An ecosystem service perspective on urban nature, physical activity, and health.

Nature underpins human well-being in critical ways, especially in health. Nature provides pollination of nutritious crops, purification of drinking water, protection from floods, and climate security, among other well-studied health benefits. A crucial, yet challenging, research frontier is clarifying how nature promotes physical activity for its many mental and physical health benefits, particularly in densely populated cities with scarce and dwindling access to nature. Here we frame this frontier by conceptually developing a spatial decision-support tool that shows where, how, and for whom urban nature promotes physical activity, to inform urban greening efforts and broader health assessments. We synthesize what is known, present a model framework, and detail the model steps and data needs that can yield generalizable spatial models and an effective tool for assessing the urban nature-physical activity relationship. Current knowledge supports an initial model that can distinguish broad trends and enrich urban planning, spatial policy, and public health decisions. New, iterative research and application will reveal the importance of different types of urban nature, the different subpopulations who will benefit from it, and nature's potential contribution to creating more equitable, green, livable cities with active inhabitants.

Exploring outdoor thermal perception-a revised model.

This paper aims at extending earlier models of outdoor thermal perception by fusing new knowledge from recent literature and deriving perspectives for future research and methods from the new model. Previous models focused on physical and physiological aspects. Only recently, the psychological aspects of thermal perception received more attention, such as spatial perception. Furthermore, in recent literature on thermal perception, two time scales have been described: the short-term and the long-term thermal perception. Based on this new literature, we develop a conceptual, more comprehensive model that takes these factors into account as well. It hypothesizes how thermal sensation and psychological processes interact on the two time scales. However, to be able to describe relationships between psychological aspects of thermal perception more precisely, more research is required on the following issues: (1) influence of momentary personal references and preferences (e.g., mood), (2) influence of long-term personal references and preferences (e.g., cultural aspects, habituation), and (3) influence of the perception of the spatial environment on thermal perception. Moreover, the relation between momentary and long-term thermal perception has not been studied yet. We conclude this paper with an outlook on possible methods to study these factors.

Exploring pathways linking greenspace to health: Theoretical and methodological guidance.

BACKGROUND: In a rapidly urbanizing world, many people have little contact with natural environments, which may affect health and well-being. Existing reviews generally conclude that residential greenspace is beneficial to health. However, the processes generating these benefits and how they can be best promoted remain unclear. OBJECTIVES: During an Expert Workshop held in September 2016, the evidence linking greenspace and health was reviewed from a transdisciplinary standpoint, with a particular focus on potential underlying biopsychosocial pathways and how these can be explored and organized to support policy-relevant population health research. DISCUSSIONS: Potential pathways linking greenspace to health are here presented in three domains, which emphasize three general functions of greenspace: reducing harm (e.g. reducing exposure to air pollution, noise and heat), restoring capacities (e.g. attention restoration and physiological stress recovery) and building capacities (e.g. encouraging physical activity and facilitating social cohesion). Interrelations between among the three domains are also noted. Among several recommendations, future studies should: use greenspace and behavioural measures that are relevant to hypothesized pathways; include assessment of presence, access and use of greenspace; use longitudinal, interventional and (quasi)experimental study designs to assess causation; and include low and middle income countries given their absence in the existing literature. Cultural, climatic, geographic and other contextual factors also need further consideration. CONCLUSIONS: While the existing evidence affirms beneficial impacts of greenspace on health, much remains to be learned about the specific pathways and functional form of such relationships, and how these may vary by context, population groups and health outcomes. This Report provides guidance for further epidemiological research with the goal of creating new evidence upon which to develop policy recommendations.

Greener living environment healthier people?: Exploring green space, physical activity and health in the Doetinchem Cohort Study.

BACKGROUND: Evidence is emerging that more green space in the living environment is associated with better health, partly via the pathway of physical activity. OBJECTIVES: We explored the cross-sectional and longitudinal associations between green space and physical activity and several health indicators in the Doetinchem Cohort Study. METHODS: A random sample of men and women aged 20-59years at baseline was measured max 5 times with 5year-intervals in the period 1987-2012. Data of round 3-5 were used. Measurements were based on examinations (height, weight, blood pressure) or questionnaires (physical activity, perceived health, depressive symptoms, chronic conditions). The percentage of green space (mainly urban and agricultural green) around the home address (125m and 1km) was calculated using satellite data. RESULTS: More agricultural green was associated with less time spent on bicycling (ß1km=-0.15, 95%CL -0.13; -0.04) and sports (ß1km=-0.04, 95%CL -0.07; -0.01) and more time spent on gardening (ß1km=0.16, 95%CL 0.12; 0.19) and odd jobs (ß1km=0.10, 95%CL 0.05; 0.15), and this was in the other direction for urban green. For only a few of the many health indicators a positive association with green was found, and mainly for total green within 1km radius. Longstanding green or a transition to more green did not show more pronounced associations with health. CONCLUSIONS: For the green space range of the Doetinchem area the findings do not strongly support the hypothesis that the percentage of green in the living environment affects health positively. The distinction by type of green may, however, be relevant for physical activity.

Nature and health.

Urbanization, resource exploitation, and lifestyle changes have diminished possibilities for human contact with nature in urbanized societies. Concern about the loss has helped motivate research on the health benefits of contact with nature. Reviewing that research here, we focus on nature as represented by aspects of the physical environment relevant to planning, design, and policy measures that serve broad segments of urbanized societies. We discuss difficulties in defining "nature" and reasons for the current expansion of the research field, and we assess available reviews. We then consider research on pathways between nature and health involving air quality, physical activity, social cohesion, and stress reduction. Finally, we discuss methodological issues and priorities for future research. The extant research does describe an array of benefits of contact with nature, and evidence regarding some benefits is strong; however, some findings indicate caution is needed in applying beliefs about those benefits, and substantial gaps in knowledge remain.

Green space and changes in self-rated health among people with chronic illness.

This prospective study analyses change in self-rated health of chronically ill people in relation to green space in their living environment at baseline. Data on 1112 people in the Netherlands with one or more medically diagnosed chronic disease(s) were used. The percentage of green space was calculated for postal code area. Multilevel linear regression analysis was conducted. We found no relationship between green space and change in health; however, an unexpected relationship between social capital at baseline and health change was discovered.

Effects of indoor plants on office workers: a field study in multiple Dutch organizations.

In the period 2019-2020, the effect of plants in the workspace on (a) the physical indoor climate, (b) the perception of the workspace by office workers, and (c) their health, well-being and functioning was investigated in nine organizations. This paper reports the outcomes of the latter part. A conceptual model describing the short-term, medium and long-term effect of plants on people was formulated, containing 18 outcome variables. A "Before After Control Impact" quasi-experimental research design was used. A control workspace and an intervention workspace were selected in each of the organizations. A pre-measurement was conducted in both. Correlational analyses, based on the pre-measurements in all organizations and workspaces, confirmed the associations proposed by the conceptual model to a large extent. After placing plants in the intervention workspace, a maximum of two post-intervention measurements were conducted (due to COVID-19 not in all nine organizations), the last one at least 4 months after the introduction of the plants. Overall significant effects were found on complaints about dry air (fewer), the sense of privacy (higher), the attractiveness of the workspace (higher), satisfaction with the workspace (greater) and having a health-related complaint, especially when at work (fewer). The first three effects were already observed in the analyses only including the first post-measurement. The latter two effects only showed up in the analyses including two post-measurements. No direct effect of the plants could be demonstrated on the 13 other outcome variables. The observed effects mainly concern outcome variables that are positioned at the beginning of the proposed causal chain, starting with plants and ending with mental health, absenteeism and job satisfaction.

Residential green space associated with the use of attention deficit hyperactivity disorder medication among Dutch children.

Several studies have observed an inverse relationship between attention deficit hyperactivity disorder (ADHD)-related behavior of children, as reported by parents or teachers, and the amount of green space in their residential environment. Research using other, more objective measures to determine ADHD prevalence is scarce and could strengthen the evidence base considerably. In this study, it is investigated whether a similar beneficial association will be observed if the use of ADHD-related medication is selected as an outcome measure. More specifically, registry data from a health insurance company on the reimbursement of ADHD-related medication in 2011 were available for 248,270 children between 5 and 12 years of age. Amounts of green space within 250 and 500 m of the home address were calculated. Multilevel logistic regression analyses for the prevalence of use were conducted, including the following covariates: sex, age, urbanity of the neighborhood, neighborhood socioeconomic status (SES), and percentage of people with a non-Western migration background in the neighborhood population. Results showed that the amount of green space was inversely related to the prevalence of use of ADHD medication. Moreover, the relationship was strongest among children living in the least wealthy neighborhoods and absent among those living in the wealthiest neighborhoods. Results also show that in less wealthy neighborhoods, there is, on average, less green space available nearby: children who are likely to benefit most from nearby green space tend to have the least of it.

Pathways linking biodiversity to human health: A conceptual framework.

Biodiversity is a cornerstone of human health and well-being. However, while evidence of the contributions of nature to human health is rapidly building, research into how biodiversity relates to human health remains limited in important respects. In particular, a better mechanistic understanding of the range of pathways through which biodiversity can influence human health is needed. These pathways relate to both psychological and social processes as well as biophysical processes. Building on evidence from across the natural, social and health sciences, we present a conceptual framework organizing the pathways linking biodiversity to human health. Four domains of pathways-both beneficial as well as harmful-link biodiversity with human health: (i) reducing harm (e.g. provision of medicines, decreasing exposure to air and noise pollution); (ii) restoring capacities (e.g. attention restoration, stress reduction); (iii) building capacities (e.g. promoting physical activity, transcendent experiences); and (iv) causing harm (e.g. dangerous wildlife, zoonotic diseases, allergens). We discuss how to test components of the biodiversity-health framework with available analytical approaches and existing datasets. In a world with accelerating declines in biodiversity, profound land-use change, and an increase in non-communicable and zoonotic diseases globally, greater understanding of these pathways can reinforce biodiversity conservation as a strategy for the promotion of health for both people and nature. We conclude by identifying research avenues and recommendations for policy and practice to foster biodiversity-focused public health actions.

Allotment gardening and health: a comparative survey among allotment gardeners and their neighbors without an allotment.

BACKGROUND: The potential contribution of allotment gardens to a healthy and active life-style is increasingly recognized, especially for elderly populations. However, few studies have empirically examined beneficial effects of allotment gardening. In the present study the health, well-being and physical activity of older and younger allotment gardeners was compared to that of controls without an allotment. METHODS: A survey was conducted among 121 members of 12 allotment sites in the Netherlands and a control group of 63 respondents without an allotment garden living next to the home addresses of allotment gardeners. The survey included five self-reported health measures (perceived general health, acute health complaints, physical constraints, chronic illnesses, and consultations with GP), four self-reported well-being measures (stress, life satisfaction, loneliness, and social contacts with friends) and one measure assessing self-reported levels of physical activity in summer. Respondents were divided into a younger and older group at the median of 62 years which equals the average retirement age in the Netherlands. RESULTS: After adjusting for income, education level, gender, stressful life events, physical activity in winter, and access to a garden at home as covariates, both younger and older allotment gardeners reported higher levels of physical activity during the summer than neighbors in corresponding age categories. The impacts of allotment gardening on health and well-being were moderated by age. Allotment gardeners of 62 years and older scored significantly or marginally better on all measures of health and well-being than neighbors in the same age category. Health and well-being of younger allotment gardeners did not differ from younger neighbors. The greater health and well-being benefits of allotment gardening for older gardeners may be related to the finding that older allotment gardeners were more oriented towards gardening and being active, and less towards passive relaxation. CONCLUSIONS: These findings are consistent with the notion that having an allotment garden may promote an active life-style and contribute to healthy aging. However, the findings may be limited by self selection and additional research is needed to confirm and extend the current findings.

Research challenges for cultural ecosystem services and public health in (peri-)urban environments.

Urbanization is a global trend, and consequently the quality of urban environments is increasingly important for human health and wellbeing. Urban life-style is typically associated with low physical activity and sometimes with high mental stress, both contributing to an increasing burden of diseases. Nature-based solutions that make effective use of ecosystem services, particularly of cultural ecosystem services (CES), can provide vital building blocks to address these challenges. This paper argues that, the salutogenic, i.e. health-promoting effects of CES have so far not been adequately recognised and deserve more explicit attention in order to enhance decision making around health and wellbeing in urban areas. However, a number of research challenges will need to be addressed to reveal the mechanisms, which underpin delivery of urban CES. These include: causal chains of supply and demand, equity, and equality of public health benefits promoted. Methodological challenges in quantifying these are discussed. The paper is highly relevant for policy makers within and beyond Europe, and also serves as a review for current researchers and as a roadmap to future short- and long-term research opportunities.

Nature and mental health: An ecosystem service perspective.

A growing body of empirical evidence is revealing the value of nature experience for mental health. With rapid urbanization and declines in human contact with nature globally, crucial decisions must be made about how to preserve and enhance opportunities for nature experience. Here, we first provide points of consensus across the natural, social, and health sciences on the impacts of nature experience on cognitive functioning, emotional well-being, and other dimensions of mental health. We then show how ecosystem service assessments can be expanded to include mental health, and provide a heuristic, conceptual model for doing so.

The need for European OneHealth/EcoHealth networks.

Elaborating from the European One Health/Ecohealth (OH/EH) workshop that took place in fall 2016 and aimed to bring together different communities and explore collaborative potential, the creation of European networks focusing on the development of important OH/EH perspectives was a direct output from discussions at the end of some sessions, in particular: - A network on transdisciplinary One Health education. - A network integrating inputs from social sciences in One Health/EcoHealth actions and networks. - A network aiming at translating research findings on the Environment-Microbiome-Health axis into policy making, with a view to make healthy ecosystems a cost-effective disease prevention healthcare strategy. It was also suggested that a European Community of Practice could be initiated in order to support these several concrete networking initiatives, and to help to promote the building of other emerging initiatives.

Green space, urbanity, and health: how strong is the relation?

STUDY OBJECTIVES: To investigate the strength of the relation between the amount of green space in people's living environment and their perceived general health. This relation is analysed for different age and socioeconomic groups. Furthermore, it is analysed separately for urban and more rural areas, because the strength of the relation was expected to vary with urbanity. DESIGN: The study includes 250 782 people registered with 104 general practices who filled in a self administered form on sociodemographic background and perceived general health. The percentage of green space (urban green space, agricultural space, natural green space) within a one kilometre and three kilometre radius around the postal code coordinates was calculated for each household. METHODS: Multilevel logistic regression analyses were performed at three levels-that is, individual level, family level, and practice level-controlled for sociodemographic characteristics. MAIN RESULTS: The percentage of green space inside a one kilometre and a three kilometre radius had a significant relation to perceived general health. The relation was generally present at all degrees of urbanity. The overall relation is somewhat stronger for lower socioeconomic groups. Elderly, youth, and secondary educated people in large cities seem to benefit more from presence of green areas in their living environment than other groups in large cities. CONCLUSIONS: This research shows that the percentage of green space in people's living environment has a positive association with the perceived general health of residents. Green space seems to be more than just a luxury and consequently the development of green space should be allocated a more central position in spatial planning policy.

Vitamin G: effects of green space on health, well-being, and social safety.

BACKGROUND: Looking out on and being in the green elements of the landscape around us seem to affect health, well-being and feelings of social safety. This article discusses the design of a research program on the effects of green space in the living environment on health, well-being and social safety. METHODS/DESIGN: The program consists of three projects at three different scales: at a macro scale using data on the Netherlands as a whole, at an intermediate scale looking into the specific effect of green space in the urban environment, and at micro scale investigating the effects of allotment gardens. The projects are observational studies, combining existing data on land use and health interview survey data, and collecting new data through questionnaires and interviews. Multilevel analysis and GIS techniques will be used to analyze the data. DISCUSSION: Previous (experimental) research in environmental psychology has shown that a natural environment has a positive effect on well-being through restoration of stress and attentional fatigue. Descriptive epidemiological research has shown a positive relationship between the amount of green space in the living environment and physical and mental health and longevity. The program has three aims. First, to document the relationship between the amount and type of green space in people's living environment and their health, well-being, and feelings of safety. Second, to investigate the mechanisms behind this relationship. Mechanisms relate to exposure (leading to stress reduction and attention restoration), healthy behavior and social integration, and selection. Third, to translate the results into policy on the crossroads of spatial planning, public health, and safety. Strong points of our program are: we study several interrelated dependent variables, in different ordinary settings (as opposed to experimental or extreme settings), focusing on different target groups, using appropriate multilevel methods.

Local availability of green and blue space and prevalence of common mental disorders in the Netherlands.

BACKGROUND: Previous studies revealed a relationship between residential green space availability and health, especially mental health. Studies on blue space are scarcer and results less conclusive. AIMS: To investigate the hypotheses that green and blue space availability are negatively associated with anxiety and mood disorders, and positively associated with self-reported mental and general health. METHOD: Health data were derived from a nationally representative survey (NEMESIS-2, n=6621), using a diagnostic interview to assess disorders. Green and blue space availability were expressed as percentages of the area within 1 km from one's home. RESULTS: The hypotheses were confirmed, except for green space and mood disorders. Associations were generally stronger for blue space than for green space, with ORs up to 0.74 for a 10%-point increase. CONCLUSIONS: Despite the different survey design and health measures, the results largely replicate those of previous studies on green space. Blue space availability deserves more systematic attention. DECLARATION OF INTEREST: None. COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

The impact of greenery on physical activity and mental health of adolescent and adult residents of deprived neighborhoods: A longitudinal study.

The aim of the study is to assess the impact of perceived and objective changes in greenery on physical activity and mental health of adolescents and adults living in severely deprived neighborhoods in the Netherlands. Longitudinal data regarding changes in greenery, walking, cycling, and depressive symptoms (CES-D), were gathered for 401 adolescents and 454 adults, using questionnaires and interviews with local district managers. Multivariate linear regression models examined the association between greenery and outcome variables, correcting for demographic and socioeconomic covariates and season. Overall, the results showed small and non-significant associations, with two exceptions. Objective improvements in greenery were associated with smaller decline in adolescents' leisure time cycling, and improvements in perceived greenery were related to a decrease in adults' depressive symptoms. In addition, there were several subgroup effects. In conclusion, changes in greenery did not yield consistent positive results among residents of severely deprived neighborhoods. However, there are some indications regarding positive effects of greenery in certain subgroups.

The impact of intervening in green space in Dutch deprived neighbourhoods on physical activity and general health: results from the quasi-experimental URBAN40 study.

BACKGROUND: Many problems concentrate in deprived neighbourhoods, among which is poor health. One possible way to address these health problems is to invest in the green space in deprived neighbourhoods. The number of evaluations of the public health impact of actual changes in neighbourhood green space is still limited. This study investigated the impact of real-life changes in the quality or quantity of green space in severely deprived neighbourhoods on physical activity and perceived general health. METHODS: Repeated cross-sectional surveys from 2004 till 2011 yielded self-reported information on leisure time walking, cycling and sports, and perceived general health of 48,132 adult residents. We fitted generalised mixed models to assess the rate of change per half year, estimate the linear trend, and the change in trends before and after the start of the urban regeneration mid-2008. Using a quasi-experimental design, we compared the trends in the intervention neighbourhoods with different selections of control areas. RESULTS: The deprived neighbourhoods that intervened in green space did not show more favourable changes in the trend of physical activity and good general health compared to all the different groups of control areas. CONCLUSIONS: We did not observe short-term positive effects on physical activity and general health among adults from improvements in green space in deprived neighbourhoods. This suggests that greening interventions that have been carried out in the context of the Dutch District Approach did not achieve short-term health gains among adults.

Streetscape greenery and health: stress, social cohesion and physical activity as mediators.

Several studies have shown a positive relationship between local greenspace availability and residents' health, which may offer opportunities for health improvement. This study focuses on three mechanisms through which greenery might exert its positive effect on health: stress reduction, stimulating physical activity and facilitating social cohesion. Knowledge on mechanisms helps to identify which type of greenspace is most effective in generating health benefits. In eighty neighbourhoods in four Dutch cities data on quantity and quality of streetscape greenery were collected by observations. Data on self-reported health and proposed mediators were obtained for adults by mail questionnaires (N = 1641). Multilevel regression analyses, controlling for socio-demographic characteristics, revealed that both quantity and quality of streetscape greenery were related to perceived general health, acute health-related complaints, and mental health. Relationships were generally stronger for quality than for quantity. Stress and social cohesion were the strongest mediators. Total physical activity was not a mediator. Physical activity that could be undertaken in the public space (green activity) was, but less so than stress and social cohesion. With all three mediators included in the analysis, complete mediation could statistically be proven in five out of six cases. In these analyses the contribution of green activity was often not significant. The possibility that the effect of green activity is mediated by stress and social cohesion, rather than that it has a direct health effect, is discussed.