Healthy parks, healthy people – Current Australian public health priorities

Current Australian public health priorities

A collaborative effort involving the Australian Government as well as State and Territory governments has identified the following Australian National Health Priority Areas: Cancer Control, Injury Prevention and Control, Cardiovascular Health, Diabetes mellitus, Mental Health, Asthma, Arthritis and Musculoskeletal Conditions (Australian Institute of Health and Welfare, 2005). Most relevant to parks and nature are Cardiovascular Health and Mental Health. There is, however, considerable overlap between all of the Priority Areas in terms of risk factors and barriers to better prevention. Hence, initiatives targeting risk factors and barriers will bring benefits across all Priority Areas (Commonwealth Department of Health and Aged Care and Australian Institute of Health and Welfare, 1999).

Cardiovascular health

Cardiovascular disease is a major health and economic burden for Australia, and is the country’s greatest health problem (Australian Institute of Health and Welfare, 2000). Recent estimates of annual costs to the health system were at AUD$3.7 billion, accounting for approximately 40% of deaths in 1998 (Australian Institute of Health and Welfare, 2000). Risks of developing the disease are associated with factors including high blood cholesterol, high blood pressure, physical inactivity, obesity, excess alcohol, and smoking (Australian Institute of Health and Welfare, 1998).

Aside from family history, lifestyle greatly influences cardiovascular health. Through adequate education and health promotion, the burden of this disease to individuals and the community could be dramatically reduced. Although campaigns addressing smoking, physical activity, cholesterol, and alcohol consumption are already in place, they could be supplemented by the promotion of the health and wellbeing benefits arising from exposure to nature through visiting a park, interacting with pets, gardening, habitat restoration, or simply contemplating a natural view.

As a result of public awareness, walking for recreation or exercise has increased with 44.9% of men and 53.3% of women reporting walking in 1995, compared with 41% and 49% respectively in 1989-90 (Australian Institute of Health and Welfare, 2000). Through raising public awareness (i.e. via health education and promotion) the same sort of result is possible for the health benefits of contact with nature. There is a synergy between these two outcomes, as recent research has indicated that the availability of parks and high quality public open spaces is associated with increased levels of walking (Giles-Corti and Donovan 2002; Giles-Corti et al. 2005; Mowen et al. 2007).

In fact, if promoted successfully, the health benefits of nature combine with the health benefits of physical activity could be brought together in a joint public campaign. There has been little recent improvement in physical activity levels despite a decline in coronary heart disease, and an increasing percentage of population is becoming overweight (especially children) (Australian Institute of Health and Welfare, 2000). This highlights the pressing nature of this health issue.

Mental health

The Mental Health Priority Area focuses primarily on depression. This is due, firstly, to predictions that depressive disorders will constitute the largest share of the burden of disease in the developing world and the second largest worldwide by 2020, and secondly because it imposes such high social and financial costs on society (Commonwealth Department of Health and Aged Care and Australian Institute of Health and Welfare, 1999). For example, 8.3% of total annual health system expenditure in Australia in 1993-94 was on mental disorders (AUD$2.58 billion) (Australian Institute of Health and Welfare, 2000). The World Bank and the World Health Organization, however, have predicted that by the year 2020 the health burden worldwide attributed to neuropsychiatric disorders could increase by about 50%, from 10.5% of the total burden to almost 15% in the year 2020 (Commonwealth Department of Health and Aged Care and Australian Institute of Health and Welfare, 1999). In an earlier report, Desjarlais et al. (1995) state that mental, behavioural and social health problems are becoming an increasing part of the health burden in all parts of the world. One of the reasons for this is the increase in average life expectancy and the occurrence of an ageing population in developed nations (Desjarlais et al., 1995). But, mental illnesses are also becoming more prevalent in young people and at younger ages (Raphael and Martinek, 1996). This is related to a number of social, ecological and technological processes, including: the polarities of high levels of urbanisation, crowding and social isolation; globalisation of economies, communication and information; human,
social, and economic epidemics related to depression, substance abuse and violence (Raphael and Martinek, 1996); the break-up of families; and perhaps an almost complete disconnection from the natural world (Roszak et al., 1995).

As many depressive symptoms and disorders are treatable as well as preventable, improvements in mental health promotion activities, prevention, and early intervention are likely to have a major impact on the level of depressive symptoms and disorders prevalent in the Australian community (Commonwealth Department of Health and Aged Care and Australian Institute of Health and Welfare, 1999). Furthermore, depressive symptoms and disorders are related to other disorders both mental and physical, including cardiovascular disease (Commonwealth Department of Health and Aged Care and Australian Institute of Health and Welfare, 1999; Hippisley-Fox et al., 1998), potentially magnifying human suffering and adding further costs to the health care system. Hence, effective prevention and treatment targeted at depression is likely to have a much wider impact on individual and community health. It is imperative, however, that action is taken now.

The Commonwealth Department of Health and Aged Care and the Australian Institute of Health and Welfare (1999) state that interventions to impact upon depression are possible across the entire continuum of health care, from promotion, prevention and early intervention, through to treatment and maintenance care. While the effectiveness of many promotion and prevention activities is yet to be demonstrated, interventions that improve people’s mental health literacy, optimistic outlook, resilience to life stress, and social support appear to be helpful (Commonwealth Department of Health and Aged Care and Australian Institute of Health and Welfare, 1999). It is here that parks and contact with nature could have the most impact, particularly in terms of facilitating a more optimistic or positive attitude, enhancing social support (via improvements in social capital), reducing stress and tension, and by providing opportunities for physical exercise.

Physical activity has recently been proved to be equally effective as medication in the treatment of depression in elderly people (Blumenthal et al., 1999). Blumenthal et al. (1999) compared the occurrence of depression in people undertaking indoor aerobic exercise, being treated with antidepressants, or a combination of both. At the end of a four month trial, approximately 65% of patients in all groups had experienced such a reduction in clinical symptoms that they were no longer classified as clinically depressed (Blumenthal et al., 1999). Recent research has investigated the effects on depression and overall mental health of exercising outside in a nature-based setting, such as a park—termed ‘green exercise’. Pretty et al. (2005), reporting on a study involving simulated green exercise (exercise on a treadmill while exposed to photographs of green spaces compared with other spaces), found that green exercise appears to have benefits both for cardiovascular health and mental health. A subsequent study by Peacock, Hine and Pretty (2007) compared exercising outdoors (in a ‘Country Park’) and exercising indoors (in a shopping centre). In comparison to the indoor exercise, the outdoor exercise was found to have more positive outcomes in terms of mood, and to be associated with an increase in the level of vigour or energy.

The term ‘ecotherapy’ has been used to describe the intentional use of nature in a therapeutic way. It involves not simply a two-way relationship between individual and nature (which is often the case in ‘green exercise’), but a three- way relationship between individual, therapist and nature, in which nature plays an active rather than passive role (Burls 2007). Both mental and physical health benefits have been found to flow from this relationship.

Mental health is much more than the absence of mental illness: it is the realisation of one’s potential and the capacity of individuals and groups to interact with one another and the environment in ways that promote wellbeing, and optimise development (Commonwealth Department of Health and Aged Care and Australian Institute of Health and Welfare, 1999). The positive influence that parks could have in terms of mental health presents many exciting opportunities for dovetailing the agendas of local and state governments in terms of health promotion and the use of parks. A recent project undertaken in Australia, involving people experiencing depression, anxiety and/or social isolation taking part in hands-on environmental activities in a park environment, demonstrated positive benefits in terms of mood (Townsend and Ebden 2006). Further work, however, is required to determine the risk factors (environmental, social, biological and psychological) associated with mental illness as well as factors that act in a protective manner (e.g. social support, optimism). Additionally, environments such as parks that enhance mental health need to be investigated
further in residential, educational, workplace, community and social settings (Commonwealth Department of Health and Aged Care and Australian Institute of Health and Welfare, 1999).

Citation

Healthy parks, healthy people
The health benefits of contact with nature in a park context
A review of relevant literature
2nd edition
March 2008
School of Health and Social Development Faculty of Health, Medicine, Nursing and Behavioural Sciences
Deakin University
Burwood, Melbourne

© Deakin University and Parks Victoria 2008
Authors Dr. Cecily Maller Associate Professor Mardie Townsend Associate Professor Lawrence St Leger Dr Claire Henderson-Wilson Ms Anita Pryor Ms Lauren Prosser Dr Megan Moore

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