Day 2: SHIFT—Public Lands/Public Health
Frustrated with his inability to affect behavior change in the clinical setting, Dr. David Sabgir a cardiologist from Columbus Ohio, decided he would invite his patients to go for a walk with him. To his surprise, over 100 people showed up on a Saturday morning in the spring of 2005, energized and ready to move. Now he leads a global program, with over 400 chapters worldwide, thats success can be traced back to this first walk he took with patients. However, Dr. Sabgir isn’t alone in his frustration to affect behavior change in the clinical setting, or in his willingness to turn to the outdoors to change behavior. Health systems, physicians and land managers from across the country gathered in Jackson Hole, Wyoming for the 2018 SHIFT festival: Public Lands/Public Health to explore the role nature and our outdoors might play in supporting individual health and community health.
There are officially more mobile devices than people in the world today. The average adult spends ten hours behind a screen, we were told at this year’s SHIFT Conference. As parents, we fight for our kids’ attention, competing with their screens in our own homes. Charges abound that our phones are crowding out physical interactions and increasing feelings of social isolation and depression. Compounding this problem is the understanding that sedentary lifestyles and chronic disease are increasing, while many people’s quality and quantity of life are decreasing. Heart disease and other chronic diseases are the leading cause of death and disability in the United States. How do we improve population and community health and wellness? There was mounting evidence and countless testimonials from patients, doctors, nature lovers, and outdoor enthusiasts that a Nature Prescription (RX)—without technology, may be the prescription we all need.
David Strayer, professor of Cognition and Neural Science at the University of Utah presented his research on how a person’s ability to pay attention can be restored by interacting with nature, ideally without a mobile device. He uses converging methodologies in his lab to measure changes in both attention and performance, from psychophysiological (EEG and fMRI), subjective ratings, to primary (e.g., driving performance) and secondary task (e.g., reaction time) measures. Images of the brain were shown, reflecting how spectral EEG frequency changes after prolonged exposure in nature without technology. What does this all mean? When technology was used outside, there was greater inflammation across the brain, as compared to time out in nature without technology. Strayer, as well as other studies on neural plasticity suggest, brain-benefits of time in nature may include: improved cognition, enhanced memory, increased creativity, attention restoration, and changes in positive affect.
Dr. Michael Suk, MD JD MPH FACS provided the opening keynote for the conference and presented additional evidence around the health benefits of time outside, mobilizing a call to action that advances nature as a social determinant of health. Current social determinants of health commonly include: education, employment and working conditions, food, housing, and social support. Access to nature is now being advanced as an important extension to a community health model. As people complain of an increasing sense of social isolation, despite technology’s promise to connect, doctors are finding they can help people be active and connect with friends and family when they send them outside. Additionally, without telling their patients to “exercise,” the prescription to go outside seems to encourage and support a more active lifestyle.
Some members of the audience asked if physicians and health systems need more evidence before widely adopting the Nature RX. The resounding answer was loud and clear: “Sure, we’d welcome more research and data, but we don’t have time to wait given the chronic disease we are seeing. We’re out of time.” Physicians are diving in, getting their hands dirty and finding ways to get their patients outside. Dr. Nooshin Razani presented her groundbreaking park prescription program called Stay Healthy In Nature Everyday (SHINE) where she takes families into nature every month. She is a pediatrician, researcher, and advocate of access to nature as a human right. As an attending physician at UCSF Benioff Oakland’s Primary Care Clinic and a Clinical Scientist at Children’s Hospital Oakland Research Institute (CHORI), she conducted the first randomized trial of park prescriptions. She implemented Park Rx by providing transportation to parks, fun activities such as community walking, group games, meditation and yoga.
Other physicians across the country are leading similar efforts. Founder and Medical Director of Park Rx America, Dr. Robert Zarr, talked about his health initiative of prescribing nature to patients and families to prevent and treat chronic disease and promote wellness. Dr. Banner of Barton Health and USFS/Lake Tahoe Basin Management Unit Collaboration discussed his system’s team of staff who are getting patients out in nature. It is clear other health systems like Aetna, Kaiser Permanente, Northwestern, University of Washington and Berkeley are advancing research and Nature RX prescription efforts of their own. At a time when chronic disease like obesity, heart disease, diabetes, hypertension and mental health disease are being widely diagnosed, it is both refreshing and exciting to see health systems looking at different models to engage their patients and communities in nature as a determinant of health.
Most doctors and health leaders will say this is just common sense. Time outside makes people happier and healthier. Nature, parks and public lands offer us a place to unwind, to recreate, to experience risks and challenges that help build population resiliency. Time outside is also a way, and a place, to connect with friends and families. Maybe we have a favorite river or lake we like to go to, a city park, a mountain we like to climb, a landscape we like to be in to feel at peace. It turns out that these places we intuitively connect with or feel a sense of wonder over, are often what make us happier and healthier.
As an Idaho native, and as Idaho Business for the Outdoor’s Executive Director, I proudly support this nonpartisan, cross-sector collaboration that reestablishes people’s relationship with nature as a path to better community health. It is with deep gratitude and pride in our great outdoor state—Idaho, that I stand firmly behind this national effort.