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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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Howard Frumkin, M.D., Dr.P.H. Rollins School of Public Health Emory University


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    1. 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

    2. Are parks good for health? • Evidence for specific health benefits of parks • Which type of park might promote health? • What partnerships come to mind?

    3. 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

    4. Specific health benefits of parks • Direct nature contact • Physical activity • Cooling • Clean air • Clean water

    5. 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

    6. 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

    7. Health benefits of nature contact Biophilia: “the innately emotional affiliation of human beings to other living organisms” E.O. Wilson, 1993

    8. Health benefits of nature contact: Empirical evidence • Animals • Plants • Landscapes • Wilderness experience

    9. Plants and human health Horticultural Therapy used in: • Acute hospitals • Children’s hospitals • Nursing homes • Psychiatric hospitals • Hospices

    10. 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

    11. 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

    12. 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

    13. 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

    14. 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)

    15. 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

    16. 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

    17. 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

    18. 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.

    19. 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.

    20. 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.

    21. 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.

    22. 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.

    23. 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.

    24. 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.

    25. 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.

    26. 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.

    27. 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.

    28. 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.

    29. 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.

    30. 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.

    31. 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.

    32. 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

    33. Diabetes among U.S. adults, 1990

    34. Diabetes among U.S. adults, 1991-92

    35. Diabetes among U.S. adults, 1993-94

    36. Diabetes among U.S. adults, 1995

    37. Diabetes among U.S. adults, 1997-98

    38. Diabetes among U.S. adults, 1999

    39. Send this boy to the park!

    40. 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

    41. 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

    42. 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

    43. Atlanta’s Heat Island Source: NASA Marshall Space Flight Center

    44. Atlanta’s Heat Island: May 11, 1997 Source: NASA Marshall Space Flight Center

    45. Atlanta’s Heat Island: May 11, 1997 Source: NASA Marshall Space Flight Center

    46. 1973 1979 1987 1997 25 Years of Urban Growth in Atlanta Source: Scientific Visualization Studio, Goddard Space Flight Center

    47. Atlanta’s heat island during sprawl, 1972 - 1993