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Derrick Crandall

We had an extraordinary follow-up meeting on parks and health last week at Cavallo Point, with some of the key participants from Partners Outdoors 2010 returning for an intense, day-long session. We developed a new name for the effort: The Vital Signs Initiative: Trailhead to Better Health

Here is my report on the topic:

The Vital Signs Initiative: Trailhead to Better Health

An extraordinary group of medical, recreation and conservation leaders met within the Golden Gate National Recreation Area near San Francisco on April 14th under the auspices of the Institute at the Golden Gate to move beyond talk regarding the health benefits from increasing time spent by the American public in parks and other outdoor spaces and develop specific recommendations and actions. The group built upon discussions in April 2009 at the Turning the Tide 2009 conference and the January 2010 Partners Outdoors meeting.

Nearly 30 participants included leading physicians, executives of health care insurers and providers, professionals from the National Park Service and other key public land managing agencies, recreation industry executives and leaders in academia. And the group quickly agreed on a name for the initiative and several key recommendations and actions.

The group labeled the effort The Vital Signs Initiative: Trailhead to Better Health. At the heart of this effort is a simple concept: physicians and other healthcare professionals need to be enlisted and empowered to prescribe activities in parks and similar places as alternatives to medications and other interventions for many chronic illnesses widely occurring across the nation, and that to do so, public and private park and recreation interests need to assist in the process by making information about suitable opportunities known to the medical community. Moreover, the medical and recreation communities need to enlist the involvement and support of the technology community to make up-to-date information available to patients and to monitor patients and reward them for following park prescriptions.

The group noted that medical studies make clear that additional outdoor activity can produce medical benefits and substantial cost savings – perhaps as much as 25-40% reductions in costs now associated with obesity and other consequences of inadequate physical activity. Also clear is that additional physical activity in parks can be encouraged by park managers and enjoyed by visitors.

The group applauded pilot efforts already underway in New Mexico and North Carolina and elsewhere, as well as the interest of the National Park Service, companies including Kaiser Permanente and others.

To realize the potential for this initiative, the group recommended:

1) immediate action on at least one new regional pilot effort, with Fresno, California, being especially appealing because of federal/state/local park interest and an offer for financial support from SeeChange Health. SeeChange Health recently launched a new health plan in Fresno that offers cost savings to people who change health behaviors and manage chronic diseases. This effort will include assembling information on available activity options and means to deliver information to those options to both the medical community and patients;

2) immediate action to create a structure to reach and to coordinate the efforts of interested healthcare providers, especially physicians, in the park prescription arena, led initially by physicians involved in the meeting (Dr. Michael Suk of the University of Florida and a former Interior White House Fellow; UCSF professor and general practitioner (and Washington Post columnist) Dr. Daphne Miller; anesthesiologist and Sutter Health Chief Medical Oficer Dr. Steven Lockhart and others);

3) immediate action to encourage HHS to permit costs of park prescription efforts and similar undertakings as allowable preventative costs in assessing insurer Medical Loss Ratios (MLR) under recent healthcare reform legislation;

4) a series of meetings in Washington, DC, by leaders of the group, ideally in June 2010. Among those to be visited are: HHS Secretary Sebelius; Surgeon General of the USA Benjamin; Interior Secretary Salazar; Office of Personnel Management Director Berry; various Members of Congress, including Senator Mark Udall and Rep. Raul Grijalva, with specific suggestions for actions by each of these key individuals; and

5) immediate follow-up with the Office of Personnel Management to encourage incorporation of park prescription initiatives, and related, in healthcare coverage choices offered to some two million civilian federal workers beginning this fall;

6) active exploration of a national forum to accelerate inclusive discussions of the park prescription model and opportunities for partnerships ranging from links to iTunes, Amazon and other online sites for redeeming earned “frequentwalkermiles” to new availability of America the Beautiful passes under co-pay provisions of healthcare coverage.

For further information, contact:

Derrick Crandall, American Recreation Coalition, (202) 682-9530
Cleveland Justis, Institute at the Golden Gate, (415) 561-3028

April 21, 2010

Duane A. Lula

I agree. I have been eagerly awaiting the results and ideas that were developed and presented during the 3 working group sessions. I know that there were lots of notes and ideas from the "Making People at Home", "Gateways" and "Healthy People - Healthy Places" sessions, but I don't see the notes in the resource book. Are those posted somewhere else on this website, or are they yet to be posted? I can't seem to find them.

Derrick Crandall

I loved the information and ideas shared by our "4 Super Docs" -- Suk, Miller, Taylor and Lockhart! And here is another great medical community advocate for getting people out and active -- the CEO of the Cleveland Clinic, a cardiologist and very effective communicator! See Dr. Delos Cosgrove at

This is also a very interesting multi-media presentation, with imbedded video and more.

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