiology, environmental health, clinical medicine, psychology, ecology, landscape architecture, urban studies, and other disciplines, along with experts from the Nature Conservancy, Seattle Children’s Research Institute, U.S. Forest Service, Willamette Partnership, Stanford University’s Center for Conservation Biology, and the Natural Capital Project. Together, they crafted a creative, ambitious research agenda, which was just published in Environmental Health Perspectives.

According to Frumkin and the other co-authors, “nature contact offers considerable promise in addressing a range of health challenges, including many — such as obesity, cardiovascular disease, depression, and anxiety — that are public health priorities. Nature contact offers promise both as prevention and as treatment” at all stages of life.

Furthermore, exposure to nature is likely cheaper than “conventional medical interventions,” safe, practical, and doesn’t require a highly-trained professional to dispense treatments. Green spaces designed to provide health benefits of nature also offer many co-benefits: they provide wildlife habitat, store stormwater, or offer shade, for example.

While the benefits of nature are increasingly understood, the team found seven domains where further research is needed. Below are high-level summaries; for greater detail, read the research agenda.

Mechanistic Biomedical Studies: We need to better understand how nature exactly works its magic on us. While some scientists believe the mechanisms, or pathways of impact, on our minds and bodies have an evolutionary origin, meaning they are deep-rooted and associated with our innate biophilia, others posit there may be more precise pathways that are psychological, relate to our immune system, or are linked with increased social contact or improved air quality. We don’t know exactly the way nature exposure works its benefits on us.

Just in terms of psychological pathways, there are a diversity of theories: some argue that nature helps by relieving stress, while others focus on the way nature can relieve mental fatigue. Those are different things. And there could be multiple mechanisms happening at once, too. Frumkin and team argue that with more research “specific neural pathways” for these benefits will likely be discovered.

There is also some research suggesting exposure to nature boosts immune function; physical activity outdoors in a green space is better than in a gym; being in nature promotes the creation of social connections, which in turn provide health benefits; and trees and other green spaces, particularly in cities, reduce air pollution, creating health benefits.

But the research agenda notes that much more evidence-based research is needed to isolate the exact mechanisms through which nature exposure works its theorized benefits.

Exposure Science: Epidemiologists try to measure the “magnitude, frequency, and duration of exposure to an agent, along with the number and characteristics of the population exposed.” When “researching the environmental impacts on people,” research focuses on “pathogens, medications, toxic chemicals, and social circumstances, or salutary exposures such as nature.”

However, they argue that “standard approaches to exposure measurement” have limitations. “First they fail to capture variations in how people in how people experience nature, nuances that may be highly relevant. Suppose that one person sits in a car atop a seaside bluff and admires the view of the beach (while checking email on a smartphone), a second person walks barefoot along the shore, enjoying not only the view, but the feel of the sea breeze and the lapping waves, and a third person plunges in a for a swim. The designation ‘beach contact’ or a measure of ‘time on a beach’ would fall short of capturing the variation in their experience.”

As such, measuring the effects of various doses of nature becomes more complicated — someone paying close attention to all the details while on a forest path and really immersing themselves in the experience and another person simply walking through while looking at their smartphone will “likely ‘absorb’ differing levels of nature.”

Epidemiology of Health Benefits: Epidemiologists, who research the health and disease profiles of populations, conduct “true experiments, ‘natural experiments,’ and observational studies.” The bulk of research on nature contact and health have been observational studies, which Frumkin and his team argue are practical, can be conducted rapidly, and reduce costs of research, given they typically use data collected for other purposes. However, there are also built-in limits to the pre-existing data, and it’s hard to control bias in these studies.

True experiments, which are clinical trials, are the “gold standard” in science. Natural experiments, which “are study opportunities that arise through circumstances outside the investigator’s control” — like Roger Ulrich’s famous study of hospital patients, their views of trees, and recovery times — enable researchers to test hypotheses in realistic settings. More of these studies are needed.

The group also recommends nature and health researchers do a better job of tapping into existing large-scale research studies and data sets; finding new sources of big data, such as using Google Street View, webcams, and location-based data-collection apps like Mappiness; and investing in more advanced statistical analysis and advancing epidemiological research in general.

Diversity and Equity — The Role of Nature Contact: More research is needed to better understand “a) patterns of disproportionate exposure; b) cultural and contextual factors that affect nature preferences; c) differing patterns of benefit across different populations; and d) the possibility that improved access to nature may have unintended negative consequences on vulnerable populations.”

As has been explored by other researchers, low-income communities are more likely than not to also have limited access to nature and green space, which only exacerbates the negative health impacts of poverty, bad diets, lack of exercise, and crime.

African Americans, Frumkin and his team write, may also have different associations with trees, fields, and forests than other groups, due to the legacy of “forced labor, lynchings, and other violence.” 

And livelihoods play a role in creating different understandings of what’s restorative: “a rural farmer has quite different preferences regarding nature from those of an urban computer programmer.”

On the positive side: there is some research that argues that access to nature and green space may disproportionately help those in low-income communities who suffer from unequal access to many services, but, again, more study is needed.

Technological Nature: Modern technologies — the Web, smartphones, games, virtual reality (VR), the list goes on — are altering our relationship with nature. Kids, who spend more and more time glued to their screens, are particularly impacted. But there are also other kinds of technologies  — those that “mediate, simulate, promote, and/or augment the human experience of nature,” which must also be better understood. Computer desktop wallpaper of nature scenes, VR movies in which users go on safari in Africa, and location-based games like Pokemon Go may offer some of the benefits of nature exposure — and may be better than nothing — but more laboratory-based experiments are needed.

Economic and Policy Studies, including Co-benefits: The benefits of nature are increasingly being quantified. As such, policies are being promoted to increase the value of these benefits for communities and ecosystems. Frumkin and the co-authors propose looking to ecological and health economics for new models of evaluation and quantification of the benefits of nature as well as the avoided health care costs.

When the value of a new park is estimated, it’s important that policymakers don’t just look at improvements in real estate value or gains in stormwater credits, but also the real, quantifiable community health benefits. Furthermore, cost-benefit analyses rooted in benefits valuations can help guide limited public funds towards the most effective forms of green space investment.

We couldn’t agree more. It’s critical to answer: What policies and regulations can positively boost the health benefits of nature and which don’t do much at all? Many cities aim to provide a park within a five minute walking distance of every resident. Is this a worthy policy? Toronto just created a shade policy to help reduce the negative health impacts of heat in the summer. What metrics should be used to measure the success of such policies?

Implementation Science — Studies of What Works: “Research findings don’t necessarily translate into action.” This group wants to see more what “intervention studies are needed to determine what works in practice.”

As an example, they point to the U.S. Forest Service’s iTree software, which helps anyone with a computer understand the ecosystem service benefits of the trees they are planting. The researchers ask: “might further development of such tools incorporate additional mental and physical health benefits?”

While this research agenda is impressive and comprehensive, there are a few other unknowns important to include:

First, doctors are now prescribing time in the park. Do these treatments, which often combine increased activity, social interaction, and nature exposure work? Is the combination of exposure, social engagement, and exercise what is key?

Second, what is the impact of climate change on the nature and health connection? As nature becomes a more changeable, and often destructive force, in many places, do we need to differentiate between safe and unsafe nature spaces? Can an ocean that floods a community every year be considered restorative when it isn’t causing damage?

Lastly, there are landscape architecture educators and researchers, like William Sullivan, ASLA, and MaryCarol Hunter, ASLA, who seek to determine which forms and arrangements of landscape elements have the most benefits. Their forward-looking studies are critical: The next step is to translate proven health benefits from nature exposure into design principles planners, landscape architects and designers, and engineers can apply in their work. What designed landscape forms and elements act as pathways to the biggest benefits?

Best Podcasts for Landscape Architects

And the best way to listen


Over the past decade, podcasts have emerged as a popular storytelling platform and captivating way to learn more about the world around us.

Podcasts offer a source of inspiration for designers exploring other disciplines and seeking fresh perspective within their own. For landscape architects, podcasts reveal new opportunities and ways of thinking about the way we design space.

The podcasts on this list seeks to capture the range of topics that influence the field — from interviews with leading landscape architects, to stories on cities, urban planning, communities, and sustainability, as well as insight from creative people in other professions.

All of these podcasts are available on iTunes and Stitcher

99% Invisible: Roman Mars and his team at 99% Invisible pull together seemingly disparate pieces of information to weave compelling stories of why things are the way they are. While not landscape-specific, this podcast is a must-listen for anyone interested in places, people, and design.

Recommended episodes: “Making Up Ground” is all about cities built on constructed land and the modern day implications of reclamation. 22 minutes

American Planning Association: The APA produces a series of podcasts that focus on everything from the people behind plans, to disruptive transportation technologies, to planning for public health and for public space. Together, the podcasts offer a good way to keep up with all things planning.

Recommended episode: In “Planning for Parks in Washington D.C.’s NoMa,” APA’s Mike Johnson interviews Robin-Eve Jasper and Stacie West, who are shaping the future of a D.C. neighborhood where, in an era of rapid development, almost no land was set aside for public parks. 23 minutes

Design Matters: If you’re in the design world and don’t know who Debbie Millman is, this podcast is a great introduction. Her podcast, Design Matters, has been around since podcasts about design have been a thing. She has interviewed influential people from a multitude of creative industries. Their stories are inspiring for designers in any field.

Recommended episode: Interview with architect Pierluigi Serraino about what creative people have in common. 28 minutes

Infinite Earth Radio: This weekly podcast explores solutions for a more sustainable world. Hosts Mike Hancox and Vernice Miller-Travis interview people — from government officials to local entrepreneurs — who are working to advance more equitable, resilient communities.

Recommended episode: “Bottom Up Water Solutions” talks about freshwater, keeping our streams clean, and smart growth in the face of climate change. 28 minutes

The Landscape Architect Podcast: This podcast, which is focused on landscape architecture, broadens the discourse within the profession by talking to leaders from all areas of the field. Host Michael Todoran with co-host Margaret Gerhart hold candid discussions with professionals in landscape architecture, as well as writers, researchers, and innovative thinkers influencing the future of the profession.

Recommended episode: “Feng Shui & Landscape Architecture” discusses movement and the environment with landscape architect Shelley Sparks as she analyzes Feng Shui for homes, business, and gardens. 53 minutes

Placemakers: Slate is a major hub for podcasts, and their Placemakers is a story-driven show about urban design and planning. Host Rebecca Sheir and the producers at Slate explore how innovative communities are tackling environmental and social issues.

Recommended episode: “The Greatest Misallocation of Resources in the History of the World” is an episode about an agricultural approach to tackling suburban sprawl. 29 minutes

Roots of Design: This podcast is by landscape architects for landscape architects. Produced by the New York Chapter of the American Society of Landscape Architects (ASLA), hosts Frank Varro and a variety of co-hosts discuss the breadth of opportunity in the profession through interviews with leaders in the field. It fills a crucial need for a landscape architecture-exclusive podcast and raises awareness of an often misunderstood field.

Recommended episode: Their first, “The Birth of Central Park and Landscape Architecture,” is a great place to start — and really any number of their interviews thereafter. 13 minutes

The Urbanist: For a global perspective, listen to Monocle’s The Urbanist. Host Andrew Tuck covers everything from urban policy to environmentalism to art. This podcast packs a variety of topics in each 30-minute episode, providing a well-rounded but thorough update on urban developments each week.

Recommended episode: “River crossing” on how rivers and bridges can both connect and divide urban areas. 26 minutes

What did I miss? Comment below and share your favorite podcasts.