The Key to Healthy Cities and Hearts Might Come from the Ground

Debra Burke grew up in the middle of a 500-acre forest in Hardin County, Kentucky. 

With no electricity or running water, she drank milk that wasn’t pasteurized, cooked with water from a nearby spring and ate vegetables caked with dirt.  

So when she moved an hour north to Louisville, Kentucky, 23 years ago, it was a bit of a culture shock, she told NationSwell.

She scoured the urban landscape for a forested pocket to meet her tree needs. “I kept looking for a community that reminded me of home,” she said.

After living in the city for about six months, she finally found it near Iroquois Park, a 725-acre expanse filled with a few of Burke’s favorites: red maples and white oaks. 

A few months ago, Burke was on her daily walk there when a yard sign caught her attention. It talked about the Green Heart project, a scientific study assessing how health is impacted by tree canopy, the percentage of a city shaded by trees.

Burke, a 59-year-old barber, is familiar with the power of trees — not just how they beautify cities, but how they transform the lives around them — so she wanted to get involved. Now she’s one of over 800 residents participating in a health assessment to track how trees and vegetation affect their cardiovascular health. 

Her neighborhood is one of the four neighborhoods in south Louisville that has embarked on a $15 million, five-year study that will once and for all answer if health is tied to an area’s tree canopy. The study launched in 2018 when researchers collected baseline information about the neighborhood’s air pollution and resident’s heart health. Over the next three years, they’ll plant trees and monitor those same residents. In 2022, they’ll observe any changes. 

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The Green Heart project will be the first controlled scientific study assessing the impact of tree canopy on heart health.

As early as 1984, researchers were beginning to understand the role greenery plays in health. Roger Ulrich watched as patients with tree-facing windows had shorter hospital stays compared to their counterparts who looked at brick walls. The links between health and vegetation have continued for decades. Scientists saw the benefits of trees in everything from absorbing auto emissions to cooling sidewalks. They studied how greenery correlates to decreases in stress levels, heart rates, muscle tension, asthma and blood pressure.  

There’s a well-known link between health and greenness. But an important component was missing from the story: a controlled scientific study. 

The Green Heart project will be the first-ever experiment to see if increasing an area’s tree canopy will improve residents’ health.

Ted Smith, the director of the Center for Healthy Air, Water and Soil at the University of Louisville’s Envirome Institute, compared it to a drug trial “except the drug is trees and bushes,” he told NationSwell. Researchers will use a control group and a test group to see if the “drug” is effective or not. 

In this study, a control group of two neighborhoods will not receive any changes to their environment, but the test group will. Test neighborhoods will have 8,000 trees and plants added to their lawns, backyards and public spaces. Green Heart’s team surveyed public and private land in search of gaps in greenery, and the greening team went door to door asking residents if they’d like trees to be planted in their yards for free. These trees will raise the community’s tree canopy by 10% — an amount that’s “consistent with the literature of seeing a clinical benefit,” Smith said.

After about a year and a half, researchers will look at whether health improved, worsened or stayed the same between the groups. 

While it’s a study that can apply to almost every urban environment, Louisville is a compelling place to start. The city’s average tree canopy is only 28% — 16% lower than the recommended percentage, Smith said. That means a little over a quarter of the city is shaded by trees, whereas a healthy city should have a canopy of 44%. Instead of increasing, Lousiville’s tree canopy has continued to decline. About 54,000 trees are lost in Louisville each year to factors like development, age and invasive species. 

In the four neighborhoods researchers are studying, the numbers are even lower. Their tree canopy averages out at just 22%. But it wasn’t just their low tree canopy area that made these neighborhoods strong candidates: They each have high owner occupancy, which means they’re less likely to be gentrified as a result of the greening; they’re decent sizes (about 40,000 residents cumulatively); and they’re ethnically and socioeconomically diverse.

“If we can provide some evidence that there is an important effect of greenness on human health, in particular, the risk of heart disease, then that will send a case in trying to preserve the tree canopy,” Aruni Bhatnagar, the director of the Center for Diabetes and Obesity Research at the University of Louisville and lead researcher for the study, told NationSwell. 

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Aruni Bhatnagar speaks at Green Heart’s tree planting.

The $15 million study is funded by the National Institutes of Health, which supports the medical testing, and The Nature Conservancy, which is funding the vegetation. Collaborators include the University of Louisville, Louisville’s metro government, Washington University in St. Louis, U.S. Forest Service, Cornell University and Hyphae Design Lab.

“You don’t see projects come together like this very often, and we’re really trying to make sure this isn’t the only time unusual funders get together to get things done that aren’t just being done,” Smith said. 

Before planting began, the Green Heart team found more than 800 residents to complete a health assessment. Hair samples, nail clippings, urine, blood and questionnaires were all collected to assess each individual’s health. In about two years, after all the planting is done, their health will be reassessed. 

Bhatnagar and other scientists will be looking for changes in their health. For heart health, they’ll look at arterial stiffness, where increased stiffness is associated with an increased risk for heart events.

Kentucky is part of the Coronary Valley, a region of the U.S. that has the highest coronary heart disease mortality rates. While this area has higher concentrations of heart deaths, it’s a risk that everyone faces, said Bhatnagar, who has spent his career at the intersection of heart health and nature.

“We can treat it with lots of different things, stents and statins and whatever, but it’s very hard to prevent,” he said. “So prevention approach is severely and sorely needed.”

Bhatnagar hopes this study could create a blueprint for other urban cities to follow.

“If we can provide some evidence that there is an important effect of greenness on human health, in particular, the risk of heart disease, then that will send a case in trying to preserve the tree canopy. ” Bhatnagar said. “Not just in Louisville, but I think globally.”

Beyond heart health, scientists are looking at other connections between trees and people. 

Smith, who is leading the ancillary studies, said the team is conducting additional research to look at variables like sleep, noise, asthma, depression, social cohesion and biodiversity. 

Overall the study has been well-received. 

The Green Heart team is present at town halls, neighborhood meetings and community events. They’re there to spread awareness about the study but also show that they’re not just planning on extracting data from the community — they’re there for the long haul.

Nicole George, one of the two council representatives in the study’s neighborhoods, said Green Heart’s presence has helped shaped community attitudes towards the study.

“Their commitment is not just planting the tree, collecting a little health survey data and leaving,” she told NationSwell. “Their commitment is to the community.”

So whether it was Green Heart members helping a resident clean debris after a tree fell on her home or sending a birthday card to a resident, this is more than just a study.

“We’re not here to fix your neighborhood or clean up your neighborhood,” Smith said. “We’re here to figure out how to have a healthier neighborhood.”

More: To Build a Healthier City, Atlanta Is Opening Its Schoolyards to Everyone

Back to Basics: How One Health Nonprofit is Rethinking Clinical Care

As Americans adjust to a new healthcare system, some providers are beginning to dig deeper into the social conditions that may lead a patient to seek medical treatment in the first place. They’re finding that sometimes, a prescribed antibiotic is simply not the answer.
That’s the thinking at Health Leads, a Boston-based organization that partners with healthcare institutions to provide non-medical assistance for vulnerable patients.
Why this new method of treatment? Too often, doctors end up prescribing medication, but instead of getting better, the patient actually worsens as he or she continues to live in poor conditions. The cyclical nature of this process leads to patients returning to seek more treatment, which then becomes a costly venture for hospitals. (For example, instead of giving medication to someone living in a car, what that patient may really need is access to proper housing or heat instead.) But what if doctors “prescribed” healthy food, housing or other basic needs?
MORE: The Checklist That Can Reform Healthcare
At Health Leads’s institutions, after seeing a doctor, patients are directed to meet with volunteer “advocates,” which typically are college students. These volunteers work with these patients to get them better access to public benefits and community resources. Their goal, according to the Stanford Social Innovation Review, is to transform the way institutions deliver health care by addressing how social factors can shape healthy living.
But the program, which connects 1,000 student volunteers with 14,000 patients and families, is keeping its focus small. Rather than expanding on a large scale, the project is partnering with just a few institutions — such as academic medical centers and for-profit hospitals — to create models for other institutions to emulate. Health Leads is also focusing on collecting data from its partnerships to further support transformation across the health care industry.
“Going small may not be glamorous,” Health Leads’s Rebecca Onie, Sarah Di Troia and Sonia Sarkar write. “But if we can couple a powerful on-the-ground demonstration with pathways to change the sector, we will have the opportunity at last to transform health care for patients, physicians, and us all.”
While addressing social conditions like public safety, economic inequality, and food security is nothing new, it’s important to see organizations like Health Leads make the connections between healthy living and health care.

Why Is This Doctor Telling Grandmas to Balance on One Leg While Brushing Their Teeth?

Falls are always a danger to the elderly. More than half of people over age 80 fall each year, and falls are the leading cause of injury to seniors. In Wisconsin, the death rate among elderly people after a fall is double the national average, so one doctor decided to try to do something to reduce the risk. Dr. Irene Hamrick of the University of Wisconsin’s School of Medicine and Public Health learned about a program in Australia called the Lifestyle and Functional Exercise program, or LiFE, that was improving seniors’ balance by incorporating simple exercises into their daily routines. Participants in the program reduced their rate of falls by 31 percent over a year of follow-up, and increased their strength.
Dr. Hamrick adapted LiFE for Wisconsin seniors. She recruited people over 70 in Wausau, Wis., to enroll in a pilot program that asked participants to perform simple strength and balance exercises during the day, like standing on one leg while brushing their teeth. The program runs counter to the standard advice that physicians give to the elderly about avoiding activities that may be challenging to their balance.
Dr. Hamrick plans to expand the program statewide, saying in a statement, “We are very excited with the success we have seen so far. Patients really want to do the program, and we have not had anyone drop out.”
MORE: Non-Profit Helps Grandma Understand What You Posted On Facebook Last Night

Improve Your Bike Commute by Re-Inventing the Wheel

Bicycling is a great option for an outdoor fitness routine, but even if you’re not training for a long ride or racking up miles on uphill climbs, you can still take part in the practical benefits of riding a bike. A bike commute, for example, helps you reduce your carbon footprint, save on gas money, and turns your commute into a workout, rather than a stressful ride through traffic. Some cyclists, especially commuters, are looking for a little extra boost in their ride, and while a few bikes come with small motors, the FlyKly Smart Wheel is a unique bike addition that has already raised four times as much money as its original Kickstarter goal. It’s designed to fit on almost any bicycle, and the motor, which takes two or three hours to completely charge, kicks in as a rider starts pedaling and cuts out upon stopping. The high-tech side of this product shows up in a mobile app that allows cyclists to lock the motor or track the bike if it gets stolen; it also lets riders set a top speed. It’ll even monitor the wheel and provide alerts when it’s time for maintenance.

 

Chef Fixes the Food Bank by Creating Healthy Meals for Four

The long lines were getting longer at the Capital Area Food Bank, and volunteers noticed a growing sense of hopelessness. Even when people came to the food bank for healthy foods, reports indicated that they were taking the fruits and vegetables home, only to fry or “shower” the produce with salt. Kate Sherwood, the executive chef of the Center for Science in the Public Interest, accepted the challenge of creating nutritious, enticing meals, for under $8 for four people. Her attitude was a fresh one–“You can’t get to healthy without delicious”–but her approach is scientific and data-driven. She comes up with a meal and tests it out with the food bank. She edits the recipe when necessary. And when it’s successful, she adds the recipe to an online database and prints cards in English and Spanish to distribute at more than 500 local agencies. It’s turning into an engaging local movement; the outreach goes as far as store cash registers and bags of donated items.

[Image: Capital Area Food Bank]

$95 Device Lets You Charge Your Phone With Energy From Riding Your Bike

Engineers have created several ways for you to convert bicycle energy into power. But often, the options involve an expensive (and heavy) wheel buildout onto your bike. The Siva Cycle Atom is a generator that easily snaps onto your bike to charge electronic things like a phone, lights, and battery pack as you ride along. The website says, “We started Siva Cycle to transform the energy and passion of cycling into usable electricity for everyday.” They launched a successful Kickstarter campaign earlier this year to put the charger into production; the first round of chargers should reach people this month. The device not only represents a renewable energy solution for electronic devices, but also promotes a healthy lifestyle and helps reduce carbon emissions. Next time you need to recharge, consider grabbing your bike.
 

Lessons in Local Shopping: Can You Go From Farm to … Grocery Cart?

One of the biggest challenges for people who want to shop local is that the prices at farmers’ markets and other local stores are often higher than those at large supermarkets. In North Carolina, two new stores are trying to make it easier and cheaper to shop locally. It’s a new spin on farm-to-table: a store that seems to connect farms and shopping carts. Designed by a veteran combat engineer Ben Greene, the Farmery is a “living building” that will start out in downtown Durham and Clayton, N.C. With hydroponic vertical growing systems right on site, as well as local foods from other nearby producers, the store has a business model geared toward lower prices and an educational model that will help food buyers learn about the process and benefits of locally sourced foods.

[Image: Farmery]

Kentucky’s Says It’s Time to Fill the State With Quitters

With the Great American Smokeout on the way, and recognizing that 22% of its state population still smokes, Kentucky has started state-wide community challenge to get people to stop smoking. American Lung Association in Kentucky and Anthem Blue Cross and Blue Shield have partnered to bring the “Quitter in You” program to the state. Since about 60% of quitters aren’t successful in their first try, this community effort doesn’t just provide support for people who are quitting. It adds a clever second layer, a robust toolkit for people who want to help a family member, friend, or co-worker quit. It even has specific resources for helping kids. Louisville, hub for the Kentucky program, has seen a slight decrease in its local smoking rates, but the city and still wants to curb tobacco use, which is tied to four leading causes of death: cancer, heart disease, chronic lower respiratory disease, and stroke.