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The Prescription for Health Lies in the Outdoors

Dr. Daphne Miller might appear, at first blush, to be one of the more unlikely speakers at the International Urban Parks Conference taking place this summer in New York City. But just scratch beneath the surface of her bio, and engage her in conversation for just a moment, and it’s perfectly clear why someone whose primary job description is “practicing family physician and associate clinical professor in Family and Community medicine at the University of California San Francisco” is, in fact, a perfect fit for a conference dubbed Greater & Greener: Re-Imagining Parks for 21st Century Cities.

We caught up with Dr. Miller as she was, typically, running — in this case, catching a plane from San Francisco to a speaking engagement in Kentucky. And we began by speaking about the idea of “Park Prescriptions” — a term she coined, and has become popularized, for a practice she began using with her patients — but which she made clear right away was the result of some collaborative brainstorming.

“I may have been the first to write about it, but it was really born of meetings with a whole lot of folks representing public lands, so I cannot take full ownership,” she explained. “I wrote about it in The Washington Post, and that really launched it, but it’s something that represented a movement that really was already happening.  Physicians can really influence behavior with their patients if they give structured advice to do things differently. It’s what I call a ‘structure prescription’: give them something specific to do for 45 minutes a day, give them a specific place to go and tell them exactly what they should do there.  I give them trail maps to parks, and the kinds of exercises they should do there….It literally is the same idea as getting medicine on a prescription pad.”

Dr. Miller has worked and lectured to spread this thinking, encouraging other physicians to do the same, and has advocated this sensibility being incorporated into public park planning and the public health discussion.

A prescription for nature

“In a nutshell, my goal is to make our public lands a part of our health care system. That’s the overarching reason I’m at the conference this summer, and I think it’s really exciting that I was asked to be a part of it because it’s not a typical place to find a physician, as part of this discussion. But a vital part of looking at our cities in the future is how to make them healthier. So it’s very creative thinking on the part of the conference, and a very exciting opportunity for me to have a voice in a very interdisciplinary approach to looking at how we build the [new] city. I’m there to give a perspective on how we can build cities to keep people healthy and even help them treat illnesses they already have.”

Dr. Miller is part of the plenary session, “Exploring The New Green City,” taking place on Monday, July 16 at 9 a.m., where the discussion will focus on the trends and challenges in designing new models for modern urban living, and the role of parks and green space in helping cities realize their greatest potential. Among the questions to be addressed: What should these cities look like? How can we create more beautiful cities? How can parks drive city building strategies? How can green space support healthier urban populations?

“Anyone can intuitively tell you,” she goes on, speaking above the airport boarding announcements, “that having access to nature and the outdoors has many beneficial effects. But in today’s busy world it can still be hard to get people to buy into it in a wholesale way. But now there’s hard research that shows being outdoors increases endurance, fights depression, improves Vitamin D levels, improves recovery time from an illness…Now we need to apply that knowledge. Many of our cities are very dysfunctional. There are no sidewalks, you need to cross freeways to get to outdoor space.”

So what should urban planners do? Where are some of the best models?

“We have to make [green space] accessible from every dwelling, so people can pass through [our parks], have a greater sense of what they can tap into. In many cities in Europe, regardless of where you live in those cities, there is public access to lead you into this artery of greenery…we need to do a better job of that, and in [providing in our parks] more structured activities — hikes, guided tours, senior exercise programs.”

And it’s about getting the word out. She tells the story of one patient  in northern California who didn’t even realize the healthful and stimulating opportunities for both physical and mental wellness within minutes of her own home.

“This patient, who lived near my office in Noe Valley had knee issues so severe that walking on any pavement hurt. But [a place called] Glen Park Canyon was right near her house and she’d never even heard of it; I saw her eyes grow wide when I spoke about it — a quarter mile loop through a nature trail that was literally 7 blocks from her front door.

“At first she drove to the trail head, and did the loop once.” But after a process of gradually upping the dosage on the park prescription, if you will, “Now, several years later, she does eight loops, two miles, and she no longer drives there, she walks, she’s lost 30 pounds, her knees are much better, she’s wonderfully fit, and she’s joined the Glen Park Conservancy Group to get the word out to others.”

Attendees of the plenary session may also get to hear Dr. Miller speak about another of her passions: healthful eating. Her book “The Jungle Effect” is “part travelogue, part nutrition adventure, part recipe book,” about what can be learned — and incorporated into western life — from some of the healthiest native diets around the world. She went to northern Iceland, to the Greek island of Crete, to Cameroon in west central Africa, to Okinawa in Japan, and to small villages in Mexico.

The journey was prompted by a patient who whenever she returned home to her native village in Brazil lost all this weight — and then immediately regained it when she returned to San Francisco. “I began thinking — these native diets have evolved over thousands of years — so I began exploring these traditional diets from all over the world, and brought them back to my practice….I tend to [incorporate] myself now into what I eat a lot of the lessons I learned from ‘Jungle Effect.'”

Which, just as she’s about to hop on another plane, leads to this obvious “travelogue” question for someone who tends to spend a fair amount of time at airports: How does one eat healthfully in an airport?

She laughs. “You try not to.”

Steve Sonsky

For more information on how to register for Greater & Greener: Re-Imagining Parks for 21st Century Cities, please visit www.urbanparks2012.org.

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