The paradox of high greenness and poor health in rural Central Appalachia.

While many studies have found positive correlations between greenness and human health, rural Central Appalachia is an exception. The region has high greenness levels but poor health. The purpose of this commentary is to provide a possible explanation for this paradox: three sets of factors overwhelming or attenuating the health benefits of greenness. These include environmental (e.g., steep typography and limited access to green space used for outdoor recreation), social (e.g., chronic poverty, declining coal industry, and limited access to healthcare), and psychological and behavioral factors (e.g., perceptions about health behaviors, healthcare, and greenness). The influence of these factors on the expected health benefits of greenness should be considered as working hypotheses for future research. Policymakers and public health officials need to ensure that greenness-based interventions account for contextual factors and other determinants of health to ensure these interventions have the expected health benefits.

Exploring the role of exposure to green and blue spaces in preventing anxiety and depression among young people aged 14-24 years living in urban settings: A systematic review and conceptual framework.

Despite the growing problem of anxiety and depression amongst young people aged 14-24 years living in urban settings, reviews about the role of exposure to green and blue spaces or nature in preventing anxiety and depression tend to focus on children, adults or sometimes adolescents. This review aims to explore whether exposure to green and blue spaces reduces the risk of anxiety and depression among young people aged 14-24 years living in urban settings and provide a conceptual framework. The academic databases CINAHL plus, Global Health, MEDLINE, ProQuest: Dissertations and Theses, PsycINFO, Scopus and OpenGrey were searched for research published in English between January 2000 and June 2020. All study designs were eligible. All included studies were assessed for quality. Searches identified 9208 sources with 48 meeting the inclusion criteria for the review. Experimental studies provided evidence that walking or being in a green space improves mood and state anxiety immediately following the intervention. Non-randomised evaluations and observational studies suggest that social interaction, physical activity, and mindfulness mediate the relationship between exposure to green space and mental health. We propose that the absence of noise and restorative qualities of green spaces promotes mindfulness and interrupt rumination, which in turn reduce the risk of anxiety disorders and depression. This review and the resulting conceptual framework provide evidence to healthcare professionals about the value of contact with nature and green social prescribing. For policymakers, it provides evidence about the value of bringing the benefits of forests, vegetation and nature into cities, and ensuring that these spaces are accessible and safe for young people to use.

Nature-based social prescribing programmes: opportunities, challenges, and facilitators for implementation.

BACKGROUND: Evidence on the health benefits of spending time in nature has highlighted the importance of provision of blue and green spaces where people live. The potential for health benefits offered by nature exposure, however, extends beyond health promotion to health treatment. Social prescribing links people with health or social care needs to community-based, non-clinical health and social care interventions to improve health and wellbeing. Nature-based social prescribing (NBSP) is a variant that uses the health-promoting benefits of activities carried out in natural environments, such as gardening and walking. Much current NBSP practice has been developed in the UK, and there is increasing global interest in its implementation. This requires interventions to be adapted for different contexts, considering the needs of populations and the structure of healthcare systems. METHODS: This paper presents results from an expert group participatory workshop involving 29 practitioners, researchers, and policymakers from the UK and Germany's health and environmental sectors. Using the UK and Germany, two countries with different healthcare systems and in different developmental stages of NBSP practice, as case studies, we analysed opportunities, challenges, and facilitators for the development and implementation of NBSP. RESULTS: We identified five overarching themes for developing, implementing, and evaluating NBSP: Capacity Building; Accessibility and Acceptability; Networks and Collaborations; Standardised Implementation and Evaluation; and Sustainability. We also discuss key strengths, weaknesses, opportunities, and threats for each overarching theme to understand how they could be developed to support NBSP implementation. CONCLUSIONS: NBSP could offer significant public health benefits using available blue and green spaces. We offer guidance on how NBSP implementation, from wider policy support to the design and evaluation of individual programmes, could be adapted to different contexts. This research could help inform the development and evaluation of NBSP programmes to support planetary health from local and global scales.

Nature Archetypes - Concepts Related to Objects and Phenomena in Natural Environments. A Swedish Case.

Do people classify nature in ways that can be described as archetypes? Could it be that these can be interpreted as health promotive? More and more researchers today suggest that archetypes can be used to analyze, describe, and develop green spaces. In parallel, an increasing number of research results since the 1980s have shown that human health and well-being are positively affected by stays in certain nature areas. The qualities in these nature areas which stand out to be most health-promoting are interpreted to be properties of nature that humans through evolution are prepared to perceive in a positive way. In this study, 547 respondents in southern Sweden answered a questionnaire on properties in natural areas. Through cluster analysis, these properties have been grouped into 10 types of nature and landscape. The 10 clusters are related to specific phenomena and places in Scandinavian nature, which could be described as archetypal. These natural phenomena and places are discussed, partly based on references to archaic Scandinavian mythology, Scandinavian lifestyle, and cultural canon, and partly on research on evolution, human preferences, and how nature can affect human health. We discuss how these nature archetypes evoke anxiety, fear, and distancing as well as calmness, tranquility, and connection. However, researchers have so far focused on how visits to natural environments have affected the sympathetic nervous system, and not realized the possibility of including the calm and connection system as well as the oxytocin in their explanatory models. In a follow-up article, we intend to develop a model for how the nature archetypes can interact with the calm and connection system.

Planetary Health: From the Wellspring of Holistic Medicine to Personal and Public Health Imperative.

The term planetary health - denoting the interconnections between the health of person and place at all scales - emerged from the environmental and holistic health movements of the 1970-80s; in 1980, Friends of the Earth expanded the World Health Organization definition of health, stating: "health is a state of complete physical, mental, social and ecological well-being and not merely the absence of disease - personal health involves planetary health". By the 1990s, the concept of planetary health was part of the fabric of integrative medicine; more recently, after the 2015 Lancet Commission on Planetary Health report, the concept has penetrated mainstream academic and medical discourse. Here, we explore this history and describe its relevance to contemporary healthcare; integrative medicine is uniquely positioned to educate and advocate on behalf of patients and communities (current and future generations), helping to safeguard health of person, place and planet. We use the emerging microbiome science as a way to illustrate the interconnectivity and health implications of ecosystems (including social/political/economic systems) at all scales. As highlighted in the Canmore Declaration, mainstream planetary health discourse will be strengthened by inter-professional healthcare perspectives, and a more sophisticated understanding of the ways in which social dominance orientation and medical authoritarianism compromise the World Health Organization's broad vision of global health. Planetary health isn't a "new discipline"; it is merely an extension of a concept that was understood by our ancestors, and remains the vocation of all healthcare providers. Discourse on the topic requires cultural competency, critical consciousness and a greater appreciation of marginalized voices.

Preventive Medicine for Person, Place, and Planet: Revisiting the Concept of High-Level Wellness in the Planetary Health Paradigm.

Experts in preventive medicine and public health have long-since recognized that health is more than the absence of disease, and that each person in the 'waiting room' and beyond manifests the social/political/economic ecosystems that are part of their total lived experience. The term planetary health-denoting the interconnections between the health of person and place at all scales-emerged from the environmental and preventive health movements of the 1970⁻1980s. Roused by the 2015 Lancet Commission on Planetary Health report, the term has more recently penetrated mainstream academic and medical discourse. Here, we discuss the relevance of planetary health in the era of personalized medicine, gross environmental concerns, and a crisis of non-communicable diseases. We frame our discourse around high-level wellness-a concept of vitality defined by Halbert L. Dunn (1896⁻1975); high-level wellness was defined as an integrated method of functioning which is oriented toward maximizing the potential of individuals within the total lived environment. Dunn maintained that high-level wellness is also applicable to organizations, communities, nations, and humankind as a whole-stating further that global high-level wellness is a product of the vitality and sustainability of the Earth's natural systems. He called for a universal philosophy of living. Researchers and healthcare providers who focus on lifestyle and environmental aspects of health-and understand barriers such as authoritarianism and social dominance orientation-are fundamental to maintaining trans-generational vitality at scales of person, place, and planet.

Hiking: A Low-Cost, Accessible Intervention to Promote Health Benefits.

Research has connected sedentary lifestyles with numerous negative health outcomes, including a significant increased risk for mortality. Many health care professionals seek ways to help clients meet physical activity guidelines recommended by the Office of Disease Prevention and Health Promotion, the World Health Organization, and the American College of Sports Medicine in order to promote active lifestyles and improve overall wellness. Hiking is a cost-effective intervention that encourages people to be physically active while spending time in nature. Time in nature can lead to health benefits through contact with the natural elements, participation in physical activity, restoration of mental and emotional health, and time with social contacts. Benefits may be immediate, such as decreased blood pressure, decreased stress levels, enhanced immune system functioning, and restored attention, or transpire over time, such as weight loss, decreased depression, and overall wellness. Health care providers are ideally positioned to recommend and prescribe hiking to clients. Federal, state, and local natural resource agencies are beginning to partner with health care professionals to promote outdoor nature-related activities. Examples of successful doctor and other health care practitioner partnership programs are described, along with tips for getting started.

A Diagnostic Post-Occupancy Evaluation of the Nacadia® Therapy Garden.

The design of the Nacadia® therapy garden is based on a model for evidence-based health design in landscape architecture (EBHDL). One element of the model is a diagnostic post-occupancy evaluation (DPOE), which has not previously been fully developed. The present study develops a generic DPOE for therapy gardens, with a focus on studying the effects of the design on patients' health outcomes. This is done in order to identify successes and failures in the design. By means of a triangulation approach, the DPOE employs a mixture of methods, and data is interpreted corroborating. The aim of the present study is to apply the DPOE to the Nacadia® therapy garden. The results of the DPOE suggest that the design of the Nacadia® therapy garden fulfills its stated aims and objectives. The overall environment of the Nacadia ® therapy garden was experienced as protective and safe, and successfully incorporated the various elements of the nature-based therapy programme. The participants encountered meaningful spaces and activities which suited their current physical and mental capabilities, and the health outcome measured by EQ-VAS (self-estimated general health) indicated a significant increase. Some design failures were identified, of which visual exposure was the most noteworthy. The DPOE model presented appears to be efficient but would nonetheless profit from being validated by other cases.

The beach as a setting for families' health promotion: a qualitative study with parents and children living in coastal regions in Southwest England.

This study explores the neglected issue of how families engage with beach environments in their local areas and use them in health promoting ways. Fifteen families with children aged 8-11 years living in coastal regions in Southwest England participated in individual semi-structured interviews. The findings indicate that beaches encouraged families to be physically active. Although families valued the opportunities for physical activity and active play afforded by beaches, the key health benefits emphasised were psychological, including experiencing fun, stress relief and engagement with nature. Increased social and family interaction was also highlighted as benefits. Despite perceiving health benefits, not all families regularly visited the beach. Barriers to visits included parents having limited time, cost of parking, lack of car access and cold weather. Parents played a key role in enabling visits by choosing to share these environments with their children. The social dimension of visits also encouraged families to make regular trips. The findings support the use of beach environments to promote families' health and wellbeing and positive relationships with nature.