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Statins and Greenspaces: Health and the Urban Environment


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  • 1. ‘Statins and Greenspaces’:Health and the UrbanEnvironmentProceedings of a conference held by the UK-MAB Urban Forumat University College London (UCL)Edited by Gerald Dawe and Alison Millward Jointly organised by: and UCL Environment Institute May 2008With the support of: NATURAL Cyngor Cefn Gwlad CymruCountryside Council for Wales ENGLAND
  • 2. ‘Statins and Greenspaces’Statins are a class of drugs usedto lower cholesterol levels inpeople at risk of heart disease.They contrast usefully with therelatively ‘non-technical’ butnonetheless complex, notion of‘green’ open spaces.
  • 3. Executive SummaryThis conference looked at the health- Some public open spaces were actuallypromoting potential of urban green open avoided by significant groups in society.spaces from different perspectives, andincluded two panel sessions. It asked the J Evidence for the psychological and mentalquestion: ‘why is greenspace not more readily health benefits of urban open space wasprescribed by doctors, given the evidence that considerable, though people couldit is good for health?’. Topic areas included: sometimes react negatively to exposure to nature, concluded Ian Douglas. The multi-J Accessibility, privacy and security of open functional nature of urban greenspace can space in relation to lifestyle secure positive health benefits for all,J Psychological and mental health benefits though it was impossible to provide a of urban open space single plan for fostering nature for health,J Health inequalities, environmental justice because of widely differing cultural and and open space socio-economic situations.J The use of plants and animals in open spaces in relation to health J ‘Majority world’ perspectives showed thatJ Health and forested open spaces in urban severe and high mortality rates in, e.g., and urban fringe areas Latin America, precluded green spacesJ A case-study of one open space and its simply being used for passive recreation. psychological and mental health benefits Here, political movements around from the users’ point of view environmental justice and practicalJ Interaction between green open spaces, sustainability were needed much more, as health and medicine: the communication a means of achieving a more equitable issues which needed dealing with, to make distribution of urban greenspace, which in effective connections turn, might achieve better healthJ Quantitative relationships between connections. Carolyn Stephens made links greenspaces and community health: does between health, the nature of what was one necessarily follow the other? grown on urban open spaces, and macro-J Two other factors came to the fore: (1) economics. She concluded that the notion contrasts between Western world and of green spaces as ‘peacemakers’, or as ‘majority world’ perspectives; and (2) the agents of social cohesion, was something relative value of scientific evidence, in underappreciated from a Western relation to socio-political concepts such as perspective. environmental justice, sustainability, and inspiration J The obvious and complete reliance of many people in the majority world on foodFindings from the contributors were as crops grown on urban or peri-urban sitesfollows: was described by Monique Simmonds. The notion of ‘biodiversity’, again viewed fromJ Individual lifestyle, personal values and the Western world viewpoint, tended to be the feeling for integration within the far removed from the actual biological community were at the heart of accessing nature and valuable properties of the urban open space, explained Russell Jones. plants themselves. Whilst tools such as Geographical Information Systems (GIS) could reveal The first panel discussion followed on from the apparent amount of open space, this this and there was commentary on was not accessible open space in reality. connections and disconnections from nature,UK-MAB Urban Forum 1
  • 4. and of both how useful and how limited The second panel session explored areas ofscience was in being able to analyse ‘health’ ‘biodiverse’ open spaces, and the fact thatand ‘environment’ connections holistically. there were many contradictions around accessing it for health reasons. Some peopleJ Projects involving the Forestry were receptive to nature, whilst others were Commission and links between health and —unfortunately— repelled by it. urban greenspace were reviewed by Liz O’Brien. To ensure effective outputs strong Conclusions emerging from the papers links had been established, from the start, emphasised the function of greenspaces as with regional Primary Care Trusts (PCTs). drivers for ‘peace making’ and community The variety and scale of individuals and cohesion, as well as the personal benefits to groups which the Forestry Commission individual mental health from participation had been involved with was valuable and in co-ordinated gardening work. These were also, integral to the success of the work. in addition to more conventional gains to physical and mental health, as identified fromJ The ‘Meanwhile Gardens’ site in London, previous papers. Aside from these benefits about which a DVD has recently been accruing from greenspaces, important made, and was shown to the conference, messages emerged regarding the practicalities was reviewed by Ambra Burls. This, and of i) how to communicate health benefits work Ambra had carried out previously, from involvement in greenspace, and ii) how showed how open spaces can not only to organise successful public involvement grow plants, but can also help develop with greenspaces. The former requires people, and improve their mental health. speaking a language which doctors and PCT Some of the gardeners reported back on administrators can understand and their growing sense of self-esteem as a combining it with the practicalities of result of being involved with the project. medical cost-benefit analyses. The latter requires solid partnership working from theJ The challenges of placing health and outset. One of the subtleties emphasised was greenspaces into a currency which policy- that ‘greenspace’ involvement should not be makers can understand was the important ‘prescribed’ to ‘patients’, but rather, people theme dealt with by William Bird and need to find more positive ways of engaging Huw Davies. A central part of this was, with it, and also, with broader levels of they argued, engaging both with PCTs and nature and the environment. Public Service Agreements (PSA). The practical importance of using health statistics, and relating these to economic savings which could be achieved by getting patients to use green spaces, was also emphasised.J Further insights using GIS, into how good health and the percentage of apparently accessible greenspace did not always coincide were given by Pete Dixon. One of his conclusions was that the ‘health- environmental quality’ concept can be used, with care, in helping to define ‘Environmental Action Areas’, and even ‘Economic Growth Areas’.UK-MAB Urban Forum 2
  • 5. ContentsIntroduction Gerald Dawe and Alison Millward ......................................................................5More than just a park: choice, individualism and risk perception ...............................................7in two contrasting areas of Glasgow by Russell Jones,Glasgow Centre for Population Health (GCPH)and Clyde Valley Greenspace NetworkPsychological and mental health benefits from nature .............................................................12and urban greenspace by Ian Douglas,University of ManchesterHealth inequalities, the majority world and urban ...................................................................23environmental justice by Carolyn Stephens,London School of Hygiene and Tropical MedicineBiodiversity and health by Monique Simmonds ......................................................................26PANEL SESSION ONE: Chaired by Pete Frost ....................................................................29Policy to practice: health and well-being projects ....................................................................31in the Forestry Commission by Helen Townsendand Liz O’Brien Forestry CommissionMeanwhile Wildlife Gardens, with nature in mind (DVD presentation) ....................................36by Ambra BurlsThe natural environment: our natural health service ................................................................40by William Bird and Huw Davies, Natural EnglandMapping community health in relation to urban greenspace ....................................................44by Pete Dixon, TEP ConsultantsPANEL SESSION TWO: Chaired by Alison Millward ..........................................................49Summing Up by Peter Shirley .................................................................................................50Conclusions and Next Steps ....................................................................................................52Appendix: Membership of UK-MAB Urban Forum.................................................................55UK-MAB Urban Forum 3
  • 6. UK-MAB Urban Forum 4
  • 7. IntroductionThis meeting held on the 27th March 2007 had Aesethetic and visual pleasures:been planned by the Urban Forum for some time. These range from the pleasure of ‘chaos’ inThis was an attempt to bring together nature (Gleick, 1993) which may, according topractitioners from the two fields: ‘health’ and some, approximate to Immanuel Kant’s‘greenspace’ into an arena where differences and sublime (Richards, 2001), to broader mentalconnections could be easily discussed. The Forum health and psychological benefits from greenfelt that common ground between health spaces (Guite, Clark and Ackrill, 2006).professionals and greenspace managers had not Subtleties of ‘favourite natural places’ mayyet been converted into action and, perhaps include their ability to induce positive moodsomewhat idealistically, into medical changes and reduce negative feelings or stressprescriptions for ‘greenspace’. (Korpela and Ylén, 2007).Three questions have been frequently posed by Cementing community cohesion:members of the Forum: Open spaces can ‘bring people together’ (Armstrong, 2000), encourage social (1) if green open space is, as all the evidence interaction and give people broader mental indicates, good for us, why is it not readily health and psychological benefits (Burls, ‘prescribed’ by doctors as at least a partial 2007a, 2007b) solution for a wide range of ailments? (2) what is the relationship between access to Relief from disease: biodiversity and health? Here, benefits mainly mainly arise from (3) how do greenspace practitioners find physical exercise (per se, as well as in common ground with health practitioners? combination with open spaces) and the recovery or rehabilitation from diseases. TheseThese questions were explored in for us by include heart disease (Taylor, 2000) and also,Professor Ian Douglas’s reviews on both mental obesity (Nielsen and Hansen, 2007).and psychological health (see pages 12-22), andphysical health (forthcoming). The conference Longevity relationships:was a useful space in which complementary areas A few studies have shown how physicalcould be expanded on, and move a little towards contact with open spaces can actuallybeing resolved. encourage greater longevity (Takano, Nakamura and Watanabe, 2002, though seeThere are a myriad series of interactions between also criticism by Adams and White, 2003).green open spaces and human health (Sanesi etal., 2006), and the possibility of gaining health From a wider perspective, green spaces obviouslybenefits is inevitably influenced by socio- can provide everything from economic well-being,economic status, or ‘social capital’ in both food supplies, and other necessities of life, andindirect and direct ways (Sooman and Macintyre, thereby can, at minimum, be regarded as1995, Sundquist and Yang, 2007, Winkler, Turrell ‘therapeutic landscapes’ (Conradson, 2005,and Patterson, 2006), together with gender and Gesler, 2005, Milligan, Gatrell and Bingley,age. The relationship has been investigated for 2004). Integration of both health, plus ‘greenwomen (Krenichyn, 2006) and children with infrastructure’ and ‘eco-therapy’ concerns in suchregard to open spaces and/or environment landscapes is now an increasingly common theme(Arneson, 2006). (Burls, 2007a, 2007b, Tzoulas et al., 2007).Some of the benefits which may occur from There are also policy issues around the equitablecontact with green open spaces are: distribution of open spaces for better healthUK-MAB Urban Forum 5
  • 8. (Timperio et al., 2007). As a consequence, Sanesi, G., Lafortezza, R., Bonnes, M., Carrus, G.(2006). Comparison of two different approaches for assessingenvironmental justice (Buzzelli and Veenstra, the psychological and social dimensions of green spaces.2007) sustainability and related political areas Urban Forestry & Urban Greening, 5, 121–129.(Richmond et al., 2005) are increasingly urgent Sooman, A. and Macintyre, S.(1995). Health and perceptions of the local environment in sociallyconcepts which determine, at least in part, contrasting neighbourhoods in Glasgow. Health & Place,peoples’ access to green open spaces. 1(1), 15-26. Sundquist, K. and Yang, M.(2007). Linking social capital and self-rated health: a multilevel analysis of 11,175 menGerald Dawe and Alison Millward and women in Sweden. Health & Place, 13, 324–334. Takano, T., Nakamura, K. and Watanabe, M.(2002). Urban residential environments and senior citizens’ longevity in megacity areas: the importance of walkable green spaces.References Journal of Epidemiology and Community Health, 56, 913- 918.Adams, J. and White, M.(2003). Health benefits of green Taylor, A.(2000). The effects of exercise training on patients spaces not confirmed. Journal of Epidemiology and with chronic heart failure. Coronary Health Care Community Health, 57, 312. 4, 10–16.Arneson, S.J.(2006). Environmental health information Timperio, A., Ball, K., Salmon, J., Roberts, R. and resources: healthy environments for healthy women and Crawford, D.(2007). Is availability of public open space children. Journal of Midwifery & Women’s Health, 51(1), equitable across areas? Health & Place, 13, 335–340. 35-38. Tzoulas, K., Korpela, K., Venn, S., Yli-Pelkonen, V.,Armstrong, D.(2000). A survey of community gardens in Kaz ´mierczak, A., Niemela, J. and James, P.(2007). upstate New York: implications for health promotion Promoting ecosystem and human health in urban areas and community development. Health & Place, 6, 319- using green infrastructure: a literature review. Landscape 327. and Urban Planning, 81(3), 167-178.Burls, A.(2007a). People and green spaces: promoting public Winkler, E., Turrell, G. and Patterson, C.(2006). Does living health and mental well-being through ecotherapy. in a disadvantaged area entail limited opportunities to Journal of Public Mental Health, 6(3), 24-39. purchase fresh fruit and vegetables in terms of price,Burls, A.(2007b). Ecotherapy: a therapeutic and educative availability, and variety? Findings from the Brisbane model. Journal of Mediterranean Ecology, 8, 19-25. Food Study. Health & Place, 12, 741–748.Buzzelli, M. and Veenstra, G.(2007). Editorial: New approaches to researching environmental justice: Combining critical theory, population health and Acknowledgements geographical information science (GIS). Health & Place, 13, 1–2. Gratitude is due to all of our speakers and toConradson, D.(2005). Landscape, care and the relational self: Therapeutic encounters in rural England. Health & Members of the UK-MAB Urban Forum, Place, 11, 337–348. especially to the welcome encouragement of PeteGesler, W.(2005). Therapeutic landscapes: an evolving theme. Health & Place, 11, 295–297. Frost, Ian Douglas and David Goode, for helpingGleick, J.(1993). Nature’s Chaos. Little Brown and Co., UK. inspire the meeting. Mark Maslin, the Director of ISBN 0-7474-0759-2. 125 pp. UCL Environment Institute, also kindly hostedGuite, H.F., Clark, C. and Ackrill, G.(2006). The impact of the physical and urban environment on mental well- this inter-disciplinary meeting, and David Goode being. Public Health, 120, 1117–1126. generously arranged the space for us at UCL.Korpela, K.M. and Ylén, M.(2007). Perceived health is associated with visiting natural favourite places in the vicinity. Health & Place, 13, 138–151. On the administrative side, we also thank ourKrenichyn, K.(2006). ‘The only place to go and be in the Secretary, Nick Jackson for helping to achieve the city’: women talk about exercise, being outdoors, and the meanings of a large urban park. Health & Place, 12, smooth running of the conference. Finally, Dana 631–643 Pridie-Sale, Manager of the UCL EnvironmentMilligan, C., Gatrell, A. and Bingley, A.(2004). ‘Cultivating health’:therapeutic landscapes and older people in Institute is also thanked for her help. northern England. Social Science & Medicine, 58, 1781– 1793. Note on CopyrightNielsen, T.S. and Hansen, K.B.(2007). Do green areas affect health? Results from a Danish survey on the use of green areas and health indicators. Health & Place, 13(4), 839- This document may be freely copied and also, 850. downloaded from the internetRichards, R.(2001). A new aesthetic for environmental awareness: chaos theory, the beauty of nature, and our (see However broader humanistic identity. Journal of Humanistic acknowledgement of any material reproduced Psychology, 41(2), 59-95. elsewhere would be appreciated. The coverRichmond, C., Elliott, S.J., Matthews, R. and Elliott, B.(2005). The political ecology of health: perceptions of illustration and other full-page illustrations are environment, economy, health and well-being among copyright Gillian Clements, 2008. ‘Namgis First Nation. Health & Place, 11, 349–365.UK-MAB Urban Forum 6
  • 9. More than just a park: choice, individualism and risk perception in two contrasting areas ofGlasgow by Russell Jones, Glasgow Centre for Population Health (GCPH) and Clyde ValleyGreenspace NetworkGlasgow Centre for Population Health, Level 6, 39 St Vincent Place, Glasgow G1 2ER.Tel: 0141 221 9439 E-mail: indicate that both the actual and perceived quality of certain characteristics of the local environment, e.g. housing,playgrounds, parks and transport, are linked with both physical and mental health. Evidence consistently shows thataccessible and safe urban greenspaces have a positive influence on levels of physical activity, as well as enhancing individuals’sense of well-being by providing opportunities for engagement with nature and an opportunity for social interaction. Moststudies, however, employ a single research method, the majority using either surveys or GIS mapping, with very fewqualitative studies that explore the complex relationships between individuals and their neighbourhoods and subjectiveexperiences of urban greenspace.The FAB Greenspace study uses a mixed method approach to explore in-depth the facilitators and barriers to the use ofgreenspace in two contrasting areas of Glasgow. The methods include GIS mapping, quality assessment, analysis of surveydata, and qualitative techniques such as in-depth interviews, participatory appraisal and participants’ photographs of theirlocal area. This presentation will first describe the study, then go on to present some of the findings from each method. Thefocus of the latter part of the presentation is on the qualitative results which looks at how park usage competes with otherforms of leisure that are either perceived to offer less risk or are better suited to increasingly individualised lifestyles. Thefindings also support other evidence that the level of community integration can mediate perceptions of risk in public space.Introduction GIS does not really assess quality or whether greenspace is in public or private ownership, andThere is a lot of research on access to urban cannot assess its quality in terms of biodiversitygreenspace. Three of these centre on urban health and / or public access or usage of the space.including the GOAL (Glasgow Outcome,Activated protein C (APC) resistance and Lipid Aims and Methodology(GOAL) pregnancy) longitudinal study. However,in general they have mostly used Geographical The GCPH set out to do qualitative work onInformation Systems (GIS). There has been very open space access in the north and south of thelittle qualitative assessment. Therefore, the Glasgow region, by means of involvingGlasgow Centre for Population Health (GCPH) participative groups of individuals and interviewdeveloped the FAB (Facilitators And Barriers) work. The objectives were to see how greenspaceapproach. was perceived by local people, how it was defined, and how it was used. Accessibility judged byThe FAB Greenspace Study consists of the using GIS alone would not have evaluated this.following partners: Methods included:J Glasgow Centre for Population HealthJ NHS Greater Glasgow and Clyde J GIS MappingJ MRC Social and Public Health Sciences Unit J Quality assessment (audit) (‘Assessing Space’)J Glasgow City Council J Survey data analysisJ Glasgow and Clyde Valley (GCV) Structure J 6 discussion groups Plan Team J 26 in-depth interviews J PhotographsGlasgow and the Clyde Valley has a very localand detailed level mapping of greenspace. Thesouth Glasgow region is in general a moredeprived area, and the north is more affluent.UK-MAB Urban Forum 7
  • 10. Greater Glasgow NHS Board: North West locality Greater Glasgow NHS Board: South West localityUK-MAB Urban Forum 8
  • 11. Results and Case Studies Qualitative studiesQuantitative studiesGIS mapping of the greenspaces within access ofthe two research populations revealed that thepopulation in the south had slightly greateraccess, although this part of Glasgow would beconsidered to be more deprived than the northarea. Access to Greenspace (300 metres from greenspace > 2 hectares)The Assessing Space audits that were undertakenby independent assessors as well as thegreenspace users, revealed that there was:J Wide variation in quality of green open spaces within both areas (North West and South West)J Most would benefit from lighting, seating and increased maintenanceJ Often there is a difference in quality inside and outside leisure facilities and community hallsJ Many were not friendly, welcoming or sociableSome preliminary findings from health surveyinformation revealed that:J More male obesity in North than South, but this pattern is reversed for femalesJ People in North are more likely to be Some of the results of community input physically active outsideJ Outside physical activity is associated with perceived burglary levelsUK-MAB Urban Forum 9
  • 12. Findings J Felt at odds with society around him - lack of respectJ Facilitators and barriers – were not J Facilitators and barriers conspired such that experienced universally he opted to use a local private bowling clubJ “Fixing the park” approach may not attract over local council facilities everybodyJ At the individual level a complex interplay of Case study 3: Father, North. A ‘middle-class’ lifestyle factors, opportunities and values family. Here, a man was more confident, and he affects park usage went to a skate park with his children. This gave him a different, more positive perspective onThe lifestyle of individuals, the values they held, young people. He did not regard them as aand the more integrated they felt within their problem, but simply as bored people, without ancommunity, were the most important predictors outlet for their activity. He:in how people would use greenspace. This is bestillustrated by some case studies: J Valued variety and diversity in his community and was happy for parks to reflect thisCase study 1: Migrant mother with young family, J Valued being with child-centred andSouth: Here, a woman had experienced racism community-minded people but also liked towhich put her off from using her local get away from the crowdgreenspace. So, instead of using the local park, J Had a lifestyle that was time poor and withshe used a community café with a small garden tastes outside the mainstream e.g. yogaarea, with a clientele she felt more comfortable J Was stoical of anti-social behaviour andwith and where her children could run about with looked for the underlying reasonsease and in safety. For this woman: J Used the park individually and as a familyJ Parks were perceived as providing a valuable resource for her children, but she experienced The young people interviewed, who wereJ Poor access to all but the most local green frequently feared by other age groups, were also spaces (low quality) fearful of their contemporaries. This finding raised the notion of who exactly was fearful ofJ She sought opportunities to talk to other who within a park and how different aged user parents groups could be encouraged to become moreJ Integration within her local community was familiar with each other, perhaps through low and she was fearful of anti-social organized whole community based creative behaviour or racism activities (e.g. fairs and community gardens), toJ Facilitators and barriers conspired against reduce this barrier. park usageJ Alternative locations were sought - community The people in the north of the city wanted to see café physical changes to their parks primarily, whereas people from the south wanted to see action toCase study 2: Male Old Age Pensioner (OAP), tackle the anti-social behaviour and racism theyNorth: An elderly man felt that young or encountered in their parks.adolescent people were a threat, and he felt muchsafer in a private bowling club. He: ConclusionJ Sought opportunities to socialise and exercise There is a complex interaction of factors that with people his own age determine whether or not an individual will make use of a greenspace. These include:J Felt vulnerable as an OAP who had been a Parks themselves victim of crimeUK-MAB Urban Forum 10
  • 13. J Quality J Quality green space is necessary, but notJ Safety sufficient to encourage useJ Things to do J People choose the ways they want to spendJ Litter/cleanliness their free time within constraints and willJ Litter/graffiti linked with safety decide whether the local park fits in with thatLifestyle J Creative activities can encourage useJ Structures, opportunity and accessJ combination of choice and constraints J Parks need to be well connected with the local community (socially and not just spatially)ValuesJ outdoor leisure versus shopping Next, the results and conclusions of this workJ Integration within local community – fear of will be disseminated by: racism or anti-social behaviourJ Stoicism versus fear • combining data from all sources into a written report • Traditional dissemination via a report,The intersection of influential factors: executive summary, seminar and website • Creative dissemination via Glasgow School of Art and the engagement of planners, park officials and communities Factors interact to determine park usageAccess and use of greenspace is all to do withlifestyle as well as the quality of the greenspacesthemselves. Significantly, quality parks and otherpublicly accessible greenspaces were not alwaysused.To sum up:J It is just about quality of green space, it is about lifestyle, values, access and level of integration within the local communityUK-MAB Urban Forum 11
  • 14. Psychological and mental health benefits from nature and urban greenspace by Ian Douglas,Emeritus Professor, University of ManchesterGeography, School of Environment and Development, The University of Manchester,Oxford Road, Manchester, M13 9PL, UK. Tel: 0161 275 3642. is good scientific evidence that contact with nature in urban areas can improve mental health and can help in therestoration of psychological well-being. This evidence is of four kinds: i) the outcomes of experiments in which subjects havebeen tested in contrasting situations; ii) the findings of studies that used photographs and videos of natural environments totest people’s reactions; iii) the results of attitudinal surveys, both quantitative and qualitative, in which people are askedabout their preferences and experiences; and iv) the use of national or regional health data sets. It is strong enough to makethe case for the inclusion of areas of natural vegetation in both urban planning, particularly for the expansion of existingtowns and the creation of new urban settlements, as planned in the Thames Gateway area of the United Kingdom. Suchareas need to be strategically located to give accessibility to both the young and older people likely to use them and toprovide for different types of enjoyment, from dog-walking and jogging to bird-watching and environmental education.Public participation in the planning and management of such areas, especially through interaction and consultation withlocal communities, will enhance their value and will help to reduce vandalism and other forms of misuse.Nevertheless, the experimental, survey and quantitative scientific evidence is based on relatively few studies from a narrowrange of countries. It indicates that there are cultural and social contrasts in attitudes to, and perceptions of, naturalvegetation in urban areas. However, it is insufficient to indicate whether the observed contrasts apply more widely than inthe specific socio-economic situations in which the surveys were conducted. To maximise the benefits from urbangreenspace, local situations and needs should be studied carefully so that urban nature is managed to provide for the outdooractivities that the local community enjoys, while also providing opportunities for biodiversity and other multiple functions,such as storm water detention, CO2 uptake, urban heat island intensity reduction and potential biofuel harvesting. No onesingle plan for maximising the mental health benefits of urban greenspace is advisable. Knowing the human society and theurban ecosystems in specific places is essential.Introduction Planning Policy Guidance 17 (Office of the Deputy Prime Minister (ODPM), 2002) “Denying the relevance of nature to our specifically mentions “promoting health and well- deepest emotional needs is still the rule in being” among the multiple functions of urban mainstream therapy, as in the culture open spaces. The National Audit Office’s Report generally. It is apt to remain so until on Enhancing Urban Green Space (Comptroller psychologists expand our paradigm of the and Auditor General, 2006) points out that self to include the natural habitat—as was “access to green spaces improves people’s quality always the case in indigenous cultures, of life, reducing stress, encouraging relaxation, whose methods of healing troubled souls and providing a sense of freedom”. The Royal included the trees and rivers, the sun and Commission on Environmental Pollution’s stars” (Theodore Roszak, 1996). Report on The Urban Environment (2007) states that there is “convincing evidence of the positiveFor urban people, the separation from nature is benefits to be gained from both active and passivegreater than in other forms of human settlement, involvement with natural areas in towns andbut need not necessarily be so. Natural cities”.This paper examines the scientific evidencevegetation fulfils many ecosystem and human for such assumptions and asks whether thewell-being functions in urban areas. One of the mental health benefits of urban greenspacesmore important is alleged to be improvement in contribute to the arguments for theirmental health, through recovery from, or incorporation into planning for the creation oralleviation of, mental illness and stress and restoration of urban areas.through helping to raise a feeling of well-beingamong people using natural areas. Since 2000, Relating environment to mental health is noturban greenspace, both quasi-natural and fully made easy by a lack of clarity in the definitionsmanaged, has had a high profile in the planning, of the concepts of mental health and ofhealth and sustainable development agendas. environment. Environment in the context ofUK-MAB Urban Forum 12
  • 15. greenspaces may be taken as the biophysical mental illness higher than the national average,surroundings of individuals, families and despite having a good layout, greenspace withincommunities. These surroundings affect the the estate and good access to Oxhey Woodshuman psyche through their direct sensory (Martin et al., 1957). Possibly this is an earlyimpacts. Equally our surroundings may influence example of the “suburban neurosis” that has beenour thoughts and feelings by the way they inhibit widely reported from Britain’s New Townsor filter our experience of other things (buildings, (Ineichen, 1993).for example, detach us from the externalenvironment). In addition, our biophysical Many emphasise that the psychologicalsurroundings mediate or affect, inhibit or differences between different urban environmentsencourage our social and personal relationships. and between urban and rural life depend uponMental health may be taken in its broadest sense people’s attitudes and life styles and cannot beof mental well-being or “peace of mind”. related simply to the biophysical environment (Howarth, 1976). Many modern secondaryThe commonly cited beliefs schoolchildren express fears about natural areas or wildlands to which they may be taken as partMuch of what is written about the importance of of school or recreation centre activities (Wohlwill,urban greenspace is related to people’s biological 1983). Such negative perceptions are often linkedneeds as mammals for room for various activities. to preferences for manicured path settings, urbanDirect relationships between these needs and environments and indoor social recreationhealth are unclear. activities (Bixler and Floyd, 1997). Neverthless, much of the literature refers to greenspace as “For a balanced urban habitat we must offering a relief from stress. Modern urban living provide brood cover for small children; safe may involve both sensory deprivation and territory for youthful exploration; flocking, information overload. People can suffer from trysting and roosting habitat for young adults; both. An excess of either one can be harmful. and finally stable and well defined territories An adequate living environment balances sensory for older cohorts. The vacant lot in his block inputs and provides a mix that is both congenial is of far more value to a five-year-old than is and consistent with people’s culturally the park located three or four blocks away. conditioned needs (Hall, 1968). Areas of natural Likewise, the elderly need readily accessible, environment in towns and cities are theoretically comfortable, and quiet parks. With man, as seen as providing the setting for recovery and with wildlife, scale and distribution of green recuperation from the stress and strains of the areas are important” (Stearns, 1972, p.275). built urban environment (Kaplan, 1984). Four themes emerge from the literature of the benefits of nature in the city (Knopf, 1987; Parry-Jones,The expansion of suburbs of semi-detached 1990):houses between 1920 and 1940 in Britain was J Nature restoresseen as increasing the scope for improvements in J Nature facilitates competence buildingphysical health. “In contrast to the dirt and J Nature carries symbols that affirm theovercrowding of inner urban areas, suburban culture or selfliving offered space, low densities, gardens andaccess to the countryside. The emigrant from the J Nature offers a pleasing could rejoice in raising his family in cleanand humane conditions” (Ineichen, 1993, p. 16). These general statements about the benefits of urban greenspace have been adopted by manyBut such benign biophysical surroundings do not UK local and regional authorities. Theiralways bring good mental health. The Oxhey comments emphasise biophysical environmentalestate near Watford, built soon after 1950 to benefits. Good quality greenspaces encouragehouse people from inner London, had a rate of people to walk, run, cycle and play. GreenspacesUK-MAB Urban Forum 13
  • 16. improve air quality and reduce noise, while trees known as ‘green gyms’ (Bird, 1999). A widerand shrubbery help to filter out dust and range of other schemes aim to promote healthpollutants. If paths and cycle networks are and wellbeing, but not necessarily or exclusivelyintegrated to facilitate commuting, they can by promoting physical activity. In these schemesreduce transport needs and provide safe and people are encouraged to enjoy the psychologicalhealthy routes to school for children that avoid benefits that can be afforded by ‘green spaces’, orhazardous road crossings. communities enabled to thrive through projects that take a holistic rather than a medicalStockport MBC stresses health and well-being approach to people and health by promotingaspects as well: participation in art and learning in ways that J Relaxation, contemplation and passive often focus on the value of local environmental recreation is essential to stress amenities, spaces and landscapes (e.g. Rigler and management in today’s busy world— Campbell, 1996). recent evidence has brought to light the extraordinary role that good quality Campaigning organisations, such as Greenroofs, greenspace plays in relieving stress and use similar arguments about the mental health promoting physical and mental health and well-being values of urban greenspace: not only of individuals but the well being of the community—quality “Many psychological studies have proven that greenspace is often absent from the overall quality of life can be enhanced by problem neighbourhoods. the addition of natural green spaces. Distinct J Greenspace issues can unite the whole therapeutic links exist between moods, health, community and can be the focus of recuperation time and nature. It has been community development and local suggested that mental health and emotional regeneration fostering a sense of stability are positively influenced by green community pride. spaces and with interaction of other elements of nature. Green spaces reflect the changing seasons and provide a psychological link withStockport MBC has put these ideas into action. the countryside. Green roofs could certainlyA pioneering development, based in Stockport, be part of a comprehensive therapeuticfunded by the local authority, the Countryside environment, especially when contrasted toAgency and the Health Authority, promotes and viewing the more common ugly roof spacesimproves access to greenspace in urban areas for from a hospital window”people with physical and mental needs. The ( creates and signs accessible paths antages.htm).through attractive greenspace close to areas ofdeprivation and ill-health. GP’s and community A commentary on the London Greenspace plannurses refer patients to the project for exercise argues that:and well-being. Local volunteers and communitygroups also work with the project, to create and “Access to green spaces also provides mentalmaintain the pathways and to complete a health benefits. Green spaces offer relaxationborough-wide network of routes. for stressed urban dwellers. Studies in the USA have shown that within three minutes of beingElsewhere in the UK (Henwood, 2002) projects in green space stress levels return to normalhave been set up to increase the health benefits of whereas recovery time in a built-up area is 25activities in the outdoor environment through minutes. One in five people will suffer fromorganised schemes to promote walking (eg the mental illness, including depression during theThames Valley and Sonning Common Heath course of their lives. Regular moderateWalk schemes) and using conservation work to exercise is as effective as medication inincrease levels of physical activity –an approach alleviating mild to moderate depression. TheseUK-MAB Urban Forum 14
  • 17. benefits of green space represent significant came from paths through thickets of savings for the health care budget which can undergrowth which may have induced an element be achieved by people having easy access to of fear into some visitors. This study and others green spaces. There are particular benefits suggest that while feelings of calm and relaxation from green spaces for minority groups which are major components of people’s emotional have poorer than average health and limited reactions to nature, more animated responses access to the countryside”. such as being emotionally moved and uplifted are also important (Rohde and Kendle, 1994).Recreational parks and green areas provide Enjoyment of green areas may help people toopportunities for healthy physical activity and the relax or may give them fresh energy (Ulrich,relief of stress. Furthermore, the passive benefits 1990).to physical and mental health of an urbanlandscape with trees have been documented in Mental health specialists have noted that theindustrialized countries (Ulrich, 1984); enjoyment nineteenth century mental asylums often hadof green areas may help people to relax or may farms. In the late twentieth century, the extensivegive them fresh energy. Such findings broadly grounds around asylums became gardens inconfirm the conclusions of others concerning which inmates continued to work. An almostcontact with nature, reduction of stress and universally accepted criticism of the closure ofescape from dense urbanity (Ulrich, 1979; asylums and de-institutionalisation of mentalGreenbie, 1981; Nicholson-Lord, 1987; Kaplan illness is about the loss of these gardens, whichand Kaplan, 1989; Bussey, 1996). implies a universal assumption that gardens are therapeutic to the mind. More recent evidence ofThe grounds for these beliefs this therapeutic value of gardening, comes from Brown and Jameton’s observation (2000) thatThe actual evidence for mental health benefits recreational gardening is a way to relax andfrom urban greenspace may be less clear than release stress and Patterson and Chang’s evidencethese assertions imply. Undoubtedly, trees fulfil (1999) of a link between physical activity such ascertain psychological, social and cultural needs of gardening and reduced anxiety and depression.urban people. They play an important social rolein easing tensions and improving psychological Gardens represent attempts at models for thehealth. One study has demonstrated that hospital environment as paradise. Should we question thispatients placed in rooms with windows facing basic idea of their therapeutic quality, we wouldtrees heal faster and require shorter hospital stays have great difficulty explaining a large proportion(Ulrich, 1984). When appropriately selected and of the world’s poetry. Evidence continues toplaced, trees are effective in screening out demonstrate the therapeutic value of gardeningundesirable views and ensuring privacy, while for many different social groups, whether thepermitting free visual access to the rest of the inmates of institutions, the elderly or the younglandscape. (Milligan et al., 2003). Gardens and gardening imply social values of greenspaces and thusParks provide easily accessible recreational demonstrate the significance of the garden cityopportunities for people and offer opportunities suburban design concept that permeatedfor healthy physical activity. In one study (Hull twentieth century planning.and Harvey, 1989) people visiting parks expectedto experience more please the more trees and the The scientific evidenceless undergrowth there were. The subjects’preference for parks increased linearly with Broadly, the scientific evidence is of four kinds: i)increasing pleasure and arousal. The arousal- the outcomes of experiments in which subjectsinducing characteristics were counter to the have been tested in contrasting situations; ii) thecalming influence of parks expected by the findings of studies that used photographs andresearchers. The exhilaration and arousal often videos of natural environments to test people’sUK-MAB Urban Forum 15
  • 18. reactions; iii) the results of attitudinal surveys, sitting in a room with tree views, and thenboth quantitative and qualitative, in which people walking in a nature reserve. In the urbanare asked about their preferences and experiences; environment, the two phases were sitting in aand iv) the use of national or regional health data room without views, and then walking in ansets. The therapeutic value of natural urban area. This careful experiment usingenvironments has only been tested in a few students around 21 years old in attractive but notcontrolled experiments which have indicated that spectacular natural vegetation and in the City ofsuch surroundings aid recovery from surgery Orange, California, revealed that in the initial 10(Ulrich, 1984); enhance the ability to focus minutes of the environmental treatment, subject’sattention (Hartig et al., 1991); and improve diastolic blood pressure (DBP) declined amongemotional states (Ulrich, 1979; Hartig et al., those seated in a room where trees could be seen1996, 2003; Wells 2000; Evans et al., 2000). To through the windows, but increased in those in athese experiments may be added studies that used room without views. After walking for 20photographs and videos of natural environments minutes, the difference in DBP of subjects in theto test people’s reactions (Ulrich, 1990; Ulrich et natural and urban areas was significant. Self–al., 1991). More numerous are the attitudinal reported overall happiness was also greater in thesurveys that demonstrate that people develop natural environment at this stage. However, afterparticular attitudes to greenspaces, wild the walk had been completed, the differences inlandscapes and natural vegetation (such as Bixler DBP between urban and natural walk subjectset al., 1994; Bixler and Floyd, 1997; Bulbeck, had disappeared. Emotional differences,1999; Milligan et al., 2003; Schroeder, 1982; however, remained. This Hartig et al. (2003)Schroeder and Anderson, 1984; Westover, 1986). found converging evidence from different types ofNational or regional data sets are able to measures that natural settings contribute todistinguish contrasts due more to location of positive outcomes. Nevertheless, they cautionresidence and occupation rather than individual that the magnitude of the effects is not solelybehaviour. produced by the influence of natural vegetation and attractive landscapes. The negative effects ofControlled experiments. The controlled the windowless room and the urban settings alsoexperiments include work that showed that views contribute to the differences.of natural scenes from hospital windows aidedpatients’ recovery from gall bladder surgery In terms of the practical implications of their(Ulrich, 1984) and that prisoners with views of work, Hartig et al. (2003) conclude that regularnature reported sick less often (Moore, 1982); and access to restorative, natural environments cansuffered fewer stress-related physical symptoms halt or slow processes that negatively affect(West 1985). These experiments suggest that mental and physical health in the short- and long-mere visibility of nature may have powerful term, and that, for urban people in particular,preventative and curative effects on people’s easy pedestrian and visual access to naturalhealth (Rohde and Kendle, 1994). Hartig et al. settings can produce preventive benefits. Public(1991) found that subjects’ completion of a health strategies that incorporate use of areas ofproof-reading exercise was improved following natural vegetation in urban areas may havecontact with nature through a hike in a particular value in an era of rapid urban growth,wilderness area or a walk through a park close to rising health care costs, and deterioratingthe city. Such findings were considered to environmental the Kaplans’ view (1984, 1995) of therestorative benefits of nature. Nancy Wells has examined the impact of transforming a barren asphalt space into a greenHartig and co-workers (2003) have gone further garden within a nursing home environment andby conducting experiments in urban and natural has studied the relationship between childhoodsituations in two phases: indoor and outdoor. In exposure to nature and adult environmentalthe natural environment, the two phases were attitudes (Evans et al., 2000; Wells 2000). A houseUK-MAB Urban Forum 16
  • 19. surrounded by nature helps to boost a child’s snakes or severe storms, and similar outdoorattention capabilities. When children’s cognitive experiences. Students reporting negativefunctioning was compared before and after they perceptions of wildland environments had lowermoved from poor- to better-quality housing that preferences for such environments and activitieshad more green spaces around, profound with them and to some degree also had higherdifferences emerged in their attention capacities, preferences for indoor environments andeven when the effects of the improved housing activities. Counter to popular assumptions aboutwere taken into account. The children studied urban attitudes to the natural world, mostly ruralwho had the greatest gains in terms of and suburban students had these negative“greenness” between their old and new homes attitudes.also showed the greatest improvements infunctioning. The results suggest that the natural Attitudinal surveys. Partly because of importantenvironment may play a far more significant role American findings and recommendations on thein the well-being of children within a housing value of physical activity as part of healthy livingenvironment than has previously been recognised (Pate et al., 1995; U.S. Department of Health and(Wells, 2000). A similar beneficial relationship Human services, 1996), many countries havewas found in rural areas (Wells and Evans, 2003). adopted new physical activity guidelines that indicate the value of moderate-intensity activity,Tests using slides and videos. Experiments by such as brisk walking, to achieve healthUlrich and co-workers suggest that visual improvements. Often it is suggested that theexposure to nature through slides or videos may surroundings in which the walking occurs addimprove subjects’ moods. Three studies have mental health benefits to the physical health gainsshown a connection between trees and lower (Ball et al., 2001). Theoretical social studieslevels of violence (Mooney and Nicell, 1992; Rice emphasise the importance of interactionsand Remy, 1994, 1998). However, these studies between individual psychological, social andinvolved prison inmates and Alzheimer’s disease biophysical environmental variables (Sallis andpatients living in nursing homes. What about Hovell, 1990; Sallis and Owen, 1997). Inpeople who are not living in institutional settings? questionnaire surveys in the East Midlands ofThe role of urban greenspaces in promoting England, getting away from stress was associatedsocial interaction and well-being among the with relaxation and nature- seeing it, being inelderly is generally regarded as highly positive natural places and learning about it, suggesting a(Kweon et al., 1998). For older adults, social role for natural greenspaces in stress reductionintegration and the strength of social ties are (Bell et al., 2004).profoundly important predictors of well-being However, there can be associations betweenand longevity. Biophysical environments getting exercise and becoming de-stressed, as wellprobably can be designed to promote older adults as just being in a natural area. Telephonesocial integration with their neighbours. Kweon interviews with over 3000 Australian adultsand colleagues (1998) examined this possibility by revealed positive associations of environmentaltesting the relationships between varying aesthetics (a composite score based on Likertamounts of exposure to green outdoor communal scale responses to questions about the friendlinessareas and the strength of ties among neighbours. of the neighbourhood, the attractiveness of the local area and the pleasantness of walking nearThus exposure to natural scenes reduces stress. home) with walking for exercise in the two weeksHowever, this is unlikely to be the same for all prior to the interview. Those reporting lowpeople, all of the time. Bixler and Floyd (1997) environmental aesthetics were about 40% lessused slides in classrooms in rural, suburban and likely to walk for exercise than those returningurban schools in Texas to discover the reactions high scores (Ball et al., 2001). As a whole, thisof 450 middle school students to examine survey supported the case for environment-reactions to insects, woodland environments, focused public policies and interventions tohandling soil and pond water, encounters with influence physical activity. Areas of naturalUK-MAB Urban Forum 17
  • 20. vegetation and wildlife habitat in urban areas The extent and nature use of parks and peri-could form a key part of the local facilities, parks, urban countryside for recreation to relieve stresscycle paths and pleasant areas that may are likely to differ widely among individuals andencourage more adults, including those with social groups. Probably most groups gain manypoorer mental health, to take exercise. well-being and emotional benefits from contact with nature in urban areas.However, there is much to suggest that natural, orwild, areas are unattractive and induce negative As reported by Kweon et al. (1998), the benefitsreactions on the part of many people. Direct of contact with natural landscapes seembehavioural evidence of such negative reactions is particularly significant among the elderly. Inlimited because the use of wildlands for focus group exercises and interviews with peoplerecreation is an activity chosen by individuals and over 65 in Carlisle, Milligan et al. (2003) foundthus those who dislike them avoid them. natural areas to be intimately linked to olderBehavioural surveys conducted among adult people’s social interactions in ways that can bevisitors in urban natural areas thus sample an central to relieving the stresses of everyday life.already self-selected group likely to have positive For many the aesthetics of a pleasing andattitudes to wildlife. Students attending tranquil landscape formed an important elementcompulsory field classes represent a broader of the therapeutic qualities of social encountersrange of attitudes. Bixler et al. (1994) collected outdoors. Overall, the natural landscape was seenexamples of negative reactions by urban students to contribute positively, in both active and passiveon field trips observed by park naturalists and ways, to the mental well-being of the interviewees.teachers of environmental science. Some of theattitudes found were generalised fears of the Sullivan and Kuo (1996) found less violence inwoods; of wildlife; and of insects and spiders; urban public housing where there were trees. Thedisgust reactions to the dirtiness of the role of natural areas in helping to reduce anger,environment; and discomfort from extreme as confirmed by Hartig et al.’s experiments (2003)weather conditions. deserves special attention particularly as anger in urban settings often leads to violence which canVulnerability in natural greenspaces was a greater affect many people other than the angryconcern among women than men responding to a individual (see Kuo and Sullivan, 2001).questionnaire about natural areas in the East Residents from buildings with trees report usingMidlands of England (Bell et al., 2004). The more constructive, less violent ways of dealingconcern was reinforced by statements made in with conflict in their homes. They report usingfocus groups in the same study and reflects reasoning more often in conflicts with theirfindings of other research (Burgess, 1995b, Ward children, and they report significantly less use ofThompson et al., 2004). Several surveys and focus severe violence. Also, in conflicts with theirgroup discussions led by Burgess and Harrison partners, they report less use of physical violencehave demonstrated diverse attitudes to urban than do residents living in buildings without trees.greenspaces in various communities, especially inGreater London (Burgess, 1995a, b; Burgess et An important caveat is added by interviews inal., 1988). Members of ethnic minorities in the New York which examined the associationEast Midlands form a smaller proportion of between both the internal living environment andvisitors to greenspaces than their proportion of the external built environment and depressionthe population as a whole (Bell et al., 2004) In that showed that while most previous work hadEast Midlands focus group discussions, people concentrated on the external environment, thefrom ethnic minorities spoke of being influence of the conditions inside dwelling mightuncomfortable in natural areas, of finding them be more important (Galea et al., 2005). This findalien to the urban settings with which they are parallels in other work on health and the urbanunfamiliar, and of not having enough environment, such as investigations of the linkinformation about green areas (Bell et al., 2004). between air pollution and lung disease whichUK-MAB Urban Forum 18
  • 21. suggest that conditions inside the home may in Implications of the scientific evidencemany cases be much more important thanconditions in the street and in urban open spaces. The scientific work reported here provides clearIn examining the evidence, care is needed to see evidence that among many sectors of societywhether all the factors contributing to mental there are positive benefits for mental health andhealth are considered. well-being to be gained from both active and passive involvement with natural areas in townsSynthesising ideas and findings on the and cities. Regular access to restorative, naturalphysiological and psychological benefits of urban environments can halt or slow processes thatforests and nature, Schroeder and Lewis (1991) negatively affect mental and physical health.developed Kaplan and Kaplan’s concept (1989) Walking in natural areas provides opportunitiesof fatigue directed attention (the result of for social interaction that are particularlyconstant externally generated demands for beneficial for the elderly. Exposure to naturalattention characteristic of the urban scenes reduces stress. Trees play an importantenvironment) and proposed several reasons why social role in easing tensions and improvingnature – “the green pause that refreshes” – might psychological health. People feel better livingact to restore spent or flagging mental capacities. around trees. Houses surrounded by nature helpThese include positive memories associated with to raise children’s attention capabilities. Thusnature; the way trees can off shelter; and deep- living in areas with trees helps to reduce angerseated, culturally ingrained emotional or spiritual and violence and improve the ability toconnections with nature. They also recognised concentrate and work effectively.negative impacts derived from feelings of fearinduced by dense tree cover and feelings of The scientific evidence broadly confirms theannoyance due to the untidiness of nature. comments of others concerning contact withPerhaps there is a threshold for many people nature, reduction of stress and escape from densewhen positive influences of nature give way to urbanity (Ulrich, 1979; Greenbie, 1981;fear and negative impulses. This threshold varies Nicholson-Lord, 1987; Kaplan and Kaplan,with people’s perceptions and may alter as 1989; Bussey, 1996, Grahn, 1994, 1996). However,environmental conditions change, for example it also implies that for many the greatest value ofbeing positive on the beach when the sea is calm urban woodlands and natural vegetation is as anbut negative when storm waves a crashing down escape or refuge away from urban life andon the sand and noisily shifting the mineral probably human (urban) activity (Greenbie, 1981;grains about the shore. In urban natural areas, Nicholson-Lord, 1987). To provide this refuge,reactions may cross thresholds, as implied by areas of urban natural vegetation have to besome of the work reported here, when well- accessible and allow the user to feel securespaced trees give way to totally shaded, dense (Burgess, 1995a and Burgess, 1995b) andthickets and undergrowth which may hide confident in their use (Coles and Bussey, 2000)unexpected terrors. Nonetheless, the number of studies is limited andNational or regional data sets. A study using data almost entirely confined to the USA, Europe andfrom the Health and Lifestyle Survey, a Australia. They sometimes embrace subjects ofpopulation based community survey of England, varying ethnic background and educationalWales and Scotland in which psychiatric attainment, but are often restricted to certain agemorbidity was assessed using the General Health groups, such as students or elderly people. ThereQuestionnaire found an association was found may be some bias in the type of researchbetween urban residence and the prevalence of questions due to the efforts in government-psychiatric morbidity (odds ratio 1.54, 95% CI funded research on such topics as urban forestry1.32-1.80) which persisted after adjustment for and the health benefits of physical recreation.various confounding factors (odds ratio 1.34, Notwithstanding these limitations, in countries95% CI 1.13-1.58) (Lewis and Booth, 1994). like the United Kingdom, there are likely to beUK-MAB Urban Forum 19
  • 22. considerable mental health gains from contact dog-walking and jogging to bird-watching andwith nature in urban areas. Put together with the environmental education. Public participation inphysical health, biodiversity, local climate the planning and management of such areas,modification, air pollution and greenhouse gas especially through interaction and consultationmitigation values of nature in urban areas, these with local communities, will enhance their valuegains warrant the inclusion of a variety of and will help to reduce vandalism and othergreenspaces in all urban design, from formal city forms of misuse.squares to patches of natural vegetation andwildlife habitat. All such greenspaces will have New work to evaluate urban greenspace benefitsmulti-purpose benefits, particularly when is underway (e.g. De Ridder et al., 2004). It mayintegrated with protection of steep slopes, urban help to clarify some of the complex, multi-faceteddrainage design and floodplain management. relationships between urban people’s mentalHowever it is important to note the negative being and their relationships with urban nature.perceptions some people have of some areas of Nevertheless, the present experimental, surveynatural vegetation. Unlit footpaths through and quantitative scientific evidence is based onnatural woodland are not suitable for commuter relatively few studies from a narrow range ofroutes to railway or bus stations. Thus planning countries. It indicates that there are cultural andfor natural landscapes in urban areas must social contrasts in attitudes to, and perceptionsinvolve public participation and close of, natural vegetation in urban areas. However, itconsultation with residents and local is insufficient to indicate whether the observedcommunities. There are no single, simple, off-the- contrasts apply more widely than in the specificshelf solutions that urban designers can socio-economic situations in which the surveysincorporate unquestioningly. Both people and were conducted. For example, would old peoplenature are complex. What works in one situation in Miami, Florida respond in the same way as oldmay not work in another either for cultural and people in Carlisle, England did? Thus a goodsocial reasons, or for ecological, biogeochemical case could be made for international comparativeor climatic reasons. However, an abundance of studies, or even comparisons between countriesexisting good practice is available to help urban and regions within the United Kingdom, todesigners, planners and managers increase the use examine how different social groups in similarof natural areas and to work with those sized urban areas in around ten different regionsconcerned with public health and mental well- or countries enjoy, use and react to urban nature.being to create healthier cities with urbanlandscapes that offer positive incentives to take Referencesphysical exercise in pleasant surroundings. Ball, K., Bauman, A., Leslie, E. and Owen, N.(2001).Conclusions Perceived environmental aesthetics and convenience and company are associated with walking for exercise among Australian adults. Preventive Medicine, 33, 434-440.There is good scientific evidence that contact with Bell, S., Morris, N., Findlay, C., Travlou, P., Montarzino, A., Gooch, D., Gregory, G. and Ward Thompson, C.(2004).nature in urban areas can improve mental health Nature for people: the importance of green spaces to Eastand can help in the restoration on psychological Midlands communities. English Nature Researchwell-being. The evidence is strong enough to Reports, 567, English Nature, Peterborough. Bird,W. (1999). The health benefits of forests close to people.make the case for the inclusion of areas of Community Forestry, 50 (5).natural vegetation in both urban planning, Bird, W. (2004). Natural Fit – Can Green Space and Biodiversity Increase Levels of Physical Activity? Reportparticularly for the expansion of existing towns for the Royal Society for the Protection of Birds, Sandy,and the creation of new urban settlements, as Bedfordshireplanned in the Thames Gateway area of the Bixler, R.D. and Floyd, M.F.(1997). Nature is scary, disgusting and uncomfortable. Environment andUnited Kingdom. Such areas need to be Behaviour, 29, 443-456.strategically located to give accessibility to both Bixler, R.D., Carlisle, C.L., Hammitt, W.E. and Floyd, M.F.(1994). Observed fears and discomforts amongthe young and older people likely to use them and urban students on school field trips to wildland provide for different types of enjoyment, from Journal of Environmental Education, 26, 24-35.UK-MAB Urban Forum 20
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  • 24. Sallis, J.F. and Hovell, M.F.(1990). Determinants of exercise Ulrich, R.S. Simons, R.F., Losito, B.D., Fiorito, E., Miles, behaviour. In Holloszy, J.O. and Pandolf, K.B. (eds) M.A. and Zelson, M.(1991). Stress recovery during Exercise and Sport Sciences Reviews, Willaims & Wilkins, exposure to natural and urban environments. Journal of Baltimore, 307-300. Environmental Psychology, 11, 201-230.Sallis, J.F. and Owen, N.(1997). Ecological models. In Glanz, U.S. Department of Health and Human Services (1996). K, Lewis F.M. and Rimer, B.K. (eds) Health behaviour Physical Activity and Health: a Report of the Surgeon- and health education: theory, research, and practice. 2nd. General. U.S. Department of Health and Human Services. Ed., Jossey-Bass, San Francisco, 403-424. Centers for Disease Control and Prevention, NationalSchroeder, H.(1982). Preferred features of urban parks and Center for Chronic Disease Prevention and Health forests. Journal of Arboriculture, 8, 317-321. Promotion, Atlanta, Georgia.Schroeder, H. and Anderson, L.(1984). Perception of Ward Thompson, C. Aspinall, P., Bell, S. and Findlay, personal safety in urban recreation sites. Journal of C.(2004). Local open space and social inclusion: case Leisure Research, 16, 178-194. studies of use and abuse of woodlands in Central Scotland.Schroeder, H. and Lewis, C.(1991) in Robdell, P.D.(ed.) OPENspace report to the Forestry Commission. Forestry Psychological Benefits and Costs of Urban Forests, Commission, Edinburgh. Proceedings of the Fifth National Urban Forest Wells, N.M.(2000). At home with nature: effects of Conference, Los Angeles, Nov. 15-19, 1991. “greenness” on children’s cognitive functioning.Seymour, L.(2003). Nature and psychological well-being. Environment and Behavior, 32, 775-795. English nature research reports 533. English, Nature, Wells, N. M. and Evans, G.W.(2003). Nearby Nature: A Peterborough. Buffer of Life Stress Among Rural Children.Stearns, F.(1972). The city as habitat for wildlife and man. In Environment and Behavior, 35, 311-330. Detwyler, T.R. and Marcus, M.G. (eds) Urbanization and West, M.J.(1985). Landscape views and stress response in the Environment: The physical geography of the city, prison environment. Master’s dissertation. University of Duxbury, Belmont, 261-277. Washington, Seattle, WA. (Unpublished.)Sullivan, W.C. and Kuo, F.E.(1996). Do trees strengthen Westover, T.N.(1986). Park use and perceptions: gender urban communities, reduce domestic violence? Technology differences. Journal of Park and Recreation Bulletin. R8-FR56. US Department of Agriculture, Administration, 4, 1-8. ForestService, Southern Region, Southern Station and Wohlwill, J.F. 1983 Concept of nature: a psychologist’s view. Northeastern Area, Atlanta, Georgia. In Altman, J. and Wohlwill, J.F. (eds) Behaviour and theUlrich, R.S.(1979). Visual landscapes and psychological natural Environment: Human Behaviour and Environment: well-being. Landscape Research, 4, 17–23. Advances in Theory and Research. Plenum, New York,Ulrich, R.S.(1984). View through a window may influence 5-35. recovery from surgery. Science, 224, 420-421Ulrich, R.S.(1990). The role of trees in well-being and health. In P.D. Rodbell. ed. Proc. Fourth Urban Forestry Conference, St Louis, Missouri, 15-19 October 1990.UK-MAB Urban Forum 22
  • 25. Health inequalities, the majority world and urban environmental justice by Carolyn Stephens,London School of Hygiene & Tropical MedicineSenior Lecturer in Environment and Health Policy, Public and Environmental Health ResearchUnit, Department of Public Health and Policy, London School of Hygiene & Tropical Medicine,Keppel Street, London WC1E 7HT. Tel: 0207 9272308. E-mail: Titular, Universidad Nacional de Tucumán, ArgentinaUnoma is nine years old. She lives in Asaba, Nigeria. Her home, next to the River Niger, is one small room in a low-incomesettlement shared with her unmarried aunt and five other girls. Four other families share the house. Unoma and herneighbours have no access to clean water and no toilets. She does not go to school. Unoma begins her 15-hour day at 6:00a.m. cleaning the house. She then spends the day selling food she has prepared—carrying up to five kilos of fufu on her headall day. After selling for nine hours, she returns to collect water for the house and cook. She collects 300 liters of water from aborehole and finally goes to sleep at 9:00 p.m. She is always very tired and often gets ill. But Unoma still hopes to go toschool one day (Ofili, 2006; Stephens and Stair, 2007).For millions of young people just like Unoma all over the world, cities are places of hope and growth, but also despair anddeath. For a tiny minority, cities and towns are places of long life, health, and, for some, luxury. But for the majority, citiesare places that they hope will give them and their children better opportunities—yet often they find only pollution, disease,and insecurity.The future of our planet now seems irrevocably urban, and we need to be sure that this urban life is healthy, equitable, andsustainable. Charting a healthier course for cities will require a model of international and local development that promotesequity and sustainability. It requires a local governance model that is geared towards social and environmental justice, and acitizenry who show solidarity with each other and with future generations. This paper will reflect on the challenges of urbandevelopment and health in the context of major inequalities and injustice.IntroductionThe inequalities between countries and withincountries are now more pronounced than theyused to be. The world’s fastest growing large cities 1950-2000 according to population growth rates Urban health in the Majority World towns and cities is characterized by: • Massive Inequalities • ‘Double Burdens’ (e.g. two hazards occurring at once) • Urban Violence • Green spaces, within this, seem somewhat marginal Percentage of population in urban areas. A short characterisation of urbanisation in the Source: David Satterthwaite 2007 majority world follows: based on UN 2006 For small towns (< 1 m people) in the ‘developing’ or what is better referred to as theUK-MAB Urban Forum 23
  • 26. ‘majority’ world, there is distinct lack of data. Examples of the problems followUrban, for the majority world, means poorpeople. The author has been involved ininvestigating the ‘double burden’ of bothinfections and chronic diseases. As people moveinto cities they become much more dependent onthe macro-economy.In Nairobi there is a terrible mortality rate. It is Urban inequality and its links to themuch worse than in the Victorian cities of the macro economy (Martínez, 2004)UK. Calcutta is another city which repays Here there is an attempt to achieve co/2004/paper/javierpf.htmsustainability in one of the most deprived cities inIndia.Violence is another major and disturbing factor.If you do not deal with inequalities within cities,then they may explode into violence.Greenspaces in developing world cities have beenmuch more to do with urban agriculture orsubsistence farming, rather than a leisure orhealth giving facility. In Dar es Salaam, 60% ofthe milk consumed in the city is produced fromwithin the city. Some 70% of the national Inequality in health outcomes in Nairobiproduction of catfish comes from within the cityof Bangok (Halweil and Nierenberg, 2007). Theypresent a contrast, as the ‘peace-builders’ of theurban environment to offer refuge from violenceand a place where people can come together tosocialise and therefore integrate with each other.Deprived communities may acquire access toschools and sanitation, but they will never “haveaccess to green spaces” unless governmentbehaves judiciously to protect greenspace andconstrain the rising levels of car ownership and The double burden in the poorest cities: Kolkatathe pollution that arises from that. Calcutta Environment and Economic StrategySao Paulo is a huge city, with one park. The way 1998we have developed ‘environmental justice’ as aconcept, will not be an option for many others. Green spaces in the urban majority world may beCars are a great problem in diminishing characterized by being for either:environmental justice everywhere. • Urban Agriculture • Urban Parks • ‘Lungs’ of Cities or • Peace buildersUK-MAB Urban Forum 24
  • 27. Urban Agriculture controllable air polluters. Wide, fast, and dangerous roads are “like fences…making the• Households involved city less humane.” And cars demand, – 50% in Dakar “unlimited investments in road infrastructure, – 14% in Accra which devour scarce public funds [for] water• In Dar es Salaam 60% of milk sold is and sewage supply, schools, parks, and produced in the city meeting the other basic needs of the poor.” Penalosa (2005 in Stephens and Stair, 2007)• Aquaculture around Bangkok generates approx $75 million per annum. Catfish farms References produce 70% of Thailand’s production of this fish Halweil and Nierenberg 2007 Halweil, B. and Nierenberg, D.(2007). Farming the Cities. In: Sheehan, M. (Ed) State of the World 2007: Our Urban Future. Worldwatch Institute. W.W. Norton, NewIn conclusion, there are clear links, contradictions York and London. pp. 48-65. Martínez, (2007). The Integration of GIS into Policyeven, between green spaces and ‘economic Making through Intra-Urban Indicators, Case Studydevelopment’ and built infrastructure. Rosario (Argentina). /paper/javierpf.htm “With economic development lower-income Ofili, C.(2006). Children’s Experiences of Water and Health groups get goods which once seemed in Low Income Urban Settlements—A Case Study in Asaba, Nigeria, University of London PhD Thesis, inaccessible to them. But they will never have London School of Hygiene & Tropical Medicine. access to green spaces unless governments act Satterthwaite, D. and McGranaghan, G.(2007). Providing judiciously.” clean water and sanitation, in Sheehan, M. (ed) State of the World 2007: Our Urban Future. Worldwatch Institute. Former Mayor of Bogotá, Enrique Penalosa W.W. Norton, New York and London. pp. 26-47. Sheehan, M. (editor) (2007). State of the World 2007: Our (in State of the World 2007) Urban Future. Worldwatch Institute. W.W. Norton, New York and London. Stephens, C. and Stair, P.(2007) Charting a New Course forCars, Equity and Greenspace Urban Public Health, in Sheehan, M. (ed) State of the World 2007: Our Urban Future. Worldwatch Institute. “As developing country cities become more W.W. Norton, New York and London. pp. 48-65. economically developed, the automobile becomes the main source of deterioration of the quality of life.” Cars become the leastUK-MAB Urban Forum 25
  • 28. Biodiversity and health by Monique SimmondsProfessor and Deputy Keeper, The Jodrell Laboratory and Head of Kew’s Sustainable UsesGroup, Royal Botanic Gardens, Kew, Richmond, Surrey, TW9 3AB. Tel: 020 8332 5655.E-mail: m.simmonds@kew.orgPlant biodiversity can be linked to health in terms of the use we make of plants for medicinal or simply health-givingproperties. This paper contrasts the very obvious and active use of plants in Africa, Asia and South America with theiralmost forgotten uses within the Western world.Introduction: Biodiversity and Health Plant diversity comparisons: • Kenya = > 5,000 speciesThe primary focus of this paper is on community • South Africa = > 25,000 speciesbased projects and what we can we learn from • UK = 1,600 speciesothers about how they use plants in:• Africa Ethnomedica – UK Project about “remembered• Asia remedies”• South AmericaIt also addresses what we in the UK may have This project has involved:forgotten about using plants. - Royal Botanic Gardens, KewFamine Foods in Africa - Eden ProjectThe Africulture Centre provides: - Natural History Museum - Chelsea Physic Gardens• Sustainable source of medicinal plants - Herbalists• Plants for cultural uses - Ethnobotanists• Fodder – building material – fuel all collecting information about traditionalThe showcase ‘Garden Africa’ exhibit at the medicinal uses of plants in England up untilChelsea Show 2007, exemplified this approach. 1948, and partly from interviewing visitors and intergenerational groups.The nutritional value of plants is key in Africaand Kew has supported this project by identifying Between 1900 and 1945 the most cited speciesthe traditional food plants grown there, how to commonly grown for remedies were:find them, conserve them, gather seed and make • Rumex – dockthem available to communities in urban areas to • Allium cepa – oniongrow again. • Urtica dioica – nettleThe Royal Botanic Gardens Kew discovered that • Tanacetum parthenium – Feverfewin parts of Africa, allotments were being used to • Allium sativum – garlicgrow irrelevant western world plants such as • Sambucus nigra – eldercabbage, which had no medicinal value to • Symphytum – comfreyAfricans suffering from HIV. Land used for • Lavandula – lavendergrowing plants must have the right cultural valuesassociated with it and must be blessed by the local • Brassica oleracea – cabbageholy person before people would feel able to • Taraxacum – dandelionmake use of the crops. Often access to food isthrough illegal trade.UK-MAB Urban Forum 26
  • 29. Wild Harvest Project – UKIn the present day people were asked:• Which plants do they eat?• What else eats the plants?• Cultural value of plants• How do you grow the plants?• Where do the plants come from?• Food miles / energy miles /carbon use• Plants in local market - supermarket• Other uses of plants – biofuels, dyes, pesticidesThis project aims to look at some of the plantbiodiversity that we are losing in the UK.Propagating projects have often been found to bevery soothing. Kew has, for example, createdlinks with hospitals to facilitate this.Plant Culture is an organisation that hascommunity-based projects around the UK,looking at the diversity of plants sold, thecultural significance of the plants and how wecan maximise the diversity of plants grown inBangladeshi and English allotments.UK-MAB Urban Forum 27
  • 30. UK-MAB Urban Forum 28
  • 31. PANEL SESSION ONE: Russell: We haven’t done work on correlating biodiversity with health in the GCPH research.Chaired by Pete Frost, Countryside Council forWales (CCW). Discussion and questions to Ian Q. What blocks public access to open spaces?Douglas, Russell Jones, Monique Simmonds andCarolyn Stephens. Russell: In general, older people tend to be afraid of young people ‘hanging out’, but this is whatQ. What are the links to permaculture in what has the young people desire – to see people likebeen discussed, what are the links in with flora? themselves.Carolyn: In the favelas of Latin America food Alison Millward: Young people are often afraid ofwas being shared with a crèche. They don’t who they meet. People may need affirmation ofnecessarily see seeds as a capitalist good. More other people like themselves using the openlike something given by God. spaces.Q. Is there a correlation between biodiversity and Russell: The level of integration is key. Barriers toincreased access or public benefits? people actually using open space are very different. Some want ‘parkies’ really, but not asRussell: Derelict land is good for biodiversity – people in authority, but people supervising and tobut it is often where vandalism takes place. It is connect with. The evidence is not prescriptive.very difficult to find the balance between the two. Discussion within the community is vital as a one sized solution will not fit all greenspaces.Ian: Carolyn’s example of the favela is very good Evidence is difficult to find. See the US andbecause it is about people not passively accessing Australian research.biodiversity, but actually about people using itwithin urban areas as crops. Q. Would it be correct to say that what marks Western society out from the majority world is itsRegarding the issue of spontaneous biodiversity disconnection from nature?versus managed biodiversity, I can remember Monique: Not necessarily. There is definitelyenjoying both. more interest in connecting with and growing plants, although young people can be distractedQ. Where is all the scientific evidence of benefits to by electronic of either engaging in urban agriculture, or inaccessing urban greenspace, or correlations Ian: I would back this by saying why are therebetween urban biodiversity and health benefits? allotment waiting lists? However, it is true to say that many regard plants as a spectacle and not asMonique: Within Chinese work there is quite a part of place where you can be amongst plants.lot. Pete Frost: Kirstenbosch advertises itself as theCarolyn: It is a very problematic area in which to ‘safest park in Capetown’ and offers manyuse epidemiology. Cartesian science is too sculptures and a programme of activities forreductionist, seeking to disprove hypotheses using visitors to engage with.randomised, controlled experiments. It mighttherefore be a dangerous route to go down, and Carolyn: Regarding reconnection, farms managedbe subject to a placebo effect anyway [the by the urban population have shifted from 2% toimplication being that there would be no 70% of the population in Argentina becausecorrelation between diversity of nature, public people’s bank accounts disappeared. It wouldaccessibility, and health benefits, or there might be great to see a similar shift in London. Peopleeven turn out to be a ‘negative’ one.] want to see plants where they do not see them now.UK-MAB Urban Forum 29
  • 32. Ian: Disconnection from nature takes many could lead to (quite radical) environmentalforms. Removal of big gardens and replacement change.with urban flats and car-parks is very different.In Kuala Lumpur ‘nature as spectacle’ is now key, Comment: [from person working for the Greaterrather than nature as the ecosystem in which London Assembly] Areas of open space deficiencyyou live. mapping is now very sophisticated and it often involves working with partners. Things areMonique: There are now prominent sculptures in improving but then it is attempting to getKew Gardens. Perhaps Kew will one day get back multiple uses out of spaces, which is the greatestthe large animals that it had in its early days. challenge.Carolyn: I have seen children, using the context Peter Shirley: Carolyn Harrison gets hot underof a storm drain, to draw flowers with furniture the collar about the disconnection from nature:on top of houses. [This was a different we have now become more voyeuristic aboutappreciation of nature] nature, rather than involved with nature. People seem content to watch television programmesQ. What about the quality of open spaces and their about wildlife and gardening rather than garden,accessibility? birdwatch or visit a greenspace. Russell: Katherine Ward Thompson found thatRussell: Capital versus revenue is a continual one of the key determinants of adult use ofproblem in guaranteeing quality in urban open greenspace is whether they have experienced itspaces. when young. She found that young people liked dense vegetation, perhaps because they couldPete Frost: I agree with what has been said about hide in it. When lack of greenspace is mappedthe crude mapping of open space versus the against mortality and morbidity there is aactual connections of people with open spaces on positive correlation. Greenspace providesthe ground. In Dundee, they first mapped open protection against morbidity (see work of Rickspace, then put a bridge over a busy road to Mitchell??0.improve access to greenspace. Monique: There are three gardening projects atRussell: Integrating health into planning is ideally Kew. 15-17 year olds want to engage with seedwhat is needed. With GCPH we have laid out a collecting.framework for the chief planner who,incidentally, is originally a botanist by training. Mathew Frith: Someone at the University ofHealth Impact Assessments (HIAs) can also help, Newcastle suggested that we now have anas can Sustainable Urban Drainage Systems environmentally illiterate population. We have the(SUDS) for the strategic planning of new first generation of young parents who cannotdevelopments. [It may also be necessary to utilise identify birds, and this is part of an emerginglocalised sources of decision-making and funding social trend. The virtual reality idea is somethingsuch as Local Area Agrements to customise the that has implications. Soon environments will betype of greenspace (and community) needs in a created by young people on the computer in thegiven locality] home, which will be more exciting than a dull February in the UK. We must take account ofMonique: We are getting a lot more enquiries this social trend.from schools. But they often have no money. Thiscan be a problem. Monique: Sometimes there can perhaps be a convergence. People at Kew Gardens take photosCarolyn: What is needed is participatory of plants when walking around the gardens andbudgeting. People are, all of the time, prioritising use these as the basis for plant identification(loosely) environmental goods. Formalising it later on.UK-MAB Urban Forum 30
  • 33. Policy to practice: health and well-being projects in the Forestry Commission by Liz O’Brien,Social and Economic Research Group, Forest Research and Helen Townsend, Social andCommunity Programme Manager, Forestry CommissionLiz O’Brien, Social and Economic Research Group, Forest Research, Alice Holt Lodge,Farnham, Surrey GU10 4lH, Tel: 01420 526155. E-mail: Townsend, Social and Community Programme Manager, Forestry Commission England.Tel: 0118 9833174 Mob: 07887 633776 E-mail: the first part of this presentation we discuss how the Forestry Commission is responding to the Government’s healthagenda. The Active Woods campaign and the Health Concordat were set up in 2005 to promote the use of woodlands andthe outdoors for improving public health. The Forestry Commission also started a number of demonstration projects thatfocused on trying to improve people’s health and well-being. The political focus of the Forestry Commission has turned towider societal issues in recent years and health and well-being is now a key social policy area for the Commission. However,at present funding opportunities tend to be local and project based and it is difficult to access large-scale national fundedprogrammes to create a wider impact.In the second part of the presentation the focus will be on research and evaluation that has been carried out for some of theForestry Commission projects that have been set up in recent years. These evaluations cover the West Midlands Woodlandand Health project, the Chopwell Wood, Active England, Forestry for People and Route to health projects. Both qualitativeand quantitative approaches have been used to evaluate these projects. Brief results will be presented. The need for pre andpost evaluation is emphasised. Future work should include longitudinal research and evaluation for example to explorewhether changes in physical activity rates last in the long term. Information will also be given on key literature reviewsand Forest Research publications that highlight the importance of using woodlands and green spaces to improve health andwell-being.Introduction the first project in 2003 with others following. FC developed its ‘Active Woods – naturally good forThe Forestry Commission (FC) has been you’ campaign in 2005 which is a promotionalinterested in the contribution of woodlands to campaign in partnership with other outdoorpeople’s health and well-being for a number of agencies to make an association in people’s mindsyears (O’Brien, 2004). As a major landholder between woodlands and health. FC along with aand creator of new woodlands it can encourage number of other agencies such as thethe use of public woodlands for public benefits Countryside Agency and English Nature (nowsuch as health and well-being. A number of Natural England), Sport England and thereviews have outlined how woodlands and natural Association of National Park Authorities signedspaces can benefit people physically, a health concordat in 2005 which set out thepsychologically and socially (see Key Reviews at commitments these agencies would undertake tothe end of this section). To progress work in this promote the use of the natural outdoors forarea FC asked Forest Research (its research health and to organise seminars in England,Scotland and Wales in 2002 to bring together Forest Research (FR) got involved in evaluatinghealth professionals and environmental some of the FC demonstration projects toprofessionals to discuss health and woodlands in explore outputs and outcomes as well theterms of policy, practice, promotion and research. processes by which the projects were run. In theA publication was produced from the following section some of these projects and briefpresentations and discussion held at these results are outlined. FR also produced anotherseminars (Tabbush and O’Brien, 2003). One of health publication in 2005 called ‘Nature’s healththe recommendations was for the FC to set up service’ that brought together information on FChealth demonstration projects and they started and other projects (O’Brien, 2005).UK-MAB Urban Forum 31
  • 34. Forestry Commission Health and Well-being Chopwell Wood Health ProjectProjects and Forest Research Evaluations and This project which ran for fifteen months fromStudies 2005 was a partnership between two Primary Care Trusts: Gateshead and Derwentside, FC,West Midlands Woodland and Health project FR and the Friends of Chopwell Wood (aThis was the first health project set up by the FC voluntary organisation). Chopwell Wood isin 2003. FC used its woodland improvement located near to Gateshead in the north east. Thegrant for this project and organisations and project had two key aspects:landowners could bid for funding to create 1) A General Practitioner (GP) referral schemeprojects that linked woodlands and health. In the in which local surgeries to Chopwell Woodfirst year seven projects were funded. The funding could refer patients whom they felt wouldcontributed to improving infrastructure such as benefit from exercise to the wood. Thepaths and creating interpretation and signage and activities available were led walks, cycle rides,other monies were allocated to publicity, events tai chi or conservation work.and developing walk programmes. In the Black 2) A series of four school visits each were madeCountry Urban Forest (BCUF) 10,000 calendars by four local schools to the wood to undertakewere produced, these showed woodland walks in physical activity sessions, a session on stressthe BCUF and the number of calories people reduction and management and a session onmight burn if they went on these walks. A post nutrition and healthy eating.project evaluation of the first year of grantfunding was undertaken (Interface NRM, 2004). An evaluation of the project was undertaken byForty seven interviews were carried out with the Primary Care Development Centre atthose involved in the projects and researchers Northumbria University (Snowdon, 2006). Forattended led health walks to talk to participants. the school visits teachers and pupils completed pre and post visit questionnaires. Focus groupsInterviews with a small number of health were undertaken with teachers to get detailedprofessionals in the region found that they did information of how they felt the school visits hadnot really recognise the benefits of using gone and what the benefits of them were for thewoodlands for health purposes, this was partly children. A focus group was undertaken with abecause they were not aware of where local small number of those who were referred by theirwoodlands were and did not know whether they GP to the woodland. The Friends of Chopwellwere accessible to the public. Participants on the Wood undertook a questionnaire in the wood ofhealth walks said that walk leaders were of key users to find out who was using the woodlandimportance as they motivated people to get and whether they felt that they derived any healthinvolved in the walks, they acted as a social point benefit from it.of contact for walkers enabling them to feel safeand they encouraged people to keep walking. For the GP referral part of the project 33 people who were referred for exercise chose to undertakeWalk participants stated that they joined the led it at Chopwell Wood and 30 completed thehealth walks for a number of reasons particularly thirteen week programme of activities. Due to thehealth concerns such as overweight or diabetes, project leader proactively publicising the project aalso to meet people, as part of rehabilitation, or further 128 people got involved in the activities,they were encouraged to join by the walk leader. particularly the walking and cycling. Six peopleThe walkers also stated that what they enjoyed bought bicycles indicating a potential lifestyleabout the walks was that they felt fitter and it was change.good to get out into the fresh air (O’Brien et al.2006). Due to the success of the project further 229 children and a number of teachers made fourfunding was made available until 2007. visits each to the woodland. There was a significant percentage of children regarding the wood as a ‘healthy place’ after the visits from 74UK-MAB Urban Forum 32
  • 35. per cent to 87 per cent. There was an increase in Route to health Projectthe number of visits to the wood by pupils and This project is taking place in Cannock Chase intheir families post project from 35 per cent to 42 the West Midlands. FC is working in partnershipper cent, suggesting that the children asked their with Cannock Chase Primary Care Trust andparents to take them to Chopwell to show them Cannock Chase District Council. The aim of thethe woodland at weekends and in the school initiative is to tackle health inequalities. Artholidays. In the on site survey 99 per cent of works have been created with the help of localvisitors felt that visiting Chopwell wood had a artists by a range of groups, such as pupilspositive impact on their health and well-being excluded from school, and people with mental(O’Brien and Snowdon, 2007). health problems. The art works all have a health theme and are placed along a one mileActive England Project community trail in Cannock Chase forest. OverThis project runs from 2005 for three years and is 1000 people have been directly involved in thefunded by Sport England through the Big project by creating health themed artworks in aLottery, with contributions from the FC. Five series of workshops. In the first year of theprojects are taking place in woodlands with the project counters recorded over 50,000 visits to theaim of encouraging under represented groups in one mile trail. A survey undertaken of 189 trailsport to become more physically active including users in 2005 found that 81 per cent felt that theblack and minority ethnic groups, women and themed artworks combined with supportinggirls, under sixteen’s, those with disabilities and information was a successful way of gettingthose on low incomes. information to people. 34 per cent of respondents agreed that the artworks had informed themThe five sites where forest projects are taking about a health issue they would not normallyplace are: think about. 63 per cent agreed that the artworksJ Haldon Forest (Devon) main purpose was to generate interest andJ Bedgebury (Kent) provide a reason for walking the trail (Cannock Chase District Council, 2005).J Rosliston (National Forest)J Great Western Community Forest (Wiltshire) Forestry for People ValuationJ Greenwood Community Forest FR was asked by Forestry Commission Scotland (Nottinghamshire) to undertake a valuation of ‘Forestry for People’ in Scotland. After a scoping study five key themesWork being undertaken includes infrastructure were identified and included in the research:improvements such as new trails (walking and J Health and well-beingcycling), play areas for children, free ride areasfor mountain bikers as well as the development of J Livelihoodsprogrammes of health walks, cycle rides and J Learning and educationevents. Outreach work is being undertaken to try J Recreation, amenity and cultureand bring in under-represented groups and local J Community capacitycommunities. FR is involved in undertaking anevaluation of the projects, this includes on site The research involves a number of surveys,questionnaires, profiling of the catchments literature reviews, GIS analysis, and case studysurrounding the woodlands and qualitative action work which is taking place in Loch Ness, and theresearch with those that use and do not use the Glasgow and Clyde Valley. The work is due forsites. Results to date highlight that the visitor completion in mid 2008. A survey in 2006 of aprofiles of forest users are changing at most of representative sample of the Scottish populationthe sites. The work is due for completion in mid asked a number of questions related to health2008. To find out more visit the following and well-being. Over 1,000 people were includedwebsite: in the sample, 87 per cent strongly agreed or forestresearch.nsf/ByUnique/INFD-6W8KLM agreed that woodlands are places to reduce stressUK-MAB Urban Forum 33
  • 36. and anxiety. 82 per cent agreed that woodlands indicate that complexity, local contingencies andare places to exercise and keep fit. 9 per cent of life stage are equally if not more important inrespondents who had visited woodlands in the determining who will use a particular woodlandprevious 12 months exercised in them on five or and for what purposes.more days a week. For 21 per cent of thosevisiting woodlands in the previous 12 months, Lessons learnt from the above projects: what seemsexercising in them was a significant part of their to workoverall exercise regime. 45 per cent ofrespondents who did not live near woodland or A number of lessons can be drawn from thedid not feel safe visiting woodland stated that projects and research outlined above that canthey would become more physically active if they inform future project creation and evaluation.had woods near to where they lived that they felt However the funding streams available for manysafe visiting. Lower socio-economic groups were of these types of projects are short term and thesignificantly less likely to have woods within a 10 enthusiasm and momentum generated by projectminute walk of where they lived compared to leaders in local communities can be lost when thehigher socio-economic groups. Women were more funding finishes and the project leader moves to alikely to feel unsafe visiting woodlands than men different job. A longer term approach is neededwere (Hislop et al. 2006). particularly when trying to involve hard to reach groups. The research project on the barriers toNew pathways to health and well-being accessing woodlands highlights that there areThis research focused on understanding the complex reasons that might prevent people frombarriers to accessing woodlands in Scotland for being able to use woodlands in the first place,health and well-being (Weldon et al. 2007). A however projects targeted at hard to reach groupscase study action research approach was can help to overcome some of these barriers. Aundertaken and targeted groups under- strategic approach to the running and evaluationrepresented in woodland and green space use of projects is needed to ensure that the impactswere identified, such as those on low incomes and across projects are captured and lessons learntyoung people. A literature review revealed that and disseminated between projects and to othersthere is a range of barriers affecting access to carrying out, or interested in similar work.woodlands and green space, and affecting Partnership working is of key importance inpeople’s physical activity rates. These barriers setting up and running projects. The followinginclude: lists provide some ideas for the future based onJ Lack of knowledge our experiences to date:J Negative perceptions, fears and safety Evaluation concernsJ Lack of motivation J Ensure monitoring and evaluation is embedded into projects and interventions fromJ Lack of time the beginning.J Physical accessibility J Pre and post project evaluation is needed -J Lack of physical fitness including a baseline in order to assess changes.J Feeling unwelcome J Interdisciplinary research can provide a moreJ Lack of reasonable facilities holistic view of the outcomes of a project.J Conflicts of use J Ensure the process of the project is explored e.g. how did the partners come together, doesFive case studies were explored and groups the project leader act as an effective linkinterviewed and taken out into woodlands for a between the community and the woodland.taster session activity such as walking or cycling.Overall the most important conclusion is that the J Longitudinal research is needed in order to gobarriers to access are less about single issues and back after the end of a project to see if activitymore to do with wider factors. The findings and changes are maintained in the long term.UK-MAB Urban Forum 34
  • 37. Projects/initiatives Interface NRM (2004). West Midlands Woodland and Health Pilot Evaluation. Report for Forestry CommissionJ Bring together partners at an early stage to England. 6HCF4N develop projects that can meet the objectives O’Brien, E.(2004). Feeling good in the woods. Green Places, of each organisation. Issue 07, July/August, pp.22-24. O’Brien, E.(2005). Trees and woodlands: nature’s healthJ Use creative solutions to enthuse people and service. Forest Research, Farnham. change behaviour e.g. Route to health project O’Brien, E.(2006). ‘Strengthens heart and mind’: using and Chopwell Wood project. woodlands to improve mental and physical well-being. Unasylva, 57, 56-61.J A project leader can act as a focus and O’Brien, E., Greenland, M. and Snowdon, H.(2006). Using woodlands and woodland grants to improve public motivator to get projects up and running and health. Scottish Forestry, 60(2), 18-24. communities involved. O’Brien, E and Snowdon, H.(2007). Health and well-being in woodlands: a case study of the Chopwell WoodJ Involve volunteers or train people to become Health Project. Arboricultural Journal, 30, 45-60. volunteers in the project. Snowdon, H.(2005). Evaluation of the Chopwell Wood Health Project. Northumbria University, Report forJ Engage with local communities and involve Forestry Commission England. them in the project from an early stage. Tabbush, P and O’Brien E.(2003). Health and Well-being:J Led activities and taster sessions can provide Trees, Woodlands and Natural Spaces. Forestry incentives for people to get involved. Commission, Edinburgh, pp. 46. Weldon, S., Bailey, C and O’Brien, E.(2007). New pathwaysJ Ensure there is effective publicity and to health and well-being in Scotland: research to communication about the project. understand and overcome barriers to accessing woodlands. Report to Forestry Commission Scotland.J Provide good facilities and trails and ensure that woodlands and green spaces are Key reviews: Links between nature and health welcoming to people.J Free or inexpensive activities and Bird W.(2004). Natural Fit – Can Green Space and Biodiversity Increase Levels of Physical Activity? Report opportunities are important when focusing on for the Royal Society for the Protection of Birds. social inclusion. Henwood, K.(2001). Exploring the linkages between the environment and health: Is there a role for environmentalJ Publicise the project and its findings. and countryside agencies in promoting benefits to health? A report for the Forestry Commission. Pretty, J, Griffin, M, Peacock, J., Hine, R., Sellens, M. and South, N.(2005). A countryside for Health and Well-References: Being: The Physical and Mental Health Benefits of Green Exercise Report for the Countryside Recreation NetworkCannock Chase District Council (2005). Route to health Rhode, C. and Kendle A.(1994). Human well-being, natural survey monitoring report. landscapes and wildlife in urban areas. A review EnglishHislop, M., Edwards, D., Elliott, A., Martin, S., Morris, J., Nature Science, No 22. O’Brien, E., Serrand, M., and Valatin, G. (2006). A valuation of the economic and social contribution of Forestry for People in Scotland: Interim report to Forestry Commission Scotland. Urban Forum 35
  • 38. Meanwhile Wildlife Gardens, With Nature in Mind (DVD presentation)by Ambra Burls, Senior Lecturer, Anglia Ruskin University. 01245 493131E-mail: a.burls@btopenworld.comThis DVD is the culmination of a series of events at a public green space in Kensington and Chelsea, London, managed byMIND, the national mental health charitable organisation. In late 2002 the Meanwhile Wildlife Garden became the subjectof doctoral research into ecotherapy. During the progression of the research it became very obvious to participants andresearcher alike that this was a ‘showcase’ example of good practice at many levels. The success of the Garden as both atherapeutic and public space is owed to the dedication and firm beliefs of the local Mind staff, as well as the trainees whowork there and the support of the local community. The DVD was a collaborative celebration of such success and wasprofessionally filmed and produced by a small team of which the main creator was a sufferer of mental ill health. The realstories of the people who work here, weaved with the opinions of the public who use this green urban wildlife haven, denotethe viability of the multifunctional aspects of this model of healthy public green space.IntroductionThe DVD “With Nature in Mind” wasprofessionally filmed and produced by those whowork and care for Meanwhile Wildlife Garden,managed by the national charity MIND.Meanwhile Wildlife Garden, is found as oneproceeds through to a wooden bridge, towardsthe end of this 12,000 m2 of green corridor. TheMIND project manages the 3.000 m2 therapeuticgarden, part of the larger public green space,located in a built up urban area, with the Grand Meanwhile Gardens offer a relaxing spaceUnion Canal on one side and residential amidst formality and the built environmenthabitation and the high-rise Modernist listedbuilding Trellick Towers on the other. This Meanwhile Gardensextensive ‘corridor’ of public park area wasdeveloped after long and difficult disputes Only a sign indicates its entrance as the Wildlifebetween the local authorities and the community. Garden, which is open to the public all the yearThe local citizens were however successful in round. This is managed as a purely ‘wild’ garden;campaigning to retain the whole area as a public there is a pond, natural hedging, some areaspark and it was restructured as such between the dedicated to culinary herbs, the arboreal andlate seventies and more recently in the year 2000. botanical collection of plants is mainly native orWhilst the disputes were ongoing the area was endemic. The plants are propagated in the roof-nick named ‘meanwhile’. This is the origin of the top and other small nursery in the garden. Thenow established name of ‘Meanwhile Gardens’. roof top area is so utilised to maximise space and it is the roof of the ex double cargo container, reclaimed and used as office, training area, dining room and meeting room. The plants are then sold at the nearby Portobello market by the project participants. The management of the garden is particularly sensitive to creating local species habitat and it is noticeable whilst walking through from the previous green areas, how much more wildlife friendly this part has become and how it stands out in an otherwise traditional town park.UK-MAB Urban Forum 36
  • 39. current global environmental challenges at the local level, but they also provide a ‘natural health service’ (Natural England, 2006) for their community by keeping this small space of wildlife healthy, accessible, recreational and educational. This public and multifunctional green urban space provided the clear focus for contemporary ecotherapy in action. The daily ecotherapeutic activities have been observed during a doctoral research study (Burls 2005, Burls 2007). The researcher was able to be a direct participant in the work carried out at the garden. As a participant observer for a period of over one year, she was able to extrapolate data from the group of service users and the practitioners at this project. The activities carried out in this creative and defined natural space have pre-determined outcomes for both the persons involved and the natural space which is a therapeutic environment, but also an ecologically significant area.A ‘showcase’ example: (top) MIND MeanwhileWildlife Garden, Office and rooftop nursery and The practice of ecotherapy has been described to (bottom) the signpost at the entry focus on the therapeutic benefits for the individual (Clinebell 1999, Burns 1998), by meansThe local fauna, now resident or regularly visiting of nature as a venue for guided personalconsists of: mammals (squirrel, field mouse, fox), reflection. However, at Meanwhile there is a moreamphibians (frogs, toads, crested newts), insects ‘action-based’ approach, which is both self-(dragonflies, damselflies), birds (Robin, Great Tit, healing and ecological. The trainees atBlue Tit, Coal Tit, Goldcrest, Wren, Blackbird, Meanwhile are engaged in attaining a directvarious owls, and many more common and less impact on ecological sustainability as acommon birds). Their visits are catalogued and simultaneous aim with improving their ownrecorded throughout the year and this health and well-being, but they also learn newinformation is provided to wildlife organisations skills that are channelled into recognisedfor their population surveys. qualifications, which lead them to employment. These activities undoubtedly augment the effortsThis is a ‘showcase project’, which typifies the of environmental and countryside agencies, but atprovision of services directed at developing and the same time participants draw on their ownmaintaining green spaces, creating habitats for efforts in terms of rehabilitation and social re-wildlife, promoting biodiversity in inner city integration, thus benefiting directly fromareas, thus it is coherent with the policies on providing such ecological service, becomingbiodiversity and the thrust on dealing with our socially included and re-integrated in a concreteecological footprints. The project is also a way rather than just dealing with their ownshowcase in terms of public health, ecological personal and social capital. Its participants arenot only the protagonists of stewardship of a Participants at Meanwhile develop a sense of selfnatural resource, contributing in tackling the and a sense of place by becoming involved, in a direct way, in providing this vital service to theirUK-MAB Urban Forum 37
  • 40. community. Meanwhile is a micro-environment there is a symbolism which comes from thein a borough of a city, which represents good sustainable model of activities, that seems to bepractice for achieving healthy people, healthy reflected in the sustainable health recovery manygreen spaces, healthy neighbourhoods, healthy of the participants have achieved. Furthercities, healthy ecosystems, in a spirit of reciprocity development of such community identity bringsof individuals with their community, man with about the new concept of embracement (Burlsnature. It promotes diversity in every sense and and Caan 2004). This active and self-directedsocial facet of the word. What happens at embracing of socio-political issues, leads someMeanwhile is a series of phases of personal, people to engage further and become agents ofgroup and environmental development, which change in educative, public health andgoes outside the needs and wishes of the environmental spheres. Their stewardship of thisparticipants (be they trainees or practitioners) or public green space, gives them a sense ofthe garden; it interacts with and draws in the ownership about the place, but more than that: ageneral public, it interacts across the boundaries sense of belonging to a greater whole, a widerof built environment and wildlife and those of space, a bigger system. With this comes a higherhuman and non-human. level of physical, psychological and social well- being, a certain level of quality of life, whichIt is this sense of place which led to the includes emotional balance and a higher sense ofproduction of the DVD, which portrays some of positive sensitivity about the alleged risks whichthe personal experiences, group activities and the are believed to be around us in our environmentphilosophy of this Skills Development Service for (Burls 2005, Burls & Caan 2005). OutcomesKensington and Chelsea MIND. reported by the participants are given in the figure below:The protagonists explain how all that goes on atMeanwhile Gardens helps to change people’sbehaviour to be sympathetic to sustainability andto see connections with the wider ecosystem anddevelop a real relationship with nature.It is striking how empathetic the Meanwhiletrainees, who suffer with ‘mental healthdifficulties’, are to the ply of wildlife and to theconservation of biodiversity and how they areproud to be able to provide this space for theircommunity. Far from feeling exploited in doingwork that would generally be seen the remit ofpublic agencies, participants feel a sense of civicengagement, ownership and personal agency,which raises their social profile and identity. The Research outcomes from Meanwhile participantssocial and personal outcomes are even morepersuasive as they learn to accept and adapt to Anders says: “one has to be patient with oneselftheir situation, taking stock from the daily and not expect instant results”. As someone whoreflective and experiential learning which takes did suffer from schizophrenia, he explains that hisplace as part of the therapeutic programme. The favourite task is the managing of a Portobellometaphorical meanings provided by the natural Market stall, selling specialist wild plants growncanvas in which they work, serves to give them an at Meanwhile. He says: “Calling yourself aunderstanding of internal and external forces gardener (having gained an NVQ qualificationwhich can be of example to them in their toil to whilst at Meanwhile) gives you a value”. “Societyrecover from illness and rehabilitate themselves values you.” “If I hadn’t been mentally ill Itowards regaining a social ‘place’. At Meanwhile wouldn’t have become a gardener”.UK-MAB Urban Forum 38
  • 41. The public is also involved in the DVD and a training can be proposed, which would withstandregular user of the garden says: “The fact that it scrutiny by a diverse range of a bit more… ‘wild’ makes it more valued” – a A multidisciplinary and multifunctional approachcomment about Meanwhile Gardens compared is necessary for this to succeed and to bring aboutwith nearby parks and managed public open a new and visible profile for ecotherapy.spaces. ConclusionThe future The very nature of the activities and what isPractitioners need to be supported in providing learnt from them on many different levels, inevidence of their work with an emphasis on projects like Meanwhile, makes a robust source ofoutcome measures for individual citizens and sustainable outcomes consistent with wider socialcommunities. For this practitioners need to be and environmental implications.recognised in their multi-skilled professional rolesand as direct witnesses of the benefits drawn from Participants (both service users and practitioners)multifunctional green spaces such as Meanwhile. whilst crafting this green space ‘product’, are alsoEqually those immediately involved who directly ‘cultivating’ well-being, renovating and repairingbenefit from ecotherapy in both health both self and the environment, giving sustenanceimprovements and social inclusion, should be to wildlife and biodiversity, but most of allencouraged to make their experiences known to connecting with the public and having a directresearchers, policy makers and health and social impact on public providers. They are the greatest ambassadorstowards strengthening the likelihood that funding Referencesbodies will begin to know and support Burls, A.(2005). New landscapes for mental health. Mentalecotherapy and its potential. Professional training Health Review 10:26-9. Burls, A.(2007) With Nature in mind. London, Mindand recognition for practitioners is also likely to Publications.achieve the goal of promoting projects like Burls, A., and Caan A. W. (2004). Social exclusion andMeanwhile, which should become more embracement: a helpful concept? Primary Health Care Research and Development 5:191-2.widespread and sustain ‘health impact Burls, A. and Caan A. W. (2005). Editorial ‘Human healthassessments’ and ‘sustainability impact and nature conservation’. British Medical Journal, 331, 1221-1222.statements’. These could in turn become a prime of scientific data, that will go a long way Burns G. W.(1998) Nature-Guided Therapy -brief integrativeto determine the success of ecotherapeutic strategies for health and wellbeing. Brunner/Mazel. Clinebell H.(1996) Ecotherapy: Healing Ourselves, Healingactivities. the Earth. Minneapolis, MN: Fortress PressWith the data collected from Meanwhile and Natural England Health Campaign (2006) sources it is hoped that professional ault.htmUK-MAB Urban Forum 39
  • 42. The natural environment: our natural health serviceBy William Bird and Huw Davies, Natural EnglandNatural England, 1 East Parade, Sheffield, S1 2ET. Tel: 0114 241 8920. William Bird. Mobile:07702 713390. E-mails:;, when presented with masses of evidence, does the health service not necessarily react? How do we lock the healthagenda together with the greenspace agenda? All sorts of National Health Service (NHS) targets are relevant, and need to be:(1) carefully integrated with evidence for the benefits of greenspaces; and (2) communicated effectively, in language whichboth doctors and administrators of Primary Care Trusts (PCTs) will understand, and which can properly motivate patients.Introduction Motivational work is also key. We need to know, what gets people engaged with the naturalWhat we are trying to do is to place health and environment?urban greenspaces into the currency whichpolicy-makers can understand. One of the The evidence for health connections withauthors (William Bird) is also a GP which helps greenspaces is good. We know that:this process. How do we lock together the healthagenda with the greenspace agenda: ‘Statins and J Natural green space can increase physicalgreenspaces’ is an excellent conference title activity levels. Regular activity halves the riskbecause it sums up the different orientations very of heart diseasewell. J Natural green space can reduce blood pressure and pulse rate. Being stressed is a proven riskIn Natural England’s overall agenda there are five factor for heart disease.strategic outcomes. Number one is health and J To provide a natural diet rich in antioxidantsenjoyment. The Natural Environment is our will reduce cardiovascular diseaseNatural Health Service. Some 15% of thepopulation visite their GP every two weeks, 70% But, what motivates people to continue toget their health information from their GPs and participate in Health Walks? Can Green Space90% of people believe their GPs compared to benefit the health of the Population?only 2% who believe their MPs. So we must getthe GPs on our side. We know that: J Senior citizens lived longer with more space toHealth work in Natural England walk and with nearby parks and tree lined streets near to where they live. See Tanaka etNatural England inherited the Walking to Health al. (1996).Initiative which is delivered by 260 health worktrainers. There is also cascade training. Therefore, J For every 10% increase in green space theretrainers beget more trainers. Jules Pretty was a reduction in health complaintsdeveloped the green walking concept. equivalent to a reduction of five years of age.Stepometers have been delivered to a wide range See De Vries (2001).of Primary Care Trusts. J Being within access to Green space can increase levels of physical activity. See Giles-It is estimated that there are now 10,000 people Corti and Donovan (2003).engage in doing walks on 340 different schemes. J The heart rate response lasted longer in for people doing Green Gym than those doingHowever, more evidence of health benefits is still step aerobics, because of additional associatedneeded. Liz O’Brien’s work is key (pages 31-35). benefits relating to the satisfaction ofUK-MAB Urban Forum 40
  • 43. achieving environmental outcomes, enjoyment Cancer and social contact, as well as personal health outcomes. J 2,500 colon cancer deaths per year attributableJ The Health Service is motivated by PSA to inactivity. See Cabinet Office Strategy Unit targets including: (2002).J To reduce overall emergency bed days by 5% J Breast cancer claims 12,000 lives and is by 2008, through improved care in primary reduced by lifelong exercise. At least five a care and community settings for people with week. CMO report 2004 DH. long-term conditions. These conditions include: Public Service Agreement Target 1.3: Obesity J To be achieved by halting the year-on-year riseDiabetes in obesity among children under 11 by 2010 in the context of a broader strategy to tackleJ About 1.3 million people in the UK have obesity in the population as a whole. (DH, diagnosed diabetes and a further 1 million DfES, DCMS) have undiagnosed diabetes.J Diabetes affect one in 20 people over the age Green Space has a role to play in increasing of 65 children’s levels of activity and playOsteoarthritisJ Osteoarthritis affects 45% of people over 65 year olds.J 36 million working days lost costing £3.2 billion in lost earnings.J Risk factors are being overweight and inactive. This reduces the muscle strength.Chronic Obstructive Pulmonary Disease (COPD) Children’s physical activity levels are strongly related to the amount of time spent outdoorsJ There are 1.5 million people with COPD Mental HealthJ COPD costs the NHS £1 billion a year mainly due to emergency admissions which can make J around 300 people out of 1,000 will experience up 12% of all emergency medical admissions. mental health problems every year in Britain;J Regular walking in patients halves the risk of J 230 of these will visit a GP; an emergency admission irrespective of the J 102 of these will be diagnosed as having a FEV1. Garcia-Aymerich et al.(2003). mental health problem;J Simple Cost Benefit J 24 of these will be referred to a specialistJ 100 patients with COPD psychiatric service;J 8 patients likely to be admitted in winter. J 6 will become inpatients in psychiatricJ A local park provides physical activity reduces hospitals. stress and anxiety and increases confidence.J From existing research this could reduce Mental Health: How can the Natural Environment admissions by half. Help?J 4 admissions (£9000) could be saved. J Natural Green space can immediately reduce stress and improve coping.UK-MAB Urban Forum 41
  • 44. J Reduction in blood pressure following a stress Conclusion event - see below. The main health problem areas for England are – Heart disease – Stroke – Obesity – Long term conditions (e.g diabetes and osteoarthritis) – Mental health The natural environment can help with all these conditions. Reduction in blood pressure To unlock the true health value of the natural following a stress event environment Natural England can generate support from central government, NHS, Local authorities, industry and above all theJ Concentration of elderly people following 1 volunteering public. hour rest in a garden versus remaining in own room - see below. However, William Bird’s past experience shows that even when the health service is presented with masses of evidence, they do not necessarily act. So: the language and the way we communicate with the NHS is absolutely critical. A Japanese experiment showed that alpha waves (indicative of relaxation) increased when looking at a plant pot.Concentration of elderly people following 1 hour rest in a garden versus remaining in own room Physical inactivity has been charted against additional healthcare costs by the Centres forAttention Deficit Hyperactivity Disorder (ADHD) Disease Control (CDC).Relationship between ADHD symptoms andplaying indoors, the built environment or in greenspace This is a critical graph. This showed the cost of additional healthcare due to inactivity. Not many Attention Deficit Hyperactivity Disorder health professionals will have seen this graph or (ADHD): alleviation of symptoms know of it.UK-MAB Urban Forum 42
  • 45. Comparison of heart-rate activity. Step-aerobics. graph. The more children are outside the less theyAll of the analysis is typically inward-looking e.g. will get obese. Physical activity is directlyGlutimus maximus and ‘Green Gym’ are all equivalent to taking anti-depressants. Gardenstalked about. But, ideally, when trying to involve are very important for old people.people with nature as a way of improving theirhealth, it is best to avoid the term ‘health’. This Attention deficit disorder is much less whentends to put people off. See Bird, 2004. greenspace is accessed. Public Service Agreement (PSA) targets can be directly linked with benefits. Everything has to be reduced to £, shillings and pence, then it will work. References Bird, W.(2004). Natural Fit. RSPB. Cabinet Office Strategy Unit(2002). Health Economics Model for Game Plan. Dec 2002. De Vries, S. (2001). Nature and health; the importance of What motivates people to continue green space in the urban living environment. Proceedings to participate in Health Walks of the symposium ‘Open space functions under urban pressure’. Ghent: 19–21 September 2001. Garcia-Aymerich, J, Farrero E, Felez MA, et al.(2003). RiskA life can be saved every year through personal Factors of readmission to hospital for COPD exacerbation: A prospective study. Thorax, 58, Brilliant chart for motivation. 60% of Giles-Corti, B. and Donovan, R.J.(2003). Relative influencepeople disagreed that they walked after being of individual, social environmental, and physical‘told to exercise by GP’. Motivation came much environmental correlates of walking. American Journal of Public Health, 93(9), 1583–1589.more from “observing changing seasons”, e.g. Tanaka, A., Takano, T., Nakamura K, et al.(1996). Healthcontact with nature. levels influence by urban residential conditions in a megacity — Tokyo.Urban Studies, 33, 879–945.All sorts of NHS targets are relevant. Reducingemergency bed admissions. Obesity: it is a linearUK-MAB Urban Forum 43
  • 46. Mapping community health in relation to urban greenspace by Pete DixonSenior Environmental Information Officer, TEP Environmental Consultancy, Genesis Centre,Birchwood Science Park, Warrington, WA3 7BH. Tel. 01925 844004. findings of a study which examined the associations between community health and the abundance and availability ofgreen infrastructure will be presented. The study was carried out in two areas in Northwest England, a metropolitan districtof Greater Manchester and a rural / coastal town area of West Cumbria. The author will outline emerging thinking in theenvironmental world as to how provision of green infrastructure might contribute to better health particularly for vulnerablecommunities such as the young and ageing, and those in dense urban areas who may be affected by heat-island effectsassociated with climate change.He will show how green infrastructure can be mapped in relation to community health and how priority areas forintervention in environmental improvement for health.Introduction Then we looked at green infrastructure and health. Some areas were ‘associated’ and someThis is an account of Geographic Information ‘disassociated’.Systems (GIS)-intensive studies relating healthand green infrastructure together. Some of the outcomes are intriguing. The audience might not think that there’s a goodThe first project was in the North West of degree of correlation. Wealthy people can buyEngland. The spurs to it were from the their Green Infrastructure (GI) by flying off toEnvironment Agency ‘Environmental Quality green places, poorer people cannot. This needs to(EQ) and Social Deprivation’ project. be borne in mind.Aims Results 1) Can ‘Environmental Deficit’ be A large number of datasets were used – measured, and mapped? Environment Agency, Forestry Commission, 2) Is there a correlation between areas of Bolton MBC, Copeland BC, Northwest Public Environmental Deficit and areas of Health Observatory, English Nature social inequality – in particular health By using the 20m raster base, the greenspace and inequity health datasets can be combined. 3) Where there is a correlation, what implications might this have for policy Raw data was ‘banded’ on a local authority basis and intervention? to allow datasets to be combinedMethodsBolton was typical of many areas in urbanindustrial decline. Copeland included Wastwaterand parts of the Lake District, plus Whitehavennearby.Raw data was collected and then transformed totake account of woodlands etc. Raster modellingwas used. Health data was based on Super Input /Output areas however, it is also grouped e.g.Health domain of the Index of Multiple RawDeprivation (IMD).UK-MAB Urban Forum 44
  • 47. BandedThese maps show the state of the environment.But what does that mean for the community?This study set out to examineJ how many people are affected by poor environmental quality or poor green infrastructure; andJ to see if these same people are affected by other aspects of deprivation, especially health.J If so, is there an imperative for combined intervention to tackle environmental and health inequity? Policy Implications: J There is, overall, an association between Green Infrastructure and health (and also betweenAssociation between health and green environmental quality and health)infrastructure J No areas with the greatest GI resource have relatively poor levels of health J Some areas with poor GI or poor EQ have good health. In urban areas these anomalies are localised and can often be explained by income. J In rural areas there seems less correlation between poor GI and health. Perhaps this is due to the proximity of other ‘greenspace’ such as private farmland not included in the Green Infrastructure dataset?UK-MAB Urban Forum 45
  • 48. Association between deprivation and green evapotranspiration. More vulnerableinfrastructure communities are located towards the more heavily urbanised regions. Policy implications: J environmental deficit can be described in terms of environmental quality and / or green infrastructure deficit J environmental datasets can be used individually or in combination to model environmental deficit across a large area J environmental deficit associates with social inequity, especially health inequity J there is a need for environmental / health programmes to integrate better J an imperative for environmental programmes to target public health where appropriate a) an imperative for green infrastructure and environmental quality to be considered in economic growth strategies; b) for enhancement where there is a combined environmental and health deficit for protection where levels are good – but vulnerable Can this method be used to define ‘Environmental Action Areas’? We looked at the areas of Bolton where population statistics suggested poorest health (worst 10%), and where Environmental Deficit was greatest:We looked at the worst 10% of health deprivationand the worst 10% of GI. Altogether, 79,554people (44%) were in this area. The Bolton andCopeland study can be downloaded. Seewww.nwph.netA second study was undertaken in North EastEngland and the East Midlands. This produced achart of lesser multi-functionality versus greatermulti-functionality.Suzanne Gill, University of Manchester, now Poor health and environmental qualityworking for the Mersey Forest found that urbanmorphology types can be correlated withUK-MAB Urban Forum 46
  • 49. Environmental Action Areas with 280m walkingPoor health and green infrastructure m.c.t: 6.0.i. buffer m.c.t: 6.0.i. 79,554 people (44% of Bolton’s population) are covered by the areas The functionality of green infrastructure in overall conclusion is broad: Economic, education, recreation, biodiversity, food production etc. Against this, the assessment of health indicators can potentially also be diverse:Poor health and Generalised Land Use Database • IMD Health Domain(GLUD) greenspace • Limiting long-term illness • Permanent sickness and disability • Self-reported general health • Standardised Mortality Ratio (SMR) (under 75) Some trends between the two sets of factors are already becoming apparent, and some are perhaps surprisingly, less obvious.Environmental Action Areas m.c.t: 6.0.i.9,836 people (3.8% of Bolton’s population) arecovered by the areasUK-MAB Urban Forum 47
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  • 51. PANEL SESSION TWO: been cut for a week, what I am paying my council tax for.Chaired by Alison Millward, of Alison MillwardAssociates. Discussion and questions to William Grant Luscombe: It’s about what happens onBird, Liz O’Brien, Ambra Burls, Huw Davies and peoples’ doorsteps.Pete Dixon. [Comment from Lanarkshire man] You couldQ: What are the biggest barriers to getting the ask what wildflowers people would like included.NHS involved? With Countryside Rangers etc. going out and collaborating with people. Communication is key.William: Sometimes things are done with nilevidence in the NHS. But perhaps more evidence Pete: People might feel reluctant not to get pills,is still needed in the ‘health – urban greenspace’ but to get exercise prescribed from their GPs.area. It is perhaps outside the comfort zone ofGPs. It is outside the normal area of their work. Liz: At Chopwell, sometimes referrals happened via walking groups getting in touch with theirLiz: Local partnerships are really important to up from day one. All projects I havementioned have involved PCTs. Peter Cush: Biodiversity in urban gardens. Gardens are very biodiverse. The division ofAlison: Volunteers in projects sometimes become greenspace is beneficial.mentors for others. Eilidh Johnston: We’re in the middle of a contractWilliam: Each February PCTs have to publish looking at qualitative aspects of greenspace. It istheir own targets. These link into the Local Area a very difficult problem because it is to do withAgreements and therefore the planners. The local public need as well as maintenance standards.authority can be an equal partner with the PCT.We need some health economists to deal with this [Commentary by a community greenspace workerand produce cost-benefit analysis. from London] What about edible greenspace. A linear orchard was planted, and now the fruitQ: Quality greenspace? What is it? trees are going to waste. The Forestry Commission doesn’t generally think aboutLiz: Have to take it on a local basis. There is a planting fruit trees. It does do fungus forays,natural greenspace toolkit available now from guided walks etc.Natural England /Countryside Council for Wales(CCW). William: A lot of PCTs are funding schools growing things. BTCV have got to the last stageMathew Frith: Natural space. All differs of the Big Lottery bid. This will involve growingdepending on your perception. I deal with mown food. A lot of this activity is sporadic.grass surrounding social housing. It is greatlyvalued by the tenants – it is a canvass for them.William: A small study showed that some peoplewould find it very hostile to go into a biodiversespace. We don’t necessarily need highly biodiversespaces for people. People in the audience wouldbe highly receptive to such areas, of course.Pete: You have to remember that in the realworld, people phone up and say the grass hasn’tUK-MAB Urban Forum 49
  • 52. Summing Up by Peter Shirley Pete Dixon’s GIS presentation was very useful and reminded us that both quantitative andThe Royal Commission on Environmental qualitative methods are useful.Pollution’s The Urban Environment (2007) makespuny efforts in the direction of health and Saving the NHS money may not necessarily begreenspace. It is far too timid. the best way forward, although it was advocated by some.Russell Jones’ and the Glasgow Centre forPopulation Health’s work makes the point about The truth is like a rabbit in a bramble patch. It isless counting and more valuing being required as in there somewhere. I think I have seen the truththe basis for decision making. We must also sometimes today. Maybe a picture is worth aaccept that some people do not and will never like thousand words, or references. We have to act onbeing in contact with nature. the best information available to us at this moment. It seems that if we do work that is goodIan Douglas made the point that the evidence we for wildlife it will be good for people too.use must be robust. Though this writer thinksthat in many other fields it may be much weaker.Ian’s other point was that too often our scientificevidence may be very narrowly based, but wemust not be deflected by thisCarolyn Stephens gave us the clear insight thatmost of the world has an entirely different set ofgreenspace perspectives and problems to worryabout relating to food and health. Environmentaljustice was mentioned. We have to keep this at theback of our minds.Monique Simmonds also mentioned the use ofgardens for growing food. Another key questionto come out of her presentation was: are wedisconnected from, or connected to, nature?Throughout the day my mind oscillated.Liz O’Brien impressed with mention ofpartnerships involving ten organisations.Networking is key to success in projects aiming tolink greenspace with health.Ambra Burls’ presentation on MeanwhileGardens in London was fascinating: people-growing as well as plant growing. This raised theissue of whether inspirational approachespersuade more than evidential approaches.William Bird and Huw Davies reminded me of anold GP somewhere in the Midlands. He hadpictures of walking and cycling on his walls. Weneed to find new ways of communicating themessages.UK-MAB Urban Forum 50
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  • 54. Conclusions and Next Steps ways. Firstly there are the added benefits that derive from biodiversity, wealth from creationValues and ‘benefits plus’ synergy and climate mitigation when people take part in the practical cultivation and management ofSeveral common themes emerged from the wide greenspace, even though their primary objectiverange of papers presented to the conference, and maybe to get fitter and meet new people.delegates were frequently invited to challengetheir perceptions of the value of greenspace to The second occurs when people then choose topeople’s health by comparing the situations in become leaders of ‘green gyms’, horticulturaldeveloped and developing countries. therapy or healthy walking groups themselves, and so pass on their enthusiasm and knowledgeIn developing countries city dwellers are using to others. This form of multiple benefit has thegreenspace primarily to grow and harvest food to potential to become increasingly effective bybenefit their physical health (if not secure their orders of magnitude and may therefore prove tovery survival), though this greenspace is be much more successful than that which wouldbecoming increasingly vulnerable to development be achieved from a doctor seeking to persuadeand in particular for road expansion, as car patients one by one at individual consultations.ownership rises. The new expanded list of the benefits to beIn developed countries, studies continue to show derived from greenspace might therefore include:that active use of greenspace benefits people’sphysical health and psychological well-being as J Utilitarian – for the production of food andwell as yielding pure enjoyment in an hedonistic medicinessense from contact with nature, intellectual J Community cohesion – as a location forbenefits in the acquisition of new knowledge and different ages and cultures to engage with eachskills. It may also catalyse social benefits from other, in addition to the more well establishedpeople being able to use greenspaces for family list ofoutings giving opportunities to meet up with J Physical healthfriends and neighbours by chance and J Psychological well-beingincreasingly at organised events. J Intellectual, and inspirational andSome new benefits emerged from the papers J Social.which related to the function of greenspaces as adriver for ‘peace making’ and community Several speakers emphasised the need tocohesion – engaging people from different age customise the approach taken to managinggroups and even opposing cultures, in enjoying, greenspace and engaging more people in derivingcultivating and managing shared space. These benefits from it, by selecting out which benefitsoutcomes would in themselves yield psychological from the list above might be most appropriate forbenefits as visitors got to know more about who the particular community living close to a givenelse was using ‘their’ greenspace and might greenspace, and so better meet their needs. Mosttherefore begin to feel more secure and confident were agreed that people should be able to enjoy aabout going there. The need to facilitate this greenspace in a multitude of ways.building of community cohesion, around theworld, through outreach work, came out verystrongly throughout the conference.Perhaps even more significantly, synergisticbenefits or the notion of ‘benefit plus’ arose fromseveral examples. This seems to occur in twoUK-MAB Urban Forum 52
  • 55. Quality and quantity, scale, distribution and therefore be quite fragile and managers need toaccessibility recognise this and invest more in helping users to feel more secure and supported.Delegates emphasised that there had to be aminimum quantity of greenspace protected Quality of the evidencewithin urban areas to ensure that everyone couldpotentially have access to a greenspace of more There was much discussion about the quality ofthan 2 ha in size within a walking distance of evidence that would be needed to better persuade300m from their homes and workplaces. the health sector of the benefits of greenspaceAccessible greenspace is now becoming firmly prescriptions.tied to concepts of environmental justice, socialequity and the precautionary principle (about Concerns were expressed about the small numberwhich urban planners must be persuaded). of experimental studies upon which the environmental sector were seeking to prove aMore than that it does seem that levels of connection. The need to convert increased levelsphysical activity are higher amongst those who of physical activity in greenspaces into healthlive closest to greenspaces (and about which the budget savings from reducing the incidence ofhealth sector must be persuaded). It is time that cardiac, respiratory, diabetic and mental healthenvironmental, health and planning professionals illness, within the population, was stressed bycame together to create more integrated strategic several speakers. The language the environmentalplans aimed at both biodiversity and health sector uses to persuade and present the evidence,outcomes. The world is becoming increasingly will therefore be key.urbanised, but urban dwellers should still be ableto enjoy a healthy, equitable and sustainable Beyond that many felt that we should still belifestyle. Access to greenspace is a key contributor trying to widen and deepen our understanding ofto this aim. the connections by continuing to collect a mix of scientific, economic, social, political andEvidence that people are put off from visiting experiential evidence. Even though it wouldpoor quality, poorly maintained greenspace undoubtedly remain difficult to convince otherscontinues to accrue, but it seems that people of evidence derived from self-reported benefits,make their decision on whether or not to visit a measured benefits that could have been caused bygreenspace on a far greater range of factors than a variety of factors and beneficial outcomes thatwe might have assumed to be the case in the past. could only have occurred as a result of proven and sustained changes in physical activity levelsLifestyle, connectedness to or integration within are still needed.the local community, and access to transport,seem to be emerging as much stronger influences The actions to achieving good quality urbanthan the ‘state’ of the local park or their own greenspaces on the ground, in a sufficienthealth and degree of mobility. Lifestyle and abundance that diverse population groups canaccess to transport are more of an issue for make use of them, are, in all likelihood, going topoorer people, so access to greenspace for them is depend on a combination of scientific evidenceparticularly significant, and even more so in the being turned into practical policy, and throughtowns and cities of developing countries. the ‘environmental justice’ route, i.e. grassroots actions of groups determined to defend such sitesPeople’s past experience of a greenspace is also and to foster their abundance within cities.influential. If a crop fails, if you have beensubject to anti-social behaviour, if you have beenattacked or injured when using your localgreenspace, you are more likely to stop using it.People’s relationships with greenspaces canUK-MAB Urban Forum 53
  • 56. Provisional next steps are as followsJ Expand our understanding of the barriers people must overcome to make use of greenspace on a regular basis and the type of projects and initiatives that can help overcome those barriers.J Develop our understanding of the multiple- benefits of greenspace across the globe and within and between social groups at the national, regional and local levels, to help with the customisation of integrated health and greenspace projects.J Identify environmental action areas where there appears to be poor health combined with poor access to greenspace.J Promote the more active use of greenspace for growing, tending and exercising as well as the more passive activities of socialising and being in contact with nature – strut and stare, stop and stare.J Adopt participatory budgeting where appropriateJ Develop national scale, integrated funding packages to effect change nationwide by improving greenspaces and access to them, in such a way as to improve health and well-being.J Adopt multi-disciplinary planning, delivery and evaluation of national and local scale projects to improve greenspaces and access to them aimed at improving health and well-being.J Support longitudinal studies to follow up studies of the past to see if behavioural change and mental health improvements linked to use of greenspaces are sustained.J Deal with the central ethical problem of providing greenspaces in a ‘built environment’ (e.g. buildings, cars, roads) -dominated world, via: proper discussion of citizens rights and the environmental justice perspective. In other words, how can we move to a more ‘green spaces’ dominated urban environment? One of our purposes should be to make the arguments and obstacles involved plain for everyone to see.UK-MAB Urban Forum 54
  • 57. Appendix: Peter JarvisMembership of UK-MAB Urban Forum School of Applied Science, University of WolverhamptonPenny Angold at AMPA Associates Eilidh Johnston* (see also Julie Proctor) Greenspace ScotlandIan Angus Natural David Knight Natural EnglandAmbra Burls & Research Officer - Cultivations& Researcher - Anglia Ruskin University Graham Centre for Ecology & Hydrology BoxAtkins Environment Grant Landlife, National Wildflower Centre CushEnvironment & Heritage Service, Northern Alison MillwardIreland Independent alison.millward@talk21.comGerald Dawe (Chair) Peter Morgan* (see also Richard Sharland)Independent specialist Groundwork Douglas David Nicholson-LordSchool of Geography, University of Manchester Independent katdab@aol.comMathew Frith Julie Proctor* (see also Eilidh Johnston)Landscape Regeneration Manager, Peabody Trust Greenspace Frost Joe RavetzCommunity Action Officer, CCW Headquarters Manchester joe.ravetz@gmail.comDavid Goode Alan ScottUniversity College London Independent Gordon Richard Sharland* (see also Peter Morgan)Countryside Agency Groundwork Judy Ling WongJohn Handley Black Environment NetworkCURE, School of Planning & Landscape, of *One of these represents the organisation at each meeting of the ForumUK-MAB Urban Forum 55
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  • 59. printed by: ORPHANS 01568 612460