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The Natural Health Service. Dr William Bird Strategic Health Advisor Natural England Senior Lecturer, Environment and Human Health Peninsula Medical School. SCARY. What’s your point of view?. HOME. National Indicators: Children and Young People.

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The natural health service

The Natural Health Service

Dr William Bird

Strategic Health Advisor

Natural England

Senior Lecturer, Environment and Human Health

Peninsula Medical School


The natural health service

SCARY

What’s your point of view?

HOME


National indicators children and young people

National Indicators: Children and Young People

  • NI 50: Emotional health of children

  • NI 55: Obesity in primary school age children in Reception**

  • NI 56: Obesity in primary school age children in Year 6**

  • NI 57: Children and young people’s participation in high-quality PE and sport

  • NI 69: Children who have experienced bullying

  • NI 110: Young people’s participation in positive activities


National indicators adults

National Indicators: Adults

  • NI 119: Self-reported measure of people’s overall health and wellbeing

  • NI 120: All-age all cause mortality rate**

  • NI 121: Mortality rate from all circulatory diseases at ages under 75**

  • NI 122 Mortality from all cancers at ages under 75**

  • NI 124: People with a long-term condition supported to be independent and in control of their condition.

  • NI 125: Achieving independence for older people through rehabilitation/intermediate care


National indicators adults cont

National Indicators: Adults (cont)

  • NI 134: The number of emergency bed days per head of weighted population

  • NI 137: Healthy life expectancy at age 65*

  • NI 138: Satisfaction of people over 65 with both home and neighbourhood

  • NI 141: Percentage of vulnerable people achieving independent living


National indicators strong and safer communities

National Indicators: Strong and safer Communities

  • NI 2: % of people who feel that they belong to their neighbourhood

  • NI 2: % of people who feel that they belong to their neighbourhood

  • NI 5: Overall/general satisfaction with local area

  • NI 6: Participation in regular volunteering

  • NI 8: Adult participation in sport and active recreation

  • NI 17: Perceptions of anti-social behaviour

  • NI 32: Repeat incidents of domestic violence


Human benefts of green space

Human Benefts of Green Space

Indirect Effects

Direct Effects

Health Inequalities

Temperature Extremes

Mental Health

Shelter:UV, noise, wind

Physical Activity

Carbon Offset

Obesity

Air Quality

Social Cohesion


Health inequalities

Health Inequalities

  • PSA 18: To promote better health and wellbeing for all which includes targets to narrow the gap in life expectancy between the poorest areas and the national average.

  • The government’s target is to reduce the difference in life expectancy between Spearhead regions and the average by 10% by 2010.

  • Age of death of the poorest compared to the average increased from 1.9 yrs to 2.0yrs in men and from 1.4 yrs to 1.6yrs in women between 1995-1997 and 2004-2006


Health inequalities1

Health Inequalities

DH, CLG

  • The Marmot review will look at all indicators that contribute to Health Inequalities. Will report to PM Dec 2010

    EVIDENCE

  • People on the same income, who lived closer to green space lived longer and had less heart disease than those with less access. (Lancet 2009)


Mental health

Mental Health

Mental illness affects 1 in 6 of the adult population

1 in 5 under 16yr olds have a mental disorder

By 2020 the WHO claims that depression will be the second most prevalent cause of ill health

The total cost to the economy is £77 billion

Each year stress from work costs employers £3.75 Billion


What are we prescribing

What are we prescribing?

  • In 2005 27.7 million antidepressant Prescriptions were written in England costing £338 million.

  • The Chief medical officer states that “Physical activity is effective in the treatment of clinical depression and can be as successful as psychotherapy or medication” (DH 2004)


Nice guidance on walking

NICE Guidance on Walking

  • ……. offer a range of walking schemes of low to moderate intensity with a choice of local routes to suit different abilities.

  • Ensure that walking schemes:

    • are organised and led by trained workers or ‘Walking the way to health initiative’ volunteer walk leaders from the local community who have been trained in first aid and in creating suitable walking routes


Nature contact in housing projects

Nature Contact in housing projects


The natural health service

Kuo F (2001) Coping with Poverty: Impacts of environment and attention in the inner city.

Environment and Behavior, Vol 33 No 1 January 2001.


How surrounding vegetation help children cope with stress

How surrounding vegetation help children cope with stress


Physical activity

Physical Activity

  • Only 40% of men and 28% of women reach 30 X 5 target of Physical Activity.

  • This falls to 8% and 3% over age 75yrs men/women.

  • Physical Inactivity Costs the NHS £1.8 Billion

  • Inactivity Costs Leeds PCT £10,189,600 (£1,405,352/100,000)


The natural health service

Sport participation: % of people participating for at least 30 mins once every 4 weeks. Sport England Active People Survey Dec 2006


Making it happen

Making it Happen

Editorial

“The challenge is to make politicians work for an environment that promotes walking, and to call on doctors to encourage patients to walk…”

BMJ 9th June 2007


The natural health service

Can Green Space increase levels of physical activity? What motivates people to continue to participate in Health Walks.


The public

THE PUBLIC

  • MORI poll of 1719 individuals commissioned by Natural England


Can green space benefit the health of the population

Can Green Space benefit the Health of the Population?

Senior citizens lived longer with more space to walk and with nearby parks and tree lined streets near to where they live.

Tanaka A, Takano T,Nakamura K, et al. Health levels influence

by urban residential conditions in a megacity — Tokyo.Urban

Stud 1996; 33: 879–945.

For every 10% increase in green space there was a reduction in health complaints equivalent to a reduction of five years of age.

De Vries, S.Nature and health; the importance of green space

in the urban living environment. Proceedings of the symposium ‘Open space functions under urban pressure’. Ghent: 19–21 September 2001.

Being within access to Green space can increase levels of physical activity

Giles-Corti B,Donovan RJ. Relative influence of individual, social environmental, and physical environmental correlates of walking. Am J Public Health 2003; 93(9): 1583–1589.


Obesity

Obesity

  • The UK has the highest rate in the EU

  • In the UK rates have tripled in the past 20 years

  • By 2050 60% of population and 1 in4 under 16 year olds will be obese

  • Total cost of obesity to society will be £45 billion by 2020


The natural health service

Is greenery associated with obesity?

N = 6919

Odds Ratio

A Ellaway

S Macintyre

BMJ 2005;331;611-2

Greenery


Childhood obesity

Childhood Obesity

  • “Local Green space can help prevent obesity by slowing weight gain in children by as much as 5kg over 2 years[i]. “

    [i]REF Neighborhood Greenness and 2-Year Changes in Body Mass Index of Children and Youth Janice F. Bell, PhD, MPH, Jeffrey S. Wilson, PhD, Gilbert C. Liu, MD, MS

  • Am J Prev Med 2008;35(6)


Social cohesion

Social Cohesion


Elderly

Elderly

There are 750,000 people with Alzheimer’s. For every mile walked per week over a lifetime there is an estimated 13% reduced risk of cognitive decline.


Reduction in blood pressure following a stress event

Reduction in Blood Pressure following a stress event


The natural health service

Social Isolation

The Car

Traffic

Poor Air Quality

Reduced Physical Activity

Reduced access to Greenspace

Planning

Social Barriers due to disconnection

Obesity

Chronic Stress

Social Inequalities leading to environmental injustice

Health Inequalities leading to environmental injustice


How stress can be seen as a major public health problem

How Stress can be seen as a major public Health Problem

Social Isolation

Reduced access to Greenspace

Social Inequalities leading to environmental injustice

Physical inactivity and Obesity

Chronic Stress

Raised Inflammatory Markers

Anxiety and Depression

Cardiovascular Disease

Lung Disease

Diabetes

Cancer


The natural health service

MRC / Natural England Research Network

The Whole of the Natural Health service will be underpinned by research being led by the Peninsula Medical School that will answer the main questions. 1) How can people get connected to their Natural Environment. 2) What are the direct health benefits of green space? 3) What physiological mechanisms cause the health benefits 4) What changes in health are generated by a change in environment (Intervention studies)


The natural health service

MRC / Natural England Research Network

The Whole of the Natural Health service will be underpinned by research being led by the Peninsula Medical School that will answer the main questions. 1) How can people get connected to their Natural Environment. 2) What are the direct health benefits of green space? 3) What physiological mechanisms cause the health benefits 4) What changes in health are generated by a change in environment (Intervention studies)


The natural health service

MRC / Natural England Research Network

The Whole of the Natural Health service will be underpinned by research being led by the Peninsula Medical School that will answer the main questions. 1) How can people get connected to their Natural Environment. 2) What are the direct health benefits of green space? 3) What physiological mechanisms cause the health benefits 4) What changes in health are generated by a change in environment (Intervention studies)


The natural health service

NHS Forest and twinning of Green Space.


The natural health service

MRC / Natural England Research Network

The Whole of the Natural Health service will be underpinned by research being led by the Peninsula Medical School that will answer the main questions. 1) How can people get connected to their Natural Environment. 2) What are the direct health benefits of green space? 3) What physiological mechanisms cause the health benefits 4) What changes in health are generated by a change in environment (Intervention studies)


Walking the way to health

Walking the Way to Health

  • National Health Walk Scheme to promote brisk walking in the Community.

  • 2200 walks a week

  • Over 525 schemes now active throughout UK.

  • Free training for over 35,000 volunteer leaders.

  • All areas eligible but deprived areas have greater priority.

  • Joint working and funding with DH.


The blue gym

The Blue Gym

  • Led by The Peninsula Medical School with DH, Natural England Environment Agency and National Marine Aquarium.

  • Helps individual projects that use water to promote physical activity to engage with PCTs and LAs.

  • Has strong environmental drive

  • To be launched later in Spring 2009


The natural health service

MRC / Natural England Research Network

The Whole of the Natural Health service will be underpinned by research being led by the Peninsula Medical School that will answer the main questions. 1) How can people get connected to their Natural Environment. 2) What are the direct health benefits of green space? 3) What physiological mechanisms cause the health benefits 4) What changes in health are generated by a change in environment (Intervention studies)


Credibility

Credibility

  • Help NICE to have the right evaluation data

  • Ensure that evidence of health benefits of natural environment are quantified.


Manchester points4life winning healthy town announced today

Manchester Points4Life Winning Healthy Town announced today

  • Loyalty card to be developed throughout Manchester .

  • To be developed using commercial expertise.

  • Points will only achieve full value if physical activity is maintained.

  • Much of the physical activity will be based on walking in greenspace


Summary

Summary

  • Green Space can help deliver National Indicators

  • The main areas are

    • Health Inequalities

    • Mental Health

    • Obesity

    • Physical Activity

    • Social Cohesion

    • Direct effects

  • The Natural Health Service will bring all evidence guidance and delivery together

  • Initial work with 4 main delivery projects


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