"Making the Natural Health
Service Work”
Stoke on Trent28 April 2015
Dr William Bird MBE, MRCGP
28 April 2015
© 2015 Intelligent Health
We were
designed to
be
connected
to nature
The Story
Yet 54% of the world’s population live in cities
Is this disconnection the underlying cause of the epidemics of obesity and other chronic diseases?Do we need healthy landscapes?
80 seconds ago
Mankind has evolved wellIf we take an hour to equal 1000 years then four days is 100,000 years; the time from the origin of mankind to today.
4 Days ago
10 hours ago 4 hours ago 9 minutes ago
4000 yrs civilisation10,000 yrs ago
Agriculture
Technology
100,000 yrs ago
Hunter gatherers
industrialisation
Fear and Chronic
Stress
PeopleLoneliness
PlaceHostile
PurposeRejection
Between 2007 and
2011 only 28% of
Americans said
that their stress
levels improved. American Psychological
Association 2012
• © 2015 Intelligent Health
© 2015 Intelligent Health
The Effect of Trees on Cognitive
Performance
-3
-2
-1
0
1
2
3
4
5
6
7
Digit Span Backward Test
No Tree Min Awareness
Mod Awareness Heightened Awareness
P=<0.001Lin, Ying-Hsuan, et al. "Does awareness effect
the restorative function and perception of street
trees?." Cognitive Science 5 (2014): 906.
Exposure to Neighbourhood Green Space and
Mental Health:
© 2015 Intelligent Health Beyer, Kirsten MM, et al. Int.J of environmental research and public health 11.3 (2014): 3453-3472.
Normalized
Difference
Vegetation Index
(NDVI)
© 2015 Intelligent Health
Association Between Trees,
Vegetation, Depression and Stress
© 2015 Intelligent Health
Place: Green space
moderates the effect
of stressful events
in children
Nearby Nature
A Buffer of Life Stress
among Rural Children
NM Wells, GW Evans
Environment and
Behavior May
2003vol. 35 no.
3 311-33
High Nature
Low Nature
0
2
4
6
8
10
12
14
Low Medium High
Psycho
log
ical S
tre
ss
Stressful events
High Nature Low Nature
1
1.2
1.4
1.6
1.8
2
2.2
No green Little green Some green More green Very green
In
cid
enc
e R
ate R
atio
Exposure to Green
Highest Income
Middle Income
Lowest Income
Linear (Highest Income)
Linear (Middle Income)
Linear (Lowest Income)
Place: Green space reduces Health Inequalities Mitchell, R. and Popham, F.
(2008) Effect of exposure to natural environment on health inequalities: an observational population study. The Lancet 372(9650):pp. 1655-1660.
Chronic Stress increases risk to Visceral Fat
Aschbacher, Kirstin, et al. "Chronic stress increases vulnerability to diet-related abdominal fat, oxidative stress, and metabolic risk." Psychoneuroendocrinology 46 (2014): 14-22.
© 2015 Intelligent Health
Visceral fat increases all cause mortality
OR 1.83 (1.23 to 2.73)
Kuk, Jennifer L et al. Obesity;2006;14: 336-341.
10% weight loss leads to 35% visceral fat weight loss
Janssen I, Ross R.. Int J Obes RelatMetab Disord. 1999;23:1035– 46.
Visceral Fat
Visceral fat reduction with exercise
-25
-20
-15
-10
-5
0
Lean Obese Type 2 Diabetes
% L
oss
of
Fat
Axis Title
Fat loss after 13 weeks of walking 60 mins a day and no weight loss
S/C Fat Viseral Fat
© 2014 Intelligent Health
Lee S et al. J Appl Physiol 2005;99:1220-1225
© 2012 Intelligent Health/NHS London
Brain Derived Neuro-trophic Factor
• Opposes Neuro-generative processes• Reduces Type 2 Diabetes in Mice• Increases Connectivity between Neurones• Improves Mitochondrial function in the
brain
Noakes T Spedding M: Olympics: Run for Your Life Nature 487, 295–296 (19 July 2012)
PA is Fundamental to Human Survival
More lives are saved by getting people fit
0
2
4
6
8
10
12
14
16
18
CardiorespiratoryFitness
Obesity Smoking Hypertension High Cholesterol Diabetes
Att
rib
uta
ble
Fra
ctio
n %
Axis Title
Men Women
© 2014 Intelligent Health
Blair S N Br J Sports Med 2009;43:1-2
Sedentary High fat diet and Stress
Mitochondrial DNA
Reactive Oxidative Species
Anti-Oxidants
Mitochondria
Oxidative PhosphorylationInner membrane
• © 2015 Intelligent Health
Manoli et al.Trends in Endocrinology and Metabolism Vol 18 No 5 2007McIntosh L et al. Neurotoxicology 17.3-4 (1995): 873-882.
Physically Active, low fat and not
stressed
Mitochondrial DNA
Oxidative Phosphorylation
Anti-oxidants
Mitochondria
• © 2015 Intelligent Health
“The mitochondria is like a dynamo it has to keep moving”
Prof Mike MurphyMRC Mitochondrial Biology Unit Cambridge University
© 2014 Intelligent Health
But with the weight of a 40 pound car battery
© 2012 Intelligent Health/NHS London
Telomeres get shorter
• © 2015 Intelligent Health
Epel, Elissa, et al. "Can meditation slow rate of cellular aging? Cognitive stress, mindfulness, and telomeres." Annals of the New York Academy of Sciences 1172.1 (2009): 34-53.
© 2012 Intelligent Health/NHS London
Telomere shortening
Epel, Elissa S. "Psychological and metabolic stress: a recipe for accelerated cellular aging." Hormones (Athens) 8.1 (2009): 7-22.
Hezel, Aram F., Nabeel Bardeesy, and Richard S. Maser. "Telomere induced senescence: end game signaling." Current molecular medicine 5.2 (2005): 145-152.
Senescence. The end of the cell.
1) People 2) Purpose
6) Poor Health Behaviour
Smoking Drinking Inactivity
5) Chronic Stress
7) Mitochondrial dysfunction, 8) Chronic Inflammation and 9) Telomere Shortening
10) Long Term Conditions (diabetes, CV disease, cancer, arthritis, COPD, mental health, dementia)
4) Resilience Stressors
2) Place
www.walkingforhealth.org.uk
• Europe’s largest walking scheme
• About 175,000 walks a year in 650 schemes (England only)
• 1.8 million contacts a year
• About 10,000 active volunteer walk leaders
Green Gym Vs Aerobics
Comparison of heart-rate response
during two sessions of activity
0
50
100
150
200
Time Minutes
Heart Rate
Green Gym
Step aerobicsV Reynolds 1999
OCHRAD
© 2015 Intelligent Health
The key purpose of Beat
the Street is to connect
people to place. In
Reading 15,000
residents will go to
parks that they had
never visited before
Days in the past week of 30 minutes or
more of physical activity (Reading)
© 2015 Intelligent Health
3 months after BTS
finished 53% of
participants met
activity guidelines
compared to 35% at
the start
• © 2015 Intelligent Health
Walking briskly
uses 3.5 METS
and can cover 3
miles an hour.
Walking is good
exercise
and it is free!
An exercise
class uses
3.5 METS
for 1 hour.
Walking 244,000
miles is the
equivalent of 3500
exercise classes
with 20 people in
each one.
Beat the Street Reading 2015
202 beat boxes
1. Boxes 0.5 km apart
2. Join a team : school,
community group,
workplace
3. Walk/Cycle/Run, tap, get
points
4. Tap two boxes within 1
hour to get 10 points
5. Points go to team total
6. Top teams win cash
prizes for
school/community
group/charity
Physical Activity as a means to an end
A better place to live and work (place)
More open parks and green space
More cafes and open squares to wander aimlessly
© 2012 Intelligent Health/NHS London
A stronger community (People)
Increased inter-generational connectionsIncreased volunteering
More family based events and activities
A stronger local economy (Purpose)
More successful local businesses More productive employees
Nature a means to an end
A better place to live and work (place)
More open parks and green space
More cafes and open squares to wander aimlessly
© 2012 Intelligent Health/NHS London
A stronger community (People)
Increased inter-generational connectionsIncreased volunteering
More family based events and activities
A stronger local economy (Purpose)
More successful local businesses More productive employees
So what is the future
• Long term conditions will soon leave the NHS financially unsustainable.
• On its own the NHS can treat these conditions
• But only with others can it prevent them.
• The natural environment is delicate but is our natural habitat (shared by many other species).
• The future of healthcare is using the natural health service.
• Nature to people and people to nature.
• © 2015 Intelligent Health
On Earth’s partall days start beautifullypatiently it revolves and revolves with its treesand oceans and lakesdeserts and volcanoesthe two of us and the rest of youand all the animals
Petur Gunnarssonone