Abstract
Parks have been associated with more physical activity and better health, but the relationship between health and how funds are expended for park programming, maintenance, or other expenses has not yet been investigated. For the largest 100 US cities, the average spending for parks and recreation in 2022-2023 was $126 per capita, with $37.59 per capita for programming and $63.11 per capita for maintenance. In contrast, the spending for health care in 2022 was $13,493 per capita. The goal of this study was to assess which allocations by Depts of Parks and Recreation are related to health outcomes. We tested the association between per capita spending in programming, maintenance, and total spending in 2022 by Depts. of Parks and Recreation in 10 Southern California cities and health outcomes among 732,504 adult members of Kaiser Permanente in 2022-2023 accounting for multiple factors. For every $30 per capita spent on programming, the prevalence ratios were lower: 0.87 for stroke (CI 0.84-0.90), 0.87 for heart failure (CI 0.84-0.89), 0.92 for atrial fibrillation (CI 0.90-0.95), 0.93 for coronary heart disease (CI 0.91-0.95), 0.94 for obesity (CI 0.93-0.95), 0.96 for type 2 diabetes (CI 0.95-0.97), and 0.96 for hypertension (CI 0.96-0.97). It is likely that programming has a stronger relationship than park maintenance with health outcomes because sports, exercise classes, and events (5 K walks and runs) more strongly attract park visitors and support physical activity (PA). While this novel study is promising, a longitudinal study is needed to prove causality.