The report ‘Health and the natural environment: A review of evidence, policy, practice and opportunities for the future’ and associated Research Briefing and Evidence Statement are published by Defra (Defra Project Code BE0109) and are available from the Department’s Science and Research Projects Database at http://randd.defra.gov.uk.
This excellent and extensive report by Dr Rebecca Lovell and Professor Michael Depledge of the European Centre for Environment and Human Health at University of Exeter Medical School and Dr Simon Maxwell of the Department for Environment, Food and Rural Affairs focused on the interconnections between the natural environment and health, and the ways in which these are, or could be harnessed in policy and practice.
The aims of the project were to:
- Clarify what is known about the linkages between natural environments and health, to characterise how different social groups understand the health potential of the natural environment, and to examine the factors that may facilitate or prevent the realisation of those benefits;
- Evaluate how evidence of the value of natural environments to health is recognised, taken into account by, and incorporated into existing policy and practice;
- Identify effective and promising opportunities to act on the value of natural environments to promote better health.
The report recognises that there are many organisations involved in activity which aims to recognise, promote or harness the health potential of the natural environment, including governmental departments, research institutions, funding bodies, 3rd sector and civil society organisations, and the private and commercial sector. The Landscape Institute is identified amongst a comprehensive list of cross-sectoral organisations, professional bodies and networks.
A key opportunity for the Landscape profession is identified in the section that identifies the most promising opportunities and strategies to act on the potential of natural environments to promote better health.
“Improve the amount, quality, standards and accessibility of urban natural environments. Some of the strongest and most robust associations relate to the positive health outcomes of living in areas with a greater amount of good quality natural environment. Strategies could include working with local authorities and other environmental managers to develop standards for health promoting natural environments and identifying the additional and interactive role of urban greenspaces in delivering wider policies and programmes (e.g. health or education).”
The report establishes evidence of the linkages between natural environments and health by commenting that there is,
” ….a growing body of evidence regarding the effectiveness of specific natural environment related interventions. Newly emerging evidence is clarifying how the siting, design or maintenance of natural environments (particularly in urban areas) can enhance health, however the results are mixed. Interventions which have sought to encourage health related access or engagement with, or which have used the environment as a setting to promote health (preventative or therapeutic), have typically resulted in positive impacts to outcomes such as mental health, quality of life and to behaviours such as physical activity.”
1. There is evidence of positive associations (after controlling for confounding factors) between living in greener environments and a range of physical, mental and developmental outcomes and reduced health inequality. There is also a growing body of evidence demonstrating the effectiveness of the use natural environments as a setting for specific health interventions and that these interventions can be cost-effective
2. There are gaps in the evidence base, these relate to mechanisms and causal linkages, and to variation in effect according to environment (location, type and quality), population or intervention. However, there is much ongoing multi-disciplinary work which may address these questions. There is a new emphasis on producing evidence suitable to inform future decision making.
3. People value the natural environment for its role in helping achieve and maintain better health. In the UK the natural environment’s contribution to health is culturally important. Perceptions of the benefits of the natural environment differ according to socio-cultural group, geographical and political context, and through the life course, however this is less well understood.
4. There is considerable interest, predominantly from 3rd sector and research organisations but also from national and local government, in finding effective ways to harness the potential of the natural environment to promote health. This relates to a tangible recognition that the environment represents an underutilised resource. Examples of activity include local health projects making use of natural environments as a health promotion setting, to regional or national scale multi-sectoral efforts to coordinate programmes of interventions. However, existing activity is often disjointed, short term and opportunities to learn valuable lessons are missed. The multi-sectoral nature of the issues and activities means the potential of the natural environment to contribute to health is, arguably, ‘falling through the cracks’.
5. The key constraints of activity are often structural, relating to the organisation and procedures of government (local and national) or institutions. Other barriers to activity relate to: the perception of the peripherality of the environment to health; reorganisations of institutions and the loss of networks and knowledge; difficulties in demonstrating impacts and outcomes of environment-health interventions; and the constrained budgets and (perceived) rigidity of the health and social care system.
6. As current policy and practice display characteristics of ‘complex adaptive systems’, future activities should involve multiple partners, policy instruments and delivery methods at a variety of scales. Key strategies to increase recognition and activity regarding the health values of natural environments relate to: i) improving the evidence base and increasing evaluative activity; ii) identifying and facilitating key intervention and delivery options; and iii) focusing on the structures and systems in which decision making and delivery takes place.
Possible areas for further research
Despite the growing evidence of positive and significant impacts of the natural environment on a variety of health outcomes, there a number of limitations to the current evidence base, these relate to the scope and extent of specific bodies of the research, the quality of the methodologies used, and the reliability and transferability of findings. Key evidence needs relate to:
- A greater understanding of the socio-cultural and temporal factors within environment-health relationships and of the heterogeneity and consistency of outcomes.
- The necessary conditions for natural environments to be effective in promoting health, and the contexts, settings and life stages during which interventions to promote the health benefits of natural environments are most effective.
- The role of the natural environment in promoting individual or community health related resilience (particularly in relation to multiple deprivation).
- The factors or interventions that are effective in encouraging health related use of the natural environment and how this can be achieved without exacerbating health inequalities.
- Clarification of how the links between natural environments and health are understood and acted upon by professionals or within institutions, for instance, in relation to the acceptability of green prescription approaches.
A research briefing of the final report can be read here.