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Nature, Recreation, Arts and the Health of Children in Cities

Cities Fit for Children, Surrey BC

21 Nov 2013

Dr. Trevor HancockProfessor and Senior Scholar

School of Public Health and Social PolicyUniversity of Victoria

Clyde Hertzman, 1953 - 2013

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Why nature, recreation and arts?Because they interest meBecause I think they are important

and neglected determinants of the health and wellbeing - and more broadly, the development of the human potential - of children

Because I sit on the Board of◦BC Healthy Communities◦Child and Nature Alliance of Canadaand the Advisory Council of ◦Arts and Health Network Canada

Beyond health to human potential“A healthy city is one that is continually creating and improving those physical and social environments and expanding those community resources which enable people to mutually support each other in performing all the functions of life and in developing to their maximum potential.”

Hancock & Duhl, 1986

Outline1. Children's

environments2. Why nature matters3. Why recreation matters4. Why the arts matter5. Why beauty might

matter

What proportion of time do we spend . . .

In an urban setting?80%Indoors?90%In vehicles5%Outdoors?5%Within a natural ecosystem?

100% of the time

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2. Why nature mattersa) Biophiliab) Dependence on ecosystemsc) The health benefits of

natured) Modern and largely urban

life leads to ‘Nature deficit disorder’

Nature, life and health

“Nature's goods and services are the ultimate foundations of life and health, even though in modern societies this fundamental dependency may be indirect, displaced in space and time, and therefore poorly recognized.”

Ecosystems and Human Well-beingMillennium Ecosystem Assessment

WHO, 2005

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2a. Biophilia“the connections that human beings subconsciously seek with the rest of life.”

E.O. WilsonWe may have an innate need for

natureWe evolved in natural

environments◦We seem to have an innate preference

for the savannah

Engaging with nature1. Viewing nature

◦ As through a window, or in a painting

2. Being in (the presence of nearby) nature

May be incidental to some other activity

3. Active participation and involvement with nature

Countryside Recreation Network (UK)

Viewing nature. . . has been linked to Improved recovery in hospitalReduced stress in prisonImproved student test scoresReduced job stress, improved

job satisfactionImproved mood, reduced anger◦ ‘Relaxed wakefulness’, ‘effortless

attention’

Healthy Parks, Healthy People, 2002

Being in nature. . . has been linked toA calming affect - relaxed and

peaceful, positive moodReduced mental fatigue and

exhaustion“the natural environment has been

found to have a restorative quality, particularly for people who live in urban environments. Natural places such as parks offer an opportunity to become revitalised and refreshed.”

Increased physical activity

Healthy Parks, Healthy People, 2002

Data courtesy Marc Imhoff of NASA GSFC and Christopher Elvidge of NOAA NGDC. Image by Craig Mayhew and Robert Simmon,NASA GSFC

Earth’s City Lights

If we can’t see the stars . . . Two-thirds of the U.S. population and more

than one-half of the European population have already lost the ability to see the Milky Way with the naked eye.

The first World Atlas of the

artificial night sky brightness, 2001 “When a 1994 earthquake knocked out the

power in Los Angeles, many anxious residents called local emergency centers to report seeing a strange “giant, silvery cloud” in the dark sky. What they were really seeing—for the first time—was the Milky Way, long obliterated by the urban sky glow.”

Chepesiuk, Env Health Persp 2009

. . . how do we know our place in the universe?

2b. Dependence on ecosystems

“Ecosystems are the planet's life-support systems - for the human species and all other forms of life. Human biology has a fundamental need for food, water, clean air, shelter and relative climatic constancy.”

Ecosystems and Human Well-being

Millennium Ecosystem Assessment, WHO, 2005

But ecosystems are in decline“Human activity is putting such a strain on the natural functions of Earth that the ability of the planet’s ecosystems to sustain future generations can no longer be taken for granted. . . . Nearly two thirds of the services provided by nature to humankind are found to be in decline worldwide.”

Millennium Ecosystem Assessment, 2005

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If you want to know more . .

Come to my session on the Ecological Determinants of Health this afternoon

2c. The health benefits of ‘green’ nature

The health impacts of ‘less green’ environmentsSocial breakdown◦ Less strength of community, courtesy, mutual

support, supervision of children outdoors◦More loneliness, graffiti, noise, litter,

loitering, illegal activity, property crime, aggression, violence, violent crime

Psychological breakdown◦ Less attention, learning, management of

major life issues, impulse control, delay of gratification Greener schools related to better scores, greening

schools leads to improved scores

◦More ADHD symptoms, clinical depression, anxiety attacks

Physical breakdown◦Poorer recovery from surgery, self-reported physical health, immune functioning

◦More obesity in children, physician-diagnosed diseases, mortality

Strength of evidence◦Based on hundreds of studies involving millions of people

◦Multiple methodologies, multiple outcomes

◦Many diverse populations

Based on Ming Kuo’s presentationHealthy by Nature, 22 Sept 2011 and on

Kuo, (2010) Parks and Other Green Environments: Essential Components of a Healthy Human Habitat

(National Recreation and Park Association)

‘Vitamin G’

If this was a drug, we would call it a miracle drug!

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4. Nature deficit disorderFrom the 2005 book “Last Child in the Woods” by Richard Louv

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We no longer live in natureWe are 80% urbanisedWe spend 90% of our time

indoors◦And 5% in vehicles

So we are only outdoors 5% of the time (= 1 hour/day)◦And 80% of that is in urban settings

Kids don’t go out and play

Roaming distance has shrunk

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Time kids spend outdoors

There is little Canadian dataA 2011 US study of self-reported time in 6 – 19 year olds found:◦most children (63%) generally spend at least 2 hours of time outdoors per day

Their reported outdoor time was spent◦playing or just hanging out (84%)◦biking, jogging or running (80%) and ◦use of electronic media outdoors (65%)

Source: Active Healthy Kids Canada

2012 Report Card

Health and social benefits of urban greenery Landscape and Human

Health Laboratory, U of Illinois - Frances Kuo and colleagues

Multiple studies of vegetation, mainly in public housing in Chicago

http://lhhl.illinois.edu/

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Some key findings about urban greenery The more natural the view from

home, the better girls scored on tests of concentration and self-discipline

The more greenery, the higher levels of optimism and sense of effectiveness

The greener the setting in which children with ADD spend time, the more their symptoms are relieved

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Some key findings about urban greenery - 2 The greater the amount of

greenery in common spaces, the higher the levels of mutual caring and support among neighbours

The higher the amount of vegetation, the lower the crime rate

Higher levels of residential greenery are associated with lower levels of aggression against domestic partners

So the challenge is not how to get people to nature, but how to get nature to people – in the settings where they live, learn, work and play

The Different Environments of Nature and the Different Ways Childrenand Youth Can Experience Nature (Adapted From the Child and Nature Alliance)

Source: Active Healthy Kids Canada (2011)The Active Healthy Kids Canada 2011 Report Card on Physical Activity for Children and Youth. Toronto: Active Healthy Kids Canada. (p 52)

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Forest Schools & Nature KGForest School is an educational

approach that fosters a connection to, and knowledge of, the natural world through repeated, regular access to local woodland areas, parks and outdoor classrooms through the lens of play-based and child-directed learning.

http://www.forestschoolcanada.ca/ e.g. Sooke SD 61 Nature KG

http://naturekindergarten.sd62.bc.ca/

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Nature Kindergarten

http://naturekindergarten.sd62.bc.ca/

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2. Why recreation matters

Recreation is . . . All of those activities in which an individual chooses to participate in their leisure time and is not confined solely to sports and physical recreation programs but includes artistic, creative, cultural, social and intellectual activities. The FTP Ministers of Recreation agreed on this definition

of recreation in 1974, later re-confirmed in 1988

http://lin.ca/resource-details/4467

It is likely to be amended in the new

National Recreation Agenda

Health benefits of urban parks

Physical (exercise) Social (being with others)Mental/emotional (relaxation,

etc)Spiritual (connecting with

nature)Ecological (air quality,

temperature regulation etc)

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Parks and obesity3173 children aged 9-10 from

12 communities in Southern California . . . followed for eight years

“children with better access to parks and recreational resources are less likely to experience significant increases in attained BMI.”

Wolch et al, 2011

“I believe that evidence supports theconclusion that physical inactivity is one of the most important public health problems of the 21st century, and may even be the most important.”

Professor Steven N BlairDepartment of Exercise Science and

Epidemiology/Biostatistics Arnold School of Public Health

University of South Carolina

Physical activity and school performance

“What if there was a program or product that had a positive, measurable impact on nearly every student's academic performance? And what if that same program or product could help reverse the epidemic of childhood obesity and had side effects such as enhanced health and self-esteem? Surely every School Board, teacher, parent and politician would want it featured in every school. The program is Physical Activity. The product is Physical Fitness.”

Source: Martin Collis, 2003

Parks for allGiven the inequalities in

health we face, how do we ensure the most disadvantaged get the benefits that ‘Vitamin G’ offers?

How do parks meet the needs of ethno-racially diverse communities?

Age–friendly parks?How do we bring nature

indoors?

Risk and playThe public health community

has been part of creating the fear of injury

Yet there is emerging evidence that risk-taking is important for problem solving and creativity (Ian Pike, BCIRPU)

Something we have to address together

Risk is natural

We evolved by taking risks

“We need to accept that it is natural and healthy for children to take risks, make mistakes, have everyday adventures and test themselves and their boundaries.”

Tim Gill, former Director, Children’s Play Council (UK)Author, “No Fear: Growing up in a risk averse

society”

‘Healthy risk’We need a conversation on the

health benefits of riskWhat level of risk is not only

acceptable, but even beneficial◦e.g. not wearing a bike helmet

Needs to include◦Municpal gov’ts, school boards, parks boards

◦Insurance industry◦Public health/injury prevention◦Child health and child play professioanls

3. Why art matters

Arts and culture have a significant role to play inReducing the costs of many medical

treatmentsRelieving stress and tension in

professional caregivers Promoting both individual and

community healthParticularly effective in reaching out to and engaging marginalised groups, youth-at-risk and the elderly

Cooley, 2003http://artshealthnetwork.ca/

Report of the Review of Arts and Health Working Group, UK NHS

Arts and health are, and should be firmly recognised as being, integral to health, healthcare provision and healthcare environments

Arts and health initiatives are delivering real and measurable benefits across a wide range of priority areas for health

There is a wealth of good practice and a substantial evidence base

"Art as a Determinant of Health” There is “a large body of evidence that underscores the significance and profound value of art as it infuses the global work of health promotion, education, research, activism, and individual therapies with curative and/or palliative intent.”

Lander and Graham-Pole, 2008Available at http://artshealthnetwork.ca/arts-health-101

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Arts and the health and wellbeing of children“It was found that

participating in creative activities can have apositive effect on behavioural changes, self-confidence, self-esteem, levels of knowledge andphysical activity.”

Bungay and Vella-Burrows, 2013(a rapid review of the literature)

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Arts & Health: An International Journal, since 2009

This fast-emerging field has developed in response to international interest regarding the multifarious ways in which the arts contribute to health, wellbeing, social inclusion and healthcare practice across a range of settings.

Published in association with the Society for the Arts in Healthcare

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The arts and neuroscience

Four volumes of Progress in Brain Research in 2013 – 2015 are dedicated to the arts and neuroscience ◦Part 1: The Fine Arts, Neurology, and

Neuroscience: Neuro-Historical Dimensions (Vol 203, 2013)

◦Part 2: The Fine Arts, Neurology, and Neuroscience: New Discoveries and Changing Landscapes (Vol 204, 2013)

◦Part 3: Neurology and neuroscience in literature (2014)

◦Part 4: Neurology and neuroscience in music (2015)

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Dance and the health of children – Systematic review “. . . a consistency of association

across a range of different populations and settings that suggest that recreational dance can improve cardiovascular fitness and bone health of children and young people and can contribute to preventing or reducing obesity. There is also more limited evidence that suggests dance participation may improve self-concept and body image and reduce anxiety.”

Burkhardt and Brennan, 2012

Music training and child cognitive development This study suggests a

significant correspondence between early music instruction and spatial–temporal reasoning abilities.

Bilhartz, Bruhn and Olson, 2000

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Music making and pro-social behaviour “joint music making among 4-year-old children

increases subsequent spontaneous cooperative and helpful behavior” – Kirschner and Tomasello, 2010

“Music improved helpfulness for both girls and boys with children in the ‘Music’ group over thirty times more likely to help than those in the ‘No Music’ group. ◦ Girls were over twenty times more likely to help than

boys. Making music was also shown to improve co-

operation among all the children in the ‘Music Group’ who were six times more likely to co-operate than those in the ‘No Music’ Group.

 Boys in the ‘Music’ Group were also four times more likely to problem solve.”

Davies, Ohl and Manyande, 2013

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5. Why beauty might matter

What links ArtNatureCities and the built environment

BEAUTY!a combination of qualities, such

as shape, colour, or form, that pleases the aesthetic senses, especially the sight -

Oxford Dictionaries

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“That which stirs the soul” Ann Petrie, Artist &

former CBC broadcaster

That which “brings you joy”Susanne Sklar, Academic &

William Blake scholar

“that which makes life worth living. Any society that doesn’t respect deep pleasure or satisfaction to the mind is a mean society.”

Peter Schjeldahl Art critic

All from Beauty Will Save the WorldIdeas, CBC Radio,

Thursday, June 10, 2010

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Surely something thatgives intense pleasure or deep

satisfaction to the mindstirs the soulbrings joymakes life worth living

has got to be good for mental health, and since mental and physical health are intimately connects, good for overall health

Note – this probably includes good sex and rock’n’roll, but I don’t believe it includes

addictive and ultimately destructive drugs, or violence against others

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So . . . Is beauty good for health?Is ugliness bad for health?Note that I am not talking here about whether people feel they are beautiful, attractive or ugly. So this is NOT aboutThe body beautiful and body

imageCosmetic surgery or dentistry The beauty industry, tanning

beds etc.

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Inequity in access to beautyDo disadvantaged groups

experience a lack of beauty or an excess of ugliness where they live?

Does this contribute to inequalities in health?

If so, should we not preferentially create beauty and ensure access to nature, art and beauty in disadvantaged communities?