London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

CONTENTS PAGE EXECUTIVE SUMMARY 2

PARKS AND GREEN SPACE HEALTH REPORT 9

1.0 INTRODUCTION 10

2.0 THE PARKS FOR HEALTH INITIATIVE 15

3.0 POPULATION HEALTH PROFILES 17

4.0 THE PARKS FOR HEALTH SURVEY: IMPROVEMENTS & INTERVENTIONS 24

5.0 HEALTH PROMOTION INITIATIVES 31

5.1 INTRODUCTION 31 5.2 SOCIAL PRESCRIBING 31 5.3 WORKPLACE WELLBEING 34

6.0 ACTIONS AND RECOMMENDATIONS 36

7.0 CONCLUSION 38

BIBLIOGRAPHY 40

APPENDIX 1 Green Spaces Health Framework 42 APPENDIX 2 Parks for Health Assessment: Strategy Report 43

Tisdall Associates are a Registered Practice of the Landscape Institute. In preparing this report, the Practice draws on qualifications and experience in Landscape Design, Environmental Science and Public Health. As Director, Richard Tisdall was also a co-author of the Landscape Institutes Position Statement, Public Health and Landscape Creating Health Places, and has spoken at national and international conferences on this important subject. The Parks for London Charity have assisted in refining the Toolkit and supporting its application. As new academic research becomes available, the results of that research will be assessed, and the methodology and associated guidance reviewed, and updated. Whilst based upon professional interpretation of current evidence and applicable to the United Kingdom, the evidence arises from international research. The application of the Parks for health Toolkit outside the UK should be reviewed by the reader and interpreted according to context, culture, legal framework and experience. In that the implementation of any initiatives rests with local decision making and is outside the control of Tisdall Associates, neither publisher nor author take any responsibility for the interpretation and practical implementation of works resulting from the interpretation of the survey, or and resulting assessments, results or application of the findings and recommendations. © Tisdall Associates Ltd All Rights Reserved 2019

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London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

EXECUTIVE SUMMARY

Introduction 1. Tisdall Associates, a Registered Practice of the Landscape Institute, has been instructed by the London Borough of Lambeth to prepare a Parks and Green Spaces Health Report for Ruskin Park. This is in response to the Local Labour Party 2018 Manifesto Pledge which stated that “Our parks are key to good physical and mental health, so we’ll pilot a new programme of ‘Health Parks’, starting with Ruskin Park next to Kings College and Maudsley Hospitals and roll out innovative health, recovery and fitness projects across other Lambeth parks and open spaces” The survey of the Park was undertaken in February 2019 by Tisdall Associates utilising the Parks for Health Assessment Toolkit, developed by Tisdall Associates. In terms of structure, this report is guided by the Green Spaces Health Framework (Appendix 1)

2. The Green Spaces Health Framework provides a context for this report. it places Parks within Primary Prevention and through practical improvements and Health Promotion, allows them to be used to promote the health and wellbeing of local communities. The Parks for Health Toolkit (upon which this Assessment is based) has evolved following a series of steps: • An extensive review of the evidence base demonstrating the association between green space and health. • The identification of elements and characteristics of a Park which have been associated with health and wellbeing. • The categorisation of these elements into identifiable criteria. • The development of a methodology to measure the health status of a Park, to deliver outputs which demonstrate that status. • The identification of practical improvements and new interventions, addressing Parks as determinants of health • The identification of Health Promotion Initiatives; be they associated with community groups, public health, social prescribing or Workplace Wellbeing

3. The quality and use of Parks, Green Spaces and the Natural Environment have been demonstrated by research to have a beneficial effect upon health and wellbeing. Access to these spaces can contribute to the prevention and treatment of obesity, non-communicative diseases and mild mental ill-health. In addition, they can help mitigate some environmental impacts; air pollution, temperature extremes, UV radiation, noise etc. As such they can have a bearing upon avoidable medical conditions associated with these risk factors. On this basis it has long been argued that Parks and Green Spaces should be valued for their contribution to Primary Prevention and treatment of avoidable diseases, rather than simply as land valued at £1.00, and with ongoing maintenance costs. Fields in Trust recently identified the following benefits associated with Green Spaces:

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London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

• The Total Economic Value to an individual is £30.24 per year (£2.52 per month). • The Wellbeing Value associated with the frequent use of local parks and green spaces is worth £34.2 Billion per year to the entire UK adult population. • Parks and green spaces are estimated to save the NHS around £111 Million per year based solely on a reduction in GP visits and excluding any additional savings from prescribing or referrals.[1]

4. In order to deliver on this Value, Parks and Green Spaces must be seen from the perspective of Public Health. This brings with it the following key principles which undergird the approach taken in developing this Health Report: • Addressing Issues “Upstream”: Public Health has to do with addressing factors which cause disease before the medical conditions develop. • The Evidence Base: There is extensive scientific evidence which demonstrates the association between green space and health. • Determinants of Health: As demonstrated by the Social Determinants of Health [2] and the Health Map [3] environmental factors can have a significant impact upon the health of a local population; for better or worse. Parks and Green Spaces represent an important component of the built environment, and as such the quality and variety of these places and spaces has to be considered in any assessment of their potential health benefit. • Health Promotion [4]: These include a series of approaches which optimise the use of health promoting parks and green spaces. They may be generated through community groups, Social Prescribing or Workplace Wellbeing programmes, and include the following application: • Medical: To identify those at risk of disease, and levels of avoidable ill-health in a population • Behaviour Change: To encourage individuals to take responsibility for their own health and choose healthier lifestyles • Education: To increase knowledge and skills about healthier lifestyles • Empowerment: To work with individuals and communities to address perceived needs • Social Change: To address inequalities in health-based interventions, status and conditions

Local Context 5. A number of activities and events are already provided by the Friends of Ruskin Park which have a positive bearing upon health and wellbeing. These include:

• Liaison with local GPs and the within the context of Social Prescribing, and the South London and Maudsley NHS Trust (SLaM) • Litter Picking, Community Gardening Sessions and Health and interest walks. Heritage wheat growing, and additional events led by others

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London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

• Community events including a Christmas market in December, a Summer Fete in June, a Harvest Community Day, and fortnightly bandstand events • Future plans also include the development of the SLaM Recovery College in the former stable block in the Park 6. Plans for capital improvements, including: • Sports, fitness and play facilities • The former stable block • The Denmark Hill entrance • The listed Mendelsohn Sundial • Signage and wayfinding and a health and wellbeing pilot

These demonstrate a track record of health-based interventions and represent a sound basis for future initiatives and interventions.

Health Profile of Lambeth 4. Public Health England (PHE) Health Profiles provide information on the health and wellbeing of a local population. This includes a range of conditions, including non-communicative diseases, obesity and expressions of mental ill-health. The health of individual Wards has also been assessed. This information reveals that in the most deprived Wards of Lambeth, life expectancy is 5.9 years lower for men and 4.0 years lower for women than in least deprived areas. This information also shows that several medical conditions, influenced by the presence and use of Green Spaces are significantly worse that the average for England. These are:

• Life expectancy at birth (Male) • Under 75 mortality rates: All causes • Under 75 mortality rates: Cardiovascular • Diabetes Diagnosis (17+) • Obese Children (aged 10-11)

The following were not significantly different from England, but worse than the regional average • Under 75 mortality rates: Cancer • Suicide Rate

At a more local level the following information indicates that for many avoidable conditions, the South East Locality (including Herne Hill Ward) are worse that average. • Obesity in Children at reception year and year 6 (Fig 6) • Stroke & All Cancers (Fig 7) (Fig 8) These conditions represent personal suffering, and a cost to society, the NHS and the Council. As such there is a strong case for treating those at risk of developing such conditions within Primary Prevention (before they present), rather than through Primary Care (after they have developed the condition).

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London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

6. Health Status By utilising the Parks for Health Assessment Toolkit, it has been possible to determine the current health status of Ruskin Park, areas for improvement and potential new interventions. From this assessment, Fig 1 below shows the Current Health Status, the extent of elements which are ‘Present, but in need of improvement’ and the improved health status if all improvements are made.

Figure 1 Potential Health Status within Primary Criteria

From this assessment it is possible to ascertain that the current health status within each of the Health Criteria lies at c 45% or above. Most strikingly, the status of the Environment and Biodiversity lies at 73%, indicating a strong basic level of provision within this criterion. The greatest potential for improvement lies in Accessibility with a 30% potential enhancement. Community Initiatives and Mental Wellbeing have the potential to increase by 20% and 19% respectively, whilst Physical Activity can be increased by some 12%. Overall it is apparent that significant improvements can be made to the health status in four of the five health categories. It should also be noted that these improvements do not yet identify potential new interventions, which would bring additional benefit. All such improvements will allow better use of the existing facilities for health, and many will represent a Low Cost/ High Impact intervention.

Improvement: (Making improvements to facilities which whilst present are not in a condition in which they are optimised for health benefit) Each of the ‘Improvements’ is identified in the Report, and includes the following examples: • Improved signage to create a sense of welcome, and signage in the wider area • Improvement of the condition of some facilities • Increased public art, elements and statuary • Improvements in Natural Play and outdoor games

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London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

New Interventions 6. New interventions are elements which whilst not currently present, would be in keeping with the scale and character of the Park, and as such are appropriate for consideration. The decision as to which of the new interventions is selected, rests with the Council, representatives of the Friends of Ruskin Park (FoRP) and the local community. The reliance on local knowledge and priorities is an important part of engaging the local community in this process and can build community cohesion. It is also the case that it may not be possible to select every new intervention. New Interventions were identified in each of the Primary Health Criteria. The following list provides some examples of these new interventions: • Health benefit information on the Website or other Social Media • A web-based Health and Wellbeing Map, identifying opportunities for Physical Activity and to support Mental Wellbeing • ‘Smart Apps’ which promote recreation, cultural interest and/or education • Provision of multi-sensory signage for the differently abled and children • Provision of a ‘Park Health and Activity Map’ • Provision of maps identifying timed and distance walking routes within the Park • Security cameras • A Therapeutic Garden • Bird boxes • External adult fitness equipment (Outdoor Gym) • Fitness equipment specifically designed for Seniors (Healthy Ageing) • ‘Trim Trail’ in the natural areas of the Park

Within the report, further information is also provided to allow improvements and new interventions to be linked to obesity, non-communicative diseases and mental ill-health.

. Health Promotion: Social Prescribing & Workplace Wellbeing 7. As noted above, local GPs are already referring patients to activities promoted in the Park. Future plans by the FoRP include food growing and other non-food-based gardening activities. In addition, the importance of Social Prescribing is recognised by the Health London Partnership, and locally by the Social Prescribing & Expert Patient Programme Modelling: NHS Lambeth CCG. In addition, The Lambeth Food Co-op works with a number of GP Practices to offer food growing as one opportunity for Social Prescribing. This is locally available through the Corner House Surgery 99 Coldharbour Lane, London SE5 9ES, and Garden at Jennie Lee House, in association with King’s College Hospital, de Crespigny Road, London SE5 8AD which lies in close proximity to Ruskin Park. The principle of Social Prescribing is thus recognised in Lambeth.

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London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

With regard to Workplace Wellbeing, there is not as yet an initiative in place to provide employees with places to engage, get fit, broaden interests and reduce stress. However, the London Healthy Workplace Charter Guide recognises the importance of creating healthy work places and identifies a series of Charter Standards. These focus on areas which can strengthen health and wellbeing in or related to the workplace. The following Standards are health related opportunities related to Parks and Green Spaces:

The Charter Standards: Mental health and wellbeing Physical activity Healthy eating

Creating a context for healthy lifestyles, and developing programmes related to mental health and wellbeing, physical activity and healthy eating, will allow Parks to contribute to the creation and maintenance of a healthy workforce. The proximity of King’s College and Maudsley Hospitals, in addition to numerous local businesses strengthens the case for the use of Ruskin Park to support the health and wellbeing of local employees.

In many ways the interventions proposed for a healthy workforce reflect those linked to Social Prescribing. As listed above, these can include the following:

Places for Emotional Restoration Café: (Social interaction) Ecotherapy: Exercise: Green Gym: Time Bank: . Volunteer Befriending:

Additional initiatives used elsewhere for Workplace Wellbeing have included: Reclaim your Lunchbreak, Organise a picnic, hold a Group Activity, take up a Challenge, Volunteering, Walking, Physical Activity, Mental Health Awareness Week, Cycle to work schemes Diet, Healthy Eating and Step Competitions.

The delivery of these activities for both Social Prescribing and Workplace Wellbeing can be planned according to availability, need and ability. However, all provide health promoting opportunities which can be delivered through the Park facilities, and skills within the Council.

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London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

Evaluation 9. Integral to the development of a Parks Health Strategy is the evaluation of health benefits emanating from the study. A robust independent evaluation is required to examine the impact of the initiatives in terms of physical and mental health, their value from a health perspective, and return on investment.

Health Maps and Plan 10. Based upon the Assessment Toolkit, it is possible to identify elements and areas of the park which are particularly suited to the different health criteria. This analysis can form the basis of a Health Survey Map. The initial purpose of this map will be to advise the development of a Landscape Masterplan. The plan can also be used to develop a Health Map for the Park, and to generate walking, exercise and interest routes around the Park. It is also possible to identify areas for community activities, physical recreation, mental wellbeing, and environmental benefit and biodiversity.

Conclusion 11. The motivation for the production of this Report was in response to the Local Labour Party 2018 Manifesto Pledge which stated that “Our parks are key to good physical and mental health, so we’ll pilot a new programme of ‘Health Parks’, starting with Ruskin Park next to Kings College and Maudsley Hospitals and roll out innovative health, recovery and fitness projects across other Lambeth parks and open spaces”. This assessment has identified a number of potential interventions within Ruskin Park. These could have a positive bearing upon the health and wellbeing of the local community. The extension of such assessments across other Lambeth Parks has the potential to extend that benefit to a far wider population; an aspiration in keeping with the above Pledge.

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London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

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London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

1.0 INTRODUCTION

1.1 Tisdall Associates, a Registered Practice of the Landscape Institute, has been instructed by the London Borough of Lambeth to prepare a Parks and Green Spaces Health Report for Ruskin Park. This is in response to the Local Labour Party 2018 Manifesto Pledge which stated that “Our parks are key to good physical and mental health, so we’ll pilot a new programme of ‘Health Parks’, starting with Ruskin Park next to Kings College and Maudsley Hospitals and roll out innovative health, recovery and fitness projects across other Lambeth parks and open spaces”

1.2 The site survey of Ruskin Park was undertaken by representatives of Tisdall Associates on 4th February 2019, utilising the Parks for Health Assessment Toolkit developed by Tisdall Associates. The Park is located in Denmark Hill in Camberwell in the London Borough of Lambeth, London. It was created in 1907, as a 24-acre Park. Later it was expanded to 36 aces with the addition of playing fields. It is currently managed and maintained by Lambeth Council, in collaboration with the Friends of Ruskin Park, an independent local charity.

1.3 Ruskin Park lies within Herne Hill Ward in the Borough of Lambeth. It also lies adjacent to the London Borough of Southwark, and the Wards of South Camberwell and Brunswick Park. As such the influence of the Park lies both within Herne Hill Ward, but also outside the boundary of Lambeth and within Southwark. The Park is bounded to the north by London Overground route from Denmark Hill Station to Clapham Junction. The eastern boundary comprises the A215 Denmark Hill, the south Ferndene Road and the western boundary by Herne Hill Road. A location Map is enclosed as Fig 1, and Aerial Map as Fig 2.

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London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

Figure 2 Ruskin Park Location Map

Figure 3 Ruskin Park

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London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

Figure 4 Ruskin Park Aerial Photograph

1.4 The quality and use of Parks, Green Spaces and the Natural Environment have been demonstrated by research to have a beneficial effect upon health and wellbeing. Access to these spaces can contribute to the prevention and treatment of obesity, non-communicative diseases and mild mental ill-health. In addition, they can help mitigate some environmental impacts; air pollution, temperature extremes, UV radiation, noise etc. As such they can have a bearing upon avoidable medical conditions associated with these risk factors. On this basis it has long been argued that Parks and Green Spaces should be valued for their contribution to Primary Prevention and treatment of avoidable diseases, rather than simply as land valued at £1.00, and with ongoing maintenance costs. In their recent report “Revaluing Parks and Green Spaces” the Fields in Trust estimated that the Total Economic Value to an individual is £30.24 PER YEAR (£2.52 per month). The Wellbeing Value associated with the frequent use of local parks and green spaces is worth £34.2 Billion per year to the entire UK adult population. Parks and Green Spaces are estimated to save the NHS around £111 Million per year based solely on a reduction in GP visits and excluding any additional savings from prescribing or referrals.[1]

1.5 In order to deliver on this Value, Parks and Green Spaces must be seen from the perspective of Public Health. This brings with it the following key principles which undergird the approach taken in developing this Health Report:

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London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

• Addressing Issues “Upstream”: Public Health has to do with addressing factors which cause disease before the medical conditions develop • The Evidence Base: There is extensive scientific evidence which demonstrates the association between green space and health • Determinants of Health: As demonstrated by the Social Determinants of Health [2] and the Health Map [3] environmental factors can have a significant impact upon the health of a local population; for better or worse. Parks and Green Spaces represent an important component of the built environment, and as such the quality and variety of these places and spaces has to be considered in any assessment of their potential health benefit • Health Promotion [4]: These include a series of approaches which optimise the use of health promoting Parks and Green Spaces. They may be generated through community groups, Social Prescribing or Workplace Wellbeing programmes, and include the following application: • Medical: To identify those at risk of disease, and levels of avoidable ill-health in a population • Behaviour Change: To encourage individuals to take responsibility for their own health and choose healthier lifestyles • Education: To increase knowledge and skills about healthier lifestyles • Empowerment: To work with individuals and communities to address perceived needs • Social Change: To address inequalities in health-based interventions, status and conditions

1.6 A wide range of activities and events are already provided by the Friends of Ruskin Park which have a positive bearing upon health and wellbeing. For example:

• The FoRP are in participating with Local GPs within the context of Social Prescribing, and these GPs are referring patients to activities promoted in the Park • The FoRP already organise weekly Litter Picking, bi-monthly Community Gardening Sessions. Health Walks are run by Everyone Active, the Southwark Leisure provider • Community events have included a Christmas market in December, a Summer Fete in June, a Harvest Community Day, and fortnightly bandstand events • A programme of guided walks has included mindfulness walks, bat walks, plant folklore walks and a bird walk • The FoRP have an interest in developing further organised group activities; be this as self- organised groups by the community, or commissioned exercise group • There are opportunities for interaction with secondary care. For example, South London and Maudsley (SLaM) patient groups use the park for gardening activities and could be integrated with Park activities and therefore the wider community, including those participating in shared activities through social prescribing • Future plans also include the development of the SLaM Recovery College in the former stable block in the Park.

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London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

In line with these activities and events the 2017/18 Annual Report has identified several improvements and new interventions which will also have a bearing upon health. These include:

To deliver community events and activity programmes for Ruskin Park, including: The Summer Fete • Summer Music at the Bandstand • A programme to mark John Ruskin’s bi- centenary, subject to funding and resources • Heritage wheat growing, and additional events led by others.

To undertake Park Maintenance including: • Paddling pool • Wildlife area and main pond • Bowling green flower garden and beds in other focal points • Benches • Litter management • Tree management

Plans for capital improvements, including: • Sports, fitness and play facilities • The former stable block • The Denmark Hill entrance • The listed Mendelsohn Sundial • Signage and wayfinding and a health and wellbeing pilot

These demonstrate a track record of health-based interventions and represent a sound basis for future initiatives and interventions. .

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London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

2.0 THE PARKS FOR HEALTH INITIATIVE

2.1 The quality and use of Parks, Green Spaces and the Natural Environment have been demonstrated by research to have a beneficial effect upon the health and wellbeing of those who use the Park, and the wider community. Access to these spaces can contribute to the prevention and treatment of obesity, non-communicative diseases and mental ill-health. In addition, they can mitigate some of the impacts of environmental impacts; air pollution, temperature extremes, UV radiation, and as such have a bearing upon medical conditions associated with these risk factors. On this basis it has long been argued that Parks and Green Spaces should be valued for their contribution to Primary Prevention, and the alleviation and treatment of avoidable diseases, rather than simply as land valued at £1.00, and with ongoing maintenance costs. In order to demonstrate this value, it has been necessary to identify from research, the elements and characteristics of a Park which have been associated with health and wellbeing, to develop a methodology to measure the health status of a Park, to deliver outputs which demonstrate that status, and to evaluate associated benefits. It is also important to explore opportunities to link Parks to Primary Prevention through Community Activities and Public Health Initiatives, Social Prescribing and Workplace Wellbeing. Finally, it is necessary to develop a process of evaluation, in order to demonstrate ROI in terms of economic and social evaluation.

2.2 The place of Parks and Green Spaces within the context of Primary Prevention, and the subsequent approach for this report, is drawn from the Tisdall Associates Parks and Green Spaces Health Framework (Appendix 1). The Parks for Health Assessment Toolkit has been developed by Tisdall Associates for the assessment of Parks and Green Spaces for health and wellbeing. Parks for London have been involved in the refining of this model and its application across local Parks, within its charitable objectives, and have assisted with the testing of the model in association with London Councils and Friends of Parks Groups.

2.3 The Toolkit was developed to provide a means whereby Parks and Green Spaces could be assessed for their health status, and which would also identify practical improvements and interventions to optimise their benefit for the health of the local community. Whilst the context for such interventions is ‘Public Health’ its application lies within the elements and characteristics which make up such open spaces. These include vegetation, play areas, seating, signage etc. In order to develop this Toolkit, it has therefore been necessary to bring together the principles and application of Public Health, academic research, and the interpretation of the evidence base in terms of landscape elements and characteristics.

2.4 The development of the Toolkit included the following stages: 1. Identifying the key principles within Public Health pertinent to this assessment. 2. A Review of academic research related to the association between Green Spaces and Health through a key word search.

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London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

3. The analysis of the findings of that research to identify elements and characteristics of Parks and Green Spaces which have been demonstrated to have a bearing on health. 4. The identification of Primary and Secondary Health Criteria from among those elements. The Primary Criteria being: a. Health Promotion b. Accessibility c. Mental Wellbeing d. Physical Activity e. Environmental Factors and Biodiversity 5. The interpretation of the evidence-base in terms of landscape elements and characteristics. 6. The development of a questionnaire which allowed a Park to be surveyed, and elements identified. 7. Through an onsite survey, the identification of elements which are satisfactory, those in need of improvement, and potential new interventions. 8. The allocation of those elements into the Primary and Secondary Criteria. 9. Based upon NICE guidance, the linkage of those elements to avoidable ill-health; non- communicative diseases, mental ill-health, and environmental risk factors. 10. The development of an assessment reporting Toolkit to allow the creation of a series of reports at increasing levels of complexity; the Audit, the Evaluation and Strategy Assessments. 11. The development of a Parks and Green Spaces Framework (Appendix 2) to set the assessment within the context of Primary Prevention, placing Parks and Green Spaces alongside other health promotion initiatives. 12. To set out guidelines and recommendations for interventions within the following areas: a. Practical improvements and New interventions in the Park, b. Community Initiatives c. Social Prescribing d. Wellness at Work. 13. To provide a framework for the evaluation of improvements and interventions.

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London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

3.0 POPULATION HEALTH PROFILE

3.1 Ruskin Park lies within Herne Hill Ward in the London Borough of Lambeth, and to the east of Coldharbour Ward. It also lies adjacent to the London Borough of Southwark, and the Wards of South Camberwell, Brunswick Park and Village. As such the influence of Ruskin Park will extend across Herne Hill Ward, but also outside the boundary of Lambeth and into Southwark.

3.2 Public Health England (PHE) provide national coverage of Health Profiles. These give a picture of people’s health, help local government and health services understand their community’s health needs, and allow these needs to be met.

3.3 The Profile for Lambeth shows that life expectancy is 5.9 years lower for men and 4.0 years lower for women in the most deprived areas of Lambeth than in the least deprived areas. The Health Profile for Lambeth is included as Fig 5 below. This also identifies medical conditions demonstrated to be alleviated or treated by access to Green Spaces. Among these, the following are significantly worse that the average for England: • Life expectancy at birth (Male) • Under 75 mortality rates: All causes • Under 75 mortality rates: Cardiovascular • Diabetes Diagnosis (17+) • Obese Children (aged 10-11)

The following were not significantly different from England, but worse than the regional average • Under 75 mortality rates: Cancer • Suicide Rate

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London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

Figure 5 Health Profile Lambeth

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London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

3.4 At a more local level, including Herne Hill Ward, the following information indicates that for many avoidable conditions, the South East Locality (including Herne Hill Ward) is worse than average; specifically, with regard to the following conditions: Obesity in Children at reception year and year 6 (Fig 6) Stroke & All Cancers (Fig 7) & (Fig 8)

Figure 6 South East Locality Lambeth Local Health Profile (1)

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London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

Figure 7 South East Locality Lambeth Local Health Profile (2)

Figure 8 South East Locality Lambeth Local Health Profile (3)

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London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

3.5 In focusing on the impact of these figures, Lambeth’ s Health Profile and the Joint Strategic Needs Assessment (JSNA) recorded avoidable deaths in 2016. This profile was produced by Lambeth and Southwark’s Public Health Intelligence Team. The key findings are included below, and indicate that in Lambeth some 29% of deaths registered in 2012-2014 were avoidable:

Figure 9 Lambeth Avoidable Deaths 2016

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London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

3.6 As noted “A death is preventable if, in the light of understanding of the determinants of health at the time of death, all or most deaths from that cause…could be avoided by Public Health interventions” Within these preventable conditions, Cancers comprise 30%, Cardiovascular Diseases (26.2%) and Respiratory diseases 10.6%.

Figure 10 Proportion of avoidable deaths by broad group and cause, Lambeth 2006-2014

Many of the identified preventable conditions could be avoided or treated by encouraging physical activity or addressing root causes related to mental wellbeing and other determinants of health. The improvements of Parks and Green Spaces, as significant environmental and urban determinants, would do much to reduce this burden of avoidable ill-health in the community. (Further information on Prevention and Determinants of Health is provided in Appendix 2)

3.7 Conclusion Combining the concepts of Determinants of Health and Prevention, it is apparent from the figures that opportunities exist in Lambeth to reduce avoidable deaths. Many are caused by medical conditions directly. Others, as co-morbidities, for example are related to obesity or mental ill-health. The local impact of these conditions on adult and social care services, and the NHS are apparent. In the report “The health of children and young people” the Lambeth Annual Report of the Director of Public Health 2016/17, the importance of addressing Childhood Obesity was fully recognised.

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London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

The Report also stated the importance of “Focusing on the wider societal, economic, environmental, policy and political influences and forces that determine health, not just on the individual risk factors or behaviours” (Our bold text) It is within this realm of the ‘Environment’, that the place of Parks and Green Spaces can be found as a significant Determinant of Health. The importance of physical and mental health is also clearly identified in the Joint Strategic Health Assessment. This offers advice on health e.g. Five Ways to Wellbeing, and also links to NHS advice on exercises. The “Move More” initiative including such initiatives as ‘Start Small’, ‘Active 10’, ‘Sharing Stories’, ‘Toning up at Home’, ‘Getting active at any age’, ‘What can I do in 10 minutes’ and ‘Be Active with Disability’. https://www.nhs.uk/oneyou/for-your-body/move-more/ 10 Minute Workouts https://www.nhs.uk/live-well/exercise/10-minute-workouts/

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London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

4.0 THE PARKS FOR HEALTH SURVEY: IMPROVEMENTS & INTERVENTIONS

Introduction 4.1 In order to optimise the potential use of Ruskin Park for health and based upon the principles of Public Health two potential interventions have been identified. These are: • Addressing the quality of the physical environment: Determinants of Health The Parks for Health Assessment: Practical improvements and interventions identified through the Parks for Health Strategy Assessment. This includes: o Community Initiatives, o Accessibility, o Mental Wellbeing, o Physical Activity o Environmental Factors. • Health Promotion Social Prescribing & Workplace Wellbeing

The full results of the survey are identified in the Strategy Assessment Report enclosed as Appendix 2.

Practical Interventions: The Parks for Health Strategy Assessment 4.2 Ruskin Park was surveyed by Tisdall Associates in February 2019. The survey consists of a series of questions exploring aspects of each of the Health Criteria. In answer to each question it is possible to confirm that the element is: • ‘Present and Satisfactory’ (i.e. Elements in good condition and in use) • ‘Present, but in need of improvement’ (i.e. Elements in poor condition and as such unable to contribute to health) • ‘Not Present but potential opportunity’ as a ‘New Intervention’. (i.e. There is space for this element, and it would be in keeping with the scale and character of the Park) • That the element would ‘Not be Appropriate’ (e.g. A formal sports pitch in a local Nature Reserve) • ‘Not Known’

4.3 The answers were entered into the Online Toolkit, and The Health Parks Strategy Assessment Report was created. This identifies the strengths and weaknesses in the Park within five Primary Criteria, and 17 Secondary Criteria. From the Tables below, it is possible to see the Current Health Status. This includes the extent of elements which are ‘Present, but in need of improvement’ and the potential health status if all improvements are made (Fig 11). The scores for each of the Primary Criteria are identified in Fig 12.

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Figure 11 Potential Health Status within Primary Criteria

Figure 12 Potential Health Status Combining Current Health Status and 'Improvements'

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4.4 From this assessment it is possible to ascertain that the Current Health Status within each of the Health Criteria lies at c 45% or above. Most strikingly, the status of the Environment and Biodiversity lies at 73%, indicating a strong basic level of provision within these criteria. Opportunities for enhancement have been identified in the remaining four Criteria. The greatest potential for improvement lies in Accessibility with a 30% potential enhancement. Community Initiatives and Mental Wellbeing have the potential to increase by 20% and 19% respectively, whilst Physical Activity can increase by some 12%. Overall it is apparent that significant improvements can be made to the health status in four of the five health categories. It should also be noted that these improvements do not yet identify potential new interventions. These are identified later in the report and will further improve each of the Health Criteria. All such improvements will allow better use of the existing facilities for health, and many will represent a Low Cost/ High impact intervention. These may be deliverable through the ongoing management of the Park or though capital expenditure. In practical terms the actual improvements are listed below.

Elements in Need of Improvement within each of the Primary Health Criteria 4.5 Based upon the survey of the Park, the following elements were identified as present, but considered to be in need improvement. For some elements, these were found to be present, but additional facilities were suggested. For other elements, the improvement had to do with their state of repair. In both case the health status would be enhanced through these improvements. The following improvements were identified.

Based upon the Survey, Improvements to this provision identified through the survey could include:

Community Initiatives • The increased promotion of the Park through Social Prescribing • Use of the Park for education about history • Use of the Park for education on promoting healthy lifestyles • Provision of Interpretation Boards identifying aspects of nature, culture, history and other features of local interest

Accessibility • Provision of bicycle racks • Signage in the surrounding area promoting awareness of the Park • Clear signage at main entrances to provide a sense of arrival and welcome • Drinking fountains • Maps identifying walking routes between the Park, other Parks and Social hubs

Mental Wellbeing • Public Art, Statuary and Fountains

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• Condition and repair of play areas • Condition and repair of signage • Condition and repair of seating • Lighting • Condition and repair of fencing

Physical Activity • Introduction of Natural Play elements within the Park (e.g. Logs, Boulders, Water, Sand) • ‘Outdoor Games’ within the Park

Environment & Biodiversity • No element recorded

New Interventions 4.6 ‘New Interventions’ are elements which whilst not currently present, were in keeping with the scale and character of the Park, and as such are appropriate for consideration. The decision as to which of the new interventions is selected rests with the Council, representatives of the Friends of Ruskin Park and local community. The reliance on local knowledge, preference, and health priorities and targets, is an important part of engaging the local community in this process and can build community cohesion. It is also the case that it may not be possible to select every new intervention. Based upon the Survey, the following ‘New Interventions’ were identified in each of the Primary Health Criteria.

Community Initiatives • Health benefit information on both the Council and Friends of Ruskin Park Website or other Social Media • A link to Government Health Guidance for Physical Activity and Mental Wellbeing on the Website (** This information is currently available on the JSNA website and other Government websites but not on the Local Authority’s or FoRP’s websites) • A web-based Health and Wellbeing Map, identifying opportunities for Physical Activity and to support Mental Wellbeing • ‘Smart Apps’ which promote recreation, cultural interest and/or education • Develop a ‘Park(s) Health Strategy’ • Organised group fitness programmes • Park based ‘Workplace Health and Wellbeing’ programmes for local employees

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Accessibility • Provision of multi-sensory signage for the differently abled and children • Provision in the Park of of a ‘Park Health and Activity Map’/Interpretation Board • Provision of maps identifying timed and distance walking routes within the Park • Provision of Waymarking Posts or Signs identifying walking routes

Mental Wellbeing • Security cameras • A Therapeutic Garden • Bird boxes

Physical Activity • External adult fitness equipment (Outdoor Gym) • Fitness equipment specifically designed for Seniors (Healthy Ageing) • ‘Inclusive’ play equipment for the differently abled • ‘Electronic Interactive Play’ • ‘Trim Trail’ in the natural areas of the Park

Environment and Biodiversity • No elements recorded

The Prevention & Treatment of avoidable Ill-health: Creating a Park within Primary Prevention 4.7 The Assessment has identified elements which are ‘In need of improvement’, and those which could be introduced as ‘New Interventions’. It is apparent from the Health Profile, that the key health issues in Lambeth and Herne Hill Ward include Non-communicative diseases and childhood obesity. If these are to be targeted through the better use of Parks, then the following approach allows the elements associated with these conditions to be prioritised and selected from the above lists. (Par 6.3 and 6.4)

4.8 It is not possible to demonstrate causality between the characteristics of a Park and the alleviation of medical conditions. Further, many of these physical and mental conditions are inextricably linked as co-morbidities, as such, an integrated approach is required to prevent ill-health [5]. Nevertheless, in the UK, the National Institute of Clinical Excellence ((NICE) sets out recommendations for the prevention and treatment of certain conditions. These are set out below in Tables 1-4, and are as follows: (i) Obesity (Child Obesity, Adult Obesity and reduced levels of physical activity) (ii) Non-Communicative Diseases (Diabetes, CHD, Cancers, Hypertension, Stroke), (iii) Mental Illness (Stress, Anxiety and Depression). (iv) Health conditions related to environmental risk factors.

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CONDITION PREVENTION OR TREATMENT OF OBESITY Healthy Eating [6] [7] Childhood Obesity [6] Physical Activity for Children under 5 [8] Physical Activity for Young People (5-18) [9] Reduced Levels of Physical Healthy Eating [7] Activity in Adults Physical Activity for Adults (19-64) [10] Healthy Eating [7] Adult Obesity [11] Physical Activity for Adults (19-64) [10] Physical Activity for Older Adults [12] Table 1 The Prevention and Treatment of Obesity

CONDITIONS PREVENTION OR TREATMENT OF NON-COMMUNICATIVE DISEASES

Type 2 Diabetes [13] CHD [14] Healthy Eating [7] Hypertension[15] Physical Activity for Adults (19-64) [10] Stroke [16] Physical Activity for Older Adults [12] Cancers [17, 18] Table 2 The Prevention and Treatment of Non-Communicative Diseases

CONDITION PREVENTION OR TREATMENT OF STRESS, ANXIETY AND DEPRESSION FIVE STEPS TO MENTAL WELLBEING [19] Stress, Anxiety & Depression [20] GET ACTIVE: Physical Activity [10, 12, 21, 22] Keep Learning/ Education & Interest Give to Others Connect Be Mindful Table 3 The prevention and Treatment of Mental Ill-Health

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CONDITION ENVIRONMENTAL RISK FACTORS

Lung Disease and Related Pollution Conditions [23] Skin Cancers [24] Ultra-violet Light Discomfort, Anxiety and Distress Flooding [25] Those at risk of Heat Stroke, Urban Temperature Extremes/ Heatwave Respiratory Disease and CVD Reduction in Heat Island Effect Parkinson’s, Mental Illness [26] Table 4 Environmental Risk Factors and Health

4.9 Based upon this guidance, it is possible to select improvements and interventions which could contribute to the prevention and treatment of identified conditions. Health data for each community has been obtained from Public Health Profiles. These identify how the health of a local population compares with that of the rest of England. Whilst it is not possible within current research to be prescriptive about interventions which have a direct bearing upon particular conditions, the guidance of NICE does provide a useful steer. By linking Park-based initiatives to health interventions identified by NICE (Table 1-4), it is possible to provide a more targeted response to identified medical conditions. The Parks for Health Strategy Report (Appendix 2) identifies such improvements and new interventions related to each of the above conditions. These can be referred to if a medical based approach is selected as a basis for Improvements. Improvements are identified in Tables 6- 9, and New Interventions in Tables 14-17 in Ruskin Park. However, in that the avoidable conditions are related as co-morbidities, it is recommended that in order to address each of the conditions, all improvements and interventions are first considered in a balance and proportionate way.

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5.0 HEALTH PROMOTION INITIATIVES

5.1 Introduction “Health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical mental and social wellbeing, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to wellbeing.” [27]

Within the context of this report, this includes a series of approaches which optimise the use of health promoting Parks and Green Spaces. They may be generated through community groups, Social Prescribing or Workplace Wellbeing programmes, and can include the following applications [4]: • Medical: Data to identify those at risk of disease, and levels of avoidable ill-health • Behaviour Change: To encourage individuals to take responsibility for their own health and choose healthier lifestyles • Education: To increase knowledge and skills about healthier lifestyles • Empowerment: To work with individuals and communities to address perceived needs • Social Change: To address inequalities in health-based interventions, status and conditions

5.2 Social Prescribing 5.2.1 At a national level the Social Prescribing Network provides useful guidance and advice into this important subject. In London itself, the Major of London’s Health Inequalities Strategy identifies Social Prescribing as one of the Key Aims, stating that “The Mayor’s key ambition is to help more Londoners in vulnerable or deprived communities to improve their health and wellbeing through social prescribing” and for “Social prescribing” [to] become[s] a routine part of community support across London” [28]

5.2.2 Building on this, The Healthy London Partnership in their report “Social Prescribing our vision for London” [29] identifies a range of applications for Social Prescribing Applications. These are identified in the areas of Art and Culture, Environment, Food Growing and Green Space, Sport, Wellness and Leisure and Education and Leisure. Green Space is of value in itself, but also as a context for each of the above interventions. In developing Social Prescribing, this report sees benefits to individuals, communities, local authorities, health and social care, Community and Social Enterprise organisations and for London as a whole. Supporting the need for these interventions, it has been suggested that 20% of visits to GP’s have to do with social isolation or financial reasons. One review of the evidence… showed average reductions following referrals to

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social prescribing schemes of 28% in GP services, 24% in attendance at A&E and statistically significant drops in referrals to hospital

5.2.3 As noted by the King’s Fund “‘Social prescribing’, sometimes referred to as community referral, is a means of enabling GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services…Recognising that people’s health is determined primarily by a range of social, economic and environmental factors, social prescribing seeks to address people’s needs in a holistic way. It also aims to support individuals to take greater control of their own health…Social prescribing schemes can involve a variety of activities which are typically provided by voluntary and community sector organisations. Examples include volunteering, arts activities, group learning, gardening, befriending, cookery, healthy eating advice and a range of sports”[30]

5.2.4 In Lambeth itself, the Healthy London Partnership Social Prescribing & Expert Patient Programme Modelling delivered by NHS Lambeth CCG [31] identifies a range of conditions suitable for treatment through Social Prescribing: • Controlled Diabetes • Dementia • Eating Disorder • Falls, Mobility • Joint problems including Arthritis and back care • Learning Disabilities • Mild and moderate Hypertension • Mild and Moderate Mental Health Conditions: Depression, Anxiety, Reaction to stress, and adjustment disorders • Mild Respiratory Conditions: Mild Asthma; Abnormalities of breathing • Obesity • Problems relating to Housing and Financing • Problem related to employment and unemployment / Education and literacy • Problem related to Primary support group • Sense Impairment • Social Isolation • Substance abuse

5.2.5 The lists below provide a range of social prescribing interventions identified by NHS Lambeth CCG from across the country. Those pertinent to Parks have been identified below. Within the brief for this Report it is not possible to provide a comprehensive list of proposals for Ruskin Park itself. However, based upon the site assessment, it is apparent that the Park as it stands has the facilities to increase the range of Social Prescribing initiatives, potentially including the following:

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5.2.6 In terms of Ruskin Park itself, the FoRP have identified a number of initiatives which are used within the context of Social Prescribing and Secondary Care. These include:

• The FoRP are in discussion with Local GP’s about how the Park can be better used within the context of Social Prescribing. Some GPs are referring patients to activities promoted in the Park. • The FoRP organise weekly Litter Picking, bi-monthly Community Gardening Sessions. Health Walks are run by Everyone Active, the Southwark Leisure provider. • A programme of guided walks has included mindfulness walks, bat walks, plant folklore walks and a bird walk. • There are opportunities for interaction with secondary care. For example, South London and Maudsley (SLaM) patient groups use the Park for gardening activities. They could also be encouraged to participate in other Park activities.

5.2.7 In addition, the Lambeth GP Food Coop are involved in a degree of Social Prescribing; as they write, “We build gardens in GP surgeries so everyone who wishes to learn how to grow food can do so in a safe, secure and supported environment. Our GP garden communities provide a space and a reason for people to socialise, learn and grow food together. People who participate are improving their own health and wellbeing. This results in people feeling less isolated and better in themselves and, as GPs are now reporting, they don’t require so many appointments…The food that is grown is distributed and sold to NHS staff as well as to NHS hospital caterers. So the GP Food Co-op not only enables and empowers local people to learn new skills, to be confident and sociable, it also makes a valuable contribution to the local economy” [32]

5.2.8 The Food Co-op operates in the GP Surgeries in Lambeth. In terms of proximity to Ruskin Park, it is the Corner House Surgery 99 Coldharbour Lane, London SE5 9ES, and Garden at Jennie Lee House, King’s College Hospital, de Crespigny Road, London SE5 8AD which lie near Ruskin Park. The principle of Social Prescribing is thus well established in Lambeth and could be expanded with further development in Ruskin Park.

5.2.9 It is apparent from the Health Assessment, and study of Social Prescribing in the Authority, that there exists immense potential to both develop existing initiatives, and to develop further opportunities. The use of the Park within this dimension of Primary Prevention makes a strong case for the joint engagement of the Parks Department, Public Health and Social Prescribing & Expert Patient Programme Modelling delivered by NHS Lambeth CCG. The detail of such a co- operative approach lies outside the scope of this report, however, based upon the findings of this Park Health Assessment, its potential benefits can justify further exploration.

5.2.10 Park based interventions proposed for Social Prescribing can reflect those which can also help maintain a healthy workforce. These can be adjusted according to age and experience and be

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delivered at times suitable for each group. The following activities have been identified at those which can be delivered through appropriately designed and staffed Parks and Green Spaces, within a context of Social Prescribing [31] Additional information can be found on the Social Prescribing/ Expert Patient Programme [33]. Within this programme the following activities have been assessed and found to deliver savings to health care.

Arts on Prescription: The use for the Park for artistic expression Deaf/ Blindness: The use of the central ornamental garden, with sensory experience. The access to circular walks for exercise Café: Whilst small in scale, this can provide opportunity for social interaction and engagement Ecotherapy: Participation in the nature conservation area, gardening and fruit and vegetable growing Exercise on Prescription: The development of measured walks, exercise routes, non-gym activities, outdoor games and more formal sports Green Gym: Participation in the nature conservation area, Central Garden and fruit and vegetable growing Time Bank: The involvement of the public to contribute to the community in the context of the Park is extensive. Volunteer Befriending: The wide range of opportunities for both physical activity and mental wellbeing, allow both group participation, and individual engagement to address loneliness, and develop social capital

5.3 Workplace Wellbeing 5.3.1 A recent report [34] indicated that: • 595,000 workers were suffering from work related stress, depression or anxiety (new or long-standing) in 2017/2018, a prevalence rate of 1,800 per 100,000 workers • 15.4 million working days were lost due to work related stress, depression or anxiety in 2017/2018 • The rate of work-related stress depression and anxiety was broadly flat but has shown signs of increasing in recent years • In 2017/18 stress, depression or anxiety accounted for 44% of all work-related ill- health cases and 57% of all working days lost due to ill-health

5.3.2 In their recent report “Revaluing Parks and Green Spaces” the Fields in Trust estimated that the Total Economic Value to an individual is £30.24 Per Year (£2.52 per month), and includes benefits gained from using their local Park or Green Space and non-use benefits such as the preservation of Parks for future generations. The Wellbeing Value associated with the frequent use of local Parks and Green Spaces is worth £34.2 Billion per year to the entire UK adult population. Parks

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and Green Spaces are estimated to save the NHS around £111 Million per year based solely on a reduction in GP visits and excluding any additional savings from prescribing or referrals.[1]

5.3.3 The Stevenson/Farmer Review [35] identified “a cost of between £33 billion and £42 billion (with over half of the cost coming from presenteeism – when individuals are less productive due to poor mental health in work) with additional costs from sickness absence and staff turnover”. They also noted that the cost of poor mental health to Government is between £24 billion and £27 billion and the cost of poor mental health to the economy is more than both of those together from lost output, at between £74 billion and £99 billion per year. On the positive side they cited a report in The Lancet which indicated that in an Australian study, the ROI from mental health training for the Fire Service was £9.98 for every pound expended on training.

5.3.4 The London Healthy Workplace Charter Guide [36] recognises the importance of creating healthy work places, and identifies a series of Charter Standards. These are as follows: The Charter Standards • Corporate support for wellbeing • Attendance management • Health and safety requirements • Mental health and wellbeing • Tobacco • Physical activity • Healthy eating • Problematic use of alcohol and other substances NB. Interventions in Bold text are suitable for Park based events and activities.

5.3.5 It is apparent that health conditions at work may be related to work-based pressures, resulting in stress, depression and anxiety. There will also be those with avoidable health conditions at work (presenteeism) which can be prevented or treated through a positive approach to health and wellbeing, and who can be encouraged and supported in healthy lifestyle choices.

5.3.6 With regard to the use of Parks for health, creating a context for and developing programmes, which address issues relating to mental health and wellbeing, physical activity and healthy eating, will allow Parks to contribute to the creation and maintenance of a healthy workforce. The proximity of King’s College and Maudsley Hospitals, in addition to numerous local businesses, strengthens the case for the use of Ruskin Park to support the health and wellbeing of local employees. The following examples have also been identified as enjoyable approaches to encourage the health and wellbeing of the workforce: ‘Reclaim your Lunchbreak’, ‘Organise a picnic’, ‘Hold a Group Activity’, ‘Take up a Challenge’, ‘Volunteering’, ‘Walking’, ‘Physical Activity’, ‘Mental Health Awareness Week’, ‘Cycle to work schemes’, ‘Healthy Eating’ and ‘Step Competitions’. Some of

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these can be delivered through the working day, others are activities provided out of working hours, but supported by the employer

5.3.7 Conclusion It is apparent that medical conditions at work are not all related to work but can be exacerbated by a stressful work environment. The use of Parks both the alleviate that mental distress, and to address underlying avoidable conditions makes sense on many different fronts. It is clear that Ruskin Park has the potential to develop Wellness at Work initiatives, to the benefits of the working community, to reduce costs and promote a healthy sustainable workforce.

6.0 ACTIONS AND RECOMMENDATIONS

6.1 This report has explored the current health status, and the potential to increase the use of Ruskin Park for the health and wellbeing of the local community. The Survey has identified several areas in which the health of the community can be improved through specific interventions, set within a broad health strategy. These can be identified as specific action points within the delivery of such a health strategy.

1. Practical Improvements and New Interventions. Through the Parks for Health Toolkit, it has been possible to identify the current health status of the Park, areas for improvement and new interventions. These have been related to Community Initiatives, Accessibility, Mental Wellbeing, Physical Activity and the Environment and Biodiversity. These interventions are identified in this report and the supporting Health Strategy Assessment Report. It is important that these suggestions are assessed, prioritised and implemented. By undertaking these practical steps, it will be possible to increase the health status of the Park, and in so doing make a significant improvement to these determinants of health. From among these it will be possible to select low cost/ high impact interventions, and then develop further opportunities in the Park with ongoing investment. In addition, within the Parks Health Strategy, improvements and new interventions have been identified to address avoidable health conditions; many prevalent in the local population. New interventions can be planned in over a period of time, in line with the developing Masterplan, and as funding becomes available.

2. Health Promotion:

a. Social Prescribing: Ruskin Park has a number of initiatives which engage the community in health promoting activities; Gardening, Health Walks etc. In addition, the Lambeth GP Food Co-op has engaged with the Corner House Surgery and King’s College Hospital in one important dimension of Social Prescribing; that of food production. From a review of the evidence, the perception and use of Social Prescribing in Lambeth is well establish. It is apparent that opportunity exists to develop further the resources of Ruskin Park within the context of Social Prescribing.

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b. Workplace Wellbeing: Opportunities have been identified in Ruskin Park for the development of a series of Workplace Wellbeing initiatives. As noted by the Care Quality Commission, King’s College Hospital NHS Foundation Trust employs around 11,723 whole time equivalent (WTE) members of staff with approximately 8,785 staff working at King’s College Hospital Denmark Hill Site. Quite apart from local businesses, this represent a significant work population. Given the proximity of the hospital to the Park, the development of Wellness initiatives and programmes related to the Park, and undertaken in collaboration with the Hospital, and local GPs, could do much to benefit the health of a significant number of people.

3. Additional Opportunities

a. Developing a Masterplan: In addition to the assessment of the health status of the park, the development of a Park requires the creation of a Landscape Masterplan, and subsequent detailed landscape proposals. These will be based upon the standard site survey and assessment procedures familiar to professional landscape architects. Whilst these will normally include the assessment of landform, vegetation aspects, views, existing assets etc., it will not normally include a health layer. In order to address this shortfall, the creation of a Health Survey Map, based upon a health assessment, allows the designer to optimise and retain the best elements from a health perspective. The assessment of the Masterplan against each of the health criteria will also ensure that their Masterplan addresses adequately and appropriately the primary and secondary health criteria identified in the assessment. This stage is fundamental to the creation of a Health Park, without which a design will be limited to non-health consideration.

b. Combined Parks Assessments: It is also the case that no single Park will exhibit all the health criteria. It may be however, that be combining the benefits of Parks in a certain proximity, and identifying these benefits in leaflets, signage and social media, these combined benefits can be optimised for the local community, without replicating all elements in each park. To achieve this, it necessary to undertake assessments within the Parks related to each community and produce a combined health strategy for those Parks.

c. Multiple Park Analysis: The assessment of multiple parks also opens up the opportunity to identify the strengths and weaknesses of a number of Parks, and to relate these to Wards, areas of deprivation or particular conditions (for example). The Multiple Park Analysis is a precursor to developing a Ward based or Council based Parks Health Strategy.

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d. Borough Council Parks Health Strategy: Based upon the Green Spaces Health Framework, this allows a Council to engage with Parks and Green Spaces, within the context of Primary Prevention across the whole Borough. This could also be broken down into Wards. In considering long term improvements, and in order to address health inequalities and related determinant of health affecting those inequalities, this broad Health Strategy provides a vehicle to make practical interventions and health promotion initiatives. It will also integrate Parks more fully with Public Health and Social Prescribing within a context of Primary Prevention.

e. Funding: Whilst the subject of this Report is Parks and Green Spaces within the context of Primary Prevention. As identified within the NHS Long Term Plan [37], the Government is planning to focus on prevention and early detection. They will introduce £2.3 Billion into mental health, and £4.5 Billion into community care and with GP’s. In addition, all parties have a responsibility for the health and wellbeing of the population; Planning, Parks, Public Health and the NHS are all committed to apply their expertise in this important area. Evidence support the view that in many areas, interdepartmental cooperation is growing. The development and use of Parks within Primary Prevention requires such integrated working, and in addition an integrated approach to funding.

f. Creation of Health and Activity Maps On the basis of Health Survey Map, it is possible to create a Health and Wellbeing Map in addition to walking, exercise and Interest route maps. This is important information in the context of Health Promotion, addressing healthy lifestyles, education, social engagement, community activities and mental wellbeing.

g. Evaluation: Integral to the development of a Parks Health Strategy is the evaluation of health benefits emanating from the study. A robust independent evaluation is essential to examine the impact of the initiative in terms of physical and mental health, return on investment and aspects that may have helped and hindered implementation.

7.0 CONCLUSION

7.1 Ruskin Park lies within Herne Hill Ward, on the eastern edge of Lambeth. The PHE Health Profile of the Borough indicates the following medical conditions prevalent in the local population, and which could benefit for the better provision and use of Green Space. • Life expectancy at birth (Male) • Under 75 mortality rates: All causes • Under 75 mortality rates: Cardiovascular • Diabetes Diagnosis (17+)

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• Obese Children (aged 10-11)

The following were not significantly different from England, but worse than the regional average • Under 75 mortality rates: Cancer • Suicide Rate (Mental Ill-health)

In the Wards included in the South East Locality the following conditions have been identified: • Obesity in Children at reception year and year 6 • Stroke • All Cancers

7.3 Ruskin Park has a strong current health status. A number of Community Initiatives are already in place, and it delivers positive health benefits across each of the Primary Health Criteria. Notwithstanding this, a number of improvements and new interventions have been identified in each of the criteria, and with regard to prevalent medical conditions in the local population. Whilst there is a level of Social Prescribing delivered through the Lambeth GP Food Coop, there are extensive opportunities to increase this service in cooperation with Ruskin Park. In addition, opportunities to use the Park for Workplace Wellbeing have also been identified. The evaluation of changes to the fabric and use of the Park can be analysed though accepted economic evaluation methodology.

7.4 The motivation for the production of this Report was in response to the Local Labour Party 2018 Manifesto Pledge which stated that “Our parks are key to good physical and mental health, so we’ll pilot a new programme of ‘Health Parks’, starting with Ruskin Park next to King ’s College and Maudsley Hospitals and roll out innovative health, recovery and fitness projects across other Lambeth parks and open spaces”. This assessment has identified a number of potential interventions within Ruskin Park. These could have a positive bearing upon the health and wellbeing of the local community. The extension of such assessments across other Lambeth Parks has the potential to extend that benefit to a far wider population; an aspiration in keeping with the above Pledge.

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London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

BIBIOGRAPHY

1. Fields in Trust, Revaluing Parks and Green Spaces Measuring their economic and wellbeing value to individuals,. 2018. 2. Dahlgren G and Whitehead M, Policies and Strategies to promote social equity in health. 1991, Institure for Framtidsstudier: Stockholm. 3. Barton H, A health map for urban planners. Built Environment, 2005. 1(4): p. 339-355. 4. Naidoo J and Wills J, Foundations for Health Promotion. 3rd ed. 2009, Edinburgh: Bailliere Tindall Elsevier,. 188. 5. Faculty of Public Health. Relationship with physical health and healthy lifestyles; Mental and physical health are inextricably linked, . 2017; Available from: http://www.fph.org.uk/relationship_with_physical_health_and_healthy_lifestyles. 6. NHS. What do I do if my child is overweight. 2017; Available from: http://www.nhs.uk/Livewell/childhealth6-15/Pages/child-health-measurement-programme-very- overweight-advice.aspx. 7. NHS. Live Well-Healthy Eating. 2017; Available from: http://www.nhs.uk/LiveWell/healthy- eating/Pages/Healthyeating.aspx. 8. NHS. Physical activity guidelines for children (under five years),. 2017; Available from: http://www.nhs.uk/Livewell/fitness/Pages/physical-activity-guidelines-for-children.aspx. 9. NHS. Physical activity guidelines for children and young people. 2017; Available from: http://www.nhs.uk/Livewell/fitness/Pages/physical-activity-guidelines-for-young-people.aspx. 10. NHS. Livewell/Fitness/ Physical activity guidelines for adults,. 2017; Available from: http://www.nhs.uk/Livewell/fitness/pages/physical-activity-guidelines-for-adults.aspx. 11. NHS. Treating Obesity. 2017; Available from: http://www.nhs.uk/Conditions/Obesity/Pages/Treatment.aspx. 12. NHS. Physical activity guidelines for older adults,. 2017; Available from: http://www.nhs.uk/Livewell/fitness/Pages/physical-activity-guidelines-for-older-adults.aspx. 13. NHS. Preventing Type 2 Diabetes,. 2017; Available from: http://www.nhs.uk/conditions/Diabetes- type2/Pages/Introduction.aspx/Pages/Introduction.aspx. 14. NHS, Coronary Heart Disease-Prevention,. 2017. 15. NHS, Preventing and reducing high blood pressure,. 2017. 16. NHS. Conditions- Stroke-Prevention. 2017; Available from: http://www.nhs.uk/Conditions/Stroke/Pages/Prevention.aspx. 17. NHS. Reducing your risk of cancer,. 2017; Available from: http://www.nhs.uk/conditions/Cancer/Pages/Introduction.aspx. 18. NHS. Preventing Cancer,. 2017; Available from: http://www.nhs.uk/Livewell/preventing- cancer/Pages/preventing-cancer-home.aspx. 19. NHS. Conditions, Improve mental wellbeing,. 2017; Available from: http://www.nhs.uk/Conditions/stress-anxiety-depression/Pages/improve-mental-wellbeing.aspx. 20. NHS. Treating clinical depression, . 2017; Available from: http://www.nhs.uk/Conditions/Depression/Pages/Treatment.aspx. 21. NHS. Exercise for Depression. 2017; Available from: http://www.nhs.uk/Conditions/stress-anxiety- depression/Pages/exercise-for-depression.aspx. 22. NHS. Conditions-stress, anxiety and depression, exercise for depression,. 2017, ; Available from: http://www.nhs.uk/Conditions/stress-anxiety-depression/Pages/exercise-for-depression.aspx. 23. NHS. Air Pollution Linked to Lung Cancer and Heart Failure,. 2013, [cited 2017; Available from: https://www.nhs.uk/news/cancer/air-pollution-linked-to-lung-cancer-and-heart-failure/. 24. NHS. Cancer of the Skin-Causes,. 2017; Available from: http://www.nhs.uk/Conditions/Cancer-of- the-skin/Pages/Causes.aspx. 25. Public Health England, Flooding and Mental Health: Essential Information for FrontLine Responders,, Extreme Events and Health Protection, Editor. 2014. 26. Choices, N. Summer Health: Heatwave. 2017; Available from: http://www.nhs.uk/livewell/summerhealth/pages/heatwave.aspx. 27. WHO. The Ottawa Charter for Health Promotion 1986,. in First International Conference on Health Promotion, Ottawa, 21 November 1986,. 1986. 28. Greater London Authority, The London Health Inequalities Strategy. 2018. 29. Healthy London Partnership, Social Prescribing: Our vision for London 2018-2028 Improving lives, improving health. 2018.

40 TAs 173 1c Ruskin Park Lambeth Health Report May 2019

London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

30. The Kings Fund. What is Social Prescribing? 2017; Available from: https://www.kingsfund.org.uk/publications/social-prescribing. 31. Healthy London Partnership, Social Prescribing & Expert Patient Programme Modelling. NHS Lambeth NHS. 2017. 32. Lambeth GP Food Co-op. Socila Prescription and Gardening. 2019; Available from: http://lambeth.gpfoodcoop.org.uk/. 33. Partnership, H.L. Social Prescribing / Expert Patient Programmes (SP/EPP) - FAQ. 2019; Available from: http://i5health.com/hlp.html. 34. Health and Safety Executive, Work related stress, depression and anxiety statistics in Great Britain 2018, HSE, Editor. 2018. 35. Farmer P and Stevenson D, Thriving at Work: Stevenson/Farmer Review of Mental Health and Employment. 2017. 36. Greater London Authority, P.H.E., Mayor of London,, The London Healthy Workplace Charter Guide,, GLA, Editor. 2015: GLA. 37. NHS, The NHS Long Term Plan, NHS, Editor. 2019.

41 TAs 173 1c Ruskin Park Lambeth Health Report May 2019

London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

APPENDIX 1 THE GREEN SPACE HEALTH FRAMEWORK

42 TAs 173 1c Ruskin Park Lambeth Health Report May 2019

London Borough of Lambeth April 2019 Ruskin Park Parks and Green Spaces Health Report

APPENDIX 2 THE PARKS FOR HEALTH ASSESSMENT RUSKIN PARK

43 TAs 173 1c Ruskin Park Lambeth Health Report May 2019

CONTENTS

1.0 Introduction 2.0 The Results

3.0 Recommendations 4.0 Conclusion

Parks for Health Assessment: Page 2 of 28 1.0 INTRODUCTION

This report represents the Parks for Health Assessment: Strategy Report for Ruskin Park in Lambeth, London. It is based upon a survey undertaken on 04 February 2019 by Tisdall Associates.

THE CONTEXT

Parks, Green Spaces and the wider Natural Environment are places for fun, getting together, getting active, growing things, learning and interest and for getting out into the natural environment. They also have great benefit for health and wellbeing. These benefits include improved relaxation, emotional restoration and improved Social Capital. They also include a reduction in certain non-communicative diseases; cancers, Type 2 Diabetes, coronary heart disease, cardiovascular morbidity, and reduced mortality. In addition benefits can include increased mental and cognitive function, and reduced anxiety depression and stress. Further they can bring enhanced economic benefits to the local area. Environmental benefits, include reduced flooding, noise, air pollution and temperature extremes. For all these reasons, it is important to assess and improve our Parks for Health if they are to contribute to the health and wellbeing of our local communities within the context of Primary Prevention.

THE ANALYSIS

This Parks for Health Assessment Toolkit has been developed from a review of the scientific research exploring how Parks and Green Spaces have a positive effect upon health. This review has identified elements within five key Primary Health Criteria; Community initiatives, Accessibility, Mental Wellbeing, Physical Activity, Environment and Biodiversity, and 17 Secondary Health Criteria. Based upon a survey of your Park, and the analysis of your answers, the Parks for Health Assessment Reports (Audit, Evaluation or Strategy) identify in increasing detail the health status of your Park. They provide you with lists of elements which can be improved and highlight new opportunities for enhancement. In your survey, you have identified elements which are 'Present and Satisfactory', 'Present: but in need of improvement', 'Not Present, but a potential opportunity', 'Not Present and Not Applicable', and 'Not Known'. For each of the criteria, the analysis provides you with a score of Elements which are 'Present and satisfactory', those 'In need of improvement'. In the Audit, this is identified through a series of charts. In the Evaluation and Strategy Reports these are also listed within each of the health criteria, and in terms of their relationship to avoidable medical conditions and environmental factors. 'Potential Opportunities' are listed in the Strategy Report and can be selected on their merits according to local priorities.

Parks for Health Assessment: Page 3 of 28 2.0 The Results

In order to provide a Park which promotes health and wellbeing it is suggested that as high a standard as possible should be delivered across each of the Health Criteria if this is achievable given the scale and character of the Park.

DETAILS OF THE PARK

In considering the local context the following information has been provided:

Health Parks ID Code: 44-1550164336

Group or Organisation doing the Audit: Tisdall Associates

What is the official name of the Park? Ruskin Park

What is the name of the City, Town or Village? Lambeth, London

What is the Postal Code of the Park? SE5 9BD

What is the name of your Local Authority or London Borough of Lambeth equivalent?

What is the scale and type of the Park? Local Parks & Open Spaces 2-20 Ha (5-50 Acres)

What country is the Park located in? United Kingdom

Parks for Health Assessment: Page 4 of 28 2.1 CURRENT HEALTH STATUS A Primary Criteria The Current Health Status comprises of elements which were found to be ‘Satisfactory’. The analysis of the survey has identified the level and standard of ‘Satisfactory’ elements within each of the Primary and Secondary Criteria. These are indicated in the following charts and tables.

Chart 1. The percentage of ‘Satisfactory’ Elements in each of the Primary Criteria

The analysis of these figures indicates the level of provision in each of the Primary Criteria as follows:

PRIMARY CRITERIA

CRITERIA LEVEL STANDARD

Community Initiatives 45 BAND 2

Accessibility 42 BAND 2

Mental Wellbeing 73 BAND 3

Physical Activity 56 BAND 3

Environment 73 BAND 3

Table 1. The Level and Standard of Provision in each of the Primary Criteria

From Table 1 it is possible to identify which band each of the Primary Criteria are in.

Parks for Health Assessment: Page 5 of 28 B Secondary Criteria

The level of 'Satisfactory' elements identified by Secondary Criteria are identified in Chart 2.

Chart 2. The percentage of 'Satisfactory Elements' in each of the Secondary Criteria

The level of provision and standard in each of the Secondary Criteria is shown in Table 2:

SECONDARY CRITERIA

CRITERIA LEVEL STANDARD

Community Initiatives

Media 40 BAND 2

Empowerment 56 BAND 3

Education 40 BAND 2

Accessibility

Access 75 BAND 4

Legibility 0 BAND 1

Facilities 67 BAND 3

Mental Wellbeing

Attractive 42 BAND 2

Natural 80 BAND 4

Therapeutic 80 BAND 4

Social 100 BAND 4

Parks for Health Assessment: Page 6 of 28 SECONDARY CRITERIA

CRITERIA LEVEL STANDARD

Growing 100 BAND 4

Physical Activity

Sports 34 BAND 2

Equipped 58 BAND 3

Informal 34 BAND 2

Walking 80 BAND 4

Environment

Environmental 100 BAND 4

Biodiversity 62 BAND 3

Table 2. The Level and Standard of Provision of 'Satisfactory Elements' in each of the Secondary Criteria

From Table 2 it is possible to identify the level and standard of the Secondary Criteria.

In developing your Park for Health, the objective is to achieve as high a standard as possible across each of the Primary and Secondary Criteria. The following sections of this report identify how this can be achieved through improvements and new interventions.

Parks for Health Assessment: Page 7 of 28 2.2 ELEMENTS IN NEED OF IMPROVEMENT

In each of the Primary and Secondary Criteria the analysis has identified the proportion of elements that were judged to be ‘In Need of Improvement’. Those in the Primary Criteria are indicated in Chart 3.

A Primary Criteria

Chart 3. Elements which are ‘Satisfactory‘ and those which are ‘In Need of Improvement‘ in the Primary Criteria

The analysis of these figures indicates the level of provision of elements needing improvement in each of the Primary Criteria as shown in Table 3:

PRIMARY CRITERIA

CRITERIA LEVEL STANDARD

Community Initiatives 20 BAND 1

Accessibility 30 BAND 2

Mental Wellbeing 19 BAND 1

Physical Activity 12 BAND 1

Environment 0 BAND 1

Table 3. The percentage of Elements ‘In Need of Improvement’ in each of the Primary Criteria

Parks for Health Assessment: Page 8 of 28 B Secondary Criteria

The percentage of elements ‘In Need of Improvement’ within each of the Secondary Criteria are identified in Chart 4.

Chart 4. The percentage of Elements ‘In Need of Improvement‘ within the Secondary Criteria

The analysis of these figures indicates the level of provision of elements needing improvement in each of the Secondary Criteria as shown in Table 4:

SECONDARY CRITERIA

CRITERIA LEVEL STANDARD

Community Initiatives

Media 0 BAND 1

Empowerment 12 BAND 1

Education 60 BAND 3

Accessibility

Access 25 BAND 2

Legibility 43 BAND 2

Facilities 17 BAND 1

Mental Wellbeing

Attractive 50 BAND 3

Natural 0 BAND 1

Therapeutic 0 BAND 1

Parks for Health Assessment: Page 9 of 28 SECONDARY CRITERIA

CRITERIA LEVEL STANDARD

Social 0 BAND 1

Growing 0 BAND 1

Physical Activity

Sports 0 BAND 1

Equipped 15 BAND 1

Informal 34 BAND 2

Walking 0 BAND 1

Environment

Environmental 0 BAND 1

Biodiversity 0 BAND 1

Table 4. The percentage of elements ‘In Need of Improvement’ in each of the Secondary Criteria

C Lists of Elements ‘In Need of Improvement’ In the following section a list of elements which are needing improvement are identified within each of the Criteria. These are then categorised against individual groups of medical conditions and environmental risk factors. From these lists it is possible to identify elements which can be improved to increase the health status of the existing Park.

The following Elements were considered ‘In Need of Improvement’ to optimise their contribution to health within each of the health criteria.

CRITERIA ELEMENTS

Community Initiatives

Empowerment The promotion of the Park for health and wellbeing through 'Social/Green Prescribing'

Education & Use of the Park for education about history Interest

Education & Use of the Park for education on promoting healthy lifestyles Interest

Education & Provision of Interpretation Boards identifying aspects of nature, Interest culture, history and other features of local interest

Accessibility

Access Provision of bicycle racks

Legibility Signage in the surrounding area promoting awareness of the Park

Legibility Clear signage at main entrances to provide a sense of arrival and welcome

Parks for Health Assessment: Page 10 of 28 CRITERIA ELEMENTS

Facilities Drinking fountains

Legibility Maps identifying walking routes between the Park, other Parks and Social hubs

Mental Wellbeing

Attractive Public Art, Statuary and Fountains Safe Spaces

Attractive Condition and repair of play areas Safe Spaces

Attractive Condition and repair of signage Safe Spaces

Attractive Condition and repair of seating Safe Spaces

Attractive Lighting Safe Spaces

Attractive Condition and repair of fencing Safe Spaces

Physical Activity

Equipped Play 'Outdoor Games' within the Park

Natural & Introduction of Natural Play elements within the Park (e.g. Logs, Informal Play Boulders, Water, Sand)

Environment

No element recorded

Table 5. List of Elements 'In Need of Improvement'

D Elements ‘In Need of Improvement’, related to identified Health Conditions In utilising Parks and Open Spaces within Primary Prevention, reference has been made to the advice of the NHS which sets out recommendations for the prevention and treatment of each condition. It is however understood that whilst each is an identifiable condition, there are associations (co-morbidities) between mental and physical conditions, and that they are 'inextricably linked'. In interpreting this Strategy, it is therefore important to appreciate the interrelated nature of the identified conditions, rather than see each in isolation. If Parks are to be used within Primary Prevention, it is important to include elements which establish an attractive welcoming context for the Park, give a sense of order and safety, as well as providing a range of facilities. A Park which feels unsafe, is poorly maintained, and is difficult to access, is unlikely to attract use for physical activity or to promote social interaction and mental wellbeing. Based upon this approach, the tables below set out the elements for improvement and their association with each of the identified medical conditions. Each is identified as being useful for the prevention and treatment of Obesity, Non-Communicative Diseases Mental Ill-health and Medical Conditions associated with Environmental Risk Factors.

Parks for Health Assessment: Page 11 of 28 ELEMENTS PRESENT BUT IN NEED OF IMPROVEMENT

OBESITY

CRITERIA ELEMENT

Community Initiatives

Empowerment The promotion of the Park for health and wellbeing through 'Social/Green Prescribing'

Education & Use of the Park for education about history Interest

Education & Use of the Park for education on promoting healthy lifestyles Interest

Education & Provision of Interpretation Boards identifying aspects of nature, Interest culture, history and other features of local interest

Accessibility

Access Provision of bicycle racks

Legibility Signage in the surrounding area promoting awareness of the Park

Legibility Clear signage at main entrances to provide a sense of arrival and welcome

Facilities Drinking fountains

Legibility Maps identifying walking routes between the Park, other Parks and Social hubs

Mental Wellbeing

Attractive Public Art, Statuary and Fountains Safe Spaces

Attractive Condition and repair of play areas Safe Spaces

Attractive Condition and repair of signage Safe Spaces

Attractive Condition and repair of seating Safe Spaces

Attractive Lighting Safe Spaces

Attractive Condition and repair of fencing Safe Spaces

Physical Activity

Equipped Play 'Outdoor Games' within the Park

Natural & Introduction of Natural Play elements within the Park (e.g. Logs, Informal Play Boulders, Water, Sand)

Table 6. List of Elements ‘In Need of Improvement’ linked to the prevention and treatment of Obesity

Parks for Health Assessment: Page 12 of 28 ELEMENTS PRESENT BUT IN NEED OF IMPROVEMENT

NON-COMMUNICATIVE DISEASES

CRITERIA ELEMENT

Community Initiatives

Empowerment The promotion of the Park for health and wellbeing through 'Social/Green Prescribing'

Education & Use of the Park for education about history Interest

Education & Use of the Park for education on promoting healthy lifestyles Interest

Education & Provision of Interpretation Boards identifying aspects of nature, Interest culture, history and other features of local interest

Accessibility

Access Provision of bicycle racks

Legibility Signage in the surrounding area promoting awareness of the Park

Legibility Clear signage at main entrances to provide a sense of arrival and welcome

Facilities Drinking fountains

Legibility Maps identifying walking routes between the Park, other Parks and Social hubs

Mental Wellbeing

Attractive Public Art, Statuary and Fountains Safe Spaces

Attractive Condition and repair of play areas Safe Spaces

Attractive Condition and repair of signage Safe Spaces

Attractive Condition and repair of seating Safe Spaces

Attractive Lighting Safe Spaces

Attractive Condition and repair of fencing Safe Spaces

Physical Activity

Equipped Play 'Outdoor Games' within the Park

Natural & Introduction of Natural Play elements within the Park (e.g. Logs, Informal Play Boulders, Water, Sand)

Parks for Health Assessment: Page 13 of 28 ELEMENTS PRESENT BUT IN NEED OF IMPROVEMENT

NON-COMMUNICATIVE DISEASES

CRITERIA ELEMENT

Table 7. List of Elements ‘In Need of Improvement’ linked to the prevention and treatment of NCD's

ELEMENTS PRESENT BUT IN NEED OF IMPROVEMENT

MENTAL ILL-HEALTH (STRESS, ANXIETY & DEPRESSION)

CRITERIA ELEMENT

Community Initiatives

Empowerment The promotion of the Park for health and wellbeing through 'Social/Green Prescribing'

Education & Use of the Park for education about history Interest

Education & Use of the Park for education on promoting healthy lifestyles Interest

Education & Provision of Interpretation Boards identifying aspects of nature, Interest culture, history and other features of local interest

Accessibility

Access Provision of bicycle racks

Legibility Signage in the surrounding area promoting awareness of the Park

Legibility Clear signage at main entrances to provide a sense of arrival and welcome

Facilities Drinking fountains

Legibility Maps identifying walking routes between the Park, other Parks and Social hubs

Mental Wellbeing

Attractive Public Art, Statuary and Fountains Safe Spaces

Attractive Condition and repair of play areas Safe Spaces

Attractive Condition and repair of signage Safe Spaces

Attractive Condition and repair of seating Safe Spaces

Attractive Lighting Safe Spaces

Parks for Health Assessment: Page 14 of 28 ELEMENTS PRESENT BUT IN NEED OF IMPROVEMENT

MENTAL ILL-HEALTH (STRESS, ANXIETY & DEPRESSION)

CRITERIA ELEMENT

Attractive Condition and repair of fencing Safe Spaces

Physical Activity

Equipped Play 'Outdoor Games' within the Park

Natural & Introduction of Natural Play elements within the Park (e.g. Logs, Informal Play Boulders, Water, Sand)

Table 8. List of Elements ‘In Need of Improvement’ linked to the prevention and treatment of Mental Ill-health

ELEMENTS PRESENT BUT IN NEED OF IMPROVEMENT

ENVIRONMENTAL FACTORS

CRITERIA ELEMENT

Environment

No element recorded

Table 9. List of Elements ‘In Need of Improvement’ linked to Environmental Factors

Parks for Health Assessment: Page 15 of 28 2.3 POTENTIAL HEALTH STATUS

By combining the elements which are at ‘Satisfactory’ with those ‘In Need of Improvement‘, it is possible to identify the potential health status of the Park if all the improvements were undertaken. Chart 5 identifies the Potential Health Status across the five Primary Criteria.

Chart 5. The Potential Health Status: Elements which are ‘Satisfactory’ and those which are ‘In Need of Improvement’ in the Primary Criteria

Table 10 below identifies the potential increase in the standard of each of the Primary Criteria through the introduction of elements needing improvement.

POTENTIAL HEALTH STATUS: PRIMARY CRITERIA

CRITERIA SATISFACTORY IMPROVE POTENTIAL POTENTIAL STANDARD

Community 45 20 65 BAND 3 Initiatives

Accessibility 42 30 72 BAND 3

Mental Wellbeing 73 19 92 BAND 4

Physical Activity 56 12 68 BAND 3

Environment 73 0 73 BAND 3

Table 10. The Increase in the level of each of the Primary Health Criteria, combining ‘Satisfactory’ elements with those ‘In Need of Improvement’

Parks for Health Assessment: Page 16 of 28 Parks for Health Assessment: Page 17 of 28 Chart 6 below indicates the Potential Health Status across each of the Secondary Criteria combining ‘Satisfactory’ elements, with elements ‘In Need of Improvement’.

Chart 6. Elements which are ‘Satisfactory’ and those which are ‘In Need of Improvement’ in the Secondary Criteria

Based upon this analysis the Standard of Provision for each of the Secondary Criteria changes as follows:

POTENTIAL HEALTH STATUS: SECONDARY CRITERIA

CRITERIA SATISFACTORY IMPROVE POTENTIAL POTENTIAL STANDARD

Community Initiatives

Media 40 0 40 BAND 2

Empowerment 56 12 68 BAND 3

Education 40 60 100 BAND 4

Accessibility

Access 75 25 100 BAND 4

Legibility 0 43 43 BAND 2

Facilities 67 17 84 BAND 4

Mental Wellbeing

Attractive 42 50 92 BAND 4

Parks for Health Assessment: Page 18 of 28 POTENTIAL HEALTH STATUS: SECONDARY CRITERIA

CRITERIA SATISFACTORY IMPROVE POTENTIAL POTENTIAL STANDARD

Natural 80 0 80 BAND 4

Therapeutic 80 0 80 BAND 4

Social 100 0 100 BAND 4

Growing 100 0 100 BAND 4

Physical Activity

Sports 34 0 34 BAND 2

Equipped 58 15 73 BAND 3

Informal 34 34 68 BAND 3

Walking 80 0 80 BAND 4

Environment

Environmental 100 0 100 BAND 4

Biodiversity 62 0 62 BAND 3

Table 11. The Increase in the level of each of the Secondary Health Criteria, combining ‘Satisfactory elements’ with those ‘In Need of Improvement’

From Table 11 it is possible to identify the potential Standard of provision within each of the Secondary Criteria.

SECONDARY CRITERIA CURRENT STANDARD POTENTIAL STANDARD

(SATISFACTORY) (SATISFACTORY & IMPROVE)

Community Initiatives

Media BAND 2 BAND 2

Empowerment BAND 3 BAND 3

Education BAND 2 BAND 4

Accessibility

Access BAND 4 BAND 4

Legibility BAND 1 BAND 2

Facilities BAND 3 BAND 4

Mental Wellbeing

Attractive BAND 2 BAND 4

Natural BAND 4 BAND 4

Therapeutic BAND 4 BAND 4

Social BAND 4 BAND 4

Growing BAND 4 BAND 4

Parks for Health Assessment: Page 19 of 28 SECONDARY CRITERIA CURRENT STANDARD POTENTIAL STANDARD

(SATISFACTORY) (SATISFACTORY & IMPROVE)

Physical Activity

Sports BAND 2 BAND 2

Equipped BAND 3 BAND 3

Informal BAND 2 BAND 3

Walking BAND 4 BAND 4

Environment

Environmental BAND 4 BAND 4

Biodiversity BAND 3 BAND 3

Table 12. A Table showing the change in the Standard of Health Provision between the Current Health Status, and with all Improvements being implemented

From this table it is possible to see the health benefits associated with introducing all the identified improvements.

It is apparent that notwithstanding the introduction of these improvements, there may be opportunity to make further improvements to the Health Status of the Park through the introduction of ‘New Interventions’. Where this is the case, these have been identified below.

Parks for Health Assessment: Page 20 of 28 2.4 NEW INTERVENTIONS

In addition to identifying elements ‘In Need of Improvement’, this analysis has also identified areas where ‘New Interventions’ could be introduced. Table 13 shows the opportunities which exist for ‘New Interventions’ within each of the five Primary Criteria.

A Lists of ‘New Interventions’ by Criteria In order to bring all the Primary and Secondary Criteria up to as high a standard as possible it may be necessary to introduce ‘New Interventions’. The following table identifies ‘New Interventions’ within each of the Criteria from which the selection may be made based upon local priorities and aspirations.

THE FOLLOWING ELEMENTS WERE IDENTIFIED AS NEW INTERVENTIONS

CRITERIA ELEMENT

Community Initiatives

Media & Health benefit information on the Website or other Social Media Communications

Media & A link to Government Health Guidance for Physical Activity and Communications Mental Wellbeing on the Website

Media & A web-based Health and Wellbeing Map, identifying opportunities Communications for Physical Activity and to support Mental Wellbeing

Media & 'Smart Apps' which promote recreation, cultural interest and/or Communications education

Empowerment Develop a 'Park(s) Health Strategy'

Empowerment Organised group fitness programmes

Empowerment Park based 'Workplace Health and Wellbeing' programmes for local employees

Accessibility

Legibility Provision of multi-sensory signage for the differently abled and children

Legibility Provision of a ' Park Health and Wellbeing Map'

Legibility Provision of maps identifying timed and distance walking routes within the Park

Legibility Provision of Waymarking Posts or Signs identifying walking routes

Mental Wellbeing

Attractive Safe Security cameras Spaces

Therapeutic A Therapeutic Garden Spaces

Natural Spaces Bird boxes

Parks for Health Assessment: Page 21 of 28 THE FOLLOWING ELEMENTS WERE IDENTIFIED AS NEW INTERVENTIONS

CRITERIA ELEMENT

Physical Activity

Sports & Fitness External adult fitness equipment (Outdoor Gym)

Sports & Fitness Fitness equipment specifically designed for Seniors (Healthy Ageing)

Equipped Play 'Inclusive' play equipment for the differently abled

Equipped Play 'Electronic Interactive Play'

Natural & 'Trim Trail' in the natural areas of the Park. Informal Play

Table 13. Potential New Interventions

B ‘New Interventions’ addressing Health Conditions Where New Interventions are required to address particular medical conditions or environmental risk factors these are identified below.

The following tables indicate ‘New Interventions’ that can be introduced to strengthen the health benefit of the Park to address particular conditions. These are identified as being linked to the prevention and treatment of: Obesity, Non-Communicative Diseases and Mental Ill-health

NEW INTERVENTIONS OBESITY

CRITERIA ELEMENT

Community Initiatives

Media & Health benefit information on the Website or other Social Media Communications

Media & A link to Government Health Guidance for Physical Activity and Communications Mental Wellbeing on the Website

Media & A web-based Health and Wellbeing Map, identifying opportunities Communications for Physical Activity and to support Mental Wellbeing

Media & 'Smart Apps' which promote recreation, cultural interest and/or Communications education

Empowerment Develop a 'Park(s) Health Strategy'

Empowerment Organised group fitness programmes

Empowerment Park based 'Workplace Health and Wellbeing' programmes for local employees

Accessibility

Legibility Provision of multi-sensory signage for the differently abled and children

Parks for Health Assessment: Page 22 of 28 NEW INTERVENTIONS OBESITY

CRITERIA ELEMENT

Legibility Provision of a ' Park Health and Wellbeing Map'

Legibility Provision of maps identifying timed and distance walking routes within the Park

Legibility Provision of Waymarking Posts or Signs identifying walking routes

Mental Wellbeing

Attractive Safe Security cameras Spaces

Physical Activity

Sports & Fitness External adult fitness equipment (Outdoor Gym)

Sports & Fitness Fitness equipment specifically designed for Seniors (Healthy Ageing)

Equipped Play 'Inclusive' play equipment for the differently abled

Equipped Play 'Electronic Interactive Play'

Natural & 'Trim Trail' in the natural areas of the Park. Informal Play

Table 14. New Interventions for Obesity

NEW INTERVENTIONS

NON-COMMUNICATIVE DISEASES

CRITERIA ELEMENT

Community Initiatives

Media & Health benefit information on the Website or other Social Media Communications

Media & A link to Government Health Guidance for Physical Activity and Communications Mental Wellbeing on the Website

Media & A web-based Health and Wellbeing Map, identifying opportunities Communications for Physical Activity and to support Mental Wellbeing

Media & 'Smart Apps' which promote recreation, cultural interest and/or Communications education

Empowerment Develop a 'Park(s) Health Strategy'

Empowerment Organised group fitness programmes

Empowerment Park based 'Workplace Health and Wellbeing' programmes for local employees

Parks for Health Assessment: Page 23 of 28 NEW INTERVENTIONS

NON-COMMUNICATIVE DISEASES

CRITERIA ELEMENT

Accessibility

Legibility Provision of multi-sensory signage for the differently abled and children

Legibility Provision of a ' Park Health and Wellbeing Map'

Legibility Provision of maps identifying timed and distance walking routes within the Park

Legibility Provision of Waymarking Posts or Signs identifying walking routes

Mental Wellbeing

Attractive Safe Security cameras Spaces

Physical Activity

Sports & Fitness External adult fitness equipment (Outdoor Gym)

Sports & Fitness Fitness equipment specifically designed for Seniors (Healthy Ageing)

Equipped Play 'Inclusive' play equipment for the differently abled

Equipped Play 'Electronic Interactive Play'

Natural & 'Trim Trail' in the natural areas of the Park. Informal Play

Table 15. ‘New Interventions’ for Non-Communicative Diseases

NEW INTERVENTIONS MENTAL WELLBEING

CRITERIA ELEMENT

Community Initiatives

Media & Health benefit information on the Website or other Social Media Communications

Media & A link to Government Health Guidance for Physical Activity and Communications Mental Wellbeing on the Website

Media & A web-based Health and Wellbeing Map, identifying opportunities Communications for Physical Activity and to support Mental Wellbeing

Media & 'Smart Apps' which promote recreation, cultural interest and/or Communications education

Empowerment Develop a 'Park(s) Health Strategy'

Parks for Health Assessment: Page 24 of 28 NEW INTERVENTIONS MENTAL WELLBEING

CRITERIA ELEMENT

Empowerment Organised group fitness programmes

Empowerment Park based 'Workplace Health and Wellbeing' programmes for local employees

Accessibility

Legibility Provision of multi-sensory signage for the differently abled and children

Legibility Provision of a ' Park Health and Wellbeing Map'

Legibility Provision of maps identifying timed and distance walking routes within the Park

Legibility Provision of Waymarking Posts or Signs identifying walking routes

Mental Wellbeing

Attractive Safe Security cameras Spaces

Therapeutic A Therapeutic Garden Spaces

Natural Spaces Bird boxes

Physical Activity

Sports & Fitness External adult fitness equipment (Outdoor Gym)

Sports & Fitness Fitness equipment specifically designed for Seniors (Healthy Ageing)

Equipped Play 'Inclusive' play equipment for the differently abled

Equipped Play 'Electronic Interactive Play'

Natural & 'Trim Trail' in the natural areas of the Park. Informal Play

Table 16. ‘New Interventions’ for Mental Wellbeing

NEW INTERVENTIONS

ENVIRONMENTAL FACTORS

CRITERIA ELEMENT

Environment

Biodiversity Provide longer Meadow Grassland where appropriate

Table 17. ‘New Interventions’ for Environmental Factors

Parks for Health Assessment: Page 25 of 28 Together these tables identify the specific `New Interventions` which can be implemented to address particular medical conditions in the local population. The priority granted to each will be guided by the prevalence of those individual conditions and the guidance of Public Health.

Parks for Health Assessment: Page 26 of 28 3.0 Recommendations

Given the benefit Parks can bring to the health and wellbeing of local communities, the aim of the Parks for Health Initiative is to achieve a high standard of provision in every Park. Based upon this Strategy, the following actions are available:

1. Take Action: To implement the findings of this assessment in consultation with the land owner, local authority and community. This Strategy identifies the current health status of the Park, practical improvements and potential opportunities which can be introduced. These are presented in Charts, Tables and Lists; the latter linking elements both to the Primary and Secondary Health Criteria, and to related medical conditions. These are practical interventions which can be implemented as appropriate to the local context. 2. Multiple Park Analysis: In order to determine the health status of Parks across an area (e.g. City, Town, Ward or Community), it is possible to analyse the results of Strategy Assessments across that area. The analysis indicates the average and variation in health status of the Parks. It identifies Parks which lie above and below this average, both overall, and within each of the Health Criteria. From this it will be possible to identify strengths and weaknesses in provision in certain communities, to address shortfalls, and to target medical conditions prevalent in that population. Further, the data will also make it possible to explore associations between the health status of those Parks and other determinants of health; deprivation, prevalence of specific avoidable diseases, air pollution etc. and to target interventions on a regional or city-wide level. 3. The Parks and Green Space Health Framework. This allows a holistic approach to the use of Parks and Green Spaces for Health and Wellbeing within the context of the ‘Primary Prevention’. It integrates the work of Local Government departments, Clinicians (Social or Green Prescribing) and Public Health, as well as local community groups and Wellness at Work practitioners. As such it provides a vehicle for the practical application of initiatives to address national and regional policy objectives and health targets.

4. Economic and Social Evaluation: By undertaking a programme of quantitative and qualitative research, and social and economic assessment, it is possible to evaluate social and financial benefits associated with the increased use of Parks and Green Spaces, and the health of the local population.

Parks for Health Assessment: Page 27 of 28 4.0 Conclusion

This report has identified the results of the Parks for Health Strategy Survey for Ruskin Park. It remains the view of many that the seriousness of avoidable physical and mental ill-health, increasingly prevalent in many populations, justifies the use of green space alongside other initiatives within Primary Prevention. The Parks for Health Assessments provide opportunities to improve the health benefits associated with Parks, and to value them as Health Assets.

Opportunities to deliver such benefits can be identified within the following areas:

Practical improvements: Enhancements to the fabric of Parks themselves, and the introduction of improvements and new interventions linked with health and wellbeing. Primary Prevention: Community Engagement and Health Promotion: To build on current Health Promotion Initiatives, identifying opportunities to increase the use of the Park through greater awareness of health benefits, programmes to involve the local community groups to use their Parks as a centre for their communities, and to develop a sense of ownership of the Park by that local community. This may include initiatives related to physical activity, recreation, education or to address loneliness, depression and dementia.

Social (Green) Prescribing: Alongside clinical interventions, to work with the local Clinicians, Public Health, local groups and charities, to use the Park as a context to prescribe physical activity and promote mental wellbeing through social interaction and engagement with the natural environment, Encouraging a Healthy Workforce: Losses to the UK economy of some £64 billion p.a. result from stress, anxiety and depression in the workplace. Identifying the health benefits of using Parks for physical activity, emotional restoration and quiet reflection could do much to improve the health and wellbeing of people at work, to produce a healthier happier workforce and to reduce suffering and cost to society. Funding: To support funding bids for new capital, and to justify the use of cross-cutting interdepartmental budgets to promote health communities through the improvement of Parks and Green Spaces.

For further information on the above, please contact us by email at: [email protected]

Parks for Health Assessment: Page 28 of 28