350 Parks: Powerful Medicine for Better Health in DC

Washington, DC | January 2014 | By National Recreation and Park Association

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Since its inception, the DC Park Rx program has helped disadvantaged youth throughout the District of Columbia create powerful connections to the outdoors. In 2013, the D.C. Department of Parks and Recreation (DCDPR) and the D.C. health community expanded the program to Ward 1 in Northwest D.C. to address significant barriers to parks and improve health outcomes in the city’s most diverse region.

Launched in 2010 by the D.C. Department of Health and the American Academy of Pediatrics (AAP), DC Park Rx was created to help physicians “prescribe” nature to patients in an effort to: “increase physical activity in parks, prevent chronic disease and obesity among youth, and create a generation of environmental stewards through outdoor exploration.” The layout of D.C.—in which local and national resources exist side by side—presented a unique opportunity for collaboration with national and federal agencies, and program partners emphasize the significant role they have played in building and maintaining momentum for DC Park Rx.

“We’ve been very successful at creating these partnerships,” affirms Dr. Robert Zarr, immediate past president of AAP, D.C. Chapter, and “physician champion” for DC Park Rx. “Everybody has had an invaluable role…the parks, the health providers, the agencies, and the champions within those agencies. And those partnerships will carry us into the future.”

A pilot program was implemented in four Children’s National Medical Center clinics in D.C. in 2011. To enable physicians to prescribe resources as close to patients’ homes as possible, volunteers from the George Washington University and the National Park Service evaluated and rated 350 local and national parks, noting transportation routes and amenities, and grading each park for safety, cleanliness, and potential for physical activity. Subsequent “Park Pages” (one-page summaries of each park) were created and inputted into a database searchable by zip code. Physicians could then print out the options that best appealed to their specific patients.

Unity Health Care’s Upper Cardozo Health Center in Ward 1 was considered an ideal location for the expansion of DC Park Rx due to the challenges faced by local residents with regard to physical activity. Ward 1’s diverse population includes a large percentage of low-income African American and Hispanic households and a large percentage of immigrants. The area has less green space than other wards, further reducing the ability of residents to engage in outdoor exercise.

“Literature clearly shows that low-income people and people of color have poorer health outcomes in terms of chronic disease, asthma, obesity, and mental health than their Caucasian counterparts,” notes Dr. Zarr.

Through detailed training and information sessions, 20 primary care clinicians were recruited and trained in the Unity clinic. And, the partners made a particularly significant achievement with regard to future evaluation: the seamless merging of Park Pages into Unity’s Electronic Medical Records (EMR), enabling the tracking of health data such as the number of prescriptions reported, biometrics data, and physician acceptance of DC Park Rx.

Between July 1 and Oct. 31, 300 prescriptions were prescribed. Responses from health care providers thus far have been extremely positive, and many have observed a positive impact made in their patients with regard to weight loss and the desire to be in a park setting.

A post-intervention survey was also implemented to study changes in the attitudes and behaviors of 400 youth before, and 3 months after, prescriptions.

Clinicians have expressed the need for more search variables for Park Pages, such as by amenity or by program, to facilitate more customized searches, and program partners have plans to make the additions in the next year. Additionally, as the digital age replaces paper, they hope to make Park Pages more accessible through mobile and hand-held technologies.

DCDPR is in the process of developing a new 10-year master plan and is helping to implement the District’s 20-year sustainability plan. The department believes insights gleaned from DC Park Rx will provide valuable input for these processes. Ultimately, program partners hope that longitudinal studies and other evidence of impact will help engage new partners for further expansion of the program throughout the city and, someday, the National Capital Region.