Some of Dr. Maria Brown's young patients won't be getting a prescription they can fill at a pharmacy.
Instead, they'll be instructed to fill their lungs with fresh air, feel the sunlight on their skin and stretch their muscles in the great outdoors. They will be told to walk around the block, visit a nature center or take a bike ride with their parents.
Brown is a nature champion, trained by the U.S. Fish and Wildlife Service to teach other health care providers at St. Agnes Hospital about the benefits of getting children outside to combat obesity and accompanying diseases such as diabetes and asthma.
"The problem in Baltimore is not insignificant," says Brown. "Thirty percent of the kids I take care of fit into the overweight or obese category."
As one of 35 pediatric health care providers selected for the pilot program, Brown received training last month at the National Conservation Training Center in West Virginia. She, in turn, has promised to teach 30 St. Agnes residents and other medical staff over the next two years.
"I thought it was a unique approach to pair up nature people with health care providers," says Brown, a member of the Johns Hopkins School of Medicine's department of pediatrics who serves as an instructor at St. Agnes. "To make a difference, we will need to work with one patient and family at a time. While we may not have measurable effects of this practice for several years, in the interim if we can get a few more kids to enjoy being physically active outside, then it is time well spent."
The nature champion idea came out of the 2007 Children and Nature Summit, when U.S. Fish and Wildlife Service staff began talking to doctors, educators and outdoors professionals about ways to overcome "nature-deficit disorder" among children.
"The question most doctors and school nurses had was, 'Where where would I advise my patients to go and what would I advise them to do when they got there?' " recalls Janet Ady, NCTC education director. "We decided that our employees were perfect for providing that kind of information and support."
And the nature professionals felt the doctors were the perfect conduit for their message, too.
"Pediatricians are great role models and traditionally have been the voice of authority," says Jen Lapis of the U.S. Fish and Wildlife Service. "They know their patients on a very personal level and can reinforce a parent's message. A child may ignore a parent who tells them to go outside, but their doctor may be another matter."
The National Environmental Education Foundation's "train-a-trainer" approach — which has proved successful in getting out the conservation message — was the most efficient way to get 1,200 health care providers across the country on board in a short amount of time.
Ady says doctors and other medical professionals came from as far away as California to take part in the training. Each nature champion was paired with a Fish and Wildlife Service employee who could suggest national parks, wildlife refuges and National Audubon Society lands near their communities.
Brown was introduced to Jennifer Hill at the Patuxent Wildlife Refuge in Laurel, which has agreed to be Maryland's pilot site. Hill will not only suggest structured activities at Patuxent, but also will scout the Baltimore area for other suitable outdoor opportunities.
With a special prescription pad called "Rx for Outdoor Activity," Brown will coach the parents of her patients on types and frequency of activities. The customized prescription has a place above the doctor's signature for the child or parent to sign.
Some Fish and Wildlife Service locations, such as Patuxent, will give patients punch cards and will award prizes to the youngsters who follow through.
"A child might visit once, but it's the repeat business we want," says Lapis. "We want them to develop a habit, to think about going outdoors like going to the movies or playing a video game. We want them to realize that just because they've gone once doesn't mean they've seen everything."
In Baltimore, however, Brown knows there are obstacles.
"I don't think getting outside is a hard sell, but I think it's difficult for some parents in Baltimore to access green spaces," she says. "There are places where it's not safe to walk around the block in the evening."
That may mean reaching out to schools to create more unstructured play time and recess and to local governments to provide more and better green spaces.
"Parents are going to be the biggest advocates in the community," says Brown. "If this is going to succeed, we've got to advocate for more green spaces. But it's not one person. All members of the community are going to have to pull together."