The Next Vital Sign - Trees & Human Health
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Ample literature has illustrated the key impact treed green spaces have on human health, and further research has shown severe inequity in access to green spaces. This inequity has a profound adverse impact on community and individual health. In this presentation, Jennifer Wisdom, M.D., will highlight peer-reviewed literature establishing this link, and Josh Behounek will outline concrete steps municipalities can take to improve access to greenspace with emphasis on social and environmental justice and equity in directing actionable movement.
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The Next Vital Sign - Trees & Human Health
- 1. The Next Vital Sign: Trees and Human Health Jennifer Wisdom-Behounek, M.D. Joshua Behounek
- 2. Presenters Jennifer Wisdom-Behounek, M.D. Family Physician, FQHC in Vermont M.D. from University of Illinois; Family Medicine residency University of Missouri No conflicts or endorsements to disclose Joshua Behounek Certified Arborist, TRAQ, Municipal Specialist Davey Resource Group
- 3. Objectives • Review research supporting nature exposure’s benefit on human health • Illustrate why inability to access green space is a risk factor for poor individual and community health • Show how nature equity is a vital component of health equity • Highlight concrete steps to improve access to green space with emphasis on social justice and equity in directing actionable movement.
- 4. What determines health? • Genetics • Behavior • Environmental & physical influences • Medical care • Social Determinants of Health • Early childhood development • Education • Employment, and type • Food security • Access to health services • Living conditions • Income • Social norms and attitudes (racism, sexism, etc.) • Literacy • Incarceration • Culture • Access to mass media CDC.gov
- 6. “Zip Code Matters More Than Genetic Code”
- 7. parkrx.org
- 8. Health Impacts • Cardiovascular health • Respiratory health • Mental Health • ADHD • Cognition • Decreased violence • Increased social connection
- 9. Nature and Cardiovascular Health Garden based learning improves children’s fruit and vegetable consumption Forest environments decrease • blood pressure (including in children) • cortisol levels • heart rate variability • sympathetic nervous system activity Emerald ash borer study Donovan et al.
- 10. Nature and Respiratory Health Air pollution – 5.5 Million deaths per year Children living in areas with street trees = lower levels of asthma Trees responsible for 15% reduction in local nitrogen dioxide levels Benefit of $7 Million U.S.D. annually 7380 missed school days avoided 4-12 year olds M. Rao, et al.
- 11. Nature and Mental Health Randomized trial in low-income areas of Philadelphia Greened lots Cleaned but not greened No intervention Costs $1597 per lot $180 per year to maintain Results Depression reduced by 48% Self-reported “poor mental health” reduced by 62.8% South et. al. (2018)
- 12. Nature and Mental Health “Resilience and Restoration” • Nature promotes • Urban environments deplete Burnout/Stress • Nature therapy is more effective in symptom improvement and cost savings • COVID-19 Mental Health • Physical activity in a natural environment > for mental health than indoors • Moving to a green area from a non-green area improved mental health and benefits seen for two years after the move Alcock et al. Psychological Stress • Adding greenspace to schoolyards decreases psychological stress Van den Berg et al. Trauma • Lessens the impact of negative life events
- 13. Nature and Mental Health of developing a psychiatric disorder 55% higher risk Engemann et al (2019)
- 14. Nature and ADD/ADHD 62% of children with diagnosis take medication (2016) CDC Annual family costs (not including treatment) 5X more for ADD families Cumulative (not including treatment) $124.5 billion per year Zhao et al. (2019) Preschool and kindergarten - fewer referrals for ADD evaluation Grahn et. al. Walking in green park environment on ADD vs. methylphenidate Taylor, Kuo (2008, 2011)
- 15. Nature and Cognition Adults Elderly Children Berman et al. Bratman Carrus et al.
- 16. Who Benefits? ● Preschool children (Agostini et al.) ● Children from low-income and/or minority neighborhoods (Bates et al.; Kuo et al.; Kuo et al.) ● Children with emotional, cognitive, and behavioral disabilities (Szczytko et al.) ● Elderly ● Mental Health ● Chronic Disease
- 17. Nature and Healthcare Costs Add in shrubs - $9 billion Trees - $6 billion Tree and shrub cover had reduction in Medicare spending (grasses did not) Kuo, Becker et al.
- 18. What is Health Equity? “When everyone has the ability to attain their full health potential, and no one is disadvantaged from achieving this potential because of their social position or other socially determined circumstance.” -Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health
- 19. Clinical Pearls ● Nature improves health ● Zip code matters more than genetic code ● Overcoming deficit has bigger impact than adding more ● Impacts are strong enough to make this a vital equity concern
- 21. Is 2 hours outdoors the new 10,000 steps?
- 22. nature.org • US (2009-2014) - 0.7% decline @ - 174,940 acres/year • Ohio (2009-2014) - 1.0% decline @ - 7,230 acres/year
- 23. Leading Indicators of Canopy Change ● Major Site Plans Reviewed ● Tree Preservation Plans Reviewed ● DBH Planted - DBH Removed = Net DBH (public trees) ● Numbers of Volunteers Trained or engaged in urban forestry ● Numbers of Neighborhoods Engaged in urban forestry projects
- 24. 2001 2014 Difference Sites 124,445 127,080 2,635 Total DBH 871,173” 817,627” -53,546” Average DBH 7” 6” -1” # Species 281 247 -34 # Removals 668 2,707 2,039 # Planting Sites 48,761 44,619 -4,142 Tree Inventory Results Buffalo, NY 2001 - 2014
- 25. Estimating Upcoming Losses from Aging Canopy
- 26. Impacts of Development in Three Projects
- 28. Make your Goal part of the Plan/Vision
- 31. Implementing your Tree Canopy Goal