title: Nature and the natural environment as health facilitators: the need to reconceptualize the ICF environmental factors.
abstract: OBJECTIVE
  This work examines the environmental factors component of the International Classification of Functioning, Disability, and Health (ICF) relative to current health-facilitating evidence about natural environmental factors. We argue that the environmental factors component warrants reconceptualization in order to offer an extended and more systematic framework for identifying and measuring health-facilitating natural environmental factors.
  
  
  METHODS
  Current evidence highlighting the potential health-facilitating benefits of natural environmental factors is synthesized and considered in the context of the ICF framework and its coding system.
  
  
  RESULTS
  In its current form, the ICF's conceptual framework and coding system are inadequate for identifying and measuring natural environmental factors in individuals and groups with and/or without health conditions.
  
  
  CONCLUSIONS
  The ICF provides an advanced framework for health and disability that reflects contemporary conceptualizations about health. However, given the scope of emerging evidence highlighting positive health and well-being outcomes associated with natural environmental factors, we believe the environmental factors component requires further advancement to reflect this current knowledge. Reconceptualizing the environmental factors component supports a more holistic interpretation of the continuum of environmental factors as both facilitators and barriers. In doing so, it strengthens the ICF's utility in identifying and measuring health-facilitating natural environmental factors.
authors.affiliation: Rehabilitation Science, Faculty of Health Sciences, Western University, London, Ontario, Canada. aday4@uwo.ca
authors.forename: Adam M B
authors.initials: AM
authors.lastname: Day
authors.forename: Julie A
authors.initials: JA
authors.lastname: Theurer
authors.forename: Allyson D
authors.initials: AD
authors.lastname: Dykstra
authors.forename: Philip C
authors.initials: PC
authors.lastname: Doyle
mesh_terms: D000203:Activities of Daily Living; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000145:classification* / Q000534:rehabilitation*; D004777:Environment; D004779:Environment Design; D006801:Humans; D038801:International Classification of Diseases; D019368:Nature; D012931:Social Environment