Tagged: health and wellbeing

Linking public health with spatial planning

healthy planning

The recently published review, ‘Healthy Planning and Regeneration: innovations in community engagement, policy and monitoring’ states that, ‘There is a growing desire to integrate design and planning measures which are known to support health and wellbeing into policies and projects. Planners want to know what has worked elsewhere and what evidence can be used to support local policies.’

The review, authored by Helen Pineo, Associate Director – Cities, BRE, was commissioned by the Planning Department at Southwark Council for a healthy planning project run jointly with Lambeth Council. The Councils received funding from Guy’s and St. Thomas’s Charity to carry out intensive social research in two regeneration areas.

The review investigates the relationship between place, planning policy and three locally identified health themes of interest: social isolation, obesity and access to health services. The “healthy planning” project led by Southwark and Lambeth combines local knowledge with scientific evidence – this review allows other planning authorities to access evidence and examples of community engagement and policy.

A range of innovative community engagement and planning activities were identified.  The review takes into account the importance of local context and that solutions may not always be transferable; however the overarching message is to recognise the value in engaging local communities to help policies and design respond to local problems and assets.

The review is split into sections:

  • Overview of urban environment health impacts, focused on the health issues outlined in Southwark and Lambeth.
  • Quick reference guide of health impacts and policy/design responses.
  • Summary of the health impact of regeneration projects with some lessons learned from previous large-scale regeneration programmes and a case study example.
  • Innovative ways to engage local communities on place and health. This is organised by types of engagement activities, but there are many examples which mix methods (such as participatory mapping and photography). Readers can pick and choose methods which may work in their area, devising new combinations and hybrid approaches.
  • Overview of local urban health indicator tools which can be used to inform policy development and monitor impact.
  • Further guidance to complement the information reported here.


Principal findings about healthy built environments are: 

Social interaction – The built environment features which affect social isolation and engagement include: residential density; mixed land use; street layout and design; transition between public/private space; environmental cues for crime and safety; greenspace; public transport; and local facilities for leisure and recreation (including cafés, pubs, religious facilities, etc.). Older residents and young mothers may be more socially isolated than other groups. Special efforts may be required to include these groups in consultation activities. Community asset mapping is a useful method for understanding the places and spaces that are important for social engagement.

Physical inactivity – The factors influencing physical inactivity are very similar to those which impact social isolation. There is a positive association between physical activity and net residential density, intersection density, public transport density, and number of parks for adults. Increased urban sprawl and decreased land use mix are positively associated with obesity in some environments. Street design, street lighting, green infrastructure and environmental cues of crime/safety impact physical activity in adults and children. Access to recreational facilities and schools is important for physical activity in children. Traffic density and speed negatively impacts physical activity (especially for children) and leads to greater injuries and fatalities.

Healthy food – Local food habits are influenced by a complex system of social, economic and environmental factors. Children’s diets may be more affected by local convenience stores and fast food outlets than adults’ diets. People living in deprived communities may have a greater number of fast food outlets than more affluent neighbours. Simply providing healthy foods (through grocery stores, farmers’ markets or green grocers) may not change behaviours. Strong engagement with the local community to understand current attitudes and requirements can help make any investments in healthy food access more successful.

Health services – Combining health services and social care services is referred to as ‘integrated care’ but does not always result in the co-location of multiple services. A systematic review found multiple benefits to integrated care including reductions in: non-emergency cases using A&E, average hospital stays, and costs per patient per site visit. A Big Lottery Fund evaluation of Healthy Living Centres found that these facilities had a range of positive benefits in the community including improved health outcomes and attracting target communities.

Key findings about healthy planning practice: 

Building trust – Multiple research and community projects highlighted the importance of building trust when working with local communities, especially on regeneration projects. The methods chosen for gathering local perceptions can impact trust. Particularly in relation to sensitive issues about social isolation and health, consideration should be taken to ensure communities feel comfortable providing their time and knowledge and that they are happy with the way the information will be used. If there is a lack of trust, the appropriate information may not be uncovered in the engagement activity.

Monitoring impact – Evaluating the impact of local policies is a key part of planning practice. Understanding where policies have succeeded or failed allows for continual improvements through planning policy and development management. A number of indicators and assessment tools have been created to support ongoing review of policies. These tools can also inform the creation of new policies, help uncover health/spatial inequalities and demonstrate performance to local communities.

Going beyond business as usual – This review found a range of innovative community engagement and planning practice activities being carried out by health and built environment professionals and academics. However these examples often related to specific major developments or funded projects and do not yet appear to be part of normal planning processes. The healthy planning project led by Southwark and Lambeth represents an innovative approach to planning healthy communities that seeks to combine extensive local knowledge with scientific evidence. Sharing the findings from this review can help other planning authorities’ access up-to-date research evidence and pick and choose from community engagement and policy examples which may work in their area.



Urban Green Space Interventions and Health: Review of impacts and effectiveness.

Urban green space is a necessary component for delivering healthy, sustainable and liveable cities. Green space interventions deliver positive health, social and environmental outcomes for all population groups – particularly among lower socioeconomic status groups. There are few other public health interventions that can achieve this.

The recent World Health Organisation’s report Urban green space interventions and health: A review of impacts and effectiveness. Full report (2017) notes that interventions on green space in urban settings can help address public health issues related to obesity, cardiovascular effects, mental health and well-being. However, knowledge on their effectiveness in relation to health, well-being and equity is incomplete.


The World Health Organisation (WHO), in 2016, published an evidence review on the health impacts of urban green spaces.  Urban green spaces and health – a review of evidence (2016). This report summarizes the health benefits, discusses pathways to health and evaluates health-relevant indicators of urban green space. Such indicators enable local authorities and urban planners to assess in which urban areas green space accessibility should be improved, and to establish respective planning decisions.



What are the most effective ways to deliver urban interventions on green spaces, and how can we guarantee that the environmental, social and health benefits are maximized while potential side effects are prevented or reduced?  WHO has compiled:

  • available research evidence on urban green space interventions and their impacts;
  • local green space intervention case studies and lessons learned;
  • existing Impact Assessment experiences on green space planning.

Results indicate that urban green space is necessary to deliver healthy, sustainable and liveable cities. Interventions to increase or improve urban green space can deliver positive health, social and environmental outcomes for all population groups, particularly among lower socioeconomic status groups. There are very few other public health interventions that can achieve all of this, and especially the impact on active lifestyles, mental well-being and social interaction is frequently highlighted as a key benefit. Yet, there is a need for better inclusion of health and equity outcomes in studies on green space interventions, and an improved monitoring of local green space management and related health and equity impacts. It is equally important to note that there is little evidence available on the unintended side effects of urban green space interventions.

Urban green space interventions seem to be most effective when a physical improvement to the green space is coupled with a social engagement/participation element that promotes the green space and reaches out to new target groups. Evidence shows that multidisciplinary and cross-sectoral collaborations help to ensure that urban green space interventions deliver on multiple outcomes and provide a variety of functional opportunities that attract different population groups.

Urban green space interventions need to be planned and designed with the local community and the intended green space users thus ensuring benefits for the local residents and the delivery of interventions that serve the needs of the community – especially in deprived areas.

As green space interventions need to be considered as long-term investments, they need to be integrated within local development policies and frameworks (e.g. urban masterplans, housing regulations, transport policies, sustainability and biodiversity strategies). This requires continued political support within local government, and the general understanding that urban green spaces go beyond environmental or ecological objectives and also deliver social and health benefits that increase the quality of life and well-being of all urban residents.

Urban Green Space Interventions and Health: A review of impacts and effectiveness – Report Conclusions

Green space should be available to all residents as a part of their daily surroundings. This applies to both small-scale and large-scale green spaces, irrespective of categorizations into private or public spaces or functionalities. Be it the remote view of green space within the neighbourhood, the passive exposure to green space by having a walk by the river or taking a break in a park, or the active use of green spaces through e.g. play, leisure or gardening – all kinds of urban green space should be promoted through urban planning and governance across all sectors

Multidisciplinary and cross-sectoral collaborations will help to ensure that urban green space interventions deliver on multiple outcomes. Urban green space interventions are most effective when a dual approach is adopted where a physical improvement to the environment is coupled with a social engagement/participation element promoting the use of the green space.

Urban green space interventions need to be situated within the overall context of the urban area and integrated within the relevant strategies, frameworks and plans (e.g. urban masterplans, health and transport policies, sustainability and biodiversity strategies). Good design, implementation and maintenance of urban green space interventions will mitigate any potential adverse outcomes from the intervention and maximize their benefits.

Urban green space interventions need to be planned and designed with the local community and the intended green space users. This will ensure the derivation of benefits for the local community and will aid the delivery of interventions that serve the needs of the community – especially in deprived areas.

Barcelona Research: links between green infrastructure, exercise and urban mortality rates



Urban and Transport Planning Related Exposures and Mortality: A Health Impact Assessment for Cities. ­Environ Health Perspect; http://dx.doi.org/10.1289/EHP220

Researchers have estimated that, annually, almost 3 000 deaths (i.e. 20% of mortality) in Barcelona, Spain, are premature, and would be preventable if residents lived in urban environments that met international exposure recommendations for physical activity, air pollution, noise, heat and access to green spaces. The results emphasise the need to reduce motorised traffic, promote active and public transport, and provide adequate green space to encourage exercise and mitigate the impacts of environmental hazards in cities.

By 2050 almost 70% of people are projected to live in urban environments globally. Certain aspects of urban living, including contemporary car-centric city designs, contribute to a sedentary lifestyle and high levels of air pollution and noise, which are known to contribute to premature death. In addition, cities experience increased heat exposure due to human activities and heat-amplifying effects of the built environment.

Green infrastructure – such as parks, urban gardens and surrounding greenness – can reduce the impacts of these environmental risks and provides well-known benefits for physical and mental health.

In this study, researchers estimated the difference between actual and recommended levels of physical inactivity, exposure to air pollution, noise, heat and insufficient access to green spaces in Barcelona. Barcelona has one of the highest air pollution and noise levels in Europe due to high traffic density, with a high proportion of diesel vehicles, and an urban design of narrow street canyons (where streets are flanked by buildings on both sides) that are shielded by dense construction. The city centre can be up to 8 °C hotter than surrounding areas during summer months and only 7 m2 of green space is available per resident; green spaces provide benefits in heat reduction and can mitigate traffic noise and possibly air pollution.

The researchers modelled preventable premature mortality and the increase in life expectancy for Barcelona residents if international recommendations for performance of physical activity and exposure to air pollution, noise, heat and provision of green spaces were met.

The researchers used existing international exposure recommendations as follows: physical activity – 150 minutes of moderate intensity or 75 minutes of vigorous intensity aerobic activity per week (World Health Organization — WHO); noise – daytime noise levels not exceeding 55 decibels (dB) (WHO); air pollution – annual mean particulate matter less than 2.5 micrometers in diameter (PM2.5) not exceeding 10 micrograms per cubic metre of air (µg/m3) (WHO).

Despite no recommendation being available for temperature, it is believed that with changes to the urban plan, such as increasing urban greenery, reducing motorised traffic and improving building design, a cooling effect of up to 4 ºC can be achieved1. The recommendation on availability of green spaces was taken from the European Commission’s working group ‘Measuring, Monitoring and Evaluation in Local Sustainability2 and the WHO, who both recommend living within 300 m of green space greater than 0.5 hectares in size.

Data on current exposure levels for Barcelona residents were taken for: (1) physical activity, from the 2011 Barcelona Health Survey; (2) air pollution, from the European Study of Cohorts for Air Pollution Effects (ESCAPE LUR) 2012; (3) noise, from Barcelona’s strategic noise map, 2006 (4) daily mean temperatures for Barcelona from 2009–2014, from the European Climate Assessment and Dataset (Klein Tan 2002) and (5) green space land use, from Urban Atlas, 2007.

The results indicated that over 70% of adults in Barcelona are insufficiently active. Air pollution and traffic noise levels (average current exposure is 16.6 µg/m3 of PM2.5 for air pollution and 65 dB for noise) far exceeded the recommended levels. Summer temperatures in the city exceeded the calculated threshold level on approximately 100 days per year and one third of the population did not live within the recommended distance of a green space.

The researchers estimated that 2 904 premature deaths could be prevented annually if all recommendations were met. This is almost 20% of all annual natural deaths in the city. The largest share of preventable deaths was attributed to insufficient physical activity (1 154 deaths), followed by air pollution (659 deaths), traffic noise (599 deaths) and heat (376 deaths). Access to green spaces was estimated to have the smallest impact on reducing premature mortality (116 deaths).

If these premature deaths were prevented, residents could expect to live, on average, 360 days longer. This benefit to society is valued at around €9.1 billion annually (based on the value-of-statistical-life approach (VoSL) — the amount of money people are willing to spend to save a statistical life).

The researchers acknowledge that the combined effects of the different environmental hazards were not modelled, resulting in potential double counting of deaths. On the other hand, air pollution deaths may also have been underestimated, as certain pollutants, such as nitrogen dioxides, were not considered in this study.

The researchers also acknowledge the limited scientific evidence on the adverse health impacts of noise exposure and beneficial impacts of green spaces. They also point out that the contextual setting and underlying population parameters, such as the general health of the population, personal choices, motivation for behavioural change and time lags between a change and a benefit in any given location, affect human health and the risk of death.

The research, however, does contribute to the understanding of multiple environmental exposures and associated health impacts in an urban setting. The researchers recommend fundamental changes to urban and transport planning. In particular, the use of active and public transport as a means of integrating physical activity into daily life is encouraged and is believed to provide numerous health benefits. Policies to reduce motorised traffic and promote active and cleaner modes of transport should therefore be prioritised. Reinforcement of green infrastructure can also promote engagement in physical activity, mitigate air pollution, noise and heat and has been associated with improvements in mental health, biodiversity and community benefits.

1. Doick et al. (2014)Zhao et al. (2014)

2. Working Groups on Measuring, Monitoring and Evaluation in Local Sustainability, Expert Group on the Urban Environment. Towards a Local Sustainability Profile: European Common Indicators. Technical Report. European Commission, 2001.

Source: Mueller, N., Rojas-Rueda, D., Basagaña X., Cirach, M., Cole-Hunter, T., Dadvand, P., Donaire-Gonzalez, D., Foraster, M., Gascon, M., Martinez, D., Tonne, C., Triguero-Mas, M., Valentín, A. & Nieuwenhuijsen, M. (2016) Urban and transport planning related exposures and mortality: a health impact assessment for cities. Environmental Health Perspectives. DOI: 10.1289/EHP220.

Contact: natalie.mueller@isglobal.org


Research: Natural capital accounting in urban parks


Public parks and green spaces provide benefits worth over a billion pounds and are not the liability they appear in conventional public accounts, a new study reveals. Research published by the National Trust shows parks provide benefits worth £1.2bn, through the contribution they make to residents’ physical and mental wellbeing. This goes against the conventional wisdom—derived from how they appear in public accounts—that they are a £16m liability.

Heritage Lottery Fund research has shown many councils face cuts to their parks budgets of up to 20%, with some facing cuts of 50-100% by 2020. The House of Commons Communities and Local Government Committee has begun hearing evidence for their inquiry into the funding crisis facing public parks.Vivid Economic’s Director Robin Smale urged MPs to consider the wider public benefits that are derived from parks and green spaces rather than their immediate financial cost.

‘Parks generate a large surplus for society in contrast to the financial liability that they appear to be in local authority financial statements,’ he said. ‘It’s essential that decisions about our parks are based on comprehensive and balanced financial accounts, which incorporate the full value of public services. Reliance on the very partial expenditure and revenue records available to local authorities will be against the public interest.’  Robin Smale, Director Vivid Economics.

The ‘Natural capital accounting in urban parks’ a report by Vivid Economics for The National Trust, highlights the public benefits of parks, most importantly for the physical and mental health of local residents. The briefing, detailed below, takes the simple but powerful step of combining evidence on health and other benefits of urban parks and green space and presenting it in a financial reporting statement: a natural capital account. The City of Sheffield’s parks, for example, offer £1.2 billion of benefits, a figure 34 times greater than expenditure on service provision. Work on other cities and rural areas will follow:

Introduction – For the first time it is possible to reveal the economic role parks play in Sheffield city life. Today’s citizens of Sheffield enjoy an extensive public parks and green space portfolio of around 4,100 hectares, created in the past and maintained by contributions from residents over decades. These parks enhance the wellbeing of citizens in a number of ways. Information, examined and presented here, on the contribution of the parks to the quality life in the city can be used to raise awareness of the value of the asset which the people of Sheffield use, pay for and which the City Council looks after. This knowledge will empower citizens and their representatives to make decisions around future strategy, spending, funding and institutions, and to monitor performance more confidently.

  • The approach uses natural capital accounting, designed to capture the overall economic, social and environmental value of the public parks and greenspace asset and the services that benefit society as a whole. The estimates are ideal for the purpose of illustrating relative and absolute magnitudes of value. The assessment presented below has been put together with great care. It employs an accounting framework which is consistent in its form and principles with financial reporting so that it can be read alongside the City Council’s financial statements. It differs from financial statements in some of the valuation methods used, to suit the nature of the services addressed. The figures have been prepared in a transparent manner, using the latest published multidisciplinary evidence and have been tested in discussion with national technical experts. Furthermore, they have been estimated in a deliberately cautious manner, choosing assumptions that are likely to under- rather than over-state a valuation, wherever assumptions are needed because of the absence of empirical evidence. The evidence base is not complete and certain, so there remain uncertainties over the impact the park has on wellbeing. Yet the figures are valid in revealing the orders of magnitude of value and relative levels of value of the parks and their services.
  • Findings –  The parks make a substantial contribution to the health and wellbeing of the people of Sheffield. Around 60 per cent of the benefits of the parks arise from their contribution to physical and mental wellness. The health benefits come through reduced circulatory diseases such as stroke, heart attack, diabetes, cardiovascular dementia and reduced burden of depression. The parks are also enjoyed for recreation, which is capitalised in the value of neighbouring properties, and there are further benefits to air quality, climate change and crime. Thus they contribute to some of the things which people care most about: quality of life including family life, health, recreational enjoyment, safety of themselves and their property, and overall a good place to live. There are also benefits to employers; a healthier workforce results in raised productivity levels. With health benefits as the most important outputs from the parks, the delivery of health outcomes ought to be a strategic focus from parks and this means close working with health service providers to target groups who would benefit the most.
  • Health service providers are major beneficiaries and can invest to save. Parks services offer attractive investment returns to health service providers. For example, if a health service provider 2 were to make an investment in an endowment yielding 3.5 per cent, the income from which was used to sustain parks services, they would receive returns of around 18 per cent in real terms, which is much higher than the return they could expect to receive from alternative conventional investments. Conventional commercial property investments have historically yielded around 9 per cent real terms in the UK and current UK government debt yields a negative real return.  It is beyond all doubt that expenditure on Sheffield’s parks services are excellent value for money. For every pound spent currently by the Council, on average £42 of services are supplied. Misleadingly, parks appear as a net cost in the Council’s financial statements. Despite the appearance from the Council’s financial statements, there are few better ways to spend money than this. This is not a comment on whether spending could be made more efficient: it may or may not be so. It is a finding that spending should not be reduced if it leads to reduced services. It also suggests that increases in spending might be excellent value for money. In comparison with spending on other infrastructure, such as road building and enhancement, parks spending performs much better. For example, Department for Transport guidance stats that value for money is ‘very high’ if benefits outweigh costs by a ratio greater than 4:1, which coincidentally is the mean ratio for all major highways schemes between 2002 and 2010, calculated by the Highways Agency. In contrast, parks spending achieves a ratio of 42:1. Residents receive much more in wellbeing than they pay in contributions, so they will not want to see services reduced. Some of the value is capitalised in the value of their homes and for those that own their own homes, a reduction in parks expenditure would erode personal wealth.
  • Sheffield’s parks have a combined asset value of around £1.4 billion. The parks asset value is around 5 per cent of the asset value of residential property in Sheffield, which is around £27 billion. Meanwhile, the present value of future expenditure to maintain parks is around £0.036 billion. Parks are thus an important asset to the city, but by no means as important as the housing stock, nor probably commercial and industrial assets, transport, health and education infrastructure. Nevertheless, they are a much more important component of the Sheffield’s economy than is indicated by the expenditure on them.
  • In conclusion, the combination of financial and natural accounting data reveals the true value of the parks to the people of Sheffield. By showing how much of the parks asset value lies outside the financial statements, the accounts emphasise how important it is to account completely for the value of services. Through the use of comprehensive accounts, stakeholders can form well-evidenced views and more effectively participate in decisions. Those decisions can direct resources towards the most valuable outputs and can ensure that valuable services are adequately supported. This would be impossible if decisions rely on financial statements alone. These accounts may now be used to inform the parks management strategy, health services providers’ engagement with the future of parks services, funding arrangements and institutional arrangements for the future of the parks service.


Source – Author contact details: Jason Eis E: jason.eis@vivideconomics.com



Activity-friendly neighbourhoods: urban design can promote walking

Following our recent post discussing the new report launched by Arup, Cities Alive: Towards a walking world, further research to support links between good urban design and well-being has been published in The Lancet – see reference link below. The Arup report, is a collaboration between Arup’s Foresight + Research + Innovation, Transport Consulting and Urban Design teams, and discusses the benefits of walkable cities – economic, social, environmental and political, setin out measures for improving walkability.

Abstract: Urban design can promote walking: people physically active for up to 1.5 hours more per week in activity-friendly neighbourhoods

Source: Sallis, J.F., Cerin, E., Conway, T.L., Adams, M.A., Frank, L.D., Pratt, M., Salvo, D., Schipperijn, J., Smith, G., Cain, K.L., Davey, R., Kerr, J., Lai, P.-C., Mitáš, J., Reis, R., Sarmiento, O.L., Schofield, G., Troelsen, J., Van Dyck, D., De Bourdeaudhuij, I. & Owen, N. (2016). Physical activity in relation to urban environments in 14 cities worldwide: a cross-sectional study. The Lancet. DOI: 10.1016/S0140-6736(15)01284-2. This study is available at: http://www.ipenproject.org/documents/IPEN-Research-Brief%20Lancet%20paper%2004-16.pdf

Contact: jsallis@ucsd.edu


People who live in the most ‘activity-friendly’ neighbourhoods do up to 1.5 hours more physical activity a week than those in the least supportive neighbourhoods. This is according to a new international study which measured levels of exercise — mainly walking for recreation or transport — in relation to the urban environment across 14 diverse cities. The results show how urban design — such as parks and local amenities — can promote healthy lifestyles which also bring environmental benefits, such as better air quality, through reduced car use.

Globally, physical inactivity is responsible for 5 million deaths per year through its effects on diseases such as diabetes, heart disease and some cancers1. It is known that people who live in very ‘walkable’ neighbourhoods tend to be more physically active than those in less walkable areas. The WHO thus recommends improving the urban environment to support ‘active transport’ (walking and cycling) and recreation in its Global Strategy on Diet, Physical Activity and Health.

This study further explores the link between the urban environment and exercise by providing objective data on activity levels in a diverse range of cities. Data were used from 6 822 participants in the study who wore accelerometers around their waist for 4–7 days. Accelerometers assess vertical movement of the body and mainly detect walking. Participants lived in one of 14 cities across 10 countries (Belgium, Brazil, Colombia, the Czech Republic, Denmark, China (Hong Kong), Mexico, New Zealand, the UK and the USA).

The researchers related activity levels to urban features which are thought to affect walkability found in a 0.5 km and a 1 km zone around each participant’s home. Six features were considered: number of residential dwellings; number of street junctions (accessible to pedestrians); mixture of land use (indicating easy access to retail areas and public buildings); number of bus, rail or ferry stops/stations; distance to nearest public transport stop/station; and number of parks.

Average activity levels varied greatly by neighbourhood. Participants with the most activity-supportive environmental features within 1 km of their home did up to 89 minutes more physical activity a week, on average, than those in 1 km zones with the fewest activity-supportive features. For 0.5 km zones, the difference in activity levels was 68 minutes. On average, participants across all 14 cities did 37 minutes of physical activity per day. Baltimore, USA, had the lowest average rate of activity (29.2 minutes per day) and Wellington, New Zealand, had the highest (50.1 minutes per day).

Three urban features were strongly associated with higher activity levels:

  • High residential density. This is needed to support important components of a walkable neighbourhood, such as local shops and a frequent public transport service.
  • High density of public transport stops. Interestingly, distance to the nearest transport stop was not associated with activity levels. Instead, the researchers suggest that a high number of transport options is more likely to meet residents’ needs and thus increase the likelihood of walking to a stop. Good access to public transport is necessary for a less car-dependent lifestyle, they state.
  • Parks. These are not just locations for recreation in themselves, but destinations that people choose to walk to.

Studies usually associate mixed land use with physical activity, but not in this case. However, the researchers say this may be due to limitations of their method; for example, they did not map unregistered shops, such as informal markets, which are common in middle-income countries. Street-junction density, which indicates connectivity, showed some influence on walking levels, but results on this feature were mixed.

Importantly, the links between built environment and physical activity were generally similar across all the cities. This suggests that improving urban design is a solution that applies everywhere.

The study recommends that decision makers in the public health, environmental, transport and park sectors work together to promote physical activity as way of cutting air pollution and greenhouse gas emissions and energy usage, whilst achieving health benefits.

  1. Lee, I.M., Shiroma E.J., Lobelo F., Puska P., Blair S.N., & Katzmarzyk P.T. (2012). Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet, 380: 219–99.


Health and green infrastructure: 2 recent research papers

This post highlights 2 recent research papers focusing on the links between health benefits and exposure to green infrastructure.


“Green spaces and cognitive development in primary schoolchildren.” – Dadvand, P., Nieuwenhuijsen, M., Esnaola, M., Forns, J., Basagaña, X., Alvarez- Pedrerol, M., Rivas, I., López-Vicente, M., De Castro Pascual, M., Su, J., Jerrett, M., Querol, X. & Sunyer, J.. (2015).  Proceedings of the National Academy of Sciences. 112(26): 7937–7942. DOI: 10.1073/pnas.1503402112

Exposure of primary schoolchildren to outdoor green spaces is linked to an improvement in their cognitive development, finds a new study, which is the first of its kind. The association may be partly explained by reductions in traffic-related air pollution (TRAP) near green areas.

Approximately half of the global population live in cities, and it is projected that by 2030, three of every five persons (60%) will live in urban areas worldwide. Yet urban areas are characterised by increased levels of pollutants and fewer green spaces. Several studies have linked exposure to urban green spaces to improved physical and mental health and wellbeing (1.)  Children may be particularly susceptible to the psychological effects of the urban environment, as key cognitive traits are developed during infancy and childhood.

Researchers have now investigated the association between exposure to green spaces and memory and attention in children. They also evaluated the role of TRAP as one of the potential mechanisms underlying this association. This new study took place in the context of the EU-funded Barcelona BREATHE project (2.) which investigates the possible effects of traffic-related air pollution TRAP on brain development in children.

In the 36 primary schools taking part in BREATHE, 58% of children aged 7–10 (2 623) agreed to participate. Children were evaluated four times every three months over a year, using computerised tests to assess their working memory and attention, both of which grow steadily during adolescence. The ‘greenness’ around each child’s home address, within and near their school and along their commute to school was measured using satellite imagery and the Normalized Difference Vegetation Index, a measure of greenness based on reflected light. The values were combined with variables such as time spent in school or at home to estimate each child’s total exposure to greenness. Models were constructed to evaluate the association between green spaces and cognitive development. The research leading to the methodology (PHENOTYPE) used in this study to assess exposure to green spaces received funding from the Commission’s Seventh Framework Programme (3.)

The researchers found that a higher level of exposure to green spaces was associated with improved cognitive development. More specifically, this consisted of a median score of 5% improvement in working memory, 6% increase in superior working memory, and a 1% reduction in inattentiveness. This was attributable specifically for greenness within and near schools. There was no association between residential surrounding greenness and cognitive measurements.
The researchers also investigated whether reduced levels of TRAP could explain the association between green spaces and cognitive development. High-quality data on exposure to the air pollutant elemental carbon (EC) — a tracer of road traffic emissions — in the schools was available through BREATHE. Previous analyses had found lower levels of EC in schools with higher greenness. Adding TRAP exposure to the models explained 20–65 % of the association between school greenness and change in cognitive development. The researchers theorise other mechanisms may include lower exposure to ambient noise and increased physical activity associated with green spaces.

The study provides evidence that targeted interventions such as improving greenness in schools could have significant effects on children’s cognitive development. Based on their study, the authors suggest that if schools with the lowest levels of greenness increased this resource to be on a par with schools with the highest greenness, the number of children with impaired superior working memory development would decrease by 8.8%. The improved cognitive development in children could lead to improved mental capabilities for the rest of their lives.  Since this was the first epidemiological study to report on the impact of exposure to green space on cognitive development in schoolchildren, further research is needed to investigate the robustness of these findings. Additional research should explore if similar effects are found during other periods of cognitive development in children, such as prenatal and preschool periods.

public health

Landscape Institute’s, “Public health and landscape: creating healthy places” Position Statement  (November 2013).  Download A4 version


“Positive health effects of the natural outdoor environment in typical populations in different regions in Europe (PHENOTYPE): a study programme protocol.” – Mark J Nieuwenhuijsen, Hanneke KruizeChristopher GidlowSandra AndrusaityteJosep Maria AntóXavier BasagañaMarta CirachPayam DadvandAsta DanileviciuteDavid Donaire-GonzalezJudith GarciaMichael JerrettMarc JonesJordi JulvezElise van KempenIrene van KampJolanda MaasEdmund SetoGraham SmithMargarita TrigueroWanda Wendel-VosJohn WrightJoris ZuffereyPeter Jan van den HazelRoderick Lawrence and Regina Grazuleviciene.  British Medical Journal, BMJ Open 2014;4:e004951 doi:10.1136/bmjopen-2014-004951. 

Growing evidence suggests that close contact with nature brings benefits to human health and well-being, but the proposed mechanisms are still not well understood and the associations with health remain uncertain. The Positive Health Effects of the NaturalOutdoor environment in Typical Populations in different regions in Europe (PHENOTYPE) project investigates the interconnections between natural outdoor environments and better human health and well-being.  This project is a Collaborative Project funded through the European Commission Seventh Framework Programme

Urban planners should be given guidelines to include a minimum amount of green space in cities, according to researchers who have found that exposure to parks and trees helps to prolong life, improve mental health and even increase the birthweight of babies.

Professor Mark Nieuwenhuijsen from the Center for Research in Environmental Epidemiology (CREAL) in Barcelona, Spain, says that access to nature does not merely top up your wellbeing, but it might actually be a necessary condition for good health.  Prof. Nieuwenhuijsen coordinates the EU-funded PHENOTYPE project (4.), which is aiming to build up the evidence base for so-called urban greening by understanding how exactly it can influence your health and why. The idea is to feed into decisions made by landscape architects, urban planners and policymakers.

‘Lack of green space causes detrimental health effects,’ he said. ‘Green space is necessary for healthy psychophysiological functioning (and) there could be a set level for good health.’

This is important as more than half of the world’s population lives in urban areas, a figure which is set to grow more than 1 % per year between now and 2030. However, there is currently no agreement on just how much greenery cities should contain for optimal health.

‘At the moment there are no guidelines for green space. It would be nice to be able to give more information to urban planning to make sure that there’s provision of green space. How much green space do you need? There are questions still remaining.’

PHENOTYPE researchers are conducting studies of the health effects of green space in four different parts of Europe: Lithuania, the Netherlands, the UK and Spain. So far they have found that an increase in surrounding greenness leads to higher birth weight for babies, reduced blood pressure during pregnancy, and lower obesity levels in children.  They have also found that an increase in surrounding greenness is associated with better mental health and self-perceived physical health.  The project is also uncovering suggestions that not all greenery is equal. Prof. Nieuwenhuijsen says that being surrounded by greenery, such as living on streets lined with trees or being able to see vegetation from your office window, may have greater health benefits than having access to a park.


Initial indications are that it is more complicated than the fact that living close to a park could encourage people to take more exercise and lead an active lifestyle. In a study of coronary artery patients in Kaunas, Lithuania, researchers found that people benefitted more from walking in parks than when they did the same amount of exercise but walked on busy urban streets.

Prof. Nieuwenhuijsen says that there is some good evidence that the reason behind this effect could be a reduction in stress levels. ‘There are some studies that show a reduced blood flow in the subgenual prefrontal cortex (which controls stress) when people are exposed to green space.’  Other mechanisms could include a reduction in air pollution and an increase in social contacts.  While the exact mechanisms are still under investigation, Prof. Nieuwenhuijsen believes that humans are hard-wired to appreciate the benefits of vegetation.



  1. http://ec.europa.eu/environment/europeangreencapital/space-increase-happiness/
  2. The BRain dEvelopment and Air polluTion ultrafine particles in scHool childrEn (BREATHE) was supported by the European Research Council. See: http://www.cordis.europa.eu/project/rcn/99632_en.html
  3. Positive Health Effects of the Natural Outdoor environment in Typical Populations in different regions in Europe (PHENOTYPE) project was funded through the European Commission Seventh Framework Programme: http://www.staffs.ac.uk/research/
  4. PHENOTYPE  –  intended to provide a better understanding of the potential mechanisms, and better integration of human health needs into land use planning and green space management.



Green Infrastructure – our natural life support system

Green Infrastructure is the network of natural environmental components and green and blue spaces that lies within and between the cities, towns and villages which provides multiple social, economic and environmental benefits. In the same way that the transport infrastructure is made up of a network of roads, railways, airports etc. green infrastructure has its own physical components, including parks, rivers, street trees and moorland.


Just as growing communities need to improve and develop their grey infrastructure (ie. roads, sewers, energy distribution etc.), their green infrastructure needs to be upgraded and expanded in line with growth. Green infrastructure differs from conventional approaches to open space planning because it considers multiple functions and benefits in concert with land development, growth management and built infrastructure planning. Successful land conservation in the 21st century needs to be proactive, less reactive and better integrated with efforts to manage growth and development. Green infrastructure planning works at national, regional and local levels and is an integral component, essential for building well designed and sustainable communities.
The following case study is used to illustrate the use of the Green Infrastructure Valuation Toolkit developed by Natural Economy Northwest, the Northern Way, Natural England, the Commission for Architecture and the Built Environment, Design for London and Tees Valley Unlimited, Genecon LLP with support from the Department for Environment, Food and Rural Affairs, the three Regional Development Agencies in the North of England, Advantage West Midlands and the London Development Agency.
The toolkit was developed to assess the potential economic and wider returns from investment in green infrastructure and environmental improvements: Building natural value for sustainable economic development: the green infrastructure valuation toolkit 


London Borough of Bexley Belvedere and the nearby towns of Erith and Thamesmead lie in the London Thames Gateway growth area. They are characterised by a low skill, low wage economy that struggles to sustain a retail and wider amenity offer. The area’s main employment location of Belvedere is blighted by 70ha of vacant or derelict land. In order to attract new businesses a new link road has been planned, with the intention of opening up the area.

5.3.01 Belevedere Wetlands The Belvedere Wetland project was created to restore the hydrological system in Belvedere and Erith  Marshes to improve flood alleviation and enhance wetland habitats to protect and encourage key  wildlife such as Water Voles. A management plan was developed to ensure the  long term sustainability of the restored works. Over 300m3 of extra flood storage capacity has been created here.

Belevedere Wetlands
The Belvedere Wetland project was created to restore the hydrological system in Belvedere and Erith Marshes to improve flood alleviation and enhance wetland habitats to protect and encourage wildlife such as Water Voles. A management plan was developed to ensure the long term sustainability of the restored works. Over 300m3 of extra flood storage capacity has been created here.


The site enjoys a unique environmental setting. It is immediately adjacent to the Erith Marshes, a site of regional importance for nature conservation. Under investment in the environment of the area needed to be addressed in order improve access, flood prevention, recreation and biodiversity as a way of maximising the functionality of the green infrastructure. The local network of drainage dykes has received little or no maintenance in recent years and its restoration is considered vital in preventing the flooding of low-lying residential areas. Pedestrian and cycleway improvements (green links) are also planned.

The Erith Marshes and Belvedere Links project aims to enhance the environmental quality of the marshland and to improve its accessibility from the surrounding area. In turn, this is expected significantly to increase the attractiveness of the Belvedere employment site to higher value businesses.  The green infrastructure valuation toolkit has been used to evaluate the benefits of this significant investment in the marshes and adjacent area. As recommended in this guide, a three stage process was applied.  Preparation: Understanding physical characteristics and beneficiaries The project would be focused on 156 ha of existing marshland, including 15km of drainage dykes, and the redevelopment of 12.5 ha of derelict land, which would be made possible by the construction of the new link road.

The works will greatly improve access, security and sustainability in Belvedere, with a range of long term benefits for local employers, staff and residents. The main direct beneficiaries of the new access and enhanced greenspace are expected to be local residents. Based on an analysis of the number of households, the number of residents living within 300m and 1200m of the project were estimated to be over 5,000 and around 47,500, respectively. [Actual figures are 5,164 and 47,518, but this sounds too precise!]  The number of recreational users is predicted to be 237,600 (based upon a likely 10 visits each year, 50% of which are assumed additional to the existing baseline figure).

Assessment: Identifying potential benefit areas and applying relevant tools As a natural green-space area, the marshes are considered likely to have a positive impact on climate change adaptation, flood alleviation and general quality of place.  The green corridor element of the project (paths and cycleways) is likely to have tourism, transport [it seems obvious we that we should mention it, although Genecon haven’t costed transport benefits] and public health and well-being benefits.  The different elements of green infrastructure within the project (exact area of canal, wetland, different types of grassland, woodland and length of footpaths and cycleways) have been analysed in the context of the likely beneficiaries.  The relevant tools were applied to assess the value of the benefits identified in monetary terms (for those benefits that could be costed) quantitative terms or qualitative terms. Some valuations were expressed as a precise figure, whereas others were expressed as falling within a range of figures. For valuation purpose, most benefits were deemed to last for 10 years, although some were deemed to last for longer periods. In each case, the valuations were discounted to give a present value (PV) figure, so that benefits which accrued for different lengths of time could be easily and directly compared.

 The benefits were calculated as follows:

  •  Climate change adaptation and mitigation – The marshes and other areas of greenspace exhibit a significant urban cooling effect. This benefit, though uncosted, is recognised as having an impact on 2,000 to 2,500 households within 300-450m of the marshes.
  •  Water management and flood alleviation – Energy costs and carbon emissions relating to water treatment will be reduced through improvement of the natural drainage system on the marshes.  The value of these benefits were calculated to be £0.6 million and £0.3 million, respectively, at present value (PV).
  •  Health and wellbeing – The calculation of reduction in mortality rates from increased take-up of moderate exercise (walking and cycling) was estimated to be £7.4million (PV) for walking and £1.5 million (PV) for cycling.  Land and property values Residential land and property uplift within a 450m radius of the site was estimated to be £9.5 million (PV).
  •  Investment – An earlier study considered employment and environmental outputs from the Belvedere Link road on its own, from the marshland improvement and green links on their own and from a combination of the two. For employment, by 2016 the link road alone might provide an additional 2,200 jobs, and the green links 650, but together the increase is predicted to be a net 8,700.  Adjusted for the relative importance of the green infrastructure, the estimation of site employment capacity and employment based GVA assessment was £31 million (PV).
  •  Labour productivity – Reduced absenteeism was calculated to be worth between £0.1 million and £0.5 million (PV).
  •  Recreation and leisure – Based on a “willingness to pay” measure, the recreational benefits were estimated to be £1.64 million (PV).
  •  Biodiversity – Erith Marshes are some of the last remnants of grazing marshes in south London. It is recognised that their enhancement through this project will bring increased qualitative biodiversity benefit, especially the promotion of rare and specially protected species such as the water vole.
  •  Land management – Direct management of the land was estimated to generate employment for three people, calculated at a benefit value of £0.6 million (PV).
Erith Marshes

Erith Marshes

The total value of the benefits generated by the improvements was estimated to be £53.1 million – £55.8 million (PV). Just over half of this (56%) was accounted for by that aspect of the site’s increased employment potential which was considered attributable to the green infrastructure. The other significant benefits included land and property uplift, improved labour productivity from fewer working days lost, enhanced health and well-being, recreation and flood alleviation.  The capital investment is to be made by regeneration and economic development agencies. The total cost of £10.54 million includes the road construction and just £1.84 million of this relates to the landscape improvements. This case study illustrates the challenge of how best to capture the relative impacts of green and grey infrastructure.  Without the link road, the number of jobs attracted would be low, but with improved access, the importance of improved environment becomes much greater. This project therefore shows a very good rate of return on investment in the natural

Source: Green Infrastructure North West project