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Sustainability Series: Green space and health

This month our Sustainability Series will be focusing on the Centre for Sustainable Healthcare’s work on green space and its benefits for healthy living and illness recovery.

Human health is linked to our environment; it influences how we feel, how we behave, the air we breathe, what we eat, how we travel, and more. At the same time, the environment is being degraded. This is leading to poorer health outcomes, with the World Health Organization calling climate change “the greatest threat to global health in the 21st Century”. In this context, having access to green spaces is vital for health promotion, illness prevention and illness recovery. The Green Space programme at CSH works on finding ways of improving people’s health and wellbeing by spending more time in nature. 

Our Green Space programme has been running since 2009, and since then the conversation about the impact of nature on human health has come a long way.  Most notably the evidence base for the positive impact green space can have on health has increased – as is summarised below. At the same time, the healthcare system faces severe funding shortages. As the NHS struggles to achieve more with less, Green Space programmes have an important role to play in supporting preventative and recovery based approaches to care. This blog gives an overview of our work, providing a summary of the evidence, the challenges and future opportunities for green space and health. Next week we will present case studies and guides to support you in implementing green space health interventions. 

Green Space directly mitigates climate change and directly benefits health. Climate change is a big health risk and healthcare is a significant source of carbon emissions.

The evidence – what impact does green space have on our health?

Green spaces play a vital role in healthy living as well as in illness recovery. (1) The effects of spending time in nature have been shown to be beneficial for a whole range of different medical conditions, from cancer, diabetes, and obesity, to ADHD, anxiety and clinical depression. So how does green space do all that? (2)

One of the main benefits of having access to green space is that people tend to be more active when outdoors: children who live near green spaces have higher levels of activity and a lower chance of increased BMI, and older people living near green spaces tend to live longer. (3)

In addition to the many benefits which exercise usually brings, there is evidence that exercising in green spaces is even more beneficial. Viewing pleasant rural scenes while exercising was shown to have the biggest positive impact on blood pressure, mood and self-esteem, compared to exercising in urban and unpleasant rural scenes. (4)

Green spaces can reduce stress – which has been linked closely with both mental and physical wellbeing, and the development of illness. Living near green spaces has been shown to reduce the number of health complaints reported to GPs as well as reducing how affected people feel by stressful situations. (5)

Even short term exposure to green space can help: a report published just last month found that participants with low wellbeing at baseline reported an average 30% improvement in wellbeing score just 12 weeks later, after having taken part in a volunteering in a nature programme. (6)

Recovery processes are also aided by access to green space. Short term recovery from anxiety or fear was seen to be faster when natural green spaces were viewed – reducing muscle tension and blood pressure. (7) Longer term recovery was also shown be accelerated, studies of cholecystectomy patients in hospital found that they recovered more quickly with a view of trees and nature from their windows. (1)

Not only can green spaces improve patient health and illness recovery, improving our environment also plays a role in preventing us from getting ill in the first place. Green space directly impacts on some chronic conditions. For example, the prevalence of asthma has been shown to correlate with the amount of trees in an area. (8)

Earlier this year the Office for National Statistics reported the healthcare savings made from green environments directly improving air quality. They estimated that as a result of plants naturally removing pollution, there were 5,000 fewer hospital admissions for respiratory illness and £1 billion were saved. (9)

Challenges ahead

There is mounting pressure on NHS Trusts to convert green spaces for development opportunities. The need for short term funding often seems to outweigh the longer term financial gains which green spaces offer. The pressure being put on estates teams to reduce green space shows how green infrastructure is often regarded as part of the burden on public finances. Instead there should be greater value placed on green space as a low-cost, preventative and holistic solution to improving health outcomes.

In this recent article for Town & Country Planning magazine, Ben William of the NHS Forest discusses what might be necessary for this paradigm shift to come about. He says we need action to 1) increase access to green infrastructure, 2) build up a better understanding of what works and where, 3) invest in skills and capacity, and 4) instil in others a will to change.

What next? Workplace wellbeing in 2018…

In 2018 it will be 70 years since the NHS opened – to mark this occasion we will be focusing on the workplace wellbeing of NHS staff. Forty per cent of NHS staff reported feeling unwell due to stress at work in 2016. (10) Green space has repeatedly been shown to have a positive effect on our wellbeing – for example, using or even just seeing open spaces, views of trees, flowering plants, lawn or shrubs is associated with increased self-reported wellbeing. (11) We will be working with healthcare centres around the UK to encourage NHS staff to use their workplace green space to improve their wellbeing. The NHS Forest conference this year will launch our workplace wellbeing and green space theme – so do come along and find out what you can do to improve the mental health of your staff! 

Get involved!

References:

1) Ulrich RS. (1984) View through a window may influence recovery from surgery. Science 224, 420-421. 

2) Two reports, sponsored by RSPB. Bird W. (2004) Natural Fit, RSPB. and Bird W. (2007) Natural Thinking, RSPB.

3) Allen and Balfour. (2014) Natural solutions for tackling health inequalities: conference report, UCL Institute of Health Equity & Natural Health England. 

4) Pretty J et al. (2005) A countryside for health and well-being: The physical and mental health benefits of green exercise. Countryside Recreation Network.

5) Van den Berg et al. (2010) Green space as a buffer between stressful life events and health. Social Science & Medicine, 70(8), 1203-1210.

6) Wildlife Trusts & University of Essex, (2017) Volunteering: A Natural Health Service.

7) Van den Berg AE, Koole SL, and Van der Wulp NY. (2003) Environmental preferences and restoration: (how) are they related? Journal of Environmental Psychology 23, 135-146.

8) Lovasi G et al. (2008) Children living in areas with more street trees have lower prevalence of asthma. Journal of Epidemiology & Community Health, 62(7), 647-649.

9) Phillips J. (2017) The UK environment – fighting pollution, improving our health and saving us money. Office for National Statistics.

10) West M. (2016) Creating a workplace where NHS staff can flourish. The King’s Fund. https://www.kingsfund.org.uk/blog/2016/01/creating-workplace-where-staff…

11) Gilchrist, Brown & Montrazino. (2015) Workplace settings and wellbeing: Greenspace use and views contribute to employee wellbeing at peri-urban business sites. Landscape and Urban Planning, Volume 138, 32-40.

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