Surmounting Barriers to Public Health/Park Agency Partnerships: Insights From a County Public Health Department

The American Public Health Association (APHA) recently recommended that health professionals partner with park agencies in order to use nature for health promotion. We aimed to 1) determine the capacity of a local public health system to implement the APHA recommendations, 2) test the hypothesis that the likelihood of implementation is associated with health professional knowledge and beliefs, and 3) identify a framework for facilitating implementation. We surveyed all staff members at the San Francisco Department of Public Health (SFDPH) Maternal, Child and Adolescent Health Branch. SFDPH, like many health departments, provides services for underserved and marginalized populations. The results of 108 quantitative surveys and the qualitative analysis from small group discussions with 120 public health professionals are presented in this paper. The majority of those surveyed (81%) agreed that patient health would improve if they spent time in nature. However, few health professionals believed that patients regularly visit parks (11%) or would follow a practitioner's recommendation to visit a park (16%) in order to experience nature. We found that if public health professionals knew of a specific location and activity to do in nature, and if they were confident that their low income patients would be welcome at parks, they were more likely to recommend a park visit. In group discussions, health professionals showed enthusiasm for collaboration with park agencies, pragmatism that their patients will need multiple supports in order to sustain outdoor behaviors, and a perspective that time in nature for underserved communities is the product of a socioecological system. This socioecological system includes factors to be considered at the individual, interpersonal, community, and societal levels. Participants engaged in a rich discussion on how health departments can partner with park agencies and community-based organizations to encourage nature for health at each of these levels. We turned to public health professionals for suggestions about how nature can be integrated into public health systems. The resulting discussions came together in the form of a framework that provides insight on public health priorities, a roadmap for those who seek to initiate interdisciplinary alliances, and suggestions for future research.