From place to prescription: salutogenic infrastructure and the environmental foundations of green prescribing

The capacity to sustain health-promoting behaviour is not evenly distributed across space. Urban form, landscape quality, and infrastructural accessibility shape the feasibility of movement long before clinical advice is given. In Aotearoa New Zealand, the Green Prescription (GRx) programme, through which clinicians refer patients to physical activity and lifestyle support, offers a lens for examining how spatial conditions mediate lifestyle prescribing. This study adopts an explanatory mixed-methods design, integrating secondary analysis of national survey data (N = 1,488) with Interpretive Phenomenological Analysis of interviews with community-dwelling older adults (N = 14; aged 65 to 86) in the Wellington region. Quantitative findings confirm that combined physical activity and dietary modification significantly improve metabolic outcomes. Qualitative analysis shows that participants sustained movement through environmental meaning, functional identity, and socio-spatial conditions. Because none were enrolled in GRx, the analysis speaks to the environmental conditions any prescription must engage with rather than clinical instruction. Steep topography, adverse weather, fragmented footpaths, and financial constraints illustrated how urban form constrains adherence independently of individual motivation. Drawing on salutogenic theory and therapeutic environments scholarship, the study argues that without spatial coherence, prescription alone is insufficient. It introduces salutogenic infrastructure, positioning the built environment as healthcare’s foundational mediator.