Green Care: A Conceptual Framework - Frisk i naturen

elative model of health may be feasible in connection with green care
because it starts from the premise that health is a multidimensional and
dynamic process and not merely an absence of a disease.
When green care is viewed as health promotion, it enables a wide range
of outcomes to be considered on different levels, both on that of the
individual and of society. Effective health promotion leads to changes in the
determinants of health which can be related both to individuals and to the
structure of the society (see: International Union for Health Promotion and
Education, 1999). In addition to direct changes in health status, outcomes
arising from green care can be seen as changes in health behaviour or in
community participation or environmental and political changes.
Health outcome measures include reduced mortality, morbidity, and
disability (ill-health). Social outcomes are related to an individual, and
measured by quality of life, functional independence, and equity (wellbeing).
Health and social outcomes can be achieved by affecting their determinants
such as personal behaviour, environmental conditions and health care
services. Changes in personal behaviour which represent healthy lifestyles
could be measured, for example, by the degree of physical exercise
undertaken or by changes in nutrition.
Environmental conditions may include the quality of the air, the noise level
and the amount of social opportunities present at a green care project. The
effectiveness of health care service may be measured by the provision of
preventive services (for example, a park or a farm can, in this context, be
considered a green care service). These three determinants of health can
be affected by modifying personal, social, and structural factors through
health promotion interventions. An effective health promotion strategy
may affect all three of these at the same time; health and social outcomes,
the determinants of health, and modifiable factors which change the
determinants of health. The effectiveness of green care, when regarded as
health promotion, could be therefore assessed by measuring changes in
different levels i.e. in knowledge, in policy, or in organisational practices.
Changes in lifestyle or in environmental conditions, and in the use of health
services are also relevant indicators in addition to changes in health status.
The health promotion perspective is not a complete framework for green
care, neither does it give unambiguous answers regarding how to measure
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