Your research looks at the impacts to physical and mental health when people in cities have access to and experiences with the natural world. Why do you think people’s mental and physical wellbeing is measurably improved by nature?
When I was growing up in the 1960s, adults often spoke about the value of getting ‘fresh air.’ As an only (and somewhat solitary) child, I spent hours alone outside in my family garden and the open area that lay beyond it, and cannot recall ever feeling bored, lonely or insecure.
Through the course of my life my relationship with nature has progressed from the haptic, intuitive experiences of childhood to academic exploration of how nature affects people’s health and wellbeing. During that time, scholarly understandings of the impacts of urban nature on people have progressed significantly beyond appreciating the benefits of ‘fresh air’ (though this concept is still surprisingly resonant). In an evidence review published in 2016 the World Health Organisation identified 9 pathways linking natural environments with improved physical and mental health and wellbeing:
- Relaxation and restoration from stress
- Stronger social capital
- Better resilience to illness
- Supporting physical activity and fitness and reducing obesity
- Buffering noise and producing natural sounds
- Reducing air pollution and the urban heat island effect
- Encouraging pro-environmental behavior
- Optimizing exposure to sunlight and healthy sleep patterns
This endorsement by the world’s principal non-governmental health organization of the value of experiencing nature is testament to the weight of evidence of the relationship between human health and the natural environment. IWUN (Improving Wellbeing through Urban Nature) the research project I am currently leading, has contributed to this evidence base, using a multi-method approach to explore the relationship between mental health and natural environments in the context of the city of Sheffield, UK.
Are there things that people who are creating, managing and maintaining parks and greenspaces can do to improve the impacts on wellbeing? If so, can you tell us about a few?
IWUN’s Policy and Practice Brief ‘ What Greenspace Managers need to Know, ‘ is a good place for practitioners to start.
In addition, IWUN asked 122 people across the health, social care and environment sectors in Sheffield, England to choose interventions that they thought would be most likely to make a difference from a shortlist of 35 evidence-based actions. The five top interventions were:
- Improved access to green and blue spaces, including walking and cycling connections, disability adaptations and internal footpaths and signage
- New or upgraded toilets and cafes in existing parks or woodlands
- Minimum standards for regular sustained maintenance of green spaces, covering safety, cleanliness, variety of planting and accessibility
- Development workers and parks staff to encourage and facilitate a range of outdoor activities, including volunteering opportunities
- Support for voluntary and community organisations that animate green spaces and provide wellbeing-enhancing activities
While these were the interventions chosen by stakeholders in Sheffield, a key IWUN finding was that context matters for wellbeing, whether that is the context of a city, a park or one individual’s experiences of nature (negative as well as positive). All places are different: they have their own interlinked social, cultural and natural histories and actualities which need to form the basis of place making and place keeping.
What happens to people’s willingness to connect with nature, if spaces are not well-maintained?
IWUN findings strongly suggest that just having green spaces is not enough to make a sustained impact on health. Quality is just as important as quantity. In Sheffield, we found the incidence of depression to be lower in areas where green spaces were well-maintained. Our life-course interviews and arts-based workshops gave further insights: developing a connection with nature is a lifelong process, with people who have positive experiences in childhood being more likely to have recourse to nature later in life to support their wellbeing.
Poorly maintained green spaces. e.g. with litter, dog mess, graffiti and signs of drug taking are unlikely to attract people (and their children if they have them) to visit a green space in the first place, or to provide a setting for the type of uplifting experiences that will encourage people to return in the future.
However, quality does not stop at cleanliness. Investment is needed in infrastructure that supports and attracts a diversity of users and in creating the ‘habitats of connection’ that will provide those users with a rich and memorable variety of encounters and experiences during their visits.
What have you found effective at changing the perception of natural areas and encouraging more people into urban greenspaces? Any advice in terms of design, program or staffing?
Our research has found that even groups that have sometimes been seen as infrequent users of natural environments, like some members of black and minority ethnic groups, have their own stories of nature connection. By focusing on so-called “low user groups,” we have learned more about a variety of ways of experiencing nature, which can help inform programs and interventions designed to attract a greater diversity of people into urban greenspaces. For example, we’ve found that having access to well-maintained toilets is essential to enable older users to visit and enjoy green spaces.
Another strong theme running through the work of our research group is that social activities and/or arts-based programs are more effective in getting people involved in natural environments and changing perceptions than education initiatives designed to provide information about ‘nature’ and ‘wellbeing.’ Green infrastructure also needs to be social infrastructure; providing environments where people feel safe enough to be social in a way that feels right for them, whether that’s active sports, volunteering, spending time with family and friends, or finding space to be alone. Parks staff who understand the local context and who can provide this social dimension of green space are important.
How can the health care system support efforts to improve the quality and accessibility of greenspaces, parks and places of nature?
Whilst the determinants of health are many and complex, it is increasingly acknowledged that ‘environmental bads’ such as air pollution, fast food outlets and an urban form that discourages active travel all have an impact. Thus, any public health agency interested in tackling the determinants of poor health upstream should support the replacement of environmental ‘bads’ with ‘goods.’ Health and social care institutions (e.g. hospitals, care homes for older people)typically have large outdoor areas, many of which have their own fair share of the “bads.” An achievable aim would be to provide easily accessible, good quality, green and natural spaces within those health and social care institutions.
We have found that having contact with nature in the everyday environment is just as important as making special trips to more iconic natural locations. Incorporating opportunities for experiencing nature in these everyday settings can support the wellbeing of users and staff.
The concept of place is increasingly emerging as a vector for health and wellbeing initiatives. Places are where people and their environments come together and interact. In the United Kingdom, the Kings Fund — an independent charity working to improve health and care — has recently advocated for place based systems of care. Whilst these recommendations don’t extend to green spaces today, there is increasing interest in developing more holistic models of care that could be much wider in their scope. Combining environmental ‘goods’ with networks including both public and non profit organisations that operate in urban places could provide the basis for new forms of care.
Mental illness, exacerbated by loneliness and social isolation, is now one of the developed world’s main health burdens. A program of social prescribing that provides supported access to the mental health and wellbeing benefits of natural environments is one of these forms of care. However, expecting the non profit sector to provide additional capacity raises questions of demand, and the resources needed to meet that demand. It’s a promising model, but more work is needed on how to resource it.
In an era of budget cuts, recommendations to improve public spaces and increase access to new greenspaces often go unheeded. What have you seen be most effective at convincing city, state and national leaders to make these investments?
AJ: Proposals to enhance access to greenspace, e.g. as part of a social prescribing model, are often met with demands for stronger evidence of efficacy and cost effectiveness. Yet there is already considerable evidence of both. IWUN carried out cost-benefit analyses of four of the interventions preferred by stakeholders (see question #2), and all were shown to be cost effective provided user targets could be achieved. The difficulty is that the financial benefits of green space interventions do not necessarily come back to greenspace providers, and convincing health and social care providers to invest in green space in a time of austerity means persuading them to disinvest in an existing health or social care program.
My own experience of working at the nexus of health and the environment over the last 10 years is that change comes slowly. The weight of the evidence grows and the arguments in favor of investment gradually gain political traction. Then, catalyzing events have the capacity to tip the balance. Climate change activism in the UK has suddenly gained huge credibility and is ushering in a new era of concern for the human environment relationship. In Sheffield, there is now cross-sector support for greening school playgrounds to mitigate air pollution, and several schools are installing green barriers. And while these are essentially privately-financed initiatives in more prosperous parts of the city, supported by the local authorities, they would have been unthinkable five years ago.
Instead of choosing one method of convincing leaders to make these investments, I think change happens when the evidence base, popular narratives and public opinion coalesce. When conditions are right, it makes it much easier for leaders to lead a green health agenda.