Prescriptions for a healthier community
By Dennis Archambault
Health providers are increasingly being drawn into population health. Population health certification, offered by the University of Michigan School of Public Health for Authority Health teaching health center residents, with a related community health rotation, orients physicians destined for private or community health center practice to the broader concerns of public health.
The “Fresh Prescription” program http://www.ecocenter.org/newsletter/2015-03/fresh-prescription-recipe-healthy-detroit, sponsored by the Ecology Center in Wayne County, encourages providers treating low income, chronically ill people to prescribe fruit and vegetable consumption through a counseling program, connected with local farm markets. The program introduces people to nutritious elements in their diet.
The National Parks Service (NPS) recently has begun promoting the “Park Prescription” program http://www.parksconservancy.org/assets/programs/igg/pdfs/park-prescriptions-2010.pdf, which helps primary care providers identify and recommend park trails and exercise programs for their patients. Inactivity has long been connected with obesity, and obesity to chronic disease. Beyond recommending diet and exercise in a general sense, providers under cost and time constraints often leave their patients with limited direction as to what they should do — other than find some place to exercise.
NPS takes the idea of exercise into their realm: “A growing body of research suggests that exposure to nature and outdoor exercise has significant health benefits such as improved wellness and mental health, reduced stress, and lower blood pressure.” So, the idea is not just to walk around the block or join a health club and walk on a treadmill, but find a park and walk on a trail.
Nature offers a qualitative difference, NPS says. Citing a 2005 article in the Journal of Medicine, NPS says that people with ready access to park or open space were 50 percent more likely to adhere to a regular walking regime and that runners report lower levels of stress and depression when exercising in nature than when exercising in an urban setting
Another study in Preventive Medicine revealed that fewer than 14 percent of primary care providers regularly gave any form of counseling on exercise.
An earlier, 2003 study in Preventive Medicine identified an annual reduction in average healthcare charges of $2,200 per person per year for individuals who were initially sedentary (physically active one or fewer days per week) and later became physically active three or more days per week.
The NPS “urban agenda” is aware that cities like Detroit, without national parks and many non-maintained parks in unsafe areas, need a different orientation to Park Prescriptions. Further complicating the issue is research that recommends against outdoor exercise in heavily industrial areas like the Rouge River Downriver Delta communities.
However, NPS is building one-mile walking trails in Rouge Park. An NPS fellow and intern are working closer with the city’s park system to create walk-able routes that provide a more natural environment than concrete streetscapes.
Exercise is Medicine http://www.exerciseismedicine.org/ is a program affiliated with the American College of Sports Medicine, which promotes the inclusion of exercise in primary care medicine.
New Mexico has a “Prescription Trail” program http://prescriptiontrails.org/index/index.shtml that outlines specific sites that providers can refer their patients to.
While social determinants are major influences on health, individuals can be introduced to primary and secondary prevention options through their primary care provider that promote population health through the adage, “one person at a time…”
Dennis Archambault is director of Public Affairs for Authority Health.