Naturally Better – Howbery Park, Wallingford – 26th March 2009

Green space, physical activity and public health

Dr. Charlie Foster – Senior ResearcherBHF Health Promotion Research GroupUniversity of Oxford

Presentation Objectives

To briefly describe the relationship between green space, public health and physical activity

Describe the evidence base for this relationship

Offer possible directions for developing this evidence base

Presentation Objectives

To briefly describe the relationship between green space, public health and physical activity

Describe the evidence base for this Describe the evidence base for this relationshiprelationship

Offer possible directions for developing Offer possible directions for developing this evidence basethis evidence base

Consensus on health benefits of green space

Green space can reduce the risk of:» Promotes good health and prevents ill health

– Stress– Anxiety– Depression

» A place for physical activity

(Bedimo-Rung et al, 2005; Hartig, 2007; Moore & Cosco, 2007; Ottoson, 2007)

Public health importance of physical activity in the UK

Adults who are physically active have a 20-30% reduced mortality risk compared to inactive adults.

Estimates put the total direct costs to England of physical inactivity to the NHS as £1.06 billion

Conservatively, this represents about 54,000 lives lost prematurely per annum.

A 10% increase in adult activity would benefit England by at least £500m a year (saving about 6,000 lives).

(Game Plan, Strategy Unit 2002; Allender et al, 2006)

Cost of physical inactivity related disease in London

The cost of illness for physical activity related disease is nearly £14 per Londoner

The PCT spend on physical activity promotion is 85p per Londoner

(Foster et al, 2009)

Presentation Objectives

To briefly describe the relationship To briefly describe the relationship between green space, public health between green space, public health and physical activity and physical activity

Describe the evidence base for this relationship

Offer possible directions for developing Offer possible directions for developing this evidence basethis evidence base

Mitchell and Popham (2008)

Access to green space is associated with better health for the poorer half of the population

Incidence rate ratios for deaths from circulatory disease in income deprivation quartiles 2–4, relative to income deprivation quartile 1 (least deprived), stratified by exposure to green space

Mitchell and Popham. Lancet, 372, 2008, p 1658

A social-ecological model of physical activity behaviour

Foster et al (2005). Understanding why adults and children participate in physical activity and sport. London, Sport England.

Law & Regulations

Fiscal

Built environment

Natural environment

Health care systems

National policies & programmes

A social-ecological model of physical activity behaviour

Foster et al (2005). Understanding why adults and children participate in physical activity and sport. London, Sport England.

Law & Regulations

Fiscal

Built environment

Natural environment

Health care systems

National policies & programmes

Obesity

A social-ecological model of physical activity behaviour

Foster et al (2005). Understanding why adults and children participate in physical activity and sport. London, Sport England.

Law & Regulations

Fiscal

Built environment

Natural environment

Health care systems

National policies & programmes

Obesity

Proximity to recreation facilities, convenienceDestination factors, micro-scale design, footpaths, trailsMixed land use, shops and services nearbyAesthetics (perceived)Population density/sprawlArea based Coastal residence Area based Urban/age of suburbCulture, social environment as most importantConnectivity

WalkabilityRoute related factors, hills, traffic

Perceived safetyHigh crime rate Unattended dogsLighting/streetlights

Green spaces, environmental correlates and physical activity

Proximity to recreation facilities, convenienceDestination factors, micro-scale design, footpaths, trailsMixed land use, shops and services nearbyAesthetics (perceived)Population density/sprawlArea based Coastal residence Area based Urban/age of suburbCulture, social environment as most importantConnectivity

WalkabilityRoute related factors, hills, traffic

Perceived safetyHigh crime rate Unattended dogsLighting/streetlights

Green spaces, environmental correlates and physical activity

Proximity to recreation facilities, convenienceDestination factors, micro-scale design, footpaths, trailsMixed land use, shops and services nearbyAesthetics (perceived)Population density/sprawlArea based Coastal residence Area based Urban/age of suburbCulture, social environment as most importantConnectivity

WalkabilityWalkabilityRoute related factors, hills, trafficRoute related factors, hills, traffic

Perceived safetyPerceived safetyHigh crime rate High crime rate Unattended dogsUnattended dogsLighting/streetlightsLighting/streetlights

Green spaces, environmental correlates and physical activity

+More

often assoc

iated

Proximity to recreation facilities, convenienceProximity to recreation facilities, convenienceDestination factors, micro-scale design, footpaths, trailsDestination factors, micro-scale design, footpaths, trailsMixed land use, shops and services nearbyMixed land use, shops and services nearbyAesthetics (perceived)Aesthetics (perceived)Population density/sprawlPopulation density/sprawlArea based Coastal residence Area based Coastal residence Area based Urban/age of suburbArea based Urban/age of suburbCulture, social environment as most importantCulture, social environment as most importantConnectivityConnectivity

WalkabilityRoute related factors, hills, traffic

Perceived safetyPerceived safetyHigh crime rate High crime rate Unattended dogsUnattended dogsLighting/streetlightsLighting/streetlights

Green spaces, environmental correlates and physical activity

++More More

often often assocassoc

iatediated

+/0Equivocal

association

Proximity to recreation facilities, convenienceProximity to recreation facilities, convenienceDestination factors, micro-scale design, footpaths, trailsDestination factors, micro-scale design, footpaths, trailsMixed land use, shops and services nearbyMixed land use, shops and services nearbyAesthetics (perceived)Aesthetics (perceived)Population density/sprawlPopulation density/sprawlArea based Coastal residence Area based Coastal residence Area based Urban/age of suburbArea based Urban/age of suburbCulture, social environment as most importantCulture, social environment as most importantConnectivityConnectivity

WalkabilityWalkabilityRoute related factors, hills, trafficRoute related factors, hills, traffic

Perceived safetyHigh crime rate Unattended dogsLighting/streetlights

Green spaces, environmental correlates and physical activity

+/0+/0EquivocalEquivocal

associationassociation

0Not associated

++More often More often associatedassociated

The contribution ofenvironmental variables in explaining variation of physical activity or walking issmall and less important than sociodemographic variables.

PerceptionsSafetyQuality of public space

ObjectivePlaces to go locallyDeprivationPoverty

Using green space to promote physical activity – NICE evidence

Only found 2 grey studies WHY?

» Different views on what is evidence?

But some evidence does exist…..

Using green space to promote physical activity via play– NICE evidence

Real v perceived risk

Using green space to promote physical activity via play– NICE evidence

Real v perceived riskReal v perceived risk Parks mean independence leading to

more physical activity (Mackett, 2007)

Using green space to promote physical activity via play– NICE evidence

Real v perceived riskReal v perceived risk Parks mean independence leading to more Parks mean independence leading to more

physical activity (Mackett, 2007)physical activity (Mackett, 2007) Parks are places for all to play (Moore, 2003)

                                                                                                               

Source: news.yahoo.com Friday 7 January 2005

Men’s Fitness CriteriaOutcomeOverweight & obesity rates

Exposure junk food outlets gyms/sporting goods retailers fruit and vegetable consumption participation in exercise/sports

alcohol use smoking TV viewing air quality water quality climate index geography commute time parks/open spaces recreation facilities health care access

Inverse Leisure Law Study

Leisure-time physical activity patterns are low and socially patterned

Is there a relationship between neighbourhood deprivation and the density of physical activity facilities in England?

Inverse Leisure Law Study - Method

A database of all indoor exercise facilities in England was obtained, and facilities were linked to administrative areas and assigned a deprivation score

Census data were used to calculate the density of physical activity facilities per 1000 people per quintile of deprivation

The density of exercise facilities by quintile ofdeprivation for the county of Kent in Southeast

England

The density of access to green space by quintile of

deprivation for the county of Kent in Southeast England

Let’s look at green space access now!

Presentation Objectives

To briefly describe the relationship To briefly describe the relationship between green space, public health between green space, public health and physical activity and physical activity

Describe the evidence base for this Describe the evidence base for this relationshiprelationship

Offer possible directions for developing this evidence base

Other missing evidence…?

Does access and actual use of green space relate to health status» Related to quality or characteristics of

green space?» Change in one lead to improvements?

The economic value of green space» Contribution to economy, health costs and

Quality of life

Green space, public health and physical

activity - Conclusions

Green space is related to health Physical activity is related to health Our environment and how we use it does

impact on our health» People, place and policy

Green space, public health and physical

activity - Conclusions

Green space is related to health Physical activity is related to health Our environment and how we use it does

impact on our health» People, place and policy

Put green space and activity into our environments

Naturally Better – Howbery Park, Wallingford – 26th March 2009

Green space, physical activity and public health

Thanks toNick CavillDr Melvyn HillsdonDr Andy Jones