Summary Brief for Policy Makers - Nature Health and Wellbeing Research

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Should we Invest More in Our Parks?

HEALTH AND WELLBEING BENEFITS OF URBAN PUBLIC OPEN SPACES – EVIDENCE SUMMARY AND POLICY RECOMMENDATIONS

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SHOULD WE INVEST MORE IN OUR PARKS? Policy recommendations are proposed to support local authorities in maximising the health and wellbeing benefits from greenspaces, particularly regarding health inequalities in deprived areas and suggestions to resolve funding issues against a climate of continued cash constraints for local authorities.

THE IMPORTANCE OF GREENSPACE TO HEALTH AND WELLBEING OUTLINE The UK pioneered parks during the industrial revolution for public health and improving the urban environment as towns industrialised (1). Research into the relationships between exposure to nature and its health and wellbeing benefits has been gathering pace in the last decade (2,3). Positive public health outcomes linked to greenspace exposure are summarised in box 1.

It is acknowledged that local authorities have no legal requirement to manage parks and open spaces, and historic pressures on local authority funding have contributed to varying levels of quality and status of public open space (1).

This brief firstly presents an assessment of the recent evidence base on the relationship of greenspace as a key determinant for wellbeing, identified for local authorities in the ‘Understanding local needs for wellbeing data’ scoping report (4).

Secondly, the report discusses a key lack of focus of the research base in suggestions for targeting funding in parks and where cautions in its use should be applied.

Box 1: Public health outcomes linked to exposure to green spaces

✓ Obesity reductions through physical ✓ ✓ ✓ ✓ ✓ ✓

activity (5,6) Higher general self-reported health perceptions (7,8) Positive mental health benefits including social support (9) Stress relief (10,11) Reductions in blood pressure and increased heart function (12) Reduced cardiovascular disease mortality (13) Healthier infant birth weights (14)

Population effects, as detailed in box 1, of the relationship with greenspace and health is germane evidence to this paper as parks are available for use by populations (1). Indeed, when taken as a whole, there is a consensus in the research that parks are key to a good quality of life for residents (15,16) and for maintaining social cohesion (17); excellent reasons to increase green space provision (18).

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HEALTH INEQUALITIES AND GREENSPACE Poor socioeconomic status strongly relates to an increased incidence in many of the health outcomes discussed thus far (see box 1) and there is a strong correlation between these health indicators and their localities (18,19).

Low socioeconomic groups and ethnic minorities have been found to have access to less acreages of parks, fewer good quality parks, and less safe areas than more privileged people (20,21). Therefore, deprived groups in society, are likely to benefit the most from greenspace improvements due to the higher incidence of health issues and the greater impact on their locality (22).

Attempts to improve parks to widen participation to encourage the benefits to be felt more broadly could be taken (23) to bring in those who will benefit the most.

Investment targeted in poorer areas may well have the greatest impacts (18).

ACCESS AND PROXIMITY TO GREENSPACE People living in greener areas have been found to walk more frequently (24), and improvements to greenspaces have been found to increase aspirations of use (15).

Studies into greenspace access are inconsistent, however, they do largely agree that improvements to access have the potential to reduce deprivation-related health inequalities (24).

English Nature guidelines (25) advise that people should have 1 site of at least 20ha of greenspace within 2km of home and at least 1 site of 55ha within 10km of home.

However, more recent research proposes a more discriminating factor may be a perception of greenspace within 8km of home and therefore, these recommendations may suggest too great a distance, and endorse too low a density

of larger greenspaces (26). When resolving health inequalities, local authorities should therefore understand the density of greenspaces.

WELLBEING IS NOT ALW AYS GAINED FROM USE OF GREENSPACE When using the outdoors, the weather; particularly high wind has been found to have significant reductions on wellbeing (27), and is more likely to reduce restorative park use than precipitation. Health can be diminished in some through exposure to pollen (28). Poor air quality also has diminishing effects on health (29), however, suggestions are widely known for managing these (28) and the majority of the research would advocate park use (3).

HOW ARE THE BENEFITS OF NATURE FOR WELLBEING BEING RE ALISED? The relationship is being demonstrated through real world projects. Figure 1 below, is a call for volunteers for an environmental and heritage-based project with these objectives at its core. In concert with the research base; using volunteers will engender social cohesion (30) and is an example of the engagement activity advocated by the measures and indicators report (4).

Parks are part of the heritage of the UK and heritage volunteering has been found to be useful for learning social skills and develops a wide range of positive healthy experiences for participants (31).

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Figure 1: Project Splash

In Scotland, investment in woodland restoration was found to have highly positive impacts on quality of life, increases in usage patterns and raised perceptions of the environment in deprived communities (15).

In the southwest, nature prescriptions were made through the NHS, for people with mental health problems. The programme included conservation activities which led to high increases in self-reported wellbeing, higher confidence in participants and a desire to continue post intervention (32).

These projects demonstrate a threefold impact; the environment, the individuals directly involved, and the wider community will all feel the benefits of the projects during and upon completion (31).

WHERE TO TARGET FUNDING Although the relationships in Box 1 are well established, and recent reports advocate the benefits of greenspace for reducing health inequalities (4) disappointingly, the

research does not easily answer questions of where funding should be targeted as it is sometimes contradictory (33) and has built up in an uncoordinated manner (3,34).

Many studies show weak or little association between health and greenspace even in the benefits outlined in box 1, but particularly when linking the wellbeing benefits of the outdoors to health indicators such as body weight (14).

Much research focusses on park users (35) and so improvements which would make greenspaces more inclusive to non-park users merits further understanding (36).

CAUTIONS IN USING THE RESE ARCH A bias in the research base is likely, as studies demonstrating positive relationships are more likely to be published (37). For example, reviews of the literature on nature assisted therapy have shown that no interventions were reported which show a negative effect, and only a few studies have defined a strict therapeutic or intervention pattern (38).

670049493 for which specific life stage or population groups parks have the best impacts (3,11).

Because the relationships (see box 1) are largely correlational, causality should not be drawn from the associations which statistically is not an issue, but this does mean that it cannot be determined which way round the relationship is happening and whether it is the exposure to the environment which is improving health or vice versa (3). Whilst frequently finding strong associations, the research at present, when taken as a whole is still poor in exploring possible evolutionary psychological causes for these associations (39), nor does it explain the important triggers which bring about wellbeing benefits from greenspaces (40).

EVIDENCE SHORTCOMING S It has been noted that despite the growing use of green care, this has as yet, not reduced country level incidence of mental health and other social structures such as family life, monetary issues and work life balance are sure to be having a greater impact on declining public health patterns (41).

The research yields very limited insights into how funding could be prioritised; useful tools to help policy makers and planners such as optimum sizes (5), optimum characteristics of good quality parks (14,42) or optimum doses for green exposure (13) for maximising parks’ wellbeing potential all await firm proposals.

Compounding this, the research currently does not point specifically to which greenspace specific activities (35) have the best results for promoting wellbeing or

Researchers acknowledge that their work often selects people who already use the outdoors (35) ; if the mission is to expand this use, there is more work to do to investigate what attributes may broaden parks appeal to non-users (36). Investment in parks could then benefit a larger number of users.

Wellbeing effects tend to be measured over short time periods (43) and many researchers call for more longitudinal studies which would better assess the benefits over time (44). However, studies have found (45,46), that contact with nature can have longer lasting results for wellbeing, than similar activities undertaken in urban environments, which ostensibly strengthens the case for investing in parks.

However, sustainability of investment remains difficult to determine.

Box 2: Guidance as to how to proceed:

“Rather than waiting until the evidence base is significantly more extensive, there appears to be a strong case for developing more integrated policy and practice across the health and natural environment spheres…

Such policies have the potential to deliver health and wellbeing benefits and strengthen the case for protecting and enhancing the natural environment” Maxwell and Lovell, (2017) (47).

It is easy to be critical of the research on the basis that a common pattern is to find only small effects at the individual level (3,14,43). However, the impact when results

670049493 are extrapolated to the population level is very important (7). This is evidenced by van den Berg (48), who calculated the effects of the incremental improvements shown in her study on the nature-health and wellbeing relationship, demonstrating a seemingly trivial benefit to the individual, is likely to be having a large effect on populations.

3. Local authorities should make activities including park runs, health walks and green gyms (35) available. Events should be driven with an inclusive range of groups within the community of people who face health inequalities and those who do not, to encourage the benefits to be as widely felt as possible (20).

A practical way forward is suggested above (see box 2).

4. Opportunities for external funding (e.g.

HLF) for improvements to parks should be taken to minimise the need to divert funding away from other services which are more likely to have a greater effect on improving health and wellbeing (3,41).

CONCLUSIONS AND POLICY RECOMMENDATIONS Notwithstanding the short comings and cautions to be taken when using the research, the role of nature in health and wellbeing is now recognised at the international policy level through the WHO (49), the central government level (50) and initiatives as outlined earlier, undertaken at the local government level, endorsed by the WHO (51). Estimates of savings to the NHS have been made; access to equitable good green space could save ÂŁ2.1billion per annum (52). However, this is an emerging area and approximations should be treated with caution (47).

POLICY RECOMMENDATIO NS 1. Local authorities should encourage their professionals with responsibilities for parks to network with other local authority professionals; education providers, social workers and community health specialists, to coordinate and promote wellbeing opportunities through utilisation of urban parks (53).

2. Local authorities should work with conservation bodies with an interest in health and wellbeing and nature, to share best practice (54).

5. Opportunities for improvement projects should maximise the use of volunteers and encourage sustainable community involvement in parks with friends groups as this in itself has been shown to be good for wellbeing (30) and would have the additional benefits of reducing costs.

6. Safety within parks has been found to be a key moderating factor for use (3) and so parks as a minimum, should be designed and maintained with appropriate lighting and other mitigating factors which will ensure parks are inviting to all sectors of society, particularly in more deprived areas (17).

670049493 7. Where funding is so constrained that parks cannot be improved, local authorities as a minimum, should protect them and make them as accessible to as many as possible, particularly in underprivileged areas (49).

The policy recommendations are prioritised in fig. 2 below.

Figure 2: Impact Effort Matrix (55) of above Policy Recommendations

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