Transcript Slide 1

The Natural Health Service
Dr William Bird
Strategic Health Advisor
Natural England
Senior Lecturer, Environment and Human Health
Peninsula Medical School
What’s your point of view?
SCARY
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National Indicators: Children and Young People
• NI 50: Emotional health of children
• NI 55: Obesity in primary school age children in
Reception**
• NI 56: Obesity in primary school age children in Year 6**
• NI 57: Children and young people’s participation in highquality PE and sport
• NI 69: Children who have experienced bullying
• NI 110: Young people’s participation in positive activities
National Indicators: Adults
• NI 119: Self-reported measure of people’s overall health
and wellbeing
• NI 120: All-age all cause mortality rate**
• NI 121: Mortality rate from all circulatory diseases at ages
under 75**
• NI 122 Mortality from all cancers at ages under 75**
• NI 124: People with a long-term condition supported to be
independent and in control of their condition.
• NI 125: Achieving independence for older people through
rehabilitation/intermediate care
National Indicators: Adults (cont)
• NI 134: The number of emergency bed days per head of
weighted population
• NI 137: Healthy life expectancy at age 65*
• NI 138: Satisfaction of people over 65 with both home and
neighbourhood
• NI 141: Percentage of vulnerable people achieving
independent living
National Indicators: Strong and safer Communities
• NI 2: % of people who feel that they belong to their
neighbourhood
• NI 2: % of people who feel that they belong to their
neighbourhood
• NI 5: Overall/general satisfaction with local area
• NI 6: Participation in regular volunteering
• NI 8: Adult participation in sport and active recreation
• NI 17: Perceptions of anti-social behaviour
• NI 32: Repeat incidents of domestic violence
Human Benefts of Green Space
Indirect Effects
Direct Effects
Health Inequalities
Temperature Extremes
Mental Health
Shelter:UV, noise, wind
Physical Activity
Carbon Offset
Obesity
Air Quality
Social Cohesion
Health Inequalities
• PSA 18: To promote better health
and wellbeing for all which includes
targets to narrow the gap in life
expectancy between the poorest
areas and the national average.
• The government’s target is to reduce
the difference in life expectancy
between Spearhead regions and the
average by 10% by 2010.
• Age of death of the poorest compared
to the average increased from 1.9 yrs
to 2.0yrs in men and from 1.4 yrs to
1.6yrs in women between 1995-1997
and 2004-2006
Health Inequalities
DH, CLG
• The Marmot review will
look at all indicators that
contribute to Health
Inequalities. Will report to
PM Dec 2010
EVIDENCE
• People on the same
income, who lived closer
to green space lived
longer and had less heart
disease than those with
less access. (Lancet 2009)
Mental Health
1. Mental illness affects 1
in 6 of the adult
population
2. 1 in 5 under 16yr olds
have a mental disorder
3. By 2020 the WHO
claims that depression
will be the second most
prevalent cause of ill
health
4. The total cost to the
economy is £77 billion
5. Each year stress from
work costs employers
£3.75 Billion
What are we prescribing?
• In 2005 27.7 million
antidepressant Prescriptions
were written in England
costing £338 million.
• 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)
NICE Guidance on Walking
• ……. offer a range of walking
schemes of low to moderate
intensity with a choice of local
routes to suit different
abilities.
• Ensure that walking schemes:
– are organised and led by
trained workers or ‘Walking
the way to health initiative’
volunteer walk leaders from
the local community who
have been trained in first
aid and in creating suitable
walking routes
Nature Contact in housing projects
Kuo F (2001) Coping with Poverty: Impacts of environment and
attention in the inner city.
Environment and Behavior, Vol 33 No 1 January 2001.
How surrounding vegetation help children
cope with stress
Physical Activity
• Only 40% of men and 28%
of women reach 30 X 5
target of Physical Activity.
• This falls to 8% and 3%
over age 75yrs
men/women.
• Physical Inactivity Costs
the NHS £1.8 Billion
• Inactivity Costs Leeds PCT
£10,189,600
(£1,405,352/100,000)
Sport participation: % of people participating for at
least 30 mins once every 4 weeks. Sport England Active
People Survey Dec 2006
20
18
16
14
12
10
8
6
4
2
0
Walking
Swimming
Gym
Cycling
Football
Running
Golf
Making it Happen
Editorial
“The challenge is to make
politicians work for an
environment that
promotes walking, and to
call on doctors to
encourage patients to
walk…”
BMJ 9th June 2007
Can Green Space increase levels of physical
activity?
90
80
70
60
50
40
30
20
10
0
Strongly agree
Im
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se tter
ex
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se ght
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G
P
% Respondants
What motivates people to continue to participate in
Health Walks.
Slightly/strongly
disagree
THE PUBLIC
• MORI poll of 1719 individuals commissioned by Natural
England
Can Green Space benefit the Health of
the Population?
• Senior citizens lived 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, et al. Health levels influence
by urban residential conditions in a megacity — Tokyo.Urban
Stud 1996; 33: 879–945.
• For every 10% increase in green space
there was a reduction in health
complaints equivalent to a reduction of
five years of age.
De Vries, S.Nature and health; the importance of green space
in the urban living environment. Proceedings of the symposium ‘Open space
functions under urban pressure’. Ghent: 19–21 September 2001.
• Being within access to Green space can
increase levels of physical activity
Giles-Corti B,Donovan RJ. Relative influence of individual, social
environmental, and physical environmental correlates of walking. Am J
Public Health 2003; 93(9): 1583–1589.
Obesity
1. The UK has the highest
rate in the EU
2. In the UK rates have
tripled in the past 20
years
3. By 2050 60% of
population and 1 in 4
under 16 year olds will
be obese
4. Total cost of obesity to
society will be £45
billion by 2020
Is greenery associated with obesity?
N = 6919
3.5
3
Odds Ratio
2.5
2
Obesity
Physical Activity
1.5
1
A Ellaway
0.5
0
S Macintyre
BMJ 2005;331;611-2
Low
High
Greenery
Childhood Obesity
• “Local Green space can
help prevent obesity by
slowing weight gain in
children by as much as
5kg over 2 years[i]. “
[i] REF Neighborhood Greenness and
2-Year Changes in Body Mass Index
of Children and Youth Janice F. Bell,
PhD, MPH, Jeffrey S. Wilson, PhD,
Gilbert C. Liu, MD, MS
• Am J Prev Med 2008;35(6)
Social Cohesion
Elderly
There are 750,000
people with
Alzheimer’s. For every
mile walked per week
over a lifetime there is
an estimated 13%
reduced risk of
cognitive decline.
Reduction in Blood Pressure following a
stress event
transit time (ms) Increased time relates to lower
blood pressure
Time after stress
0
0.5
1
1.5
2
Traffic
Pedestrian Mall
Nature
2.5
3
3.5
4
4.5
0mins
3mins
6mins
9mins
Social
Isolation
Reduced
Physical
Activity
Obesity
The Car
Reduced
access to
Greenspace
Chronic Stress
Traffic
Poor Air
Quality
Planning
Social Barriers due
to disconnection
Health
Social Inequalities
leading to environmental
injustice
How Stress can be seen as a major public Health
Problem
Social
Isolation
Physical
inactivity
and Obesity
Anxiety and
Depression
Diabetes
Reduced
access to
Greenspace
Social Inequalities
leading to environmental
injustice
Chronic Stress
Raised
Inflammatory
Markers
Cancer
Cardiovascular
Disease
Lung
Disease
The Natural
Health Service
Increasing high
quality Green
Space
Connecting
people to the
Green Space
NICE Guidance
ANGST
QOF and other
Planning will be a key
driver
NHS Forest
Twinning NHS
with local
Greenspace
rewards to GPs
Olympic Park
East London
Green Grid
WHI
To create 10,000
walks per week
Blue Gym
activities connected
with Marine
Green Gym
all conservation
volunteering
MRC / Natural England Research Network
The Whole of the Natural Health service will be underpinned by research being led by the Peninsula Medical School that will
answer the main questions. 1) How can people get connected to their Natural Environment. 2) What are the direct health
benefits of green space? 3) What physiological mechanisms cause the health benefits 4) What changes in health are
generated by a change in environment (Intervention studies)
The Natural
Health Service
Increasing high
quality Green
Space
Connecting
people to the
Green Space
NICE Guidance
ANGST
QOF and other
Planning will be a key
driver
NHS Forest
Twinning NHS
with local
Greenspace
rewards to GPs
Olympic Park
East London
Green Grid
WHI
To create 10,000
walks per week
Blue Gym
activities connected
with Marine
Green Gym
all conservation
volunteering
MRC / Natural England Research Network
The Whole of the Natural Health service will be underpinned by research being led by the Peninsula Medical School that will
answer the main questions. 1) How can people get connected to their Natural Environment. 2) What are the direct health
benefits of green space? 3) What physiological mechanisms cause the health benefits 4) What changes in health are
generated by a change in environment (Intervention studies)
The Natural
Health Service
Increasing high
quality Green
Space
Connecting
people to the
Green Space
NICE Guidance
Planning
QOF and other
rewards to GPs
NHS Forest
Twinning NHS
with local
Greenspace
WHI
To create 10,000
walks per week
Blue Gym
activities connected
with Marine
Green Gym
all conservation
volunteering
MRC / Natural England Research Network
The Whole of the Natural Health service will be underpinned by research being led by the Peninsula Medical School that will
answer the main questions. 1) How can people get connected to their Natural Environment. 2) What are the direct health
benefits of green space? 3) What physiological mechanisms cause the health benefits 4) What changes in health are
generated by a change in environment (Intervention studies)
NHS Forest and twinning of Green Space.
The Natural
Health Service
Increasing high
quality Green
Space
Connecting
people to the
Green Space
NICE Guidance
Planning
QOF and other
rewards to GPs
NHS Forest
Twinning NHS
with local
Greenspace
WHI
To create 10,000
walks per week
Blue Gym
activities connected
with Marine
Green Gym
all conservation
volunteering
MRC / Natural England Research Network
The Whole of the Natural Health service will be underpinned by research being led by the Peninsula Medical School that will
answer the main questions. 1) How can people get connected to their Natural Environment. 2) What are the direct health
benefits of green space? 3) What physiological mechanisms cause the health benefits 4) What changes in health are
generated by a change in environment (Intervention studies)
Walking the Way to Health
• National Health Walk
Scheme to promote brisk
walking in the Community.
• 2200 walks a week
• Over 525 schemes now
active throughout UK.
• Free training for over
35,000 volunteer leaders.
• All areas eligible but
deprived areas have
greater priority.
• Joint working and funding
with DH.
The Blue Gym
• Led by The Peninsula
Medical School with DH,
Natural England
Environment Agency and
National Marine Aquarium.
• Helps individual projects
that use water to promote
physical activity to engage
with PCTs and LAs.
• Has strong environmental
drive
• To be launched later in
Spring 2009
The Natural
Health Service
Increasing high
quality Green
Space
Connecting
people to the
Green Space
NICE Guidance
Planning
QOF and other
rewards to GPs
NHS Forest
Twinning NHS
with local
Greenspace
WHI
To create 10,000
walks per week
Blue Gym
activities connected
with Marine
Green Gym
all conservation
volunteering
MRC / Natural England Research Network
The Whole of the Natural Health service will be underpinned by research being led by the Peninsula Medical School that will
answer the main questions. 1) How can people get connected to their Natural Environment. 2) What are the direct health
benefits of green space? 3) What physiological mechanisms cause the health benefits 4) What changes in health are
generated by a change in environment (Intervention studies)
Credibility
– Help NICE to have the right evaluation data
– Ensure that evidence of health benefits of natural
environment are quantified.
Manchester Points4Life
Winning Healthy Town
announced today
• Loyalty card to be developed
throughout Manchester .
• To be developed using commercial
expertise.
• Points will only achieve full value if
physical activity is maintained.
• Much of the physical activity will be
based on walking in greenspace
Summary
• Green Space can help deliver National Indicators
• The main areas are
– Health Inequalities
– Mental Health
– Obesity
– Physical Activity
– Social Cohesion
– Direct effects
• The Natural Health Service will bring all evidence guidance
and delivery together
• Initial work with 4 main delivery projects