I wear three hats in my professional life:

1. I’m a pediatrician working primarily with under-resourced and historically marginalized patient populations.
2. I’m a nature champion, promoting the health benefits of spending time outside in nature.
3. I’m part of a leadership team that advocates for anti-racism, diversity, equity, inclusion, and justice in patient care.

For many who see my work from the outside, my hats all seem separate, but, for me, these three roles work synergistically to allow me to help my patients access significant and lasting health benefits.

Health Benefits of Nature
Numerous studies link spending time outside to experiencing better health outcomes including lower blood pressure and heart rate, better immune system function, lower levels of stress, and decreased risk of chronic diseases like diabetes and cardiovascular disease. Studies also demonstrate a link between nature exposure and improved cognitive function and development, brain activity, sleep, and mental health (including decreased risk of depression and anxiety).(1) But as many as 100 million people in the U.S. — 30 percent of the population — lack access to the benefits parks and green spaces provide.(2)

Inequities in Park Access
Many historically marginalized communities cannot access high-quality and safe parks and green spaces due to a combination of racial and economic disparities. This may mean that these resources do not exist near them, or, if they do, they may have damaged play equipment, be poorly maintained, or have criminal activity or other conditions that make the parks feel unsafe. A lack of affordable transportation may also limit access to green spaces outside of their neighborhoods, and, in the event that families are able to find transportation, the location itself may feel unwelcoming or non-inclusive due to discriminatory practices such as signage or programming not being offered the languages they speak. There are also some communities of color who do not feel safe accessing parks because of a history of intimidation or violence perpetuated against those communities while in nature. Policies and practices like segregation, redlining, racially-biased planning decisions, and exclusionary zoning, have created stark inequities in which communities have access to parks and nature.(3) This means that I can’t advise my patients to be active in nature unless I also advocate to help them overcome the barriers that prevent them from accessing nature. This is why the intersection of my three roles is working for inclusion, diversity, justice, and equity in park access.

Park equity means that all communities have access to the health-promoting resources of parks and green spaces regardless of their different challenges, needs, and histories.(4) Achieving park equity requires closing the gaps in park access that disproportionately affect low-income communities and communities of color. To do that I need to collaborate outside of the clinic to advocate for my patients and the policy, systems, and environmental changes that will help my patients and all families in our community achieve park equity.

What We’re Doing in Santa Clara County
Several years ago, I began collaborating with the Santa Clara County Department of Public Health and Santa Clara County Parks to address inequities in park access. Together with my clinic, we started a Park Prescription program that was designed to help our patients access parks by providing transportation, free parking, a bilingual community worker, and a provider from the clinic who offered a familiar face at events. We also worked with park staff to create a welcoming environment that helped families feel comfortable in park spaces. Over the years we have had thousands of patients and their family members attend our park prescription events, with 70 to 90 participants at each of our twice-monthly events. And we have utilized their feedback to refine and improve our program. Working with the Champion Provider Fellowship, we were able to strengthen and expand our collaboration so that every pediatrician in our county system now screens for access to safe parks and green spaces. And to help improve park access, pediatricians can provide free annual parking passes and additional resources such as information about family-friendly hikes and culturally appropriate and inclusive guided events that all families can attend. We’ve also implemented a county-wide Children’s Outdoor Bill of Rights (COBOR) to serve as a systems and policy lever to help our community achieve park equity so that all families can access resources and opportunities for nature connection and its associated health benefits.

As we better understand the social drivers of health and health inequities, it is vital for health professionals to work both inside and outside of the clinic to help their patients improve their health. By working outside of the clinic to help my patients I have a far more significant, lasting, and meaningful impact on their health and well-being than I ever could have had by simply providing information and guidance in a clinic visit.

References:

1. Jimenez, M. Associations between Nature Exposure and Health: A Review of the Evidence. International Journal of Environmental Research and Public Health. May 2021.
2. National Recreation and Park Association. Parks and an Equitable Recovery. https://www.nrpa.org/our-work/Three-Pillars/equity
3. Rowland-Shea, J. The Nature Gap: Confronting Racial and Economic Disparities in the Destruction and Protection of Nature in America. Center for American Progress. July 2020.
4. Prevention Institute. What is Park Equity? https://www.preventioninstitute.org/people-parks-power/what-is-park-equity.

Dr. Bostick Cammon is a pediatrician who has been in practice for over 20 years and has a career focus on working in urban areas with under-resourced, historically marginalized, and truly resilient patient populations. She is passionate about fighting for anti-racism, diversity, equity, and inclusion and about helping families thrive by improving their health and well-being holistically, especially by being joyfully active in nature.