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 HOME

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 high-quality 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 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 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 £77 billion 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

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 Can Green Space increase levels of physical activity? What motivates people to continue to participate in Health Walks.

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 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

Is greenery associated with obesity? Odds Ratio A Ellaway S Macintyre BMJ 2005;331;611-2 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

Reduced Physical Activity Reduced access to Greenspace Planning Social Isolation The Car Traffic Poor Air Quality Reduced Physical Activity Reduced access to Greenspace Planning Social Barriers due to disconnection Obesity Chronic Stress Health Inequalities leading to environmental injustice Social Inequalities leading to environmental injustice

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

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)

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)

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.

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

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