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Professor Muir Gray, head of Knowledge for the NHS, responded: ‘We should hit patients with carrots’, when questioned about the rising obesity epidemic. The NHS cannot tackle it on its own and recent reviews have shown that altering the physical environment is a major component to combating the problem. The natural environment has a vital role to play as the carrot because major studies indicate that being near accessible green space can increase levels of physical activity.1
Natural England is campaigning for accessible quality green space near every home because this provides the opportunity for people to be more active.
Dr Fitzpatrick in the BJGP last month suggested that the Natural England health campaign is both fascist and sinister and then included some gross inaccuracies such as ‘supported by a £500 million budget’.2 If only! £500 million is the total budget of Natural England, which employs 2500 people to conserve the natural environment and promote access to it including our national parks, coastline, woodland, and environmental spaces in our towns and cities. The health campaign team consists of a handful of people, most of whom, like myself, have other work. It is unfortunate that Fitzpatrick didn't mention any solutions for patients or appear to have a grasp on the substantial and mounting evidence linking green space and health. I am sure that the Chinese Association in Islington would love to invite him to their own successful Health Walk scheme near to Dr Fitzpatrick's practice. They have worked hard to encourage many sedentary and isolated people to become active using the small areas of green space in this tight urban environment.
It was a problem with inactivity of my diabetic patients that led to Walking the Way to Health and Green Gym 10 years ago. There are now 20 000 trained volunteers who give up their time to lead Health Walks throughout the UK. Research has shown that the two most cited reason why patients continue walking are to improve their fitness and a chance to be in the countryside (green space). Green space even comes ahead of social benefits or losing weight and other physical benefits.
Proximity to green space can increase physical activity levels. We know that physical activity on its own halves the risk of developing CHD, diabetes, colon cancer, and stroke; reduces disability in osteoarthritis; and halves the admission of COPD patients. Lifelong physical activity significantly reduces the risk of developing breast cancer and Alzheimer's.3 A Japanese study found that the 5-year survival of senior citizens increased with local access to more walkable green streets and spaces regardless of socioeconomic status.4 A Dutch study has shown that for every 10% increase in green space there was a reduction of symptoms equivalent to a population being 5 years younger.5
Being in green space has an almost immediate physiological effect by reducing blood pressure, pulse rate, and muscle tension. Viewing greenery as opposed to concrete increases α-wave activity in EEGs, increases concentration, and reduces aggression among older people in nursing homes. Views of greenery from the ward window reduces length of stay in hospital following operations, with less analgesia being required.4
Accessible green space is only part of the solution to deal with inactivity and poor mental health, particularly among very young and older people. Yes, more research is needed to quantify the link, but unless we campaign now there will be no green space left to benefit patients for the future. Now that is sinister.