Naturally Better – Howbery Park, Wallingford – 26th March 2009
Green space, physical activity and public health
Dr. Charlie Foster – Senior Researcher
BHF Health Promotion Research Group
University of Oxford
Presentation Objectives



To briefly describe the relationship
between green space, public health
and physical activity
Describe the evidence base for this
relationship
Offer possible directions for developing
this evidence base
Presentation Objectives



To briefly describe the relationship
between green space, public health
and physical activity
Describe the evidence base for this
relationship
Offer possible directions for developing
this evidence base
Consensus on health benefits of green space
 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)
Public health importance of physical activity in the UK




Adults who are physically active have a 20-30%
reduced mortality risk compared to inactive adults.
Estimates put the total direct costs to England of
physical inactivity to the NHS as £1.06 billion
Conservatively, this represents about 54,000 lives
lost prematurely per annum.
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)
Cost of physical inactivity related disease in London

The cost of illness for physical activity related
disease is nearly £14 per Londoner

The PCT spend on physical activity promotion
is 85p per Londoner
(Foster et al, 2009)
Presentation Objectives



To briefly describe the relationship
between green space, public health
and physical activity
Describe the evidence base for this
relationship
Offer possible directions for developing
this evidence base
Mitchell and Popham (2008)

Access to green
space is associated
with better health
for the poorer half of
the population
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
A social-ecological model of physical activity behaviour
National policies
& programmes
Law & Regulations
Fiscal
Built environment
Natural
environment
Health care systems
Foster et al (2005). Understanding why adults and children participate in physical activity and sport. London, Sport England.
A social-ecological model of physical activity behaviour
National policies
& programmes
Law & Regulations
Fiscal
Built environment
Natural
environment
Health care systems
Foster et al (2005). Understanding why adults and children participate in physical activity and sport. London, Sport England.
Obesity
A social-ecological model of physical activity behaviour
National policies
& programmes
Law & Regulations
Fiscal
Built environment
Natural
environment
Health care systems
Foster et al (2005). Understanding why adults and children participate in physical activity and sport. London, Sport England.
Obesity
Green spaces, environmental
correlates and physical activity
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
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
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
+
More often
associated
Green spaces, environmental
correlates and physical activity
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
+
More often
associated
+/0
Equivocal
association
Green spaces, environmental
correlates and physical activity
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
+
More often
associated
+/0
Equivocal
association
0
Not associated
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
Using green space to promote
physical activity – NICE evidence
Only found 2 grey studies
 WHY?

» Different views on what is evidence?

But some evidence does exist…..
Using green space to promote physical
activity via play– NICE evidence

Real v perceived risk
Using green space to promote physical
activity via play– NICE evidence
Real v perceived risk
 Parks mean independence leading to
more physical activity (Mackett, 2007)

Using green space to promote physical
activity via play– NICE evidence
Real v perceived risk
 Parks mean independence leading to more
physical activity (Mackett, 2007)
 Parks are places for all to play (Moore, 2003)

Source: news.yahoo.com Friday 7 January 2005
Men’s Fitness Criteria
Outcome
Overweight & obesity rates



Exposure
 junk food outlets
 gyms/sporting goods
retailers
 fruit and vegetable
consumption
 participation in
exercise/sports








alcohol use
smoking
TV viewing
air quality
water quality
climate index
geography
commute time
parks/open spaces
recreation facilities
health care access
Inverse Leisure Law Study


Leisure-time physical
activity patterns are low
and socially patterned
Is there a relationship
between
neighbourhood
deprivation and the
density of physical
activity facilities in
England?
Inverse Leisure Law Study - Method
A database of all indoor exercise
facilities in England was obtained, and
facilities were linked to administrative
areas and assigned a deprivation score
 Census data were used to calculate the
density of physical activity facilities per
1000 people per quintile of deprivation

The density of exercise facilities by quintile of
deprivation for the county of Kent in Southeast England
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!
Presentation Objectives



To briefly describe the relationship
between green space, public health
and physical activity
Describe the evidence base for this
relationship
Offer possible directions for developing
this evidence base
Other missing evidence…?

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?

The economic value of green space
» Contribution to economy, health costs and
Quality of life
Green space, public health and physical
activity - Conclusions
Green space is related to health
 Physical activity is related to health
 Our environment and how we use it does
impact on our health

» People, place and policy
Green space, public health and physical
activity - Conclusions
Green space is related to health
 Physical activity is related to health
 Our environment and how we use it does
impact on our health

» People, place and policy

Put green space and activity into our
environments
Naturally Better – Howbery Park, Wallingford – 26th March 2009
Green space, physical activity and public health
Thanks to
Nick Cavill
Dr Melvyn Hillsdon
Dr Andy Jones