2. Partnerships with Health and Wellness Stakeholders

Participants at the 2018 workshop take advantage of the weather during the breakout sessions

Workshop participants agreed on the value of developing partnerships between outdoor recreation leadership positions and health and wellness stakeholders. The advancement of health-and-wellness objectives is more effectively achieved via collaboration than by working in silos. Collaboration among a variety of stakeholders also provides different perspectives and a better understanding of different realities.

The Colorado Outdoor and Health Collaborative’s Colorado Outdoor Rx report emphasizes collaboration as one of the guiding principles of an effective cross-sector approach: “Partners and stakeholders work together to develop outdoor and health initiatives by engaging public and private partners from conservation, healthcare, and outdoor industries. The diverse sectors contribute their complementary skills and resources to the common goal of improving health through time outside.”

Key recommendations from SHIFT that can be put into action quickly

Hone Message Delivery

Participants agreed that intentional, specific messages about the health care benefits of outdoor recreation programs and initiatives will help facilitate innovative partnerships that can in turn fulfill shared visions. Takeaways include:

  • Identify appropriate messengers for each community
    • The messenger matters. Different communities require different messengers. Whenever possible, it’s important to craft not only the right message for the right audience, but to also have it delivered by someone who has that audience’s trust 
  • When seeking to advance an outdoor recreation initiative, consider leading with a health care message rather than a conservation message, which runs the risk of limiting potential allies
    • Participants noted that objectives and priorities framed within a conservation message reach a finite audience and carry a risk of alienating potential partners for whom conservation is not a priority. Leading with a public health message can add credibility, increase the attention of groups outside the outdoor and conservation communities and secure buy-in from a broader audience
    • For example, leading with the argument that time in the outdoors improves mood, concentration, and increases exercise can create a more powerful, bipartisan message than focusing on conservation priorities alone
  • Speak to local and regional health priorities 
    • Make sure the message you are trying to deliver aligns with the needs of the community you are delivering it to 
    • According to this paper, messaging should include contextualized regional priorities (economic drivers, prevailing beliefs, culturally-specific references, etc.) and how they tie into the outdoors 
  • Build a business case that is informed by different industries
  • Have a spokesperson present at conferences and events
    • Take advantage of opportunities to present your message to influencers and audiences in different sectors

Refine Message Content

When delivering a message, take the time to make sure it is accessible to the audience to which you’re delivering it. Doing so will provide recipients with a better takeaway that they can use to remind themselves and to share with others.

Bring people together

Convening representatives from different stakeholder groups creates more nuanced perspectives, stronger coalitions and more powerful arguments. 

  • Create shared values—e.g., access, equity, prevention, economic prosperity
    • That which unites us is more powerful than that which divides us. Identifying common priorities helps create stronger collaborative opportunities 
    • Although the primary goal of the Utah Outdoor Recreation Infrastructure Grant is to build recreation infrastructure, healthcare and university professionals help review the grants, ensuring Utahns can live a healthy active lifestyle through recreation
    • Blue Cross and Blue Shield of Kansas (BCBSKS) partnered with the Kansas Department of Wildlife, Parks and Tourism to sponsor Healthy Trails Adventure Day on Oct. 1, 2016. Healthy Trails Adventure Day featured free admission to all 26 Kansas State Parks, which include more than 500 miles of trails, 32,200 acres of land and access to more than 130,000 surface-acres of water
    • Founded by Colorado’s City of Westminster, Rx for Health is a growing coalition of healthcare and parks/recreation professionals that aims to connect patients from a clinical setting to local recreation centers and programs. Through a series of planning and outreach meetings in Spring 2018, over a dozen parks and recreation agencies and healthcare practices from the Greater Denver Metropolitan area have joined the movement.
  • Host events 

Aggregate, share data 

Data, including both the evidence for the public health benefits of outdoor recreation and its health care costs savings in terms of deferred costs, is one of the great missing links in the movement to promote nature as a social determinant of health. Wherever possible, participants agreed that state leadership positions should coordinate on the collection, aggregation and sharing of date, both among stakeholders and via partnerships at the state level, and and across states among the various offices themselves.

Best practices for collaborations between outdoor recreation and health and wellness stakeholders

Fund and incentivize reciprocal relationship

Mutually-beneficial relationships are key to any successful partnership. The benefits of collaboration, and the sources of funding for collaborative ventures, need to be clear, desired, and sustainable for both parties. Some examples of blended funding between the outdoor and healthcare spaces are as follows:

  • Incentivize insurance providers and health care stakeholders to fund outdoor recreation
    • Blue Cross Blue Shield of North Carolina Foundation has invested $2 million with the Blue Ridge Parkway Foundation’s Kids In Parks and its “TRACK Trails” program
    • Blue Cross and Blue Shield of North Carolina (Blue Cross NC) teamed up with North Carolina State Parks and other hiking experts to create a new initiative focused on making it easier to enjoy North Carolina’s outdoors. The initiative, named Go Hike NC, incorporates a series of more than 60 guided hikes in North Carolina’s state parks, nature preserves and outdoor spaces across the state.
  • Create incentives for incorporating health outcomes of outdoor recreation into planning
    • Colorado’s Outdoors Rx report recommends that investments in getting people outdoors may be increased by aligning with value-based care opportunities, such as: 
      • State Medicaid, Medicare, or accountable care entities that align payor and provider incentives to focus on value instead of volume of care (e.g., incentivizes healthcare payors and providers to incorporate social determinants of health into their care delivery and refer members to community resources) 
      • Commercial programs that incorporate pay-for-performance or other value-based payment streams to reward healthcare providers for patient outcomes and meet certain quality health metrics (e.g., The Colorado Hospital Transformation Program offers incentive payments to support hospital-led projects related to care integration, integration of physical and behavioral health, and population health management)
  • Educate employers about the health benefits of outdoor recreation for their employees so the employers can empower (and incentivize) their employees to get outdoors
    • From Colorado’s Outdoors Rx report:
      • REI operates the “OptOutside” campaign, which encourages employees, and customers, to spend time in the outdoors. As part of the OptOutside campaign, REI has closed its physical store doors as well as internet sales on Black Friday. In 2016 this campaign resulted in 6.7 billion media impressions, 1.7 billion social impressions, and encouraged 1.4 million people to get outside on the busiest shopping day of the year.
      • One of the signature programs of the Center for Health, Work, and Environment is Health Links, which collaborates with employers to build a culture of health and safety in the workplace. Not only does Health Links provide assessments of organizations’ health and safety policies and programs, the program also provides trainings for employees focused on mental health, physical health, and continuing education. Over 400 organizations from a variety of sectors and industries have connected with Health Links to become recognized as a Health Links Healthy Business. 
      • By empowering value-based purchasing, The Colorado Business Group on Health is able to use power of numbers to promote change from within the current health system. Members include the US Olympic Committee, TIAA, Boulder Valley School District, and State of Colorado. These members are spread across the state, and represent thousands of voices within the healthcare system, private industry, and school districts.

Identify and Elevate Leaders

Champions for the health benefits of outdoor recreation exist across healthcare sectors and industries. Wherever possible and whenever organic, empower them to “carry the flag” for your programs and priorities.

  • Have physicians lead initiatives
    • Walk with a Doc, which provides the inspiration and the infrastructure for health care providers to meet with their community and spend time with them in a non-threatening environment outdoors, was founded by Dr. David Sabgir. Walk with a Doc is currently in  471 communities, 48 states and 25 countries. In 2018, the program had 160,000 walker visits led by physicians. 
    • Park Rx America is a community health initiative led by Dr. Robert Zarr that allows physicians to prescribe nature to patients and families to prevent and treat chronic disease and promote wellness. 
    • In Texas’ Lower Rio Grande Valley, 10 municipalities in Cameron County are collaborating to create the Lower Rio Grande Valley Active Transportation and Tourism Plan, or “Active Plan,” a 428-mile network of multiuse trails, bicycle routes and paddling trails aimed at connecting the region’s rich natural and cultural resources while addressing regional health crises such as diabetes and obesity. The plan is being championed by Dr. Rose Gowen, a local OB/GYN who also serves as a city commissioner for Brownsville.
    • In South Lake Tahoe, CA,Stephen Bannar, MD, worked with Khristy Gavigan, RN, and Joseph Flower, Wildllife Biologist, USFSto partner Barton Health, a not-for-profit health care facility, with Lake Tahoe Basin Management Unit, South Lake Tahoe’s local United States Forest Service (USFS) branch, to host cooperative Wellness Outings: guided walks that promote nature as medicine 
  • Engage with and listen to underserved groups
    • In Oakland, CA, the East Bay Regional Park District connects underserved groups to health and nature in public lands via their Park Rx and SHINE Programs. Their efforts have benefited thousands of children and adults who historically have underutilized parks. 
    • In Bozeman, MT, Eagle Mount Bozeman provides quality therapeutic recreational opportunities for people with disabilities and young people with cancer
    • Queer Nature is a queer-run nature education and ancestral skills program serving the LGBTQ2+ community. Their program envisions and implements ecological literacy and wilderness self-reliance skills as vital and often overlooked parts of the healing and wholing of populations who have been silenced, marginalized, and even represented as “unnatural.” 
  • Identify local champions for the health benefits of outdoor recreation
    • In Oregon, Chad Brown, a decorated US Navy veteran who received multiple honors after serving in Desert Storm Gulf War and Operation Restore Hope, Somalia, runs Soul River, Inc., a nonprofit that aims to share the healing power of rivers with veterans and inner-city youth.
    • In Jackson, WY, Ryan Burke runs the Mindstrength Project, which incorporates the fields of neuroscience, consciousness studies and evolutionary psychology into an addictions treatment program 

Create Easily Accessible, Easily Digestible Materials

Communicating the health benefits of outdoor recreation requires multiple touchpoints, all of which should be easy to find and easy to understand. Participants recommended the following:

  • Create knowledge base for sharing
  • Outreach with introductory material
    • Creating “stock” emails and printed materials that are succinct and contain links to relevant resources allows for easy customization
  • Create a white paper for the private sector
    • Sara Griffith, Jessica Gustafson, Ian Stafford recently completed a year-long capstone project with the Outdoor Industry Association that includes the development of two papers on the health benefits of outdoor recreation and how they can be used to shape new policies 

Collaborate for Promotion

Participants agreed that state outdoor recreation leadership positions should collaborate with partners in the health and wellness sector to promote the health benefits of time outside. Suggestions for ways to do so include the following.

  • Attend conferences of different industries 
  • Identify and attend state, local, and federal gatherings to promote the health benefits of outdoor recreation
    • Beth Shumate, state parks administrator for Montana Fish, Wildlife & Parks, served as the outdoor recreation representative at The Montana Healthy Communities Conference, which brought over 200 professionals from the community development and health and human services fields together to address “upstream” factors that influence health
  • Work with hospital and health care associations
    • Indiana Dunes National Lakeshore works with Porter Health System, a prominent regional health provider, to promote the use of the park for health and fitness along the 15 miles of southern shoreline of Lake Michigan and 15,000 acres of beach, woods, marshes, and prairie. Porter Health System healthcare providers write prescriptions for use along the Lakeshore. The National Park Service works to reach out to local communities to share information regarding opportunities for physical recreation on park lands
    • Working with the National Association for Community Health Centers (NACHC), The National Park Service Rivers, Trails & Conservation Assistance (RTCA) Program  developed a model for integrating physical activity in green space and parks into conversations health providers have with patients. The partnership placed Community HealthCorps Navigators (AmeriCorps youth) in community health clinics for 10 months. Two navigators per city connected clinic patients to nearby green space and led walks, fitness programs, and other outdoor activities with youth and senior citizens 

Who are some key allies in the health and wellness sector that outdoor recreation needs to work with to achieve collaborative success?

Partnerships with health and wellness stakeholders can help determine shared values and common goals, build relationships, and generate innovative partnerships that in turn fulfill shared visions. Key allies can be found in the following sectors.

Government

  • Municipal, State and National Parks 
    • The National Park Service’s Healthy Parks Healthy People program was established in 2011 to reframe the role of parks and public lands as an emerging, powerful health prevention strategy. With this renewed focus on health, the initiative hopes to bring about lasting change in Americans’ lifestyle choices and their relationship with nature and the outdoors.
    • Healthy Parks Healthy Person Tennessee is being shared by State, County, and City parks as well as in healthcare facilities, private businesses, and communities throughout the entire state to create positive change in Tennessee’s health outcomes while at the same time creating new stewards of Tennessee’s natural spaces 
  • Centers for Disease Control and Prevention
    • Maine Bureau of Parks and Lands has partnered with Maine Center for Disease Control to utilize the RALA data set specifically to generate positive health outcomes. The end goal of this analysis will be recommendations within their SCORP that encourage investments in outdoor recreation facilities that are proximate to populations that will directly benefit from that project, and or to fit identified needs for outdoor recreation investments and therefore will have a greater probability of being enjoyed by the public.
    • The CDC’s Community Preventive Services Task Force recommends built environment approaches that combine one or more interventions to improve pedestrian or bicycle transportation systems (activity-friendly routes) with one or more land use and community design interventions (everyday destinations)
    • Action Communities for Health, Innovation, and EnVironmental changE (ACHIEVE) and Communities Putting Prevention to Work (CPPW) are federal programs supported by the Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services (HHS) that empower local park and recreation agencies to bring together local leaders and stakeholders to implement policy and environmental changes that promote healthier lifestyles and reduce the risk of chronic diseases such as obesity, diabetes, arthritis, cardiovascular disease, stroke, and cancer
  • Federal Land Managers
  • Local and Regional Governments
    • In Michigan, the Outdoor Adventure Center in downtown Detroit created an innovative destination that provides hands-on options for Metro Detroit youth and families to experience and learn about the abundance of outdoor recreation opportunities in Michigan. The project was catalyzed by Governor Engler and overseen by the Department of Natural Resources. In 2016, its first full year of operation, the OAC saw 100,000 visitors
    • Healthy Hastings is a collaboration of agencies in the City of Hastings, Nebraska, whose purpose is to improve the health of the community through effective policy change, program enhancement, and advocacy for healthy lifestyles. Originally led by a group of civic leaders that included city council members, the mayor, public employees, local business representatives and leadership from local nonprofit organizations, the initiative developed “Complete Streets”—an infrastructure of sidewalks and trails to encourage walking and biking

Community Leaders

  • Faith-based organizations
    • Let’s Move! Faith and Communities was launched to help faith-based and neighborhood organizations promote healthy living for children and communities
    • GirlTrek, a nonprofit organization that inspires and supports African-American women and girls to live their healthiest, most fulfilled lives, simply by walking, works to address the problems that lead to childhood obesity. They launched “Prayer Treks” to give women an opportunity to jumpstart more active lives while practicing random acts of kindness and learning healthier habits for eating, stress management and fitness.
    • In California, the East Bay Regional Park District works with church leaders and faith-based organizations to reach out to the diverse communities it serves
  • Veterans and military families
    • The Wounded Warriors in Action Foundation serves our Nation’s combat wounded Purple Heart recipients by providing world-class outdoor sporting activities as a means to recognize and honor their sacrifice, encourage independence and connections with communities, and promote healing and wellness through camaraderie and a shared passion for the outdoors.
    • Outward Bound for Veterans helps thousands of returning service members and recent veterans readjust to life at home through powerful wilderness courses that draw on the healing benefit of teamwork and challenge through use of the natural world
    • Force Blueis a nonprofit uniting the community of Special Operations veterans with the world of coral reef conservation for the betterment of both. Veterans with PTSD and traumatic brain injuries work to rehabilitate coral reefs, healing themselves in the process
    • Outdoor Recreation Therapy for Veterans Act establishes an interagency force to help veterans utilize outdoor recreation for medical treatment such as public lands access and hurdles within the research and medical community

Health-Care Community

  • Health Departments
    • In Jackson, Wyoming, the Teton County Public Health Department worked with Jackson Parks and Recreation Department and the Bridger-Teton National Forest to enter the county’s trails into the Parks Rx America database
    • The Miami-Dade (FL) Parks, Recreation and Open Spaces Department,  supported by the Miami-Dade Health Department and a variety of other agencies, is developing a Parks and Open Space Master Plan to reduce park inequity and increase physical activity
    • In Hawaii, as part of the Mayor of Kauai’s efforts to address a decline in health of local residents due to sedentary lifestyles and unhealthy eating habits, the Kauai Parks and Recreation Department collaborated with the Kauai District Health Office, Kauai Path, Inc., and a collection of other organizations — local, county, and federal — to develop Ke Ala Hele Makalae, a coastal multi-use path for biking, walking, and running.
  • Integrated health systems 
    • The primary focus of integrated health systems is to provide seamless care or coordinated care for patients and their families. The theory is that it will lead to a higher quality of care as well as better health outcomes for patients by making sure a patient transitions appropriately through the healthcare system
    • Beckers’ Hospital Reviews publishes the review, 100 Integrated Health Systems to Know
  • Physicians and clinicians’ professional organizations
    • The American College of Lifestyle Medicine is a professional medical association for physicians, medical professionals, allied health professionals and those with professional careers devoted to advancing the mission of lifestyle medicine that considers nature a social determinant of health
    • The American Board of Integrative Medicine considers all factors that influence health, wellness, disease – including mind, body and spirit
    • The Association of Nature and Forest Therapy is a research-based framework for supporting healing and wellness through immersion in forests and other natural environments inspired by the Japanese practice of Shinrin-Yoku
  • Hospitals
    • The Colorado report notes that one of the opportunities for the outdoor and conservation industries to align with the healthcare industry is through the community benefits requirements of non-profit hospitals. Non-profit hospitals receive financial benefits from their tax-exempt status—valued at $24.6 billion in 2011. In light of recent changes outlined in the Affordable Care Act (ACA) there is a renewed effort to refocus a larger percent of these funds towards community benefit activities. While costs of charity care remain a recognized community benefit activity, other cash and in-kind contributions to specific community-level health improvement activities are also recognized (e.g., hosting a health screening). Furthermore, hospitals can claim community development activities such as investments in housing or environmental improvements (e.g., parks, trails, healing gardens) if there is documentation that such investments are linked to health improvements.
    • Non-profit hospitals are required to conduct community health needs assessments (CHNA) every three years along with an implementation strategy that addresses the needs identified during the CHNA. To increase engagement of healthcare sectors in the outdoors and nature, conservation and parks and recreation organizations can evaluate a hospital’s CHNA priority health issues, and align their nature and recreation proposal to address the hospital region’s community health goals. Depending on local needs, this may include support of a parks improvement project or creation of a healing trail around the hospital.

Insurance

  • Accountable Care Organizations
    • Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers who come together voluntarily to give coordinated high-quality care to their Medicare patients. 
    • The Colorado Accountable Care Collaborative is an innovative program designed to pay providers for the increasing value they deliver while better coordinating care for members. A hybrid of a traditional accountable care organization and a primary care case management system, Colorado’s Accountable Care Collaborative works to improve quality and access to care as well as reduce costs for Health First Colorado, the state’s Medicaid program.
  • Employer health initiatives
    • Johnson & Johnson (J&J), which has instituted culture of health programs, reports that, “Our biggest challenge is in the area of physical activity. Just over 36 percent of employees report they are not sufficiently active, compared to the national target of 20 percent.” To address this, the company provides employees with pedometers, and organizes team competitions to encourage more physical activity.”
    • Vail Resort’s Epic Wellness Program highlights the wide variety of mental, physical, and financial wellness resources available to Vail Resorts employees, their dependents, and household members
    • Along with encouraging people to spend time outdoors, Colorado-based companies such as Ground Floor Media and Forum Phi Architecture actively encourage their employees to take advantage of team building and coworker-led hikes, bike rides, and ski sessions during the business day as a break from the standard 9-5 schedule
  • Insurance providers
    • Blue Cross and Blue Shield of Kansas (BCBSKS) partnered with the Kansas Department of Wildlife, Parks and Tourism to sponsor Healthy Trails Adventure Day on Oct. 1, 2016. Healthy Trails Adventure Day featured free admission to all 26 Kansas State Parks, which include more than 500 miles of trails, 32,200 acres of land and access to more than 130,000 surface-acres of water.
    • The Boston Public Health Commission, the Boston Parks & Recreation Department, and Blue Cross Blue Shield MA are partnering to provide the Boston Parks Summer Fitness Series—free fitness programming in Boston Parks. The Fitness Series activates Boston parks while increasing opportunities for physical activity across Boston’s neighborhoods. 
    • The HPHP: Bay Area program, with generous support from Kaiser Permanente, has developed strong partnerships with local healthcare providers and the Golden Gate National Park, and is a core leader in the National ParkRx Initiative

Education

Education providers were one of the key partners recognized by SHIFT 2018 participants. In levels of higher education, partners could comprise researchers and scientists, helping the outdoor industry to create, study, and improve existing efforts. Their counterparts in K-12 could serve as champions for the benefits of outdoor exercise in their communities. 

  • Universities
  • School systems
    • Tennessee’s School Health Coordinators Office is working with Healthy Parks Healthy Person Tennessee to share the benefits of getting outdoors with more students across the state
    • Utah’s Every Kid Outdoors initiative is being developed to integrate with school systems

Associations

A number of healthcare organizations and associations share values and priorities with outdoor recreation leaders regarding the health benefits of outdoor recreation. A few examples provided by participants include:

Back to Breakout Discussions

One thought on “2. Partnerships with Health and Wellness Stakeholders

  1. John La Puma MD March 19, 2019 at 8:41 pm Reply

    This is a helpful summary of the professionalization of nature as medicine, or green medicine as it is coming to be called, and official relationships as discussed.

    Also identified during these discussions was http://www.agreenrx.com which many clinicians and researchers have found helpful as they seek to begin to learn about the actual data and mechanism of action which explain the therapeutic effect of nature as medicine.

    The site is updated regularly and kept current.

    Thanks for publishing these partnerships.

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