Parks, Public Health, and Partnerships
National 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?
• 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
• 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
1. Direct nature contact2. Physical activity3. Cooling4. Clean air5. Clean water
“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
Nature contact: a health benefit?1.
“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 contact
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• Animals• Plants• Landscapes• Wilderness experience
Plants and human health
Horticultural Therapyused in:• Acute hospitals• Children’s hospitals• Nursing homes• Psychiatric
hospitals• Hospices
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 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 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
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
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?• 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?
• 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
• 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
2.
Obesity Trends* Among U.S. AdultsBRFSS, 1985
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19% >20%
Source: Mokdad AH et al. J AMA 1999;282:16, 2001;286:10.
No Data <10% 10%-14% 15-19% >20%
Source: Mokdad AH et al. J AMA 1999;282:16, 2001;286:10.
Obesity Trends* Among U.S. AdultsBRFSS, 1986
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19% >20%
Source: Mokdad AH et al. J AMA 1999;282:16, 2001;286:10.
Obesity Trends* Among U.S. AdultsBRFSS, 1987
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19% >20%
Source: Mokdad AH et al. J AMA 1999;282:16, 2001;286:10.
Obesity Trends* Among U.S. AdultsBRFSS, 1988
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19% >20%
Source: Mokdad AH et al. J AMA 1999;282:16, 2001;286:10.
Obesity Trends* Among U.S. AdultsBRFSS, 1990
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19% >20%
Source: Mokdad AH et al. J AMA 1999;282:16, 2001;286:10.
Obesity Trends* Among U.S. AdultsBRFSS, 1991
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19% >20%
Source: Mokdad AH et al. J AMA 1999;282:16, 2001;286:10.
Obesity Trends* Among U.S. AdultsBRFSS, 1992
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19% >20%
Source: Mokdad AH et al. J AMA 1999;282:16, 2001;286:10.
Obesity Trends* Among U.S. AdultsBRFSS, 1994
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19% >20%
Source: Mokdad AH et al. J AMA 1999;282:16, 2001;286:10.
Obesity Trends* Among U.S. AdultsBRFSS, 1995
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19% >20%
Source: Mokdad AH et al. J AMA 1999;282:16, 2001;286:10.
Obesity Trends* Among U.S. AdultsBRFSS, 1996
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19% >20%
Source: Mokdad AH et al. J AMA 1999;282:16, 2001;286:10.
Obesity Trends* Among U.S. AdultsBRFSS, 1997
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19% >20%
Source: Mokdad AH et al. J AMA 1999;282:16, 2001;286:10.
Obesity Trends* Among U.S. AdultsBRFSS, 1998
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19% >20%
Source: Mokdad AH et al. J AMA 1999;282:16, 2001;286:10.
Obesity Trends* Among U.S. AdultsBRFSS, 1999
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19% >20%
Source: Mokdad AH et al. J AMA 1999;282:16, 2001;286:10.
Obesity Trends* Among U.S. AdultsBRFSS, 2000
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
OverweightIncreasing 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
Diabetes among U.S. adults, 1990
Diabetes among U.S. adults, 1991-92
Diabetes among U.S. adults, 1993-94
Diabetes among U.S. adults, 1995
Diabetes among U.S. adults, 1997-98
Diabetes among U.S. adults, 1999
Send this boy to the park!
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?• Medical Association• Public Health Association• Sports Medicine specialists• Academy of Pediatrics• AARP, Geriatricians• Heart Association• Lung Association• Cancer Society• Diabetes Association• Fitness enthusiasts
Cooling3.
• 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
Source: NASA Marshall Space Flight Center
Atlanta’s Heat Island: May 11, 1997
Source: NASA Marshall Space Flight Center
Atlanta’s Heat Island: May 11, 1997
Source: NASA Marshall Space Flight Center
1973 1979
1987 1997
25 Years of Urban Growth in AtlantaSource: Scientific Visualization Studio, Goddard Space Flight
Center
Atlanta’s heat island during sprawl, 1972 - 1993
• 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
Heat-Related Illness and Death
Chicago heat wave, 1995
Source: Whitman et al., AJPH 1007;87:1515-18.
• Elderly, children, chronically ill, urban poor are especially vulnerable
• Mitigating factors:– Adaptation– Decreased cold-related morbidity/mortality
Heat-Related Illness and Death
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?• Medical Association• Emergency medicine• Disaster management agencies• Public Health Association• AARP
Clean AirThe major air pollutants:• CO• SOx (SO2)• NOx (NO, NO2)• Particulates (PM)• Ozone• Lead• Volatile organic compounds (Hydrocarbons)• Air toxics (solvents, pesticides, metals, etc.)• Allergens
secondary pollutants
primary pollutants
4.
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 effects
Susceptible subgroups include:• Asthmatics• Children• The elderly• Those with certain underlying
diseases
Particulate air pollution and mortality: the Six Cities Study
All-cause mortality bypollution 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
effectsSeveral 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?
• 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
• 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
Ozone
0.00
0.04
0.08
0.12
0.16
0.20
Apr May Jun Jul Aug Sep Oct
O3
(pp
m)
Ozone Season in Atlanta
Unhealthful
Source: M. Chang, Ph.D., Georgia Tech
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?• Medical Society• Lung Association• Heart Association• Thoracic Society• Public Health
Association• Asthma patients
Clean water5.
Source: Center for Watershed Protection
Relationship Between Watershed Imperviousness (I)and the Storm Runoff Coefficient (Rv)
(Source: Schueler, 1987)
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
0 10 20 30 40 50 60 70 80 90 100Watershed Imperviousness (%)
Run
off C
oeff
icie
nt (R
v)
Source: Center for Watershed Protection
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
“Source water protection is public health protection.”
R. Jackson, CDC
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?• Medical Association• Public Health Association• State and local health departments• Infectious disease specialists
Summary: Parks and health
DENSE URBAN PARKS
GREEN URBAN PARKS
NATURAL AREAS
NEAR CITIES
LARGE REMOTE NATURAL
AREAS
1.DIRECT NATURE CONTACT
2.PHYSICAL ACTIVITY
3. COOLING 4.
CLEAN AIR
5.CLEAN WATER
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
• 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!
Doc who likes parks
Dog who
agrees
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