Before You Go - August 2014
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Rx: Back to Nature

By Deborah L. Vence

Your prescription: Spend some time in nature.

That is what Dr. Robert Zarr is prescribing to patients as a way to help treat chronic diseases, such as obesity.

Zarr, a practicing primary care pediatrician at Unity's Upper Cardozo Health Center in Washington, D.C., came up with an innovative program—DC Park Rx—after discovering that more than 40 percent of Unity's adult patients and 25 percent of Unity's pediatric patients are categorized as obese.

"This is a unique opportunity for obesity prevention by prescribing parks for children and adults who are suffering from chronic diseases. Nature is free and readily available; we simply have to access it," Zarr stated in a press release.

The Park Rx initiative is a component of the broader Healthy Parks Healthy People movement that recognizes the physical, mental and spiritual benefits gained from time spent outdoors. Participants in the Healthy Parks Healthy People program include national, state and local parks, as well as business innovators, healthcare leaders, scientists, foundations, and advocacy organizations that foster and build upon the role that parks and nature play in the health of our society.

"The goals of Park Rx are to help doctors 'prescribe nature' to patients and families in order to change patients' behavior by increasing physical activity and time spent outdoors. This helps reduce the effects of chronic diseases such as obesity, asthma, ADHD, anxiety, stress and depression," said Kathy Kupper, spokesperson for the National Park Service.

And, interest in the program is catching on.

This summer, in fact, Democratic Congressman John Sarbanes of Maryland along with National Park Service Director Jonathan B. Jarvis met with Zarr to learn more about the innovative program.

The short-term goal of the program is to prescribe nature to patients and families to encourage outside time in one of 350 green spaces/parks rated in Washington, D.C. The long-term goal is to decrease the impact of non-communicable chronic disease like obesity, asthma and mental health disorders, and create the next generation of environmental stewards.

What's unique about the Park Rx program is the fact that Zarr has integrated it into Unity's electronic health records system in order to make park prescriptions easy for everyone. The National Park Service, DC Departments of Health and Parks and Recreation, National Environmental Education Foundation, DC American Academy of Pediatrics, George Washington University and Children's National Medical Center worked collaboratively to create a searchable database of 350 parks located within the city, and rate them according to specific criteria such as level of activity, accessibility, cleanliness and safety.

Clinicians now can ask their patients which activities might be of interest to them and then search the database to find the right park closest to their homes. Patients can leave their doctor's office with a printed copy of the prescribed park and activities tailored to their areas of interest.

"What is different about DC Park Rx from other initiatives is that with partners, all the green space in DC was assessed and is linked electronically to the electronic medical record (EMR) to make it easier for doctors to write a Park Rx for a patient and to find out what activity the patient prefers to do ... and then the doctor writes a Park Rx for that patient to a park where that activity is permitted. This program provides RXs for biking, walking/hiking, swimming, playing soccer, basketball, Frisbee, etc.," Kupper said.

To boot, she explained that the National Environmental Education Foundation (NEEF) held a Nature Champion Training about four to five years ago where they connected health providers with public land managers.

"From this training, DC doctors connected with National Park Service leaders. Dr. Robert Zarr, DC Park Rx Champion, was inspired by colleagues who went to this training. He also heard Richard Louv (author of Last Child in the Woods) speak at an AAP Conference. Dr. Zarr became energized to try to combat chronic disease (obesity, asthma and mental health disorders) in children and families," she said. "With Park Rx, health partners are extensions of park staff, referring people to parks. As a result, patients will visit and be more connected to parks and the outdoors through the improvement of their health via permitted active and passive recreation."

And, so far, there have been several accomplishments that include:

  • The development of a park rating tool to standardize rating of green space (
  • Recruitment of volunteers to rate parks.
  • Mapping and rating of 350 parks.
  • Development of DC Park Rx Tools (one page summary for each park/green space in DC).
  • Development of DC Park Rx searchable database.
  • DC Park Rx pilot launched at Unity Health Care's flag ship community health center Upper Cardozo (more than 600 Rx prescribed since July 1, 2013).
  • Merged electronic health record with DC Park Rx searchable database to increase the likelihood of adoption by health providers and to expedite evaluation and measurement of biometrics.
  • Developed and administered surveys to assess behavioral and attitudinal changes in health providers and patients (analysis in process).

"Parks can play a vital role in contributing to a new system of healthcare delivery, and Park Rx is a promising approach to alleviate the growing burden of chronic disease and healthcare costs," Kupper said.