2021 Nature and Health Symposium: Generating Understanding Across Communities and Disciplines
More than 300 participants from across the globe joined us for our first virtual symposium, Generating Understanding Across Communities and Disciplines. Over the three-day conference, over 100 speakers gave presentations related to disciplines such as social and natural sciences, humanities, health, conservation, planning and education that are currently shaping policies, programs, practices, and designs to benefit all people and nature in a variety of settings.
Across this diverse array of subject matter, we were struck by the creative ways that speakers connected their work back to this year’s conference theme, “Generating understanding across communities and disciplines.” Whether we were learning about urban greening in cityscapes, the impacts of structural racism on nature access and connectedness, or how nature could positively impact developmental life stages from birth to death, each presentation marked a significant moment to discover a new mindset, approach, or consider multiple ways of knowing that build bridges between nature and well-being.
This conference theme was inspired by collective action, innovative partnerships, and working together to find sustainable paths toward a healthier future–for ourselves, our communities, and generations yet to come. We were honored to be joined by so many passionate community leaders, students, researchers and practitioners as we discovered new and cross-cutting applications on the subject of nature and health.
Keynote Speakers
We’d like to give a special thank you to our keynote speakers:
- Hilary Franz, Commissioner of Public Lands
- Howard Frumkin, DrPH, MPH, MD
- Michelle Johnson-Jennings, PhD, EdM (Choctaw Nation)
- Eugenia C. South, MD, MS
Session 1: Incorporating Nature into Built Environment at Different Spatial Scale for Population Health
The rapid trend toward global urbanization, resulting in more than half of the world’s population living in cities, is associated with decreased access to natural environments. Additionally, residents in the industrialized world spend up to 90% of their time indoors, further distancing people from activities formerly spent in nature. This urban living is associated with increased stress-related diseases and decreased quality of life. The routine separation of human contact with nature may contribute to those negative health and well-being outcomes to various degrees related to density and spatial scales across urban gradients. In this session, we will discuss the health impact of bringing nature into the built environment at different spatial scales (i.e. building, neighborhood, city etc.). Beginning at the building level, we will discuss several experimental studies that quantify the physiological, psychological, and cognitive responses to biophilic design in buildings using emerging technologies like virtual reality, eye-tracking, and bio-monitoring sensors. At the neighborhood level, we will discuss how urban agriculture has been used by communities to improve and promote overall health and combat structural racism. Moving across population densities, we will present a survey study that explores which elements of nature exposure contributed to self-assessed feelings of nature deprivation and how feeling nature deprived experienced under the COVID-19 pandemic differentially affected individual wellbeing. Finally, we will discuss how forest bathing or therapy programs are shown to affect psychophysiological responses on a larger spatial scale. Examining complementary evidence at distinct spatial scales offers the opportunity to consider how nature-based health interventions can be appropriately tailored and distributed.
Moderator: John D. Spengler, Akira Yamaguchi Professor of Environmental Health and Human Habitation, Harvard T.H. Chan School of Public Health
Presentations
Quantifying Health Impact of Biophilic Design in Buildings: Experiments in Virtual Reality
Jie Yin, Assistant Professor, College of Architecture and Urban Planning, Tongji University
Biophilic design, which incorporates natural elements into the indoor environment, has received increasing attention in both the design and health fields. Previous research has demonstrated the associations between outdoor nature contact and health and well-being. But study quantifying health impacts of indoor biophilic features is limited. This presentation aims to discuss the short-term health impact of biophilic design in buildings. To achieve that, we developed a tool by combining virtual reality (VR), eye-tracking and wearable biomonitoring sensors. With that tool, we conducted multiple experiments with different study designs to measure physiological and cognitive responses to different biophilic indoor environments. First, 28 participants spent time in an indoor environment featuring biophilic design elements and one without. In each visit, they experienced the environment for 5 minutes in reality and virtually by using VR. We found that participants experiencing a biophilic environment virtually had similar physiological and cognitive responses, including reduced blood pressure and skin conductance and improved short-term memory, as when experiencing the actual environment. Second, we designed a randomized crossover study to let 30 participants experience three versions of biophilic design in simulated open and enclosed office spaces in VR. Compared to the base case, participants in three spaces with biophilic elements had consistently lower levels of physiological stress indicators and higher creativity scores. In addition, we captured the variation in the intensity of virtual exposure to biophilic elements by using eye-tracking technology. Lastly, we conducted a between-subjects experiment with 100 participants using VR. Participants were randomly assigned to experience one of four virtual offices (i.e. one non-biophilic base office and three similar offices enhanced with different biophilic design features) for six minutes after stressor tasks. We found that participants in biophilic indoor environments had consistently better recovery responses after stressor compared to those in the non-biophilic environment. Those restorative effects differed among three different types of indoor biophilic environments. We show significant physiological and cognitive benefits in indoor environments with diverse biophilic design features, which could help in understanding, applying and promoting biophilic design in buildings.
An Environmental Justice Approach to Exploring the Connection between Urban Agriculture and Health in Philadelphia
Ashley Gripper, PhD Candidate, Harvard Graduate School of Arts and Sciences, RWJF Health Policy Research Scholar
Black people have used farming to build self-determined communities and resist the oppressive structures that seek to tear them down for over 150 years. Today, Black farmers continue to grow to provide healthy food access to their families and communities, exercising collective agency and community resilience. Poor Black neighborhoods tend to have a disproportionate amount of junk food stores and low produce grocery stores. Through spatial analysis, we use conditional autoregressive models to determine if there are spatial associations between race, poverty, food access and urban agriculture in Philadelphia, while controlling for common spatial confounders/covariates. The findings of this study indicate that support of urban agriculture may be a potential solution to the lack of healthy food access in Black and Brown low-income neighborhoods.
The Relationship between Nature Deprivation and Individual Wellbeing across Urban Gradients under COVID-19
Linda Powers Tomasso, PhD Candidate, Harvard Graduate School of Arts and Sciences
Lockdown aiming at slowing COVID-19 transmission has altered nature accessibility patterns, creating quasi-experimental conditions to assess if retracted nature contact and perceived nature deprivation influence physical and emotional wellbeing. We measure through on-line survey methods (n = 529) how pandemic mandates limiting personal movement and outdoor nature access within the United States affect self-assessed nature exposure, perceived nature deprivation, and subsequent flourishing as measured by the Harvard Flourishing Index. Results indicate that perceived nature deprivation strongly associates with local nature contact, time in nature, and access to municipal nature during the pandemic, after controlling for lockdown mandates, job status, household composition, and sociodemographic variables. Our hypothesis is that individuals with strong perceived nature deprivation under COVID-19 leads to diminished wellbeing proved true. Interaction models of flourishing showed positive modification of nature affinity with age and qualitative modification of nature deprivation with race. Our results demonstrate the potential of local nature contact to support individual wellbeing in a background context of emotional distress and social isolation, important in guiding public health policies beyond pandemics and other environmental health emergencies.
Restorative Benefits of Forest Therapy and the Role of Forest Therapy Guide
Simon Yu, Associate Professor, National Taiwan University
This study aims to provide a scientific evidence for the efficacy of different guidance styles in forest therapy program. We investigated the restorative benefits of three forest therapy programs: a guided program, a self-guided program, and a walk alone program. The study utilized a single-blind, between-subject, pretest–posttest field experimental design to examine the influence of the experiential type has on physiological measures and mood states during a forest therapy program. The results indicate all three programs offer forest therapy’s restorative benefits of reducing systolic blood pressure and improving moods. We found the three programs in the study did not exhibit significant differences with regard to changes in restorative benefits of physiological and psychological measures, except for a significant difference in changes in sympathetic nervous system activity between the walk alone program and the guided program. Our findings suggest the Xitou Nature Education Area (XNEA) management team should continue promoting forest therapy as a public health intervention because the restorative benefits of forest bathing are apparent regardless of the program type. Visitors unfamiliar with the XNEA are encouraged to participate in the guided program to improve the quality of their restorative experience, particularly concerning improvement in emotions. Visitors who are familiar with the XNEA and are equipped with safety knowledge are encouraged to choose the walk alone program to maximize the immersiveness of their experience.
Session 2: Deep Learning of Street View Imagery to assess Urban Green Space Relationships with Mental Health
Green space is emerging as an important modifiable determinant of human health, yet our ability to measure green space exposures, especially specific components important to health, is limited. The emergence of ubiquitous geo-referenced imagery, such as Google Street View (GSV) imagery, combined with advances in image processing using deep learning algorithms, offers unprecedented opportunity for exposure science and environmental epidemiology. In this session we will highlight work conducted within a NIEHS funded R21 grant that is developing new methods for assessing green space exposures and relationships with mental health outcomes within the Washington State Twin Registry (WSTR).
Presentations
Google Street View Approaches to Assess Green Space Exposure in Large Health Studies
Perry Hystad, PhD, Associate Professor, College of Public Health and Human Sciences, Oregon State University
Ubiquitous geo-referenced images, such as Google Street View (GSV) imagery, combined with advances in image processing, using deep learning algorithms, offers unprecedented opportunity to measure novel green space exposures. These “person-level” measures are not typically captured using traditional satellite and GIS “birds-eye view” approaches that are used in existing epidemiological studies. This presentation will highlight new methods that use GSV images to assess green space exposures, including image segmentation methods to classify 150 image objects, which can be used to quantify specific vegetation types (e.g. street-level trees, grass, or flowers). We compare this approach to existing spatial methods used to assess green space exposures in epidemiological research, including satellite derived normalized vegetation difference index (NDVI), parks, and land use.
Predicting Green Space Quality, Safety, and Attractiveness on Streetscapes
Andrew Larkin, PhD, Assistant Professor Senior Research, College of Public Health and Human Sciences, Oregon State University
While numerous studies have characterized green space features (e.g. NDVI, trees, parks), few studies have examined green space quality, as well as other perceptions (safety, attractiveness) that may modify how green space influences health. We use transfer learning and crowd-sourced labelling methods for Washington State Google Street View (GSV) images to develop new deep learning models that predict green space quality, safety and attractiveness of street-scapes based on GSV. We compare these new metrics to GSV features and existing measures of green space exposure to assess the additional information provided by these perception measures.
Associations between Novel Green Space Exposure Measures and Mental Health within the Washington State Twin Registry
Perry Hystad, PhD, Associate Professor, College of Public Health and Human Sciences, Oregon State University
To test the utility of our novel green space metrics to better capture influences on mental health we apply the GSV image segmentation, perception measures and traditional NDVI to approximately 12,000 adults in the Washington State Twin Registry (WSTR). In cross-sectional and longitudinal analyses we evaluate associations between novel green space exposure measures and depression, anxiety and stress as well as self-reported general health. We further conduct Twin-pair analyses to control for genetics and early life exposure.
Session 3: Rethinking Mobility After Covid-19: Healthier, Greener, Urban Spaces
The COVID-19 pandemic has changed the way in which we navigate our cities. Alongside an increased need for outdoor exercise, we need sufficient space for social distancing and for safe personal interactions with our neighbors and friends. Pop-up cycle lanes and widened sidewalks have shown us what aspects of city design matter for our health and now, in the mid-to-post pandemic period, we have an opportunity to make more permanent changes in city design for active travel and healthier societies.
This session brings together leading researchers in landscape architecture and environmental psychology who will present three studies exploring how aspects of city design (e.g. street closure, urban gardens, parks, and neighborhood quality) have impacted mobility and health during COVID-19. We will identify the implications of this research to advance COVID-19 driven changes in urban design for active travel and improved health, including the opportunities for unused streets and parking lots to create healthier, greener, public spaces.
Presentations
The Impact of Urban Walks on Public Health in Richmond, VA During COVID-19
Authors: Neale, C., Hoffman, J., Gohlke, J., Jefferson, D., Mondschein, A., Boukhechba, M., Roe, J.
This study reports the findings of walking in ‘green’ streets (with higher levels of street trees and urban greenery) versus ‘grey’ streets (n=40) during COVID-19 and the effects of air / noise pollution and heat stress on a suite of health outcome measures including stress physiology (HRV), cognitive functioning and subjective wellbeing.
The Post-Pandemic Urban Landscape: Analyzing and Re-Envisioning Automobile Infrastructure After COVID-19
Authors: Carr, S.J. and Kennen, K.
As a significant portion of the workforce shifts to permanent remote work, there will be a surplus of commuter infrastructure. This study examines the possibilities for unused streets and parking lots after COVID-19 with a spatial analysis of Boston mobility patterns and proposals for a phytoremediation process and landscape interventions to convert those places to healthier, greener, public spaces.
Increased Active Travel During COVID-19 and Road Closure Experiment at Frankfurt Riverfront, Germany
Authors: Pandit, L., Fauggier Vasquez, G., Gu, L., Knöll, M.
This study reports on the findings before and during a year-long closure of an arterial street at the Frankfurt riverfront that coincided with COVID-19 including 30 % more cyclists, 1175% more children cycling independently and 20% more pedestrians with mobility restrictions. Mappings show a more active and widely spread usage, while survey (n=161) suggests no change in users’ perception of the adjunct green space.
Session 4: Spatial Mobility and Simulation: Understanding How Environment Affects Health
The session explored how urban environments do, or can, protect, and improve population health and reduce health inequalities. Firstly, it explored changes in access to environments, the consequences for population health and related behavior, focusing on inequalities for those with health conditions and by socio-economic indicators. Secondly, the session examined the relationship between children’s objectively measured time spent outdoors, contact with nature, and emotional and behavioral resilience. Neighborhood level exposure to nature and more novel approaches to measure ‘real’ exposure from GPS data was presented. The session also demonstrated the application of Agent Based Models for understanding how place affects health and related behavior.
Presentations
Exploring Use and Experiences of Green Space During the COVID-19 Pandemic: A Nationally Representative Cross-Sectional Study of UK Adults
Hannah Burnett, University of Glasgow
Background & Objectives
The health impacts of contact with green spaces are well studied, with green space previously being found to positively influence health and well-being. However, inequalities in green space visitation are prevalent. Restrictions on movement enforced due to the COVID-19 pandemic could have exacerbated the existing inequalities regarding who visits green space. Therefore, we aimed to explore how patterns have changed throughout the pandemic, focusing on changes in the frequency and experiences of visits to green space in the United Kingdom (UK) and how these differed by individual-level demographic and socio-economic characteristics.
Methods
Multiple nationally representative cross-sectional surveys were administered through YouGov. The first survey data was collected in April 2020, at the very start of the first UK lockdown, followed by surveys in November 2020 and April 2021. Data were collected on the frequency of visits to green space and experiences within green space (such as feeling greater mental health benefits in green space and missing social interaction). Demographic information was collected on sex, age, ethnicity, social grade and dog ownership. Data were analysed using descriptive statistics and multiple regression models.
Results
Overall, 63% of respondents reported a decrease in visitations following initial restrictions on movement (April 2020). Lower social grade respondents were less likely to visit green space before and after the initial restrictions were enforced. They were also significantly less likely to have visited green spaces in November 2020 and April 2021. Older adults (65+) were less likely to report an increase in visits to green space in April 2020 and November 2020 than middle age respondents (25-64). In April 2020, 65% of respondents felt that green space benefitted their mental health more during the first lockdown. Following this, 89% of respondents in November 2020 and 90% in April 2021 agreed that green spaces benefitted their mental health.
Conclusion
We found that inequalities were still prevalent, particularly by social grade. The inequalities may have been exacerbated by the COVID-19 pandemic and restrictions on movement. However, green spaces supported the population’s mental health during this time, and therefore must be protected and prioritised.
Neighbourhood Natural Space and The Narrowing Of Socioeconomic Inequality In Children’s Social, Emotional, and Behavioural Wellbeing
Dr. Paul McCrorie, University of Glasgow
Background & Objectives
The natural environment may benefit children’s social, emotional and behavioural wellbeing, whilst offering a lever to narrow socioeconomic health inequalities. We investigated whether immediate neighbourhood natural space and private gardens were related to children’s wellbeing outcomes and whether these relationships were moderated by household income.
Methods
A nationally representative sample of 774 children (55% female, 10/11 years old) from the Studying Physical Activity in Children’s Environments across Scotland (SPACES) study. Social, emotional and behavioural difficulty scores (Strengths and Difficulties Questionnaire (SDQ)) represented wellbeing outcomes. Percentage of total natural space and private gardens within 100m of the child’s residence was quantified using Ordnance Survey’s MasterMap Topography Layer®. Linear Regression, including interaction terms explored the two main research questions.
Results
A 10% increase in residential natural space was associated with a 0.08 reduction (-0.15, -0.01; 95%CI) in Emotional Problem scores and a 0.09 improvement (0.02, 0.16; 95%CI) in Prosocial Behaviour scores. Household income moderated the associations between % natural space and private gardens on Prosocial Behaviour scores: for natural space, there was a positive relationship with those in the lowest income quintile (0.25 (0.09, 0.41; 95%CI)) and a null relationship for those in the highest quintile (-0.07 (-0.16, 0.02; 95%CI)); for private garden space, there was a positive relationship with those in the highest quintile (0.15 (0.05, 0.26; 95%CI)) and negative relationship with those in the lowest quintile (-0.30 (-0.50, -0.07, 95%CI)).
Conclusion
Findings suggest natural environment could be a lever to benefit those from less advantaged backgrounds, particularly the development of prosocial behaviours.
Socioeconomic Inequality in Children’s Exposure and use of Natural Space Measured Using Individual-Level GPS Data
Dr. Jonathan Olsen, University of Glasgow
Background
Exposure to natural space has been shown to be positively associations with a number of health outcomes, including reduced mortality, mental health and improved birth weight. Greater availability of greenspace in childhood has been found to benefit academic outcomes and successful cognitive aging however there is limited evidence describing how and where children use natural spaces.
Objectives
The objectives of this study were to: (i) determine, by distance from home, children’s proportion of time spent natural space (NS) and natural space/private garden (NS/PG); (ii) calculate accessibility to natural space and natural space/private garden surrounding children’s homes, and (iii) explore variation in accessibility and use of NS and NS/PG by sex and socio-economic status.
Methods
Detailed mobility data of 10/11-year-old Scottish Children (n=667) were obtained from the SPACES study. Children wore GPS devices for 7-days during waking hours, the GPS tracks were spatially joined to Ordnance Survey MasterMap data to identify if that track were within NS or NS/PG. 100meter(m) to 800m (at 100m intervals) buffers were created around each child’s home and each GPS track was given a distance from home variable. The proportion of NS and NS/PG within 100m and 800m of each child’s home was also calculated. School time wear was excluded, and only outdoor wear was included in the analysis.
Results
There was variation in NS wear and distance from home by socio-economic status; children living in the most deprived areas spent 1% of their total wear in NS less than 100m and 3% over 800m from their home. In contrast, children from the least deprived areas spent 0.2% less than 100m and 8% over 800m from their home. An increase in the amount of NS (Coef: 0.09, 95% CI 0.05 to 0.13) and NS/PG (Coef: 0.21, 95% CI 0.13 to 0.29) around the home was associated with an increase in use.
Conclusion
Children from the least deprived areas are further from their home when spending time in NS and NS/PG provide a key location that children spend their outdoor time, particularly those from more deprived areas.
The Influence of Space and Social Mix on Patterns of Urban Green Space Usage—An Agent-Based Model
Dr. Stefano Picascia, University of Glasgow
Background & Objectives
Contact with nature is known to be socially and spatially patterned, however there is no accepted explanation of the mechanisms producing such inequalities. We test the plausibility of inter-group perception playing a role in shaping observed patterns of urban green-space usage.
Methods
A theoretical agent-based model informed with empirical data on Scottish cities and green spaces
Results
Inter-group perception can, on its own, produce observed spatial and social inequalities in urban green space usage. When adding environmental factors known to influence contact with nature, such as walkability and green space quality, the model reproduces the observed phenomena under more relaxed behavioural assumptions.
Conclusion
The broader socio-spatial arrangement of cities, and the preferences of individuals for sharing (or not) space with people of other backgrounds can combine, in a complex system, to create both inter- and intra- city inequalities in the use of UGS. We urge more attention on the social and spatial context of UGS as we attempt to increase and equalise its use.
Session 5: Does Nearby Nature Matter? What’s Going on With Proximity to Green/Blue Spaces and Health?
Proximity to green/blue space, measured in various ways, is a crucial part of many studies of nature and health. However, the evidence is really quite mixed on proximity/distance to green and blue spaces and how it determines use and health benefit. Some studies indicate limited or no association between nature in the immediate neighbourhood and health outcomes. Other studies investigate multiple distance metrics (such as buffer zones) without a clear theoretical argument for why different distances might be important, and sometimes end up focusing on selected results.
Presentations
Socio-Spatial Inequalities in Greenspace and Wellbeing
Dr. Vikki Houlden, Lecturer in Urban Data Science, Centre for Spatial Analysis and Policy School of Geography, University of Leeds, UK
With rapid global urbanisation, greenspaces in cities must be preserved and maintained, to protect the valuable connections between humans and the natural environments which enable us to flourish. Understanding exactly how to incorporate greenery is challenging; disparate definitions of both ‘greenspace’ and ‘wellbeing’, alongside the compositional and contextual disparities between people and places, have contributed to mixed, and sometimes confusing, evidence. To unravel some of these complexities, research must analyse greenspace characteristics and wellbeing outcomes through the lenses of socio-spatial inequalities and individual experiences. Holistic measures of greenspace, spanning availability, accessibility, and typology, are needed, to identify what kinds of spaces are most valuable, and where they should be located, to support health and wellbeing. Consideration should be given to the specific needs of different socio-demographic populations. Initial priorities should be to identify and improve areas with the poorest greenspace provision, and which have the potential to benefit most.
How Does Blue Space Proximity Relate to Visits in the Blue Health International Survey?
Dr. Lewis Elliott, Lecturer in Environment and Public Health, European Centre for Environment and Human Health, University of Exeter Medical School, UK
Research which associates neighbourhood exposure to nature (e.g. within 1km of the home) with health and wellbeing outcomes assumes that people derive benefits from those same spaces, often through direct recreational contact. Using cross-national data on blue spaces and health, this presentation demonstrates that people often visit blue spaces outside their immediate neighbourhood, even when they are available within 1km of their home. As well as looking at potential reasons for this, such as perceived quality of neighbourhood bluespace, it also explores for which population subgroups more proximal, and more distal, bluespace may be most beneficial for well-being.
Methods for Understanding Spatial Dimensions of Greenspace Access
Dr. Rich Fry, Associate Professor, Environment and Health Lead, Health Data Research UK Wales and Northern Ireland, Swansea University Medical School, UK
Measuring spatial access to greenspace has several challenges both conceptual and pragmatic. There are numerous methods employed throughout the literature which use GIS methods to measure exposure to green space with varying degrees of sophistication. What is less well understood is the impact of the methodological choices on associations with health outcomes and how these vary by different social settings. Methodological choices in relation to exposure modelling are rarely discussed in the interpretation of results, yet they are numerous including spatial data quality, buffer distance, buffer type and choice of greenspace. Exploring the methodological differences in exposure modelling allows us to interpret associations between exposure and health outcomes with more confidence and identify gaps in our understanding.
Session 6: How Natural Environments Might Mitigate the Mental and Physical Health Impacts of the COVID-19 Pandemic
Public awareness of the importance of nature and the Great Outdoors rose sharply during the COVID-19 pandemic. People around the world yearned to be in parks, gardens, urban forests, and blue spaces with water. Lockdown measures severed travel to stress-reducing destinations and focused interest in restorative qualities of the home and neighborhood. Long before COVID-19, researchers, planners, architects, designers, ecologists, and engineers advocated for parks and other forms of green infrastructure and its array of ecosystem services. Experimental and epidemiological research shows that nature and being outdoors can improve mental/physical health and well-being as well as catalyze social change, thus reducing socioeconomic and educational inequalities. Emerging evidence suggests that green infrastructure may protect against COVID-19 and its psychological impacts. The mechanisms underlying these myriad benefits are multi-faceted and complex.
Moderator: Matthew Browning, Department of Parks, Recreation, and Tourism Management, Clemson University, USA
Presentations
Benefits of Nature Exposure During and After Pandemic Urban Living: A Narrative Review of Evidence and Implications
S. M. Labib, Research Associate, Center for Diet and Activity Research, University of Cambridge, (incoming Assistant Professor, Utrecht University
While COVID-19 lockdowns have slowed coronavirus transmission, such structural measures also have unintended consequences on mental and physical health. Growing evidence shows that exposure to the natural environment (e.g., blue-green spaces) can improve human health and wellbeing. In this narrative review, we synthesized the evidence about nature’s contributions to health and wellbeing during the first year of the COVID-19 pandemic. We found that during lockdowns, people experienced multiple types of nature, including both outdoors and indoors. Frequency of visits to outdoor natural areas (i.e., public parks) depended on lockdown severity and socio-cultural contexts. Other forms of nature exposure, such as spending time in private gardens and viewing outdoor greenery from windows, may have increased. The majority of the evidence suggests nature exposure during lockdowns was associated with less depression, anxiety, stress, and more happiness and life satisfaction. Additionally, nature exposure was correlated with less physical inactivity and fewer sleep disturbances. Evidence was mixed regarding associations between nature exposure and COVID-related health outcomes, while nature visits might be associated with greater rates of COVID-19 transmission and mortality when proper social distancing measures were not maintained. Findings on whether nature exposure during lockdowns helped ameliorate health inequities by, for example, impacting the health of lower-socioeconomic populations more than their higher-socioeconomic counterparts, were mixed. Based on these findings, we argue that nature exposure may have buffered the negative mental and behavioral impacts of lockdowns during the first year of the COVID-19 pandemic. Recovery and resilience during the current and future public health crises might be improved with nature-based solutions, interventions, designs, and governance.
Exposure to Nature and Mental Health Outcomes During Covid-19 2 Lockdown: A Comparison Between Portugal and Spain
Ana Isabel Ribeiro, Public Health Institute of the University of Porto: Researcher at Public Health Institute of the University of Porto; Invited Assistant Professor at Faculty of Medicine University of Porto; Coordinator\Founder of the ‘Health and Territory’ Lab from the ITR (Laboratory for Integrative and Translational Research in Population Health)
Background/Objectives
Countries worldwide were forced to impose general lockdowns to control COVID-19 epidemic. Lockdowns, however, have a negative effect on well-being and mental health. Contact with nature may reduce stress and provide relaxation opportunities to cope with COVID-19 lockdowns. This study evaluated if changes in the exposure to nature during COVID-19 lockdown were associated with mental health outcomes and tested whether these associations differed according sociodemographic factors and country, since Portugal and Spain experienced different restrictions and epidemiological situations.
Methods
During the lockdown period, a 25-items online questionnaire was launched for adults residing in Portugal and Spain to measure changes in exposure to nature, mental health outcomes (psychological distress, somatization, stress levels), and sociodemographic, housing and lockdown-related characteristics. Adjusted regression models were fitted to estimate associations.
Results
This study included 3157 participants (1638 from Portugal, 1519 from Spain). In Portugal, maintaining/increasing the use of public natural spaces during the lockdown was associated with lower levels of stress (adjusted beta -0.29; 95%CI -0.49, -0.08) and maintaining/increasing the frequency of viewing nature from home was associated with reduced psychological distress (0.27; -0.51, -0.03), somatization (-0.79; -1.39, -0.20), and stress levels (-0.48; -0.74, -0.23). In Spain, maintaining/increasing contact with private green space and greenery was associated with lower stress levels: for contact with indoor plants (-0.52; -0.96, -0.07) and for use of private community green spaces (-0.82; -1.61, -0.03).
Conclusion
Exposure to nature provided mental health benefits during COVD-19 lockdown. Policy-makers should ensure and organize safe and controlled opportunities for exposure to nature in the event of future COVID-19 outbreaks or other pandemics.
To What Extent Did Visits to Green and Blue Spaces Enable Respite, Connection and Exercise During the COVID-19 Pandemic, and Whether Such Benefits Might Have Been Negatively Impacted by Restrictions in Spatial Mobility Generated by ‘Lockdowns’
Xiaoqi Feng, Associate Professor in Urban Health and Environment, NHMRC Career Development Fellow, School of Population Health, University of New South Wales, Founding Co-Director of Population Wellbeing and Environment Research Lab (PowerLab), Australia
Introduction
We investigated to what extent visits to green and blue spaces may have enabled respite, connection and exercise during the COVID-19 pandemic, and whether such benefits might have been negatively impacted by restrictions in spatial mobility generated by ‘lockdowns’.
Method
A nationally representative online and telephone survey conducted in 12–26 October on the Social Research Centre’s Life in AustraliaTM panel (aged ≥ 18 y, 78.8% response, N = 3043) asked about access, visitation, and felt benefits (respite, connection, exercise) from visiting green and/or blue spaces. Participants in Melbourne, who were in lockdown during the study, were contrasted with counterparts in Sydney, who were not in lockdown.
Results
Residents of Melbourne compared with Sydney reported consistently increased visitation of (OR = 1.66, 95% CI = 1.23, 2.19), discovery of (IRR = 1.16, 95% CI = 1.05, 1.29), and greater levels of various felt benefits derived from green and/or blue spaces, including more respite (OR = 1.65, 95% CI = 1.21, 2.19), connection (OR = 1.44, 95% CI = 1.05, 1.95), and exercise (OR = 2.11, 95% CI = 1.58, 2.79). The odds of visiting preferred green and/or blue space at least once a week for the past 4 weeks were also notably higher in Melbourne compared with Sydney (OR = 2.10, 95% CI = 1.56, 2.76). These results were robust to adjustment for a range of covariates including financial circumstances, working from home opportunities, and preferences for natural settings.
Conclusion
Contrary to expectation, people living through COVID-19 lockdown visited green and blue spaces more often, and appeared to benefit more from those visits, than counterparts who were not in lockdown. These results underline the importance of keeping green and blue spaces open, and highlights the value that previous investments in green and blue space have played in enabling coping during the COVID-19 pandemic.
Outdoor Activity Participation Improves Adolescents’ Mental Health and Well-Being During the Covid-19 Pandemic
Lincoln R. Larson, Associate Professor, College of Natural Resources, NC State University
COVID-19 is reshaping human interactions with the natural environment, potentially generating profound consequences for health and well-being. To assess the effects of COVID-19 on the outdoor recreation participation and subjective well-being of adolescents, as well as how participation in outdoor activities may mitigate declines in subjective well-being, we used a Qualtrics XM panel to conduct a nationally representative survey of youth ages 10–18 across the United States (n = 624) between 30 April and 15 June 2020. Survey questions focused on frequency of participation in outdoor activities before and during the pandemic, as well as changes in subjective well-being. Paired t-tests revealed decreases in both outdoor recreation participation (64% reported declines) and subjective well-being (52% reported declines). A regression model examining correlates of changes in subjective well-being (R2 = 0.42) revealed strong associations with changes in outdoor play (B = 0.44, p < 0.001) and nature-based (B = 0.21, p = 0.016) activities. Adolescents’ from all backgrounds who participated in these activities during the pandemic reported smaller declines in subjective well-being. Results highlight the critical role that time outdoors and time in nature play in bolstering adolescents’ resilience to stressors such as the COVID-19 pandemic and underscore the need to facilitate outdoor recreation opportunities for youth during times of crisis.
Behavioral Patterns and Experiences of US Outdoor Enthusiasts During The Covid-19 Pandemic: Longitudinal Results from March 2020 to March 2021
Derrick Taff, Assistant Professor, Recreation, Park and Tourism Management, Penn State University
This research examined avid outdoor recreationists through a four-phase, year-long nationwide study, to determine how the Pandemic influenced their perceptions and recreation behaviors over the span of March 2020—when the World Health Organization (WHO) announced the Pandemic—to March 2021. This presentation focuses on salient results that merit consideration for land managers and recreation service providers, as well as health policy officials. For example, results from the spring of 2020 indicated that the behaviors of respondents were driven first and foremost by their desire for physical and mental well-being resulting from outdoor recreation, and second, guidance and clear communication from the Centers for Disease Control and Prevention, the WHO, and federal and state agencies. Spring 2020 results indicated significant disparities between frequent outdoor recreation by residency type, suggesting that urban residents were unable to access outdoor recreation as much as those in rural settings; this discrepancy yielded no significant differences by March of 2021. Over the span of the study, respondents indicated participating in more types of outdoor recreation, more often, traveling further and in larger groups, and ultimately using their local public lands more frequently for outdoor recreation than during the beginning of the Pandemic. Forty-three percent of respondents indicated that these behaviors would continue after the conclusion of the Pandemic. Results highlight the importance of outdoor recreation for health, and current issues regarding equitable access to public recreational opportunities. Finally, results suggest that the change behaviors of avid outdoor recreationists during the Pandemic, may be here to stay, leaving implications for land managers and outdoor recreation service providers as they address different types of use at increased levels.
County-Level Exposures to Green Spaces and Associations with Covid-19 Incidence and Mortality in the United States
Jochem Klompmaker, Harvard T.H. Chan School of Public Health
Background
COVID-19 is an infectious disease that has killed more than 600,000 people in the US. During a time of social distancing measures and increasing social isolation, green spaces may be a crucial factor to maintain a physically and socially active lifestyle while not increasing risk of infection.
Objectives
We evaluated whether greenness was related to COVID-19 incidence and mortality in the US.
Methods
We downloaded data on COVID-19 cases and deaths for each US county up through June 7, 2020, from Johns Hopkins University, Center for Systems Science and Engineering Coronavirus Resource Center. We used April-May 2020 Normalized Difference Vegetation Index (NDVI) data, to represent the greenness exposure during the initial COVID-19 outbreak in the US. We fitted negative binomial mixed models to evaluate associations of NDVI with COVID-19 incidence and mortality, adjusting for potential confounders such as county-level demographics, epidemic stage, and other environmental factors. We evaluated whether the associations were modified by population density, proportion of Black residents, median home value, and issuance of stay-at-home orders. We performed sensitivity analyses with public park cover instead of greenness, and with COVID-19 data through August 31, 2020.
Results
An increase of 0.1 in NDVI was associated with a 6% (95% Confidence Interval: 3%, 10%) decrease in COVID-19 incidence rate after adjustment for potential confounders. Associations with COVID-19 incidence were stronger in counties with high population density and in counties with stay-at-home orders. Greenness was not associated with COVID-19 mortality in all counties; however, it was protective in counties with higher population density. Sensitivity analyses showed that public park cover was associated with a decrease in COVID-19 incidence and mortality. Extended analyses, with COVID-19 data through August 31, 2020, showed weaker associations with COVID-19 incidence compared to our primary analyses.
Discussion
Exposures to greenness were associated with reduced county-level incidence of COVID-19 in the US as well as reduced county-level COVID-19 mortality rates in densely populated counties.
Session 7: Microbiome and Exposure to Natural Settings
Research on the human microbiome has exploded in the past 20 years, and many of the findings have implications for research on the health benefits of nature exposure. Unique airborne microbial entities (such as bacteria, fungi, archaea, and viruses) exist in different natural settings, ranging from forests and agriculture, to urban green spaces and oceans. These entities can be transferred to people through touch, inhalation, or ingestion and subsequent colonization of the skin, respiratory tract, and gut, among other systems. Exposure to some entities is determinantal to human health but exposure to many others can be health-promoting as a result of the commensal relationships that have evolved between microbial genera and humans.
Moderator: Matthew Browning, Department of Parks, Recreation, and Tourism Management, Clemson University, USA
Presentations
Transfer and Persistence of Garden Soil Microbes on Human Skin
Gwynne Mhuireach, Institute for Health in the Built Environment, University of Oregon, Eugene, OR, USA
Accumulating research has improved our understanding of soil microbial life and how it affects the growth, health, and survival of crop plants. However, we still know very little about how exposure to soil microbes might affect the health of farmers and gardeners who spend a great deal of time in direct contact with soil. To begin filling this knowledge gap, we orchestrated a community science project recruiting 40 Master Gardeners from two different climate zones in Oregon to characterize microbial communities in garden soil and their ability to transfer onto the skin during gardening, as well as their persistence on the skin for 24 hours afterward. Preliminary results indicate that the skin microbiome is substantially altered by gardening activities that involve direct soil contact, such as weeding and transplanting seedlings. The majority of soil microorganisms were non-pathogenic and transient on skin, largely disappearing after 12–24 hours. In addition, we found that management practices (organic vs. nonorganic) and geographic location had small but significant effects on taxonomic composition of garden soil microbiomes. With improved understanding of how many microorganisms are transferred onto skin during gardening, to which taxa they belong, and how long they persist, gardeners will be better able to make important health decisions, such as whether to wear gloves while working directly in the soil.
Gardening and Family Health: Elucidating the Role of the Human and Environmental Microbiota
Matthew Browning, Department of Parks, Recreation, and Tourism Management, Clemson University, USA
Historically, humans have interacted with soils, which contain a rich source of microorganisms. However, urbanization has reduced these interactions. Reductions in environmental exposure to microbes is hypothesized to underlie the rise in non-communicable disease. Fruit and vegetable gardening is the primary interaction humans have with soil today. Yet, microbial factors that may underpin the health benefits of gardening are under-investigated. The current case-controlled cohort study enrolled gardening families (n=10) and non-gardening (control) families (n=9). Families included two adults and one child (5-18 years) for a total of 56 participants. All participants provided a fecal sample and diet history questionnaires before the gardening season (April 2018) and during the peak of the gardening season (August 2018). Soil samples were collected from respective gardening plots at these same time points (n=17). Healthy Eating Index (HEI-2015) scores and nutrient analysis were performed. Fecal and soil DNA were extracted, the 16S rRNA gene (V4 region) was amplified, and sequence data were processed and analyzed. Peak season gardening families tended to have greater fecal operational features, a greater Faith’s Phylogenetic Diversity score, greater fiber intake, and higher abundances of fiber fermenting bacteria (Bacteroides ovatus and Eubacterium xylanophilum group spp.) than peak control families. Soil endemic microbes were also shared with gardening participant’s fecal samples. This study revealed that the fecal microbiota of gardening families differs from non-gardening families, and that there are detectable changes in the fecal microbial community of gardeners and their family members over the course of the gardening season.
Restoring an Ecological Exposure Pathway of Environmental Microbiota
Martin Breed, College of Science & Engineering, Flinders University
Half the world’s seven billion people live in cities, with >70% expected by 2030. Urbanisation brings an unexpected outcome: loss of exposure to outdoor microbiomes that have co-evolved with humans and provide important health functions. Indeed, urbanisation is also linked to dramatic changes in environmental microbiomes, perhaps via its impacts on macrodiversity such as vegetation communities. The specific exposure pathways of environmental microbiomes to people is increasingly well characterised. In this talk, I’ll cover work on (a) how ecosystem restoration can shift soil microbiomes towards more natural states, (b) the associations between soil microbiomes and the aerobiome, and (c) how vegetation complexity may have a role to play.
Panel: Intersecting Social and Nature Systems
Urban Forestry and Human Health: Evidence to Economic Value
Kathleen Wolf, Research Social Scientist, College of the Environment, University of Washington
Background
What is the economic value of having trees in cities and towns? This work is important as arborists and urban foresters are often challenged to justify the costs of tree planning, planting and management. Evidence of environmental services has generated support in many communities. Meanwhile, 40 years of research describes the human health benefits gained from experiences of nature in cities.
Objectives and Methods
This project compiled first research about human health benefits specific to city trees and forests, synthesized the findings as an academic review, and conducted economic valuation using a benefits transfer approach. Partners included Health Canada, Natural Resources Canada (national offices), Tree Canada and the University of British Columbia.
Results
The first challenge was, “what is the scientific evidence of trees and human health?” The research literature about nature and health can be difficult to access as it is distributed across the publications of multiple and diverse disciplines. Our team leveraged prior research and publication review to assemble a collection of studies that focused on city trees and human health response, synthesizing the diverse collection into key messages.
The second challenge was, “how do we place economic value on health outcomes?” Our team has included economists that adapt strategies from other natural resources economics domains for market-based and non-market valuations. The work for this project built off of our team’s prior peer-reviewed published work: 1) a framework of potential valuation topics and monetization methods, and 2) public health valuation across the human life cycle. Using a synthesis of 1) health outcomes effects from existing studies, 2) published annual costs of major chronic diseases in the United States, and 3) projected avoided costs associated with experiences of trees in urban communities, we we able to calculate potential valuations of billions of dollars on an annual basis.
Conclusions
The project demonstrates that urban forest investment generates a social determinant of health that has important economic implications. The findings suggest that urban forest planning and management should incorporate human health to build the business case for urban forestry with local decision makers and community leaders.
Quantifying and Managing for Urban Ecosystem Services Under a Changing Climate
Meghan Hayden, PhD Student, University of Colorado, Boulder
Urban forests and other greenspaces provide numerous benefits to society and human well-being through carbon sequestration, runoff and flood mitigation, reduction of the urban heat island effect and recreational opportunities. Nonetheless, urban landscapes have not received as much attention as ecosystem service providers as their rural counterparts. As cities formulate climate mitigation and adaptation strategies, considering the co-benefits and tradeoffs between multiple ecosystem services is important for urban municipalities and their residents. Using Boulder, Colorado and outlying areas as a case study, we assess spatial patterns in ecosystem service provisioning to demonstrate the potential for various land management strategies and climate adaptation efforts to maximize delivery of multiple ecosystem services. Our partnership with the city of Boulder constitutes an effort to develop working relationships between research institutions and city planners on a national scale through a Climate Adaptation Initiative. The framework that we lay out for assessing urban ecosystem service provisioning in the city of Boulder thus serves as a promising case study for other urban centers, both in developing cross-disciplinary partnerships and in ensuring climate resilience. As part of this framework, we employ Natural Capital’s InVEST models to assess carbon sequestration, flood mitigation, urban cooling, and habitat for urban wildlife across historic, contemporary and future scenarios for land cover. We develop scenarios for future land cover based on stakeholder (i.e. city and open space managers) input to include potential management interventions (i.e. conversion of open lots to green space) and predicted environmental changes (i.e. increase in number of summer days over 90 degrees). We validate the output of our models against ecosystem service indicators measured via remote sensing and on-ground sensors. Ultimately, this analysis allows us to propose management strategies that both enhance delivery of multiple ecosystem service benefits and ensure an equitable distribution of ecosystem service benefits under climate change.
Setting a Collective Agenda for Health-first Green Stormwater Infrastructure in Philadelphia
April Mendez, Chief Executive Officer, Greenprint Partners
Greenprint Partners is a green infrastructure (GSI) delivery partner that helps cities achieve high-impact, community-driven stormwater solutions at scale. In 2021, with funding from the William Penn Foundation (WPF), Greenprint is engaging healthcare stakeholders in the prioritization and development of planned and potential nature-based projects in Philadelphia that can improve health outcomes. In the coming years, we seek to explore the extent to which health benefits derived from GSI projects may stimulate investment or other participation of health-motivated payors, resulting in evaluation health outcomes and potential cost savings. This may lead to targeted GSI interventions to address specific neighborhood health needs in Philadelphia that align with the priorities and interests of healthcare stakeholders. The immediate goals of the 2021 WPF-funded project include: 1) creating a mechanism for healthcare stakeholders, including payors and providers, to be engaged in the discussion, prioritization, location, development, and financing of GSI projects in Philadelphia, and 2) establishing a common understanding of stakeholder goals, and determine an agenda for getting there. This presentation will highlight the preliminary results from the first months of stakeholder engagement, convenings, and collaborative goal setting. It will provide a candid look at the successes and challenges in bringing together diverse payors to set an agenda for collaboratively funding health-focused GSI.
Forest Biodiversity and Human Thermal Comfort
Loïc Gillerot, Faculty of Bioscience Engineering, Ghent University, KU Leuven
Thermal comfort and human wellbeing are closely linked, and especially temperature extremes represent potential health threats. From urban planning and health studies on the one hand and ecological research on the other hand, the climate-buffering capacity of vegetation and, especially, forests, is well established. However, it is rarely approached from an interdisciplinary angle, leading to incompatible indicators. How ecological forest characteristics such as species diversity and stand structure influence the microclimate experienced by humans remains an open question. To address this, we installed 147 microclimate stations in different forest stands dispersed over eight sites in four European countries. During one year, these continuously logged the four variables that influence thermal perception: air temperature and humidity, mean radiation temperature and wind speed. Those variables allow the computation of indices that accurately reflect thermal perception, such as the physiologically equivalent temperature (PET), which is then related to measured ecological forest traits: tree species diversity, basal area, tree height, canopy closure and leaf area index. As microclimate stations will be logging until September 2021, the first results will be presented. This study is part of the interdisciplinary BiodivERsA project “Dr. Forest”.
Landscape Structure Evaluation for Nature-Based Solutions Design in Cities
Marina Ribeiro, Universidade Federal de São Carlos (UFSCar)
The current climate change scenario, natural resource degradation, and decline in global biodiversity have placed cities at the center of concerns about the present and future of health, humanity, and well-being. More than half of the world’s population lives in cities, and with continued population growth, it is necessary to make these spaces resilient to minimize environmental and social impacts. Design solutions based on natural elements help build resilience in cities, promote biodiversity, and provide ecosystem services, including cleaner air and water, temperature regulation, and improving human health. This main objective was to evaluate a city’s landscape structure located in the Atlantic Forest biome, Brazil. We evaluated natural and semi-natural areas in the city using landscape metrics to provide subsidies for the nature-based solutions model in the urban landscape. The natural vegetation cover was quantified by mapping land-use/land-cover, which was assessed by the metrics: area (AREA) and proximity among patches (NEAR). Our results showed that Sorocaba has 37.4% of its area covered by built areas. The native vegetation and silviculture areas represent 17.6% and 6.3%, respectively, and anthropic grassland represents 21.7%. Only 2.25% of the natural areas are in protected areas, and the others belong to private properties and institutional areas. The majority of forest patches (84.9%) have a size less than 10 ha, and 57.3% are in 50m from another patch. The promotion of urban design focusing on nature-based solutions depends on incentives to conserve native vegetation located in private properties and institutional areas. Still, it should be supported by actions as natural vegetation restoration in anthropic grasslands, actions to restore small urban forest fragments, riparian zones restoration, and finally, the planning of the residential areas without the need for built areas spreading.
Linking Restorative Human Health Outcomes to Protected Area Ecosystem Diversity and Integrity
Catherine Reining, Wilfrid Laurier University
The human health and well-being benefits associated with nature contact is well established and recognition for the role parks and other forms of protected areas play in contributing to these benefits is mounting. However, limited research has focused on the influence of ecosystem type and quality on these outcomes. This study builds on previous work to better understand how visitor experiences provided by diverse ecosystems affect perceived restorative outcomes as one aspect of health and well-being, reporting the results of an in-situ survey of 467 visitors to a protected area in Ontario, Canada. Tablet computers were used to capture visitor responses at intercept points, identified using Ecological Land Classification (ELC) data. The survey included a modified Restorative Outcome Scale (ROS) to measure participant’s well-being and mood as well as scale questions concerning perceived ecological integrity and species richness, socio-demographics, and overall health factors. Results revealed high overall restorative outcomes from contact with nature in the park. The type of environment and length of stay had little influence on visitor’s perceived restorative outcomes. However, restorative outcomes were perceived to be greater by women than men. Visitors reported high restorative outcomes irrespective of their self-reported state of mental and physical health. The perceived integrity of the environment had the greatest impact on reported outcomes. Visitors who perceived an environment to have higher ecological integrity or species richness also reported higher restorative outcomes. These results underscore the important links between human health and ecological integrity and point to a need to better understand the synergies between managing for ecological integrity and visitor experiences in protected areas.
Nature on Prescription: Co-Creating an Intervention Development Resource
Harriet Hunt, European Centre for the Environment and Human Health – University of Exeter
Background
Interest in the UK and more widely in both the theory and practice of nature-based interventions for common mental health conditions is expanding. The Nature on Prescription (NoP) programme was built on the findings of a series of systematic and realist reviews by our research group, which identified the dearth of high quality evidence for effectiveness of nature-based mental health interventions, and indeed social prescribing in general. Qualitative findings indicated broad satisfaction with nature-based interventions and perceived participant benefits in terms of mental health and wellbeing on the behalf of both providers and recipients but robust, consistent evidence for effectiveness is lacking. This has created a problematic situation whereby activity in the sector has moved ahead of the evidence, with concomitant issues around safety and confidence in effectiveness emerging. There is a strong demand from all stakeholders to identify what actually works in this area and employ it in practice.
Objectives
To co-create an intervention development resource for providers, which builds on our existing research, and will be made available online in a format that is user friendly and adaptable.
Methods
Through a structured and phased development programme, we created guidance documentation. Working with stakeholders through online workshops to further refine the guidance, content was transposed into an online format, followed by a multi-stakeholder ‘soft launch’ event allowing participants to feedback on the proposed content. We integrated further stakeholder feedback from the engagement event and tested the user interface and stability of website with a subgroup of stakeholders. Finally, we launched the co-created intervention development guidance in the public domain, and wrote up the co-creation process and outcomes for publication in a peer reviewed journal.
Results
Via stages of development and active co-creation we have produced a handbook of intervention guidance that is relevant and practical for providers of nature-based interventions.
Conclusions
Through previous work, we have found that providers of nature-based interventions struggle to integrate available and emerging research into their work. This intervention guidance has been co-produced to create an online handbook that can be used by existing and potential providers, to develop nature-based interventions addressing common mental health conditions.
Health and Wellbeing Benefits from Nature May not Persist Under Intense Urbanisation
Rachel Oh, University of Queensland
A growing number of policies and programs in cities aim to increase the time people spend in nature so that they can experience the health benefits delivered by such interactions. Indeed, four decades of research have linked experiences of nature with a range of positive health outcomes. While health outcomes are known to vary across cities, and the quantity and quality of nature experiences, there has been little research investigating whether nature experiences can continue to deliver health and wellbeing benefits even under conditions of extreme urbanisation and high population density. Here, we assessed the relationships between nature dose (frequency, duration and intensity) with three mental (depression, stress and anxiety) and two physical (high blood pressure, diabetes) health outcomes in Singapore, one the most intensely urbanised cities in the world. In our analyses, we specifically controlled for whether people with poor health are prevented by their condition from visiting greenspaces, since that could result in a spurious relationship between nature dose and positive health outcomes. Overall, our results demonstrate that nature dose is not associated with elevated health and wellbeing outcomes in Singapore. In fact, longer durations of nature exposure, and stronger ecological identity (affective connection to nature) were correlated with a higher depression, stress and anxiety. Conversely, stronger social cohesion was associated with a reduced occurrence of depression, and increased frequency of physical exercise was associated with lower stress and anxiety. Neither area of tree cover nor ecological complexity of the visited green spaces were significantly associated with any of the five health and wellbeing outcomes. Our results suggest that stresses from urban living, under conditions of extreme urbanisation and population density, could eclipse health and wellbeing benefits accrued from nature experiences. We further highlight an urgent need for future studies to expand on the evidence base investigating the causal relationships between exposure to nature and health outcomes, as this is necessary to provide direct and actionable information for public health decision making and development of nature-related recommendations.
Sponsors
This powerful symposium would not have been possible without the generosity of REI, Boeing, The Trust for Public Land, The Wilderness Society, and Ecopsychology (Mary Ann Liebert, Inc. publishers). We are grateful for their support.
Nature and Health Symposia
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