Category Archives: Natural Environments

What is ‘on the ground’ in a city linked to levels of inequality in life satisfaction

In a European-wide study of 63,554 people from 66 cities in 28 countries, we found links between urban design and levels of inequality in life satisfaction. This is the first study to theorise and examine how the entire urban landscape may affect levels of and inequalities in wellbeing in a large international sample.

Cities with an even distribution of facilities, housing and green space were linked with lower levels of inequality between residents’ life satisfaction levels, suggesting that more equal access to a range of facilities and types of land may help reduce the gap in life satisfaction between the most economically-deprived and most affluent residents of a city.

There was a strong link between higher life satisfaction and living in cities with homes surrounded by natural, green space. However, lower life satisfaction was linked to living in cities that had more wasteland, more space dedicated to housing, and more space in which all the land is concrete or tarmacked.

Implications for policy and planning.

The findings of our study suggest that urban planning has a role to play in addressing inequalities in cities. Our finding that more equal distribution of land cover/use is associated with lower levels of socio-economic inequality in life satisfaction supports the idea that city environments could be equigenic – that is, could create equality.

What people want or need from their city varies moment to moment, day to day, life stage to life stage. If a city is varied enough to offer people what they need, when they need it, it is likely to support a higher quality of life.

Three Generation Out Walking

Why understanding city design is important for population health and well-being?

With the United Nations reporting that more than half the world’s population residing in urban areas and this proportion rising, it is important to understand how well-planned urban environment might improve, and reduce inequalities in, quality of life. Therefore, understanding the influence urban environments can have on all aspects of health and wellbeing is increasingly important. Cities are continuously evolving and there is ample opportunity to ensure these are healthier and happier place to live.

What we did:

We applied theory and methods from landscape ecology to explore associations between cities’ land cover/use, residents’ reported life satisfaction and within-city socio-economic inequalities in life satisfaction. We joined individual-level responses to the European Urban Audit (EUA) Perception Surveys (2012 and 2015) with city-level data from the European Urban Atlas classifying land cover/use into 26 different classes. Our sample included 63,554 people from 66 cities in 28 countries.

The study, ‘Are urban landscapes associated with reported life satisfaction and inequalities in life satisfaction at the city level? A cross-sectional study of 66 European Cities’ is published in Social Science & Medicine (Open Access). The work was funded by The Medical Research Council (MRC) and Scottish Government Chief Scientist Office.

By Rich Mitchell, Natalie Nicholls & Jon Olsen , Neighbourhoods and Communities programme, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.

Do people actually use the facilities in their home neighbourhood?

This blog explores a key question in neighbourhood and health research: if there is a facility or amenity close to someone’s home, is it OK to assume they use it? Surprisingly, this assumption is at the heart of a lot of health and environment research.

We often have data which tells us where facilities and amenities are, and we tend to make the assumption that proximity means use. So, for example, if we see that some neighbourhoods have more parks or more leisure facilities, we expect the people who live in that neighbourhood use them more. Understanding local amenity and facility use is important because we want to know whether / how these things affect health.

With technological advances in recent years, studies have started to collect precise data which tell us exactly where people go using global position system (GPS) devices. We no longer have to assume, for example, that if there’s a park close to a child’s home, they will visit it. The GPS tracks we collect will tell us if they did or not. That presents an opportunity to test our assumptions.

Do children use facilities they have access to in their home neighbourhood?

Our team is interested in children’s use of facilities in and around their homes and to test whether we need GPS to research this we conducted an analysis of facility availability and facility use for 30 10-year-old children living in Glasgow. We used data from GPS devices worn by the children for eight days. These children were part of our ‘Studying Physical Activity in Children’s Environments across Scotland’ Study (SPACES).

The diagram below shows what we did. Our key finding was that facility availability in the home neighbourhood is not a good indicator of facility use; the children used facilities from across a much wider area in the city, even if they had a facility close to their home.  For example, 18 of the 30 children (60%) had a leisure centre within their ‘neighbourhood’ (which we defined as 800m around their home). Only 3 of the 18 actually visited that facility (as identified by their GPS tracks). Of those 18 children, 8 actually visited a leisure centre outside of their ‘neighbourhood’. We saw the same kind of pattern when exploring availability and visits to playing fields, public parks and libraries

Blog graphic

Are our results similar to other research?

Yes, other studies that used GPS devices have found that children do spend time outside of their immediate home area for specific purposes. For example, a 2017 study by Chambers and colleagues in Wellington, New Zealand analysed leisure time GPS data (before and after school) in 114 children aged 11 to 13 years from 16 schools, and found that 38% of their leisure time was spent outside of the home neighbourhood (using a 750m buffer around the home). Time outside of the home neighbourhood was mostly spent visiting their school, other residential locations, and fast food outlets.

These results, and those from similar studies, show that it is important not to treat what’s in someone’s immediate home neighbourhood as a good measure of what they do, or in epidemiological language ‘what they are exposed to’. We must challenge the idea that residential neighbourhood is an adequate way to capture the socio-environmental factors which contribute to health. Many people, including children, can and do access environments well beyond their immediate home neighbourhood. We think that a much wider geographic area should be considered when we’re asking questions about how environment affects health and we call this the city-wide landscape.

What does this mean for future research?

It’s clear that the ‘traditional’ approach which uses someone’s neighbourhood (often defined by a distance around their home, or an administrative area in which their home sits) to assess their access to facilities or exposure to environments is seriously flawed.

  • Other methodological approaches are required to measure ‘exposure’ to environment;
  • We must move beyond traditional fixed neighbourhood-health relationships (although we can’t ignore them);
  • We should embrace and integrate innovative technology to explore mobility (e.g. GPS and accelerometer).

Of course, even when we’re able to see exactly where people go and what they do, we still need to understand the decisions people make about whether or not to visit or spend time at different places.

By Jon Olsen, Research Associate with the Neighbourhoods and Communities programme, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.

How does the availability of green space throughout life affect cognitive ageing?

New research has found that a greater provision of parks in childhood and adulthood may help to slow down cognitive decline in later life. Published in Social, Science and Medicine, the CRESH team demonstrated how the availability of public parks throughout life affected cognitive ageing.

Cognitive ageing describes how our mental skills change over time. As we get older our mental skills, used for activities such as following directions or reading a map, deteriorate, which can lead to a reduction in quality of life and general health. Everyone experiences these declines differently and to a certain degree this is due to the places where you have lived. Features of the urban environment such as parks can provide opportunities for social interaction and physical activity, which can build resilience to change, a concept called ‘cognitive reserve’.

We considered whether there were critical times during life (e.g. childhood or older age) when the availability of local parks mattered most. We used data collected from a cohort of people all born in 1936 (the Lothian Birth Cohort 1936). We asked the participants to provide information on their addresses throughout their lives. Using some historical data we then worked out the amount of parks near to where they lived at each stage of life. We had two key findings.

We found a link between park availability in childhood and adulthood and cognitive test scores. Greater provision in both childhood and adulthood predicted better change in cognitive test scores between age 70 and 76. The argument for a link between the experiences of green spaces in childhood and adulthood has previously been described as the ‘childhood factor’. The ‘childhood factor’ describes how our experiences of green spaces in childhood shape our attitudes and patterns of use in adulthood, and possibly our health in later life. What we have found is that the ‘childhood factor’ may be the key to unlocking the potential benefit of green spaces on how we age.

We also found that this benefit might be felt most by certain groups of people. In addition to the lifestyle factors mentioned earlier, there are demographic, genetic and socioeconomic determinants of cognitive ageing. We found that women, those without an APOE e4 allele (a genetic risk factor for dementia) and those in a lower socioeconomic group benefited the most (in terms of cognitive ageing) from having good access to a park. Finding stronger relationships amongst lower socioeconomic groups may be explained by greater time spent in parks closer to home which would act to boost the potential benefits that come with better availability. This finding is similar to some earlier work by the CRESH team which found that environments can be ‘equigenic’ – or assist in reducing health inequalities.

The findings from this new work suggest that not only can greener places improve cognitive ageing and reduce inequalities but that the influence of access to high quality green spaces in childhood through to adulthood – particularly access to parks – can have life-long benefits.

Edinburgh Science Festival Event 2017: Why Places Matter for Mental Health and Wellbeing

The important influence of the places in which we live, work and play on our mental health and wellbeing was the topic of a recent lively discussion at the Edinburgh Science Festival 2017 organized through Centre for Research on Environment, Society and Health (CRESH).

The event was chaired by Professor Jamie Pearce, (from School of GeoSciences at the University of Edinburgh and CRESH) and, in his introduction, he emphasised the policy-relevance of the event as evidenced by  the Scottish Government’s newly released Mental Health Strategy 2017-2027. The Strategy details how institutions, services and organisations will work together to enhance mental health in Scotland. Especially relevant for this discussion was the acknowledgement on P8 of the report that ‘Working to improve mental health care is not just the preserve of the NHS or the health portfolio. We will be working not only across the Scottish Government, but also across the wider public services to harness the broadest range of opportunities to improve the population’s mental health…’.  It is therefore acknowledged that promoting good mental health and wellbeing is not only about medical care, but also involves action to improve the ‘wider determinants’ of mental health – especially how conditions in the places where we live, work, learn and play can affect mental health and wellbeing.

We were therefore interested to explore how academic research contributes to our understanding of how places affect wellbeing.  Our main aim was to exchange ideas with our audience of over 70 people, representing a range of views from those living in the communities in and around Edinburgh. Several participants also reported on knowledge and experience gained in their professional lives, including medical practitioners, public health specialists, leaders in independent organisations whose mission relates to mental health and wellbeing (such as Support in Mind, and the Cyrenians), urban planners and architects and social service providers.

The event started with a series of comments from a panel of academic researchers representing a variety of social science disciplines, who introduced ideas from academic research that may help to frame thinking on these issues.

Professor Sarah Curtis (Professor Emeritus at Durham University) used her own experience of volunteering in the Edible Garden project at the Botanic Gardens to illustrate ideas from Health Geography about Therapeutic Landscapes, originally put forward by Wil Gesler (e.g. in his book on Healing Places).  This conceptual framework suggests we can think of places in terms of: material and physical landscapes (agreeable and relaxing green spaces, water spaces and built environments), social landscapes (supportive social relationships and community processes) and symbolic landscapes (features of our environment that stand for beliefs, principles and memories that are important for us). All of these dimensions of places, experienced in the different settings where we spend our lives, can be important for creating and maintaining our sense of mental wellbeing.  These features of landscapes, the ways they change, and how different groups of people experience them over time, have been studied extensively by health geographers (e.g. reviewed by Sarah Curtis in her book Space, Place and Mental Health).

Professor Steve Platt (Professor Emeritus at University of Edinburgh) then presented ideas from research in Sociology and Health Policy about what we might consider the ‘reverse’ of therapeutic landscapes; focussing on factors that are associated with risk of suicide and why suicide matters for suicide prevention. He used the example of the iconic Golden Gate Bridge in San Francisco, which has been a ‘magnet’ for people intent on taking their own lives.  He described the public controversies surrounding action to alter the architectural form of the bridge in order to install protective structures to reduce the suicide risk. He also underlined the evidence for socio-economic deprivation as a risk factor for suicide, with the risk of suicide being 2-3 times higher in the local areas in Scotland ranked among the worst 10% for social deprivation, as compared with populations living in areas ranked in the least deprived areas. He went on to elaborate further on the idea of suicidogenic contexts combining various dimensions that may be cultural, socio-economic, political, historical, as well as including built infrastructures and other aspects of the physical environment.

The significance for wellbeing of green space, viewed from a Landscape Architecture perspective, was introduced by Professor Catharine Ward Thompson, Director of the OPENspace Centre at the University of Edinburgh’s College of Art. She underlined that, since stress is a major problem for society and is associated with physiological as well as mental illness, researchers at OPENspace, together with their colleagues from around the world, are exploring how attractive and accessible green spaces can have beneficial ‘restorative’ effects on our mental state and help us to cope better with stress.  Studies using biomarkers (that measure the functioning of psychoneuroendochrine systems in the human body) show that our mental and physical states are linked, which helps to explain why environments that help to restore mental wellbeing are also helpful for our physical health. Good access to green and natural spaces in the residential environment is associated with lower levels of stress as shown by these biomarkers, as well as from self-reports of stress among people out of work and living in urban poverty. Attractive green spaces are often also places where we enjoy supportive social relationships and healthy physical exercise.  Conversely, when there is a shortage of green space in the urban environment, this appears to be associated with feelings of loneliness and lack of social support. Professor Ward Thompson has published research exploring these relationships in the journal Landscape and Urban Planning and the International Journal of Environmental Research and Public Health. Findings such as these help to strengthen the case for providing and maintaining access to healthy green spaces, such as public parks and gardens, allotments, and public rights of way in the countryside.

Dr Niamh Shortt (School of GeoSciences at the University of Edinburgh) leads research at CRESH relating to how aspects of consumption and retail environments are significant for behaviours linked to mental health and wellbeing. She focused her talk especially on issues associated with alcohol consumption and unhealthy drinking, which can be closely linked to mental distress and mental health conditions. While lower income groups report consuming the same, or less, alcohol on average than higher income groups, they suffer more from alcohol related harm. This has been called the ‘Alcohol Harm Paradox’. Dr Shortt presented findings from research she is leading which show that risks of unhealthy alcohol use are not only associated with individual level characteristics, but can also be influenced by the social and commercial environment.   Access to and advertising of retail outlets selling alcohol is not currently controlled to the same extent as for tobacco sales, yet research is showing that there the ways people drink may be influenced by the organization and availability of alcohol retailing in their neighbourhood, and that this is especially important for those living in poorer areas who may be most reliant on their local retail facilities. This research demonstrates the importance for wellbeing of work of retail planning and licensing systems.

As the discussion widened to include the audience at this event, a number of other thoughtful and important points were made. We heard from a number of representatives of relevant non-academic organizations, explaining how actions to promote mental wellbeing and to prevent and treat mental illness may draw upon research, and also contributes to knowledge about ‘what works’ to promote wellbeing.

Dr Margaret Douglas, Consultant in Public Health Medicine for NHS Lothian, underlined concerns about the unequal impacts of places on both health for different groups in Scottish society. She highlighted links between physical and mental health. The geographical variations in mental health and wellbeing, and inequalities between rich and poor areas, are a major issue for public health in Scotland, as in other countries, so research is important to help to identify the places where health disadvantage is most concentrated and needs for mental health care are greatest. This said, not all of the people most at risk of poor mental wellbeing and mental illness live in the poorest areas, so that there is also a need for information on the social and geographical pattern of mental health problems across the whole of Scotland. Dr Douglas particularly noted the range of aspects of the environment that are important for health. Her comments drew attention to the range of partners who need to collaborate to address actions to improve the various environmental factors that are beneficial for wellbeing and can help to prevent mental health problems. The Scottish Health and Inequalities Impact Assessment Network has produced documents summarising evidence on several aspects of the environment including community venues, greenspace, transport and housing.

These comments were reinforced by Johnny Cadell, from Architecture and Design Scotland, who underlined the significance of Scottish Government architecture policy (Creating Places), Scottish Planning Policy and the Place Standard, which promote healthy environments across Scotland. The Place Standard is a joint initiative between Scottish Government, Health Scotland and Architecture & Design Scotland. The discussion highlighted the strong interest in how good urban design can benefit mental health. We noted that there is very good potential for the transfer of knowledge from research into policy and practice, and this is gaining momentum through collaboration between researchers and government agencies promoting various initiatives, such as work by the Design Council entitled ‘Active by Design’ and, in Scotland, initiatives such as ‘Good Places Better Health’, ‘Go Well in Glasgow’ and, most recently, the development of the ‘Place Standard Tool’ to guide local development. Increasingly, Health Impact Assessment is being applied to interventions outside the medical sector, to ensure that health impacts of new urban developments are considered at the planning stage. The Place Standard brings together commitments in architecture policy (Creating Places) to produce a tool linking spatial design with the health/wellbeing agenda and the commitment in Good Places Better Health to produce a ‘Neighbourhood Quality Standard’.  Those involved in Good Places Better Health and Go Well were closely involved in the design of the new tool.

Frances Simpson, from Support in Mind, helpfully drew attention to the fact that a good deal of research is currently focussed on more urban communities, but that it is also important to understand the experience of the rural communities in Scotland.  Among a range of activities promoted by Support in Mind is a project that is currently collecting valuable information on what it is like living with mental ill-health in rural Scotland.  Communities in rural areas may benefit from greater proximity to extensive green spaces than those living in cities, but there are other issues such as social isolation and exclusion, and problems of access to the right kinds of mental health services, which need to be considered in rural settings. These points resonate with an article recently published by Hester Parr and Chris Philo in The Geographer magazine reporting research involving participants in rural areas.

Hugo Whitaker, from the charitable organization Cyrenians, also pointed out that recovering from mental illness can be a long process and that access to supportive environments over time can be very helpful to restoring mental wellbeing. He provided examples (including 2 film clips) of how community gardens and healthy activities organised in grounds that are part of NHS estates can help to restore and maintain good health.

A number of useful film clips have also been published by the Green Exercise Partnership  to help spread the word about this kind of activity (see example film here), as well as recordings of individual accounts from the perspective of those involved in design and planning (here) and stories of patient users’ experiences: (here).

Also relevant to this debate is the Our Natural Health Service action programme. It shows how “high quality local greenspace, supportive nature-based projects, and better links between health and social care practitioners and the environment sector, can be part of the solution to many of Scotland’s health issues.” NHS Lothians’s report ‘Health Promoting Health Service: Action in Secondary Care Settings’ issued by the Chief Medical Officer in October 2015 includes targets on “current use and improved plans of the outdoor estate for physical activity (green exercise and active travel) for staff, patients and the local community” as well as targets for staff health and wellbeing.

The debate included further comments from a number of other members of the audience. Points made by the panel about long term effects were picked up on by a retired General Practitioner who practised in one of the most deprived areas in Scotland. He commented that deprivation was transmitted across generations and that the conditions causing mental health problems in one generation would resurface in the next generation who were also treated in his surgery. Research reporting on the environmental experiences of people at different life stages was considered. For example, experiences of adolescents were commented on and it was pointed out that mental health problems can become apparent relatively early in life, and that young people have relatively little control over the social and physical environment, so it is important for their voices to be heard in environmental planning processes. Aspects of the environment that are beneficial for wellbeing of young people vary from those which are important for adults, so their experience needs to be taken into consideration.

Individuals with different characteristics may react quite variably a given environment and research can help to improve understanding of how places interacting with personal characteristics relate to mental wellbeing. It was noted, for example, that people vary in terms of cognitive and physical abilities and that making public spaces well adapted and inclusive for people with a range of abilities can help to promote mental wellbeing for all ability groups.

Other comments underlined the importance of a sense of autonomy and freedom to exercise independence and choice in the way we interact with our environment. It was noted that it was not only the visual aspect of the environment that was important, and that it was important for architects and others designing the environment to be sensitive to aspects such as noise levels and ambient temperature which can also affect one’s sense of wellbeing in a particular setting.

Overall, this event clearly demonstrated the breadth of interest in the question of why places matter for mental health and wellbeing. The panel were very grateful to the audience for engaging in the discussion and making such thoughtful comments and to SciFest for organizing the event. We felt this was a good example of how academic researchers and others with relevant ideas and experiences can join together to ‘co-produce’ our understanding of the research agenda and how research can help to inform action. We hope to be able to keep in touch with participants, via the CRESH webpages and blog, in order to share future research findings and knowledge of what is important for our wellbeing in the places where we live.

Job available: research associate, looking at impacts of woodlands on health

The CRESH team have a new post available. We’re looking for a quantitative researcher to work with us, and our colleagues at OPENspace, on a project looking at the impact of woodland improvement on community health. You can read more about the project in our protocol paper.

The job will be based in Glasgow and has funding until the 31 March 2017. The closing date for applications is 27 March 2016.

Continue reading Job available: research associate, looking at impacts of woodlands on health

More reasons to think green space may be equigenic – a new study of 34 European nations

Today we published a paper which builds on our ideas about equigenic environments – places that can reduce health inequalities – and continues the investigation of associations between nature and health. This new study builds on a paper CRESH’s Rich Mitchell published a long time ago (2008) with Dr Frank Popham, suggesting that populations which have more green space in their neighbourhood tend also to have a smaller health gap between richer and poorer residents. Other people have found something similar (see this for example, or this). The idea that ‘equigenic’ environments might be able to disrupt the usual conversion of inequalities in wealth to inequalities in health has gained attention, partly because it seems so difficult to do anything about the health gap that almost inevitably follows a wealth gap, and partly because politicians and society seem unwilling to tackle the wealth gap itself. Continue reading More reasons to think green space may be equigenic – a new study of 34 European nations

Is multiple environmental deprivation related to population health in Portugal?

By Ana Isabel Ribeiro

In our recently published paper (open access version here) we describe the development of a multivariate measure of physical environmental deprivation for the 278 municipalities of Portugal, and demonstrate its strong relationship with mortality rates. Continue reading Is multiple environmental deprivation related to population health in Portugal?

New MRC funded PhD studentship available, looking at our environment, our biology and healthy ageing

We have an exciting opportunity for a fully funded PhD place at the University of Glasgow. The project will join health geography / epidemiology, environmental science and cell biology. The project will be supervised by Profs Rich MitchellPaul Shiels and Ewan Macdonald. The funding comes from the MRC. The financial package will include a 3.5-year stipend, approved University of Glasgow fees, Research Training Support Grant (RTSG) and a conference allowance. Continue reading New MRC funded PhD studentship available, looking at our environment, our biology and healthy ageing

CRESH research on children and the outdoors mentioned in House of Lords debate

Research by Rich Mitchell was mentioned in a House of Lords debate on 16 May. The debate centred on the contribution of outdoor activities to the United Kingdom economy and to the health and well-being of the population. The research cited was completed  in 2009. Rich Mitchell and Rebecca Shaw followed a group of children (average age 13) undertaking an outdoor education scheme; the John Muir Award. The children completed questionnaires before, during and then 18 months after, their Award experience. The study showed massive inequalities in experience of outdoor environments. Children living in the poorest circumstances were over 6 times more likely to have had no prior experience of wild places than their more affluent peers. The study showed that participation in the Award increased aspirations for visiting the outdoors, particularly among the most deprived children, but it did not affect actual visiting behaviour.
You can find out more about the John Muir Award here
There is a summary of the research here
The full report is here

Greenwash: have the benefits of green space been exaggerated?

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Greenwash” is sometimes used to describe exaggerated or otherwise misleading claims made about a product or company’s environmental benefits.  People are understandably becoming more and more cynical about environmental friendliness claims – but the danger is that genuine environmental benefits are rejected along with the greenwash, which “threatens the whole business rationale for becoming more environmentally friendly” (Futerra 2008). 

I am concerned that the green space and health research agenda is at risk of being overtaken by a form of greenwash, as ironic as that may sound.  Green spaces – also known as natural/vegetated/open spaces – clearly have some social, environmental and economic benefits.  The research of CRESH and many other groups has demonstrated this.  But these benefits are not experienced everywhere, or by everyone.  The same wooded park may be a valued jogging or walking area for some people, but a terrifying no-go area for others.  There is much important research to be done to understand and address the barriers that prevent different groups benefitting from green spaces.  CRESH researchers are among many jointly trying to bridge this knowledge gap.

The greenwash that concerns me is the mantra that ‘green space is good’ – end of story.  At a recent GreenHealth Conference (11th March 2013, Edinburgh) the fascinating results from a four-year Scottish Government funded research programme were presented.  CRESH’s own Rich Mitchell presented on the topic “More green = better health?” and concluded that this is not always the case (see blog post).  Nonetheless, in one of the afternoon discussions one attendee called for less research and more action “because we know green space is good already”.  Additionally, some important Greenspace Scotland work – showing that investment in ten community green space projects across Scotland provides good social, environmental and economic value for money – has been misleadingly reported elsewhere as “Greenspace is good… fact!”  This is greenwash.  It is also an example of a factoid – an assumption or speculation that is reported and repeated until it is considered true (see Cummins and Macintyre’s 2002 paper on how “food deserts” made it into UK policy by such a pathway).  Policy-making based on assumptions is dangerous: Cummins and Macintyre urge policy makers to look at the facts more critically.

Jane Jacobs – the influential American writer on urban planning – wrote about the greenwash surrounding green spaces (or ‘grass fetishes’ as she called it) more than 50 years ago.  In The Death and Life of Great American Cities (1961, Random House, NY) she wrote that “In orthodox city planning, neighbourhood open spaces are venerated in an amazingly uncritical fashion…” (p.90).  She qualifies that, while ”parks can and do add great attraction to neighbourhoods that people find attractive for a great variety of other uses”, they may also “exaggerate the dullness, the danger, the emptiness” (p.111).  If the barriers to green space use are not identified and addressed local people cannot be expected to use and benefit from them, regardless of the intentions of well-meaning city planners.  Informing people that ‘green space is good’ won’t help.  The danger is that when their touted benefits don’t materialise, green spaces may fall out of favour, when in truth, and with greater attention to what the evidence tells us, they may have been a great public health resource.  Instead of less research we urgently need to strengthen the evidence base and publicise our findings more widely.  Watch this space.

Author: Liz Richardson

Greener urban areas in Scotland are not healthier

Studies from around the world have looked for links between how much green space a neighbourhood has and the health of the resident population. We expect to find this link because evidence from experimental studies in the laboratory and field suggests that being in natural environments may reduce stress, enable recovery from fatigue, lower blood pressure and promote healing. Green spaces may also encourage physical activity, and social contact. However, not all studies find a link between green space and health; the relationship seems to vary by country, gender, socio-economic position and, importantly, by the measure of health used.

Until recently there had been very little work looking at the relationships between green space and health in Scotland specifically. On March 11th, results of the GreenHealth programme are being launched at a conference in Edinburgh. CRESH was part of GreenHealth, together with colleagues from several other institutions in Scotland including The James Hutton Institute and our friends at the OPENspace Research Centre. In this blog I am going to tell you about some of the results from our part of the work.

A key part of our work was to look at the link between how much green space a neighbourhood has, and its rates of mortality and morbidity. The graph below is typical of the results we found.

result1

The graph shows the relationship between the amount of green space in urban neighbourhoods in Scotland, and the risk of mortality for working age men. The risk is shown relative to urban areas with the least amount of green space, and the further a bar extends below the horizontal axis, the lower the risk in that type of area. The risk of death excludes that from external causes such as traffic accidents or suicide. The graph shows that in England and Wales, the risk of mortality falls as the amount of green space in an urban neighbourhood increases but in Scotland, there’s no significant relationship.

We spent a long time looking at whether these relationships were different for men and women, for older, working and younger age people, for more and less urban areas, for richer and poorer groups, for deaths from cardiovascular and respiratory disease, for measures of self-reported illness, and for different definitions of green space and neighbourhood. We only found a significant, protective relationship between mortality and green space for working age men living in the poorest two income-deprivation quartiles. Among these working-age men, those resident in the greenest urban areas were about 16% less likely to die than those resident in the least green urban areas.

On the whole though, we found very little evidence supporting the idea that urban neighbourhoods with more green space also have lower rates of mortality and morbidity.

The absence of effects for women echoes findings in England and Wales, and is likely linked to gender differences in the frequency and type of green space use. Women are known to use green spaces less often than men. We have written about this in the past and you can read our paper about it here.

So – why don’t we see a strong link between how much green space there is in a neighbourhood in Scotland, and how healthy it is? It seems very unlikely that the beneficial  biological and psychological processes which being in green space seem to trigger, just don’t happen to Scottish people. We may be different up here, but we’re not a different species…

We checked to see if our methods, or the data sets used might explain it, but we got the same results whichever data or method we tried. We could not allow for differences in the quality or types of urban green space within Scotland, and between England, Wales and Scotland, and it is possible that this is partly responsible; perhaps urban green spaces in Scotland are smaller, or less conducive to use. Perhaps the weather is so awful up here, that people just don’t want to go outside (though, it has been known to rain in Wales too…). We also wondered whether the so-called Glasgow effect was responsible, but we got the same pattern of results when we excluded Glasgow from the analysis.

Our best bet is that the Scottish population has a higher level of underlying poor health and risky behaviours such as smoking and drinking. The impact of green space on risk of mortality is, even in England, relatively weak. Any benefits of green space in urban Scotland may just be swamped by other things that damage health.

It’s not all bad news though. Whilst greener neighbourhoods might not be healthier in urban Scotland, the people who actually visit and use green spaces, whether for exercise, or just to get away from it all for a while, do seem to have better mental health and more life satisfaction, all else being equal We have published some of those results already and blogged about them too. We have more evidence that folk who do use green spaces reap health and wellbeing benefits, and will be blogging more about it once those studies are published.

In the meantime, the message is that park down the road will probably do you an awful lot more good if you actually visit it…

Key questions for researching natural environments and health

There was a long session on natural environments and health at the Royal Geographical Society /IBG conference yesterday. It was put together by Dr Liz Richardson, from CRESH, and it featured an intriguing range of 9 papers. All were exploring the relationships between natural environments and health, but there was great variety in the perspectives, methodologies and opinions on display. The session felt like a nice summary of many current issues and questions in the field.

You can read the abstracts for the papers in the first part of the session here, and the second part of the session here. At the end, I led a discussion which tried to bring together the range of questions and perspectives in the session. Here’s what we talked about.

What can we expect natural environments to do for us? Nina Morris, from Edinburgh University, used the lovely expression ‘mission creep’ in her talk and it prompted us to note that green spaces suddenly seem to be responsible for doing an awful lot. If you believed everything you read, you might think that your local park or forest will cure all ills, make everyone thin, make everyone happy, be a boon to the local economy, prevent climate change and protect rare species. It’s likely that some natural environments can contribute to some of these things, some of the time, but they’re not miracle-workers. Keeping expectations realistic and evidence-based is important.

Several talks began with the assertion that green space is thought to be, (or even known to be) ‘good for health’. There were also anecdotes that, when hearing about plans for or results from research on natural environments and health, some policy makers, journalists (and even research funders) reply “we know that already”. So, we debated, is our job done? Do we now know enough about the relationships between natural environments and health? Can we stop researching it and turn our attention to something else? Perhaps not surprisingly, a room full of researchers disagreed… I do think they had good reason though. Some of the papers really challenged what we thought we knew about whether and how natural environments are related to health. The paper from Katherine Ord, a PhD student at CRESH, for example, strongly questioned the role of physical activity in the relationship between green space and health. Whilst we’re still discovering that we know relatively little about how, when and for whom natural environments matter for human health and wellbeing, there is more work to do. The fact that many people seem now to believe that ‘green space is always good for everyone’, makes the research even more important.

Assuming that there is more work to do, what kind of research is needed? There was much talk about the value of different approaches. Qualitative, quantitative and mixed methods studies were all on display and the range of insights and types of knowledge was a powerful argument for variety in study design and methodology. The epidemiological studies CRESH specialises in are important for learning if and how natural environments contribute to the health and wellbeing of populations, and how they relate to health inequalities. But the insights from qualitative work into how and why individuals use, move within and feel about natural spaces provide crucial depth in understanding. The need to study non-natural environments as part of our research (akin to a control group) was another thread running through the debate. This is vital to be sure that any apparent impacts on health and wellbeing are a function of the natural environment itself and not something else, like just being in a different environment, or a much loved place.

Finally, we discussed the need to understand how we should manage natural environments and our access to them, to maximise their potential benefits. A paper from Michelle Newman at Coventry University, for example, took a critical look at the issues surrounding children’s access to green space in schools. Its exploration of ideas about accessing ‘risky’ environments and who is paying for (and therefore controlling) access to these spaces, prompted wider thoughts about what kinds of spaces to preserve, make accessible or construct. There is a need to ask who has access and who uses their access. Governments and policy makers now explicitly acknowledge the values of green space for health and wellbeing, which is great. Would it be so great if they started to set targets for green space use, or even compel it?

It was a fascinating, useful (and long…) session.

Regular physical activity in natural environments halves risk of poor mental health

Regular exercise in a natural environment may cut the risk of suffering from poor mental health by half, according to a new study published by CRESH today.

Rich Mitchell studied the use of natural and non-natural environments for physical activity, like walking, running and cycling. He found regular use of natural environments such as forests and parks seemed to protect against mental ill-health, whilst use of non-natural environments like a gym, did not.

Previous experimental studies have shown that exercise in natural environments has a positive effect on biomarkers and self-reports of stress, on mood and reported levels of fatigue. This new study was designed to look at whether such effects can be detected in the general population in every day settings.

Data from the Scottish Health Survey 2008, described the different environments in which 1890 respondents were physically active, including woodlands, parks, swimming pools, the gym, the streets and the home. The data also showed how often respondents used each environment and how physically active they were overall. Rich looked at the association between use of each environment and the risk of poor mental health as measured by the General Health Questionnaire. Only activity in natural environments was associated with a lower risk of poor mental health.

Rich said “I wasn’t surprised by the findings that exercise in natural environments is good for your mental health, but I was surprised by just how much better it is for your mental health to exercise in a green place like a forest, than in other places like the gym.”

 “Woodlands and parks seemed to have the greatest effect, so the message to doctors, planners and policy makers is that these places need protecting and promoting.

 “The results suggest that making the decision to exercise in a natural environment just once a week could be enough to gain a benefit. Any additional use may have a bigger effect.”

The study, published online by Social Science & Medicine, revealed that local pavements or streets was the environment most commonly used regularly for physical activity, followed by home/garden. Around 50 per cent of the sampled group reported using any natural environment at least once in the last month.

Rich did not know the type, duration or intensity of activity conducted in each environment and noted that this was a weakness in the study, but is also an area that could be looked at in more detail in future.

You can see Rich talking about the study here: http://itunes.gla.ac.uk/web/news/video/RichardMitchell.mp4 

You can read the full study here http://dx.doi.org/10.1016/j.socscimed.2012.04.012 (access required). If you don’t have access and want to read it, please email Rich at Richard.Mitchell@glasgow.ac.uk and ask for a copy.

The research was funded by the Scottish Government’s Rural and Environmental Science and Analytical Services division (RESAS).

More green space equals less stress (as measured by cortisol)

A project team which includes Rich Mitchell has just published a study showing that cortisol circulation (a marker of stress) is more favourable in areas with greater amounts of green space. The team was led by Catharine Ward Thompson, at OpenSpace research centre. The study is the first to show effects of green space on biomarkers of stress in everyday (i.e. non-experimental) settings. It’s published in Landscape and Urban Planning and you may be able to read it here . The study is part of the wider GreenHealth project, in which CRESH plays a large part. It was funded by the by the Scottish Government’s Rural and Environment Science and Analytical Services (RESAS) Division. For those without access to the journal, here’s the abstract:

Green space has been associated with a wide range of health benefits, including stress reduction, but much pertinent evidence has relied on self-reported health indicators or experiments in artificially controlled environmental conditions. Little research has been reported using ecologically valid objective measures with participants in their everyday, residential settings. This paper describes the results of an exploratory study (n = 25) to establish whether salivary cortisol can act as a biomarker for variation in stress levels which may be associated with varying levels of exposure to green spaces, and whether recruitment and adherence to the required, unsupervised, salivary cortisol sampling protocol within the domestic setting could be achieved in a highly deprived urban population. Self-reported measures of stress and general wellbeing were also captured, allowing exploration of relationships between cortisol, wellbeing and exposure to green space close to home. Results indicate significant relationships between self-reported stress (P < 0.01), diurnal patterns of cortisol secretion (P < 0.05), and quantity of green space in the living environment. Regression analysis indicates percentage of green space in the living environment is a significant (P < 0.05) and independent predictor of the circadian cortisol cycle, in addition to self-reported physical activity (P < 0.02). Results also show that compliance with the study protocol was good. We conclude that salivary cortisol measurement offers considerable potential for exploring relationships between wellbeing and green space and discuss how this ecologically valid methodology can be developed to confirm and extend findings in deprived city areas to illuminate why provision of green space close to home might enhance health.

CRESH at the EUPHA conference on Public Health and Nature

Rich Mitchell is giving a keynote address at a pre-meeting of the European Public Health Association in Copenhagen on the 9th November. Rich will be talking about Public Health’s new found interest in natural environments, the demand for high quality evidence and the relationships between experimental and observational studies. More details on the meeting can be found here.

Our green space work in the news

Green spaces keep men healthy

Jun 21, 2010

Recent work by Dr Elizabeth Richardson and Prof Richard Mitchell attracted considerable media interest recently.

Their study found that men who live in neighbourhoods with more green space are less likely to die from cardiovascular and respiratory diseases – conditions that account for almost half of all deaths in the UK. But it also found that these benefits of greener neighbourhoods do not extend to women. The results were a surprise because it had previously been widely assumed that green spaces are equally good for everyone, through offering opportunities for physical activity and social contacts for example. The reasons for the findings were unclear, but other literature tells us that women use green space less than men and don’t exercise as much there, particularly if they perceive the area to be unsafe or threatening. This could explain the findings.

The study was the first to study green space and health relationships for the UK as a whole, as the researchers combined remotely sensed data and Ordnance Survey map data to quantify green space at a national level. Mortality statistics based on a population of almost 30 million adults were used, giving the results substantial significance. It should be stressed that as the study only considered mortality statistics it cannot be assumed that women’s health does not benefit from green space in other ways.

The paper “Gender differences in relationships between urban green space and health in the United Kingdom” was funded by the Forestry Commission and originally published in the journal Social Science and Medicine, but has now received diverse coverage through outlets such as BBC Radio Scotland, the Daily Telegraph, and even The Sun, where the headline read “Park life is better for blokes’ hearts”.

Links:

Daily Mail: “Why living near a park is good for a man’s heart and lungs”

Scotsman: “Women miss out on health benefit of green spaces, major study finds”

Scottish Sun: “Park life is better for blokes’ hearts”