Podcast: A Business Case for Medicaid to Pay for Trees

Podcast Length: 7:57 minutes

Your zip code may say more about your health than your genetic code. In this interview, Bobby Cochran, executive director of Willamette Partnership, tells you why Medicaid should be paying for trees; why outdoor educators should consider themselves public health officials; and why stormwater utilities could be advancing justice in health equity.

Transcript of Interview:

Bobby Cochran: “I think for Willamette Partnership, as a conservation organization, when we come out and talk fairly directly about the importance of advancing health and equity, people listen because we don’t always talk about that. So, I think the impact of hearing our voice in that conversation is important. I think we’re drawing connections that other organizations are not drawing. And I think that’s one of our strengths.”

Christopher Springmann: Hello, I’m Christopher Springmann and this the second segment of our interview with Bobby Cochran, executive director of the environmental nonprofit Willamette Partnership. Bobby is discussing their work linking public health and environmental protection, an effort known as the Oregon Health and Outdoors Initiative. He’ll touch on why teachers should consider themselves public health officials, how stormwater utilities can be advancing justice in health equity, and to kick us off, Bobby explains why Willamette Partnership thinks Medicaid should be investing in trees.

Bobby Cochran: Chris, I think if you closed your eyes—or any of your listeners close their eyes—and were asked to think about, kind of, their first outdoor experience or their meaningful experience in nature, you hear a lot of the same adjectives. What would be some of the adjectives that you would think of?

CS: “It’s so quiet. It’s so big. And the stars are so bright. And, gosh, this is the first time I’ve really been able to see the night sky or see wild animals in person.”

BC: Hm-hmm [affirmative]. Other things that we hear is, “I feel inspired. I feel relaxed. I feel scared.” Or, “I fall in love.” Really intense emotions. And all of that is intuitive. But what a study out of University of California at Berkley did is, when we felt those feelings of awe, they would actually come and swab your cheek and look at levels of cortisol and other hormones in your saliva and understand that when you had that experience of awe, not only did your stress levels come down in the immediate—immediately after that experience—but they stayed down several weeks afterwards. So, you’re starting to make a case that—well, if we can talk about cortisol levels, the medical community knows exactly what that starts to mean for chronic disease risk. And so, by measuring, we’re starting to make the business case of why Medicaid should be investing in trees—why hospitals and health systems should be thinking not just about how you have a nice picture of nature in every hospital room—because that decreases recovery time.  No. We actually need the healthy places. So, we create a culture of health outside the hospital so you never even have to go in the door in the first place. And measurement is a big part of making that business case. And so, [there’s] a lot of the research that is out there—and it’s growing really quickly. We’re getting a big body of research. We’re trying to get to the point where we’re consolidating that and making sense of it so that it gets easier to inform decisions with.

CS: And, frankly, results in outcomes that are quantified or verified, let’s be honest, have a tendency to drive funding. And that’s very helpful.

BC: A hundred and ten percent, that’s true. We don’t want to lose the anecdotes and the stories and the heart.  I think we need to be able to speak to both the head and the heart. So the stories of a mother going out with her kids for the first time to the outdoors, paired with numeric information on stress reduction and increase in physical activity, that’s where we start creating a powerful narrative.

CS: Is that a difficult sell? You’ll look better. You’ll feel better. You’ll be calmer. Stress will be reduced. And who knows? Lose some weight. And, besides, you’re going to be with your friends.

BC: That’s a mom and apple pie kind of story.

CS: Absolutely.

BC: Right? But I think it’s one that’s getting people to dabble their toes in. You’re starting in the bigger media outlets. You’re seeing more and more stories about the links between health and nature, but it has yet to inform core infrastructure decisions on how we create healthy places for people to live. So, the Robert Wood Johnson Foundation did a study that basically said, “Your zip code is going to determine way more of your health outcome than your genetic code.

CS: Hm-hmm [affirmative].

BC: So, how we live, who we live with, the environment around us is really key. And I think when we first started the Health and Outdoor Initiative, one of the biggest things, we thought we would be convincing the healthcare community and the Medicaid providers to really be interested in healthy places. I think one of the things that we’re surprised at, but probably shouldn’t have been, is the municipal water utilities—particularly folks who are looking at stormwater infrastructure, wastewater infrastructure—are increasingly interested in asking, “If I’m going to spend $1 billion on my stormwater requirements, how can I do that in a way that maximizes health and equity?” Those are some of the questions that we’re starting to get from places like Seattle and Portland and other municipalities.

CS: Ten years ago, would those agencies have thought of those questions? Or would they be thinking along that track? How, how recent is that change in perspective?

BC: I wouldn’t have gotten those questions one year ago.

CS: Really?

BC: Yeah. I mean it’s—I think the change in perspective is new. I think part of it is, there’s a stronger narrative around understanding these social determinates of health. I think there is a much stronger commitment to advancing equity. And I think a real understanding that the way we’ve done things in the past has not moved justice forward. So, I think you do see things starting to change in some places. And I think that’s one of the places we’re going to be working closely with those municipalities to move on health and equity.

CS: Justice and equity. My, you’ve changed people’s vocabularies. Probably your own, too.

BC: I certainly talk differently about it. I don’t know that we’ve changed other people’s vocabularies. We’re still fairly early on and when I say we, Willamette Partnership, are new in thinking about what equity, diversity, inclusion really means for us. But it’s part of why we got interested in the health links in the first place. At Willamette Partnership, we care about collaborative solutions and engagement and real authentic inclusion, but we hadn’t made equity part of our value system. And for us, health was a really tangible way to do that because if we’re going to advance health, you have to advance health equity. And so it was something that we could talk with a waste water engineer or a rancher or someone else about.

CS: I suddenly realized that Bobby sounded just like a concerned public health official speaking to a group of diverse community interests, so I asked him . . . is that the case?

BC: Absolutely. I just gave a speech at the Oregon Outdoor Education Summit and was making the pitch that every educator is a public health official, as well.  And, particularly, if you’re an outdoor educator, this is exactly why you’re responsible for the health of the public. And so, I think that frame is a compelling frame. And now we need to continue backing it up with substance. So, when people get the “aha, okay,” then they’re asking, “Now give me the tools that I can use to make more specific decisions about that. You’ve convinced me. Now give me the tools.” And I think that’s the stage where the Health and Outdoors Initiative is, is giving the tools and the substance so that when people flip the switch on—“Yes. I am a health provider”—now we’ve given them the tools that they need to act on that.

CS: Support today for this Willamette Partnership podcast came from the Robert Wood Johnson Foundation, the Nation’s largest philanthropy solely dedicated to health, which has honored Bobby Cochran with their Culture of Health Leaders award. Thank you for joining us today. I’m Christopher Springmann.