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A Sense of Place
H ealth notes
Byron Y. Newman, O.D.
A Sense of Place “Some places are romantic, and some places are depressing. There are places that are confusing, places that are peaceful, places that are frightening, and places that are safe. We like some places better than others. Place Matters.” So opens an article by Howard Frumkin, M.D., M.P.H., Dr.Ph. in the September 2003 issue of the American Journal of Public Health entitled Healthy Places: Exploring the Evidence. Frumkin continues with thoughts about place and talks of the various responses people have toward “place.” Some like forests, others like deserts, others like manicured back yards, and others like bustling city streets, he says. “There is every reason for those who care about public health to care about place,” he states. “If places have such varied and far-reaching effects on people, we would expect some places to surpass others in promoting health and well-being. The field of environmental health has focused much more attention on safety,” he said, “like defining the dangers of such places as cliff edges, hazardous waste sites, and lead smelters.” Then he asks, “How do we know what makes a good place?” Some authors have asserted that humans should be around natural places. Rachel and Stephen Kaplan of the University
of Michigan, pioneers in environmental psychology, did a study in which they showed respondents photographs of different kinds of places and asked them to choose which they prefer. People consistently favored such features as a balance of trees and pasture, clear borders, and alluring paths that curved out of sight, reported the Kaplans. In hospitals in which patients were recovering, those with a better view from their rooms had statistically significantly shorter hospitalizations, less need for pain medications, and fewer negative nurses’ notes than patients with just a view of a wall. The appreciation that place matters for health is not new. Hippocrates helped his readers distinguish unhealthy places (like swamps) from healthy places, such as sunny, breezy hillsides. More recently, urban planners have recognized the implications of their work for public health, and the field of Medical Geography has been reinvigorated, including a new journal Health & Place. Today’s challenges are different: our buildings are more complex, and technical advances have improved indoor air (eliminating the need for wood and coal-burning stoves). Members of the public increasingly value their health and consider the environment to be an important influence, preferring to live, work, and play in
Byron Y. Newman, O.D.
healthy environments. For these reasons, then, public health needs to refocus on the health implications of place. Research is ongoing, but it has been shown that contact with nature means fewer sick call visits among prisoners, improved attention among children with attention deficit hyperactivity disorder, an improved self-discipline among inner-city girls, and even lower blood pressure and anxiety among dental patients. Contact with nature has been credited with reducing stress and pain plus improving work performance. So, should hospitals offer healing gardens? Should windows in offices offer views of trees? Building design principles offer health considerations. (See the US Green Building Council at www.usgbc.org.) The health benefits of environmental building practices will yield important insights. More research continues.
562 OPTOMETRY
VOLUME 76 / NUMBER 10 / OCTOBER 2005
HEALTH NOTES
Many of the best places are neither home nor work, but “third places” in the public realm: streets and sidewalks, parks and cafes, theaters and sports facilities—all important venues for a wide variety of activities. These places also have clear health implications. Research on parks suggests that several design features play a role, including amount
and type of vegetation, presence of interesting meandering pathways, quiet areas for sitting and reading, recreational amenities, adequate information and signage, and a perceived level of safety. Frumkin, of the Rollins school of Public Health, Emory University, Atlanta, Georgia concludes by saying that public health needs to rediscover the importance of place. He says,
“As health professionals, urban planners, architects, transportation engineers, real estate developers, environmental psychologists, and geographers learn the vocabularies and perspectives of each other’s fields and pursue active collaborations, research questions will be asked and answered with solid evidence creating healthier more sustainable human environments.”
563 VOLUME 76 / NUMBER 10 / OCTOBER 2005
OPTOMETRY
Byron Y. Newman, O.D.
A Sense of Place “Some places are romantic, and some places are depressing. There are places that are confusing, places that are peaceful, places that are frightening, and places that are safe. We like some places better than others. Place Matters.” So opens an article by Howard Frumkin, M.D., M.P.H., Dr.Ph. in the September 2003 issue of the American Journal of Public Health entitled Healthy Places: Exploring the Evidence. Frumkin continues with thoughts about place and talks of the various responses people have toward “place.” Some like forests, others like deserts, others like manicured back yards, and others like bustling city streets, he says. “There is every reason for those who care about public health to care about place,” he states. “If places have such varied and far-reaching effects on people, we would expect some places to surpass others in promoting health and well-being. The field of environmental health has focused much more attention on safety,” he said, “like defining the dangers of such places as cliff edges, hazardous waste sites, and lead smelters.” Then he asks, “How do we know what makes a good place?” Some authors have asserted that humans should be around natural places. Rachel and Stephen Kaplan of the University
of Michigan, pioneers in environmental psychology, did a study in which they showed respondents photographs of different kinds of places and asked them to choose which they prefer. People consistently favored such features as a balance of trees and pasture, clear borders, and alluring paths that curved out of sight, reported the Kaplans. In hospitals in which patients were recovering, those with a better view from their rooms had statistically significantly shorter hospitalizations, less need for pain medications, and fewer negative nurses’ notes than patients with just a view of a wall. The appreciation that place matters for health is not new. Hippocrates helped his readers distinguish unhealthy places (like swamps) from healthy places, such as sunny, breezy hillsides. More recently, urban planners have recognized the implications of their work for public health, and the field of Medical Geography has been reinvigorated, including a new journal Health & Place. Today’s challenges are different: our buildings are more complex, and technical advances have improved indoor air (eliminating the need for wood and coal-burning stoves). Members of the public increasingly value their health and consider the environment to be an important influence, preferring to live, work, and play in
Byron Y. Newman, O.D.
healthy environments. For these reasons, then, public health needs to refocus on the health implications of place. Research is ongoing, but it has been shown that contact with nature means fewer sick call visits among prisoners, improved attention among children with attention deficit hyperactivity disorder, an improved self-discipline among inner-city girls, and even lower blood pressure and anxiety among dental patients. Contact with nature has been credited with reducing stress and pain plus improving work performance. So, should hospitals offer healing gardens? Should windows in offices offer views of trees? Building design principles offer health considerations. (See the US Green Building Council at www.usgbc.org.) The health benefits of environmental building practices will yield important insights. More research continues.
562 OPTOMETRY
VOLUME 76 / NUMBER 10 / OCTOBER 2005
HEALTH NOTES
Many of the best places are neither home nor work, but “third places” in the public realm: streets and sidewalks, parks and cafes, theaters and sports facilities—all important venues for a wide variety of activities. These places also have clear health implications. Research on parks suggests that several design features play a role, including amount
and type of vegetation, presence of interesting meandering pathways, quiet areas for sitting and reading, recreational amenities, adequate information and signage, and a perceived level of safety. Frumkin, of the Rollins school of Public Health, Emory University, Atlanta, Georgia concludes by saying that public health needs to rediscover the importance of place. He says,
“As health professionals, urban planners, architects, transportation engineers, real estate developers, environmental psychologists, and geographers learn the vocabularies and perspectives of each other’s fields and pursue active collaborations, research questions will be asked and answered with solid evidence creating healthier more sustainable human environments.”
563 VOLUME 76 / NUMBER 10 / OCTOBER 2005
OPTOMETRY