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Natural Thinking Improving public health through contact with the Natural Environment: Clearer Future Conference September 18th 2008

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Title: Natural Thinking Improving public health through contact with the Natural Environment: Clearer Future Conference September 18th 2008


1
Natural Thinking Improving public health through
contact with the Natural Environment Clearer
Future Conference September 18th 2008
  • Dr William Bird
  • Strategic Health Advisor
  • Natural England

2
The Environment Good or bad?
  • HOME

SCARY
3
Health Inequalities
  • 1n 1991 the difference between the lowest and
    highest fifth of life expectancy was 9.7 yrs and
    it is now 12.3 years.
  • There appears to be no improvement (slight
    worsening) since the baseline of 1997
  • The governments target is to reduce the
    difference in life expectancy by 10 by 2010

4
Mental Illness
  • Mental illness affects 1 in 6 of the adult
    population
  • 1 in 5 under 16yr olds have a mental disorder
  • By 2020 the WHO claims that depression will be
    the second most prevalent cause of ill health
  • The total cost to the economy is 75 billion
  • (12 billion to NHS)

5
What are we prescribing?
  • In 2005 27.7 million antidepressant Prescriptions
    were written in England costing 338 million.
  • There is doubt whether most anti depressants are
    any better than Placebo. Initial Severity and
    Antidepressant Benefits A Meta-Analysis of Data
    Submitted to the Food and Drug Administration
    Irving Kirsch et al
  • The Chief medical officer states that Physical
    activity is effective in the treatment of
    clinical depression and can be as successful as
    psychotherapy or medication (DH 2004)

6
Obesity
  • The UK has the highest rate in the EU
  • In the UK rates have tripled in the past 20 years
  • By 2050 60 of population and 1 in 4 under 16
    year olds will be obese
  • Total cost of obesity to society will be 45
    billion by 2020

7
Diabetes
  • There are 2.2 million people with diabetes in
    England (4.48 of the population) i
  • This will increase to 3.6 million by 2025 (64
    increase)
  • Half this increase is from the rise in obesity.
  • for those at high risk regular exercise
    reduces their chances of developing diabetes by
    up to 64
  • At least five a week
  • CMO report 2004 DH
  • i Yorkshire and Humber PHO 2005

8
Evidence linking Health and the Natural
Environment
  • The Natural Environment has three main affects
    on the Human
  • Reduces Chronic Stress
  • Increases Physical activity
  • Creates a sense of purpose and belonging

9
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10
Social Isolation
Traffic
The Car
Poor Air Quality
Reduced Physical Activity
Reduced access to Greenspace
Planning
Social Barriers due to disconnection
Chronic Stress
Obesity
Social Inequalities leading to environmental
injustice
Health Inequalities leading to environmental
injustice
11
How Stress can be seen as a major public Health
Problem
Social Isolation
Reduced access to Greenspace
Social Inequalities leading to environmental
injustice
Physical inactivity and Obesity
Chronic Stress
Raised Inflammatory Markers
Anxiety and Depression
Cardiovascular Disease
Lung Disease
Diabetes
Cancer
12
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13
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14
When asked the best age for children to be
allowed out with friends unsupervised most
respondents (43 per cent) said aged 14 or over,
despite the fact that most of them had been
allowed out without an adult at the much younger
age of 10 or under The Childrens Society June
5th 2007
15
Walking
IncreasedPhysical Activity
Social Inclusion
Increased access to Greenspace
Good Air Quality
Reduced Chronic Stress
Anxiety and Depression
Cardiovascular Disease
Lung Disease
Diabetes
Cancer
16
Nature Contact in housing projects
17
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18
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19
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20
Benefits of Green Space
  • People living in those flats with an outlook onto
    trees and grass were associated with
  • Reduced stress in children
  • Increased concentration and self discipline in
    children
  • Reduced symptoms of ADHD in children
  • Increased the amount of play for local children.
  • Half the incidence of violent and property crimes
    and domestic violence
  • Increased strength of community
  • Increased ability for the poorest single parent
    mothers to cope with major life issues.

21
Kuo F (2001) Coping with Poverty Impacts of
environment and attention in the inner
city. Environment and Behavior, Vol 33 No 1
January 2001.
22
Is greenery associated with obesity? N 6919
Odds Ratio
A Ellaway S Macintyre BMJ 2005331611-2
Greenery
23
Children and the Natural Environment
  • Children use the natural environment to recover
    from stress.
  • Children are more active when outdoors.
  • Children who are not able to explore the natural
    environment without an adult before the age of 11
    are less likely to value the natural environment
    when older.

24
Summary So Far
  • Regular Contact with Green Space
  • Reduces Chronic Stress
  • Increases Physical activity
  • Creates a sense of purpose and belonging
  • Chronic stress causing depression and chronic
    inflammation
  • Environmental injustice may be a major component
    of health inequalities.

25
THE GOVERNMENT
  • We must do nothing less than transform the
    environment in which we all live. We must
    increase the opportunities we all have to make
    healthy choices around the exercise we take and
    the food we eat.
  • The Prime Minister Jan 2008

26
THE ACADEMICS BMJ 9th June 2007
Editorial The challenge is to make politicians
work for an environment that promotes walking,
and to call on doctors to encourage patients to
walk
27
Physical Activity Care Pathway
  • Work to include physical activity in the QOF.
  • Link natural environment through physical
    activity to obesity, diabetes, mental health and
    inequalities

28
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29
Every GP practice to plan their Natural
Extension. Natural England / NHS Alliance
30
National Walking Campaign
  • Announced last week (but was dunked by free
    swimming!)
  • 7 million over 3 years but will liberate
    considerable more from PCTs.
  • Walking should be integral to the advice by
    doctors and nurses in all Chronic diseases.
  • Exercise referral is biased to indoor venues.
    This is wrong.
  • Clinicians are hopelessly ignorant about the
    benefits of walking. They want to refer but have
    no information about how.

31
Walking the Way to Health (WHI)
  • Over 33k volunteer health walk leaders having
    been trained by300 cascade trainers
  • They lead 4000 walks a week in over 550 WHI
    schemes.
  • Significant growth to increase capacity and
    referrals from NHS leading up to 2012.

32
On the Horizon
  • In Manchester planning to use incentives.
  • WHO walking evaluation to provide economic proof
  • Active England and Get Active Alliance and OHF
  • NHS Forest with Natural England/NHS
    Sustainability Unit
  • Olympic Park to be an exemplar of the Natural
    Health Service.
  • Greenery in each hospital space to improve
    patient experience with Natural England
  • New Environment and Human Health Unit at
    Peninsula Medical School

33
NHS Forest
  • For Manchester, an extra 10 green cover is
    projected to keep temperatures 1C above current
    temperatures over the next 70 years.
  • If there is no change to green space then
    temperatures will increase by 3.7C.
  • In contrast if there is 10 less green cover then
    urban temperatures would increase by about 8.2C

34
NHS Forest
  • 1.3 million trees (one for each NHS employee)
    would absorb 689,000 tonnes of CO2 each year.
    Gill S, Handley J, Ennos R, Pauleit S (2007)
  • Senior citizens live longer with more space to
    walk and with nearby parks and tree lined streets
    near to where they live. Tanaka A, Takano
    T,Nakamura K,
  • Each year 1.3 million trees remove 2535 tonnes of
    pollutants from the air (425 tonnes of ozone and
    477 tonnes of particulate). McPherson EG,
    Simpson JR2005.
  • A belt of trees can reduce noise levels by as
    much as 6-8 decibels for every 30 metres width of
    woodland
  • A broadleaf can reduce UVB radiation by a factor
    that is equivalent to a factor 10 sun cream. 60
    of the UV radiation

35
From advocacy to action
  • Create a Natural Health Service.
  • Twin every NHS institution with local Green
    Space.
  • Make every environment favourable to walking.
  • Integrate all NHS physical activity pathways with
    outdoor activities in local Green Space.
  • Reduce Environmental injustice by greening up
    deprived areas.
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