1. Naturally Better – Howbery Park, Wallingford – 26 th March 2009 Green space, physical activity and public health Dr. Charlie Foster – Senior Researcher BHF Health Promotion Research Group University of Oxford

2. Presentation Objectives l To briefly describe the relationship between green space, public health and physical activity l Describe the evidence base for this relationship l Offer possible directions for developing this evidence base

3. Presentation Objectives

4. Consensus on health benefits of green space l 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 )

5. Public health importance of physical activity in the UK l Adults who are physically active have a 20-30% reduced mortality risk compared to inactive adults. l Estimates put the total direct costs to England of physical inactivity to the NHS as £1.06 billion l Conservatively, this represents about 54,000 lives lost prematurely per annum. l 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)

6. Cost of physical inactivity related disease in London l The cost of illness for physical activity related disease is nearly £14 per Londoner l The PCT spend on physical activity promotion is 85p per Londoner (Foster et al, 2009)

7. Presentation Objectives

8. Mitchell and Popham (2008) l Access to green space is associated with better health for the poorer half of the population

9. 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

10. 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

11. 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

12. 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

13. Proximity to recreation facilities, convenience Destination factors, micro-scale design, footpaths, trails Mixed land use, shops and services nearby Aesthetics (perceived) Population density/sprawl Area based Coastal residence Area based Urban/age of suburb Culture, social environment as most important Connectivity Walkability Route related factors, hills, traffic Perceived safety High crime rate Unattended dogs Lighting/streetlights Green spaces, environmental correlates and physical activity

14. Proximity to recreation facilities, convenience Destination factors, micro-scale design, footpaths, trails Mixed land use, shops and services nearby Aesthetics (perceived) Population density/sprawl Area based Coastal residence Area based Urban/age of suburb Culture, social environment as most important Connectivity Walkability Route related factors, hills, traffic Perceived safety High crime rate Unattended dogs Lighting/streetlights Green spaces, environmental correlates and physical activity

15. + More often associated

16. Green spaces, environmental correlates and physical activity +/0 Equivocal association

17. Green spaces, environmental correlates and physical activity 0 Not associated

18. The contribution of environmental variables in explaining variation of physical activity or walking is small and less important than sociodemographic variables. Perceptions Safety Quality of public space Objective Places to go locally Deprivation Poverty

20. Using green space to promote physical activity – NICE evidence l Only found 2 grey studies l WHY? »Different views on what is evidence? l But some evidence does exist…..

22. Using green space to promote physical activity via play– NICE evidence l Real v perceived risk

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

27. Source: news.yahoo.com Friday 7 January 2005news.yahoo.com

28. Men’s Fitness Criteria Outcome Overweight & obesity rates Exposure l junk food outlets l gyms/sporting goods retailers l fruit and vegetable consumption l participation in exercise/sports l alcohol use l smoking l TV viewing l air quality l water quality l climate index l geography l commute time l parks/open spaces l recreation facilities l health care access

29. Inverse Leisure Law Study l Leisure-time physical activity patterns are low and socially patterned l Is there a relationship between neighbourhood deprivation and the density of physical activity facilities in England?

30. Inverse Leisure Law Study - Method l A database of all indoor exercise facilities in England was obtained, and facilities were linked to administrative areas and assigned a deprivation score l Census data were used to calculate the density of physical activity facilities per 1000 people per quintile of deprivation

31. The density of exercise facilities by quintile of deprivation for the county of Kent in Southeast England

32. 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!

35. Presentation Objectives

36. Other missing evidence…? l 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? l The economic value of green space »Contribution to economy, health costs and Quality of life

37. Green space, public health and physical activity - Conclusions l Green space is related to health l Physical activity is related to health l Our environment and how we use it does impact on our health »People, place and policy

39. Green space, public health and physical activity - Conclusions l Green space is related to health l Physical activity is related to health l Our environment and how we use it does impact on our health »People, place and policy l Put green space and activity into our environments

40. Naturally Better – Howbery Park, Wallingford – 26 th March 2009 Green space, physical activity and public health Thanks to Nick Cavill Dr Melvyn Hillsdon Dr Andy Jones