Woodland - Summer 2019 - 9

COUNTIES WITH MORE TREES AND SHRUBS SPEND LESS ON MEDICARE, STUDY FINDS
REPRINTED WITH PERMISSION OF THE UNIVERSITY OF ILLINOIS NEWS BUREAU

A new study finds that Medicare
costs tend to be lower in counties with
more forests and shrublands than in
counties dominated by other types of
land cover. The relationship persists
even when accounting for economic,
geographic or other factors that might
independently influence health care
costs, researchers report.
The analysis included county-level
health and environmental data from
3,086 of the 3,103 counties in the
continental U.S.
Urban and rural counties with the
lowest socioeconomic status appeared
to benefit the most from increases in
forests and shrubs, said University
of Illinois graduate student Douglas
A. Becker, who led the new research
with Matt Browning, a professor
of recreation, sport and tourism at the
U. of I.
"At first, I was surprised by this,"
Becker said. "But then it occurred to
me that low-income communities are
getting the biggest bang for their buck
because they probably have the most
to gain."
The findings, reported in the journal
Urban Forestry and Urban Greening,
are observational and do not prove that
having more trees and shrubs directly
lowers health care costs, Becker said.
But the study adds to a growing body
of evidence linking green space - in
particular, forested areas - to better
health outcomes for those living nearby.
"Previous studies have looked at
any health outcomes people think
might be linked to nature: depression,
cardiovascular disease, physical activity
levels, even recovery from surgery,"
Becker said.
Several studies report no
association between access to green
space and health, he said.
"But there is also a lot of work -
including experimental work, which we
consider to be the strongest - showing
a link between exposure to green
space and beneficial health effects,"
Becker said.

The study found that increases in forest and shrub cover corresponded to decreases in health care
spending. No such relationship was found with other types of vegetative land cover, however.
IMAGE COURTESY OF GOPIKRISHNA J. PILLAI, SCIENTIFIC ILLUSTRATOR

For example, studies have shown
that people in intensive care units
recover more quickly and have
fewer complications after surgery if
their hospital rooms look out over
trees rather than parking lots. Other
studies have found that forest walks
can influence potentially healthpromoting hormone levels or anticancer immune cells in the blood.
For the current study, the team
turned to the National Land Cover
Database, which divides each
county into 30-meter-square plots
and identifies the environmental
composition of each plot.
Categories include urban developed
or open space, forest, grassland,
shrubs and agricultural cover.
"We took the average of
different types of land cover and
the per capita Medicare spending
in a county and compared these
two while controlling for several
socioeconomic and demographic
factors like age, sex, race, median
household income, health care
access and health behaviors,"
Becker said.
The Centers for Medicaid and
Medicare Services adjust the
Medicare expenditure data to reflect
differences in health care costs and
health-risk profiles in different regions
of the U.S., he said.
The analysis revealed that each 1%
of a county's land that was covered in
forest was associated with an average

Medicare expenditure savings of $4.32
per person per year, Becker said.
"If you multiply that by the number
of Medicare fee-for-service users in a
county and by the average forest cover
and by the number of counties in the
U.S., it amounts to about $6 billion in
reduced Medicare spending every year
nationally," he said.  
Adding the effects of shrublands
increases the estimated savings to $9
billion annually.
As a follow-up to these findings,
Becker, Browning and their colleagues
are looking at individual health and
environmental data in collaboration with
Kaiser Permanente in California.
A
The U.S. Department of Agriculture's
U.S. Forest Service and the National and
Urban Community Forestry Advisory
Council supported this research.

University of Illinois graduate student Douglas A.
Becker and his colleagues found that U.S. counties
with more trees and shrubs tended to have lower
Medicare costs.
IMAGE COURTESY OF FRED ZWICKY

Summer 2019 * WOODLAND 9



Woodland - Summer 2019

Table of Contents for the Digital Edition of Woodland - Summer 2019

Overstory
Foresets and Families
Forest Interactions
The Family Forest Carbon Program
2019 Regional Outstanding Tree Farmer of the Year Finalists Announced
Tree Farmers Visit Washington to Advocate for Family Forest Interests
Tools and Resources
Woodland - Summer 2019 - Intro
Woodland - Summer 2019 - cover1
Woodland - Summer 2019 - cover2
Woodland - Summer 2019 - 3
Woodland - Summer 2019 - Overstory
Woodland - Summer 2019 - 5
Woodland - Summer 2019 - Foresets and Families
Woodland - Summer 2019 - 7
Woodland - Summer 2019 - Forest Interactions
Woodland - Summer 2019 - 9
Woodland - Summer 2019 - 10
Woodland - Summer 2019 - 11
Woodland - Summer 2019 - 12
Woodland - Summer 2019 - 13
Woodland - Summer 2019 - 14
Woodland - Summer 2019 - 15
Woodland - Summer 2019 - 16
Woodland - Summer 2019 - 17
Woodland - Summer 2019 - 18
Woodland - Summer 2019 - 19
Woodland - Summer 2019 - 20
Woodland - Summer 2019 - 21
Woodland - Summer 2019 - The Family Forest Carbon Program
Woodland - Summer 2019 - 23
Woodland - Summer 2019 - 24
Woodland - Summer 2019 - 25
Woodland - Summer 2019 - 26
Woodland - Summer 2019 - 27
Woodland - Summer 2019 - 2019 Regional Outstanding Tree Farmer of the Year Finalists Announced
Woodland - Summer 2019 - 29
Woodland - Summer 2019 - 30
Woodland - Summer 2019 - 31
Woodland - Summer 2019 - 32
Woodland - Summer 2019 - 33
Woodland - Summer 2019 - Tree Farmers Visit Washington to Advocate for Family Forest Interests
Woodland - Summer 2019 - 35
Woodland - Summer 2019 - 36
Woodland - Summer 2019 - 37
Woodland - Summer 2019 - 38
Woodland - Summer 2019 - 39
Woodland - Summer 2019 - 40
Woodland - Summer 2019 - Tools and Resources
Woodland - Summer 2019 - 42
Woodland - Summer 2019 - cover3
Woodland - Summer 2019 - cover4
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