Park Prescription programs are designed to improve the physical and mental health of both individuals and the communities that they are part of. This is accomplished through creating programs that are designed collaboratively among park professionals, health care providers, public health professionals, and community based organizations.
At the 2016 Health Outdoors! Parks and Public Health Forum, two questions commonly raised by participants were: How do I build a Park Prescription program? What sectors should I partner with in order to get my programs started?
In response to these questions the Institute’s Health program did two things: 1) create collaboratives in various counties throughout the Bay Area to help facilitate the creation of Park Prescription programs within them, and 2) create a comprehensive toolkit that efficiently and effectively models each step needed to create a Park Prescription program.
What is unique and wonderful about this toolkit is that it allows the user to not only see the steps that are needed within their own sector, but also allows them to see the steps that other sectors have to follow as well.
How to use this toolkit:
To get started, select the portal for the sector that you represent (clinical, public health, community, or parks) or would like to view.
This will then open a series of steps in green, below is an example using the portal for park professionals.
Select the step that you are interested in learning more about by clicking on each green box. Once selected, the box that you have chosen will expand to provide training videos and technical assistance tools that support your progress in this step. Below is an example of what Parks Step 1: Determine your population looks like when selected.
As with most toolkits, the implementation of this toolkit works best when supported and championed by all of the agencies and sectors involved. If you have any questions or feedback about the toolkit, email firstname.lastname@example.org.
I’m excited to be joining the Institute at the Golden Gate as the new Health Program Manager. I come to the Institute with a public health perspective, having worked with California’s SNAP-Ed nutrition education and obesity prevention program since 2005. Through SNAP-Ed, I learned how local health departments work with state agencies on federal funding while staying attuned and responsive to community needs – a complicated dance of staying nimble and staying focused.
I also come to the Institute as an avid park enthusiast! On the weekends, you’ll find me hiking, biking, and snowshoeing in search of wildflowers, waterfalls, expansive views, fresh air, and those perfectly placed park benches. For several years, I was an outdoor trip leader with Sacramento State’s Peak Adventures. I relished seeing strangers become friends by the time we arrived at camp, the cooperative attitudes along the journey, the feeling of accomplishment doing something that seemed beyond reach, and the appreciation of nature, ourselves, and each other at the end of the day. This is why I love parks and being outdoors—this feeling of connectedness is something I want every person, particularly those with the highest health need, to experience. Parks are a place to be healthy, from the inside out.
How can we connect more people to parks? I am impressed by the Institute’s commitment to bringing parks, health care, public health, and community partners together in the Healthy Parks Healthy People: Bay Area collaborative. This type of multi-sector collaborative approach is a meaningful way to create change and build healthier communities, literally, one step at a time (preferably in nature!).
I am inspired by the Institute’s vision to imagine parks as key players in solving complex human challenges, like stress reduction and obesity prevention. As I explore opportunities at the intersection of parks and health, I hope to continue the good work of the Health program to position parks as a catalyst for social change so that everybody sees parks as preventative health care and a place for them.
For the many partners out there working on nature & health and getting people outdoors, I look forward to working with you. May we rally together: Parks for All! Health for All!
Our Health program’s newest report is now complete!
Since its creation in 2012 we have seen many successes with the HPHP: Bay Area collaborative, and wanted to capture our challenges, successes, and lessons learned to not only share with those who work at the intersection of parks and health, but also with those interested in creating their own regional cross-sector collaboratives.
As a collaborative, HPHP: Bay Area seeks to be a space for park and health agencies to share best practices, workshop programmatic challenges, and accomplishes this through the initiatives of First Saturday programs and Park Prescription programs.
We decided to frame this report as a roadmap and case study for regional collaboration because the story, successes, and challenges of HPHP: Bay Area provide a unique case study and potential roadmap for other collaboratives across the county who are looking to connect health and parks within their agencies and communities.
We also wanted to frame this report within the context of a roadmap because the evolution and growth of the HPHP: Bay Area collaborative has been –and continues to be— a wonderful journey of innovation, exploration, partnership, and iteration.
This report pulls from 30 interviews of collaborative members and comprehensively describes the history of the HPHP: Bay Area collaborative. The roadmap is broken down into six steps, allowing readers the ability to take a deep dive into how to create a vibrant cross-sector collaborative such as Healthy Parks Healthy People: Bay Area. The steps are as follows:
This report also provides successful program models of current Bay Area Park Prescription programs.
Photo credit: Kirke Wrench, National Park Service
Call me sentimental, but I love the holiday season. I love the lights, the flavors, and the smells. I love that we make time in our busy schedules for friends, for family, for loved ones, and for our community. I also love the sense of perspective it gives me – the opportunity to reflect on what is important in my life and how my decisions reflect those values, both personally and professionally.
I won’t sugar coat it, the past month or two has been a challenging time for many of us. Whatever your political stripes, most people can agree that the rhetoric in 2016 was more divisive than ever, and that we are entering a time of uncertainty and transition. How the things we value may be impacted in the years to come is not yet clear. Now, more than ever, I seek solace and inspiration from those around me, the values that we all share, and the work we are doing to amplify those values.
Over the past year, the Institute team has dug deep into who we are as an organization, the key beliefs and values that motivate our work, and how those show up in what we do every day. One core value that has come through loud and clear is our belief in the role of parks as safe and healing spaces. We believe that parks must be welcoming and be available to all, no matter their background, ethnicity, religion, orientation, age, ability… the list goes on and on.
Parks have so much to give to society – they are places to build community, to engage in open and respectful dialogue, to deeply connect with people who are different from us, and to explore and overcome our common challenges. This belief is core to who we are as an organization.
In this time of change and season of giving, we’d like to share just a few examples of park-based programs that are building community and offering healing, growing spaces. We hope that you find them as inspiring as we do.
Please use the comment box to add your favorite to this short list, we know there are so many inspiring programs out there!
As the Institute continuously champions our beliefs that parks are for everyone, we know that our park partners are working tirelessly to make this belief a reality in the different communities around the Bay and country. Through our work in Healthy Parks Healthy People: Bay Area, we know that parks have been providing warm welcomes to new users for years through multicultural programming and First Saturday programming.
East Bay Regional Park District creates large, intentional walks that bring together many different ethnicities to share wellness, culture, and enjoyment through its Healthy Parks Healthy People Multicultural Wellness Walks. San Francisco Recreation and Parks Department offers gorgeous scenery while leading participants through Tai Chi and Qigong exercises.
With park leaders playing a crucial role in carving out space for meditation, interaction, and reflection, we hope that you follow their lead to ensure that parks continue to be a democratic space for health, both physically and mentally. If you see prejudice or hate happening in parks, or your neighborhood, speak up and protect your neighbors. Parks are for all, forever.
This past year has brought to the fore a number of challenges this country still faces around racial, economic, and social justice. Tied in with all of these is climate justice. Parks provide invaluable ecosystem services like carbon sequestration and are also uniquely threatened by climate change. Through the Institute’s Climate Education program we work with park interpreters and other informal educators to provide them with the necessary tools for them to be the best climate communicators they can be. This includes not only telling the story of how our parklands are threatened by climate change but also how it will affect neighboring communities, particularly groups that are most vulnerable.
There are a number of organizations working at the intersection of environmental challenges, public lands, and social justice, with one of the most prominent being Literacy for Environmental Justice (LEJ). LEJ is based out of Southeast San Francisco and provides local residents opportunities in urban greening, eco-literacy, community stewardship, and workforce development. The Institute looks forward to continuing to celebrate how parks and their partners can not only help heal the environment but also how maintaining these democratic spaces is central to building an inclusive community.
Lake Merritt, at the heart of Oakland, CA, is an obvious setting for a picnic, or a walk. As a proud resident of Oakland, Lake Merritt holds a special place in my heart. This park holds many fun memories for me.
This year, Lake Merritt has also been a site for healing. When Oaklanders were reeling from the loss of friends and artists from the devastating Ghost Ship fire, it was Lake Merritt where we grieved together. After an election filled with dangerous rhetoric, Oaklanders stood up against hatred at #handsaroundlakemerritt, a show of solidarity and appreciation for the diversity of Oakland. These beautiful moments of Oaklanders coming together proved that Lake Merritt is where the best of Oakland can be seen.
April 24th is National Park Rx Day and it is a day celebrated across the United States to promote the growing movement of prescribing parks and nature to patients to improve human health. Additionally, National Park Rx Day encourages everyone to start seeing visits to parks and public lands as very important parts of their health. Last fall, the U.S. Surgeon General released a call to action to promote walking and walkable communities. National Park Rx Day builds on this call to action and provides citizens with parks and green spaces to promote public health.
WHY A DAY TO CELEBRATE PARK RX?
One of the signature events will take place in Meridian Hill Park in Washington, DC. While the park has weekly drum circles and many different users, it is also a site that has seen it share of violence. When we talk about the health of a community, the violence within a community is just as important to curb as alcohol abuse or obesity rates. Although there is a lot of buzz and interest in Park Rx programs, it is a tactic to bring forth larger changes in a place. It is also a tactic to bring in new sectors to look at the role that the built environment plays and our relationship to it.
I encourage us lovers of nature and Park Rx managers to think about the role that Park Rx has in combatting community violence so that others can have the chance to love nature and feel attached to their neighbors and neighborhoods. Park Rx programs and certainly National Park Rx Day cannot solve all of this in one fell swoop, but having a concerted effort to start and sustain these dialogues is a first step.
My office is just a short walk away from Fort Mason’s Great Meadow. This park has gentle, grassy hills and stunning views of the Golden Gate Bridge. Every morning as I head into work, I’m greeted with the ocean, air, bees, and native plants. Luckily for me, I don’t have to sneak away to see this beautiful space. Here at the Institute, we have an organizational culture that values outdoor time; I am encouraged to spend time in nature.
View from where I meditate.
I take full advantage of this park perk. I enjoy walking meetings and impromptu botany lessons on the Great Meadow. But most of all, I cherish my daily mindfulness practice. It’s nothing fancy— lasting only 7 minutes— but it is the best perk my employer can ever give. Better than any sweet, salty or caffeinated snack, these 7 minutes help me refocus after a hectic morning, or calm my nerves before a big meeting. I’m more creative in my problem-solving, more patient with obstacles, and more present with my co-workers. In short, it makes me a better employee.
I don’t want to be one of those self-righteous hippies, pushing the latest crunchy granola health practices on my co-workers, but I can’t help it when it comes to mindfulness. I think mindfulness is a useful tool for all park professionals. I know from experience, but science supports it too. Mindfulness can bolster mental and physical health. It can even change our neural pathways –changing the physical structure of the brain. Lastly, and perhaps most importantly, it builds up inner resilience. Mindfulness and meditation practices are linked to increasing compassion, mental flexibility, and attention.
Inner resilience is a crucial asset for park professionals right now. Urban parks are entering frontiers that require us to tap into our best attributes. Climate change, health disparities, and homelessness are all daunting challenges that parks must bravely face. These challenges deserve our creativity, patience, focus, and best interpersonal skills. In order to be better stewards of our parks and our communities, we need to invest in our own inner stewardship.
So, at the risk of sounding preachy, take advantage of your park perks. Prepare for a challenging, and exciting future. I’ll meet you at the Great Meadow.
As I am still struggling to remember to end all of my dates with a “6” rather than a “5”, it feels like it is not yet too late to reflect on the past year and ponder what the next year may bring.
2015 saw a lot of change at the Institute. We welcomed three new fulltime staff members and were excited by the opportunity to continue to support the growth and development of our existing staff members. We moved out of our Fort Baker offices and are grateful to our NPS partners who have offered us temporary office space at Fort Mason. Our climate, health, and urban programs continue to grow, evolve, and have a greater and greater impact. We welcomed our second class of Emerging Leaders Fellows and I am confident that we learned as much from their new perspectives as they learned from our team of mentors and friends.
Here is a brief synopsis of some of the Institute’s key programmatic milestones and our hopes for 2016:
Climate: In 2015, the Bay Area Climate Literacy Collaborative, for which the Institute plays the backbone support role, saw its first full year of activity. Over the course of the year, the Collaborative grew to include over 30 different environmental education organizations and worked through a strategic planning process, articulating a clear vision, mission, and priority initiatives. In 2016, we are looking forward to getting our boots of the ground and beginning to develop and implement a range of activities based on identified priorities. We are also excited to partner with the NPS Pacific West Region and NASA to host an “Earth-to-Sky” climate communications training at Golden Gate this coming spring.
Health: The Institute continued to support the development of the HPHP: Bay Area regional collaborative and strengthened the network through a growing partnership with Kaiser Permanente. As the collaborative moves into its fourth year, the Institute is looking forward to building the capacity of the region by creating trainings, toolkits, and further resources for the collaborative members. On the national level, the Institute is working closely with the National Park Service, the National Recreation and Park Association, and Dr. Robert Zarr, the NPS Park Prescriptions Advisor, to strengthen the network of and resources available for Park Rx practitioners. Stay tuned in early 2016 when we will be launching a National Park Rx web portal and a HPHP: Bay Area website!
Urban: Last April, the National Park Service launched its Urban Agenda. This report was the culmination of a long engagement process spearheaded by NPS’s Stewardship Institute, in close partnership with the Institute at the Golden Gate, the NPS Rivers, Trails, and Conservation Assistance Program, the Center for Park Management, and the Quebec Labrador Foundation. As a part of the initiative, the Institute has been actively supporting a team of Urban Fellows who have been charged with activating the Urban Agenda in 10 model cities. In the coming year, the Institute is looking forward to continuing to build on this partnership work. We are particularly excited to leverage our network to dive deeper into the issues of authentic community engagement and to look at how we can support parks in their efforts to increase their relevance for urban communities.
Thanks so much to all of our partners, supporters, and colleagues who made 2015 such a success – we’re looking forward to continuing this exciting work in 2016!
Our new view for 2016 - life on the other side of the bridge. Photos courtesy of Paul Meyers.
On September 9, the U.S. Surgeon General, Vice Admiral Vivek Murthy, launched a nationwide Call to Action on Walking. As chronic disease, depression, and obesity rates in the country soar, “America’s Doctor” is extolling the health benefits of walking.
The “Step It Up!” campaign challenges the nation to make walking a national priority in all facets of American life. Dr. Murthy’s Call to Action seeks to promote development of communities where it is safe and easy to walk, launch walking programs, and conduct research on walking.
As lovers of parks and open space, we at the Institute at the Golden Gate (a Parks Conservancy program in partnership with the National Park Service) are doing our part to answer the Surgeon General’s call. In fact, our belief in the health benefits of parks is so great that we’re taking many approaches to promote parks as places to walk and recreate.
Take the first step, and reconnect with the physical, mental, and social benefits of visiting a park. Attend a Healthy Parks Healthy People: Bay Area program this Saturday, October 3rd. There are over 10 family-friendly, easy, and fun walks all over the Bay Area to get you started.
Catalyzing Change by Rhianna Mendez
It has been a little over two months since I began my fellowship and was tasked with detailing the story of the Healthy Parks Healthy People: Bay Area collaborative. As I continue to interview stakeholders and partners from the world of parks, public health, and community based organizations, I am amazed by the many leaders in the bay area who catalyze change. Healthy Parks Healthy People lives within the individuals who work around hectic schedules to impact the lives of others. Healthy Parks Healthy People lives within the communities it reaches. I have been seeking out promising practices and potential lessons learned and along the way I have uncovered refreshing narratives filled with enthusiasm. The collaborative continues to grow and evolve after three years and I know all involved are excited to see what the next three years have to bring.
As First Saturdays continue to thrive with consistency and Park Prescriptions begin to take root, many are looking forward to larger systematic changes. Of particular interest is a change in the way we structure medical care. This concept, of course, is nothing new but there has never been a time where so many sectors are chipping away at an over-haul. There has been recent success in changing the way we bill a doctor’s time that allows for a conversation instead of just a diagnosis or prescription. One example revolves around palliative care and end-of-life discussions between doctors and patients. A very contentious topic in 2009 has now seen wider appeal as society begins to rethink the time doctors spend with us. The time is ripe for change and the collaborative will use this momentum to continue to impact lives locally and forge change nationally.
Visualizing The History of Fort Baker by Sophia Choi
It has been a little over two months since I took on the role as the Urban Fellow at the Institute. An important part of my project on post-to-park conversions has been looking back at the history of how Fort Baker and Crissy Field in the Bay Area, and Governors Island in New York, have developed into such wonderful public parks in urban areas.
One of the first steps in my search for lessons learned from the transformations of these urban parks was visiting Golden Gate’s park archive, located in the Presidio of San Francisco. The military building turned gold mine of photos, plans, and letters, was overwhelmingly abundant – in the best way. My first visit to the archives was a bit daunting, but the archival curator, Amanda, was extremely helpful in guiding me through millions of archived material on the Golden Gate National Parks.
Not knowing what exactly I was looking for, Amanda suggested I start from a large binder of photos and plates of Fort Baker. As I flipped through, page-by-page, I was amazed to find that the black and white images of military infrastructure looked exactly the same as how the buildings look now; the look of the building that used to be the home of military officers but now houses the Institute had not changed since its history.
Officer housing during military occupation at Fort Baker - Golden Gate NRA Park Archives & Record Center
Literature and document research has been crucial to gaining insight and learning from the transformation at Fort Baker. These photos showed a critical transition from a dilapidated military post to a thriving public place of nature and respite, all the while preserving the sites specific cultural landscape.
I felt a sense of nostalgia, tracing the steps of the park history vicariously through these photos. Being able to visualize and see Fort Baker’s history was impactful in my research both emotionally and intellectually. I was reminded of the importance of telling a unique story of a place, and how that story can create a more profound connection between people and their parks.
Here at the Institute, we are BIG believers in collaboration. As a small but mighty team, we realize that to have the biggest possible impact and to create the change we want to see, we need to seek out, engage, and support other organizations to achieve our collective goals.
As such, a number of our programs focus on supporting collaborative efforts. Healthy Parks Healthy People: Bay Area and the Bay Area Climate Literacy Collaborative are two such projects. In both, the Institute plays the “backbone” role; supporting the collaborative through coordination, holding the vision, and ensuring that the group is functioning effectively in the pursuit of its goals.
Through both of these initiatives, we at the Institute have learned a lot about supporting multi-group collaborations (HPHP: Bay Area has over 40 members while our younger Climate Collaborative has over 20). By keeping an open mind and constantly striving to learn from those around us and our mistakes, we’ve picked up a number of tips and tricks along the way. This week, we thought we’d combine our collective knowledge and share our top pieces of advice for building effective collaboratives.
Kristin: The first step is always the hardest. Stop thinking about it and just do it.
Easier said than done right? Bringing together a group of individuals or organizations for the first time can strike fear in even the most seasoned collaborator. After ten years of community organizing and coalition building I’ve made my fair share of mistakes, stumbled over a few hurdles, and certainly learned some valuable lessons. Some of the biggest, and translatable, lessons I’ve learned for getting an effective collaborative off the ground are:
If you go in knowing the collaborative is a process not a project you’re already ahead of the game. Just don’t let perfect be the enemy of good. Have you had enough metaphors? Great. Get out there and do it and don’t forget to report back on your lessons learned.
Oksana: Manage structure without managing content.
Supporting collaborative initiatives is exciting work but requires unique skills, separate from those of collaborative members. One such skill that I have found to be incredibly helpful is the ability to manage structure without taking over managing the content coming out of the collaborative. For example, I may present on some best practices for drafting mission statements but will follow it with an opportunity for the collaborative members to use these tools to craft their own mission statement. Collaborative members must have the opportunity to share their thoughts, have their questions taken seriously, and make the ultimate decisions on the direction of the work, as they are the driving force behind the collaborative’s success. As the facilitator, I am best able to provide coordination and backbone support—setting the agenda, providing logistical support, keeping meetings on track, and jumping in if meetings are diverging dramatically from the agenda. However, the vision, goals, and activities of the group are decided by its members. Providing space for their input is crucial to creating a successful group where all members feel like they have buy-in.
Donna: Humility is crucial.
Humility is a crucial mindset to have when in a backbone position because it is the main bridge between a theory of change and its practice. As a backbone, it is often the case that you are not a practitioner in your topic of interest; for example, as a backbone to the Healthy Parks Healthy People: Bay Area collaborative, the Institute neither leads park programs nor prescribes time in parks. While being a backbone organization allows you to dive deep into the needs and future goals of your collaborative, this theory of change is colored by your role as a non-practitioner with a different set of agency constraints. When a collaborative’s practitioners implement these goals, they will necessarily adapt them to fit their own agency constraints. Humility and keeping an open mind is important when drafting these goals, but it is especially important considering that implementing these goals may look very different from the theory of change. Understanding the crucial role that humility plays in collaborative efforts ensures that there is flexibility and feedback when charting the course forward.
Catherine: Have patience!
Kristin’s sage advice that collaboration is a process, not a project, is something that has stuck with me since we first started thinking about forming a regional climate literacy collaborative. If I have learned one thing since then, it’s that processes take time! This is especially true when you want to ensure that all of your partners feel ownership of the process and are inspired by the results. In today’s grant-driven, output-oriented world, it can be scary and challenging to dedicate the time that it takes to make sure you have the right people at the table, that they’re all on the same page, and that they all feel connected to you, to each other, and to the work. While walking through the process can seem slow, creating a strong foundation is critical to the overall success and sustainability of the collaborative.
Blog co-written with Donna Leong
At the Institute, we look at health inequity and climate change as imperative social issues, particularly now that mounding research is illustrating how the two are inextricably linked. Specifically, we create and join conversations where taking action includes viewing parks as part of the solution to these issues. Community health inequities and climate change are problems that affect societies on a collective scale. That is to say, the actions of a single individual are not necessarily the root of the cause, but the collective actions of many individuals can be. For example, one group may decide to close a grocery store in an underserved neighborhood or another group may open a coal mine, leading to food deserts and expanded fossil fuel emissions, respectively.
The individual scale on which most people operate creates a powerful psychological barrier to acknowledging the realities of climate change and health inequities. Climate change in particular is still perceived by some as a distant threat that is not directly relevant to existing communities, even despite the fact that a majority of Americans believe global warming is happening. Spurred by the misinformation campaign against the realities of climate change, this mentality of “not here, not now, not me” is quite tempting to adopt. However, illustrating the connection between climate change and health inequities is one powerful tool to make this issue more tangible and resonate with more Americans, without the political polarization which often arises in discussions of climate change as such.
There is robust research illustrating the connection between these two issues, ranging from the severe effects of extreme heat exposure, leading to preventable heat-related injuries and deaths, to increased levels of asthma and other respiratory illnesses as a result of air pollution made worse by climate change. These impacts are already being felt locally, nationally, and globally.
• Between 1999 and 2009, extreme heat exposure caused more than 7,800 deaths in the United States.
• In California, we are facing a first-ever statewide executive order for water reductions in order to combat the current drought likely resulting from climate change.
The infographic below illustrates the vast impacts that a warming climate can have on communities. The effects of climate change on health are far-reaching, effecting people living in rural, woodland areas, where they are more at-risk for wildfires, as well as urban populations that are disproportionately affected by heat-island effect. Particularly vulnerable groups include young children, the elderly, people with chronic medical conditions, and people of low-income.
(Infographic source: United States Centers for Disease Control and Prevention)
While these impacts are pervasive, and perhaps daunting, people ranging from grassroots organizers to President Obama are discussing the connectivity of these issues with renewed vigor and taking action. At the Institute, we believe parks are problem solvers that provide unique solutions to the greatest issues, including the health impacts of climate change. Parks, especially urban parks, offer a number of ways to combat the effects of higher temperatures exacerbated by heat island effect. They temper high temperatures through shading and evapotranspiration, improve wind patterns in cities via park breezes, moderate precipitation events, and trap carbon in addition to other pollutants that adversely affect the ozone. Parks are also incredibly effective classrooms, acting as neutral venues to discuss—and witness—the effects of climate change. Additionally, parks are well-documented for having far-reaching physical, psychological, and mental health benefits.
When confronted daily by the immense challenges facing our environment and our public health, advocates for these issues are sometimes tempted to despair. At the same time, simple and tested policy solutions like parks tend to be overlooked in the political discourse surrounding climate change. As Occam’s razor would have it, though, the simplest answer can often be the right one. As part of a comprehensive program for addressing climate change, parks are the practical and scalable seed of environmental advocacy, ready to be nurtured in every community.
At this point, is it safe to assume that the term “social determinants of health” is readily understood? What about “social determinants of park use?” Can we also work towards consensus that these two terms describe the same barriers, for both health and parks?
Social determinants of health (SDH) are factors outside of an individual’s genetic makeup that influence a person’s entire health. SDH focus less on DNA factors, but more on the societal, community factors that determine access, amount, and quality of prevention and treatment a person receives. Not having health insurance covering the cost of treating an overactive thyroid problem is an SDH. Not being able to find a therapist who speaks the same language as you is an SDH.
As parks inventory their programs and activities to figure out how to bring more residents to the great outdoors, they are finding more and more that there are a set of barriers that create social determinants of park use (SDPH). Uncoincidentally, these barriers look very much like SDH. Here are a few examples that illustrate the convergence of SDH and social determinants of park use:
Capital: Families that are middle class or above are more likely to be healthier and live longer lives. Additionally, most park users (especially for national parks) are middle class and can afford the time and travel costs associated.
It is not a coincidence that SDH and SDPU are aligned in these substantial ways. Most parks were built around the idea of improving community health; Central Park in NYC was intended to be a natural refuge from the mechanical toils of factory work.
As National Public Health Week focuses on positioning the country to be the healthiest nation by 2030, we should pay special attention to nontraditional community health stewards that are already part of the community infrastructure. Mitigating social determinants of park use will be much like mitigating social determinants of health; we will have to be diligent about using resources to uplift the communities especially suffering from these social determinants.
Taking care of a community's health starts at making sure everyone has health coverage, but it doesn't end there. Giving all fourth graders a pass to visit America's national parks is a great first step, but it doesn't end there. To ensure that communities especially feeling the compounded effects of social determinants use their parks and live their healthiest lives, we have a special obligation to dedicate more resources to these specific communities. For a healthier nation in 2030, the onus cannot be on a single mother of two to wait 2 hours in a waiting room to be seen by a physician. As well, the onus cannot be on families living in neighborhoods plagued by gang violence to seek out safer parks.
To create a healthier nation by 2030, systems of care need to be changed and improved so that everyone gets timely care from health care providers, and cities need to work together to reduce gang activity and ensure that every park, no matter their location, is a safe park.
Bonus activity: Can you think of anything that could not be considered a social determinant of health or park use? It's harder than you'd think.
Do you ever listen to The Moth Radio Hour? If you don't then I suggest binge listening immediately. The concept is simple - in dozens of cities across the country, people, just like you and I, stand on stage and tell a story. It must be true and there are no cue cards or scripts allowed. It makes for some powerful and entertaining radio. For the last three years I've listened to about 1-2 hours a week (yes I know I have a problem) of personal stories, from people I've never and will likely never meet.
It's not uncommon for me to walk into the office still wiping tears from my eyes after listening to a story during my commute. Some stories hit me hard and fast and others linger in my thoughts for days. One of the common threads in the hundreds of stories I've now consumed is the power of place. Many of the stories told are deeply personal and shed light on moments of stress, hardship, and loss. More often than not the most vividly described character is not a person but a place - a park bench, a lake front, or simply a backyard. Nature is often the backdrop or even the main character in our stories of healing and there's a good reason for that.
The research and evidence of why we turn to nature in times of stress is abundant. The healing powers of being in wild, green spaces are endless. From lowered stress levels to safe spaces for healing from trauma, time and time again nature has come to the rescue.
Around the world, people head out their doors and into nature to help mark milestones in their lives. We turn to nature to help us gain clarity on a tough decision, to find solace in the loss of a loved one, or simply to feel a part of something greater than ourselves. Nature has been there for many of us in good times and in bad, in sickness and in health, no paperwork required.
The challenge for our rapidly urbanizing population is to increase these interactions and opportunities to heal in nature - to go from a society whose stories and memories of nature are marked by milestones to one in which nature is a daily part of our lives. To do this will require foresight from city planners and authentic engagement with more than just our park agencies. Spending time, safely, in nature should be easier than popping a pill. We can start by sharing these stories of healing and thriving around the bonfire and the water cooler.
"I go to nature to be soothed and healed, and to have my senses put in tune once more."
- John Burroughs
See you in the parks.
When we got to East Bay Regional Park District’s (EBRPD) Crab Cove, it was hot, and we were late. Naturalists were teaching participants how to use compasses—real compasses—and real maps, hand-drawn on paper, with lines showing magnetic and true north. They did not come with Siri’s reassuring voice. I felt a little panicked thinking that this was not entertaining enough for the patients who had taken their day off to come into nature with us. My own children sat down and announced they were not participating.
UCSF Benioff Children’s Hospital Oakland (CHO) Primary Care Center has partnered with EBRPD to take our patients into nature by offering a monthly shuttle from our clinic to a local park. Doctors and their families, as well as EBRPD staff, join patients and their families on these monthly outings.
Our goal is to increase opportunities for physical activity while having fun. The Centers for Disease Control and Prevention (CDC) states children should enjoy 60 minutes of physical activity a day, at least 5 days a week, and most of it should be aerobic. That means we should be getting aerobic activity—such as brisk walking—everyday; and three times a week, this should be a vigorous activity, such as running. Adults need 75 minutes of jogging or running every week and muscle-strengthening activities two or more days a week.
This may sound hard to achieve. Yet, research shows that simply being outside leads to increased physical activity. Children are two to three times more physically active outdoors than indoors. For every hour children are outside, they spend about 27 minutes of it in activity. Exercise in natural setting has added emotional and mental health benefits: for example, improved attention span, as well as improved feelings of serenity, energy, happiness.
have access to a variety of landscapes—“hardscapes” such as asphalt as well as natural landscapes. Play in outdoor settings with natural elements, such as a hiking trail or boulder-size rocks, has been shown to have added benefits of improved motor strength, balance, and coordination for children. A variety of landscapes may engage a wider variety of personalities or temperaments of children in physical activity. More imaginative children may be more engaged in natural settings.
As I felt my own mental resistance to figuring out the compass, I worried that this activity was not active enough to achieve our goal—I was wrong.
Once we learned how to use compasses, the families were split into groups and came up with their own team names: Team Confused, Team Larry, Team Gooze, and Team Marbin. Most groups ran off in the wrong direction. Team Marbin, led by CHO’s own Dr. Jyothi Marbin and her husband Seth, realized everyone else’s error and stealthily headed in the other way. By the time others realized, the Marbins were way ahead of the rest.
And then it was on!
As we followed our compasses towards the site where the last flag appeared to be, each team running to catch up with the Marbins, we saw that the Marbins (now joined by members of team Gooze) had veered just slightly to the right of the correct path. Team Confused quietly ran in the direction of the flag while trying not to be seen. They saw it at the same time as the Marbins, and although members of the Marbins and Gooze ran as quickly as they could to the flag, Team Confused touched it first. Team Larry arrived seconds after.
In the end, Marbins, Confused, and Gooze happily shared the glory.
A quiet calm came over the well-exercised children and adults as we walked back to the Crab Cove visitor’s center to watch some fish-feeding. That is, until doctors and patients, children and adults, burst into a fierce game of banana tag.
I can’t tell you exactly how many minutes of physical activity we got that day. But I can tell you that no family was going to be left behind. And, my total pedometer steps in that 2 hour excursion: 6,000.
With that, I hope to see you in the parks!
Nooshin Razani, MD MPH. Nooshin is a pediatrician and Nature Champion trained by the National Environmental Education Foundation to prescribe nature for health. She is currently Senior Health Fellow at the Institute at the Golden Gate.
with Kelley Meade, MD. Dr. Meade is a pediatrician and Associate Director of the Primary Care Clinic at UCSF Benioff Children’s Hospital Oakland. The shuttle project is part of her healthcare leadership fellowship at the Center For Health Professions sponsored by the California Healthcare Foundation.
Photos by Nooshin Razani and Mona Koh of EBRPD.
Many thanks to East Bay Regional Parks Foundation for sponsoring the outings, and to the Institute at the Golden Gate for donating water bottles and pedometers.
Last Thursday, Institute staff and Healthy Parks Healthy People: Bay Area (HPHP: Bay Area) champions made the trek to Microsoft’s offices in Mountain View to attend a “Collaboration for Great Impact” workshop. We joined our friends who have been working on environmental and climate change initiatives to reflect on the Collective Impact model’s role in our own work with HPHP: Bay Area. Pioneered by the social impact consultants, FSG, Collective Impact is a framework to align the work of different organizations into a single goal. Briefly, the five pillars of Collective Impact are: (1) a common agenda, (2) shared measurement, (3) mutually reinforcing activities, (4) continuous communication, and (5) backbone support.
When the HPHP: Bay Area program started in 2012, the Institute was under no illusions that this would be anything but a seriously complicated endeavor. Not only were we asking for help to create more public programming in the park, but we were asking the collective Bay Area to see nature and parks through the lens of wellness. In working with physicians to prescribe nature and encouraging parks to pave more trails in underserved communities, we have been making small steps towards a change in the broader culture of health, wellness, and parks.
Thankfully, we at the Institute are not doing this alone. Through the years, the HPHP: Bay Area program has cultivated a group of organizations and advocates that is engaged in bridging public health and public parks. As we continue to roll out the HPHP: Bay Area programming and bring more healthcare advocates to the fold, this workshop was a time for us to think critically about the future of HPHP: Bay Area through the lens of Collective Impact and its five pillars of success. Often, we are so wrapped up in the day-to-day operations that it is hard to find the time to reflect and learn from our past efforts.
During the workshop we participated in an exercise that had us imagine what HPHP: Bay Area would look like in 2025 and what would be telltale signs of its success. One partner answered that all awareness campaigns about the significant linkages between nature and wellness are obsolete because communities in 2025 will see that as blatantly obvious. Another partner highlighted the potential lessening of chronic diseases in 2025 as a measurement of success. Working backwards from these visions for the future, our group looked at potential steps we could take in the next month or year to make these goals a possibility. We listed different sectors we wanted to bring into the world of HPHP: Bay Area, as well as plans to create ongoing communication and dialogue within the group. We are still digesting all of the different ideas related to the five pillars that we came up with and will be eager to share them with you soon!
The year 2025 might be over a decade away, but we at HPHP: Bay Area know that change does not happen all at once. We are amplifying our efforts today in order to make sure that communities in 2025 have the motive, means, and opportunities to visit parks and increase wellness.
Special thanks to our friends at ChangeScale for hosting such a great event!
Urban parks create opportunities for community intervention and social interaction, which allows for the transfer of social capital. As social beings, humans require interactions with others and what better place to be amongst friends and soon–to-be friends than an urban park! A question that I have grappled with throughout my research as a health consultant at the Institute at the Golden gate is--how do we create positive interactions within these immensely important spaces? Parks can be both loved and feared places depending on how the space is being used.
Through my previous work as a park ranger and environmental educator I have seen first-hand what green space can do for people from all walks of life. Now, at the Institute I am able to dig a little deeper on the important connection between parks and social cohesion. The great landscape architect, Fredrick Law Olmstead, designed both Central Park and Prospect Park with the grand notion of vast open plazas built for social interaction. The ultimate melting ground—parks—offer an opportunity for tremendous information sharing and knowledge. The great opportunity of parks as a place for social cohesion also proposes a potential problem; parks are not always a safe place. As a UC Berkeley masters student studying city planning, I have often looked to Jane Jacobs, a journalist, author and activist known for her fight against urban renewal. Jacobs proposes more eyes on the street—meaning taking ownership of your community.
One of the most successful community based projects is the Dudley Street Neighborhood Initiative. Tired of disinvestment, neglect and redlining practices, members of the Roxbury/North Dorchester neighborhood of Boston established the coalition in 1984. The initiative accomplished so many wonderful things including convincing the government of Boston to grant the power of eminent domain over 60 acres of abandoned land called the Dudley Triangle. Another important success story was turning three urban parks in this neighborhood, once used as a primary instrument for drug trade, into positive coalition driven public space.
The opportunity is the nexus between city planning and health- which the Institute at the Golden Gate strives to answer with both Park Prescriptions and Healthy Parks, Healthy People. The built environment can influence all aspects of a person’s life from education, job opportunities, physical fitness, food offerings, and overall life span. Parks provide a tremendous opportunity for connection amongst a growing diversity of people in urban areas. Much of the existing research has focused on connections between social cohesion and health but many studies have not included how parks can influence social cohesion. The Institute will be digging further into these important links and I look forward to sharing this research and work.
If you were to perform a simple online search using the key words "mental health benefits of nature" you would be met with over 62 million hits, many of them news articles touting the endless benefits that green space has on our mental wellbeing. Additionally you can now find an abundance of resources from around the world focused on improving the mental health of of youth, refugees, veterans, and urbanites.
Mental wellbeing is quickly becoming a major public health issue. In 2011 the U.S. Centers for Disease Control and Prevention (CDC) reported that the use of antidepressants in the United States had increased nearly 400% in the last two decades alone. As the world becomes a more urbanized and complex place, we have to start asking ourselves just how important our green spaces are to us.
Just last week The Guardian published an article titled "Why green is good for you" and pointed to a study that tracked the mental health of a 1,000 people - half had moved to an area with higher rates of green space and half who moved to an area with less green space. As predicted the group who moved to an area with more abundant green spaces had an immediate improvement in their mental health. The most striking outcome was the improvement in mental health that was still present three years later.
It's been ten years since the term "nature deficit disorder" has entered our vocabulary. From forest bathing in Japan, to refugee walking programs in Australia, to the rise of park prescription programs throughout the United States, it's clear that we're making strides to improve the health and wellbeing of our population.
You don't need to plan your retirement to a cabin in the woods just yet to reap the mental benefits of nature. Taking the path that winds through the park on your way to school, ditching your couch for the shade of a tree to read the newspaper, or playing on the local playground with your kids are all good ways to become happier, and thus feel better. It doesn't take a lot but it does take a little.
We'll see you in the parks.
The Institute and the National Recreation and Park Association—with assistance from the Centers for Disease Control and Prevention—convened more than a dozen leaders representing the parks and health sector to refine on-the-ground tactics for program development program delivery, measurement, and professional training around park prescriptions.
Together, the partnering organizations are furthering the movement to elevate the initiative from a new idea to a best practice in preventive health. The goal of the National Park Prescriptions Initiative is to establish national standards, based on qualitative and quantitative evidence from programs across the country, to increase the quality of new and existing programs and support more accurate evaluation of program impacts. This time next year we hope to be disseminating a suite of resources to make it easier for diverse communities to implement a park prescriptions program of their own.
Experts in the fields of health, parks, and recreation are committed to making individuals and communities healthier through regular use and enjoyment of parks and public lands. In the coming years health care providers will be able to easily prescribe time outside for patients of all backgrounds—and parks will continue to be seen as places for health and wellness across the country.
See you in the parks!
I want to share one example of a process we have used to strengthen Healthy Parks, Healthy People practice in our region. The model is called “collective impact” and it is gaining traction around the country. We first heard about collective impact in Stanford Social Innovation Review (SSIR) and have been implementing it ever since.
Healthy Parks, Healthy People (HPHP) doesn’t refer to any one program. Originally a messaging campaign adopted by Parks Victoria in Australia, HPHP serves as an umbrella for any and all activities that draw a connection between public lands and human health.
For the past several years, parks all over the globe have been working to put this concept into practice, figuring out what it means by reaching out to unfamiliar partners and testing new programs and practices. Here in the Bay Area, we saw this happening to varying degrees of success. There was a fair amount of friendly competition as different agencies were tried to solve different pieces of the HPHP puzzle. Here at the Institute, we thought creating a more formalized community of practice could create a rising tide to lift all boats. But more than just sharing information with each other, we believed there may be some things we could only achieve if we tackled them together—an elephant in the room we might only move if we each put a hand on it.
Beginning in June 2012, we launched a series of monthly meetings that were very carefully crafted to help all park and public land agencies in the Bay Area to realize a common health agenda. Participants spanned parks and public lands, public health, private healthcare, and community advocacy groups.
Get Others Excited
Our first meeting was an invitation to play in the kiddie pool, giving our participants an opportunity to see if this kind of collaborative work was for them. We asked participants to think about areas in their HPHP practice where they were struggling to make traction on their own as a single organization. We shared those—which ranged from addressing transportation needs to using the right language to communicate with local communities—and then broke into groups to tease out what some collaborative solutions in those areas might look like. At our meeting’s close, we invited folks to continue the conversation by joining our series of monthly strategy meetings and craft an HPHP agenda that would move our entire region forward. Of the 50+ participants in this meeting, about 12 organizations committed to meeting monthly with us to create the initiative from scratch.
Define a Clear Target
At the next session with this committed leadership team, we mapped out all of our current activities and identified gaps. We started to see that we weren’t sure if our HPHP activities were reaching those communities that could benefit the most from healthy activities in our parks. And to be honest, we didn’t know those communities very well. We also recognized that, so far, our new HPHP regional collaboration had mostly attracted interested park actors but not as many health or community leaders. We guessed that we might not yet be attracting the right health stakeholders because we didn’t have something really concrete to offer yet from the park side and took that into account as we proposed activities we might take on together.
At our third session, we tried to more concretely articulate our purpose statement in coming together. We recognized that we could not take on all HPHP principles at once, so we chose a defined target. There is evidence that park prescriptions most benefit communities of low income and traditionally low access to parks. These are often also communities with the most health disparity and at the highest risk of chronic health problems. We decided that, to really make an impact with HPHP, we were going to prioritize our activities to serve those communities with high health risk first.
Start Something Tangible
With this target now in place, we had a clear outcome to strategize toward: increase the wellbeing of high health need communities through regular use and enjoyment of our parks. This statement, though simple, clarified our audience (high health needs first) and the type of behavior change we were aiming for (prioritize enjoyment rather than rigorous activity; regular use rather than one-off or semi-annual events).
We debated several proposals for “first step, low-hanging fruit” activities we could take on together. We judged them against a set of criteria we created to help us stick close to our target. After much brainstorm and debate, we agreed that the best first step we could take was to commit to offering consistent, culturally relevant programing designed for first-time park users that health care providers could prescribe just as easily as a drug you could pick up at Walgreens. We thought, how incredible would it be for this to take place in every park and open space in the Bay Area at a time that works for residents and is consistent? The Director of Maternal and Child Health at the San Francisco Department of Public Health agreed that this targeted programming would be a huge offering to the healthcare and public health community in our region. This became our agenda for 2013.
The Power of Collective Impact
Our “warm-welcome” HPHP park programming now takes place the first Saturday of every month in over 23 park sites around the Bay Area with over thirty agencies and organizations on board. Some things are standardized, like the way we measure participation and program outcomes, but in many ways the programming itself is varied, as well as the recruitment strategy, so we are able to compare different approaches in different communities, evaluate and improve what we are doing.
Just to tease out the timeline: within two months we were committed to a target—the change or outcome we were trying to seek together. Within about four months we had committed to an agenda for action and a timeline. And after twelve months we are moving full steam ahead, practicing and measuring our progress. This group of over twenty park agencies and a dozen health and community supporters decided that it wanted to create an MOU that would hold us accountable to this agenda through 2015. All of this was driven by the members of the collaborative; as the facilitative leaders, we committed to holding the process and asking the right questions at the right times.
Friends and Allies
If you are looking to create a collective impact collaboration for your social issue or cause, know that you’ve got allies behind you. Click here for a summary of different programs we modeled our own effort on. While it may not be exactly clear which “low-hanging fruit” your community will take on right away, we are confident that you can get started with only the resources you have at hand. Once you share a commitment to improvement with the right stakeholders and have set a few ways you plan to measure your success and hold yourselves accountable, taking meaningful action comes easily.
Since 2009, the Institute at the Golden Gate has been catalyzing partnership opportunities into action and helping to make the idea of Healthy Parks, Healthy People mainstream. To this point, the Institute has built a national movement by telling the stories of successful "park prescriptions" programs around the country and inspiring leaders in the parks and health fields to take up the charge.
Over the last year we have begun a partnership with the Centers for Disease Control & Prevention and the National Recreation and Park Association to compare data from park prescription pilots around the country. Together we have reached out to over two dozen experts and those already implementing park prescriptions, in order help to set national standards for programming. These experts and implementers will gather for an in-person convening in October 2013 to set the agenda and vision for park prescriptions moving forward. We hope this will further solidify Healthy Parks, Healthy People as a policy practice, and provide the evidence and rigor it needs to survive beyond any one administration or individual champion.
The Institute is committed to supporting a growing network of medical practitioners, insurance providers, parks and federal lands, and the communities they serve to establish and share best practices to connect healthcare and park resources. We look forward to reporting back in mid-October to share next steps on how park prescriptions programs will be improved and increased around the country in the coming years.
See you in the parks!
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