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For stressed-out families, local doctors are prescribing a new fix: public parks

 
Local doctors are now prescribing visits to public parks (like Edgewood Park) to combat stress and reap the health benefits that come from going outside. (Photo by Frances Freyberg Blackburn.)

It's no secret that getting outdoors is good for people.

In Japan, a practice called "shinrin yoku" meaning "forest bathing," which "essentially involves hanging out in the woods," according to Outside Magazine, has grown in popularity since the 1980s and is now considered a standard practice in preventive health care.

In Norway, people practice the concept of "friluftsliv," or "open-air living," through lifestyles that prioritize time spent outdoors.

And over the past decade, the Bay Area has been at the heart of a growing national movement to get people in under-resourced communities outdoors to reap the inherent health benefits provided by sunshine, greenery and an open trail. The movement has united doctors, public health officials, community health workers and park rangers alike with a goal of getting more people – especially families with kids, and in particular families that have traditionally underutilized public parks – enjoying time in nature.

Benefits

While the notion that spending time in nature has health benefits isn't a new one, it is getting increasing scientific scrutiny with daily screen time on the rise and daily outdoors time in decline. Research indicates that besides the straightforward benefit that physical activity burns calories and can help with weight management, nature carries with it a plethora of additional benefits.

In 1984, scientist Edward O. Wilson presented the theory of "biophilia," which posits that humans have an innate tendency to seek connections with nature and other forms of life, developed as part of the evolutionary process.

More recent research suggests that "time spent in nature may improve social bonding and reduce violence, stimulate learning and creativity, help raise standardized test scores, and serve as a buffer to toxic stress, depression and anxiety," according to a recent Sierra Magazine story on efforts to recognize access to nature as a human right.

The good news is that both San Mateo and Santa Clara counties have a significant portion of their land dedicated as open space, much of which is publicly accessible. According to the Bay Area Greenprint Project, a collaboration between The Nature Conservancy, Bay Area Open Space Council, American Farmland Trust, Greenbelt Alliance, and GreenInfo Network, 43% of the land in San Mateo County and 31% of the land in Santa Clara County is protected by ownership or conservation easements.

The nature cure

The movement to "prescribe" parks as a health practice was launched in its current iteration in 2008 when the Institute at the Golden Gate, part of the Golden Gate National Parks Conservancy, was founded. In 2012, the institute first piloted a "park prescription" program in San Francisco's Bayview-Hunters Point neighborhood. Later that year, it launched the "Healthy Parks Healthy People: Bay Area" collaborative with the East Bay Regional Park District and the National Park Service.

According to Betty Sun, program manager at the institute, nature helps people make deeper connections on three levels: with themselves, with others and with the planet.

Being alone outside – and sometimes in places without cellphone service – can help people unplug from devices, she explained. For the already-converted like herself, she said, it's easy to notice how good it feels to take a 20-minute walk outside on a stressful day, or visit a local park on the weekend.

Spending time with people outside can also help deepen the quality of their interactions, Sun says. Going on a road trip or hanging out in nature with friends helps people feel more connected. Among veterans her programs work with, she says, some people prefer to hike in silent contemplation, while others open up on the trail, telling stories and enjoying the companionship of other veterans.

"You can enjoy the quiet side of nature and also enjoy the power of bringing people together," she says.

At the risk of sounding touchy-feely, she added, there's the less tangible feeling that comes from touching redwood trees, walking in the dirt, and contemplating life while gazing out at spectacular vistas.

New research about the science of "awe" indicates that, as Sun describes, "Feeling small is really good for us."

A recent study by Bay Area researcher Craig Anderson found that when military veterans and youth from underserved backgrounds experienced feelings of "awe" while whitewater rafting, they reported lessened symptoms of post-traumatic stress disorder and overall stress a week after the trip, along with improved social relationships, life satisfaction and happiness.

"We believe parks are public lands and should be for everyone," Sun said, but noted that, "Those that need nature most are also not coming to our parks."

Unequal access

Despite the growing body of evidence on the health benefits of outdoors time and the significant amount of land dedicated to public outdoor recreational use, both San Mateo and Santa Clara counties have found in recent analyses that members of the public are not accessing these resources equally.

A 2015-16 study found that in San Mateo County, park visitors tended to be older, whiter, and more educated than county residents as a whole. According to the study, park visitors were on average 50 years old. More than 75% were white and 75% had a bachelor's degree or additional higher education. Among county residents, the median age is 40, 40% of residents are white and 48% of residents have bachelor's degrees or additional higher education.

In Santa Clara County, a 2018 survey of park users found that 53% of visitors were white, 16% were Hispanic, and 22% were Asian – the county's top three most populous ethnicities – compared with population estimates that the county's resident population is 51% white, 26% Hispanic and 37% Asian.

So where do doctors fit into the campaign to make "outdoorsy" a more inclusive adjective, one that doesn't just connote mostly upper middle-class, mostly white folks who don't mind paying a small fortune for waterproof jackets and boots?

Two approaches

Over the last couple of years, both San Mateo and Santa Clara counties have started doing "awesome work" to get "low-income, stressed-out families out at parks to enjoy the health benefits of nature," Sun says.

While there are many similarities in the two counties' efforts, each has taken different first steps to try to get more people out in nature, according to Sun.

San Mateo County

In San Mateo County, initial efforts have come from the county's top public health official, Dr. Scott Morrow, to make it easier for doctors to talk to patients about outdoors time by embedding the option of prescribing park time into the county health system's electronic medical records software. With a few clicks, doctors – mainly pediatricians at this point – can now direct their patients to their prescribed outdoor remedy, which even includes a preset dosage: "Spend time in nature, one hour, twice a week."

Embedding this option into the workflow of harried physicians is a critical step toward making such prescriptions sustainable in the medical community, Morrow explains.

"There's lots of evidence this is an effective recommendation," he says. What's less evident is which type of park or what kind of activity or program is best. When it comes to which parks to seek out, as a Half Moon Bay resident, Morrow says he's biased toward the majesty of the Coastside redwoods, but proximity and convenience of outdoor spaces are important factors too.

So far, it's been easier for pediatricians to incorporate prescribing parks into their interactions with patients – a symptom of an adult health care system more focused on addressing acute problems than preventive care, especially for the low-income adults he sees at the county clinic, Morrow says. But he adds that he's very interested in getting these recommendations systematically provided to adults as well.

"It's a culture change we're going for," he says.

Morrow adds that for him, nature time is more about mental than physical health. Sure, walking in a park for an hour is healthy for one's body. But even just sitting on a bench in a park can be great for one's mental health. Dedicated nature time can also help people with another practice he recommends, what he calls a "digital sabbath" – the notion of setting boundaries with personal technology use and taking one day a week to unplug from technology.

The county health department also helps to organize outdoor activities with specific clinics, including the Ravenswood Family Health Center in East Palo Alto. The health department works with the state's Nutrition Education and Obesity Prevention Branch program and its coordinator, Gloria Cahuich Gonzalez, to assemble participants and provide transportation when needed to outdoor programs, which are led by park rangers and park support nonprofits such as Friends of Huddart and Wunderlich Parks and Peninsula Open Space Trust. In a trial study, participating doctors are also providing patients free passes – funded by the San Mateo County Parks Foundation – to parks that charge access fees.

But there are still some barriers families face when venturing outside for the first time. As Sun explained, it can be intimidating to go places where there may not be information available in one's native language. Knowing what to wear, where to go, and how to get there, especially with limited transportation options, are other common barriers people can experience.

While the project is still in a pilot phase with limited public results, Dr. Rachel Borovina, a pediatrician at the San Mateo Medical Center, will be speaking at the Children & Nature Network Conference May 16 through 18 to present the findings of the county's case study.

Santa Clara County

In contrast, Santa Clara County's efforts to prescribe parks, Sun says, focus on working with families to remove the barriers they experience in accessing the outdoors, though this can be more expensive and require more intensive efforts by physicians.

According to Michelle Wexler, prevention program analyst with the Santa Clara County Public Health Department, the county first got involved through the "Healthy Parks Healthy People" initiative. Members in the initiative started hosting "First Saturday" events that encouraged first-time or infrequent park visitors to access free, introductory park activities.

About two years ago, she says, she partnered with the county parks department for a grant from Santa Clara Valley Open Space Authority, funded by Measure Q, to work with physicians to write park prescriptions, hire a bilingual community worker to follow up with families and help get them to parks, and organize monthly "First Saturdays" at parks where free activities and programs are organized the first Saturday of each month.

Since then, the program has only grown, with many families returning to the events again and again, she says. Today, it is so popular they've expanded it to the first and third Saturdays of each month.

They also provide families with free passes since many of the local county parks have paid parking. And for families with limited or no car access – say they have only one car and a parent needs to take it to work on Saturday – the community worker helps families figure out transportation options. In some cases, this involves lining up a taxi to take a family to the park.

Laurie Cammon, a pediatrician with the Santa Clara Valley Medical Center in Santa Clara County, explains that in addition to seeing patients become more active outside, the program has had significant, less obvious benefits for her patients and her practice.

Many of the families who participate in the program, she says, have developed friendships and are building a community around the park walks. And for the health providers in her clinic, she adds, going out and connecting with patients in the outdoors can help them avoid burnout.

Since the program began, she says, she's also seen her rate of patient no-shows and cancellations decline. "When families attend, then come back to the clinics, they feel more comfortable with (health care) providers," she says.

She tells the story of how one teen she works with often missed appointments, avoided eye contact, and gave one-syllable responses to questions before participating in the program. After attending the program, the teen seemed more comfortable talking to her, provided more thorough responses and smiled more.

Another family she works with, she recalls, was feeling really overwhelmed and stressed out, and didn't feel like they'd be able to make some of the lifestyle changes she was recommending.

She told them: "If you can't do anything else, just come to a park walk."

The whole family came.

At their next visit, Cammon says they told her: "It's a wonderful thing you do. We felt like we could breathe there." They reported feeling less overwhelmed, more relaxed, and more empowered to make lifestyle changes.

"The experience of being outside at this program gave them some hope and confidence to make changes they hadn't felt before," Cammon says.

"I was a true believer before," she says. "Now I'm an over-the-top believer."

As for what's next for the program, Wexler says, "We're dreamers. We would love to make it so that every pediatrician in Santa Clara County could write a park prescription for their patients."

•••

Want some ideas on where to go to enjoy area parks and trails? See related story.

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Comments

18 people like this
Posted by Peter G
a resident of Menlo Park: Fair Oaks
on May 11, 2019 at 10:26 pm

It is untrue that San Mateo tries to "get people in under-resourced communities outdoors to reap the inherent health benefits provided by sunshine, greenery and an open trail". Almost 40% of families own a dog and just want to come home at the end of a working day and put the kid in a stroller and the dog on a leash and go for a walk in the park, which is forbidden in 95% of the parks by SMC Parks & Rec. Pointless name by the way. Though if you ride a horse, you can get access to 90% of the Parks, but that probably means living in wealthy Woodside, Supervisor Horsley's district. The part about SMC Parks & Rec giving approx 2X access to older, white, college educated elites compared to the "under-resourced communites" is true. It is time to provide fair access to taxpayer funded SMC Parks for families that own dogs, up from the current 5% availability. Marin and East Bay provide more than 90% access, so the problem is clearly with SMC Parks & Rec and the Supervisors priorities.


17 people like this
Posted by Bill F
a resident of Woodside: Emerald Hills
on May 12, 2019 at 9:13 pm

I like the recommendation for a doctor to prescribe "Spend time in nature, one hour, twice a week" in San Mateo County. Nothing is more important for a healthy body and healthy mind than cardio exercise and relaxation, both accomplished when hiking/walking through the woods. Unfortunately, in San Mateo County, I can't do that with my dog. Unlike the rest of the Bay Area, almost no parks in San Mateo County allow my dog on leash to join me while I get my necessary dose of nature and activity. I can only think of a couple of trails on Windy Hill (part of the Peninsula Open Space District) and no San Mateo County parks (except maybe a few all the way on the coastside) and no GGNRA parks in San Mateo County that even allow dogs on-leash. It seems ridiculous to take a nice hike up to the meadow at Wunderlich and then come home and have to walk my dog because he's not allowed to join me. I heard there are more households in San Mateo County with dogs than kids. Imagine if you were told that you couldn't take your son with you on your walks in the woods. Makes no sense.

Thanks for a great article and would love to spend more time walking in the woods and taking advantage of all the beautiful nature San Mateo County has to offer. But I don't have the time and energy to do that and, then, come home and walk my dog.


7 people like this
Posted by Vivian R
a resident of Menlo Park: Fair Oaks
on May 13, 2019 at 9:35 am

In North Fair Oaks there's no open space or trails, so no wonder people rarely get out. I want to walk with my dog and I have to drive to places in the East Bay, San Francisco or Marin where there are dog-friendly trails for off-leash walking. Not very environmentally friendly, but that's what San Mateo County forces me to do by not providing open space for off-leash walking.


29 people like this
Posted by I see wildlife due to no dogs
a resident of Portola Valley: Los Trancos Woods/Vista Verde
on May 13, 2019 at 10:30 am

I have a dog, I love dogs and I sometimes actually feel separation anxiety when the day goes long and I haven;t seen him...love him to pieces.
I don;t support dogs in the OSPs though for many reasons, but the biggest is that simply by all the pee-scenting they do, the wildlife I'm used to seeing (bobcats, deer, rabbits, coyote, and once even a cougar) move out of areas when predators move in and claim as theirs. A regular influx of dogs will in fact "sanitize" an area of much of it's ground based wildlife.

You also have to plan for the lowest common denominator with regards to public use. There is simply zero chance of leash laws being observed by everyone and even one or two off leash dogs can wreck havoc. Also, by simple street and park observation, the poop will NOT be picked up by far too many.

I and my dog would be 100% perfectly behaved in the parks, but I know so many would not be, and even if 100% were on leash, the wildlife gets driven out.
There are really good reasons all dogs can't go everywhere.


12 people like this
Posted by Alan
a resident of Menlo Park: Belle Haven
on May 13, 2019 at 10:56 am

I'm sympathetic to people who want more places to walk their dog on leash, but people should acknowledge the problems that occur when you have a number of unleashed dogs in public space; those rules did not appear in a vacuum. It's not pleasant to be walking out in nature when someone's large dog, of unknown disposition, decides to "greet" you. Someone might own the sweetest dog in the world, but they have to write the rules for the bad cases. There are dog parks available.


10 people like this
Posted by Mocha W.
a resident of Menlo Park: other
on May 13, 2019 at 12:00 pm

It would great to have options for enjoying the outdoors with my dog, but there are so few places in San Mateo County that allow it. The article mentions research on the many health benefits to individuals from connecting with nature. While it might seem obvious to pet owners, there is also research showing that dog walking has broad community benefits, including strengthening the social fabric of a community. The unequal access is unfortunate. When Chicago opened a 2.7 mile long dog-friendly trail in 2015 (the 606, along an old railroad line) ) they found a reduction in crime in neighborhoods closest to the trail, with the largest decrease in lower-income neighborhoods (results published in the journal Environment and Behavior).


8 people like this
Posted by diesel
a resident of another community
on May 13, 2019 at 12:58 pm

diesel is a registered user.

Bedwell Bayfront Park along Menlo Park's Bay frontage is a nice nearby open space. It's not redwoods and native wildflowers and all that, but does allow leashed dogs and is valued by the many families who go there with kids in strollers and on bikes. Views from the hills extend over the bay and wildlife refuge. It's managed by Menlo Park, but is free to all. The city is gradually improving it in accordance with the Master Plan.
Regarding leashed dogs: our open spaces should accommodate other species besides humans. After all, seeing pocket gophers, banana slugs, birds, deer -- all that is part of our experience. Even leashed dogs can scare or stress the wildlife.


8 people like this
Posted by La Hondan
a resident of another community
on May 13, 2019 at 1:26 pm

Wow. Such whining from dog owners (BTW, I've been a dog owner my whole life.) First of all, horses on the trails have nothing to do with dogs on the trails. Horses are in conflict with mountain bikers, who are usually the ones who complain about horses on trails. And please don't roll out the tired, "All horse owners are rich" trope. There are plenty of people out here in the rural part of the county who aren't rich, but who are teachers and nurses who love horses, live out here because they can have a horse here affordably, and ride on the local trails.

Second, Don Horsley also represents some of the poorest rural areas of SM County and he does so well. Study the SM County Supervisorial District map, and you'll see that farmers and farm workers on the rural coast are also ably represented by Supervisor Horsley and he's the first Sup we've had in awhile who didn't completely ignore the rural Coast in favor of Menlo Park and Woodside, so try again with that trope.

Finally, the reason why dogs are not permitted on many trails are because selfish, rude people let their dogs go off of leash, chase wildlife, attack other people's dogs and children and leave their dog droppings everywhere without picking it up.


2 people like this
Posted by diesel
a resident of another community
on May 13, 2019 at 4:22 pm

diesel is a registered user.

To Vivian R - is Bedwell Bayfront park an option for you and your dog? Many N. Fair Oaks people use it, both from the MP and RWC N. Fair Oaks.


2 people like this
Posted by Jack Hickey
a resident of Woodside: Emerald Hills
on May 14, 2019 at 3:21 pm

Jack Hickey is a registered user.

Interesting story about the GGNRA
Web Link
EXCERPT:

"GGNRA officials and their co-conspirators purposefully carried out their collusion using the personal/private e-mail addresses of GGNRA officials, including the GGNRA’s Public Affairs and FOIA Officer, who also instructed GGNRA colleagues to delete e-mails that reflected this misconduct. With the GGNRA trying to ram the final proposed rules through in late 2016, this effort was thwarted by the posting on the “Woofieleaks” website yet more e-mails revealing the GGNRA’s record destruction, collusion with “park partners,” bias against groups supportive of dog walking, and use of private e-mails to orchestrate and conceal the conspiracy."

Also see: Web Link

I have a copy of a 1967 report entitled "Recreational Potential of The Junipero Serra Freeway Through the Upper Crystal Springs Watershed" prepared for the State of California Division of Highways by Hall and Goodhue, Architects and City Planners, and Robert Trent Jones, Inc., Golf Course Architects.

GGNRA and the San Francisco Water Dept. put the kabosh on the plans in that report.
EXCERPT:
"The four-mile section of the drive now under study will be like a four-minute reel of a movie travelogue extolling the beauty of and variety of the natural Peninsula landscape, enhanced by the green grass of golf courses and the the contrasting blue of several lakes.

Maybe the pro-bono attorneys, who took on the GGNRA for the dog owners, can do it again for the rest of us. There's more than enough open-space for all of us. (even the homeless)


4 people like this
Posted by golf is dying
a resident of Woodside: Family Farm/Hidden Valley
on May 14, 2019 at 4:38 pm

...a 1967 'report' by a golf course developer.

Oy, vey.

Mr. Hickey has a golf course about a mile from his home in Redwood City, and it is so underutilized that one can walk on to the course frequently during any given week. He has long jonesed for a course within 2 miles of the underutilized course.

And Crystal Springs Golf Course is a couple exits away from Edgewood, about ten minutes.

He wants to use public land to have two golf courses next to each other, three within minutes.

At the risk of repeating myself: oy vey.

...

google 'golf is dying':
Golf is dying, many experts say. According to one study by the golf industry group Pellucid Corp., the number of regular golfers fell from 30 to 20.9 million between 2002 and 2016. ... Unless the golf industry can change its ways, the decline will mean a lot of empty greens across the country.


Like this comment
Posted by Fair
a resident of Menlo Park: Downtown
on May 16, 2019 at 7:32 am

If 40% of families have dogs then the fair solution would be for 40% of parks to permit leashed dogs, not 5% which is the current state.

Having 1-2 parks way across town doesn't benefit most people.

I walk in the rare parks that allow dogs and see plenty of deer and other wildlife.


43 people like this
Posted by Mike G.
a resident of Atherton: West Atherton
on May 16, 2019 at 9:40 am

"If 40% of families have dogs then the fair solution would be for 40% of parks to permit leashed dogs, not 5% which is the current state."

It doesn't work that way. The reason dogs are not allowed is not because they think too few families own dogs and that 100% of dog owning families are "Entitled" to use the park. The decision is based on each specific area, applying science and real life expectations.

Though anecdotal stories don't bare much weight, my observations differ.

The parks I walk my dog in has no where near the amount of wildlife I see in no dog areas.
I also see off leash dogs every single time I go as well as regularly seeing dog poop. My dog "Triggers" to poop when he comes across another dog's poop so I tend to find it a lot and pick it up, two for one bag. (Your welcome to those selfish dog owners)

You dog will be totally happy to visit any of the current dog allowed OSP parks. There's a good variety of options.
Web Link
Care must always be given when bringing a non-natural, predator capable animal into a natural setting, for all the many reasons everyone else made in the above posts.


Like this comment
Posted by Alan
a resident of Menlo Park: Belle Haven
on May 20, 2019 at 9:34 am

Something obvious to point out: the 40% of dog owners are free to use the parks in every way the 60% of non-dog owners use them. They just can't bring their dogs to some of those parks.


4 people like this
Posted by resident
a resident of Menlo Park: Downtown
on May 20, 2019 at 2:04 pm

Very curious that Santa Clara County park user demographics closely match the demographics of the general population, while San Mateo County park users are much different from the general population. I believe a big part of the problem is the heavy use of horses in San Mateo County parks which leaves a stench that greatly discourages others from using the same parks. San Mateo County parks also ban bicycle riding on most park trails, which is a much more popular activity with lower income residents.


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