History of the Green Prescription Program in New Zealand Primary Care
The Green Prescription (GRx) program in New Zealand is a pioneering primary care physical activity scripting program that has evolved significantly since its inception, becoming a cornerstone of New Zealand's approach to physical activity promotion through healthcare settings.
Origins and Development
The Green Prescription program was first introduced in New Zealand in the 1990s as a primary care initiative to increase population levels of physical activity 1. It was designed as a formal written prescription for physical activity provided by general practitioners (GPs) to patients with low activity levels.
Key historical developments include:
- The program was developed as a response to insufficient physical activity levels among New Zealanders, recognizing the role of regular physical activity in both prevention and management of chronic health conditions 1
- It established a structured approach where GPs could "prescribe" physical activity similar to medication, giving the recommendation more weight and formality
- The program evolved to include ongoing support through telephone counseling to help patients maintain their physical activity regimens
Program Structure and Implementation
The Green Prescription operates through a collaborative partnership model that includes:
- Initial prescription by GPs during primary care consultations
- Written prescription detailing physical activity recommendations
- Follow-up support from patient support counselors
- Telephone-based coaching and motivation
The program has been particularly notable for its integration into the primary healthcare system and its collaborative approach involving local communities, academics, medical staff, the Ministry of Health, and the private sector 2.
Evolution and Expansion
Over time, the Green Prescription program has expanded in scope:
- By 2011, it was being used by GPs for both primary prevention (e.g., weight control) and secondary management (e.g., diabetes management) purposes 1
- In 2013, the program was incorporated into the broader Healthy Homes Initiative (HHI), which takes a more comprehensive approach to health promotion 2
- The program has been modified to better serve specific populations, including the development of a pedometer-based version specifically designed for older adults 3
Evidence of Effectiveness
The program has demonstrated significant positive outcomes:
- A 2007 study showed that 56% of participants reported increases in physical activity levels after the GRx program, with 70% still undertaking some form of physical activity after completion 4
- Participants who increased their physical activity levels reported substantially higher energy levels and improved breathing compared to those who didn't increase activity 4
- The program has shown cost-effectiveness, with an independent evaluation of the broader Healthy Homes Initiative finding significant healthcare savings, estimated at approximately NZ$10.4 million annually 2
Barriers and Challenges
Despite its success, the program has faced challenges:
- Time constraints within GP consultations have been identified as the primary barrier to more widespread implementation 1
- For older adults specifically, chronic health conditions, fear of injury, transportation constraints, set routines, and lack of confidence have been identified as barriers to engagement 5
- Some physical educators have raised concerns about the strategies employed and have advocated for greater involvement of exercise professionals in the referral process 6
Recent Developments
The Green Prescription has continued to evolve:
- The program has been adapted to address specific health conditions, including being used for management of depression alongside conventional treatments 1
- A modified pedometer-based Green Prescription has been developed specifically for older adults, which has received positive evaluations 3
- The program has influenced the development of similar initiatives internationally, with exercise referral systems now recognized as cost-effective interventions in multiple countries 2
The Green Prescription program represents a significant innovation in integrating physical activity promotion into primary healthcare and has demonstrated sustained effectiveness over its history in New Zealand, serving as a model for similar programs worldwide.