Panel Discussion

The Role of State Offices in Connecting Outdoor Recreation with Public Health and Wellness

Facilitated by Noah Wilson, President of Emergent Opportunities Inc. and project manager for the Growing Outdoors Partnership, the workshop kicked off with a panel discussion of major programs and work currently underway at the intersection of the outdoor recreation and public health at the state level. 

Cailin O’Brien-Feeney (OR), David Knight (NC), Domenic Bravo (WY), Rachel VanderVoort (MT), David Weinstein (OIA), and Janette Heung (CO) during the panel discussion

Panelists were as follows:

Panelists agreed that current and emerging research on the health benefits of outdoor recreation offers the potential for states to develop and implement programs around public health objectives. Such an approach aligns with the goal of The Confluence Accords as well.

Two main points emerged from the discussion:

  • Numerous conversations and initiatives are currently underway at the intersection of outdoor recreation and public health across sectors in every state 
  • State offices are in a unique position to foster cross-sector collaborations necessary for the advancement of public health and outdoor recreation initiatives

Panelists agreed that current and emerging research on the health benefits of outdoor recreation offers the potential for states to develop and implement programs around public health objectives. Such an approach aligns with the goal of The Confluence Accords as well.


In her capacity as Deputy Director of Colorado’s Office of Outdoor Recreation, Janette Heung was the lead author of the groundbreaking Outdoor Rx report. The report outlines a framework for incorporating nature into health and wellness policies and programs through three different strategies—individual, organizational, and environmental—all with an underlying science-based approach. 

Janette Heung (center) at the Nature Rx think tank at SHIFT. Heung was the lead author of Colorado’s groundbreaking Outdoors Rx report

In her presentation, Heung highlighted the importance of a holistic approach to recreation access, and to integrating outdoor recreation into the broader social determinants of health, particularly as the world continues to urbanize. Heung noted that by 2050, the UN estimates that two-thirds of the world will be living in a city, which in turn underscores the importance of incorporating nature and green space in urban areas. 

She also emphasized the importance of nature contact to early childhood development, and the link between early introduction and appreciation. “If not introduced to nature by age 12, you’re much less likely to appreciate it,” she said.

She noted that outdoor recreation can be an essential ingredient of a population health approach, building healthier communities and taking advantage of opportunities such as employee health and wellness programs. 

Colorado’s progressive State Medicaid System is increasingly focused on value-based care, better integration of physical and behavioral health and addressing social determinants of health. As such, it allows for these concepts to be implemented on the ground today. This presents an opportunity to elevate the role of outdoor and green space access as a core social determinant of health, opening the opportunity for healthcare payers, providers, outdoor-oriented nonprofits, and parks and recreation entities to align incentives and jointly promote recreation opportunities to improve public health. 

Heung also emphasized the importance of the metrics behind nature contact. “The healthcare industry wants numbers and data,” she said. “As such, it’s important to design your systems and programs to track and capture metrics.”

According to Heung, with good data, it will be possible to integrate outdoor recreation into the healthcare system. This in turn will allow healthcare providers to prescribe time outside from within the clinical system. An evidence-based approach, supported by data, also plays an important role in engaging people who aren’t as familiar with the health benefits of outdoor recreation.


Wyoming’s State Parks and Outdoor Recreation Office engages communities state-wide. The office is unique in that, while it houses both the State Parks and Outdoor Recreation offices, the two entities maintain their own specific charters, missions, and goals.

Domenic Bravo (third from left) listens as Cailin O’Brien-Feeney makes a point during the panel discussion. Also pictured are David Knight and Rachel VanderVoort

Domenic Bravo, the Office’s Director, noted Wyoming is currently redeveloping their State Comprehensive Outdoor Recreation Plan (SCORP). While the state’s SCORP will include planning around public health objectives, Bravo did not expect it to call them out specifically, noting that they will be more strongly represented in the Department of Health’s health assessment for the state.

Bravo’s office worked with the Department of Health on its State Health Assessment, a multi-sectoral, multi-partner collaborative process that creates a roadmap for Wyoming health departments and their partners to identify important health-related issues and inform health improvement planning. 

Bravo’s office has seen great success with their programs for at-risk youth, including their Wyoming Kids eXtreme activities, which encourage youth and families to experience, explore, and engage in Wyoming’s cultural and natural resources. Bravo furthermore noted that the benefits of such programs far outweigh the costs.

Other initiatives spearheaded by the office that are centered around health and outdoor recreation include:

  • Summer Outdoor Slam, which provides exposure to outdoor events that children might not otherwise get to experience
  • The annual First Day Hikes, held January 1 in state parks around the state. Similar to the Summer Outdoor Slam, the events introduce state parks to people who might not otherwise experience them

Bravo’s office is also in discussion with Blue Cross Blue Shield of Wyoming to help advance public health and wellness objectives via outdoor recreation. For example, Wyoming has entered its trails and parks into the national database of Parks Rx America, a non-profit organization whose mission is to decrease the burden of chronic disease, increase health and happiness, and foster environmental stewardship, by virtue of prescribing Nature during the routine delivery of healthcare. Bravo’s office is currently working on a partnership with Blue Cross Blue Shield of Wyoming to offset the costs of this data entry and help with marketing and promotion of the results.


Rachel VandeVoort, Director of Montana’s Office of Outdoor Recreation, noted that Beth Shumate, Parks Administrator for Montana Fish, Wildlife, and Parks, is currently leading the state’s efforts on outdoor recreation and health. In Montana, according to VandeVoort, efforts to connect health and the outdoors have been underway for several years. 

Participants during the panel discussion listen in

Montana is exploring ways to utilize all of its public lands for health and wellness, such as through the Montana Trails Rx Program, the goal of which is to is to increase daily physical activity among Montanans, especially those who are physically inactive or faced with chronic disease.

VandeVoort’s office has also partnered with the Montana Department of Public Health and Human Service to develop the Building Active Communities Initiative, which supports community-led approaches to develop active and healthy communities so that people of all ages, abilities and income levels can safely walk, bike or take public transportation to places they need to go.

The Montana office’s directives regarding health and wellness include launching a joint initiative between outdoor recreation and health care stakeholders in 2019. VandeVoort is also seeking to expand partnership efforts with Blue Cross Blue Shield and other insurance/healthcare providers within the state.

North Carolina

North Carolina is home to four of the ten poorest counties in the nation. Providing low-cost health and wellness programming through outdoor recreation is thus of great interest to its Outdoor Recreation Industry Office, according to the office’s Director, David Knight. 

David Knight (L) listens in as participants workshop opportunities to advance public health and outdoor recreation priorities

In his presentation, Knight highlighted three key population groups his office is focused on: 

  • Military bases and organizations that support the military are prioritizing outdoor recreation as a major aspect of treating PTSD and other combat-related mental health issues
  • Disaster victims (from recent hurricanes and floods): The state is emphasizing outdoor recreation for post-natural disaster, post-traumatic stress and physical health recovery
  • Minority groups from across the state, by supporting other state-level programs working with lower socio-economic groups

Knight also highlighted the ways the state’s largest health insurance company, Blue Cross/Blue Shield, is using outdoor recreation as a major incentive for lower insurance rates.

In particular, he noted that the Blue Cross Blue Shield of North Carolina Foundation has invested in nature and trails via a number of grants totaling $2 million with the Blue Ridge Parkway Foundation’s Kids In Parks (which won the 2018 SHIFT Award in the Youth Engagement category) and its “TRACK Trails” program.


Oregon is in the process of establishing its long-term plan for its newly created Office of Outdoor Recreation. Director Cailin O’Brien-Feeney noted that health and wellness is emerging as a key pillar in their planning. 

O’Brien-Feeney leads a breakout session during the workshop

In 2017 the state recorded 794 million user days for outdoor recreation. Building on these user days, it will be a priority for the state to focus on access and opportunity to open spaces, buildinganetwork of users and partners,andquantifying datato back findings and reasoning behind decisions. 

For example, in January 2019, Oregon Parks and Recreation Department released a report that noted that “Oregonian’s participation in outdoor recreation activities saves the state $1.4 billion annually in healthcare costs.”

Outdoor Industry Association

As the trade association of the outdoor industry, OIA represents more than 1,300 member companies across the country. David Weinstein, the OIA’s State and Local Policy Director, noted the organization’s keen interest in the topic of health and wellness because of the opportunities it provides to:

  • help grow the industry’s customer base while cultivating healthy habits
  • increase brand awareness with new communities and activities

That said, the organization has yet to take a formal stand on public health. An unpublished paper by Sara Griffith et al is the most substantive foray the OIA has yet made into the space.

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