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A1. Greenness and physical health

Health benefits of urban tree canopy

Aims and method:

Investigates the health-promoting potential of trees in an urbanised region of the United States. Utilises high-resolution LiDAR and imagery data to quantify tree cover within 250 yards of the residence of 7910 adult participants, and establishes the main and mediating associations between tree cover and multiple health measures care of the California Health Interview Survey.

Key findings:

· The results indicated that more neighbourhood tree cover, independent from green space access, was related to better overall health

· This is primarily mediated by lower overweight / obesity and better social cohesion, and to a lesser extent by less type two diabetes, high blood pressure, and asthma.

Reference:

Ulmer, J. M., Wolf, K. L., Backman, D. R., Tretheway, R. L., Blain, C. J., O’Neil-Dunne, J. P., & Frank, L. D. (2016). Multiple health benefits of urban tree canopy: The mounting evidence for a green prescription. Health & Place, 42, 54-62.

http://www.sciencedirect.com/science/article/pii/S1353829216301332

Green space benefits by socio-economic group

Aims and method:

Investigates the strength of the relation between the amount of green space in people’s living environment and their perceived general health. This relation is analysed for different ages and socioeconomic groups. It is also analysed separately for urban and more rural areas, because the strength of the relation was expected to vary with urbanity. Multilevel logistic regression analyses were performed at three levels – individual level, family level, and practice level – controlled for socio-demographic characteristics.

Key findings:

· The percentage of green space within a one kilometre and three kilometre radius had a significant relation to perceived general health. The relation was generally present at all degrees of urbanity.

· The overall relation is stronger for lower socio-economic groups.

· Elderly, youth, and secondary educated people in large cities seem to benefit more from the presence of green areas in their living environment than other groups in large cities.

Reference:

Maas, J., Verheij, R. A., Groenewegen, P. P., De Vries, S., & Spreeuwenberg, P. (2006). Green space, urbanity, and health: how strong is the relation?. Journal of epidemiology and community health, 60(7), 587-592.

http://jech.bmj.com/content/60/7/587.short

Urban green spaces and health

Aims and method:

This World Health Organisation (WHO) report summarises the available evidence of beneficial effects of urban green spaces on health. It draws together a large body of evidence in support of the Global Sustainable Development Goals

Key findings:

· The finding shows how urban green spaces improved mental health, reduced cardiovascular morbidity and mortality, obesity and risk of type two diabetes, and improved pregnancy outcomes.

· Mechanisms leading to these health benefits include psychological relaxation and stress alleviation, increased physical activity, reduced exposure to air pollutants, noise and excess heat.

Reference:

World Health Organisation. (2016). Urban Green Spaces and Health–A Review of Evidence. Geneva, Switzerland: WHO.

http://www.euro.who.int/en/health-topics/environment-and-health/urban-health/publications/2016/urban-green-spaces-and-health-a-review-of-evidence-2016

The health benefits of urban green spaces

Aims and method:

Reviews the evidence of health benefits of urban green spaces. A search of academic and grey literature was conducted for studies and reviews of the health effects of green space. Articles found were appraised for their relevance, critically reviewed and graded accordingly.

Key findings:

· Environmental factors such as the quality and accessibility of green space affects its use for physical activity. User determinants, such as age, gender, ethnicity and the perception of safety, are also important

· In 2010 the evidence for the links between physical, mental health and well-being, and urban green space was still weak and many studies were limited by poor study design, failure to exclude confounding, bias or reverse causality and weak statistical associations.

Reference:

Lee, A. C., & Maheswaran, R. (2011). The health benefits of urban green spaces: a review of the evidence. Journal of public health, 33(2), 212-222.

https://academic.oup.com/jpubhealth/article/33/2/212/1585136

Greenspace and self-reported health

Aims and method:

Explores a hypothesis that people are healthier in greener areas. Empirically tested by combining Dutch data on the self-reported health of over 10,000 people with land-use data on the amount of green space in their living environment.

Key findings:

· Living in a green environment was positively related to health indicators at the municipal level.

· Relationship between green space and one of the health indicators was somewhat stronger for homemakers and the elderly, two groups that are assumed to be more dependent on, and therefore exposed to, the local environment.

· For all the applied health indicators the relationship with green space was somewhat stronger for lower educated people.

Reference:

De Vries, S., Verheij, R. A., Groenewegen, P. P., & Spreeuwenberg, P. (2003). Natural environments—healthy environments? An exploratory analysis of the relationship between green space and health. Environment and planning A, 35(10), 1717-1731.

http://journals.sagepub.com/doi/abs/10.1068/a35111

Urban park accessibility, physical activity and mental health

Aims and method:

Examines the impact of different activities engaged in during park use on positive mental health. The researchers conducted a questionnaire survey to investigate respondents' physical activity status, self-reported mental health and the relationship with urban parks.

Key findings:

· Park accessibility within 500 m of homes and park use were significantly correlated with resident’s physical activity.

· Physical activity and nature interaction in parks were positively correlated with multiple mental health benefits.

· People reported the greatest improvements in self-confidence (69.9), followed by energy levels (61.4), self-perceived health (60.0), mood restoration (52.0) and relaxation (37.8)

Reference:

Liu, H., Li, F., Li, J., & Zhang, Y. (2017). The relationships between urban parks, residents' physical activity, and mental health benefits: A case study from Beijing, China. Journal of environmental management, 190, 223-230.

http://www.sciencedirect.com/science/article/pii/S0301479716310416

Green walkability and physical activity

Aims and method:

The study investigated associations of walkability and green walkability with physical activity in an urban adult cohort. It drew on cross-sectional data from Greater London UK Biobank participants (n = 57,726) and assessed walkability along roads and footpaths within 1000 m of their residential addresses. Green walkability was assessed by integrating trees and low-lying vegetation into the walkability index. Physical activity outcomes included self-reported and accelerometer-measured physical activity and active transport. Associations were assessed using log-linear, logistic and linear regression models, adjusted for individual- and area-level confounders.

Key findings:

· Higher green walkability was associated with favourable International Physical Activity Questionnaire responses and achievement of weekly UK government physical activity guideline recommendations.

· Participants living in the highest versus lowest quintile of green walkability participated in 2.41 min additional minutes of moderate-and-vigorous physical activity per day.

· Higher walkability and green walkability scores were also associated with choosing active transport modes such as walking and cycling.

Reference:

Roscoe, C., Sheridan, C., Geneshka, M., Hodgson, S., Vineis, P., Gulliver, J., & Fecht, D. (2022). Green Walkability and Physical Activity in UK Biobank: A Cross-Sectional Analysis of Adults in Greater London. International Journal of Environmental Research and Public Health, 19(7), 4247.

https://doi.org/10.3390/ijerph19074247

Urban green infrastructure, heat island effect, and health impact

Aims and method:

The research estimated the mortality burden that could be attributed to urban heat islands and the mortality burden that would be prevented by increasing urban tree coverage in 93 European cities. A quantitative health impact assessment in the summer 2015 demonstrated the effect of urban heat islands on all-cause mortality for adults aged 20 years or older in 93 European cities. The temperature reductions that would result from increasing tree coverage to 30% for each city and the number of deaths that could be potentially prevented as a result were estimated.

Key findings:

· Urban heat islands had deleterious effects of on mortality.

· Increasing tree coverage by 30% to cool urban environments had health benefits equivalent to a 1.84% reduction in all summer deaths (or 2644 deaths across the cities studied)

Reference:

Lungman, T., Cirach, M., Marando, F., Pereira Barboza, E., Khomenko, S., Masselot, P., Quijal-Zamorano, M., Mueller, N., Gasparrini, A., Urquiza, J., Heris, M., Thondoo, M., & Nieuwenhuijsen, M. (2023). Cooling cities through urban green infrastructure: a health impact assessment of European cities. Lancet, 401(10376), 577–589.

https://doi.org/10.1016/s0140-6736(22)02585-5

Green space quality and health

Aims and method:

The research conducted a systematic review to examine whether particular green space types and qualities have been shown to provide health benefits and if so, which specific types and qualities, and which health outcomes. Five databases were searched and all studies examining a wide range of green space characteristics on various health outcomes were included.

Key findings:

· Environment types, vegetation types, and the size and connectivity of green spaces were associated with improved health outcomes though with contingencies by age and gender.

· Health benefits were more consistently observed in areas with greater tree canopy, but not grassland.

· The main outcomes with evidence of health benefits included allergic respiratory conditions, cardiovascular conditions and psychological wellbeing.

· Both objectively and subjectively measured qualities demonstrated associations with health outcomes.

· Evidence was lacking for needs-specific or culturally appropriate amenities and soundscape characteristics.

Reference:

Nguyen, P.-Y., Astell-Burt, T., Rahimi-Ardabili, H., & Feng, X. (2021). Green Space Quality and Health: A Systematic Review. International Journal of Environmental Research and Public Health, 18(21), 11028. https://doi.org/10.3390/ijerph182111028

Green space and mortality

Aims and method:

The research estimated the number of natural-cause deaths among adult residents that could be prevented in cities in 31 European countries if the WHO recommendation for universal access to green space was achieved. A quantitative health impact assessment was conducted at the grid-cell level based on the GHSL population layer to estimate the impact of insufficient exposure to green space on natural-cause mortality for the European city inhabitants.

Key findings:

· By meeting the WHO recommendation for access to green space, a large number of premature deaths in European cities could be prevented, while contributing to sustainable, liveable and healthy cities.

· This would be equivalent to 2.3% of the total natural mortality or 245 years of life lost per 100,000 inhabitants

Reference:

Barboza, E. P., Cirach, M., Khomenko, S., Iungman, T., Mueller, N., Barrera-Gómez, J., Rojas-Rueda, D., Kondo, M., & Nieuwenhuijsen, M. (2021). Green space and mortality in European cities: a health impact assessment study. The Lancet. Planetary Health, 5(10), e718–e730.

https://doi.org/10.1016/S2542-5196(21)00229-1

Urban greenness and mortality

Aims and method:

A national study in Canada examined the impact of urban greenness on mortality. Data came from a large cohort study of about 1.3 million adult, non-immigrant urban Canadians in 30 cities who answered the mandatory 2001 Statistics Canada long-form census.

Key findings:

· Increased amounts of residential greenness reduced risks of dying from several common causes of death among urban Canadians.

· Inequalities existed in terms of exposures to greenness and mortality risks by personal socioeconomic status among individuals living in generally similar environments with reasonably similar access to health care and other social services.

Reference:

Crouse, D. L., Pinault, L., Balram, A., Hystad, P., Peters, P. A., Chen, H., van Donkelaar, A., Martin, R. V., Ménard, R., Robichaud, A., & Villeneuve, P. J. (2017). Urban greenness and mortality in Canada’s largest cities: a national cohort study. The Lancet. Planetary Health, 1(7), e289–e297.

https://doi.org/10.1016/S2542-5196(17)30118-3

Green space and health and wellbeing during the COVID-19 pandemic

Aims and method:

The research explored the role of both public and private green space on subjective health and wellbeing during and after the first peak of the COVID-19 outbreak in the UK in the first half of 2020. The study used the longitudinal COVID-19 Public Experiences study, with baseline data collected in March/April 2020 and follow-up data collected in June/July 2020.

Key findings:

· Both perceived access to public green space and reported access to private green space were associated with better subjective wellbeing and self-rated health.

· Private gardens had a greater protective effect where the nearest green space was perceived to be more than a 10-minute walk away.

· Both public and private green spaces are an important resource for health and wellbeing in times of crisis.

Reference:

Poortinga, W., Bird, N., Hallingberg, B., Phillips, R., & Williams, D. (2021). The role of perceived public and private green space in subjective health and wellbeing during and after the first peak of the COVID-19 outbreak. Landscape and Urban Planning, 211, Article 104092.

https://doi.org/10.1016/j.landurbplan.2021.104092

Home garden use during COVID-19 and older adults’ physical and mental wellbeing

Aims and method:

The research examined whether home garden usage is associated with self-reported mental and physical wellbeing in older adults during the COVID-19 lockdown. The study analysed data from 171 individuals from Scotland who completed an online survey two months after lockdown.

Key findings:

· Higher frequency of garden usage during lockdown was associated with better self-rated physical health, emotional and mental health, sleep quality, and a composite health score.

· Spending time in a garden has positive health benefits although the associations may be bidirectional.

· Domestic gardens could be a potential health resource during pandemics.

Reference:

Corley, J., Okely, J. A., Taylor, A. M., Page, D., Welstead, M., Skarabela, B., Redmond, P., Cox, S. R., & Russ, T. C. (2021). Home garden use during COVID-19: Associations with physical and mental wellbeing in older adults. Journal of Environmental Psychology, 73, Article 101545.

https://doi.org/10.1016/j.jenvp.2020.101545

Urban parks and health benefits during the COVID-19 pandemic

Aims and method:

The research discussed the benefits of urban parks on residents’ health during the COVID-19 pandemic. The research drew on a survey conducted in April 2020; it collected 386 responses from residents of Chengdu, China, during the pandemic based on an online survey questionnaire.

Key findings:

· Visiting urban parks can significantly improve overall health and assist in meeting individuals’ social interaction needs.

· Although residents had reduced the frequency of park visits during the pandemic, even once a week was seen as beneficial.

· Urban parks and large outdoor, open spaces can provide residents with a place for safe outdoor activities and social interactions in a green environment during a pandemic, and can serve as a buffer area to maintain favourable health.

Reference:

Xie, J., Luo, S., Furuya, K., & Sun, D. (2020). Urban Parks as Green Buffers During the COVID-19 Pandemic. Sustainability, 12(17), 6751.

https://doi.org/10.3390/su12176751

Physical health benefits of green space for different socioeconomic groups

Aims and method:

The research examined whether green space showed stronger associations with physical health for disadvantaged groups than for privileged groups. It reviewed 90 qualifying articles examining whether socioeconomic status or race/ethnicity modify the green space-health association.

Key findings:

· Lower socioeconomic status people show more beneficial effects than affluent people, particularly when concerning public spaces/parks rather than green land cover/greenness.

· There are no notable differences in the protective effects of green space between racial/ethnic groups.

· Green space might be a tool to advance health equity and provide ways forward to address health disparities.

Reference:

Rigolon, A., Browning, M. H. E. M., McAnirlin, O., & Yoon, H. (2021). Green Space and Health Equity: A Systematic Review on the Potential of Green Space to Reduce Health Disparities. International Journal of Environmental Research and Public Health, 18(5), 2563.

https://doi.org/10.3390/ijerph18052563

Older adults’ perception and usage of green space

Aims and method:

The study investigated the interrelationships between older adults’ perception and usage of urban green space and how the perception and usage of urban green space are related to older adults’ self-rated health in three different types of urban green space in Hong Kong. 462 questionnaires were conducted on-site by residents aged above 55 to understand their usage pattern, perception on facilities, aesthetics, accessibility and safety aspects of urban green space.

Key findings:

· Older adults’ usage pattern of urban green space varies across age and the types of urban green spaces they visit

· Perceived proximity is a major factor affecting urban green space usage among older adults.

· Longer exposure to urban green space predicts better physical and mental well-being.

· Physical attributes may play a less significant role then other social and community factors in motivating urban green space use in compact urban environments.

Reference:

Lau, K. K.-L., Yung, C. C.-Y., & Tan, Z. (2021). Usage and perception of urban green space of older adults in the high-density city of Hong Kong. Urban Forestry & Urban Greening, 64, Article 127251.

https://doi.org/10.1016/j.ufug.2021.127251

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