Park Prescription programs are initiatives designed in collaboration among public land agencies, healthcare providers, and community partners to encourage people to utilize parks, trails, and open space for the purpose of improving individual and community health. National Geographic just wrote about Park Prescription programs and these programs have been recognized by the Surgeon General’s Office, the National Park Service, and the American Public Health Association as important tools to promote wellbeing.
This is all to say that Park Prescription programs have really flourished in the United States. One question still remains: “How do I build my own Park Prescription program?”
That’s the question that the Institute always receives. As the convener of the Healthy Parks Healthy People: Bay Area collaborative and the National ParkRx Initiative, it makes sense that we get fielded this question. Answering this question has been our guiding light for the past few years. We’ve led workshops, hosted webinars, and written reports, all in pursuit of finding out what makes a Park Prescription program work.
After years of observing programs, especially those in the Bay Area, we have created a Park Prescription program toolkit to guide the process of creating a program. This toolkit is a "program-in-a-box," curating examples, templates, and guidance for those interested in implementing Park Prescription programs. We know that there are a myriad of agencies interested in building these programs, so this toolkit was created with sector-specific guidance for clinicians, public health providers, community service providers, and parks staff.
I hope that this resource makes it easier for you to serve your community!
By now you’ve probably heard us mention the Crissy Field Park Prescription Day event that we are so excited for on Sunday, April 23, 2017. But did you know that the Crissy Field celebration is just one of 14 events taking place across the Bay Area? Healthy Parks Healthy People: Bay Area member organizations are pulling out all the stops to celebrate the second annual Park Prescription Day the only way they know how – by having free, fun, and family-friendly activities in parks and open spaces!
There are events in several different counties and all of them offer guided programs that encourage being healthy outdoors, such as hiking, nature walks, yoga, and more! Here’s a list of all the fun and FREE activities happening in the Bay Area on Sunday, April 23:
For more information about the Bay Area events, visit hphpbayarea.org. See you in the parks on Sunday, April 23!
Over the past several months, the National ParkRx Initiative administered a series of webinars relating to Park Prescription programs. The theme of the series was creating/strengthening Park Prescription programs and the three webinars focused on partnership, needs assessments, and implementation/evaluation, respectively.
Attendance was robust for all of the sessions, with 260 registrants for Part I, 236 for Part II, and 199 for Part III. Based on pre-webinar registration questions, participants came from a variety of professional fields, including the parks/recreation and public health/medical industries. Participants most often expressed challenges with partnership, funding, and attendance in their Park Prescription programs.
After each webinar ended, attendees were directed to a post-session survey. The overall results of these surveys show that 98% of attendees thought their knowledge increased as a result of the webinar. 82% of attendees thought the webinar helped them create/implement a Park Prescription program. Questions participants had during and after the webinars revolved around topics such as program development, partnership-building, funding, and program evaluation.
Based on participant feedback, the webinars were helpful for many individuals. The audience’s level of understanding of Park Prescription programs ranged from “wanting to learn about Park Prescriptions” to “wanting to improve an existing program”. Even so, the vast majority of attendees left each webinar with more knowledge and ability to create or strengthen a Park Prescription program.
If you’d like to view recordings of the webinars and resources distributed, please visit http://www.parkrx.org/resources/fall-2016-webinar-series.
Park Prescriptions Program Panel at American Public Health Association Conference. Photo courtesy of Donna Leong.
The American Public Health Association Annual Meeting took place in Denver earlier this month and I had the privilege of attending on behalf of the Institute at the Golden Gate. For the Institute’s work at the intersection of parks and public health, it was important for us to understand how parks fit into the priority areas of this large field of public health. Joining 12,000 other colleagues, I saw firsthand the enthusiasm that these public health professionals had for community health promotion.
For community health promotion, APHA looks at the local services that can be accessed for healthier communities; parks, unsurprisingly, were important parts of the social fabric of community engagement. It is always heartening to hear the importance placed on parks from other sectors and the public health professionals at APHA acknowledged the potential that parks had not only to increase public health, but to also create connected communities and mitigate climate change. The emphasis on creating upstream solutions framed the role of parks on creating vibrant communities.
Additionally, I went to show support for the National ParkRx Initiative, which had a panel presentation. As a testament to how parks are received in the public health community, the room was filled and became standing-room only. Drs. Jean Coffey, Nooshin Razani, Robert Zarr, and Daniel Porter discussed their Park Prescriptions programs, which dot the nation, from DC to Vermont, and Texas to California. As equally engaged as the doctors were in their work, it was also exciting to hear the level of enthusiasm that the audience had for the topic. Psychiatric nurses, community liaisons, and students wanted to understand how they could incorporate park and nature-based prescriptions into their own line of work.
As with many conversations around Park Prescriptions, the important question is not just why incorporate the program, but how to incorporate the program? A sentiment that I took away from the conversation was that the first step to incorporating it into any public health field was to try. The entire APHA conference was a crash course in understanding how creativity and a can-do attitude can create a multitude of effective public health solutions. How did communities help to regulate the consumption of tobacco products? They tried programs that would reduce the number of storefront advertisements for them. Now, most counties in the nation are adopting this practice of working with local stores to reduce environmental advertisements of tobacco. How can communities start using parks to create community cohesion, mitigate climate change impacts, and improve human health? The Institute at the Golden Gate is trying out its programs that address these issues and so are our partners.
National ParkRx Initiative Convening Attendees
Last week, the Institute hosted the 3rd National ParkRx Initiative Convening in St. Louis, along with our partners: NRPA and NPS. At this convening, we discussed the next phases of development for not only the National ParkRx Initiative, but also for the ParkRx movement, as it relates to each individual program.
At the meeting, we discussed roles, responsibilities, fundraising goals, and communications plans for the National ParkRx Initiative. We were grateful to the dozens of people and agencies that came to the convening, as we were able to take a day to reflect on the collective goals of these many different organizations. At the National ParkRx Initiative, we know that there are many different ways that programs have started and we are interested in building up the Initiative to be able to support many different types of ParkRx programs.
When we had met in 2014 for the 2nd National ParkRx Initiative Convening, only a handful of ParkRx programs were on the ground; now, the US Surgeon General has approved of ParkRx and dozens of programs have started their second phase of development. It is quite a different landscape that we are working within now and the Initiative is excited to bolster its strategic direction. This strategic direction will bolster the National ParkRx Initiative’s role as the support system for different programs both in existence and starting up. We will reveal more information once the plans have solidified.
When I began my position as Health Fellow with the Institute in June, I never could have imagined time would fly by so quickly. In what feels like an instant, three months have come and gone.
I suppose my sense of time has been skewed by the last four years of my life – the constant buzz of assignments, exams, and extracurricular activities in college stretch thin the hours in each day and make weeks feel like months. This fellowship has introduced me to the fast-paced reality of the working world.
During my first and second months with the Institute, I dove headfirst into learning about the National ParkRx Initiative and planning for the webinar series I am organizing. I spent my time brainstorming what the webinars would cover, contacting and giving direction to potential panelists, and devising marketing and communications strategies to get the word out about the series.
Once the webinar topics, panelists, and logistics were sorted out, I focused my energy on the first webinar in the series. My third month was spent refining the details of and marketing the first webinar. The session went live on Wednesday, September 28, with Donna Leong, the Institute’s Health Program manager, moderating the session. 151 individuals participated and engaged in the webinar - it was a success! (If you’d like to view a recording, visit www.bit.ly/parkrxweb1.)
That brings me to now. As excited as I am to delve deeper into my projects, I also realize that my time with the Institute is slowly coming to an end. Despite this, I am excited for the next step in my professional journey, and I will be eternally grateful for all of the skills I have acquired during my time here. I know I have already grown immensely as a professional and I am thrilled to continue learning from my colleagues and assignments.
Are you wondering how you can strengthen your agency’s park prescription program? Want to start a park prescription program, but don’t know how? Unsure of what park prescriptions are, but eager to learn more?
Join us for the National ParkRx Initiative’s three-part webinar series this fall, Creating and Strengthening Park Prescription Programs. The webinars are free, open to the public, and will explore some of the most important elements for successful park prescription programs. Experts will provide case studies and best practices from their own successful park prescription programs.
For some background on the organizer of these webinars, the National ParkRx Initiative aims to strengthen the connection between health, parks, and public lands to improve physical and mental health of individuals and communities. By collaborating with national partners and subject-matter experts, the Initiative helps improve the quality of new and existing park prescription. The Initiative is currently led by the Institute at the Golden Gate, the National Recreation and Park Association, and the National Park Service.
Why webinars, you might ask? In the process of developing a park prescription toolkit, there were several key themes that emerged as essential to the successful creation and execution of park prescription programs. These topics have been formatted into three different webinars:
In Part I, participants will get a general overview of the park prescriptions movement while learning about the specific needs, roles, and responsibilities of both park and health professionals. Speakers will focus on how to build partnerships. In Part II, participants will learn about why needs assessments are essential to successful park prescription programs. Speakers will focus on how to conduct and use space and community assessments to establish program modules. In Part III, participants will learn about park prescription program implementation, evaluation, marketing, and outreach. Speakers will focus on program sustainability.
Register for the webinars by clicking the links above, or click here for more information. We hope to see you there!
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 bringing 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.
Zarnaaz Bashir and Robert Zarr presenting at the APHA session "Prescribing the outdoors to improve overall health and well-being."
Photo courtesy of Robert Zarr, Clinician at Unity Health Care, Founder of DC ParkRx, and ParkRx Advisor for the National Park Service.
This week, thousands of public health aficionados descended upon Chicago for the annual American Public Health Association conference to discuss the latest and greatest preventative health measures for communities. Just as we have seen Park Prescriptions take hold in parks conferences, there's an influx of Park Prescriptions presentations in health conferences. This year at APHA, there were many different sessions focused on how the health community views and uses natural areas for community health.
In particular, Zarnaaz Bashir, Leyla McCurdy, Dr. Nooshin Razani, and Dr. Robert Zarr each had sessions on how the health community can understand, articulate, and implement their crucial roles in the Park Prescriptions movement, which comes at the intersection of community health and environmental health. Click on each of the names to see a summary of their sessions.
We are excited that these Park Prescriptions practitioners and champions are presenting this concept to the larger public health community. Now it's time to get the stewards of the land and stewards of health to come together to turn these ideas, programs, and ideals into large-scale reality!
(co-written by Kristin Wheeler, Associate Director)
Parks need health partners and public health needs parks. That was the ever-emergent theme of this year’s National Recreation and Park Association Congress. At this congress—one of the biggest parks and recreation conferences in North America—the Surgeon General announced his call to action on walking and specifically highlighted the importance of how parks and recreation create healthy, active communities. At the Institute, we know that the intersection of human health and parks is prominent, but hearing our colleagues at the national level discuss their involvement with this intersection was educational and rewarding.
What we learned
There are infinite ways in which parks can and do contribute to community health. Being able to share promising practices openly and willingly benefits the entire movement of making sure that parks and open space are seen as active and vocal advocates for the wellbeing of their communities.
With that, I hope to see you in the parks. The Surgeon General insists.
Pass by corner of Drake Avenue near Phillips Drive in Marin City and take in the sights and sounds of George “Rocky” Graham Park. Initially built in the 1940s, the park had been dismantled in the 1990s due to maintenance issues. Rocky Graham Park had its official reopening on July 11th, 2015, and its vibrant green turf and nature-themed playgrounds have been in continuous use since.
The story of Rocky Graham Park not only encompasses a community’s tireless advocacy for a public good, but also the bringing together of different partners, agencies, and stakeholders to make it happen. To sustain the use and enjoyment of this beautiful, community-built space, Rocky Graham Park will be a pilot site for park prescriptions programs.
In partnership with the Marin Health and Wellness Center, the Marin City Community Services District will be offering a plethora of free programs in Rocky Graham that will help to promote the wellness of the community. For most fitness levels, the programs range from guided gentle walks around the park and neighborhood to martial arts on the turf. These programs not only encourage physical health, but also usher in the mental and social health benefits that being in nature and learning about one’s own community offers.
Check out Marin City Community Services District’s website for more information on the programs being offered. If you are client of the Marin City Health and Wellness Center, be on the lookout; your health care providers will be prescribing park programs to you very soon!
If you do find yourself wandering around the park before you receive a park prescription, fear not! Here's a prescription for activities that you can already do in the park without attending a program:
I joined the Institute at the Golden Gate three years ago and in that time I've watched the conversation around the connection between parks and health shift and grow. In my first year conversations around the benefits and importance of spending time in natural settings were met with skepticism and a lot of blank stares. Often it took multiple, high touch conversations to convince and empower new partners to join us at the table.
Today, the table is large and still growing. The conversation is fueled by passion and carried by forward thinking champions from all sectors of society. Our biggest problem is literally finding a table large enough to hold these conversations around. Not a bad problem to have.
The first official meeting of the Healthy Parks Healthy People: Bay Area collaborative was centered around creating a unified vision. One that we could all see ourselves in - from health providers to community leaders to park agencies. What does a future where parks and health work alongside of each other look like? It was clear that everyone in the room could envision a world in which parks and health worked more closely together. Our individual visions, written on brightly colored sticky notes, filled a twelve foot wall in no time. Many months and hundreds of sticky notes later we came to our guiding mission: to improve the health and well-being of all Bay Area residents, especially those with the highest health needs, through regular use and enjoyment of parks and public lands.
Since launching in 2012, the coalition has grown to over 40 park, health, and community agencies representing all nine counties. This regional initiative has become a catalyst for broad policy change that advances the adoption of measurable recreational models that improve the physical and mental health of the highly diverse Bay Area population. The coordinated regional effort is setting its sights on creating the structural changes needed to resolve challenges such as transportation and access, which are critical to the people/parks/health connection.
We won't be able to tackle these hurdles alone. It's critical that every voice is heard, loud and clear. Our parks and public lands are imperative to the health of our population and it will take all of us to ensure that these spaces remain protected and supported for generations to come. That's why HPHP: Bay Area is proud to partner with Outdoor Voice, a regional initiative from the Bay Area Open Space Council.
With Outdoor Voice, you can discover opportunities to support the scenic treasures that best fit your interests, from quick actions you can take at home to outdoor experiences you can share with your whole family. Together, we can ensure that current and future generations will experience the awe and amazement of being outdoors.
HPHP: Bay Area is committed to amplifying all outdoor voices. Sign up today to help preserve outdoor spaces that help our communities thrive.
See you in the parks!
The social determinants of health, which coincidentally are the social determinants of park use (credit)
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.
Less than two weeks ago, close to 5,000 leaders from around the world came together in Sydney, Australia, for the IUCN World Parks Congress – the once-in-a-decade global forum on protected areas. Together, we tackled challenges such as climate change and illegal poaching, shared successes of healthcare partnerships to improve wellbeing, and heard from the next generation for stories of inspiration and hope. It was an honor to not only attend, but to share the stage with remarkable leaders from Finland, Australia, Singapore, and beyond to discuss how parks around the world are seeking solutions for a better world.
During the opening ceremony, leaders from across the globe took the stage to share what they bring to the table and express their hopes for a healthier, more sustainable future. We reflected on the last Congress that took place in Durban, South Africa a little over ten years ago, where keynote speaker Nelson Mandela pointed out that our youth may be the key to a better future, but that it will take each and every one of us to teach and empower current and future generations to steward the magnificent places that we are privileged to call home. Mandela’s words rang true at this year’s Congress, but I found examples of leadership and empowerment in unlikely places. The inspiration and examples of action that struck me most came not from the keynote speakers or high up government officials, but from community organizers, Indigenous leaders, and youth. Perhaps this is what Mandela wished for all along.
Given the state of our planet I see no reason why we shouldn't be filling every international stage with stories from the “doers" – those that choose to take the information we already know and turn it into action. I found the most inspiration and hope from the one on one conversations struck up while sharing a bench in the shade between sessions. It was in these deeper more personal moments that I felt the most connected to the global community. Sharing the challenges of partnerships with a community leader from Gabon and swapping ideas on how to engage low-mobility park users with friends in Australia – these are the stories I wish to hear, these are the actions that deserve the attention of our leaders, and these are the people that know enough to act and are bold enough to act now.
To read more about the actions and achievements coming out of all corners of the globe, I encourage you to read the Promise of Sydney. This document includes commitments, goals, and achievements that leaders and organizations from around the world will strive to make before we get back together in the next decade. While the details and testimonials are still coming together, what we do know is that our global community promises to INVIGORATE, INSPIRE, and INVEST in every way that we can to create a healthier and more sustainable future for all.
I personally promise to look for inspiration at all levels and more importantly continue to act so that future generations inherit a better planet than the one we have now. In ten years’ time when park and protected area professionals come together again I have hope that those on stage will be Indigenous leaders, youth, community organizers, and the “doers” of the world. If this comes to fruition I believe we will have made Mandela and our global community proud.
San Francisco is a city of innovation. With a world class public health system and an equally impressive park system, it’s fitting that the two would work together to improve the health and well-being of its residents. Since 2012 the Institute has partnered with the San Francisco Department of Public Health, Golden Gate National Recreation Area, and the San Francisco Department of Recreation and Parks to bring the idea of Park Prescriptions to reality – and now to scale.
Despite having close to 6,000 acres of parkland within the city limits current San Franciscans, like most Americans, are now far more sedentary and disconnected from the land than previous generations. We are feeling the burden not only in our bodies but in our pocket books and communities. There is a rigorous body of evidence to prove that access to and time spent in nature improves our physical and mental well-being. But don’t just take the leading scientists and researcher’s word for it – take a stroll through a forest, swap out your treadmill for a local park, or simply take a step outside and breathe in deeply.
Last week San Francisco was once again put on the map for innovation. A joint training of 200 park and health professionals helped launch and cement Park Prescriptions as more than just a good idea. The groundbreaking training included welcome speeches from the leaders of the Golden Gate National Recreation Area, Golden Gate National Parks Conservancy, San Francisco Department of Recreation and Parks, and the Department of Maternal, Child and Adolescent Health.
The role of the Institute was to help support, convene, and facilitate the day. A job that is often filled with spreadsheets, late night copy runs, and making a lot of last minute changes seem effortless. We’ve taken on this role to make it easier for our partners and champions to do what it is they are great at – to educate, inspire, and empower park and health professionals to work together, learn together, and ultimately make San Francisco a better place to call home.
It didn’t take long for me to forget about those late night copy runs and fifteen page spreadsheets when our leaders in parks and health took to the podium. I expected many words of congratulations and praise to be said throughout the day but what I didn’t expect was to hear such personal and authentic stories. Each speaker and trainer shared their connection to the outdoors; to the role nature had played in healing themselves and their loved ones and how those experiences have deepened their commitment to this movement.
The passion running through that room of public health providers and park professionals last week made all of the hard work worth it. I’m more confident than ever that we not only know enough to act now but that we will act now. Improving the health of our most vulnerable populations, strengthening ties in the community, and lowering healthcare costs doesn’t require a medical breakthrough. It’s time we all tap into those positive outdoor memories, roll up our sleeves and get to work together. San Francisco may be the first city to take Park Prescriptions to scale but I guarantee it won’t be the last.
Special thanks to Dr. Nooshin Razani, UCSF Benioff Children's Hospital Oakland; Dr. Curtis Chan, San Francisco Department of Public Health; Howard Levitt, Golden Gate National Recreation Area; and Jim Wheeler, San Francisco Recreation and Parks for their continued leadership and bringing this dream to reality.
Here at the Institute at the Golden Gate, we believe the time is ripe to help bring Park Prescriptions to scale. There are dozens of organizations testing the concept in parks and health clinics around the country, and the early results are encouraging. Imagine what would happen if every healthcare professional began to prescribe nature and every park agency was able to welcome these high health need patients. With so many people suffering from physical and mental illnesses, we have the potential to improve tens of thousands of lives across the United States each year.
To support the national movement, the Institute launched an initiative back in 2012 to connect experts in the fields of parks and health engaging in Park Prescriptions. In partnership with the U.S. Centers for Disease Control and Prevention and the National Recreation and Park Association, we convene a national coalition of over 35 experts and practitioners.
Two weeks ago, the partners co-hosted the 2nd National Convening on Park Prescriptions in Charlotte, North Carolina. The workshop brought together leaders from around the country drawn from both the parks and health fields. During this full day workshop the group created strategies for on-the-ground advancement of the movement in order to support any park or health agency in starting their own program. Together, we set goals for communications, program resources, and data and research, and mapped the year to come.
One personal epiphany at the meeting was hearing from several doctors in the room about how Park Prescriptions can be used not only to treat people with illnesses ranging from ADHD to diabetes, but also as a "preventive" health treatment that can help healthy people stay that way. It is extremely rare for any health intervention to be both a treatment and prevention. I left the meeting inspired to do my utmost to help bring this growing movement to a whole new level across the nation.
In the coming months, we'll have more news as we start to deliver on the goals set by the coalition partners earlier this month.
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.
UCSF Benioff Children’s Hospital Oakland (CHO) Primary Care Clinic has partnered with the East Bay Regional Park District (EBRPD) to bring families to nature for health. The result has been, in a word, magical. Through the generosity of the Regional Parks Foundation, a Nature Shuttle takes patients, their families, and accompanying clinic staff to a variety of East Bay Regional Parks on the first Saturday of each month. The first two trips have been to Healthy Parks Healthy People programming at Crab Cove Visitor Center at Crown Memorial State Beach on the Alameda Shoreline where we were greeted by a naturalist, participated in guided activities exploring the outdoors, and have enjoyed a meal together.
One family was recruited to the Nature Shuttle during a busy clinic morning when a single mother and two toddlers had come in for vaccines and asthma. During the course of the visit, the doctor learned that the family was struggling with housing. Among other more urgent topics, the provider was able to suggest this specific nature activity as a way to relax and recuperate. Once at the tide pools, with her boots covered in mud, this mother said: “This is my last pair of shoes.” She laughed and said that she had to wait until next month to have enough funds to buy a replacement pair, but that it was worth it.
We are a Federally Qualified Health Center, so a large portion of our patients live below the poverty line. Many lack basic resources such as food, house stability, transportation and child care. Poverty has profound effects on health. Over the course of life, the increased health risks associated with poverty have a cumulative impact of 14 years of difference in life expectancy. It also happens that people with the lowest resources, highest health needs, are often those with the least access to nature.
We look to nature to help our patients become resilient. We believe nature has the potential to heal because it buffers stress. When people have trees and vegetation around them, they have lower blood pressure, better emotional control, and improved attention and cognition. In larger population studies, green environments reduce stress, anxiety, depression, and increase the sense of well-being and longevity. Children living in more green environments have been shown to have more resilience against stressful life events such as family strife, divorce, and bullying. Associations with improved mental health and access to nature are even more profound for people living in poverty.
We also look to nature to help families spend quality time with each other. The best conditions to reduce childhood stress are those where young people can feel safe and connected to others and to the world around them; spending time with a loving adults builds resilience in children. Opportunities for quality time increase when families are outdoors. We have observed many distraction-free moments of quiet, tenderness, and laughter between parents, grandparents, and siblings in nature.
We refer patients to the nature shuttle to increase physical activity, but also to help with stress relief and social isolation.
I want to stay here forever
“I want to stay here forever,” said an 11-year-old girl at the end of one of our trips. Her exclamation surprised us as she had been completely silent through out the excursion. For the most part, she helped her parents care for three younger siblings, quietly accompanying them around the tide pools, pond and the Crab Cove Visitor Center. She maintained a vigorous grasp on an adult’s hand as we followed a naturalist out into the muddy tide pools to search for crabs, worms and bat rays. Her sequined pink sneakers were covered in mud, and after a few minutes she turned around and quietly went back to the shore.
Partnering with children such as this young girl and families to get outdoors has taught us not to make assumptions about how children feel about or experience nature. One young boy jumped into the dirt almost head first, elated, running back and forth to the group to announce his latest discovery such as Mermaid’s Hair Seaweed. One family group spanned three generations, including a teenager wearing headphones. Despite this teen’s cool demeanor, she was just as engaged as her elders when we saw baby ducks. Another boy separated from the group; staying on shore. When we returned from the tide pools we discovered that he had been completely engrossed in finding crabs of different sizes. Filled with pride, he held up his hand which was filled with several little crabs. The toddlers in the group often struggle to sit still, but come to life when allowed simply to run.
Fun looks different depending on a child’s developmental stage. Young children ages zero to five learn, explore, engage and get active through play. Play is best when spontaneous and self directed. Natural environments that are enriched – that is, with natural elements such as sticks, rocks, and streams – foster healthy development and invite young children to explore while gaining physical skills and coordination. With the little ones, we are often reassuring and encourage parents to find a safe outdoor space and to give their preschooler unstructured time to discover and play. Elementary aged children, on the other hand, enjoy being outside with their parents or friends. To engage an adolescent, it is important to listen to her ideas on where to go and what to do in the outdoors.
Getting kids to nature is not always easy on the adults
The parents on our trips work hard to give their children this opportunity. A half-day excursion into the outdoors takes time, access to nature, and money for supplies, meals, transportation, and childcare. For many people these are formidable challenges. The shuttle leaves from our clinic on the first Saturday of each month. Getting to our clinic poses it’s own challenges: one couple with four children had taken three buses to get there and were running to get to our clinic, as one of their buses was delayed. One grandmother had hailed a taxi when her connecting bus failed to show up. Another mother arrived early so her children could take a nap and catch up on sleep before the trip. Another family of four children had spent two hours on a bus to get to our shuttle. We are humbled by our families’ determination to explore with us.
But, as is the magic of nature, the barriers between families fall when we are outdoors. Families and staff help each other out. On the bus ride over, several of the mothers traded information on housing options. A naturalist held one mother’s toddler for much of the day so she could tend to another child. The formalities between doctor and patients also drop; one doctor ran and ran with a two year old across a grassy lawn until they both sat down, smiling, and finally tired. The physicians had the opportunity to talk with families in a way that they would never have the opportunity to do otherwise. As social isolation is a true public health issue, the potential for community building in these trips is profound.
When we say nature, we mean community
What is it exactly about being outdoors that heals us and heals children? Science tells us the health benefits of nature include physical activity, stress relief, and social contact. Our experience tells us nature is about having fun with friends, family, and community. Being in nature is also about expanding our definition of community. For a child, attaching to the place where they live, and to the plants and animals that share this space with them also has the potential to help them feel connected. Reducing stress and being connected to loving adult and community helps kids become resilient.
Parks remain an invaluable resource for free and local opportunities to experience nature. Thank you, East Bay Regional Park District for being an amazing collaborator and for caring for our parks. Thank you to UCSF Benioff Children’s Hospital for believing in nature. Thank you to parents and caregivers for exploring. Thank you to all the naturalists, environmental educators, and guardians of our nation’s natural resources. You are public health in action.
We would like to recognize Carol Johnson, Elizabeth Carmody, Sharon Nelson-Embry, Yogi Francis, Pat Chase, Kelley Meade, Christine Schudel, Kelvin Dunn, Curtis Chan, and Kristin Wheeler for helping to create this vision.
About the Authors
Dr. Dayna Long is a staff pediatrician at UCSF Benioff Children's Hospital Oakland (CHO) where she co-directs the Family Information and Navigation Desk (FIND). She has been a dedicated Nature Champion at CHO and currently collaborates with EBRPD to integrate nature into clinical care in a program called FIND Nature! Dr. Long also serves as Medical Director for the Asthma Clinic where she and her team run an annual camp for children with asthma to spend a week in nature called "Camp Breath Easy."
Dr. Nooshin Razani is a pediatrician practicing at the Silva Clinic in Hayward and UCSF Benioff CHO. She was trained as a "Nature Champion" by the National Environmental Education Foundation in 2010 and serves as the lead medical Senior Fellow to the Institute at the Golden Gate. She is thrilled at this opportunity to share her love for nature with families through a collaboration with the FIND Nature! team at Children's Hospital Oakland and EBRPD.
Photos by Nooshin Razani and Elizabeth Carmody