The Doctor is Out(side in Her Local Park)

June 1, 2015, Department, by Samantha Bartram

Dr. Lillian Rivera views parks as yet another tool for health in her medical bag.Dr. Lillian Rivera isn’t a park and recreation professional. She doesn’t run an aquatics center, create programming or plot where to install next year’s community garden. But she is the administrator of the Florida Department of Health in Miami-Dade County (DOH-Miami-Dade) — as well as an ardent evangelist for the power of parks to transform lives and health outcomes.

Making the Connection

This writer witnessed firsthand Rivera’s advocacy for the idea that parks, when viewed as tools to facilitate better health, are an effective medicine for a number of ailments. At NRPA’s Innovation Lab, held in Miami, Florida, Rivera spoke passionately about the Florida Department of Health’s partnership with Miami-Dade Parks, Recreation and Open Spaces Department (PROS). “Parks are part of my tool chest to help improve my community,” she said in March. In a more recent discussion with Rivera, she elaborated on her earlier statement. “My advice as a public health official is to select activities that require minimal facilities or equipment, such as walking, jogging, jumping rope or calisthenics, and to identify inexpensive, convenient resources available in a resident’s local community. Examples are park and recreation programs, worksite programs, etc.”

At DOH-Miami-Dade, Rivera says there’s always been an atmosphere encouraging cooperation among municipal entities. “DOH-Miami-Dade for years has supported a culture of collaboration and inter-professional practice,” she says. “The work to improve the health of the population cannot be done alone.” But, instead of looking to private gyms to help her patients lose weight or improve cardiovascular health, Rivera looked to her colleagues at PROS and more than 160 other organizations to form the Consortium for a Healthier Miami-Dade. Rivera says the consortium is “united by the common belief that through collaboration and prevention-focused initiatives, Miami-Dade County residents can live longer, happier and healthier. [Its vision is] ‘Healthy Environment, Healthy Lifestyles and Healthy Community.’”

Exercise Equity

There are many reasons a person may live a less-healthy lifestyle, and many barriers that prevent people from accessing their local parks for fun or fitness. These can include proximity, income level, safety and distraction through technology. “Many technological advances and conveniences have made our lives easier and less active, and many personal variables, including physiological, behavioral and psychological factors, may affect our plans to become more physically active,” Rivera says. She identifies the top three reasons as a lack of time, inconvenience and a lack of self-motivation. “It is very important to understand that where we live, work and play makes a difference on your health status and that our social conditions also make a difference,” Rivera continues. “The causes of health inequality are complex but they do not arise by chance. The social, economic and environmental conditions in which we live strongly influence health. These conditions are known as the social determinants of health, and are largely the results of public policy.”

In her position at DOH-Miami-Dade, and as part of the Consortium for a Healthier Miami-Dade, Rivera’s suggestions carry significant weight when she discusses what such public policies should look like. “We as community leaders need to play a role in reducing or mitigating existing social and economic inequities and conditions that lead to inequities in the distribution of disease, premature death and illness,” Rivera says. “As such, a need to advocate for comprehensive policies that improve physical, environmental, social and economic conditions in the community is vital. In addition, promoting public investments in community infrastructure that sustain and improve community health, such as education, childhood development, parks, mass transit, employment, healthy design in the built environment, and neighborhood grocery stores are important to improve the health of our community. Health inequalities are preventable.”

Fit Outcomes

The concept of parks as partners in fitness is becoming more ingrained in the Miami-Dade population with each visit to one of Rivera’s public health staff members. “We deliver the message every day that parks play a critical role in improving health,” she says. “The reality is that [PROS] is helping residents be more physically active, feel a connection with their neighbors and enjoy the benefits of a healthy environment.”

And how does that help manifest, exactly? “There are several key points to keep in mind,” Rivera says. “Parks provide people with a way to contact with nature, which is known to confer certain health benefits and enhance well-being. Physical activity opportunities in parks help to increase fitness and reduce obesity. Parks resources can mitigate climate, air and water pollution impacts on public health. Cities need to provide all types of parks, to provide their various citizen groups with a range of health benefits.”

Rivera identifies “Fit2Play” as a particularly successful collaborative health program created through a DOH-Miami-Dade/PROS partnership. “It has been proven that [Fit2Play] makes kids healthier,” she says. “The initial results of a study that Sarah Messiah, Ph.D., research associate professor of pediatrics [at the University of Miami], is conducting in partnership with [PROS] have found that the Fit2Play after-school program offered in many county parks is ‘highly effective’ in improving the health of kids, reducing and preventing childhood obesity, and other health risk factors.” [PROS] established the program in response to startling statistics that showed the rate of obesity and overweight adults in Miami-Dade County was even higher than the national average.”

Indeed, according to an article published by the University of Miami Miller School of Medicine, “Messiah found that Fit2Play participants maintained healthy weight and BMI throughout the school year, and those who started the program with high blood pressure lowered it. The school children also improved their physical health, fitness levels, and knowledge about nutrition and healthy lifestyle behavior.”

Parks were essential to the success of Fit2Play. The cost to participate in the program was minimal — with sliding payment scales — and it was offered at 34 parks across the county where kids would engage in exercise and nutrition education through fun activities like obstacle courses and relay challenges. Daily Fit2Play sessions include homework help and SPARK (Sports, Play and Active Recreation for Kids) activities, which are designed to develop and improve motor skills, movement and social skills. The American Heart Association and Alliance for a Healthier Generation’s empowerME4Life curriculum was used to impart nutritional education. 

For Rivera, partnerships that facilitate programs like Fit2Play are a no-brainer. “DOH-Miami-Dade and [PROS] are logical partners in local efforts to build healthy communities, as they both focus on improving community livability and promoting healthy lifestyles,” she says. “Miami-Dade health officials implement local prevention and wellness initiatives and park and recreation officials promote community use of recreational facilities and involvement in healthy lifestyle programming.”

We Don’t All Live in Miami

Rivera acknowledges the weather in her locale plays a major role in the success of promoting outdoor exercise in local parks, as well as the allure of its world-class parks system. However, she assures that even those of us who don’t live in 80-degree weather year-round can also make ready use of community parks. “Add physical activity to your daily routine. For example, walk or ride your bike to work or shopping, organize school activities around physical activity, walk the dog and park farther away from your destination,” she advises. “Exercise with the kids, or other family members or friends! Go for a walk in our parks and open spaces. You can spend time together and still get your exercise.”

Samantha Bartram is the Executive Editor of Parks & Recreation magazine.