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 on healthly living and illness recovery. We’re also excited to announce the upcoming NHS Forest conference on the 27th of February 2018 on the theme of workplace wellbeing and green space. Find out more here.

Human health is linked to our environment; it influences how we feel, how we behave, what we breathe, what we eat, how we travel, and the list goes on… At the same time, the environment is being degraded.  This is leading to poorer health outcomes, with the World Health Organisation 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 nearer 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 whilst 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 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 nature programme (6).

Recovery processes are also aided by access to green space. Short term recovery from anxiety or fear was seen to be sped up 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 the UK’s natural pollution removing from plants, there were 5,000 fewer hospital admissions for respiratory illness and £1 billion were saved (9).

Challenges ahead:

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

In his recent blog on this issue, 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. You can read his full blog here. 

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. 40% 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 work place 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!

  • Get outside and enjoy your local green space, be it parks, hospital sites, or local woodland.
  • If you are looking to get involved with making green spaces for health benefits more accessible to your patients or community, you will find support to do this in next week’s blog- it is all about implementing green space interventions which CSH has trialled and tested at healthcare sites around the UK. 
  • Check out our NHS Forest website to start planting trees on or near your healthcare centre.
  • Sponsor a tree - £10 helps us buy, transport and maintain a tree for a hospital site.

References:

1) Ulrich, R.S.,1984. View through a window may influence recovery from GP practice. Science 224, 420-421 

2) Two reports, sponsored by RSPB: Bird, W (2004) ‘Natural Fit’, RSPB - www.rspb.org.uk/Images/natural_fit_full_version_tcm9-133055.pdf and Bird, W (2007) ‘Natural Thinking’, RSPB - www.rspb.org.uk/Images/naturalthinking_tcm9-161856.pdf

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

4) Jules Pretty, Murray Griffin, Jo Peacock, Rachel Hine, Martin Sellens and Nigel South (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 Volume 70, Issue 8, April 2010, Pages 1203-1210

6) Wildlife Trusts & University of Essex (2017), Volutneering: A Natural Health Service. http://www.wildlifetrusts.org/sites/default/files/summary_volunteering_-...

7) Van den Berg, A.E., Koole S.L., and van der Wulp N.Y. (2003). ’Environmental preferences and restoration: (how) are they related?’ Journal of Environmental Psychology 23, 135-146

8) Lovasi, G., Quinn, J., Neckerman, K., Perzanowski, M. & Rundle, A. (2008) ‘Children living in areas with more street trees have lower prevalence of asthma.’ Journal of Epidemiology & Community Health, 62(7), pp. 647-649

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

10) West, M c(2016) Kings Fund, ‘Creating a workplace where NHS staff can flourish’ 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, June 2015, Pages 32-40