Green space benefits for health and well-being: A life-course approach for urban planning, design and management
Introduction
Across the globe, urban policy-makers are increasingly exploring the links between urban planning and public health as concerns rise on the impacts of urban environments on health outcomes and healthy lifestyles. For example, the recent Habitat III Agenda (United Nations General Assembly, 2016) places promoting human health and well-being as a key urban goal for the 21st Century, while the European Union has been linking health and the urban environment for more than a decade, illustrated by its Thematic Strategy on the Urban Environment with a primary aim to ‘improve the environmental performance and quality of urban areas to secure a healthy living environment for Europe's urban citizens’ (CEC, 2006; 4). In part, these initiatives echo the early roots of modern urban planning which emerged in the late 19th and early 20th Century to tackle slum conditions in Europe's industrial cities (Barton, 2010). However, the renewed interest in health and urban planning inter-relationships today reflects the growing evidence that the environment is one of the key determinants of health and well-being alongside inherited characteristics and socio-economic variables (Barton, 2009). Despite this interest, Crawford (2010) notes that close working relationships between urban planners and public health practitioners are remarkably scarce. Moreover, while studies of the environmental and place-based determinants of health and studies of subjective measures of well-being have increased significantly over the last decade, from a planning and design perspective this evidence-base is often piecemeal (e.g. focused on a specific cohort), and translating public health knowledge into urban planning and design interventions and actual proposals remains problematic. In this paper, we address this disconnect by exploring the role of urban green spaces in providing benefits for health and well-being.
Within the academic literature, over the past 10–15 years, there has been a re-emergence of interest examining the impact of the environment on health in advanced economies, with a considerable expansion of theoretical and empirical studies investigating the role of contextual factors in the production and maintenance of health variations (Cummins, Curtis, Diez-Roux, & Macintyre, 2007).1 While there is a longstanding recognition of the negative impacts on health of environmental ‘bads’ such as poor air quality and the distribution of various forms of pollution, more recently increasing attention has focused on the potential positive influence on health of environmental ‘goods’, such as well-designed and walkable cities, access to ‘nature’/biodiversity and the distribution of urban green space (Lake & Townshend, 2006). ‘Lifestyle illnesses’ such as heart disease, obesity, diabetes, osteoporosis, mental illness and some cancers are increasingly attributed to the poor quality of the environment in our cities (Corkery, 2015, Barton, 2010, Berke et al., 2007, Gast et al., 2007, Lake and Townshend, 2006, Frank et al., 2004, Latkin and Aaron, 2003, Gregg et al., 2000, Coutts, 2016). The literature generally endorses the view that urban green spaces, as part of the wider environmental context, promote health and well-being in cities (Gascon et al., 2016, Sugiyama et al., 2010, Kaczynski and Henderson, 2007, Tzoulas et al., 2007, Giles-Corti et al., 2005, Ellaway et al., 2005, Giles-Corti and Donovan, 2003, Maas et al., 2006, WHO, 2016) and provide health services as part of a wider array of ecosystems services (Pretty et al., 2011, Jackson et al., 2013, Lennon and Scott, 2014). These health services are understood to range from direct positive effects on mental and physical health from increased biodiversity, to improved well-being resulting from increased exposure to nature, physical activity and social engagement in green spaces (Sandifer, Sutton-Grier, & Ward, 2015).
In response to the identified health benefits, high-level policy frameworks and guidance documents have increasingly promoted the creation of health supporting urban environments through the increased provision of urban green space (see for e.g., WHO, 2012, WHO, 2013, WHO, 2010, Un General Assembly, 2015). More recently, Habitat III, the United Nations' New Urban Agenda adopted in October 2016, identifies the improvement of human health and well-being as a key priority urban goal. Signatories to the agenda committed to the promotion of a safe, healthy, inclusive, and secure environment in cities and human settlements, specifically highlighting the importance of the creation and maintenance of well-connected and well-distributed networks of green spaces to improve physical and mental health, urban liveability and to enhance resilience to environmental risks. While such policy guidance clearly supports an emphasis on green space provision for population health and well-being, it does not provide detailed guidance for urban policy in terms of the specific attributes required to tackle lifestyle illnesses in multiple cohorts. This is partly consequent on the aggregation and homogenisation of different spatial typologies in much planning and design policy into a measure of so called “green space”, without further qualification as to type or quality of such spaces. Of particular significance is how this homogenisation fails to account for the health benefits afforded to different users by different types of green space distributions and configurations (Hartig et al., 2014, Bowler et al., 2010, Velarde et al., 2007, Jorgensen and Gobster, 2010, Bedimo-Rung et al., 2005). Furthermore, where locational and demographically specific design guidelines for the planning, design and maintenance of green open space do exist in local contexts, the extent to which they reflect or respond to empirical evidence relating to the green space-health relationship can be disputed. Indeed, the health benefits they assert may instead emerge from designs and practices founded on ecosystems protection, flood mitigation or landscape beautification. Such motivations do not necessarily correspond with improved amenity or health benefits.
This paper addresses these issues by collating and reviewing the large quantity of evidence linking health, well-being and green space, and distilling it in a manner that renders it both accessible and useful for those involved in the planning and design of urban green spaces. This is achieved by adopting a novel life-course approach to examine the evidence for health and well-being benefits accruing from green space from prenatal development through childhood, adolescence, adulthood and old age. A literature search was undertaken using research databases including Scopus, Web of Science and Google Scholar. ‘Green-space’ and ‘health’ search terms and their variants were applied and identified articles were grouped by life-course stage. In order to ensure that all key empirical studies were included, comprehensive review articles were subsequently identified and their references were cross-checked with the initial articles. Finally, the most recent articles in quality peer reviewed journals citing these review articles were identified. Informed by the evidence collated and reviewed hereunder, we propose planning and design interventions for each cohort group. Following this, we synthesise the key findings from the review of cohort-specific studies to formulate a series of cross-cutting interventions for health promoting urban green space. We conclude by suggesting a path for future research and practice. It is intended that this approach can facilitate the formulation of site specific planning guidance for the provision of more inclusive green spaces that respond to the varying needs of people across all life-course stages.
Section snippets
Green space and health across the life-course
Numerous studies have investigated whether there is an association between people's access to green space or nature and personal levels of activity. More specifically, studies have examined how the design of the public realm encourages people to be more physically active, if it contributes to improved health outcomes, or if it attracts people to be more active (Ord et al., 2013, De Vries et al., 2003, Hillsdon et al., 2006, Kessel et al., 2009, Coombes et al., 2010). The majority of such
Developing an integrated green space framework for health and well-being
In adopting a life-course approach, this review has identified key variations within and between population cohorts regarding the green space attributes that promote health and well-being. That is, it is demonstrated how different green space configurations afford different activities and promote different physical and psychological responses for different age groups. As such, this life-course approach facilitates a more nuanced understanding of those green space attributes that promote health
Conclusion
Urbanisation and the associated increasing rise of obesogenic environments are creating health and well-being challenges for the planning and design of urban environments (Davies, 2013). Concomitantly, green spaces in cities are increasingly viewed as providing locations for ‘restorative’ contact with nature, physical activity and social engagement, which evidence suggests positively influences well-being and triggers behavioural change towards healthier lifestyles (Beyer et al., 2014, Van Den
Funding acknowledgement
This work was undertaken as part of the ECO-Health project, funded by the Environmental Protection Agency (EPA) and the Health Service Executive under Grant Award No. 2015-HW-MS-6, and supports the implementation of the EPA Strategic Plan 2016–2020 – ‘Our Environment, Our Wellbeing’ and Healthy Ireland, the national framework for action to improve the health and wellbeing of the people of Ireland.
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