Abstract Body: Introduction: Parks and park programming have been associated with more physical activity (PA), yet investments in parks are low. For the largest 100 US cities, the average spending for parks and recreation in 2022 was $126 per capita, with an average of $30 per capita devoted to programming. In contrast, the spending for health care in 2022 was $13,493 per capita. Physical inactivity accounts 11% of health care costs, and PA is strongly associated with better health and lower rates of cardiovascular disease. The goal of this study was to assess whether greater investments in parks and recreation will have a positive health benefit.

Hypothesis: Spending on parks, programming and maintenance may be associated with better health outcomes, including lower cardiovascular disease (CV), hypertension (HTN) and Type 2 diabetes (T2DM).

Methods: We tested the association between per capita spending by Depts. of Parks and Recreation and health outcomes among local residents who receive healthcare from Kaiser Permanente, which serves >20% of the Southern California (SoCal) population. Data consisted of 2022 per capita spending on park maintenance and programming collected by Trust for Public Land and 2022-2023 electronic health records from 732,504 adults in 10 SoCal cities. We calculated the risk ratio for CV, HTN and T2DM using Poisson model with robust variance estimator controlling for body mass index (BMI), population density, neighborhood deprivation index (NDI), age, gender, and race/ethnicity.

Results: Of the 732,504 adults in 10 SoCal cities, 48,042 had CV conditions, 205,462 had HTN, 115,758 had Type2 DM. We found that for every $30 per capita per city spent on programming there were 8.9% fewer CV diagnoses (e.g. MI, CHF, atherosclerosis, cardiomyopathy, angina, etc.), 3.9% fewer diagnoses of HTN and 3.8% fewer T2DM cases (p<.0001 for all). Investments in park maintenance were not associated with CV outcomes but were associated with 1.3% lower T2DM and 1.8% lower HTN rates (p <.0001 for both).

Conclusions. Programming has a stronger relationship than park maintenance with health outcomes, probably because it is the programming (sports, exercise classes, 5K walks and runs) that more strongly attracts park visitors and supports PA. While this is a cross-sectional study verifying the relationships between investments in park programming, park maintenance and health, a longitudinal study is needed to prove the health benefits of park programming and events.