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Assistant Prof. Nature, Health, and Recreation
University of Washington
OECD
Mental health and well-being: quality of life
December 9, 2021
https://native-land.ca/
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Slavich, 2020 Annu Rev Clin Psychol DOI: 10.1146/annurev-clinpsy-032816-045159
Social safety circles:
social groups in which
individuals are
embedded, which
determine the quality
of daily and lifelong
social interactions, and
shape social safety
schemas
can focus on modifying the factors described above that indirectly shape perceptions of social
safety and threat (e.g., by reducing inflammatory activity). In terms of more direct interpersonal
and social-cognitive strategies, these will need to consider the fact that humans are embedded in a
series of social safety circles that independently and interactively shape moment-to-moment and
lifelong experiences of social safety and threat (see Figure 2). Because objective characteristics of
the social environment influence the extent to which people generally regard their surroundings
as socially safe versus threatening, strategies for enhancing social safety can focus on improv-
ing actual social environments (e.g., by promoting social inclusion, connection, and belonging).
World
Neighborhood
S
c
h
o
ol/Work/Church Comm
u
n
i
t
y
State
Country
City
Friends
Family
Person
Figure 2
Individuals are embedded in a variety of social safety circles that determine their moment-to-moment and
lifelong experiences of social safety and threat. These social networks directly affect human health and
behavior by influencing the extent to which people are exposed to objective forms of social safety (e.g.,
strong family cohesion, welcoming neighbors, inclusive public policy) and social threat (e.g., family conflict,
hostile neighbors, divisive public policy). In addition, these networks indirectly affect health and behavior by
exposing individuals to construals, messages, and meanings that shape their social safety schemas, which in
turn influence their perceptions of the surrounding environment as being socially safe versus threatening.
Strategies for promoting social safety can target any of these circles to promote social safety and reduce
social threat as a means of improving human health and behavior.
www.annualreviews.org • Social Safety Theory 285
Annu.
Rev.
Clin.
Psychol.
2020.16:265-295.
Downloaded
from
www.annualreviews.org
Access
provided
by
2601:602:9602:9070:28e0:af1c:125:4547
on
01/10/21.
For
personal
use
only.
culture. Communities are comprised of culturally based norms
and practices that can shape and be shaped by the larger social
and environmental contexts. Thus, intra-individual,
community-level, social, and physical environmental factors
independently and jointly play a role in the health of individ-
uals. At any given moment, individuals are both exposed and
responding to an array of interrelated physical environmental
factors (e.g., natural, built) and social-structural factors (e.g.,
race, socioeconomic position). These factors in turn jointly or
independently influence biologic (e.g., inflammation) and
as traditional foods, thereby adding to the complex set of risk
factors facing many Native communities.
In addition, ISEM explicitly notes that biological and behav-
ioral responses can have either adverse effects and contribute to
disease onset and ill being, or protective effects and contribute
to positive health and well-being. Finally, ISEM recognizes that
exposures and outcomes may be connected by dynamic pro-
cesses that are evident at and continually operate across all life
stages and may transcend generations. Model components are
described in detail in the following sections.
Fig. 1 The Integrated Socio-Environmental Model of Health and Well-being (ISEM)
Olvera-Alvarez et al., 2018 Current Enviro Health Reports DOI: 10.1007/s40572-018-0191-2
https://www.oecd.org/wise/measuring-well-being-and-progress.htm
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OECD. 2013. OECD guidelines on measuring subjective well-being. OECD Publishing.
Bratman et al., 2012 Annals NY Acad Sci doi: 10.1111/j.1749-6632.2011.06400
D
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White et al., 2019 Scientific Reports
doi: 10.1038/s41598-019-44097-3
Adapted from Gross, 2015
Situation
Selection
Situation Attention Appraisal Response
Situation
Modification
Attentional
Deployment
Cognitive
Change
Response
Modulation
Positive
Distraction
Decreased
Rumination
Reappraisal
Opportunities
Favorite
Places
Integration of
Nature
Decreased
Suppression
Bratman et al. 2021, Social and Pers Psych Compass
doi: 10.1111/spc3.12630
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Pritchard et al., 2019. Journal of Happiness Studies
doi: 10.1007/s10902-019-00118-6
Martin et al., 2020 JEP
doi:10.1016/j.jenvp.2020.101389
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Lambert et al., 2020 International Journal of Wellbeing,
doi:10.5502/ijw.v10i2.1037
OECD. 2013. OECD guidelines on measuring subjective well-being. OECD Publishing.
Orban et al., 2017 J. Urban Health doi: 10.1007/s11524-016-0112-3
Jennings et al., 2019 Int. J. Environ. Res. Public Health doi: 10.3390/ijerph16030452
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EQUITY
The Heat Is On, 2021 Trust for Public Land
SCIENCE ADVANCES | REVIEW
SOCIAL SCIENCES
Nature and mental health: An ecosystem
service perspective
Gregory N. Bratman1,2,3,4
*, Christopher B. Anderson3,5
, Marc G. Berman6,7
, Bobby Cochran8
,
Sjerp de Vries9
, Jon Flanders10,11
, Carl Folke12,13,14
, Howard Frumkin15,16
, James J. Gross17
,
Terry Hartig18,19
, Peter H. Kahn Jr.1,20
, Ming Kuo21
, Joshua J. Lawler1,2
, Phillip S. Levin1,2,22
,
Therese Lindahl14
, Andreas Meyer-Lindenberg23
, Richard Mitchell24
, Zhiyun Ouyang25
,
Jenny Roe26
, Lynn Scarlett27
, Jeffrey R. Smith3,5
, Matilda van den Bosch28,29
,
Benedict W. Wheeler30
, Mathew P. White30
, Hua Zheng25
, Gretchen C. Daily3,4,5,31
*
A growing body of empirical evidence is revealing the value of nature experience for mental health. With rapid
urbanization and declines in human contact with nature globally, crucial decisions must be made about how to
preserve and enhance opportunities for nature experience. Here, we first provide points of consensus across the
natural, social, and health sciences on the impacts of nature experience on cognitive functioning, emotional
well-being, and other dimensions of mental health. We then show how ecosystem service assessments can be
expanded to include mental health, and provide a heuristic, conceptual model for doing so.
INTRODUCTION
Human well-being is linked to the natural environment in myriad
ways, and actionable understanding of these links is deepening in
diverse disciplines (1–3). Many of the contributions of living nature
(diversity of organisms, ecosystems, and their processes) to people’s
quality of life can be referred to as “ecosystem services.” They in-
clude water purification, provision of food, stabilization of climate,
protection from flooding, and many others (2). Worldwide, major
efforts are underway to bring ecosystem services and their values
into policy, finance, and management (4–6).
These efforts rely increasingly upon models that relate scenarios
of change in ecosystems to change in the provision of services (7),
and they have been adopted on an international scale. For example,
the Natural Capital Project’s InVEST models (for Integrated Valuation
of Ecosystem Services and Tradeoffs) are being used in 185 countries
around the world (6). The InVEST models are based on production
functions that define how changes in an ecosystem’s composition,
configuration, and function are likely to affect the flows and values
of ecosystem services across a landscape or seascape. They are open
source and are being tested and adapted through a broad network.
In some areas, such as in hydrology, this modeling is advanced and
builds upon decades of work, although challenging frontiers remain
(8). In other areas, such as pollination services for agriculture and
human nutrition (9), the modeling and its empirical basis are in com-
paratively early stages of development. These models are designed
to be used in an ensemble to estimate change in multiple ecosystem
services.
To date, these modeling and decision-making efforts have focused
predominantly on services tied to biophysical dimensions of Earth’s
life-support systems and more recently on cultural services (10).
However, relatively little attention has been given in the field of eco-
system services to the ways in which nature experience directly af-
fects human mental health (see Box 1 for our definitions of “nature”
and “nature experience”), with a few important exceptions (11). This
omission is particularly concerning in light of indications that mental
illness accounts for a substantial proportion of suffering in all re-
gions of the world (12). The fraction of the total global burden of
1
School of Environmental and Forest Sciences, University of Washington, Seattle, WA
98195, USA. 2
Center for Creative Conservation, University of Washington, Seattle, WA
98195, USA. 3
Center for Conservation Biology, Stanford University, Stanford, CA
94305, USA. 4
The Natural Capital Project, Stanford, CA 94305, USA. 5
Department of
Biology, Stanford University, Stanford, CA 94305, USA. 6
Department of Psychology,
University of Chicago, Chicago, IL 60637, USA. 7
Grossman Institute for Neurosci-
ence, Quantitative Biology, and Human Behavior, University of Chicago, Chicago, IL
60637, USA.8
WillamettePartnership,Portland,OR97239,USA.9
WageningenEnviron-
mentalResearch, Wageningen University and Research, Wageningen, Netherlands.
10
School of Biological Sciences, University of Bristol, Bristol, UK. 11
Bat Conservation
International, Austin, TX 78746, USA. 12
Global Economic Dynamics and the Biosphere,
Royal Swedish Academy of Sciences, Stockholm, Sweden. 13
Stockholm Resilience
Centre, Stockholm University, Stockholm, Sweden. 14
Beijer Institute, Royal Swedish
Academy of Sciences, Stockholm, Sweden. 15
Wellcome Trust, London, UK. 16
School
of Public Health, University of Washington, Seattle, WA 98195, USA. 17
Department
of Psychology, Stanford University, Stanford, CA 94305, USA. 18
Institute for Housing
and Urban Research, Uppsala University, Uppsala, Sweden. 19
Department of Psy-
chology, Uppsala University, Uppsala, Sweden. 20
Department of Psychology, Uni-
versity of Washington, Seattle, WA 98195, USA. 21
Landscape and Human Health
Laboratory, Department of Natural Resources and Environmental Sciences, Univer-
Copyright © 2019
The Authors, some
rights reserved;
exclusive licensee
American Association
for the Advancement
of Science. No claim to
originalU.S.Government
Works. Distributed
under a Creative
Commons Attribution
NonCommercial
License 4.0 (CC BY-NC).
on
July
24,
2019
http://advances.sciencemag.org/
Downloaded
from
SCIENCE ADVANCES | REVIEW
SOCIAL SCIENCES
Nature and mental health: An ecosystem
service perspective
Gregory N. Bratman1,2,3,4
*, Christopher B. Anderson3,5
, Marc G. Berman6,7
, Bobby Cochran8
,
Sjerp de Vries9
, Jon Flanders10,11
, Carl Folke12,13,14
, Howard Frumkin15,16
, James J. Gross17
,
Terry Hartig18,19
, Peter H. Kahn Jr.1,20
, Ming Kuo21
, Joshua J. Lawler1,2
, Phillip S. Levin1,2,22
,
Therese Lindahl14
, Andreas Meyer-Lindenberg23
, Richard Mitchell24
, Zhiyun Ouyang25
,
Jenny Roe26
, Lynn Scarlett27
, Jeffrey R. Smith3,5
, Matilda van den Bosch28,29
,
Benedict W. Wheeler30
, Mathew P. White30
, Hua Zheng25
, Gretchen C. Daily3,4,5,31
*
A growing body of empirical evidence is revealing the value of nature experience for mental health. With rapid
urbanization and declines in human contact with nature globally, crucial decisions must be made about how to
preserve and enhance opportunities for nature experience. Here, we first provide points of consensus across the
natural, social, and health sciences on the impacts of nature experience on cognitive functioning, emotional
well-being, and other dimensions of mental health. We then show how ecosystem service assessments can be
expanded to include mental health, and provide a heuristic, conceptual model for doing so.
INTRODUCTION
Human well-being is linked to the natural environment in myriad
ways, and actionable understanding of these links is deepening in
diverse disciplines (1–3). Many of the contributions of living nature
(diversity of organisms, ecosystems, and their processes) to people’s
quality of life can be referred to as “ecosystem services.” They in-
clude water purification, provision of food, stabilization of climate,
protection from flooding, and many others (2). Worldwide, major
efforts are underway to bring ecosystem services and their values
into policy, finance, and management (4–6).
These efforts rely increasingly upon models that r
of change in ecosystems to change in the provision
and they have been adopted on an international scal
the Natural Capital Project’s InVEST models (for Integ
of Ecosystem Services and Tradeoffs) are being used i
around the world (6). The InVEST models are based
functions that define how changes in an ecosystem’
configuration, and function are likely to affect the fl
of ecosystem services across a landscape or seascape.
source and are being tested and adapted through a b
In some areas, such as in hydrology, this modeling is
builds upon decades of work, although challenging fr
(8). In other areas, such as pollination services for a
human nutrition (9), the modeling and its empirical b
paratively early stages of development. These mode
to be used in an ensemble to estimate change in mul
services.
To date, these modeling and decision-making effor
predominantly on services tied to biophysical dimen
life-support systems and more recently on cultura
However, relatively little attention has been given in
system services to the ways in which nature experie
fects human mental health (see Box 1 for our definiti
and “nature experience”), with a few important excep
omission is particularly concerning in light of indicati
illness accounts for a substantial proportion of suff
gions of the world (12). The fraction of the total gl
disease(GBD)attributabletomentalillnesshasrecently
to be as high as 32% of total years lived with disabi
and 13% of disability-adjusted life-years (DALYs), o
diovascular and circulatory diseases (13). It is importa
determinethedegreetowhichnatureexperiencemightless
and to integrate these effects into ecosystem service
NATURE EXPERIENCE AS A DETERMINANT OF MEN
A variety of interacting factors can affect mental he
1
School of Environmental and Forest Sciences, University of Washington, Seattle, WA
98195, USA. 2
Center for Creative Conservation, University of Washington, Seattle, WA
98195, USA. 3
Center for Conservation Biology, Stanford University, Stanford, CA
94305, USA. 4
The Natural Capital Project, Stanford, CA 94305, USA. 5
Department of
Biology, Stanford University, Stanford, CA 94305, USA. 6
Department of Psychology,
University of Chicago, Chicago, IL 60637, USA. 7
Grossman Institute for Neurosci-
ence, Quantitative Biology, and Human Behavior, University of Chicago, Chicago, IL
60637, USA.8
WillamettePartnership,Portland,OR97239,USA.9
WageningenEnviron-
mentalResearch, Wageningen University and Research, Wageningen, Netherlands.
10
School of Biological Sciences, University of Bristol, Bristol, UK. 11
Bat Conservation
International, Austin, TX 78746, USA. 12
Global Economic Dynamics and the Biosphere,
Royal Swedish Academy of Sciences, Stockholm, Sweden. 13
Stockholm Resilience
Centre, Stockholm University, Stockholm, Sweden. 14
Beijer Institute, Royal Swedish
Academy of Sciences, Stockholm, Sweden. 15
Wellcome Trust, London, UK. 16
School
of Public Health, University of Washington, Seattle, WA 98195, USA. 17
Department
of Psychology, Stanford University, Stanford, CA 94305, USA. 18
Institute for Housing
and Urban Research, Uppsala University, Uppsala, Sweden. 19
Department of Psy-
chology, Uppsala University, Uppsala, Sweden. 20
Department of Psychology, Uni-
versity of Washington, Seattle, WA 98195, USA. 21
Landscape and Human Health
Laboratory, Department of Natural Resources and Environmental Sciences, Univer-
sity of Illinois, Urbana, IL 61801, USA. 22
The Nature Conservancy, Seattle, WA 98121,
USA. 23
Central Institute of Mental Health, Medical Faculty Mannheim/University of
Heidelberg, Mannheim, Germany. 24
Centre for Research on Environment, Society
and Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
25
State Key Laboratory of Urban and Regional Ecology, Research Center for Eco-
Environmental Sciences, Chinese Academy of Sciences, Beijing, China. 26
Center for
Design and Health, University of Virginia, Charlottesville, VA 22904, USA. 27
The
Nature Conservancy, Fairfax, VA 22203, USA. 28
School of Population and Public
Health, University of British Columbia, Vancouver, British Columbia, Canada.
29
Department of Forest and Conservation Sciences, University of British Columbia,
Vancouver, British Columbia, Canada. 30
College of Medicine and Health, University
of Exeter Medical School, Exeter, UK. 31
Stanford Woods Institute, Stanford University,
Stanford, CA 94305, USA.
Cop
The
righ
exc
Am
for
of S
orig
Wo
und
Com
Non
Lice
SCIENCE ADVANCES | REVIEW
Step 2: Exposure
Exposure is a broad term, here referring to the amount of contact
that an individual or population has with nature. Because data on
actual exposure are usually not available, especially in cases in which
we are concerned with hypothetical scenarios, actual exposure is often
estimated by access/availability metrics based on the presence of the
types of natural features identified in step 1.
The proximity of people to nature is likely to be a large determi-
Fig. 1. A conceptual model for mental health as an ecosystem service. (1) Nat-
ural features include the characteristics (size, type, and qualities such as configura-
tion) of the nature under consideration. (2) Exposure is estimated through methods
that take proximity, likelihood, and duration of nature contact into account. (3)
Experience characterizes the types, forms, and intensity of experience that expo-
sure instantiates. (4) Effects (i.e., mental health impacts) will vary according to the
moderating influences of individual differences and sociocultural context, which
may affect the impact experienced by people [here represented conceptually by
groups A to D (e.g., different age groups)], members of which may receive different
benefits from nature experience, given these moderators. It is also possible that a
group will receive a net negative effect due to individuals’aversion to urban green
spaces or the negative repercussion of green gentrification in their area, for example
Box 2. Valuation and decision-making contexts.
There is a considerable literature describing the monetary valuation of
mental health. Analyses have focused on the avoided costs of mental
illness and on the economic benefits of happiness, well-being, and
thriving. A range of methods has been used in these cases, including
direct market valuation, indirect market valuation (avoided cost, factor
income, hedonic pricing, etc.), and contingent valuation (106). In general,
mental distress and mental illness account for considerable costs, and
relief of such suffering yields large benefits for society and the individuals
affected (107, 108). Improved learning and work productivity resultant
from nature contact may also have positive economic impacts (109).
However, monetary value is only one of many ways to quantify the
mental health benefits produced by nature exposure. Many noneconomic
measures of quality of life, well-being, and happiness have been
developed (110), both in clinical settings and in sustainability science, and
these may have a role in valuing mental health as an ecosystem service.
One example is the DALY, now a standard currency in quantifying burden
of disease and potentially suitable in ecosystem services calculations.
Another form of valuation includes a ranking approach (rather than
absolute values) that projects the expected relative benefits of alternative
scenarios of change in a specific location.
These valuation approaches can help reveal the contribution of
ecosystems to mental health in decision-making. With a more complete
picture, decision makers can more fully consider the repercussions of
losing or enhancing access to nature, in the context of urban design,
including the spatial layout of built and natural environments, and
proximity to workplaces and homes. Valuation can help inform judgments
of whether to invest in nature and how to do so while also considering
other pressing needs. Our knowledge regarding the magnitude of mental
health benefits on their own may not be enough to justify the costs
associated with increasing nature within cities, but together with benefits
such as water quality, flood security, urban cooling, and recreation, we can
obtain a more complete picture of the impact of these types of decisions.
on
July
24,
2019
http://advances.sciencemag.org/
Downloaded
from
Bratman et al. 2019, Science Advances
doi: 10.1126/sciadv.aax0903
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• JPB Harvard Environmental Health Fellowship
• Doug Walker Endowed Professorship
• Craig McKibben, Sarah Merner, John Miller
• Environment & Well-Being Lab @ UW
• Nature and Health Group @UW
ACKNOWLEDGMENTS
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OECD Well-being and Mental Health Conference, Gregory Bratman, University of Washington

  • 1. Assistant Prof. Nature, Health, and Recreation University of Washington OECD Mental health and well-being: quality of life December 9, 2021 https://native-land.ca/ D r a f t
  • 2. Slavich, 2020 Annu Rev Clin Psychol DOI: 10.1146/annurev-clinpsy-032816-045159 Social safety circles: social groups in which individuals are embedded, which determine the quality of daily and lifelong social interactions, and shape social safety schemas can focus on modifying the factors described above that indirectly shape perceptions of social safety and threat (e.g., by reducing inflammatory activity). In terms of more direct interpersonal and social-cognitive strategies, these will need to consider the fact that humans are embedded in a series of social safety circles that independently and interactively shape moment-to-moment and lifelong experiences of social safety and threat (see Figure 2). Because objective characteristics of the social environment influence the extent to which people generally regard their surroundings as socially safe versus threatening, strategies for enhancing social safety can focus on improv- ing actual social environments (e.g., by promoting social inclusion, connection, and belonging). World Neighborhood S c h o ol/Work/Church Comm u n i t y State Country City Friends Family Person Figure 2 Individuals are embedded in a variety of social safety circles that determine their moment-to-moment and lifelong experiences of social safety and threat. These social networks directly affect human health and behavior by influencing the extent to which people are exposed to objective forms of social safety (e.g., strong family cohesion, welcoming neighbors, inclusive public policy) and social threat (e.g., family conflict, hostile neighbors, divisive public policy). In addition, these networks indirectly affect health and behavior by exposing individuals to construals, messages, and meanings that shape their social safety schemas, which in turn influence their perceptions of the surrounding environment as being socially safe versus threatening. Strategies for promoting social safety can target any of these circles to promote social safety and reduce social threat as a means of improving human health and behavior. www.annualreviews.org • Social Safety Theory 285 Annu. Rev. Clin. Psychol. 2020.16:265-295. Downloaded from www.annualreviews.org Access provided by 2601:602:9602:9070:28e0:af1c:125:4547 on 01/10/21. For personal use only. culture. Communities are comprised of culturally based norms and practices that can shape and be shaped by the larger social and environmental contexts. Thus, intra-individual, community-level, social, and physical environmental factors independently and jointly play a role in the health of individ- uals. At any given moment, individuals are both exposed and responding to an array of interrelated physical environmental factors (e.g., natural, built) and social-structural factors (e.g., race, socioeconomic position). These factors in turn jointly or independently influence biologic (e.g., inflammation) and as traditional foods, thereby adding to the complex set of risk factors facing many Native communities. In addition, ISEM explicitly notes that biological and behav- ioral responses can have either adverse effects and contribute to disease onset and ill being, or protective effects and contribute to positive health and well-being. Finally, ISEM recognizes that exposures and outcomes may be connected by dynamic pro- cesses that are evident at and continually operate across all life stages and may transcend generations. Model components are described in detail in the following sections. Fig. 1 The Integrated Socio-Environmental Model of Health and Well-being (ISEM) Olvera-Alvarez et al., 2018 Current Enviro Health Reports DOI: 10.1007/s40572-018-0191-2 https://www.oecd.org/wise/measuring-well-being-and-progress.htm D r a f t
  • 3. OECD. 2013. OECD guidelines on measuring subjective well-being. OECD Publishing. Bratman et al., 2012 Annals NY Acad Sci doi: 10.1111/j.1749-6632.2011.06400 D r a f t
  • 4. White et al., 2019 Scientific Reports doi: 10.1038/s41598-019-44097-3 Adapted from Gross, 2015 Situation Selection Situation Attention Appraisal Response Situation Modification Attentional Deployment Cognitive Change Response Modulation Positive Distraction Decreased Rumination Reappraisal Opportunities Favorite Places Integration of Nature Decreased Suppression Bratman et al. 2021, Social and Pers Psych Compass doi: 10.1111/spc3.12630 D r a f t
  • 5. Pritchard et al., 2019. Journal of Happiness Studies doi: 10.1007/s10902-019-00118-6 Martin et al., 2020 JEP doi:10.1016/j.jenvp.2020.101389 D r a f t
  • 6. Lambert et al., 2020 International Journal of Wellbeing, doi:10.5502/ijw.v10i2.1037 OECD. 2013. OECD guidelines on measuring subjective well-being. OECD Publishing. Orban et al., 2017 J. Urban Health doi: 10.1007/s11524-016-0112-3 Jennings et al., 2019 Int. J. Environ. Res. Public Health doi: 10.3390/ijerph16030452 D r a f t
  • 7. EQUITY The Heat Is On, 2021 Trust for Public Land SCIENCE ADVANCES | REVIEW SOCIAL SCIENCES Nature and mental health: An ecosystem service perspective Gregory N. Bratman1,2,3,4 *, Christopher B. Anderson3,5 , Marc G. Berman6,7 , Bobby Cochran8 , Sjerp de Vries9 , Jon Flanders10,11 , Carl Folke12,13,14 , Howard Frumkin15,16 , James J. Gross17 , Terry Hartig18,19 , Peter H. Kahn Jr.1,20 , Ming Kuo21 , Joshua J. Lawler1,2 , Phillip S. Levin1,2,22 , Therese Lindahl14 , Andreas Meyer-Lindenberg23 , Richard Mitchell24 , Zhiyun Ouyang25 , Jenny Roe26 , Lynn Scarlett27 , Jeffrey R. Smith3,5 , Matilda van den Bosch28,29 , Benedict W. Wheeler30 , Mathew P. White30 , Hua Zheng25 , Gretchen C. Daily3,4,5,31 * A growing body of empirical evidence is revealing the value of nature experience for mental health. With rapid urbanization and declines in human contact with nature globally, crucial decisions must be made about how to preserve and enhance opportunities for nature experience. Here, we first provide points of consensus across the natural, social, and health sciences on the impacts of nature experience on cognitive functioning, emotional well-being, and other dimensions of mental health. We then show how ecosystem service assessments can be expanded to include mental health, and provide a heuristic, conceptual model for doing so. INTRODUCTION Human well-being is linked to the natural environment in myriad ways, and actionable understanding of these links is deepening in diverse disciplines (1–3). Many of the contributions of living nature (diversity of organisms, ecosystems, and their processes) to people’s quality of life can be referred to as “ecosystem services.” They in- clude water purification, provision of food, stabilization of climate, protection from flooding, and many others (2). Worldwide, major efforts are underway to bring ecosystem services and their values into policy, finance, and management (4–6). These efforts rely increasingly upon models that relate scenarios of change in ecosystems to change in the provision of services (7), and they have been adopted on an international scale. For example, the Natural Capital Project’s InVEST models (for Integrated Valuation of Ecosystem Services and Tradeoffs) are being used in 185 countries around the world (6). The InVEST models are based on production functions that define how changes in an ecosystem’s composition, configuration, and function are likely to affect the flows and values of ecosystem services across a landscape or seascape. They are open source and are being tested and adapted through a broad network. In some areas, such as in hydrology, this modeling is advanced and builds upon decades of work, although challenging frontiers remain (8). In other areas, such as pollination services for agriculture and human nutrition (9), the modeling and its empirical basis are in com- paratively early stages of development. These models are designed to be used in an ensemble to estimate change in multiple ecosystem services. To date, these modeling and decision-making efforts have focused predominantly on services tied to biophysical dimensions of Earth’s life-support systems and more recently on cultural services (10). However, relatively little attention has been given in the field of eco- system services to the ways in which nature experience directly af- fects human mental health (see Box 1 for our definitions of “nature” and “nature experience”), with a few important exceptions (11). This omission is particularly concerning in light of indications that mental illness accounts for a substantial proportion of suffering in all re- gions of the world (12). The fraction of the total global burden of 1 School of Environmental and Forest Sciences, University of Washington, Seattle, WA 98195, USA. 2 Center for Creative Conservation, University of Washington, Seattle, WA 98195, USA. 3 Center for Conservation Biology, Stanford University, Stanford, CA 94305, USA. 4 The Natural Capital Project, Stanford, CA 94305, USA. 5 Department of Biology, Stanford University, Stanford, CA 94305, USA. 6 Department of Psychology, University of Chicago, Chicago, IL 60637, USA. 7 Grossman Institute for Neurosci- ence, Quantitative Biology, and Human Behavior, University of Chicago, Chicago, IL 60637, USA.8 WillamettePartnership,Portland,OR97239,USA.9 WageningenEnviron- mentalResearch, Wageningen University and Research, Wageningen, Netherlands. 10 School of Biological Sciences, University of Bristol, Bristol, UK. 11 Bat Conservation International, Austin, TX 78746, USA. 12 Global Economic Dynamics and the Biosphere, Royal Swedish Academy of Sciences, Stockholm, Sweden. 13 Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden. 14 Beijer Institute, Royal Swedish Academy of Sciences, Stockholm, Sweden. 15 Wellcome Trust, London, UK. 16 School of Public Health, University of Washington, Seattle, WA 98195, USA. 17 Department of Psychology, Stanford University, Stanford, CA 94305, USA. 18 Institute for Housing and Urban Research, Uppsala University, Uppsala, Sweden. 19 Department of Psy- chology, Uppsala University, Uppsala, Sweden. 20 Department of Psychology, Uni- versity of Washington, Seattle, WA 98195, USA. 21 Landscape and Human Health Laboratory, Department of Natural Resources and Environmental Sciences, Univer- Copyright © 2019 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to originalU.S.Government Works. Distributed under a Creative Commons Attribution NonCommercial License 4.0 (CC BY-NC). on July 24, 2019 http://advances.sciencemag.org/ Downloaded from SCIENCE ADVANCES | REVIEW SOCIAL SCIENCES Nature and mental health: An ecosystem service perspective Gregory N. Bratman1,2,3,4 *, Christopher B. Anderson3,5 , Marc G. Berman6,7 , Bobby Cochran8 , Sjerp de Vries9 , Jon Flanders10,11 , Carl Folke12,13,14 , Howard Frumkin15,16 , James J. Gross17 , Terry Hartig18,19 , Peter H. Kahn Jr.1,20 , Ming Kuo21 , Joshua J. Lawler1,2 , Phillip S. Levin1,2,22 , Therese Lindahl14 , Andreas Meyer-Lindenberg23 , Richard Mitchell24 , Zhiyun Ouyang25 , Jenny Roe26 , Lynn Scarlett27 , Jeffrey R. Smith3,5 , Matilda van den Bosch28,29 , Benedict W. Wheeler30 , Mathew P. White30 , Hua Zheng25 , Gretchen C. Daily3,4,5,31 * A growing body of empirical evidence is revealing the value of nature experience for mental health. With rapid urbanization and declines in human contact with nature globally, crucial decisions must be made about how to preserve and enhance opportunities for nature experience. Here, we first provide points of consensus across the natural, social, and health sciences on the impacts of nature experience on cognitive functioning, emotional well-being, and other dimensions of mental health. We then show how ecosystem service assessments can be expanded to include mental health, and provide a heuristic, conceptual model for doing so. INTRODUCTION Human well-being is linked to the natural environment in myriad ways, and actionable understanding of these links is deepening in diverse disciplines (1–3). Many of the contributions of living nature (diversity of organisms, ecosystems, and their processes) to people’s quality of life can be referred to as “ecosystem services.” They in- clude water purification, provision of food, stabilization of climate, protection from flooding, and many others (2). Worldwide, major efforts are underway to bring ecosystem services and their values into policy, finance, and management (4–6). These efforts rely increasingly upon models that r of change in ecosystems to change in the provision and they have been adopted on an international scal the Natural Capital Project’s InVEST models (for Integ of Ecosystem Services and Tradeoffs) are being used i around the world (6). The InVEST models are based functions that define how changes in an ecosystem’ configuration, and function are likely to affect the fl of ecosystem services across a landscape or seascape. source and are being tested and adapted through a b In some areas, such as in hydrology, this modeling is builds upon decades of work, although challenging fr (8). In other areas, such as pollination services for a human nutrition (9), the modeling and its empirical b paratively early stages of development. These mode to be used in an ensemble to estimate change in mul services. To date, these modeling and decision-making effor predominantly on services tied to biophysical dimen life-support systems and more recently on cultura However, relatively little attention has been given in system services to the ways in which nature experie fects human mental health (see Box 1 for our definiti and “nature experience”), with a few important excep omission is particularly concerning in light of indicati illness accounts for a substantial proportion of suff gions of the world (12). The fraction of the total gl disease(GBD)attributabletomentalillnesshasrecently to be as high as 32% of total years lived with disabi and 13% of disability-adjusted life-years (DALYs), o diovascular and circulatory diseases (13). It is importa determinethedegreetowhichnatureexperiencemightless and to integrate these effects into ecosystem service NATURE EXPERIENCE AS A DETERMINANT OF MEN A variety of interacting factors can affect mental he 1 School of Environmental and Forest Sciences, University of Washington, Seattle, WA 98195, USA. 2 Center for Creative Conservation, University of Washington, Seattle, WA 98195, USA. 3 Center for Conservation Biology, Stanford University, Stanford, CA 94305, USA. 4 The Natural Capital Project, Stanford, CA 94305, USA. 5 Department of Biology, Stanford University, Stanford, CA 94305, USA. 6 Department of Psychology, University of Chicago, Chicago, IL 60637, USA. 7 Grossman Institute for Neurosci- ence, Quantitative Biology, and Human Behavior, University of Chicago, Chicago, IL 60637, USA.8 WillamettePartnership,Portland,OR97239,USA.9 WageningenEnviron- mentalResearch, Wageningen University and Research, Wageningen, Netherlands. 10 School of Biological Sciences, University of Bristol, Bristol, UK. 11 Bat Conservation International, Austin, TX 78746, USA. 12 Global Economic Dynamics and the Biosphere, Royal Swedish Academy of Sciences, Stockholm, Sweden. 13 Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden. 14 Beijer Institute, Royal Swedish Academy of Sciences, Stockholm, Sweden. 15 Wellcome Trust, London, UK. 16 School of Public Health, University of Washington, Seattle, WA 98195, USA. 17 Department of Psychology, Stanford University, Stanford, CA 94305, USA. 18 Institute for Housing and Urban Research, Uppsala University, Uppsala, Sweden. 19 Department of Psy- chology, Uppsala University, Uppsala, Sweden. 20 Department of Psychology, Uni- versity of Washington, Seattle, WA 98195, USA. 21 Landscape and Human Health Laboratory, Department of Natural Resources and Environmental Sciences, Univer- sity of Illinois, Urbana, IL 61801, USA. 22 The Nature Conservancy, Seattle, WA 98121, USA. 23 Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany. 24 Centre for Research on Environment, Society and Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK. 25 State Key Laboratory of Urban and Regional Ecology, Research Center for Eco- Environmental Sciences, Chinese Academy of Sciences, Beijing, China. 26 Center for Design and Health, University of Virginia, Charlottesville, VA 22904, USA. 27 The Nature Conservancy, Fairfax, VA 22203, USA. 28 School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada. 29 Department of Forest and Conservation Sciences, University of British Columbia, Vancouver, British Columbia, Canada. 30 College of Medicine and Health, University of Exeter Medical School, Exeter, UK. 31 Stanford Woods Institute, Stanford University, Stanford, CA 94305, USA. Cop The righ exc Am for of S orig Wo und Com Non Lice SCIENCE ADVANCES | REVIEW Step 2: Exposure Exposure is a broad term, here referring to the amount of contact that an individual or population has with nature. Because data on actual exposure are usually not available, especially in cases in which we are concerned with hypothetical scenarios, actual exposure is often estimated by access/availability metrics based on the presence of the types of natural features identified in step 1. The proximity of people to nature is likely to be a large determi- Fig. 1. A conceptual model for mental health as an ecosystem service. (1) Nat- ural features include the characteristics (size, type, and qualities such as configura- tion) of the nature under consideration. (2) Exposure is estimated through methods that take proximity, likelihood, and duration of nature contact into account. (3) Experience characterizes the types, forms, and intensity of experience that expo- sure instantiates. (4) Effects (i.e., mental health impacts) will vary according to the moderating influences of individual differences and sociocultural context, which may affect the impact experienced by people [here represented conceptually by groups A to D (e.g., different age groups)], members of which may receive different benefits from nature experience, given these moderators. It is also possible that a group will receive a net negative effect due to individuals’aversion to urban green spaces or the negative repercussion of green gentrification in their area, for example Box 2. Valuation and decision-making contexts. There is a considerable literature describing the monetary valuation of mental health. Analyses have focused on the avoided costs of mental illness and on the economic benefits of happiness, well-being, and thriving. A range of methods has been used in these cases, including direct market valuation, indirect market valuation (avoided cost, factor income, hedonic pricing, etc.), and contingent valuation (106). In general, mental distress and mental illness account for considerable costs, and relief of such suffering yields large benefits for society and the individuals affected (107, 108). Improved learning and work productivity resultant from nature contact may also have positive economic impacts (109). However, monetary value is only one of many ways to quantify the mental health benefits produced by nature exposure. Many noneconomic measures of quality of life, well-being, and happiness have been developed (110), both in clinical settings and in sustainability science, and these may have a role in valuing mental health as an ecosystem service. One example is the DALY, now a standard currency in quantifying burden of disease and potentially suitable in ecosystem services calculations. Another form of valuation includes a ranking approach (rather than absolute values) that projects the expected relative benefits of alternative scenarios of change in a specific location. These valuation approaches can help reveal the contribution of ecosystems to mental health in decision-making. With a more complete picture, decision makers can more fully consider the repercussions of losing or enhancing access to nature, in the context of urban design, including the spatial layout of built and natural environments, and proximity to workplaces and homes. Valuation can help inform judgments of whether to invest in nature and how to do so while also considering other pressing needs. Our knowledge regarding the magnitude of mental health benefits on their own may not be enough to justify the costs associated with increasing nature within cities, but together with benefits such as water quality, flood security, urban cooling, and recreation, we can obtain a more complete picture of the impact of these types of decisions. on July 24, 2019 http://advances.sciencemag.org/ Downloaded from Bratman et al. 2019, Science Advances doi: 10.1126/sciadv.aax0903 D r a f t
  • 8. • JPB Harvard Environmental Health Fellowship • Doug Walker Endowed Professorship • Craig McKibben, Sarah Merner, John Miller • Environment & Well-Being Lab @ UW • Nature and Health Group @UW ACKNOWLEDGMENTS D r a f t