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Parks, Public Health, and Partnerships National Governors Association Promoting Quality of Life Through Parks Washington, April 22, 2002 Howard Frumkin, M.D., Dr.P.H. Rollins School of Public Health Emory University Are parks good for health? Evidence for specific health benefits of parks

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Parks, Public Health, and PartnershipsNational Governors AssociationPromoting Quality of Life Through ParksWashington, April 22, 2002

Howard Frumkin, M.D., Dr.P.H.

Rollins School of Public Health

Emory University

are parks good for health
Are parks good for health?
  • Evidence for specific health benefits of parks
  • Which type of park might promote health?
  • What partnerships come to mind?
a health related typology of parks
A health-related typology of parks
  • Dense urban parks
    • Liberty Bell
    • MLK National Historic Site
  • Green (often waterway-related) urban parks
    • Wissahickon Park
    • Minneapolis bike trails
  • Natural areas near cities
    • Chattahoochee River greenbelt
    • C&O Canal
  • Large remote natural areas
    • Yosemite
    • Smokies
specific health benefits of parks
Specific health benefits of parks
  • Direct nature contact
  • Physical activity
  • Cooling
  • Clean air
  • Clean water
nature contact a health benefit

1.

Nature contact: a health benefit?

“Nature matters to people. Big trees and small trees, glistening water, chirping birds, budding bushes, colorful flowers—these are important ingredients in a good life.”

Rachel Kaplan

health benefits of nature contact
Health benefits of nature contact

“Thousands of tired, nerve-shaken, over-civilized people are beginning to find out that going to the mountains is going home; that wilderness is a necessity; and that mountain parks and reservations are useful not only as fountains of timber and irrigating rivers, but as fountains of life.”

John Muir

health benefits of nature contact7
Health benefits of nature contact

Biophilia: “the innately emotional affiliation of human beings to other living organisms”

E.O. Wilson, 1993

health benefits of nature contact empirical evidence
Health benefits of nature contact: Empirical evidence
  • Animals
  • Plants
  • Landscapes
  • Wilderness experience
plants and human health
Plants and human health

Horticultural Therapy

used in:

  • Acute hospitals
  • Children’s hospitals
  • Nursing homes
  • Psychiatric hospitals
  • Hospices
landscapes and human health
Landscapes and human health

State Prison of Southern Michigan, 1978:

Sick call attendance from inside cells was 24% higher than from outside cells

Moore, J. Env. Systems, 1981-2

landscapes and human health11
Landscapes and human health

Recovery from surgery:

  • All cholecystectomies in a Pennsylvania hospital, May-October, 1972-1981
  • Exclusions: age <20 or >69; serious complications; history of psychological problems
  • Matched pairs: “tree view” patients with “brick wall view” patients
landscapes and human health12
Landscapes and human health

Results: The “tree view” patients had

  • shorter hospitalizations (8.70 days vs 7.96 days)
  • less use of analgesic medications
  • fewer negative nurse notes (e.g. “needs much encouragement,” “upset and crying”)

Ulrich, Science, 1984

pain control during bronchoscopy
Pain control during bronchoscopy

80 patients undergoing bronchoscopy

40 viewed a pristine meadow scene, heard bubbling brook sounds

40 controls

29.3% with “very good” or “excellent” pain control

20.5% with “very good” or “excellent” pain control

Lechtzin et al., ATS, 2001

wilderness and human health
Wilderness and human health

Reported benefits of wilderness experiences:

  • Improved measures of cooperation and trust among adolescents with depression, substance abuse, or adjustment reactions (Witman, 1987).
  • Improved coping ability and locus of control among psychiatric inpatients (Plakun et al., 1981).
  • Improved function and greater probability of discharge among inpatients at the Oregon State Mental Hospital (Jerstad and Stelzer, 1973)
parks nature contact and health which kinds of parks might help
Parks, nature contact, and health:Which kinds of parks might help?
  • Dense urban parks
    • Liberty Bell
    • MLK National Historic Site
  • Green urban parks
    • Wissahickon Park
    • Minneapolis bike trails
  • Natural areas near cities
    • Chattahoochee River greenbelt
    • C&O Canal
  • Large remote natural areas
    • Yellowstone
    • Tetons
parks nature contact and health what partnerships are possible
Parks, nature contact, and health:What partnerships are possible?
  • Medical Association
  • Public Health Association
  • State and local Health Departments
  • Mental Health Association
  • Academy of Pediatrics
  • Children's health advocates
  • Rehabilitation medicine specialists
  • Disease-specific associations
    • Autism, Multiple sclerosis, Alzheimer’s, others
physical activity

2.

Physical activity
  • A sedentary lifestyle increases the risk of
    • overall mortality (2 to 3-fold)
    • cardiovascular disease (3 to 5-fold)
  • The effect of low physical fitness is comparable to that of hypertension, high cholesterol, diabetes, and even smoking.

Sources: Wei et al., JAMA 1999; Blair et al., JAMA 1996

obesity trends among u s adults brfss 1985 bmi 30 or 30 lbs overweight for 5 4 woman

No Data <10% 10%-14% 15-19% >20%

Obesity Trends* Among U.S. AdultsBRFSS, 1985(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad AH et al. J AMA1999;282:16, 2001;286:10.

obesity trends among u s adults brfss 1986 bmi 30 or 30 lbs overweight for 5 4 woman

No Data <10% 10%-14% 15-19% >20%

Obesity Trends* Among U.S. AdultsBRFSS, 1986(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad AH et al. J AMA1999;282:16, 2001;286:10.

obesity trends among u s adults brfss 1987 bmi 30 or 30 lbs overweight for 5 4 woman

No Data <10% 10%-14% 15-19% >20%

Obesity Trends* Among U.S. AdultsBRFSS, 1987(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad AH et al. J AMA1999;282:16, 2001;286:10.

obesity trends among u s adults brfss 1988 bmi 30 or 30 lbs overweight for 5 4 woman

No Data <10% 10%-14% 15-19% >20%

Obesity Trends* Among U.S. AdultsBRFSS, 1988(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad AH et al. J AMA1999;282:16, 2001;286:10.

obesity trends among u s adults brfss 1990 bmi 30 or 30 lbs overweight for 5 4 woman

No Data <10% 10%-14% 15-19% >20%

Obesity Trends* Among U.S. AdultsBRFSS, 1990(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad AH et al. J AMA1999;282:16, 2001;286:10.

obesity trends among u s adults brfss 1991 bmi 30 or 30 lbs overweight for 5 4 woman

No Data <10% 10%-14% 15-19% >20%

Obesity Trends* Among U.S. AdultsBRFSS, 1991(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad AH et al. J AMA1999;282:16, 2001;286:10.

obesity trends among u s adults brfss 1992 bmi 30 or 30 lbs overweight for 5 4 woman

No Data <10% 10%-14% 15-19% >20%

Obesity Trends* Among U.S. AdultsBRFSS, 1992(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad AH et al. J AMA1999;282:16, 2001;286:10.

obesity trends among u s adults brfss 1994 bmi 30 or 30 lbs overweight for 5 4 woman

No Data <10% 10%-14% 15-19% >20%

Obesity Trends* Among U.S. AdultsBRFSS, 1994(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad AH et al. J AMA1999;282:16, 2001;286:10.

obesity trends among u s adults brfss 1995 bmi 30 or 30 lbs overweight for 5 4 woman

No Data <10% 10%-14% 15-19% >20%

Obesity Trends* Among U.S. AdultsBRFSS, 1995(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad AH et al. J AMA1999;282:16, 2001;286:10.

obesity trends among u s adults brfss 1996 bmi 30 or 30 lbs overweight for 5 4 woman

No Data <10% 10%-14% 15-19% >20%

Obesity Trends* Among U.S. AdultsBRFSS, 1996(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad AH et al. J AMA1999;282:16, 2001;286:10.

obesity trends among u s adults brfss 1997 bmi 30 or 30 lbs overweight for 5 4 woman

No Data <10% 10%-14% 15-19% >20%

Obesity Trends* Among U.S. AdultsBRFSS, 1997(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad AH et al. J AMA1999;282:16, 2001;286:10.

obesity trends among u s adults brfss 1998 bmi 30 or 30 lbs overweight for 5 4 woman

No Data <10% 10%-14% 15-19% >20%

Obesity Trends* Among U.S. AdultsBRFSS, 1998(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad AH et al. J AMA1999;282:16, 2001;286:10.

obesity trends among u s adults brfss 1999 bmi 30 or 30 lbs overweight for 5 4 woman

No Data <10% 10%-14% 15-19% >20%

Obesity Trends* Among U.S. AdultsBRFSS, 1999(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad AH et al. J AMA1999;282:16, 2001;286:10.

obesity trends among u s adults brfss 2000 bmi 30 or 30 lbs overweight for 5 4 woman

No Data <10% 10%-14% 15-19% >20%

Obesity Trends* Among U.S. AdultsBRFSS, 2000(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad AH et al. J AMA1999;282:16, 2001;286:10.

overweight
Overweight

Increasing weight associated with:

  •  risk of overall mortality (up to 2.5-fold in the 30-44 age group, less at older ages)
  •  risk of cardiovascular mortality (up to 4-fold in the 30-44 age group, less at older ages)
  •  risk of diabetes (up to 5-fold)
  •  risk of hypertension
  •  risk of some cancers
  •  risk of gall bladder disease

Source: Willett et al., New Eng J Med, 1999

physical activity parks and health which kinds of parks might help
Physical activity, parks, and health:Which kinds of parks might help?
  • Dense urban parks
    • Liberty Bell
    • MLK National Historic Site
  • Green urban parks
    • Wissahickon Park
    • Minneapolis bike trails
  • Natural areas near cities
    • Chattahoochee River greenbelt
    • C&O Canal
  • Large remote natural areas
    • Yellowstone
    • Tetons
parks and physical activity what partnerships are possible
Parks and physical activity:What partnerships are possible?
  • Medical Association
  • Public Health Association
  • Sports Medicine specialists
  • Academy of Pediatrics
  • AARP, Geriatricians
  • Heart Association
  • Lung Association
  • Cancer Society
  • Diabetes Association
  • Fitness enthusiasts
cooling

3.

Cooling
  • Urban heat island: On warm days, cities can be warmer than surrounding countryside, by as much as 6-8oF.
  • Two major reasons:
    • Loss of trees leads to loss of evapotranspiration
    • Dark surfaces (low albedo) retain and reradiate heat
atlanta s heat island
Atlanta’s Heat Island

Source: NASA Marshall Space Flight Center

atlanta s heat island may 11 1997
Atlanta’s Heat Island: May 11, 1997

Source: NASA Marshall Space Flight Center

atlanta s heat island may 11 199747
Atlanta’s Heat Island: May 11, 1997

Source: NASA Marshall Space Flight Center

slide48

1973

1979

1987

1997

25 Years of Urban Growth in Atlanta

Source: Scientific Visualization Studio, Goddard Space Flight Center

heat related illness and death
Heat-Related Illness and Death
  • Less severe effects:
    • heat syncope
    • heat edema
    • heat tetany
    • heat cramps
  • More severe effects:
    • heat exhaustion
    • heat stroke
  • Long-term exposure associated with infertility, teratogenesis
slide52

Chicago heat wave, 1995

Source: Whitman et al., AJPH 1007;87:1515-18.

heat related illness and death53
Heat-Related Illness and Death
  • Elderly, children, chronically ill, urban poor are especially vulnerable
  • Mitigating factors:
    • Adaptation
    • Decreased cold-related morbidity/mortality
the cooling effects of parks which kinds of parks might help
The cooling effects of parks:Which kinds of parks might help?
  • Dense urban parks
    • Liberty Bell
    • MLK National Historic Site
  • Green urban parks
    • Wissahickon Park
    • Minneapolis bike trails
  • Natural areas near cities
    • Chattahoochee River greenbelt
    • C&O Canal
  • Large remote natural areas
    • Yellowstone
    • Tetons
parks cooling and health what partnerships are possible
Parks, cooling, and health:What partnerships are possible?
  • Medical Association
  • Emergency medicine
  • Disaster management agencies
  • Public Health Association
  • AARP
clean air

4.

Clean Air

The major air pollutants:

  • CO
  • SOx (SO2)
  • NOx (NO, NO2)
  • Particulates (PM)
  • Ozone
  • Lead
  • Volatile organic compounds (Hydrocarbons)
  • Air toxics (solvents, pesticides, metals, etc.)
  • Allergens

primary pollutants

secondary pollutants

ozone health effects
Ozone health effects
  • Respiratory effects (ozone > PM):
    • Airway inflammation
    • Decreased air flow
    • Increased symptoms, ER visits, medication use, hospitalizations
  • Cardiovascular effects (PM > ozone)
    • Increased mortality
  • Immune effects
    • Increased susceptibility to infection
ozone health effects59
Ozone health effects

Susceptible subgroups include:

  • Asthmatics
  • Children
  • The elderly
  • Those with certain underlying diseases
particulate air pollution and mortality the six cities study
Particulate air pollution and mortality: the Six Cities Study

All-cause mortality by

pollution levels:

  • RR  1.3 for most polluted vs least polluted city
  • Excess was lung cancer and cardiopulmonary disease
  • Unaffected by other variables
particulate air pollution and and acute health effects
Particulate air pollution and and acute health effects

Several dozen time-series studies in

  • asthmatics, COPD patients, and healthy individuals
  • children and adults
  • European and U.S. cities

show associations between  PM and

  •  symptoms,ER visits, hospitalizations
  •  lung function
do parks clean the air
Do parks clean the air?
  • Olmsted: Parks as the “lungs of the city”
  • Benefits of parks for air quality:
    • Direct removal of pollutants
    • Cooling effect   ozone formation
    • Cooling effect   energy demand
direct removal of pollutants
Direct removal of pollutants
  • Leaves directly resorb CO, SO2, NO2, ozone, particulates.
  • Chicago: Urban tree canopy removes 15 metric tons of CO, 84 metric tons of SO2, 89 metric tons of NO2, 191 metric tons of ozone and 212 metric tons of particulates each year.

David Nowak, project leader, USFS Urban Forest Ecosystem Research Unit, quoted in Emagazine, Vol XII, No 6, Nov-Dec 2001

slide65

Ozone Season in Atlanta

Unhealthful

Source: M. Chang, Ph.D., Georgia Tech

clean air which kinds of parks might help
Clean air: Which kinds of parks might help?
  • Dense urban parks
    • Liberty Bell
    • MLK National Historic Site
  • Green urban parks
    • Wissahickon Park
    • Minneapolis bike trails
  • Natural areas near cities
    • Chattahoochee River greenbelt
    • C&O Canal
  • Large remote natural areas
    • Yellowstone
    • Tetons
parks clean air and health what partnerships are possible
Parks, clean air, and health:What partnerships are possible?
  • Medical Society
  • Lung Association
  • Heart Association
  • Thoracic Society
  • Public Health Association
  • Asthma patients
clean water

5.

Clean water

Source: Center for Watershed Protection

slide70

Water quantity

Source: Center for Watershed Protection

water quality
 non-point source pollution

Well documented for PAHs, zinc, organic waste, nutrients (nitrogen, phosphorus)

Likely for pesticides, other metals, bacteria

 siltation, potentially compromising water treatment

Water quality
clean water which kinds of parks might help
Clean water:Which kinds of parks might help?
  • Dense urban parks
    • Liberty Bell
    • MLK National Historic Site
  • Green urban parks, especially those on waterways
    • Wissahickon Park
    • Minneapolis bike trails
  • Natural areas near cities
    • Chattahoochee River greenbelt
    • C&O Canal
  • Large remote natural areas
    • Yellowstone
    • Tetons
clean water parks and health what partnerships are possible
Clean water, parks, and health: What partnerships are possible?
  • Medical Association
  • Public Health Association
  • State and local health departments
  • Infectious disease specialists
summary potential health partners for park advocates
Summary: Potential health partners for park advocates
  • Medical Associations
  • Medical specialist groups: pediatrics, geriatrics, rehabilitation medicine, sports medicine, pulmonary medicine
  • Disease advocacy groups: Heart Association, Lung Association, etc.
  • Public Health Associations
  • State and local Health Departments
  • Medical research agencies (NIEHS, CDC, IOM)
  • Health payors (insurers, HMOs, MCOs)
parks public health and partnerships an agenda
Parks, public health, and partnerships: an agenda
  • Understand more fully the health benefits of parks.
  • Publicize these benefits.
  • Form partnerships with potential allies based on shared goals.
  • Advocate for park-friendly policies.
thank you
Thank you!

Doc who likes parks

Dog who agrees