The CRESH symposium on mental health and the environment was one of those (quite rare) conference days that worked incredibly well. I’m not sure what it was that made the day so interesting and exciting. Perhaps it was the unusual mix of academics, practitioners, policy makers and GPs in the audience, all of whom seemed keen and willing to engage and debate. Perhaps it was the variety of interesting presentations. Whatever the magic ingredients, I came away from the day inspired and full of thoughts. I’d like to share two of them
1) There was much discussion during the day about the nature of ‘evidence’ for the influence of environment on health. There was a clear tension between the desire for evidence from ‘intervention / evaluation’ type studies, which hold the promise of identifying causal mechanisms and offer a higher standard of ‘proof’ about whether environment does or does not hold influence over health (especially if the studies are controlled in some way), and the bulk of existing evidence which stems from observational designs. It certainly feels like the balance of funding available for health research is shifting rapidly to favour study designs which are more experimental than observational. Colleagues of mine have recently had funding requests turned down because of their observational study design, and we have had papers rejected from leading medical journals specifically because of an observational design. This pressure is, rightly or wrongly, asking scientists to work further up the hierarchy of study designs. What concerns me is the extent to which we are ignoring the weakness of experimental / evaluation study designs, especially in a) the extent to which they have external validity (i.e. can we really learn anything about how the wider world works from the controlled and unusual situations that experimental studies either create or exploit) and b) the extent to which we are tempted to believe that what are often relatively short-term studies can really tell us much about how social and physical environments really influence population health and health inequalities. This is a topic to which we intend to return in the next CRESH event. What is the right balance between experimental and observational studies in a portfolio, or mixed economy, of evidence? Is it all over for observation?
2) Critical thinking is essential to the progress of science. If we don’t ask how, and for whom, our results or conclusions might not hold, our work is weaker. If we don’t question how and why we think and research in the way we do, our approaches will not develop. In one area CRESH researches, the health effects of contact with green spaces or natural environments, we frequently encounter land managers, policy makers and planners who adhere to a general orthodoxy that ‘green space is good for you’. The value of critical science is that it makes us aware that not everyone feels comfortable walking in the woods or the park, and that some people even feel threatened by open spaces in the their neighbourhoods. There is plenty of evidence from qualitative and quantitative studies that this is true.
One of the weaknesses of critical thinking in the field at the moment however is that the critique seems to stop at ‘not everyone benefits from green space’. My question is, what do we do with that knowledge? If we can understand how and for whom benefits are not realised, that could help adjust expectations about what green space can deliver, and also help us think through how benefits could be brought to a wider range of people. Perhaps the real value of critical approaches to thinking about environment and health is that they pose these questions.
News about the next CRESH symposium will appear on the site soon. In the meantime, if any attendees want to post their thoughts on the mental health and environment day, please use the form below.
This is a personal post, written by Rich Mitchell. It doesn’t represent the views of ‘CRESH’