Faculty Spotlight: Eugenia South

Eugenia (Gina) South is Assistant Professor of Emergency Medicine at the University of Pennsylvania’s Perelman School of Medicine and Penn IUR Faculty Fellow. Her research focuses on how neighborhood context affects health and safety in urban environments, with a particular interest in urban nature. Her studies evaluating the impact of vacant lot greening on violent crime, perceptions of safety, physiologic stress, and mental health have been published in JAMA Network Open, PNAS, and AJPH, and have been featured in national and international media outlets including NPR, NBC News, TIME, and the Philadelphia Inquirer. Dr. South received her MD from Washington University School of Medicine in 2008 and her MSHP from the University of Pennsylvania in 2012, during which time she was also a Robert Wood Johnson Clinical Scholar.

You have a medical degree from Washington University. What drew you to medicine? Did you always want to practice medicine?

I am the first physician in my family. I knew when I took high school biology that I was fascinated by the body and how it works. I was fortunate to have people around me who recognized that interest and pointed me in the direction of medicine. My parents actually asked their primary care physician if I could shadow him, so I was able to shadow a physician when I was young. He gave me a job as a medical assistant in high school and early college, which gave me further exposure. I loved it. I loved thinking about the biology and I loved interacting with people and helping people feel better.

Your path-breaking work is about how neighborhood context affects safety and health, particularly mental health. How did you become interested in this topic?

I can remember a specific point in time when I started down this path. I was a resident on the pediatric trauma service in St. Louis when an 11-year-old boy came into the emergency department. I remember going through the protocol for trauma patients: checking his airway, his breathing, his circulation, and finally checking for disability. We discovered that he couldn’t move his legs. He had been shot through his spinal cord and was rendered paralyzed. An 11-year-old boy sleeping on his couch at home, shot by a stray bullet.
We did an excellent job caring for his physical injuries, and even addressing the profound impact this shooting had on his mental health, and his family. But we did nothing to address what caused him to be shot in the first place. Taking care of this boy crystalized for me that I wanted to use my career to address the upstream, root causes of poor health.

You became a Robert Wood Johnson Clinical Scholar at Penn after earning your medical degree. Tell us how you made that decision and how it informed your future work?

Taking care of individual patients is very important, and I still do that in the emergency department, but I wanted to have a broader, population-level impact. The Robert Wood Johnson Clinical Scholars Program (RWJ), which is now called the National Clinician Scholars Program, is an amazing training program: it trains physicians and nurses to apply their clinical knowledge to population-level research questions. I came to Penn in 2010 for that program and was paired with Dr. Charlie Branas as my mentor; that was when I had the opportunity to turn a growing passion into a research question and project.

You investigate the ways in which the physical attributes of where people live, work, and play influence chronic stress, cardiovascular and mental health, and violent crime. Recently, you’ve focused in particular on how nature affects physical and mental health; your work in this area has received widespread media attention. Can you tell us a bit about this research?

The fundamental idea that underpins all of my work is that the places where we spend time (the places we live, play, pray, and recreate) have a profound impact on our health—even more, I would say, than the individual biological and genetic factors that may predispose us to disease. I have taken this broad concept and focused in particular on the physical environment around where we live.

I focus a lot on blighted spaces, like vacant lots and abandoned buildings: places and spaces that have fallen into disrepair, that are full of trash, overgrown with unwanted vegetation, and that may harbor unsafe activities—we'll often find condoms or needles and we think that people probably hide weapons in these spaces. These uncared-for spaces become nodes of poor health. In a city like Philadelphia, these spaces are pretty ubiquitous and especially common in low-resource and minority neighborhoods. These spaces are the result of a complicated web of structural economic and political forces, and impact the most vulnerable among us.

I've been involved in designing and testing several different interventions to find low-cost ways to transform these spaces from unhealthy to healthy. I’ve looked, for example, at how greening vacant urban lots—turning blighted spaces into green spaces—affects the health of neighborhood residents. My first project as an RWJ Clinical Scholar was a pilot randomized controlled trial of vacant lot greening. Under the mentorship of Dr. Branas, I worked closely with the Pennsylvania Horticulture Society (PHS) to study their LandCare model of greening. We found that people living near the greened vacant lots reported feeling safer after greening compared to the control site (see “Greening Vacant Lots to Reduce Violent Crime: A Randomised Controlled Trial” in Injury Prevention 2013; 19 (3)).

In a separate study, we used GPS enabled heart rate monitors to see how people reacted physiologically to walking past the vacant lots, before and after greening. We used heart rate as a marker of acute stress. Heart rate dropped up to 15 beats per minute after greening—demonstrating a link between the neighborhood environment and what is happening inside the body (see “Neighborhood Blight, Stress, and Health: A Walking Trial of Urban Greening and Ambulatory Heart Rate” in American Journal of Public Health 2015; 105 (5)).

These studies culminated in a large citywide randomized controlled trial of vacant lot greening. We studied over 500 vacant lots across the city and demonstrated that vacant lots that that got the greening intervention or a trash clean-up intervention had up to a 29 percent reduction in violent crime (see “Citywide Cluster Randomized Trial to Restore Blighted Vacant Land and Its Effects on Violence, Crime, and Fear” in PNAS 2018; 115 (12)).

We also showed that people living near the greened vacant lots report feeling less depressed (see “Effect of Greening Vacant Land on Mental Health of Community-Dwelling Adults: A Cluster Randomized Trial” in JAMA Network Open 2018; 1 (3)).

I’m wrapping up another study now. While much of my work has been on changing the physical environment, for this pilot study—called Nurture in Nature—my team and I are trying to influence how people interact with their existing environment. For this study, we enrolled post-partum women and designed an intervention meant to influence their interactions with nature. We paired these women with a nature coach—someone who herself loves nature—who visited with each woman twice: once to talk about nature one-on-one and to suggest nearby nature locations to visit and a second time to go with them to a local green space. We also worked with the women to set goals, reminded them with text messages, and followed the women for a couple of months to see how often they went outside. We want to know: a) Will this intervention influence people’s interactions with nature? And b) Will it have any impact on preventing post-partum depression? We're almost done with our data collection and then we'll analyze the results. It’s another exciting avenue through which I'm trying to impact the relationship people have with their environment.

You continue to see patients. How does practicing medicine influence your research? How does your research influence your medical practice?

I think of this as a continuum. When I'm working clinically in the emergency department, I see the farthest downstream causes of poor health: I see people who have uncontrolled blood pressure, or have been shot, or delivered babies, or overdosed on drugs. I take care of individual health problems one-on-one. In the research world, I take several steps back and ask: What are the upstream causes of what I'm seeing in the emergency department? I work on those root causes of health. What I see in the emergency room definitely informs the types of problems that I'm working on in my research.

My research also affects my clinical practice. Because of the work that I've done with urban greening and thinking about nature as an important health promotion tool, when I have patients in the emergency department for things that I think may be related to underlying stress or to life challenges, I often take a step back and ask them a little bit about their life. After I've done my medical workup to make sure there’s no immediate life-threatening causes of symptoms, I ask patients about themselves and, in particular, if they spend any time outside in Philadelphia’s parks or natural areas. People often say “no.” I recommend that they spend time outside in a way that feels right to them, and explain that there’s a lot of research showing that time in nature can help with a variety of health problems. That's definitely not part of the medical training. That’s the influence of the work that I do as a researcher coming out in my clinical practice.

A number of researchers at the university (you, Charles Branas, John Macdonald, Doug Wiebe, and others) investigate how spatial variables affect health. How did the University of Pennsylvania become a center of excellence in this field of research? What strengths do you think the university has in this field?

I think that this happens a lot at universities: an individual or two begins building a body of work and, as they grow that body of work, they attract other researchers, students, and mentees who are also interested in that work. The university then becomes a center of excellence in that field. Charlie Branas—who is now at Columbia—really was a pioneer in looking at how space and place impacts health and, working alongside the other individuals you mentioned, built that foundational body of work that attracted so many others that have made Penn a center of excellence in this field.

Sponsors are also important. Mentors help people with their scholarship; sponsors really find ways to promote them and give them opportunities, which in academia is so important particularly for women and people of color. Charlie is an incredible mentor and sponsor. Having sponsors really helps to grow a field of excellence at Penn by growing people who are interested in contributing to that field and to Penn.

Given your findings on the health impacts of the physical environment, what are the most important things you think planners, policymakers, and others can do to support health and well-being?

Healthcare systems are thinking more about upstream causes of poor health. Investing in a relatively low-cost and scalable intervention like vacant lot greening can have a potentially very tangible impact on the health of the population that you're taking care of. With any intervention, the healthcare system wants to see an impact on the bottom line. I am doing work right now to try to show that certain types of neighborhood interventions could actually reduce expensive acute care utilization, which would be a compelling economic argument for health systems. I would love to see health systems invest in greening the neighborhoods where their most vulnerable patients come from.

In terms of policy, there’s a great example of research influencing policy here in Philadelphia. For the first time this past year the city of Philadelphia’s Violence Prevention Plan actually includes vacant lot greening and abandoned house remediation because of the work we have done here at Penn showing to be a cost-effective way to reduce violence. It is a researcher's dream to see their work lead to policy change.