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Green Rx

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Speaker: Cindy Blain

Speaker: Cindy Blain

Published in: Education, Health & Medicine
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  • This Summit could not have taken place without our Sponsors ..I’d like to thank our Gold Sponsors Sacramento Metropolitan Air Quality Management District Larry Green Charles Anderson Tim Taylor Paul Philley ??? Carter Kelly is a local construction firm – and one of our partners on the Urban Greening project we’re implementing at Grant Union High School Greg Witherow is here today representing Carter Kelly Sierra Health Foundation Who? We’re very pleased with the diversity of our sponsors…which reflects our goal of multi-sector cooperation and shared expertise.
  • Okay, what do we mean by Greenprint? In Sac, Blueprint, the regional smart growth plan developed by the Sacramento Area Council of Government is called the Blueprint, so Greenprint is the urban forest and urban greening counterpart to the Blueprint. The mission of the tree foundation is to grow healthy, livable communities in the Sacramento Region by building the best urban forest in the nation. Key to this is thinking regionally – eliminating silos and 1. Creating regional collaboration and partnership – to share best practices and work on issues region wide Having a Shared vision of the Urban Forest And Optimizing the benefits of the urban forest – not just maximizing but optimizing – for example, the right air quality tree in the right place. …………………………… ??Our roadmap for mobilizing and empowering community partners and volunteers to plant 5 million trees in the Sacramento region by 2025.
  • Why 5 Million Trees? 4 million are replacement trees while 1 Million are new trees . As the population of the Sacramento Region grows, we need more green infrastructure to maintain our health and quality of life. These economic benefits are based on the urban forest research of Greg McPherson of the USDA Forest Service -- which has informed our work with local government – to show the value of the urban forest in terms of ecosystem benefits / green infrastructure. This data has been critical to helping municipalities appreciate the value of the urban forest. You’ll see the fiscal impact -- in terms of clean up or infrastructure savings…air pollution clean up avoided or stormwater runoff costs avoided ….these costs do not reflect the health impact savings
  • This is not Star Trek, it’s not the Final frontier, but it’s the Next Frontier for the Urban Forest. Those benefits mean improved public health. But there is more we need to understand and more work is needed to put a econ value on the public health services. KATHY WOLF Economic valuation grant from NUCFAC working with forest economist from Univ. of Alabama Working on economic valuation of some of the benefits – list of 8 including crime and low birth weight (geoff donovan & australian study) Activity and obesity – very difficult due to different methodologies -- mixed research methods and mixed units of scale of valuation. The way urban greening benefit expenses are calculated is different from the way public health and epidemiological benefit expenses are calculated. Itree has its issues (favors NE region, broad assumption and not always transparent)…but consistent over time. Could still be more consistent on unit of analysis for urban greening / canopy.
  • Identify Tony Iton as Anthony B. Iton, M.D., J.D., MPH Senior Vice President, Healthy Communities and ULI presentation last year. Tony Iton presented at ULI last year and said he likes to cut straight to the conclusion at the beginning of a presentation. This was his conclusion. I really liked the simplicity of this and I agreed with the conclusion. I liked it so much I’m applying it to the urban forest
  • We’re here today to talk about trees leading to health – the second equation -- I believe we cannot forget this third equation. This is not a touchy feeley statement…at one level, it’s a basic fact that any child in elementary school can tell you. Trees create air for us to breathe ….as well as other health benefits. We’ve always taken trees and the availability of air for granted. The game changer now and the reason this equationis up here… is climate change and the impact it’s having on the worlds forests. Jim Robbins, a science writer for the New York times, started studying trends in tree loss around the world after he lost 8 or 9 acres of trees around his home in Montana. He’s writtena book called the Man who planted trees. The Trends are shocking. We’ve all heard about temperatures.Severe tree loss due to warmer winter temperatures –NOT JUST HOTTER TEMPS at high end -- and the results pests are ravaging forests in north America and elsewhere. Loss in Montana, Colorado and XXXX is X%. In British Columbia, the loss is gauged at over 40%. To give you a visual: Robbins talks about A forester in British Columbia who flew for 2 hours over a swathe of land that had been forested – not a single tree remained. Jim Robbins said he used to think that planting a tree was a nice, warm and fuzzy thing to do – now he believes it’s critical to our survival. You all have in your packet a PDF of an Atlantic Monthly article entitled “when Trees Die, People Die” talking about the health impacts in areas that have lost a lot of trees to pests like Emerald Ash Borer. It’s sobering. My thanks to Joe Benassini for sending me the article just last week.
  • Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals." [1] It is concerned with threats to health based on population health analysis. The population in question can be as small as a handful of people or as large as all the inhabitants of several continents (for instance, in the case of a pandemic ). The dimensions of health can encompass "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity", as defined by the United Nations' World Health Organization . [2] Public health incorporates the interdisciplinary approaches of epidemiology , biostatistics and health services . Environmental health , community health , behavioral health , health economics , public policy , insurance medicine and occupational health (respectively occupational medicine ) are other important subfields. The focus of public health intervention is to improve health and quality of life through the prevention and treatment of disease and other physical and mental health conditions, through surveillance of cases and health indicators , and through the promotion of healthy behaviors. Promotion of hand washing and breastfeeding , delivery of vaccinations , and distribution of condoms to control the spread of sexually transmitted diseases are examples of common public health measures. Modern public health practice requires multidisciplinary teams of professionals including physicians specializing in public health/community medicine/infectious disease, epidemiologists , biostatisticians, public health nurses, medical microbiologists, environmental health officers / public health inspectors, pharmacists, dental hygienists, dietitians and nutritionists, veterinarians, public health engineers, public health lawyers, sociologists, community development workers, communications experts, and others
  • Public Health vs Clinical care or Primary Care (many vs individual) Morbidity . A diseased state. The incidence or prevalence of a disease. California Health Interview Survey (CHIS) UCLA (self-reported data)
  • Trees / Hi Traffic Roadways Breathe California As we move into this next Decade, we realized how integral public health is to the work of the Urban Forest. Health is now in our mission, we have health professionals including physicians on our board. our projects increasingly have public health as either the primary goal or a major focus. We have to thank Dr. Desiree Backman for helping shape our perspective on trees and public health, while she was Deputy Director of the Tree Foundation for 2 ½ years. Connection made with CDPH for Skin Cancer via Dr. Doug Lyman – a deputy director of CDPH in the 90’s whom Ray knew through Church. Had led the campaigns against smoking, xxx and then skin cancer – daughter had skin cancer between the toes. Will discuss Green Rx and Fruit 4 Families in more detail
  • UF is open source – Honolulu has used, Mexico city working on now, discussing with Portland, Utah flip flopping between ESRI’s Envision Tomorrow and UF,   Calif. UF SACOG, SCAG (SoCAl Assoc of Govt’s) SDAG (San Diego Assoc of Govts) ESRI prohibitive licensing costs if one wants all the jurisdictions to use. 2010’s – Technology & crowdsourced support – new ways to map, manage and calculate benefits – public health benefits
  • 2 Hypotheses: health behaviors/health outcomes and urban greening are statistically related, with more urban greening being better for health and supportive of healthy behaviors certain health behaviors and health outcomes are more positively influenced by the presence of urban greening than others.
  • Better canopy data Investigated using objective data – mortaliity and hospitilization data -- but wrong scale (zip code) For GreenRx, we were testing buffers of 50, 100, 250, and 500 meters. Our final analysis plan is to test only a single buffer that both fit the results of the exploratory analysis and is an appropriate conceptual match - for example, we're planning to use a 500m buffer for physical activity variables (where the neighborhood is more relevant), whereas for asthma, we're planning to use a 100m buffer (where the area/air immediately surrounding the home is much more relevant). We were planning to test out to 1 km, but the processing time required to develop data for such a large buffer for all CHIS participants was prohibitive.
  • Quick Recap of Green Rx Meeting Highlights September 2012     Research Priorities Concentrate on Physical Activity, Obesity, Social Capital, Mental Health Curtail work on Cardiovascular Disease, Diabetes, Asthma, General Health due to lack of significance Put on hold Collisions , due to funding priorities at this time. Figure out income data index and any income data anomalies. Sort out mental health data issues so that story includes Physical, Social, Psychological.
  • Here's a summary of the results from our " generic" exploratory models. All of these models adjust for the same set of basic covariates (age, gender, socioeconomic status, etc.). The final models will be more tailored to include only relevant confounders, so these results are subject to change in either direction : Strong association between tree canopy & outcome (p < 0.01) Adult, teen, child body mass index Adult, child overweight/obesity (teen obesity is actually null) Adult, child general health status Neighborhood social capital cohesion Weak association between tree canopy & outcome (p < 0.2) Adult high blood pressure, Adult type 2 diabetes Teen general health status , teen mod/vig physical activity Teen psychological distress, Child ADHD Adult , Teen asthma status Null association between tree canopy & outcome (p > 0.2): Adult, teen, child moderate/vigorous physical activity Adult, child , teen asthma Adult psychological distress Child ADHD
  • Literature Review of the current research. Findings summary report Professional research report describing the project, the results, conclusions and recommendations for action. This report will be prepared for publication in peer-reviewed journals. Policy brief(s) which will be targeted to decision-makers and those who influence the continued convergence of public health and urban greening. The purpose of this report will be to describe the project and results briefly and translate the results to practical design guidelines so that communities can more effectively plan, plant, and manage city trees to achieve maximum health benefits Interactive website which will visually depict the association between the extent of urban greening and health behaviors and outcomes by zip code in the Sacramento region. Various educational and presentation tools to share the results of the project.
  • Here's a summary of the results from our " generic" exploratory models. All of these models adjust for the same set of basic covariates (age, gender, socioeconomic status, etc.). The final models will be more tailored to include only relevant confounders, so these results are subject to change in either direction : Strong association between tree canopy & outcome (p < 0.01) Adult, teen, child body mass index Adult, teen, child overweight/obesity Adult, child general health status Neighborhood social capital Weak association between tree canopy & outcome (p < 0.2) Adult high blood pressure Teen general health status Teen psychological distress Teen asthma status Null association between tree canopy & outcome (p > 0.2): Adult type 2 diabetes Adult, teen, child moderate/vigorous physical activity Adult, child asthma Adult psychological distress Child ADHD
  • Here's a summary of the results from our " generic" exploratory models. All of these models adjust for the same set of basic covariates (age, gender, socioeconomic status, etc.). The final models will be more tailored to include only relevant confounders, so these results are subject to change in either direction : Strong association between tree canopy & outcome (p < 0.01) Adult, teen, child body mass index Adult, teen, child overweight/obesity Adult, child general health status Neighborhood social capital Weak association between tree canopy & outcome (p < 0.2) Adult high blood pressure Teen general health status Teen psychological distress Teen asthma status Null association between tree canopy & outcome (p > 0.2): Adult type 2 diabetes Adult, teen, child moderate/vigorous physical activity Adult, child asthma Adult psychological distress Child ADHD
  • Here's a summary of the results from our " generic" exploratory models. All of these models adjust for the same set of basic covariates (age, gender, socioeconomic status, etc.). The final models will be more tailored to include only relevant confounders, so these results are subject to change in either direction : Strong association between tree canopy & outcome (p < 0.01) Adult, teen, child body mass index Adult, teen, child overweight/obesity Adult, child general health status Neighborhood social capital Weak association between tree canopy & outcome (p < 0.2) Adult high blood pressure Teen general health status Teen psychological distress Teen asthma status Null association between tree canopy & outcome (p > 0.2): Adult type 2 diabetes Adult, teen, child moderate/vigorous physical activity Adult, child asthma Adult psychological distress Child ADHD
  • At or below 185% of Federal Poverty Level – BASED ON ZIP CODES 2009 F4F – Food Stamp Outreach program – Nutrition education Your nutrition education program, which may include some physical activity promotion must primarily target one of the following: Persons participating in or eligible for the USDA Food Stamp Program Target audience with at least 50 percent having household incomes of not higher than 185 percent of the Federal Poverty Level, and/or
  • Food security and reaching new participants through community connections. At or below 185% of Federal Poverty Level – BASED ON ZIP CODES 2009 F4F – Food Stamp Outreach program – Nutrition education Your nutrition education program, which may include some physical activity promotion must primarily target one of the following: Persons participating in or eligible for the USDA Food Stamp Program Target audience with at least 50 percent having household incomes of not higher than 185 percent of the Federal Poverty Level, and/or
  • Food security and reaching new participants through community connections. At or below 185% of Federal Poverty Level – BASED ON ZIP CODES 2009 F4F – Food Stamp Outreach program – Nutrition education Your nutrition education program, which may include some physical activity promotion must primarily target one of the following: Persons participating in or eligible for the USDA Food Stamp Program Target audience with at least 50 percent having household incomes of not higher than 185 percent of the Federal Poverty Level, and/or
  • Trees / Hi Traffic Roadways Breathe California As we move into this next Decade, we realized how integral public health is to the work of the Urban Forest. Health is now in our mission, we have health professionals including physicians on our board. our projects increasingly have public health as either the primary goal or a major focus. We have to thank Dr. Desiree Backman for helping shape our perspective on trees and public health, while she was Deputy Director of the Tree Foundation for 2 ½ years.
  • Consistently high rates of poor health outcomes (above county and state benchmarks) related to chronic disease and mental health.
  • 4 local health care orgs UC Davis Health System Kaiser Permanente Sutter Health
  • Here are the goals of the summit:
  • Footnotes and alphabet soup
  • Reference material for grants especially to california health related funders
  • Thank you for sharing your expertise to make this day productive and fruitful!
  • Transcript

    • 1. Green Rx: August 1, 2013 The Livable City Workshop Los Angeles Bridging Public Health and the Urban Forest
    • 2. 1. Interactive Discussion 2. Quick Greenprint 3. How & Why Health 4. Green Rx 5. Health Partners 6. Resources 7. Recommendations Re-cap The Flow
    • 3. Our Mission To build healthy, livable communities in the Sacramento Region by growing the best urban forest in the nation. →
    • 4. Greenprint ThinkThink RegionallyRegionally
    • 5. 5 Million Trees $25M Air Pollution Clean-up/Year 10M lbs of air pollution $17.5M Stormwater Runoff Cost/Year 1.75B gal of rainwater Air Water Energy $50M Energy Savings/Year 30% Summer Cooling Cost Savings
    • 6. Next Frontier Public Health
    • 7. Anthony Iton, MD, JD, MPH Senior Vice President California Endowment health ≠ healthcare
    • 8. Urban Forest Perspective trees  health
    • 9. The Reality trees = life
    • 10. Public Health "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals.“ It is concerned with threats to health based on population health analysis.
    • 11. Public Health Terminology • Public Health vs Clinical care / Primary Care • Population Health • Health Behaviors vs Health Outcomes • Morbidities • Chronic illnesses  Lifestyle Choices • California Health Interview Survey (CHIS) • Causality vs Correlation or Association (Longitudinal studies vs snapshot)
    • 12. Tree Foundation Health Projects • Skin Cancer / CDPH (1990s) • Urban Heat Island / NASA (1998 – 2001) • Urban Forest for Clean Air /AQDs (2006) • Fruit for Families / CDPH (2009) • Green Rx / USFS (2010) • Green Rx Expansion / CALFIRE (2012) • Spreading the Canopy / Trees Forever (2012)
    • 13. Trees & Health: Of Note 2011 Health In All Policies Calif. Obesity Prevention Plan2010 • Strategic Growth Council Project • SGC Grant Requirements 2014? Urban Footprint?
    • 14. SGC Grant: Pacer Promenade
    • 15. Green Rx Project Objective: Conduct original research to determine the association between urban greening and major health behaviors & outcomes in the six-county Sacramento region of California.
    • 16. Green Rx Data sets: 1)Urban canopy cover (and grass) based on 2008 LiDAR and 2010 aerial imagery 2)California Health Interview Survey – adult, teen, and child. 3)CHIS is x, y data 4)Buffer around x, y -- 50m, 100m, 250m, 500m 100m for asthma / 500m for physical activity
    • 17. Green Rx Associations investigated: • ADHD • Body Mass Index • Diabetes • General Health Status • High Blood Pressure • Neighborhood Social Cohesion • Overweight/Obesity • Physical Activity • Psychological Distress
    • 18. Green Rx Preliminary Results: • ADHD • Body Mass Index – Adult Teen Child • Diabetes • General Health Status – Adult Child • High Blood Pressure • Neighborhood Social Cohesion • Overweight/Obesity – Adult Child • Physical Activity • Psychological Distress
    • 19. Green Rx Products • Literature Review • Findings summary report • Research report(s) prepared for publication • Policy brief(s) • Interactive website • Presentation tools
    • 20. Expert Advisory Committee Desirée Backman, DrPH, MS, RD Chief Preventive Officer UC Davis Health System Teri Duarte, MPH Executive Director WALKSacramento Greg McPherson, PhD Project Leader US Forest Service Pacific Southwest Research Station Dee Merriam, FASLA Landscape Architect /Community Planner Centers for Disease Control/Prevention   Mary E Northridge, PhD, MPH Editor-in-Chief, American Journal of Public Health Department of Epidemiology & Health Promotion NYU College of Dentistry Shannon Ramsay CEO & Founding Director Trees Forever Iowa Ray Tretheway Executive Director Sacramento Tree Foundation
    • 21. Expert Advisory Committee Glennah Trochet, MD Former Sacramento County Public Health Officer Aimee Sisson, MD, MPH As of March 1, 2012: Organic Farming Apprentice Soil Born Farms Formerly: Public Medical Officer California Department of Public Health Kathy Wolf, PhD Research Social Scientist Urban Forestry & Urban Ecology Univ of Washington - College of Forest Resources
    • 22. Additional Advisors Janine Bera, MD Kaiser Permanente Board Member, SacTree Lianne Dillon Policy Associate, Public Health Institute Health in All Policies Task Force Office of Health Equity California Department of Public Health John Melvin State Urban Forester CALFIRE Robert Waste Government Relations Director UC Davis Health System Lawrence D. Frank, PhD President, Urban Design 4 Health Director of the Health & Community Design Lab, University of British Columbia. Research Project Lead: Jared Ulmer, AICP, MPH. Project Manager and Data Analyst Urban Design 4 Health
    • 23. Fruit 4 Families Project Objective: Provide Nutrition Education and Physical Activity Promotion and Free Fruit Trees to SNAP eligible families SNAP = Supplemental Nutrition Assistance Program
    • 24. Fruit 4 Families “The Fruit 4 Families program was affordable and effective, generating great interest by the attendees and exceeding expectations for participation. The combination of food security with evidenced based nutrition and physical activity education is very powerful. I found program staff responsive, motivated and invested in an excellent program.” Vicki Sanderford-O’Connor, Program Manager Network for a Healthy California, California Department of Public Health
    • 25. Fruit 4 Families Potential New Partners: • Sierra Health Foundation • Local Health Departments (SNAP funded) • Fruit Tree Growers • Health Education Council • Walmart • High Schools with greenhouses or gardens • Sacramento Consolidated Charities - Bingo Hall
    • 26. Grant High School Garden
    • 27. Where Trees Meet Public Health • Built Environment & Urban Form • Active Design • Active Living/Healthy Eating • Walkability • VMT – Vehicle Miles Traveled • Urban Greening
    • 28. M U L C H M A D N E S S
    • 29. Community Health Groups • California Endowment Building Healthy Communities (14 in state) • Sacramento Area Council of Governments Sustainable Communities Planning (HUD grant) • Sierra Health Foundation Healthy Sacramento Coalition (CDC grant)
    • 30. Communities of Focus 15 Zip Codes
    • 31. Community Health Groups • Health Effects Task Force Breathe California – Sacramento chapter • American Planning Association Speakers • National Leadership Academy for the Public’s Health (NLAPH) • Community Needs Assessment Report for 4 local healthcare organizations
    • 32. Recommendations 1. Leverage your board – anyone – to connect with health professionals. 2.Invite public health professionals to join boards, advisory committees, conferences. 3.Attend community meetings related to healthy urban design. 4.Get involved with APA, local university’s public health departments, local health foundations..
    • 33. Recommendations 5. Partner with community groups in under-resourced neighborhoods. 6. Leverage research by ranked journals on proposals to government agencies and community foundations. 7. Reference HiAP and Calif. Obesity Plan – especially on proposals to government agencies.
    • 34. Resources… • Green Cities:: Good Health – Human Health & Well-Being Research in relation to trees. Website - Kathy Wolf. http://depts.washington.edu/hhwb/ • Environmental Protection Agency - Eco-Health Relationship Browser. PDF of bibliography on health and nature. http://www.epa.gov/research/healthscience/browser/introduction.html See Laura Jackson video on this: http://dels.nas.edu/global/basc/uf-presentations • California Obesity Plan 2010 http://www.cdph.ca.gov/programs/COPP/Pages/default.aspx • Health in All Policies http://www.sgc.ca.gov/hiap/about.html
    • 35. Resources… http://healthleadership.org/node/1894? utm_source=NLAPH&utm_campaign=f1fcb41cb3- Leadership_Learning_Network_Upcoming_Webinar_and_C&utm_medium=e mail&utm_term=0_5b21bf353f-f1fcb41cb3- • Aug. 16, 2013 Zoning for the Public's Health: Using Mixed-Use Zoning to Increase Walkability & Reduce Crime Nat’l Leadership Academy For The Public's Health • March 2014 Healthy Communities by Design Conference Loma Linda University. http://www.llu.edu/public-health/hcbd/2012/videos.page
    • 36. Thank you! Questions? Call me… Cindy Blain cindy@sactree.com (916) 974-4319 Next Greenprint Summit on Public Health: Thursday, January 30, 2014

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