1. Greenspace and Wellbeing event 13 February 2008 Dr William Bird Strategic Health Advisor Natural England

2. The Natural Environment and Health “We must do nothing less than transform the environment in which we all live. We must increase the opportunities we all have to make healthy choices around the exercise we take and the food we eat.” The Prime Minister Jan 2008

4. Health Values of society Environment Individual SustainableHealth Equality Community

5. Introduction to Health The Main Health issues –Life Expectancy –Health Inequalities –Mental Illness –Obesity –Diabetes The Government’s response –Our Health Our Say –Healthy Weight Healthy Lives Natural England’s work –Relevance –Credibility –Delivery

6. Life Expectancy Life Expectancy is at its highest and infant mortality at its lowest. Life expectancy rose for men by 5.1 yrs and 3.6 years for women to 76 and 80.5 yrs respectively People are suffering poorer health for longer More people consider themselves in poor health compared to the mid 90s.

7. Health Inequalities 1n 1991 the difference between the lowest and highest fifth of life expectancy was 9.7 yrs and it is now 12.3 years. There appears to be no improvement (slight worsening) since the baseline of 1997 The government’s target is to reduce the difference of life expectancy between the highest and lowest quintile by 10% by 2010

8. Mental Illness –Mental illness affects 1 in 6 of the adult population –1 in 5 under 16yr olds have a mental disorder –By 2020 the WHO claims that depression will be the second most prevalent cause of ill health –The total cost to the economy is £75 billion –(£12 billion to NHS)

9. Obesity The UK has the highest rate in the EU In the UK rates have tripled in the past 20 years By 2050 60% of population and 1 in4 under 16 year olds will be obese Total cost of obesity to society will be £50 billion by 2020

10. Diabetes About 2 million people in the UK have diagnosed diabetes and a further 1 million have undiagnosed diabetes. Diabetes uses up 5% of the total NHS budget (£105b) 80% is preventable 80 times risk of developing diabetes if obese.

11. “Our Health and Our Say” Better prevention services with early intervention Give people more choice and a louder voice Tackling inequalities and improving access to community services More support for people with long term conditions [1][1] Our Health, Our Care, Our Say: A new direction for community services: DH White Paper 2005

12. Healthy Weight, Healthy Lives: Children Promoting Healthy Food Choice Building Physical Activity into Our Lives Creating Incentives for better health Personalised Advice and Support

13. National Campaign for Walking “Support a Walking into Health programme of innovative campaigns with the aim of getting a 1/3 of England walking at least 1000 more steps daily by 2012.- an extra 15 billion steps a day.” Natural England to lead on Health inequalities and those with Chronic Disease.

14. BMJ 9 th June 2007 Editorial “ The challenge is to make politicians work for an environment that promotes walking, and to call on doctors to encourage patients to walk… ”

15. The NHS and Natural England Relevance –Include physical activity in the QOF. –Link natural environment through physical activity to obesity, diabetes, mental health and inequalities Credibility –Help NICE to recommend Community walking schemes in 2010 –Ensure that evidence of health benefits of natural environment are quantified Delivery –Ensure that we increase capacity of WHI –Develop a package of care for commissioning

16. Relevance –Work to include physical activity in the QOF. –Link natural environment through physical activity to obesity, diabetes, mental health and inequalities

18. Credibility –Help NICE to recommend community walking in 2010 –Ensure that evidence of health benefits of natural environment are quantified.

19. Walking the Way to Health (WHI) Over 33k volunteer health walk leaders having been trained by300 cascade trainers They lead 13k walks a week in over 650 WHI schemes. Aim to increase to 1000 cascade trainers training over 30,000 walk leaders a year. Create 2012 WHI schemes by 2012.

20. Introduction to Health The Main Health issues –Life Expectancy – rising but in poor health –Health Inequalities - worsening –Mental Illness – not good –Obesity – rising rapidly –Diabetes – rising rapidly The Government’s response –Our Health Our Say – shift to prevention and community –Healthy Weight Healthy Lives – environment important Natural England’s work –Relevance – linking to major issues –Credibility – collecting evidence –Delivery – linking people to place

21. Evidence linking Health and the Natural Environment The Natural Environment has three main affects on the Human: Reduces Chronic Stress Increases Physical activity Creates a sense of purpose and belonging

22. Nature Contact in housing projects

28. The Health Ticket to Nature % of participants who felt that this factor was very importance

29. The NHS (Natural Health Service) The Natural environment is a perfect extension to the other NHS If delivered well a healthy natural environment may yet prove to the most important public health initiative since water (19 th century) and air (20 th century) were tackled.