5 Key Trends in Parks and Public Health
A fundamental—and agonizing—paradox defines American public
health in the 21st century. While Americans are more gravely afflicted by
chronic disease than ever before, we have also never had such an array of
treatments for our deadliest diseases so readily available to us. Deepening
this paradox is a stunning fact: Many of the most potent and lasting treatments
for our national epidemics come not from pharmaceutical labs but from changed
Consider a few of the following national health statistics:
Seven out of 10 deaths among Americans each year
result from chronic diseases—with heart disease, cancer, and stroke accounting
for more than half of those deaths.
Nearly half of American adults suffer from at
least one chronic illness.
One in three American adults is obese—and almost
one in five children.
Arthritis is the leading cause of disability,
with nearly 19 million Americans reporting activity limitations.
Diabetes is the leading cause of kidney failure,
non-traumatic lower-extremity amputations, and blindness among American adults.
Decades of medical research attest to the preventive and curative
effects of increased fitness—particularly outdoor exercise and walking-oriented
lifestyles—on children and adults. And there is growing public consensus on the
priority of offering children smoke-free environments in which to grow up (not
to mention tobacco-free adult role models to emulate).
Indeed, leaders from both the public health and park and
recreation fields make compelling arguments that custodians of our green
spaces, trails and greenways, recreation facilities, community centers, and
playgrounds hold the keys to our most widely accessible dispensary of national
Doctors really ought to prescribe parks and
public recreation programs to their patients most at risk for obesity-related
Communities should seek to identify and address
“recreation deserts” and connect residents with under-utilized recreational
spaces through bike and walking trails.
Community-led studies of public health
consequences should inform and guide changes to the built environment—and parks
should play key roles.
Organizations chartered to fight chronic
diseases should partner with the caretakers of local walking trails and
And, we should all agree to keep parks
In fact, each of these five common-sense approaches to
improved community health is currently occurring—often with little or no
funding and just a small handful of local champions. Champions like Washington,
D.C.’s Dr. Robert Zarr, a park-prescribing pediatrician who believes “it’s time
to move away from merely recommending ‘diet and exercise’” and exhorts his
medical colleagues to “work with our communities’ and nation's natural
resources to get Americans to move more outside.”
Each of these five concepts represents a distinct, growing
public-health trend, and each shares a common theme: Local parks are working
alongside health care professionals, nonprofits, public health specialists, and
community stakeholders to prevent and treat our most devastating diseases.
And the side effects range from enhanced well-being to
greater appreciation for nature to new friendships.
Trend #1: Parks are
“To prescribe NATURE to patients and families to encourage
outside time in one of 350 green spaces/parks…”
So reads the short-term goal statement of D.C. Park Rx, an
experimental partnership among Washington, D.C., pediatricians, the D.C.
Department of Health, the U.S. Department of Health and Human Services, George
Washington University, and several private foundations.
The program’s longer-term goals are to combat obesity and
asthma, promote mental health, and foster environmental stewardship among the
younger generation. D.C. Park Rx is one of a number of recent park prescription
initiatives around the country based on collaboration between physicians and
park agencies. Because Washington, D.C., is a city where federal lands and resources
exist side by side with high percentages of low-income families and children
with obesity challenges, the nation’s capital provides a unique platform for a
multi-agency partnership linking public lands to public health.
Pediatrician Robert Zarr, who heads the D.C. chapter of the
American Academy of Pediatrics and whose practice serves a low-income and
immigrant population, is a leader of the program and a champion of the park
prescription concept. Influenced by author Richard Louv’s writings (Last
Child in the Woods: Saving Our Children from Nature-Deficit Disorder) and
alarmed by the growing rates of childhood obesity and asthma, Zarr urges
doctors to back up recommendations with practical guidance on local resources.
Zarr describes an approach to park prescriptions that blends
a traditional exam with a media display. During a well-child visit, if an exam
and patient survey indicate the patient could benefit from increased activity
outdoors (whether due to asthma or obesity risk), Zarr says the next step is to
pull up an illuminated, blown-up electronic map showing nearby parks and other
public recreational facilities. Map coordinates are set according to the
patient’s address, and doctor, patient, and parent(s) confer as to whether a
park prescription might be appropriate.
As an additional resource, Zarr offers families one-page
park summaries (evaluated according to a standardized park rating tool and
compiled by medical residents who visit each park). So far, he says, the
map-customized prescriptions have been well received. And follow-ups one to
three months after the park prescriptions show that families are indeed
spending more time at the 10 to 15 parks around Zarr’s clinic.
“Many people,” he comments, “simply weren’t aware of all the
parks around them.”
Zarr says the next steps are to finish rating Washington’s
parks, to connect park data with patient medical records (so that doctors can
easily show proximity of parks and recreational programs), and to find funds
with which to formally research the impact of park prescriptions.
“The evidence is anecdotal now, but in D.C., where 40
percent of children over the age of 8 are obese…we have to give clinicians—and
ultimately families—something concrete to do about it.”
In Oregon, where another park prescription pilot program
recently concluded, Oregon State Parks outdoor recreation planner Terry
Bergerson offers a cautiously optimistic perspective. The initiative found
support in the Portland area, Bergerson says, because “the physical inactivity
crisis was one of the top statewide issues in the 2008 Oregon Statewide
Comprehensive Outdoor Recreation Plan…[and] one of the recommendations was to
look at park prescriptions.”
Inspired by a New Zealand “green prescriptions” program, a
20-member group of recreation providers, health care administrators,
pediatricians, and health program researchers developed a plan to target
physically inactive Portland-area youth, ages 6 to 12, during well visits with
their pediatricians. The ultimate goal of the Oregon park prescription plan was
to encourage sign-ups for such recreational programs as swimming, dancing, or
“It’s easier said than done,” Bergerson admits. Even though
physicians’ prescriptions were sent to a park and recreation provider—who then
followed up with a welcome phone call—resulting sign-ups were lower than
Bergerson believes program costs created obstacles for some
families. Other difficulties may have included unfamiliarity with the concept
and language barriers. An unusual doctor’s prescription, followed up by a phone
call from a stranger, “might have led to some confusion and sort of a feeling
of being singled out,” especially for non-English-speaking parents.
Despite the hurdles that have come with the program’s
newness and bare-bones funding, Bergerson says he’s never worked on a project
“that had more excitement and more potential” than this pilot that spanned
three park districts and linked parks and doctors in unprecedented ways. He
hopes to see future versions of the program modeled more on scholarships,
though, than on prescriptions:
“These families don’t have a lot of extra income. It’d be
different if there were some funded programs doctors could send patients to.”
Trend #2: Tobacco-Free
Parks Set a New Norm
Tobacco-free parks made headlines last year when New York
City Mayor Michael Bloomberg signed legislation making all of the city’s parks,
beaches, and pedestrian plazas smoke-free. While that blast of media attention
(and the resulting controversy) created a new national awareness of the issue,
the tobacco-free parks movement has been gaining momentum for well over a
decade. And most of its successes have come not from sweeping legislation like
Mayor Bloomberg’s, but from gradual consensus-building within communities.
In Minnesota, for example, where the first parks went
smoke-free nearly 20 years ago, 150 communities statewide now boast
tobacco-free parks. As Emily Anderson, program coordinator for the Minnesota
nonprofit Tobacco-Free Youth Recreation (TFYR), points out, the majority of
those communities have adopted policies—not ordinances enforceable by fines.
(In some states, localities have no authority to pass ordinances banning
smoking in public places. In those states, patient efforts toward local policy
consensus is really the only option for achieving smoke-free parks.)
“The driving force behind a policy is really community
enforcement, setting a new norm within the community that makes citizens kind
of reach out to one another and say, ‘You know this isn’t allowed here,’”
Anderson explains. “Tobacco use is not normal in the parks.”
Typically, those policy changes result when residents, local
health advocates, TFYR members, and park employees cooperate in raising public
awareness on widely approved tobacco-related issues.
First among those points of consensus, she says, is that
secondhand smoke is harmful to everyone. Second is that cigarette litter comes
with high costs—both in dollars and in environmental and safety hazards.
Finally, there is the issue of providing healthy role models for children—and
breaking the advertising-fueled connection between sporting events and tobacco
Most Minnesota communities that have adopted smoke-free
parks report high levels of public cooperation, much to the relief of park
directors who expressed concerns about enforcement difficulties, Anderson says.
In fact, 70 percent of the state’s population supports tobacco bans in public
One key to the widespread public support has been the
leadership of youth in the tobacco-free movement. Anderson recounts youth-led
cleanups that have culminated in park displays featuring enormous jars of
cigarette litter. Communities can agree that the gallons and gallons of
discarded butts have no place in parks—and that their youngest members
shouldn’t have to demonstrate that point.
Trend #3: Community
Walking Programs Gain Speed
“Couch potatoes can do this. The only requirement is that
you can stand for 10 minutes without pain.”
This is how Jeannine Galloway of the Arthritis Foundation
describes the criteria for her organization’s program to get arthritis
sufferers of all fitness levels out walking. “Walk with Ease,” like other
structured walking programs sponsored by such national nonprofits as the
American Heart Association and the American Association of Retired Persons,
centers on inclusiveness, consistency, social interaction, and the celebration
of small fitness gains.
The many health benefits of walking are certainly not new
discoveries. Parks have long offered community-based walking programs, and
building and connecting trails and greenways have become top priorities for
regional planning boards throughout the country. Moreover, walking has been on
the rise among Americans. According to the U.S. Centers for Disease Control and
Prevention, the percentage of people who report walking at least once for 10
minutes or more in the previous week rose from 56 percent in 2005 to 62 percent
What programs like the Arthritis Foundation’s Walk with Ease
initiative provide that localities cannot is investments in nationwide program
development, commissioned research, member education, and best practices
insights. Furthermore, nonprofits specializing in a particular type of chronic
illness provide programs designed for people suffering with disease-specific
In Walk with Ease, six-week group classes led by certified
instructors include discussion topics relevant to arthritis management. An
individual program is also available in the form of a workbook that guides
participants through the walking plan. Because the program depends on safe,
convenient walking routes, the Arthritis Foundation is eager to partner with
park systems and workplaces.
Galloway says the content and strategies are based on
research and tested programs in exercise science, behavior change, and
arthritis management. And studies among program participants have shown
improvements in balance, strength, walking pace, and pain reduction.
Best of all, Galloway remarks, there’s a “built-in synergy”
between the expanding trails and greenways in our country and the population’s
growing need for low-impact exercise programs.
The National Recreation and Park Association will be
responsible for implementing the Arthritis Foundation Exercise Program (AFEP)
and Walk With Ease (WWE) intervention in 30 park and recreation agencies
selected through a competitive RFA process. This will be conducted in two
phases. The programs will initially be piloted in 15 agencies in the first
phase and then pilot in the remaining 15 agencies in the second phase with a
total reach of at least 1,500 persons with arthritis. NRPA will collect data
from participating agencies on a semi-annual basis to demonstrate overall program
success. NRPA will also disseminate successes from the studies by producing
resources and materials that highlight key successes, challenges, and lessons
learned from grantees. A best-practices document and a webinar will be produced
that encourage replication of the interventions by other park and recreation
Trend #4: Weighing
the Pros and Cons: Health Impact Assessments
See your doctor before beginning this program.
It’s the standard advice accompanying any new
self-improvement regimen. A Health Impact Assessment (HIA) might be considered
the community health equivalent of “seeing your doctor first.” It is a
structured discovery-and-reporting tool for maximizing the potential health
benefits—and lessening the risks—of changes to the built environment.
The HIA process generates a collage of health
recommendations from across a community. Typically, local government officials,
residents, and health, economic, and environmental groups form the
representative core. Participants identify project specifics and relevant
health issues, develop concrete recommendations, report to decision-makers, and
monitor and evaluate actions taken.
Kara Vonasek-Blankner, an Arlington, Virginia, volunteer
leader under the CDC’s ACHIEVE (Action Communities for Health, Innovation, and EnVironmental
ChangE) grant to her city, describes the HIA as “a great tool for engaging
community members and bringing critical information to policymakers at timely
What do park agencies bring to HIAs? While roles vary and
park input might range from operations insights to public-outreach strategies,
Vonasek-Blankner illustrates this with a walking-trail discussion: “During
stakeholder input meetings, [park leaders] might say, ‘Of course, this trail is
good for health—and sure, we can build it there. But unless we install
lighting, increase entrance and exit points, and increase patrols, it won’t get
the use we’re hoping for.’”
Bike Plan as Community Health Conversation
Planners Don Kostelec and Chris Danley have facilitated
exactly those kinds of discussions. The park and recreation departments of
North Carolina’s Haywood and Buncombe Counties hired the two consultants to
manage their respective HIAs for improving biking and walking infrastructure.
In Haywood County, where the park and recreation agency
sought to develop a comprehensive bike plan in 2011, HIA participants included
representatives from the county health department, the local school district, a
regional air-quality office, the social services department, the sustainability
office of the local community college, and a bike advocacy group. Kostelec
relates a discussion in which the county social services director commented
that he could reimburse expenses for a client’s vehicle repairs but not for a
“Right there, we had identified a policy barrier—and one
that was not just about physical health but…about mental health and autonomy.”
In other discussions that identified trail-adjacent parking
facilities and bike racks as needs, community college representatives offered
resources. In one instance, the college provided parking facilities as part of
a “park and pedal” trail access solution. And in another, the college’s metal
shop provided bike racks as a student project.
But the most dramatic example of how the health conversation
steered Haywood County’s bike plan came in the form of data the school district
provided—data Danley says ended up being “pivotal in prioritizing
“One elementary school had gone in a five-year time span
from 19 percent of its students with a BMI [body mass index] of overweight or
obese to 40 percent,” Kostelec says. “When we started to cross-tabulate that
with other Census data that are indicators of poor health, such as lower
income, rental housing, and density, [that area] flagged across the board.
That’s when we said, 'Okay, we’ve found health priority number one.'”
The consultants are now applying lessons learned from
Haywood County to an HIA for an ambitious greenways and trails master plan in
adjacent Buncombe County. Kostelec says they often hear from park and
recreation departments the frustration that “if I build that park or I build
that greenway, that doesn’t cure diabetes.” But from the consultants’
perspective, an HIA lends structure to the kind of holistic project that can
help cure and prevent chronic illnesses—while enriching a local culture of
Trend #5: Turning
Recreation Deserts into Community Oases
As U.S. obesity rates accelerate—particularly among those
with limited access to recreational opportunities—the drive to eliminate
“recreation deserts” has also gained momentum. Addressing this notion of
recreational impoverishment is, perhaps, where public health priority most
tangibly intersects with social equity ethics.
The term “recreation desert” may bring to mind visions of a
dilapidated playground half-hidden in a maze of elevated on-ramps. Or perhaps a
tenement-dotted urban grid where only a few stubborn blades of grass sprout
between sidewalk cracks. While haphazard urban planning and freeway-bisected
suburbs are often to blame for recreation-deprived areas, identifying and
improving these impoverished spaces is a complex undertaking that demands
insight into more than green spaces, facilities, and mapped distances.
“It’s just as much about the people using the spaces,” Bill
Beckner, NRPA's senior research manager, explains, “and how they get there and
whether they perceive them as being safe and welcoming.”
In a creative partnership between parks and academia, the
City of Allentown (Pennsylvania) Parks and Recreation sought to better
understand its users. With funding from the Pennsylvania Recreation and Park
Society, the city worked with Penn State University to connect the city into a
Greg Weitzel is Allentown’s former park and recreation
director and presently parks director for the City of Idaho Falls, Idaho. He
says aging infrastructure and safe-access problems presented known obstacles to
residents. And he and his colleagues wanted to eliminate those obstacles while
also gaining insight into the many factors influencing use.
Penn State’s Andrew Mowen conducted a pre- and
post-renovation study of Allentown’s Cedar Creek Parkway, a linear park
connecting the eastside and westside neighborhoods of Allentown, to determine
what improvements mattered most to residents. The following attractions were
the most commonly cited in Mowen’s study:
A large destination playground with universal
accessibility and multigenerational appeal (including fitness trail)
Paved access trail
Cleanliness of supporting facilities, such as
restrooms and water fountains
Installation of a rose garden.
Clearly, these kinds of renovations (not to mention the many
less visible to the public) require a substantial investment in master-planning
and dollars. Weitzel, known for championing thoughtful, built-environment
approaches to increased recreational access, says the study—and his own years
of experience—point to one overarching conclusion.
“Park departments simply can’t do it alone. You’ve just got
to have the political will—the support of the entire community—to make
these kinds of changes.”
Maureen Hannan is a
Virginia-based freelance writer and former staff editor with Parks & Recreation (email@example.com).