1) The document discusses the health and social benefits of nature and biodiversity protection. It notes several health issues facing Europe like air pollution, heat stress, and obesity that put pressure on public spending. 2) Nature-based solutions can help address these issues by improving climatic conditions, air quality, noise reduction, and promoting physical activity and mental well-being. Urban green spaces, wetlands, and protected natural areas can reduce heat stress, absorb air pollutants, and provide places for recreation. 3) Examples from cities like Vitoria-Gasteiz, Lyon, and Stuttgart show how green infrastructure projects along rivers and increasing urban green cover have helped lower temperatures, improve air quality, and support healthier

1. www.ieep.eu
@IEEP_eu
Health and Social Benefits of Nature and
Biodiversity Protection
Patrick ten Brink
Director, IEEP-Brussels, and Head of the Green Economy Programme
Building on the report by the wider team: ten Brink P., Mutafoglu K., Schweitzer J.-P., Kettunen M., Twigger-Ross
C., Kuipers Y., Emonts M., Tyrväinen L., Hujala T., Ojala A. (2016) The Health and Social Benefits of Nature and
Biodiversity Protection – Executive summary. A report for the European Commission (ENV.B.3/ETU/2014/0039),
Institute for European Environmental Policy, London / Brussels.
European BfN/ENCA conference
Biodiversity and Health in the Face of Climate Change
29 June 2017
Bonn

2. The Problem
We face a range of health and social issues that merit urgent attention – air
pollution, heat stress, obesity, noise pollution, mental disorders.
The EU health sector represents 15% of public expenditure and costs are
expected to rise.
There is considerable pressure on public spending budgets.
Heat stress: Europe’s 2003 heat wave caused 70,000 additional deaths. The urban heat island effect,
and projected climate change will exacerbate the risks.
Air pollution: More than 400,000 cases of early mortality in the EU-28 in 2012 - and recent progress on air
quality in cities has been limited.
Low physical activity levels: with high levels of obesity and related diseases (e.g. Type-2 diabetes),
undermining wellbeing and health, and putting enormous strain on health care systems.
Mental disorders alone account for about 20% of the burden of disease in the European Union (EU).
Depression is responsible for about 15% of all days lived with disability.

3. Objectives of the study
• Understand & communicate
benefits
• Understand different
stakeholder roles
• Communicate integration
opportunities
• Recommendations for a way
forward
Direct and Indirect Health Benefits
Improved climatic conditions – heat stress
Improved air quality
Noise reduction benefits
More pleasant & peaceful, less stressful
environment
Healthier lifestyles – nature experience
Outdoor recreation and physical activity
Wellbeing – living in attractive location
Promoting social cohesion
Quality of green public spaces, reduced social
tension
Opportunities for involvement from all sectors
of society – volunteers, employment

4. Improved climatic conditions & avoiding heat stress
The Problem:
• Climate change implies higher average and extreme temperatures for most of Europe.
• An estimated up to 70,000 people died during the 2003 heat wave in Europe.
• Urban heat islands can be between 2 to 12 degrees warmer than peri-urban, low-density
areas with ample green spaces.
• Further urbanisation contributes to more pronounced urban heat islands.
Nature based solutions: The evidence from literature suggests that:
• Protected areas & wider Green Infrastructure can contribute to mitigating urban heat
islands. Urban parks particularly important and more so if wetlands and blue
infrastructure.
• Benefits are observable for nature on a larger-scale (e.g. protecting coherent and
connected undeveloped land) & small-scale

5. Spain, Vitoria-Gasteiz - Salburua Wetlands
Vitoria-Gasteiz and Salburua
Wetlands
Urban Heat Island (UHI) and vulnerability to
heatwaves
• Green belt around the city connects
urban areas and integrates wetlands,
Salburua (Ramsar, No. 1263) and the
Zadorra River.
• Provide 250,000 citizens opportunities for
cooling oases and recreation spaces.
Never more than 300 meters from green
or blue infrastructure
• Vitoria-Gasteiz was European Green
Capital in 2012
Natura 2000
Peri-urban GI

6. France, Lyon- Berges du Rhône
Lyon, Berges du Rhône
• 2003: heat wave increased mortality in Lyon by
80%, above average for a French city
• Rhône River which runs through the city has
been at the heart of the solution.
• Aim: to increase access to cool & shaded areas,
rain water harvesting, sustainable drainage
and reduce flood risk by increasing run off.
• 2007: reopened public access to the banks of
the river (Grand Lyon, 2014). €42 million
redevelopment, Berges du Rhône - asphalt car
park replaced with 5km of riverside pathway
and green spaces
• Riverside redevelopments to provide 25,000
new homes and 14,000 new jobs by 2030

7. Improved air quality & health benefits: Causal links
Air quality in Europe
Green Infrastructure
Benefits of Nature
Health Impacts
Natura 2000/Conservation
Standards: WHO and EU (COM, 2013)
Current levels: 21% of EU stations exceed EU targets for PM10.
>80% of urban dwellers exposed to harmful levels
Air pollution: impacts on respiratory and cardio health,
482,000 deaths WHO European Region 2012.
Total economic burden >€1 trillion
Direct role of vegetation: dry deposition, absorption of gaseous
pollutants, and impacts on dispersal and shielding.
Further indirect impacts.
Natura 2000: Important sinks for pollutants. Network
facilitates and guarantees health benefits.
E.g. Collserola Park, Barcelona (Chaparro & Terradas, 2009)
Green Infrastructure: opportunities for strategies &
investments to maximise the benefits of nature in area of high
pollution. E.g. London green walls via Air Quality Fund (TfL, 2014)

8. Improved air quality & health benefits
Stuttgart KlimaAtlas
Air quality in Stuttgart
Green Infrastructure
Benefits of Nature
Natura
2000/Conservation
Stuttgart has had the worst air quality of any Germany city.
Suffers from high levels of industry and particular geography.
PM and NO2 exceed EU and WHO limits by up to 4x.
In 2013 the city exceeded PM limits on 91 days.
In 2008 developed Klima Atlas to map air pollution and local
climate. Using software to generate a conservation/GI strategy
to improve air quality. 2013-2014 saw both of its measurement
sites fall below 100 μg/m³ for the first time for NO2.
Whilst the city does not contain a Natura 2000 site, 39% of the
city’s green space is now under conservation, a record for
Germany. In 2010 60ha of development projects were
prevented to preserve green corridors and spaces. Large trees
are all protected (WWF, 2012)
Stuttgart is zoned according to role in developing clean air
flows. Green space now covers 60% of the city, 300,000 m2 of
rooftops have been greened, and 40 out of 250 km of tram
track have been greened (Baden-Württemberg, 2012)

9. Drivers, Barriers and Policy Needs to realise the Potential for nature
to support climate adaptation
Illustrative indicators:
• million m2 of green roofs
• Per capita
• % of city green cover
• Average distance from green spaces
Current Situation
National plans and
strategies for
climate change
adaptation
Research and
innovation
Political and
administrative
barriers
Lack of
awareness/
knowledge
Protected
areas
Land use change
Future potential
Development of existing and new
markets; management and
restoration of ecosystems;
reduced losses from climate
change
Reduced climate-induced risks to
health; opportunities for exercise
and recreation
Job creation in research,
technology, infrastructure,
construction, ecological
engineering etc.
Employment generation in rural
areas; nature-based solutions
RD
New investment; improved
housing conditions; protection
against climate change in cities
UD
Access to green space for cooling
for vulnerable populationsDSJ
Benefits
PH
JS
EG
National plans and
strategies on green
infrastructure
Goal: Increase GI
measures for climate
adaptation; increase access
to urban & peri-urban parks
Contribution
to priorities
EU: Economic losses due
to climate-change impacts
persist
Green
infrastructure
and building
requirements
Funding and
budget
constraints
Adaptation
measures across
different sectors to
address climate
change impacts
Enhance green
infrastructure
for climate
adaptation
Resilience of
ecosystems
Protection
measures
against
climate
change
Legislation
EU funding
EAFRD,
ERDF, CF,
ESF, EMFF

10. Wider health benefits

11. Outdoor recreation and physical activity
Nature based solutions: The evidence from literature suggests that:
• Exercising and being physically active in green areas provide not only physical health
benefits but also positive effects on mental health.
• Green areas increase the level and willingness to do physical activity.
• People want to spend more time exercising in green areas.
The Problem:
• Almost two thirds of adults and 80% of young people do not reach the minimum
recommended levels of weekly 150 minutes of aerobic physical activity in Europe
(Hallal et al. 2014).
• Globally, inactivity causes ~ three million deaths/yr, (Lim et al. 2012) as well as 6–10% of
the coronary heart disease, Type-2 diabetes, and breast & colon cancers (Lee al. 2012).
• As a cause of death inactivity is considered as a “new smoking”. It causes as many
deaths (Lee et al. 2012).

12. Finland, Kuopio – Moved by Nature
• Aim: to promote collaboration with the health
sector in Finland and allow vulnerable groups
to benefit from access to physical activity in
natural spaces across Finland
• Activities in the pilot study in Kuopio: ice
fishing, canoeing & swimming in Lake Kallavesi
• 16 men at risk of Type-2 Diabetes involved -
reduced average weight by 3.75 kilos each.
• Funded by the European Union Social Fund
(75%) and public and private organisations, with
a total budget of 348 000 €.
Finland, Kuopio – Moved by Nature

13. Mental health benefits: nature experience
Nature based solutions: The evidence from literature :
• Nature areas related to children’s better functioning - concentration, motoric skills, self-
esteem, emotion regulation.
• Strong evidence on natures’ positive effects on mental health - nature has restorative,
stress reducing effects and even short break from work in green area can have positive
effects of stress reduction.
• Some evidence that nature environments lower blood pressure and pulse rate, reduce
cortisol level.
The Problem:
• Mental disorders account for about 20% of the burden of disease in the European
Region, rising to 26% in the countries in the European Union (EU).
• Depression alone is responsible for about 15% of all days lived with disability.
Example from literature: Doctors prescribe fewer anti-depressants in urban areas
with more trees on the street (Taylor et al., 2015).

14. Sweden, Alnarp – Rehabilitation Garden
Alnarp – Rehabilitation Garden
• Ongoing pilot into the effectiveness of
nature based rehabilitation (NBR).
Exploring impacts on stress related
mental illness, post stroke rehabilitation
and war neuroses (i.e. with refugees)
• Alnarp garden was the first pilot site, now
expanded to 11 gardens, supported by
local universities and regional
government.
• Alnarp results– patients primary care cost
dropped 28%, days in hospital fell 64%
• 1.3 million euros to treat 250-300
patients per year

15. • In Denmark, people living more than 1 km from green
space were more likely to be obese and less likely to
exercise rigorously than those living closer than 300 m
(Toftager et al., 2011).
• In Spain, people living within 300 metres of green
spaces report better self-perceived health and mental
health (Triguero-Mas et al., 2015).
• People are happier and have lower mental distress
when living in urban areas with more green space
(White et al., 2013).
• Pregnant women living more than 300 meters away
from green spaces have higher blood pressure
compared to those who live closer (Grazuleviciene et al.,
2014).
• Growing up and living in microbe-rich environments
can reduce the development of allergies (Ege et al., 2011;
Hanski et al., 2012; Haahtela et al., 2013).
• Living 2 to 5 km from diverse natural environments (like
forest areas or traditional farms) reduces the chance of
allergies in children 6 years or older (Ruokolainen et al.,
2015).
The equity dimension is also critically important
15

16. Drivers, Barriers and Policy Needs to realise the Potential for nature
to support health
Illustrative indicators:
• Total Area of Natura 2000 and wider attractive
landscapes, particularly in proximity to urban
areas
• Availability of nature based recreation areas
Current Situation
Boost research on
benefits of nature
Funding
Environmentally
harmful subsidies,
e.g. fossil fuels
Direct investments
in GI and protected
areas
Poor compliance
with EU air quality
objectives
Lack of awareness
of the health
benefits of nature
Future
potential
Benefits
Strategies and laws
that integration
nature – health links
explicitly or implicitly
Goal: improve public
access to green areas, and
integrate in national health
strategies & practice
Contribution to
priorities:
Low realisation of the benefits of
nature across MS
EAGF, EAFRD,
EFDR, ESF
Lack of
knowledge
Integration of
biodiversity & GI
- e.g. green roofs law
e.g. climate adaptation
strategies
Provide a
strong
evidence base,
including
Reduce public
expenditure on health
Increased activity,
improved air quality,
reduced heat stress
Improve productivity of
workforce
Climate resilience of
regions and cost savings
RD
Support sustainable urban
development. Reduce
economic impacts of
congestion
UD
Address social
inequities in public
health
DSJ
PH
JS
EGCitizen initiatives and civil
society engagement
Training
volunteers

17. Capitalising on the Benefits: Who can do what? Examples
Actor Tools Examples
EU • Implementation
• Integration and funding
• Birds & Habitats directives,
WFD,MSFD
• CP, LIFE, ENPI, TEN-GI, NCFF
National
authorities
• Green roof regulation
• Integration of nature
• Belgian: green roofs
• Partnership Agreements &
operational programmes (OPs)
City authorities • Air quality, climate and green
infrastructure strategies
• Tree planting campaigns
• Lyon, France: Berges du Rhône
(2007)
Protected area
managers
• Recruitment: e.g. health wardens
• Training volunteers
• Pembrokeshire, UK: Walkability
Project (2011)
Citizens • Citizen science, mobile
applications, guerrilla gardening,
advocacy
• Berlin: Initiative ‘100%
Tempelhofer Feld’ & referendum
(2014)
Science • Research, dedicated mapping and
climatology teams
• Stuttgart, Germany: StadtKlima
NGOs • Communications, (volunteer)
engagement, advocacy
• FoE Communications on Nature
for Health & Equity
Improvedcollaborationsforhealth-social-naturesynergies

18. Nature and Health: Conclusions
There is robust scientific and practice-based evidence that nature can contribute to
addressing the health and social challenges
While nature cannot be a remedy to all challenges of society, there exist untapped
opportunities for health benefits that also support biodiversity
Protected areas are increasingly being recognised as “preventative health care
centres” and “health hubs”
Increasing numbers of health related activities taking place in Natura 2000 sites, other
protected areas and wider green infrastructure
The potential is barely tapped and there is a need for system change in the
appreciation of protected areas’ multiple roles for environment, society and economy.
It requires systems thinking & multi-level governance engagement, the integration of
benefits to improve policy coherence, and champions to make it happen.

19. IEEP is an independent, not-for-profit institute dedicated to the analysis, understanding and
promotion of policies for a sustainable environment. www.ieep.eu
4 Rue de la Science, Brussels 1000, Belgium & 11 Belgrave Road, London, SW1V 1RB, UK
Report available at www.ieep.eu
Health and Social Benefits of Nature and Biodiversity Protection
Executive summary
Main Report
Annex 1: Case Studies
Workshop summary
Annex 2 & 3