Naturally Better – Howbery Park, Wallingford – 26 th March 2009

Naturally Better – Howbery Park, Wallingford – 26th March 2009 Green space, physical activity and public health Dr. Charlie Foster – Senior Researcher BHF Health Promotion Research Group University of Oxford

To briefly describe the relationship between green space, public health and physical activity Describe the evidence base for this relationship Offer possible directions for developing this evidence base Presentation Objectives

Consensus on health benefits of green space Green space can reduce the risk of: Promotes good health and prevents ill health Stress Anxiety Depression A place for physical activity (Bedimo-Rung et al, 2005; Hartig, 2007; Moore & Cosco, 2007; Ottoson, 2007)

Public health importance of physical activity in the UK • Adults who are physically active have a 20-30% reduced mortality risk compared to inactive adults. • Estimates put the total direct costs to England of physical inactivity to the NHS as £1.06 billion • Conservatively, this represents about 54,000 lives lost prematurely per annum. • A 10% increase in adult activity would benefit England by at least £500m a year (saving about 6,000 lives). (Game Plan, Strategy Unit 2002; Allender et al, 2006)

Cost of physical inactivity related disease in London • The cost of illness for physical activity related disease is nearly £14 per Londoner • The PCT spend on physical activity promotion is 85p per Londoner (Foster et al, 2009)

Mitchell and Popham (2008) • Access to green space is associated with better health for the poorer half of the population

Incidence rate ratios for deaths from circulatory disease in income deprivation quartiles 2–4, relative to income deprivation quartile 1 (least deprived), stratified by exposure to green space Mitchell and Popham. Lancet, 372, 2008, p 1658

National policies & programmes Law & Regulations Fiscal Built environment Natural environment Health care systems A social-ecological model of physical activity behaviour Foster et al (2005). Understanding why adults and children participate in physical activity and sport. London, Sport England.

National policies & programmes Law & Regulations Fiscal Built environment Natural environment Health care systems A social-ecological model of physical activity behaviour Obesity Foster et al (2005). Understanding why adults and children participate in physical activity and sport. London, Sport England.

Green spaces, environmental correlates and physical activity Proximity to recreation facilities, convenience Destination factors, micro-scale design, footpaths, trails Mixed land use, shops and services nearby Aesthetics (perceived) Population density/sprawl Area based Coastal residence Area based Urban/age of suburb Culture, social environment as most important Connectivity Walkability Route related factors, hills, traffic Perceived safety High crime rate Unattended dogs Lighting/streetlights

Green spaces, environmental correlates and physical activity Proximity to recreation facilities, convenience Destination factors, micro-scale design, footpaths, trails Mixed land use, shops and services nearby Aesthetics (perceived) Population density/sprawl Area based Coastal residence Area based Urban/age of suburb Culture, social environment as most important Connectivity Walkability Route related factors, hills, traffic Perceived safety High crime rate Unattended dogs Lighting/streetlights • + • More often • associated

Green spaces, environmental correlates and physical activity • + • More often • associated Proximity to recreation facilities, convenience Destination factors, micro-scale design, footpaths, trails Mixed land use, shops and services nearby Aesthetics (perceived) Population density/sprawl Area based Coastal residence Area based Urban/age of suburb Culture, social environment as most important Connectivity Walkability Route related factors, hills, traffic Perceived safety High crime rate Unattended dogs Lighting/streetlights +/0 Equivocal association

Green spaces, environmental correlates and physical activity Proximity to recreation facilities, convenience Destination factors, micro-scale design, footpaths, trails Mixed land use, shops and services nearby Aesthetics (perceived) Population density/sprawl Area based Coastal residence Area based Urban/age of suburb Culture, social environment as most important Connectivity Walkability Route related factors, hills, traffic Perceived safety High crime rate Unattended dogs Lighting/streetlights + More often associated +/0 Equivocal association 0 Not associated

The contribution of environmental variables in explaining variation of physical activity or walking is small and less important than sociodemographic variables. Perceptions Safety Quality of public space Objective Places to go locally Deprivation Poverty

Using green space to promote physical activity – NICE evidence • Only found 2 grey studies • WHY? • Different views on what is evidence? • But some evidence does exist…..

Using green space to promote physical activity via play– NICE evidence • Real v perceived risk

Using green space to promote physical activity via play– NICE evidence • Real v perceived risk • Parks mean independence leading to more physical activity (Mackett, 2007)

Using green space to promote physical activity via play– NICE evidence • Real v perceived risk • Parks mean independence leading to more physical activity (Mackett, 2007) • Parks are places for all to play (Moore, 2003)

Source: news.yahoo.com Friday 7 January 2005

Outcome Overweight & obesity rates Exposure junk food outlets gyms/sporting goods retailers fruit and vegetable consumption participation in exercise/sports alcohol use smoking TV viewing air quality water quality climate index geography commute time parks/open spaces recreation facilities health care access Men’s Fitness Criteria

Leisure-time physical activity patterns are low and socially patterned Is there a relationship between neighbourhood deprivation and the density of physical activity facilities in England? Inverse Leisure Law Study

Inverse Leisure Law Study - Method • A database of all indoor exercise facilities in England was obtained, and facilities were linked to administrative areas and assigned a deprivation score • Census data were used to calculate the density of physical activity facilities per 1000 people per quintile of deprivation

The density of exercise facilities by quintile ofdeprivation for the county of Kent in Southeast England

The density of access to green space by quintile ofdeprivation for the county of Kent in Southeast England Let’s look at green space access now!

Other missing evidence…? • Does access and actual use of green space relate to health status • Related to quality or characteristics of green space? • Change in one lead to improvements? • The economic value of green space • Contribution to economy, health costs and Quality of life

Green space, public health and physical activity - Conclusions • Green space is related to health • Physical activity is related to health • Our environment and how we use it does impact on our health • People, place and policy

Green space, public health and physical activity - Conclusions • Green space is related to health • Physical activity is related to health • Our environment and how we use it does impact on our health • People, place and policy • Put green space and activity into our environments

Naturally Better – Howbery Park, Wallingford – 26th March 2009 Green space, physical activity and public health Thanks to Nick Cavill Dr Melvyn Hillsdon Dr Andy Jones

Naturally Better – Howbery Park, Wallingford – 26 th March 2009