The health benefits of the great outdoors: A systematic review and meta-analysis of greenspace exposure and health outcomes.

BACKGROUND: The health benefits of greenspaces have demanded the attention of policymakers since the 1800s. Although much evidence suggests greenspace exposure is beneficial for health, there exists no systematic review and meta-analysis to synthesise and quantify the impact of greenspace on a wide range of health outcomes. OBJECTIVE: To quantify evidence of the impact of greenspace on a wide range of health outcomes. METHODS: We searched five online databases and reference lists up to January 2017. Studies satisfying a priori eligibility criteria were evaluated independently by two authors. RESULTS: We included 103 observational and 40 interventional studies investigating ~100 health outcomes. Meta-analysis results showed increased greenspace exposure was associated with decreased salivary cortisol -0.05 (95% CI -0.07, -0.04), heart rate -2.57 (95% CI -4.30, -0.83), diastolic blood pressure -1.97 (95% CI -3.45, -0.19), HDL cholesterol -0.03 (95% CI -0.05, <-0.01), low frequency heart rate variability (HRV) -0.06 (95% CI -0.08, -0.03) and increased high frequency HRV 91.87 (95% CI 50.92, 132.82), as well as decreased risk of preterm birth 0.87 (95% CI 0.80, 0.94), type II diabetes 0.72 (95% CI 0.61, 0.85), all-cause mortality 0.69 (95% CI 0.55, 0.87), small size for gestational age 0.81 (95% CI 0.76, 0.86), cardiovascular mortality 0.84 (95% CI 0.76, 0.93), and an increased incidence of good self-reported health 1.12 (95% CI 1.05, 1.19). Incidence of stroke, hypertension, dyslipidaemia, asthma, and coronary heart disease were reduced. For several non-pooled health outcomes, between 66.7% and 100% of studies showed health-denoting associations with increased greenspace exposure including neurological and cancer-related outcomes, and respiratory mortality. CONCLUSIONS: Greenspace exposure is associated with numerous health benefits in intervention and observational studies. These results are indicative of a beneficial influence of greenspace on a wide range of health outcomes. However several meta-analyses results are limited by poor study quality and high levels of heterogeneity. Green prescriptions involving greenspace use may have substantial benefits. Our findings should encourage practitioners and policymakers to give due regard to how they can create, maintain, and improve existing accessible greenspaces in deprived areas. Furthermore the development of strategies and interventions for the utilisation of such greenspaces by those who stand to benefit the most.

Microbiota composition is moderately associated with greenspace composition in a UK cohort of twins.

Exposure to natural environments, known as greenspace, appears to positively influence health, yet the mechanisms are unclear. Given that gut microbiota are associated with inflammatory disorders more prevalent in urban areas and individuals with lower greenspace exposure, microbiota may act as a mediator between greenspace and health. Using 2443 participants of the TwinsUK cohort, microbiota differences were compared in relation to rural/urban living and with quantiles of area-level greenspace at three different neighbourhood distances: 800 m, 3000 m and 5000 m. Using microbiota data captured from faecal samples using 16S rRNA marker gene sequencing, small compositional differences in association with 3000 m greenspace (p = 0.003) in models adjusted for confounders of microbiota variance (sequencing depth, antibiotics use, body mass index, frailty, age, diet, region and socioeconomic variables) were observed. Differences in abundances of genus were observed for all measures of greenspace in adjusted models; a key pathogenic genus was increased in abundance in association with urbanicity (Escherichia/Shigella, logFC = 0.73742, padj <0.001). Further, utilising the twin structure, within-pair differences in microbiota composition were compared and associations with 800 m greenspace observed (factor level significance in association with greatest difference, ß = 0.08, p = 0.0162) as were differences in Escherichia/Shigella. The microbiota signature of those with a greater exposure to greenspace, but not necessarily explicitly rural individuals, was distinct from other individuals, suggesting microbiota as a potential mediator for greenspace and health.