(in Volume 25)
It was great to welcome so many people as delegates, speakers, workshop presenters and boulevard stall holders to the Outdoor Recreation Network conference in March 2014.
The event was some 6 months in the planning and it was extremely positive to get early support from a number of key agencies including Rebecca Evans from Hywed Dda Health Board, Wendy Thompson from Natural England and Elinor Gwyn from Natural Resources Wales. Not forgetting Catrin Dellar from Welsh Government who also helped us translate part of the delegate pack into Welsh. The interest as Jo mentions in his forward was such that we decided to include a boulevard style network session so that the depth and breadth of the work in this area could be highlighted and shared amongst delegates.
We decided that it would be good to get people into the mood of the conference topic by getting delegates out in the outdoors to physically experience some of the things we would later be theoretically exploring. With the help of the National Trust Team at the magnificent Tredegar House we started the conference with a range of outdoor activities. So, whilst we had bite-sized dips into Nordic walking, bush-craft, gardening and horticulture, outdoor games we did so welcomed by an inspiring green space on a bright fresh sunny day in March. Energized and from the afternoon in Tredegar and with the ice having already been broken over roasted marshmallows and delegates came ready to consider the matter of ‘public health and outdoor recreation’. Further opportunities to network were found at the diverse boulevard displays and it was great to have such a good range of projects giving an extra layer of colour into the conference.
Much has changed in the world of outdoor recreation and health care since the last Outdoor Recreation Network conference on this topic in 2005. Ten years ago despite the growing links between health and outdoor recreation, ‘health care’ itself was largely seen as the responsibility of the health sector, ten years on and it would seem that the landscape has indeed shifted. It truly is time to reconsider the World Health Organisation’s 1946 statement: ‘good health is a state of complete physical, social and mental well-being, and not merely the absence of disease or infirmity’, and place this in the context of the opportunities afforded by our ‘natural health services’.
Dr Ruth Hussey Chief Medical Officer for Wales and Mr Ken Skates AM (Wales) clearly set the scene. In an era of austerity, rising health care costs, ongoing concerns about population health needs, and increasing awareness in preventative, alternative and complementary medicines and therapies we are seeing a renewed interest in the health benefits to be gained from interactions with nature and the outdoors. We heard strong messages that health is not, and cannot be the sole responsibility of the health sector alone, but extends to all.
Throughout the conference there were examples of partnership between the health and the outdoor recreation and appreciation that on a more fundamental level both sectors operate in ‘co-production’ in order to meet contemporary public health challenges. Public health and health promotion is about helping people to stay healthy, and protecting them from risks to their health. People must be encouraged and supported to make healthier choices so that the risks to and impact of illness are reduced. In the presentations and workshops that addressed key health issues including obesity from Dr Nadim Haboubi, cancer from Sarah Worbey and Siobahn Harkin , heart disease and other long term conditions by Kim Buxton. We saw how the role of outdoor recreation can be a powerful preventative medicine, a protective factor against chronic disease and illness and a positive intervention in promoting well-being. This as the Bridget Finton’s presentation ‘healthy parks healthy people’ showed is a growing global movement and not just a passing fad or ‘temporary cover’ for ‘ expensive real medicine’ until the ‘age of austerity’ passes.
Delegates were familiarised with the concept of ‘prudent healthcare’ by a number of speakers including Dr Ruth Hussey and Ken Skates. This concept states that interventions and care are to be tailored to meet the real needs of patients whilst reducing unnecessary interventions that are not to the patients benefit. Prudent health care supports simple yet effective (and enjoyable) interventions such a walking and places such interventions when appropriate are on par with other forms of medical treatment.
Delegates came away with tools, ideas and actions to help drive the ‘green health’ agenda forward but also took with them a clear sense that ‘green health’ is gathering momentum and emerging in the ‘main stream’ to change how the health of the nation is perceived and managed. Workshops like ‘Small Woods’ (Kate Hamilton) and ‘Venture out’ (Jonathan Lee) showed how important it is to develop projects focusing on ‘person centered care’ where it is the person who is important rather than simply diagnosis. Many workshops including that by the Ramblers (Mel Jones) highlighted the importance of ‘motivation’ in engaging people with taking an active role in being healthy and making health choices. Outdoor recreation and interactions with nature make health interventions meaningful, motivational and able to engage life-changing momentum for recipients. In fact health interventions don’t even need to ‘feel. Look and sound like’ health interventions, and with good planning and understanding of what the issues and opportunities there outdoor recreation can be ‘the wonder drug’.
However the conference also highlighted that although ‘green health’ holds many keys to better health overall, it must also work with more ‘conventional’ approaches – there are no single ‘magic bullets’ in health. To encourage people to engage with ‘green health’ intervention requires to a great or lesser an element of behavior change. Taking pills and applying potions can often be a lot easier than engaging with and maintaining changes to your behavior that requires consistent and long term commitment before tangible benefits are felt. In addition to this the condition of very many people’s health in western societies has deteriorated to such an extent, often because people are sedentary, have poor diets, smoke and drink, that the chronic and often critical state of their health requires full on medical intervention. Going for a walk is not going to help you if you are actually having a heart attack, but it certainly will help you in your recovery, and would have helped prevent it in the first place. However to put the onus on individuals themselves to engage with ‘green health’ is unlikely to yield results in the general population, the structural issues relating to ill health also need to be addressed, with policy, services and infrastructure supporting a ‘green health’ agenda.
The presentation from Ambra Burls was most interesting highlighting the importance of the ‘ecological self’ and why connection to nature and the outdoors is a vital human need. This highlighted why ‘ecotherapy’, ‘ecohealth’, ‘green care’, ‘natural health services’ and ‘green exercise’ are far from a passing ‘health craze’ but something that in an age of increasing urbanization and distance physically, socially and emotionally from nature needs to be embraced. It is a broad and evolving area embracing a diverse range of health and well-being related activities that cover and often interconnect physical and mental health.
During the conference not only did I personally discover how some of the opportunities for health and well-being are being rolled out beyond the clinics and hospitals, but I had the opportunity to look again at what health ‘is’ and what this means for people and socially. Importantly we all need to remember that in terms of public health, maters of health is not a level playing field, those who are most disadvantaged in our society have the poorest health outcomes as Jessica Allen’s presentation made clear . If outdoor recreation and activity is to be employed as a health intervention then matters of inequality, social inclusion and community development must be a critical element.
Finally going back to the very start of the conference – we certainly did get the opportunity to get direct experience for our how we are all beneficiaries of the ‘ecosystem services’ gifted to us by nature and the great outdoors. If the profound health assets of the outdoor environment are to be fully achieved and we must take care to protect these natural resources so that they will be here for the benefit of our future generations too.