Green Space and Public Health

TUESDAY, 8 DECEMBER 2020

The COVID-19 pandemic has caused lockdown restrictions to be brought in across the UK to help contain the spread of the virus. Whilst the pathogen itself has certainly affected the health and wellbeing of those infected, the wider public health impacts of the pandemic will extend beyond impacts specific to SARS-CoV-2, the virus that causes COVID-19. Patients requiring non-COVID-related treatments and check-ups may avoid hospitals, meaning many may be left without the care they need. However, an adverse impact that may affect even the healthy is the lockdown-induced lack of access to public green space. Nature provides a whole host of public health benefits, including sustained improvements in mental health, faster postoperative recovery rates, and reductions in health disparities related to socioeconomic inequalities. Affluent areas tend to be greener, whilst people in lower income and minority ethnic groups tend to have less access to natural areas, but removing this disparity has the potential to reduce health inequalities along with it. So, what are the effects of removing people’s access to nature, especially at a time when turning to the natural world for physical and psychological recovery might be more important than ever?

Benefits of green space

Research into the health and wellbeing benefits of green space began in the late 1970s, with Rachel and Stephen Kaplan developing Attention Restoration Theory (ART)¹. They proposed that there are two types of attention: Directed and Involuntary.

Directed attention is the kind we need to make an active effort to maintain, when reading or driving, for example. It is thought that this type of attention is a limited resource, and it can become fatigued as you use it up. Think of trying to concentrate on reading a book for a prolonged period of time. After a while, we find our attention straying and need to take a break. On the other hand, involuntary attention is the kind we pay inadvertently towards things which naturally catch our attention — a tree outside the window swaying in the breeze, colours in a painting, or a fly landing on our desk. The idea is that employing our involuntary attention allows our directed attention to replenish itself.

The Kaplans posited that the natural world is full of stimuli which engage our involuntary attention, so spending time in natural areas allows our directed attention to reload, recharging our cognitive batteries. This makes intuitive sense — going for a walk through the woods or across a meadow when we’re stressed or struggling to be productive usually helps us feel better, and we return to our desks with renewed focus.

This was just the start of the vast body of literature that explores nature’s impacts on people. ART is now supported by numerous studies which show that viewing or spending time in natural landscapes improves concentration, memory, and attention. Several studies show that natural views are associated with improved performance on various cognitive tests, including proofreading activities², digit recall³, and attention to detail⁴. These measures of attentional functioning have been linked to behaviour; playing in greener areas is associated with reduced severity of ADHD symptoms in diagnosed children, compared with those who play in more artificial urban surroundings⁵.

We also know that moving to a greener residential area is associated with sustained improvements in mental health which last for at least three years after the move⁶. In fact, the odds of developing a major depressive disorder drop by 4% with a set amount of increase in greenness, as measured by the Normalised Difference Vegetation Index (NDVI)⁷.

There are also myriad physiological benefits associated with spending time in nature. For example, the risk of developing stress-related diseases, such as cardiovascular disease, decreases with increased access to green space⁸. A key early study in this discipline was produced by Roger Ulrich in 1984⁹. He looked at the recovery of 46 patients following gall-bladder removal at a suburban hospital in Pennsylvania. Half of the patients were assigned randomly to a bed with a view out onto trees, whilst the other half looked out onto a brick wall. Those with the natural view were given fewer doses of analgesics after the operation, suffered fewer postoperative complications, and were discharged from hospital sooner.

Effects on the immune system are also prevalent. In Japan, the idea of shinrin-yoku, literally translated as ‘forest bathing’, is a common practice, and researchers here have found that spending time in woodlands leads to decreased adrenaline levels and increased natural killer cell activity, which is key in our immune response¹⁰.

Finally, use of green space in education is also associated with a wealth of benefits — better educational attainment¹¹, improvements in behaviour and concentration¹², and an increase in engagement and enthusiasm for learning¹³. The recent forced switch to home schooling across the UK in the light of COVID-19 has brought the benefits of outdoor learning to the attention of parents across the country¹⁴.

Inequity in access

However, these benefits are not felt equally across demographic groups. Those with greater levels of stress, from lower income backgrounds, or with less contact with the natural world tend to experience the largest benefits¹⁵. Unfortunately, we also know that people from these groups are the least likely to visit green spaces on a regular basis16. Furthermore, in the UK, those from Black, Asian, or other minority ethnic groups are less likely to access high-quality natural areas in comparison with the rest of the population. Just 56% of under-16s from these communities visit the natural environment once a week, versus 74% of under-16s from white households¹⁷. The reasons behind this inequality of access are many and complex, and include, but are by no means restricted to, differential engagement with conservation organisations through tradition, membership fees, representation within these institutions, differential provision of green space in residential areas, and prejudices and expectations on different cultural groups, which mean that these individuals often do not feel welcome or accepted within conservation or nature communities¹⁸.

Increasing connection to nature amongst these demographics is likely to lead to a reduction in health disparities related to socioeconomic inequalities. Research by Richard Mitchell and Frank Popham in 2008 looked at all-cause mortality, and mortality from circulatory diseases, across groups with different incomes and levels of access to green space¹⁹. First of all, they found that the groups with the lowest access to nature had the highest mortality rates. Secondly, when accounting for different income groups, the difference in mortality rates between the highest and lowest earners was significantly reduced in the group with greatest access to green space. In other words, having a greener local area acted as a buffer which reduced health disparities related to socioeconomic inequalities.

What does all this mean in the context of COVID-19?

Given the higher death rates from COVID-19 amongst lower-income and ethnic minority groups²⁰, differential access to green space is likely to exacerbate this trend further, long after the initial effects of the pandemic have been contained. This is because the lockdown restrictions have confined people to the green space to which they have immediate access, either to a garden or a local green space in our immediate area. Couple this with the fact that lower socioeconomic groups are less likely to have access to both kinds of green space — home and local — and we can see that the lockdown restrictions are likely to exacerbate the health disparities related to socioeconomic inequality already in existence.

When it comes to children, plenty have been stuck at home without a garden or local park in which to expend excess energy, or to use as part of a home-schooling regime. This is likely to have exacerbated differences in educational attainment already apparent between different socioeconomic groups²¹, as well as the health inequalities.

Research has shown that greater access and engagement with the natural world during childhood is associated with better mental health as adults and with a greater connection to nature later in life²². Depriving those children with already limited access to green space is likely to have negative effects for years down the line, long after the pandemic has run its course.

The new normal

Perhaps this is the impetus policymakers have been waiting for in order to start prioritising green space and nature in the planning of urban areas. Perhaps, as well as legal population density limits, a set amount of green space should be provided for a set number of people in urban developments. Perhaps interaction with the natural world should be included in the national curriculum for all ages, so that schools have the justification they need to spend some of their limited funds on greening up their playgrounds and taking lessons outside. This, at least, would allow vulnerable children to access green space whilst at school.

As for so many issues, the COVID-19 pandemic seems to be leading to a shift in attitudes. Maybe, as we move out of pandemic mode, there will be a renewed desire for nature for all in the new normal. Maybe, finally, this growing body of literature exploring the benefits of nature for public health will become central to urban planning and public health policy.

Kate Howlett is a third-year PhD student in zoology at Newnham College.

References:

[BACK] Kaplan, R., Kaplan, S. (1989). The Experience of Nature: A psychological perspective. New York: Cambridge University Press.
[BACK] Hartig, T., Mang, M., Evans, G.W. (1991). ‘Restorative effects of natural environment experiences’. Environment and Behavior. 23 (1). 3-26.
[BACK] Wang, X., Rodiek, S., Wu, C., Chen, Y., Li, Y. (2016). ‘Stress recovery and restorative effects of viewing different urban park scenes in Shanghai, China’. Urban Forestry & Urban Greening. 15. 112-122.
[BACK] Tennessen, C.M., Cimprich, B. (1995). ‘Views to nature: Effects on attention’. Journal of Environmental Psychology. 15. 77-85.
[BACK] Kuo, F.E., Taylor, A.F. (2004). ‘A potential natural treatment for attention-deficit/hyperactivity disorder: Evidence from a national study’. American Journal of Public Health. 94 (9). 1580-1586.
[BACK] Alcock, I., White, M.P., Wheeler, B.W., Fleming, L.E., Depledge, M.H. (2014). ‘Longitudinal effects on mental health of moving to greener and less green urban areas’. Environmental Science & Technology. 48. 1247-1255.
[BACK] Sarkar, C., Webster, C., Gallacher, J. (2018). ‘Residential greenness and prevalence of major depressive disorders: a cross-sectional, observational, associational study of 94,879 adult UK Biobank participants’. The Lancet Planetary Health. 2 (4). e162-e173.
[BACK] Vienneau, D., de Hoogh, K., Faeh, D., Kaufmann, M., Wunderli, J.M., Röösli, M., The SND Study Group. (2017). ‘More than clean air and tranquility: Residential green is independently associated with decreasing mortality’. Environment International. 108. 176-184.
[BACK] Ulrich, R.S. (1984). ‘View through a window may influence recovery from surgery’. Science. 224 (4647). 420-421.
[BACK] Song, C., Ikei, H., Miyazaki, Y. (2016). ‘Physiological effects of nature therapy: A review of the research in Japan’. International Journal of Environmental Research and Public Health. 13 (781). 1-17.
[BACK] Browning, M., Rigolon, A. (2019). ‘School green space and its impact on academic performance: A systematic literature review’. International Journal of Environmental Research and Public Health. 16 (429). 1-23.
[BACK] Bates, C., Bohnert, A., Gerstein, D. (2018). ‘Green schoolyards in low-income urban neighbourhoods: Natural spaces for positive youth development outcomes’. Frontiers in Psychology. 9. 805.
[BACK] Quibell, T., Charlton, J., Law, J. (2017). ‘Wilderness Schooling: A controlled trial of the impact of an outdoor education programme on attainment outcomes in primary school pupils’. British Educational Research Journal. 43 (3). 572-587.
[BACK] Lemmey, T. (2020). Connection with nature in the UK during the COVID-19 lockdown. Centre for National Parks & Protected Areas, University of Cumbria.
[BACK] The Wildlife Trusts, University of Derby. (2019). 30 Days Wild: A Five-Year Review.
[BACK] Strife, S., Downey, L. (2009). ‘Childhood development and access to nature: A new direction for environmental inequality research’. Organization & Environment. 22 (1). 99-122.
[BACK] Hunt, A., Stewart, D., Burt, J., Dillon, J. (2016). Monitor of Engagement with the Natural Environment: A pilot to develop an indicator of visits to the natural environment by children - Results from years 1 and 2 (March 2013 to February 2015). Natural England Commissioned Reports, Number208.
[BACK] Redway, J. (2020). ‘Diversity in birding: Why it matters’. BTO - British Trust for Ornithology.
[BACK] Mitchell, R., Popham, F. (2008). ‘Effect of exposure to natural environment on health inequalities: An observational population study’. The Lancet. 372 (9650). 1655-1660.
[BACK] Office for National Statistics. (2020). Coronavirus COVID-19 related deaths by ethnic group, England and Wales: 2 March 2020 to 10 April 2020.
[BACK] Cullinane, C., Montacute, R. (2020). COVID-19 and social mobility impact brief #1: School shutdown. The Sutton Trust.
[BACK] Wells, N.M., Lekies, K.S. (2006). ‘Nature and the life course: Pathways from childhood nature experiences to adult environmentalism’. Children, Youth and Environments. 16 (1). 1-24.