Role of Parks and Public Spaces in Public Health. Sonja A. Wilhelm Stanis, PhD MU School of Natural Resources
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1 Role of Parks and Public Spaces in Public Health Sonja A. Wilhelm Stanis, PhD MU School of Natural Resources
2 Some Broad-Based Benefits of Parks & Green Space Protect the environment (reduced pollution, flood control, reduced urban heat island effect.) Enhance real estate values; attracting & retaining businesses Promote youth development Facilitate community pride, connectedness, social capital Promote individual mental & physical health
3 Contact with Nature: Mental & Physical Health Benefits Reducing Stress Restoring Attention Promoting Physical Activity
4 Contact with Nature: Mental & Physical Health Benefits Reducing Stress Restoring Attention Promoting Physical Activity
5 Stress Defined as the process used by individuals to respond psychologically and physiologically to situations that challenge or threaten well-being Although not all stress is bad, a major factor impacting health in modern day societies Baum et al. 1985; Grahn & Stigsdotter 2003; Pretty 2004
6 Chronic stress has adverse health consequences Undermines the immune system Delayed wound healing Progression of cancer Linked with cardiovascular disease & type 2 diabetes Impacts mood and life satisfaction Headaches Poor sleep habits Cognitive function, anxiety disorders & depression Webster & Glaser 2008; Godbout & Glaser 2006; Arranz et al 2007
7 What can nature contact do?
8 What can nature contact do? Stress Reduction in stress & stress-related symptoms Lessens annoyance, anger, frustration, aggression Lowers blood pressure, heart rate & muscle tension Reduces risk of cardiovascular disease Studies show that stress levels can fall within minutes of viewing green spaces Frumkin & Fox, 2011; Nielsen & Hanson 2007; Lee et al. 2009; Derbyshire 2007
9 What can nature contact do? Workplace Stress Multiple studies have identified the benefits of views of nature through a window and office plants for employees. Reduced stress Fewer ailments & sick leave Less frustration & more patience Higher job & life satisfaction Enhanced concentration & work performance Decreased intentions to quit Kaplan 1993; Leather et al. 1998; Pretty 2004; Wells 2000
10 What can nature contact do? Driving Stress Drivers stuck in traffic with view of nature less stress compared to drivers stuck in densely built-up areas Driving to work in urban settings increased work stress; driving in green settings protective against work stress Ulrich 1981; Parsons et al 1998
11 What can nature contact do? Surgery/Illness Recovery Recovery of surgical patients with window views overlooking stand of trees compared to those looking onto a brick wall Faster recovery/shorter hospitalizations Less need for painkillers Lower levels of stress, fear & anger Another study showed viewing nature pictures (compared to abstract pictures or white panels) had similar results Ulrich 1984; Ulrich et al 1993
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13 What can nature contact do? Surgery/Illness Recovery In other studies, contact with nature has been associated with: Fewer sick calls and stress symptoms among prisoners Better pain control in patients Improved health for people with chronic & terminal illnesses Improved immunity & cardiovascular function Lower blood pressure & anxiety among dental patients Moore 1981, Heerwagen 1990; Armstrong 2000; Diette et al 2003; Karjalainen 2010
14 What can nature contact do? Improves Mood Contact with nature (viewing images; walks in nature) has significant positive effects on mood. Reduce anxiety, depression, anger & aggression Increase positive feelings Feel more hopeful & less hopeless about confronting life issues Comparing mood profiles for people active in natural settings vs. gyms showed that those in nature were significantly less depressed Hartig et al 2003; Lindemuth 2007; Peacock et al 2007; Kuo 2001; Pretty et al. 2005; Morita et al. 2007
15 What can nature contact do? Importance of Parks Park visits associated with Improved mood Lower stress/anxiety Less sadness & depression Mental health is significantly related to residential distance from parks: highest mental health scores for residents in short walking distances of parks. High quality parks (attributes such as water features, shade, birdlife, trails) lowers psychological distress of neighborhood residents irrespective of whether or not they used the park. Orsega-Smith et al. 2004; Lawlor & Hopker 2001; Sturm & Cohen 2014; Hansmann et al., 2007; Francis et al. 2012
16 What can nature contact do? Youth Stress The stress-reducing potential of natural environments is applicable to children as well as to adults. Children exposed to nearby nature experience less stress and a faster recovery rate from stressful incidents Research suggests children may perform better throughout the day if provided breaks in green settings at school Wells & Evans 2003; Dyment 2005
17 Contact with Nature: Mental & Physical Health Benefits Reducing Stress Restoring Attention Promoting Physical Activity
18 Attention fatigue Two types of attention: Effortless attention/fascination (inherently interesting, such as observing wildlife) Directed attention (completing a work task, reading a text book) Directed attention subject to fatigue after sustained mental effort, making it difficult to concentrate. Kaplan, 1995
19 Nature & Attention Restoration Numerous studies show viewing and spending time in nature reduces attention fatigue and improves ability to concentrate across all ages. Attention Restoration Theory (ART): natural environments inherently restorative allows directed attention to recover from fatigue better concentration Kaplin 1995, Ottosson & Grahn 2005, Hartig et al 1991; Wells 2000
20 Cognitive functioning & directed attention Studies across a variety of populations & settings show improved performance on cognitive tasks with exposure to nature: Residents living in greener environments Workplace offices with plants Natural views from windows Walks in nature (parks, forest) Contact with nature in nursing homes Kuo, 2001; Lohr et al., 1996; Tennessen & Cimprich 1995; Berman et al., 2008; Taylor et al., 2002; Ottosson & Grahn, 2008
21 Attention fatigue & ADHD Individuals with Attention Deficit Hyperactivity Disorder (ADHD) are particularly susceptible directed attention fatigue ADHD is one of the most commonly diagnosed behavioral disorders in childhood, affecting 1 in 20 children in the US Inattention & related impacts often persist into adolescence & adulthood AAP 2000; MHA 2009; Wilens et al 2009; Doshi et al 2012; Kessler et al 2005
22 Nature & Attention Restoration Compare ADHD symptoms & cognitive task performance before and after activities in nature vs urban environments Youth activities in nature settings yielded significantly greater improvements Performance boost similar to widely prescribed ADHD medications on similar task. Recent MU study showed similar findings in college students with ADHD Faber Taylor et al 2001; Kuo & Faber Taylor 2004; Faber Taylor & Kuo 2008; Thal & Wilhelm Stanis 2014
23 Contact with Nature: Mental & Physical Health Benefits Reducing Stress Restoring Attention Promoting Physical Activity
24 Obesity* Trends Among U.S. Adults, 1985 No Data <10% 10% 14% *BMI 30, or ~ 30 lbs. overweight for 5 4 person Source: Behavioral Risk Factor Surveillance System, CDC
25 Obesity* Trends Among U.S. Adults, 1986 No Data <10% 10% 14% *BMI 30, or ~ 30 lbs. overweight for 5 4 person Source: Behavioral Risk Factor Surveillance System, CDC
26 Obesity* Trends Among U.S. Adults, 1987 No Data <10% 10% 14% *BMI 30, or ~ 30 lbs. overweight for 5 4 person Source: Behavioral Risk Factor Surveillance System, CDC
27 Obesity* Trends Among U.S. Adults, 1988 No Data <10% 10% 14% *BMI 30, or ~ 30 lbs. overweight for 5 4 person Source: Behavioral Risk Factor Surveillance System, CDC
28 Obesity* Trends Among U.S. Adults, 1989 No Data <10% 10% 14% *BMI 30, or ~ 30 lbs. overweight for 5 4 person Source: Behavioral Risk Factor Surveillance System, CDC
29 Obesity* Trends Among U.S. Adults, 1990 No Data <10% 10% 14% *BMI 30, or ~ 30 lbs. overweight for 5 4 person Source: Behavioral Risk Factor Surveillance System, CDC
30 Obesity* Trends Among U.S. Adults, 1991 No Data <10% 10% 14 15% 19% *BMI 30, or ~ 30 lbs. overweight for 5 4 person Source: Behavioral Risk Factor Surveillance System, CDC
31 Obesity* Trends Among U.S. Adults, 1992 No Data <10% 10% 14% 15% 19% *BMI 30, or ~ 30 lbs. overweight for 5 4 person Source: Behavioral Risk Factor Surveillance System, CDC
32 Obesity* Trends Among U.S. Adults, 1993 No Data <10% 10% 14% 15% 19% *BMI 30, or ~ 30 lbs. overweight for 5 4 person Source: Behavioral Risk Factor Surveillance System, CDC
33 Obesity* Trends Among U.S. Adults, 1994 No Data <10% 10% 14% 15% 19% *BMI 30, or ~ 30 lbs. overweight for 5 4 person Source: Behavioral Risk Factor Surveillance System, CDC
34 Obesity* Trends Among U.S. Adults, 1995 No Data <10% 10% 14% 15% 19% *BMI 30, or ~ 30 lbs. overweight for 5 4 person Source: Behavioral Risk Factor Surveillance System, CDC
35 Obesity* Trends Among U.S. Adults, 1996 No Data <10% 10% 14% 15% 19% *BMI 30, or ~ 30 lbs. overweight for 5 4 person Source: Behavioral Risk Factor Surveillance System, CDC
36 Obesity* Trends Among U.S. Adults, 1997 No Data <10% 10% 14% 15% 19% 20% *BMI 30, or ~ 30 lbs. overweight for 5 4 person Source: Behavioral Risk Factor Surveillance System, CDC
37 Obesity* Trends Among U.S. Adults, 1998 No Data <10% 10% 14% 15% 19% 20% *BMI 30, or ~ 30 lbs. overweight for 5 4 person Source: Behavioral Risk Factor Surveillance System, CDC
38 Obesity* Trends Among U.S. Adults, 1999 No Data <10% 10% 14% 15% 19% 20% *BMI 30, or ~ 30 lbs. overweight for 5 4 person Source: Behavioral Risk Factor Surveillance System, CDC
39 Obesity* Trends Among U.S. Adults, 2000 No Data <10% 10% 14% 15% 19% 20% *BMI 30, or ~ 30 lbs. overweight for 5 4 person Source: Behavioral Risk Factor Surveillance System, CDC
40 Obesity* Trends Among U.S. Adults, 2001 No Data <10% 10% 14% 15% 19% 20% 24% 25% *BMI 30, or ~ 30 lbs. overweight for 5 4 person Source: Behavioral Risk Factor Surveillance System, CDC
41 Obesity* Trends Among U.S. Adults, 2002 No Data <10% 10% 14% 15% 19% 20% 24% 25% *BMI 30, or ~ 30 lbs. overweight for 5 4 person Source: Behavioral Risk Factor Surveillance System, CDC
42 Obesity* Trends Among U.S. Adults, 2003 No Data <10% 10% 14% 15% 19% 20% 24% 25% *BMI 30, or ~ 30 lbs. overweight for 5 4 person Source: Behavioral Risk Factor Surveillance System, CDC
43 Obesity* Trends Among U.S. Adults, 2004 No Data <10% 10% 14% 15% 19% 20% 24% 25% *BMI 30, or ~ 30 lbs. overweight for 5 4 person Source: Behavioral Risk Factor Surveillance System, CDC
44 Obesity* Trends Among U.S. Adults, 2005 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% *BMI 30, or ~ 30 lbs. overweight for 5 4 person Source: Behavioral Risk Factor Surveillance System, CDC
45 Obesity* Trends Among U.S. Adults, 2006 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% *BMI 30, or ~ 30 lbs. overweight for 5 4 person Source: Behavioral Risk Factor Surveillance System, CDC
46 Obesity* Trends Among U.S. Adults, 2007 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% *BMI 30, or ~ 30 lbs. overweight for 5 4 person Source: Behavioral Risk Factor Surveillance System, CDC
47 Obesity* Trends Among U.S. Adults, 2008 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% *BMI 30, or ~ 30 lbs. overweight for 5 4 person Source: Behavioral Risk Factor Surveillance System, CDC
48 Obesity* Trends Among U.S. Adults, 2009 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% *BMI 30, or ~ 30 lbs. overweight for 5 4 person Source: Behavioral Risk Factor Surveillance System, CDC
49 Obesity* Trends Among U.S. Adults, 2010 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% *BMI 30, or ~ 30 lbs. overweight for 5 4 person Source: Behavioral Risk Factor Surveillance System, CDC
50 33% youth in US overweight or obese 70% adults in US overweight or obese Health-related issues (mental & physical) Staggering costs of medical care Overweight children are more likely to be overweight or obese as adults Flegal et al. 2016; Ogden et al. 2016; CDC 2010; Franks et al. 2010; Yeung et al. 2010
51 Physical Activity (PA) PA can reduce risk of obesity & related diseases Also shown to have a beneficial effect on psychological health & well-being Most Americans (youth & adults) do not meet recommended PA guidelines McGovern et al 2013; CDC 2015; Kann et al. 2013, Rimmele et al. 2009
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54 Parks provide important behavior settings in communities that can promote physical activity (PA) Coupled with other motivations for park visits, park-based PA can be intrinsically enjoyable & satisfying, and help to achieve recommended levels.
55 Parks & Green Space as Important PA Resources Evidence suggests that green spaces encourages PA in all age groups Time outdoors & in parks are powerful predictors of PA, particularly in children Baranowski et al 1993; McCurdy et al 2010; Sallis et al. 2000; Wilhelm Stanis et al 2014
56 Parks & Green Space as Important PA Resources Evidence suggests that green spaces encourages PA in all age groups Time outdoors & in parks are powerful predictors of PA, particularly in children Preferences for tree-lined and scenic routes for walking and running King et al. 2000; Bird & Adams 2001; Bodin & Hartig 2003
57 Parks & Green Space as Important PA Resources Evidence suggests that green spaces encourages PA in all age groups Time outdoors & in parks are powerful predictors of PA, particularly in children Preferences for tree-lined and scenic routes for walking and running Access to green space is associated with increased PA and park use Supply & proximity (more & closer are better) Cohen et al 2006; Cohen et al. 2007; Kaczynski & Henderson 2007; Wilhelm Stanis et al 2012; Kaczynski et al. 2009; Li et al., 2005; Besenyi et al. 2016
58 Parks & Green Space as Important PA Resources Park features & access characteristics also important Number & types of features/facilities Quality of park and features (e.g., renovations) Ease of accessing the park from surrounding neighborhood
59 Parks & Green Space as Important PA Resources Park features & access characteristics also important Number & types of features/facilities Quality of park and features (e.g., renovations) Ease of accessing the park from surrounding neighborhood Youth 2.5x more likely to achieve PA recommendations if had a park with a playground within 1/2 mile of home Importance of trails for PA across age groups Park amenities such as shade is associated with greater PA Wilhelm Stanis et al 2014; Besenyi et al. 2016; Kaczynski et al., 2008; Cohen et al 2006; Li et al., 2005
60 Parks & Green Space as Important PA Resources Park features & access characteristics also important Number & types of features/facilities Quality of park and features (e.g., renovations) Ease of accessing the park from surrounding neighborhood Renovations to playgrounds and park features result in increase use and PA. Park quality and renovations also associated with increased perceptions of park safety, which promotes use and PA Timperio et al., 2008; Colabiachi et al. 2009; Cohen et al. 2015
61 Parks & Green Space as Important PA Resources Park features & access characteristics also important Number & types of features/facilities Quality of park and features (e.g., renovations) Ease of accessing the park from surrounding neighborhood Residents less likely to use park if must cross high-speed road on their way to the closest park Residents with greater intersection density (street connectivity) were more likely to use parks and engage in PA in parks Wilhelm Stanis et al 2014; Besenyi et al. 2016; Kaczynski et al., 2014
62 Contact with Nature: Mental & Physical Health Benefits Reducing Stress Restoring Attention Promoting Physical Activity Strong evidence of the benefits what s next?
63 Moving forward Consider ways to add green to our lives Disparities & environmental justice Park prescription programs Investments in parks and green space
64 Moving forward Consider ways to add green to our lives Disparities & environmental justice Park prescription programs Investments in parks and green space
65 Adding Green Consider the range from small micro-restorative encounters (views of nature) to deep restoration in wilderness Views of nature Inside plants Tree-lined streets Community parks Naturebased resources Wilderness Around schools: views out window can help teachers stress, youth cognitive restoration, & promote youth PA at recess Green travel routes: decrease driving stress, mitigate work stress, encourages more active transportation
66 Moving forward Consider ways to add green to our lives Disparities & environmental justice Park prescription programs Investments in parks and green space
67 Environmental Justice Green space availability, park features & quality, and safe access are generally worse in low income and/or high-minority areas Given nature s importance for mental and physical health, considered the next wave of environmental justice An important way to make changes is to engage community members to take action to address community-based issues Vaughan et al. 2013; Crawford et al., 2008; Estabrooks et al., 2003; Moore et al., 2008
68 Community Park Audit Tool (CPAT) Developed with & for community members to quickly & reliably assess parks for their potential to promote PA Comprehensive (key areas covered) yet user-friendly (length, format) 6 pages with 4 sections: Park Information Access & Surrounding Neighborhood Park Activity Areas Park Quality and Safety Kaczynski, Wilhelm Stanis et al 2012
69 Community Park Audit Tool (CPAT) Currently: Electronic format (ecpat) Advocacy efforts with youth Workshop trainings in communities Data collection on Mobile Device + App Kaczynski, Wilhelm Stanis et al 2012
70 Moving forward Consider ways to add green to our lives Disparities & environmental justice Park prescription programs Investments in parks and green space
71 Park Prescriptions Growing movement of park prescription programs designed to better connect the health care community and public lands to create healthier people Goal to increase the prescription of outdoor activity in recognition of the many mental and physical health benefits
72 Moving forward Consider ways to add green to our lives Disparities & environmental justice Park prescription programs Investments in parks and green space
73 Investments in green space as a public health resource Recognize parks & green space as an essential component of the health care system Ensure parks & green space providers are aware of & promote health outcomes Design & renovate parks, buildings, neighborhoods to facilitate contact with nature Develop new policies around nature & health Enhance partnerships between green space providers & health related organizations (can t do it alone!) Continue to evaluate & document the contributions
74 Summary The evidence is clear that contact with nature provides many mental & physical health benefits Parks & green spaces are important public health resources Opportunities to extend the benefits and impacts
75 Thank you! Sonja A. Wilhelm Stanis, PhD School of Natural Resources University of Missouri
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