Time for a “Grow Outside Movement’ in Health Care

By Richard Louv

Do we really want to improve the nation's health care system -- or just throw more money at it? If better health is the true objective, a seldom-mentioned approach deserves more attention. That is, the preventive benefits of outdoor recreation and the restorative power of nature.

"Medical care accounts for about 10 percent of influences on health outcomes; the rest is environmental," says Gail Christopher, vice president of Health, Women and Families for the Joint Center for Political and Economic Studies in Washington, D.C. The center was founded in 1970 by black intellectuals and professionals to train and advise newly elected black officials. Christopher's specialty is studying disparities in public health in our society -- not just in the traditional brick-and-mortar sense, but environmentally.

When I spoke with Christopher recently, an interesting idea emerged.

In a national campaign (let's call it "Grow Outside!") pediatricians and other health professionals, recognizing the physical and mental health benefits of nature play, could use office posters, pamphlets and personal persuasion to encourage parents and other guardians to get their kids outside. When appropriate, health providers would also add nature therapy to the traditional approaches to attention deficit disorders and childhood depression.

Christopher is already exploring the need for a major national study to "greenprint" the availability of nature in urban areas -- to use new technologies to create health-related maps showing parks and natural areas available to inner-city residents. This map would go beyond mere proximity; for example, it would also chart the safety of the parks. What good is a park to public health if drug dealers have taken it over? Such research is overdue.

As Christopher and other health experts recognize, a walk in the woods may not be a panacea, and it isn't encapsulated in a pill, but it's powerful medicine; it's not stigmatizing, has no serious side- effects -- and it's free. Unfortunately, nature still doesn't get much respect from the medical establishment.

When it comes to our national conversation about child obesity, nature is missing in action. A few months ago, The New York Times included a special section on child obesity in its Sunday edition. Although the tome, partly sponsored by Kaiser Permanente, included some 10,000 words, natural play was barely mentioned. What the authors did suggest was that parents get their kids into organized sports.

Fine. Not a bad prescription, but incomplete. The greatest increase in child obesity in our history occurred during the same two decades as the greatest increase in organized sports for children.

Consider, too, such maladies as depression and attention deficit disorder. As I've reported earlier, ongoing studies at the University of Illinois indicate that nature play substantially reduces the symptoms of ADD in children. The research suggests that nature therapy as third option for ADD, after prescription medications and behavioral therapy.

Or perhaps it could be the first option.

Swedish researchers found similar results when they compared children within two child care settings: at one, the quiet play area was surrounded by tall buildings and a brick path; the second was based on an "outdoors in all weather" theme with lots of nearby nature. Children in the green center had better motor coordination and more ability to concentrate. They played outside every day, regardless of weather, even in the coldest months of winter.

Even so, they also had fewer colds and flu.

In 2001, Howard Frumkin, chairman of the Department of Environmental and Occupational Health at Emory University's School of Public Health, pointed out that environmental health has traditionally been associated with pollution. In an article for the American Journal of Preventive Medicine, he argued that public health experts should expand their definition of environmental health beyond toxins; in the future, it should encompass how the environment can improve human health.

He suggested that environmental health research be conducted in collaboration with architects, urban planners, park designers and landscape architects.

And he describes how such a shift could affect patient care: "Perhaps we will advise patients to take a few days in the country, to spend time gardening . . . or build hospitals in scenic locations, or plant gardens in rehabilitation centers. Perhaps the employers and managed care organizations that pay for health care will come to fund such interventions, especially if they prove to rival pharmaceuticals in cost and efficacy."

Today, Frumkin holds the influential position and weighty title of director, National Center for Environmental Health/Agency for Toxic Substances and Disease Registry. He says we need more research, but he emphasizes that public policy should not wait to act on what we know.

Gail Christopher isn't waiting. She's decided to dedicate a piece of land she owns into a nature health retreat for kids from inner- city Washington. She's going to tell them to grow outside.

Richard Louv

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