Whenever he can, Dr. Robert Zarr takes a lunchtime stroll to a nearby park to commune with his favorite tree, watch children play with sticks and acorns—to practice what he preaches. Zarr is a pediatrician at Unity Healthcare, a clinic in northwest Washington, DC, and one of the brains behind the DC Park Prescription Program (DC Park Rx). Inspired by the writings of Richard Louv, author of Last Child in the Woods, he and a growing number of colleagues prescribe nature to inner-city children who live with obesity, asthma, anxiety, and depression. From personal and professional experience, Zarr knows that just twenty minutes spent in green space can improve health. He’s also convinced that children treated with parks will become adults who steward the environment.
On a hot, humid day typical of summer in the U.S. capital, I joined Zarr on a bench in Meridian Hill Park to talk about his cutting-edge work in environmental health, or environmental healing. As he noshed on a healthy dish of okra, he told the story of a little girl now five or six years old. Her parents brought her to him because they were concerned about her inability to sit still at home and her frequent temper tantrums. Unlike many doctors, he didn’t prescribe a pill or lab test, and he didn’t refer them to a psychiatrist. Instead, he asked how she spent her weekends. They confessed she remained indoors the whole time. He explained that she might feel better after unstructured play in the woods. Would they be willing to take her to Rock Creek Park? Let her roam and listen to birds for two hours on Saturday and two hours on Sunday? They agreed. During the follow-up visit, he deliberately didn’t ask them what happened. Toward the end of the appointment, they volunteered that the park prescription had worked. She was getting into far less trouble, could focus, and sleep much better. She was a different person.
Zarr is full of moving anecdotes. He worked with one young woman who was concerned about her weight. Together, they changed her long route to school on public transportation. She agreed to walk the last leg of the trip. Then, they added time in a park to her schedule. Her weight plummeted, and her confidence rose so much that she pursued soccer camp in the summer. She told her story on National Public Radio.
Why Park Prescriptions?
A park prescription can lead to frequent, evermore complicated encounters with nature. A child who picks up a stick with great trepidation the first time in the forest builds a tree house several months later. Over time, Zarr contends, a generation now deprived of the outdoors will no longer suffer from Louv’s nature-deficit disorder.
Right now, one in three American children are overweight or obese. Seven million have asthma, and close to six million have Attention Deficit Hyperactivity Disorder. Approximately, 3,600 young people are diagnosed each year with type-2 diabetes. Over recent decades, children have lost 25 percent of playtime and 50 percent of unstructured outdoor activity. “We’re now very much a sedentary culture. Children aren’t moving. There’s been a culture shift from moving to sitting,” Zarr said.
DC Park Rx
That’s why he got moving. DC Park Rx is a community initiative of health providers and foundations, the National Park Service, DC Department of Health, U.S. Department of Health and Social Services, National Environmental Education Foundation, American Academy of Pediatrics, and George Washington University, where Zarr teaches public health. Across the United States, there are other programs, all part of the National Park Service’s Healthy Parks, Healthy People. It drew inspiration from a similar program in Australia, where healthcare providers actually donate a percentage of their earnings to preserve and maintain green space. The DC Park Rx database went up in July 2013; it now lists 380 District parks. Zarr and his colleagues have written over 500 prescriptions on bilingual English and Spanish prescription pads.
Last year, he finished a study of approximately 400 children for whom he prescribed one or more parks for three months. On average, the patients spent twenty-two more minutes a day and six more days a year outdoors and in physical activity than other children. Next year, Zarr hopes to show that nature prescriptions lead to statistically significant decreases in overall weight, body mass index, blood pressure, and diabetic measurements like hemoglobin levels. He’d also like to document fewer visits to emergency rooms and less use of medicines by asthma and mental health patients.
For Nature and People
But does nature benefit from Park Rx and comparable programs? The question can touch a nerve in conservationists, Zarr admitted. After all, organizations like the Nature Conservancy and Green Peace struggle to lessen the human impact on the environment to protect other species and their habitats.
“This would be a fascinating time to take health advocates and environmental activists and put them in the same room to come up with a consensus about how we can create a healthier population and planet,” Zarr said. “I’m of the opinion we can do both.”
He has had good support from local and national park services. “Park Rx doesn’t exist only to decrease the burden of chronic disease,” he said. “It’s intricately linked to conservation efforts. If we don’t get kids to appreciate a tree, we’re in big trouble.” Today, most environmentalists worldwide are over fifty and white; they don’t reflect the future. Zarr, not quite fifty and fluent in Spanish, would like to be part of a paradigm change. He feels a sense of urgency.
Fortunately, he doesn’t encounter much skepticism or lack of compliance in the families he serves. Individuals of all socio-economic backgrounds warm to Park Rx. After all, given the opportunity to eat well and spend time in nature, most people jump at the chance. Any barriers that exist are systemic, Zarr believes. Children spend too much time inside schools preparing for standardized tests and too little in recess and physical activity. Parents work two to three jobs. Zarr knows mothers who spend forty dollars on train fare to get their children to the clinic. They find cabs cheaper. Because of climate change, it’s often too hot or too cold outside. Yet architects still design buildings without windows or green roofs, without indoor or outdoor landscaping.
“People are in desperate situations. We need to ask ourselves as a population if our routines are healthy for the planet and us,” Zarr advised. “What constitutes happiness and well-being is the nature of what we’re talking about—pardon the pun.”
How Park Rx Works
The Trust for Public Land scored over fifty of the nation’s urban areas on access to parks. The Washington, DC, metro area came in sixth. A number of District parks are adjacent to recreation centers with pools, stationary bicycles, and yearlong programs. So users can pursue regular or “green” exercise. Enter a zip code into the Park Rx database and out pops at least one park or green space within a five-mile radius. Usually, people can walk to its gates. If not, they can take the recommended bus or Metro line. Although database volunteers don’t research crime stats, they do subjectively rate parks on safety and cleanliness at different times of the day. They also note who visits the parks. Park Rx encourages people to go as families and use parks in different ways—to develop a sense of ownership.
For some people, particularly those coming out of violence here or, say, Central America, connecting with park rangers and families like theirs can alleviate fears. Park officials must be committed to greeting everyone, including those who might have had traumatic experiences in forested areas. “It’s a doctor’s job to be culturally aware of their patients—where they come from, their backgrounds, experiences, and routines—to make educated decisions about the right time and place to prescribe nature,” Zarr said. “The onus is on the doctor to establish a relationship with the person they’re counseling. For the health-provider community, Park Rx is a tool.” A good one the public can access.
Other Tools, Future Plans
At Unity, there are two other tools for doctors and patients, including the Fruit and Vegetable Prescription Program and Ways to Enhance Children’s Activity and Nutrition (appropriately abbreviated We Can!), a National Institutes of Health program. Children and adults spend the first half of classes indoors to get their vitals measured and learn about healthy eating. Then, they go to Meridian Hill Park for aerobics.
When asked what he had in the works, Zarr said he would soon find out if he had funding from the DC Department of Health to finish and revamp the database. He wants to make it more user friendly for providers and individuals, so they can search for activities like jogging, swimming, horseback riding, and qualities like shade and cleanliness. He’d like to have the time patients spend in parks come back via their smartphones to their electronic medical records. He’d also like to design an app and find out what patients learn about nature.
But even the near future is a dream—or so the starlings were shouting from the trees. The man who had walked laps before us for an hour had gone inside. “It’s very, very hot, and I’m almost getting dizzy,” Zarr suddenly said. Whether his infectious enthusiasm or the weather had overheated me, I had to agree. The day’s park prescription had run its course. I looked forward to another.