How the Landscape can improve Health and Wellbeing

Dr Caroline JesselNHS England

Lead for Sustainability and Health South Region

We all cherish beauty

“The role of the environment we live in is hugely important in shaping our lives and, consequently, our health…having access to high quality, local natural environments is critically important to promoting physical health and wellbeing in children and adults.” Duncan Selbie CEO of Public Health England

© 2016 Intelligent Health

How does nature benefit health?(a) Less stressed,

(b) More exercise,

(c) More positive social interactions and (d) Better quality environment for health promotion (i.e. has lower levels of air pollution)

Hartig T., Mitchell R., De Vries S. and Frumkin H. (2014) Nature and health. Annual Review of Public Health 35, 207–228.

Some killer facts• 20-30% risk reduction in all cause mortality from

“green prescriptions” Elley et al. 2003 New Zealand • Spending time in a forest reduces blood pressure and

benefits cardiovascular risk in several ways Mao et al. Asia

2012 also improves immune function Li 2012

• Populations exposed to greenest environments have lowest levels of health inequalities Mitchell and Popham the Lancet 2008

• Multiple positive psychological and mental health effects demonstrated including for depression, anxiety, stress, dementia, children with ADHD and for psychosis

© 2015 Intelligent Health

Green Space reduces Health Inequalities

No green Little green Some green More green Very green1.0

1.2

1.4

1.6

1.8

2.0

2.2

Highest Income

Linear (Highest Income)

Middle Income

Linear (Middle Income)

Lowest Income

Linear (Lowest Income)

Exposure to green

Mitchell, R. and Popham, F. (2008) Effect of exposure to natural environment on health inequalities:an observational population study. The Lancet 372(9650):pp. 1655-1660.

Incidence Rate Ration

Being productive

Health is a vital resource for our country

Building a strong society

A virtuous circle

Healthy People

• Health and wellbeing are the work of a lifetime • They do not happen by chance• Health must be promoted all through life

Good education

Strong community

Decent housing

The building blocks of good health

Sense of purpose

Meaningful workAdequate

income

Safe Environment

Individual behaviours

We know what the fundamental causes of ill-health are…

From the Global Burden of disease report 2014

Overweight & obesity

Top 10 contributors to years of life lived with disability

…the immediate causes of ill health…

1. Musculoskeletal disorders2. Mental illness3. Diabetes4. Chronic respiratory diseases5. Neurological disorders6. Unintentional injuries7. Cardiovascular disorders8. Cancer

Global Burden of Disease DWP data

…which contribute to the main forms of disability…

The main forms of disability map exactly to incapacity benefits – mental illness and musculoskeletal come out on top

Sustainable health and care

Commissioning and Procurement

Leadership Clinical and care models

Carbon hotspots Resilient Communities

Creating social value

Research, innovation and tech

Integrated approach to metrics

Background: The Five Year Forward View • The NHS Five Year Forward View, published in October 2014, considers the

progress made in improving health and care services in recent years and the challenges that we face leading up to 2020/21. These challenges include:

• the quality of care that people receive can be variable• preventable illness is common• growing demands on the NHS means that local health and care

organisations are facing financial pressure• the needs and expectations of the public are changing. New

treatments options are emerging, and we rightly expect better care closer to home.

 

• There is broad agreement that in order to create a better future for the NHS, all those with a stake in health and care must make changes to how we live, how we access care, and how care is delivered.

• This doesn’t mean doing less for patients or reducing the quality of care provided. It means more preventative care; finding new ways to meet people’s needs; and identifying ways to do things more efficiently.

• For the NHS to meet the needs of future patients in a sustainable way, we need to close the gaps in health, finance and quality of care between where we are now and where we need to be in 2020/21.

 

• The NHS Shared Planning Guidance, published in December 2015, asked every health and care system to come together to create their own ambitious local blueprint for accelerating implementation of the Five Year Forward View (5YFV).

• Sustainability and Transformation Plans (STPs) will be place-based, multi-year plans built around the needs of local populations. They will help ensure that the investment secured in the Spending Review does not just prop up individual institutions for another year, but is used to drive a genuine and sustainable transformation in patient experience and health outcomes over the longer-term.

• STPs are not an end in themselves, but a means to build and strengthen local relationships, enabling a shared understanding of where we are now, our ambition for 2020 and the concrete steps needed to get us there.

• STPs will delivered by local health and care systems or ‘footprints’: organisations working together to deliver transformation and sustainability. The footprints used will not cover all planning eventualities. As with the current arrangements for planning and delivery, there are layers of plans which sit above and below STPs, with shared links and dependencies. For example, neighbouring STP areas will need to work together when planning specialised or ambulance services or working with multiple local government authorities and, for areas within a proposed devolution footprint that cross STP boundaries, further discussion will be required in working through the implications. Other issues will be best planned at Clinical Commissioning Group (CCG) level.

Delivering the Forward View: STPs

Obesogenic lives?

Healthy lives

Who we work with

• Children, from 5 to 14 years affected by trauma through abuse, neglect or early life attachment difficulties

• Vulnerable children and families with complex needs

• Parents and carers

• Fostered and adopted children, especially where there is a risk of a placement breakdown

• Children and families that have experienced domestic abuse

• Adults with chronic health difficulties

Contact with nature

• enlivening the senses, building sensory memories• affecting our sense of time• observing the process of time, the seasons, life and death• calming and healing, reparative• the value of gardening and harvesting food from the

garden instead of the supermarket,• eating healthy unpolluted fruit, vegetables and eggs• helps build a relationship to the land… A reconnection

with nature, a reward for physical effort• animals...a trusting relationship

Craft work

• Practical purposeful activities, making useful items • Natural materials collected or harvested by families from the

land • Using the imagination – child and family member• Craftwork.. an achievement…improving confidence, imagination

and self belief• Each piece a unique expression of engagement – to often take

home

Research on scent memory

‘He loved digging things up…but then didn’t want to take them in…he knew what was coming next…he wanted to be outside with the animals’.

‘The children saw how something like a cut down tree, was made into something happy’.

‘Now we’ll go for a walk, just for fun, and we enjoy it…we never did before we went there’.

Summary

• engage all the senses actively

• be involved in garden and craft-work that is practical and useful

• encourage creative and artistic activity, based around experiences and observations within the natural world

• help develop a relationship of care and interest, giving back to the natural world, becoming a custodian

Some solutions

• Raising awareness to health professionals -networks

• Self care and personalised care• Education – schools and workplaces - wellness

training • Increasing the evidence base • Train and develop natural therapy

practitioners

Enable the positives

Reduce the negatives

Sustainable,Resilient,Healthy,PlacesandPeople

• Nature is vital to our health and wellbeing• Reconnecting acknowledges our mutual interdependence

• We are only just beginning to understand human neuroscience

Thank youcjessel@nhs.net

@crjessel @SouthRSHN