If you haven’t heard already, this coming Sunday is the third annual National ParkRx Day. Here at the Institute, we are celebrating the growing Park Prescription movement as more are prescribing time outside to improve health and wellbeing. The Institute has been working to promote Park Prescription programs since 2010, and we are inspired and proud to be a part of the rapid growth of this concept, nationwide.
For a quick refresher, Park Prescription programs are collaboratively created among healthcare providers, public land agencies, and community partners with the goal of improving health through time spent outdoors. While these programs can be as diverse as the communities for which they are designed, often, they include some type of referral or “push” from a healthcare or social service provider and “pull” from a park system that connects participating individuals with local outdoor activities.
When the Institute launched parkrx.org in 2016, the website featured case studies from eight different Park Prescription programs. Just two years later, we are excited to announce the addition of 11 new case studies. These case studies highlight diverse programs from across the country and are intended to serve as a resource for those interested in starting their own Park Prescription program.
As you peruse these case studies, keep an eye out for the many ways Park Prescription programs can be designed and implemented. Here are some things to think about:
Gathering these case studies and creating a nationwide directory of Park Prescription programs are just a few first steps as we build parkrx.org into the leading hub of information on Park Prescription programs and develop it as a space for knowledge sharing in the practitioner community. Our goal is to ensure that parkrx.org is home to the best tools and resources to help others develop and strengthen their own programs. If you have a relevant Park Prescription case study, tool, resource, or media article to share, we encourage you to submit that information here.
Additionally, if you’re interested in learning more and sharing your ideas on the future of parkrx.org, please join us for our first community-wide ParkRx call on May 8, 1 p.m. EDT/ 10 a.m. PDT, by visiting GoToMeeting on the date of the call and dialing into the conference line: (605) 468-8015, PIN:297788#
We look forward to hearing from you on our community-wide call!
On January 10 I participated on a panel titled “Maximize Community Active Living Opportunities Through Partnerships with Parks” at the California Supplemental Nutrition Assistance Program Education (SNAP-Ed) Local Implementing Agency Forum in Sacramento, California. This panel featured the Parks After Dark (PAD) program from the County of Los Angeles Department of Parks and Recreation, Marin County’s Parks Prescription programs, and the Institute at the Golden Gate's work as a technical assistance provider for issues at the intersection of health and parks.
County of Los Angeles Parks After Dark
Los Angeles’s PAD program transforms parks into community hubs through extended summertime park operation hours, bringing together a variety of programs and services that help build strong families and communities. Agencies involved in this program include the Los Angeles Board of Supervisors, Chief Executive Office, Department of Public Health, Probation, Sheriff’s Office, Public Defender’s Office, Department of Human Resources, Department of Mental Health, the Public Library, the Department of Public Social Services, and a variety of community-based organizations all working across sectors to build community cohesion through parks. At a PAD program, you may see law enforcement officers playing basketball with local youth, walking clubs, team sports, at-risk youth hired to assist with park programming, talent shows, movie nights, cooking demos, career fairs, resource fairs, or a neighborhood potluck!
Marin County Park Prescription Programs
Marin County is an innovative leader in Park Prescription programming through their Marin City and San Rafael-Canal pilot programs. Working closely with federally qualified health clinics, social services, local park agencies, public health educators, and community-based organizations, these Park Prescription programs create a referral process that supports patients in making healthy lifestyle changes that lead to improved health biometrics and other markers of success. Some of Marin County’s keys to success include building on existing momentum within the community, building partnerships to leverage resources, and engaging community members throughout the process.
Institute at the Golden Gate Technical Assistance - Connecting Parks and Public Health
If you’re a public health or social service organization interested in learning about how you can connect with parks, check out this handout for ideas on how to help your communities get healthy outdoors. It’s organized into four sections: Promotion, Program, Policy-Systems-Environmental Change, and Technical Assistance & Training. Even though this piece was created for SNAP-Ed program planners, I hope you will find this list useful for finding the wide range of ways to connect parks and public health.
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 email@example.com.
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!
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.
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.
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
San Francisco took a huge stride forward last month by committing to fully adopting Park Prescriptions throughout their public health system. The estimated 30% of San Franciscans who use some form of public health service will be "prescribed" time outside in one of the city’s local, national, or state parks. The program is being implemented by the Department of Public Health in partnership with San Francisco Recreation and Parks and the Golden Gate National Recreation Area and represents the first time in the world that an entire city has taken steps to fully implement Park Prescriptions.
Thanks to the leadership of San Francisco’s park agencies, patients are able to fill their prescription at one of the specially designed Healthy Parks, Healthy People programs. Patients are met by a park staff member and led on an introductory walk to get them familiar with the features of the park while getting physically active and improving their overall wellbeing.
The first Park Prescription program in San Francisco was piloted at the Southeast Health Center in the Bayview Hunters Point neighborhood. The Kaiser Permanente funded pilot was led by the Institute and championed in clinic by Dr. Nooshin Razani and Dr. Jamal Harris. The lessons learned from this pilot and many others in the Bay Area and across the country will help guide the implementation and long-term plan for the program throughout San Francisco.
See you in the parks...Doctor's orders!
There is growing consensus that nature has many health benefits, from increased physical activity to mental, emotional, and community health benefits. At the Institute we have brought this concept to implementation on a local, regional, and national scale. Recently our local Park Prescriptions pilot in the Bayview Hunters Point community in San Francisco was highlighted in the National Parks Magazine, produced quarterly by the National Parks Conservation Association. The article, A Prescription For Nature, was written by Dr. Daphne Miller - a partner and early advocate of the Healthy Parks, Healthy People movement.
The pilot program has made significant strides since its inception in summer 2012. This opportunity, funded by a Community Benefit grant from Kaiser Permanente, allowed us to take lessons learned and existing promising practices from around the country and adapt them to fit the unique needs of the Bayview Hunters Point community. After successfully training the staff of the Southeast Health Center and implementing park prescriptions in the clinic we will be continuing to elevate the important message of spending time outside to improve your health by training community leaders this summer. The community docents will have the knowledge and resources to be ambassadors for the parks and will help bring new audiences to participate in Healthy Parks, Healthy People programs in the Bayview Hunters Point neighborhood.
Stay tuned for stories and images from this summer's community docent program. Until then, see you in the parks!
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!
The idea that health care professionals could prescribe nature and outdoor activity has been around for several years, with "park prescriptions" now being pioneered by several organizations in various parts of the country.
On Monday, October 7, representatives of some key organizations agreed to take things to the next level at the first ever "National Convening on Park Prescriptions". The event, which took place in Houston, Texas, was co-hosted by the Institute at the Golden Gate and the National Recreation and Park Association (NRPA). The meeting included leaders and park champions from across the country, such as the National Environmental Education Foundation (NEEF), the "Walk With a Doc" group, Kids in Parks, and groups working on diabetes treatment and prevention, children's health and kinesiology. Other groups that played a critical role in the lead up to this meeting but were unable to attend due to the government shutdown included the National Park Service and the U.S. Centers for Disease Control and Prevention.
The event was a huge success and we will now be moving forward together as part of a growing national movement to prescribe parks and nature for people's mental and physical health. Watch this space for more news on this exciting movement in the coming weeks and months!
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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