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76 publications listed under Health and well-being

Time Spent Interacting with Nature Is Associated with Greater Well-Being for Girl Scouts Before and During the COVID-19 Pandemic

2023 / Children, COVID, Health and well-being, Scouts

The onset of the COVID-19 pandemic rendered daily life overwhelmingly difficult for many children. Given the compelling evidence for the physical and mental health benefits of interaction with nature, might it be the case that time spent interacting with nature buffered the negative effects of the pandemic for children? To address this question, we conducted a longitudinal investigation with a cohort of 137 Girl Scouts across two time periods: right before the onset of the pandemic (December 2019–February 2020) and one year later (December 2020–February 2021). We found that during the pandemic (compared to pre-pandemic), Girl Scouts fared worse on measures of physical activity, positive emotions, negative emotions, anxiety, behavioral difficulties, and problematic media use. However, by using mixed models, we also found that, on average, Girl Scouts who spent more time interacting with nature fared less poorly (in this sense, “did better”) on measures of physical activity, positive emotions, anxiety, and behavioral difficulties, irrespective of the pandemic. Further analysis revealed that these advantageous associations were present even when accounting for the amount of nature near each child’s home (as measured by the normalized difference vegetation index, percent of natural land cover, and self-reported access to nature). To the best of our knowledge, this is the first study investigating nature interaction and children’s well-being to use data collected from the same cohort prior to and during the pandemic. In addition, we discuss the importance of opportunities to interact with nature for children’s well-being during future periods of social upheaval.

Urban Green Space and Mental Health Among People Living Alone: The Mediating Roles of Relational and Collective Restoration in an 18-Country Sample

2023 / Green spaces, Health and well-being, Loneliness

Figure 1. Theoretical model linking exposure to green space to mental health via social restoration processes. Rates of living alone, especially in more urbanised areas, are increasing across many industrialised countries, with associated increases in feelings of loneliness and poorer mental health. Recent studies have suggested that access to nature (e.g. parks and green spaces) can reduce the stressors associated with loneliness, partly through providing opportunities to nurture personal relationships (relational restoration) and engage in normative community activities (collective restoration). Such associations might vary across different household compositions and socio-demographic or geographical characteristics, but these have not been thoroughly tested. Using data collected across 18 countries/territories in 2017–2018, we grouped urban respondents into those living alone (n = 2062) and those living with a partner (n = 6218). Using multigroup path modelling, we tested whether the associations between neighbourhood greenspace coverage (1-km-buffer from home) and mental health are sequentially mediated by: (a) visits to greenspace; and subsequently (b) relationship and/or community satisfaction, as operationalisations of relational and collective restoration, respectively. We also tested whether any indirect associations varied among subgroups of respondents living alone. Analyses showed that visiting green space was associated with greater mental well-being and marginally lower odds of using anxiety/depression medication use indirectly, mediated via both relationship and community satisfaction. These indirect associations were equally strong among respondents living alone and those living with a partner. Neighbourhood green space was, additionally, associated with more visits among respondents living with a partner, whereas among those living alone, this was sensitive to the green space metric. Within subgroups of people living alone, few overall differences were found. Some indirect pathways were, nevertheless, stronger in males, under 60-year-olds, those with no financial strain, and residents in warmer climates. In conclusion, supporting those living alone, as well as those living with a partner, to more frequently access their local greenspaces could help improve mental health via promoting relational and collective restoration.

Where Wilderness is Found: Evidence From 70,000 Trip Reports

2023 / Health and well-being, Public land, Recreation, Social media

Figure 1. The study area, showing the boundaries of the Mt. Baker-Snoqualmie National Forest, wilderness areas within it and the trailheads for the 470 hikes in the Washington Trails Association hiking guide that we included in the sample. Map created with the R programming language using the sf, ggspatial and cowplot packages (Dunnington, 2022; Pebesma & Bivand, 2023; R Core Team, 2022; Wilke, 2019). Data from USDA Forest Service, Washington Trails Association, Washington Department of Transportation, Environmental Systems Research Institute map service and Natural Earth, facilitated by the basemaps and rnaturalearth packages for R (ESRI, 2009; Massicotte & South, 2023; Schwalb-Willmann, 2022; USDA Forest Service, 2019; WSDOT, 2023; WTA, 2023c). 1. Outdoor recreation is an essential way many people engage with nature. The provision of public spaces for recreation intersects with conservation practices motivated by intertwined social and ecological values, such as strict practices associated with the concept of ‘wilderness’. Debates persist about how such concepts and management practices influence people’s recreation experiences. 2. Many US public land management agencies facilitate opportunities for outdoor recreation, relying on management frameworks and tools intended to foster specific experiential qualities. But these frameworks and tools assume simplistic relationships between settings and people’s experiences, and managers rarely assess these relationships. 3. This study uses a data set of nearly 70,000 crowdsourced trip reports from a hiking website to understand the qualities of visitors’ experiences on trails. We study the geographic distribution of experiential qualities commonly associated with US wilderness areas: aesthetics, awe, challenge, pristineness, quietness, solitude and timelessness. Using analytical methods that rely on machine learning and natural language processing, we identify these experiential qualities in trip reports from hundreds of routes, and use generalized linear models to analyse relationships between the frequency of each experiential quality and the route’s administrative, built, biophysical, geographic and social settings. 4. We find that four of the seven experiential qualities (aesthetics, awe, challenge and solitude) are commonly described in trip reports, each appearing in 15%–55% of manually coded reports. The extent to which setting characteristics explained variability in experiences differed, ranging from 34% of the variability in the proportion of trip reports describing aesthetics to 55% for awe. The setting characteristics associated with each experiential quality also differed, with characteristics such as trail mileage and summit destinations having stronger influences on experiential qualities than characteristics such as wilderness designation. 5. Synthesis and applications. Our findings suggest the need to consider more diverse variables in experience–setting relationships, develop more robust models to characterize those relationships and create new data sources to represent understudied variables. These advances would help empirically inform and improve frameworks and tools used for recreation and wilderness planning and monitoring, and potentially promote more responsive management to evolving social– ecological values.

Development and Validation of an Attitudes Towards Spending Time in Nature Scale

2022 / Development, Health and well-being

Figure 1. Pictorial representation of methodology steps Time spent in nature (TSN) is related to improved health and well-being; however, many adults spend little time in nature. Interventions based on health behavior theories may be effective at increasing TSN. Attitudes toward a behavior have been shown to be a strong predictor of both intention and behaviors, but valid and reliable measures regarding these attitudes are lacking. The study aim was to develop a valid and reliable attitude toward TSN scale. This scale was developed using a sequential procedure: domain identification and item generation, content validity, question pretesting, survey administration, item reduction, factors extraction, dimensionality, reliability, and validity. The investigative team generated 49 unique items. Content validity and pretesting reduced the item set to 21. A countrywide sample of 2109 adults (50.3% male, median age = 58.1; 38.8% non-White) completed an online survey. Using split-half measures, principal components analysis indicated a three-factor solution: positive attitudes, negative attitudes, and concerns about being in nature. The factor structure was upheld in confirmatory factor analyses with strong internal consistency (α = 0.92 positive attitudes; 0.84 negative attitudes; 0.84 concerns). The scales were strongly related to intentions and TSN with large effect sizes. The study resulted in a reliable and valid three-factor attitudes toward spending time in nature scale that could be used to develop interventions to increase TSN.

Nature and Health: Perspectives and Pathways

2022 / Health and well-being, Stress

As many scholars have noted, research and publications on the benefits of nature experience have grown substantially over recent years. Progress has been made on empirical fronts based on perspectives from psychology, epidemiology, sociology, exposure science, urban design, and other disciplines. Studies have revealed ways in which health outcomes differ by population characteristics (e.g., socioeconomic status), individual differences (e.g., states of baseline mental health), and interactions with different types of nature (e.g., street trees vs. large parks vs. deserts) (Barnes et al., 2019; Mitchell & Popham, 2008; Mitchell, Richardson, & Shortt, 2015; Olvera-Alvarez, Browning, Neophytou, & Bratman, 2021; Tester-Jones et al., 2020; Wheeler et al., 2015; Yin, Bratman, Browning, Spengler, & Olvera-Alvarez, 2022). Together, the evidence also illustrates the importance of accounting for different ways of “operationalizing nature” (e.g., Normalized Difference Vegetation Index [NDVI]), and methods of measuring exposure (e.g., subjective vs. objective), as well as the granularity in assessments of frequency and duration (Ekkel & de Vries, 2017; Shanahan et al., 2016).

The Relationship Between Natural Environments and Subjective Well-Being as Measured by Sentiment Expressed on Twitter

2022 / Health and well-being, Social media

Fig. 1. (A) The spatial distribution of tweets in the sample. (B) Land cover in Seattle. (C) Tree canopy coverage in Seattle. (D) Parks in Seattle. Land-cover and tree-canopy data were taken from the 2016 National Land Cover Database (NLCD) (Dewitz, 2019). Polygons representing urban parks within Seattle were downloaded from Seattle GeoData portal (Seattle Parks, 2012). There is growing evidence that time spent in nature can affect well-being. Nonetheless, assessing this relationship can be difficult. We used 1,971,045 geolocated tweets sent by 81,140 users from Seattle, Washington, USA to advance our understanding of the relationship between subjective well-being and natural environments. Specifically, we quantified the relationships between sentiment (negative/neutral/positive) expressed in geolocated tweets and their surrounding environments, focusing on three environmental indicators: land-cover type, tree-canopy density, and urban parks. We allowed the relationships to vary according to the broader type of environment (i.e., land-use zoning). We estimated three random-intercept partial proportional odds models corresponding to the three environmental indicators while controlling for multiple covariates. Our results suggested that for a given land-use type, tweets sent from some natural land-cover types were less likely to be negative compared to tweets sent from the urban built land-cover type. For tweets sent in industrial zones, an increase in tree-canopy cover was associated with a lower probability of having negative sentiments and with a higher probability of having positive sentiments; but for tweets sent in commercial/mixed zones, the association was reversed. Also, urban parks were generally associated with a lower probability of having negative sentiments, but tweets sent from large natural parks in residential zones were less likely to be positive. Our results suggest that the relationship between subjective well-being and natural environments depends on where people are situated in the built environment and may be more complex than previously thought. The more nuanced understanding provided by analyzing geolocated social media has potential to inform urban planning and land management.

What Can We Do When the Smoke Rolls In? An Exploratory Qualitative Analysis of the Impacts of Rural Wildfire Smoke on Mental Health and Well-Being, and Opportunities for Adaptation

2022 / Health and well-being, Wildfires

Figure 1. Suggested content, distribution location, medium, and messenger for a wildfire smoke and wellbeing toolkit Background Extreme, prolonged wildfire smoke (WFS) events are becoming increasingly frequent phenomena across the Western United States. Rural communities, dependent on contributions of nature to people’s quality of life, are particularly hard hit. While prior research has explored the physical health impacts of WFS exposure, little work has been done to assess WFS impacts on mental health and wellbeing, or potential adaptation solutions. Methods Using qualitative methods, we explore the mental health and wellbeing impacts experienced by community members in a rural Washington State community that has been particularly hard hit by WFS in recent years, as well as individual, family, and community adaptation solutions. We conducted focus groups with residents and key informant interviews with local health and social service providers. Results Participants identified a variety of negative mental health and wellbeing impacts of WFS events, including heightened anxiety, depression, isolation, and a lack of motivation, as well as physical health impacts (e.g., respiratory issues and lack of exercise). Both positive and negative economic and social impacts, as well as temporary or permanent relocation impacts, were also described. The impacts were not equitably distributed; differential experiences based on income level, outdoor occupations, age (child or elderly), preexisting health conditions, housing status, and social isolation were described as making some residents more vulnerable to WFS-induced physical and mental health and wellbeing challenges than others. Proposed solutions included stress reduction (e.g., meditation and relaxation lessons), increased distribution of air filters, development of community clean air spaces, enhancing community response capacity, hosting social gatherings, increasing education, expanding and coordination risk communications, and identifying opportunities for volunteering. Findings were incorporated into a pamphlet for community distribution. We present a template version herein for adaptation and use in other communities. Conclusions Wildfire smoke events present significant mental health and wellbeing impacts for rural communities. Community-led solutions that promote stress reduction, physical protection, and community cohesion have the opportunity to bolster resilience amid this growing public health crisis.

Affective Benefits of Nature Contact

2021 / Health and well-being

Figure 1. Nature contact and the process model of emotion regulation. We describe the ways in which these five family of strategies may be influenced by natural environmental factors, which in turn leads to affective benefits. Figure icon made by eucalyp from www.flaticon.com Mounting evidence demonstrates that nature exposure can have affective benefits. These include behavioral and psychophysiological responses consistent with (a) decreases in stress and negative affect; and (b) increases in subjective well-being and positive affect. What is less clear, however, is what mechanisms are responsible for these effects. In this article, we examine the evidence for affective impacts of nature exposure, consider underlying mechanisms (with a focus on affect regulation), and discuss what might moderate these effects at the individual and population level. We end by pointing to future research directions and practical applications. This includes investigations into the range of effects and duration of their impact, harnessing knowledge about temporal dynamics for insights into causal mechanisms, broadening the discussions around moderators and effect modifications to include diverse perspectives on the relationship between nature exposure and psychological well-being, and integrating findings into existing frameworks from public health.

Affective Benefits of Nature Contact: The Role of Rumination

2021 / Health and well-being

Figure 1. Structural equation mediation model of the relationships between time in nature, rumination and positive and negative affect. Ovals denote latent variables (i.e., all but “Weekly time in nature”). Standardized coefficients are presented. *indicates path with significant relationship (α = 0.05). †Indicates path with marginally significant relationship (α = 0.10). For the “ab” paths, significance was tested with bootstrapped 95% confidence intervals. The “ab” paths indicate the indirect effect of time in nature on affect. The “c” paths indicate the total effect of time in nature on affect. The “c”’ paths indicate the direct effect of time in nature on affect. Mounting evidence shows that nature contact is associated with affective benefits. However, the psychological mechanisms responsible for these effects are not well understood. In this study, we examined whether more time spent in nature was associated with higher levels of positive affect in general, and lower levels of negative affect and rumination in general. We also conducted a cross-sectional mediation analysis to examine whether rumination mediated the association of nature contact with affect. Participants (N = 617) reported their average time spent in nature each week, as well as their general levels of positive and negative affect, and the degree to which they typically engaged in rumination in daily life. We then used structural equation modeling to test our hypotheses. Our results support the hypothesis that nature contact is associated with general levels of affect, and that rumination mediates this association for negative affect, and marginally mediates this association for positive affect.

An Ecosystem Service Perspective on Urban Nature, Physical Activity, and Health

2021 / Green spaces, Health and well-being

Figure 1. Conceptual model of the relationships among urban nature (as part of the urban system), PA (quantity and quality), and health, alignedwith an ecosystem service approach. Numbers correspond with The Current State of Knowledge points 1 and 2. Nature underpins human well-being in critical ways, especially in health. Nature provides pollination of nutritious crops, purification of drinking water, protection from floods, and climate security, among other well-studied health benefits. A crucial, yet challenging, research frontier is clarifying how nature promotes physical activity for its many mental and physical health benefits, particularly in densely populated cities with scarce and dwindling access to nature. Here we frame this frontier by conceptually developing a spatial decision-support tool that shows where, how, and for whom urban nature promotes physical activity, to inform urban greening efforts and broader health assessments. We synthesize what is known, present a model framework, and detail the model steps and data needs that can yield generalizable spatial models and an effective tool for assessing the urban nature–physical activity relationship. Current knowledge supports an initial model that can distinguish broad trends and enrich urban planning, spatial policy, and public health decisions. New, iterative research and application will reveal the importance of different types of urban nature, the different subpopulations who will benefit from it, and nature’s potential contribution to creating more equitable, green, livable cities with active inhabitants.

Associations Between Green/Blue Spaces and Mental Health Across 18 Countries

2021 / Blue spaces, Green spaces, Health and well-being

Figure 1. Relationships between: (1) Green space visits in last 4 weeks, (2) Inland-blue space visits in last 4 weeks, (3) Coastal-blue space visits in last 4 weeks, and (4) nature connectedness (1–7); and positive well-being (0–100; a,e,l,m), risk of mental distress (0–1; b,f,j,n), use of depression medication (0–1; c,g,k,o), and use of anxiety medication (0–1; d,h,l,p), averaged across 18 countries (n = 16,302). Living near, recreating in, and feeling psychologically connected to, the natural world are all associated with better mental health, but many exposure-related questions remain. Using data from an 18-country survey (n = 16,307) we explored associations between multiple measures of mental health (positive well-being, mental distress, depression/anxiety medication use) and: (a) exposures (residential/recreational visits) to different natural settings (green/inland-blue/coastal-blue spaces); and (b) nature connectedness, across season and country. People who lived in greener/coastal neighbourhoods reported higher positive well-being, but this association largely disappeared when recreational visits were controlled for. Frequency of recreational visits to green, inland-blue, and coastal-blue spaces in the last 4 weeks were all positively associated with positive well-being and negatively associated with mental distress. Associations with green space visits were relatively consistent across seasons and countries but associations with blue space visits showed greater heterogeneity. Nature connectedness was also positively associated with positive well-being and negatively associated with mental distress and was, along with green space visits, associated with a lower likelihood of using medication for depression. By contrast inland-blue space visits were associated with a greater likelihood of using anxiety medication. Results highlight the benefits of multi-exposure, multi-response, multi-country studies in exploring complexity in nature-health associations.

Associations of Residential Brownness and Greenness with Fasting Glucose in Young Healthy Adults Living in the Desert

2021 / Children, Health and well-being, Underserved populations

Figure 1. Aerial image showing examples of brownness, greenness, and grayness in a residential area of El Paso, Texas, in June, 2019. Image source: GoogleEarth®, © 2020 Google; © 2020 INEGI. Evolutionary psychology theories propose that contact with green, natural environments may benefit physical health, but little comparable evidence exists for brown, natural environments, such as the desert. In this study, we examined the association between “brownness” and “greenness” with fasting glucose among young residents of El Paso, Texas. We defined brownness as the surface not covered by vegetation or impervious land within Euclidian buffers around participants’ homes. Fasting glucose along with demographic and behavioral data were obtained from the Nurse Engagement and Wellness Study (n = 517). We found that residential proximity to brownness was not associated with fasting glucose when modeled independently. In contrast, we found that residential greenness was associated with decreased levels of fasting glucose, despite the relatively low levels of greenness within the predominantly desert environment of El Paso. A difference between the top and bottom greenness exposure quartiles within a 250 m buffer was associated with a 3.5 mg/dL decrease in fasting glucose levels (95% confidence interval: −6.2, −0.8). Our results suggest that within the understudied context of the desert, green vegetation may be health promoting to a degree that is similar to other, non-desert locations in the world that have higher baselines levels of green.

Nature at Work: The Effects of Day-to-Day Nature Contact on Workers’ Stress and Psychological Well-Being

2021 / Health and well-being, Workers

Interior shot of the Spheres. Image source: AshlynG/Flickr, CC BY-ND 2.0 (G A, 2018). Objectives Chronic stress and burnout are key health issues for office workers that may contribute to a myriad of poor health outcomes. The presence of natural elements may improve psychological well-being in workers but the number of existing studies is relatively low, and more longitudinal research is specifically needed to assess how characteristics of workers’ day-to-day environments may impact mental health outcomes like affect, depression and stress. This report outlines a multi-study investigation of workers at Amazon, a multinational e-commerce company based in Seattle, Washington, USA, and the mental health benefits associated with exposure to nature. Methods In Study 1, participants (n = 153) responded to a cross-sectional survey that assessed the association of self-reported visitation to an indoor company greenspace with psychological well-being including symptoms of depression, anxiety, positive and negative affect, and stress. In Study 2, a subset of participants from Study 1 (n = 33) completed multiple surveys in a 2-week period that assessed the association of the naturalness of their current environments with their state levels of psychological well-being. Results We found contact with more natural outdoor environments was significantly associated with reduced state anxiety, after adjusting for activity type, location, and participants’ trait levels of nature relatedness. Conclusions Findings demonstrate that nature contact in everyday life is significantly associated with decreased levels of state anxiety. More research is needed to investigate the role of nature contact as a potential intervention in the workplace for improved mental health.

Taking the Long View for Oceans and Human Health Connection through Community-Driven Science

2021 / Blue spaces, Community science, Health and well-being, Indigenous communities, Reciprocal healing

Figure 1. Olympic Region Harmful Algal Bloom (ORHAB) partners and sampling sites. The most proactive approach to resolving current health and climate crises will require a long view, focused on establishing and fostering partnerships to identify and eliminate root causes of the disconnect between humans and nature. We describe the lessons learned through a unique scientific partnership that addresses a specific crisis, harmful algal blooms (HABs), along the northeast Pacific Ocean coast, that blends current-day technology with observational knowledge of Indigenous communities. This integrative scientific strategy resulted in creative solutions for forecasting and managing HAB risk in the Pacific Northwest as a part of the US Ocean and Human Health (OHH) program. Specific OHH projects focused on: Understanding genetic responses of Tribal members to toxins in the marine environment Knowledge sharing by elders during youth camps Establishing an early warning program to alert resource managers of HABs are explicit examples of proactive strategies used to address environmental problems. The research and monitoring projects with Tribal communities taught the collaborating non-Indigenous scientists the value of reciprocity, highlighting both the benefits from and protection of oceans that promote our well-being. Effective global oceans and human health initiatives require a collective action that gives equal respect to all voices to promote forward thinking solutions for ocean health.

The Planetary Wellbeing Initiative: Pursuing the Sustainable Development Goals in Higher Education

2021 / Health and well-being, Planetary Health

We live in a time of pressing planetary challenges, many of which threaten catastrophic change to the natural environment and require massive and novel coordinated scientific and societal efforts on an unprecedented scale. Universities and other academic institutions have the opportunity and responsibility to assume a leading role in an era when the destiny of the planet is precisely in the hands of human beings. Drawing on the Planetary Health project promoted by the Rockefeller Foundation and The Lancet, Pompeu Fabra University launched in 2018 the Planetary Wellbeing Initiative, a long-term institutional strategy also animated by the United Nations Sustainable Development Goals (SDGs). Planetary Wellbeing might be defined as the highest attainable standard of wellbeing for human and non-human beings and their social and natural systems. Developing the potential of these new concepts involves a substantial theoretical and empirical effort in many different fields, all of them interrelated by the crosscutting challenges of global complexity, interdisciplinarity, and urgency. Close collaboration of science, humanities, and culture is more desperately needed now than ever before in the history of humankind.

“Being on the Walk put it Somewhere in my Body”: The Meaning of Place in Health for Indigenous Women

2020 / Health and well-being, Indigenous communities

Relationship to place is integral to Indigenous health. A qualitative, secondary phenomenological analysis of in-depth interviews with four non-Choctaw Indigenous women participating in an outdoor, experiential tribally-specific Choctaw health leadership study uncovered culturally grounded narratives using thematic analysis as an analytic approach. Results revealed that physically being in historical trauma sites of other Indigenous groups involved a multi-faceted process that facilitated embodied stress by connecting participants with their own historical and contemporary traumas. Participants also experienced embodied resilience through connectedness to place and collective resistance. Implications point to the role of place in developing collective resistance and resilience through culturally and methodologically innovative approaches.

Closing the Gap Through Rewilding, Interacting, and Overcoming

2020 / Health and well-being, Nature school

The Research Handbook on Childhoodnature provides a compilation of research in Childhoodnature and brings together existing research themes and seminal authors in the field alongside new cutting-edge research authored by world-class researchers drawing on cross-cultural and international research data. The underlying objectives of the handbook are two-fold: Opening up spaces for Childhoodnature researchers; Consolidating Childhoodnature research into one collection that informs education. The use of the new concept ‘Childhoodnature’ reflects the editors’ and authors’ underpinning belief, and the latest innovative concepts in the field, that as children are nature this should be redefined in this integrating concept. The handbook will, therefore, critique and reject an anthropocentric view of nature. As such it will disrupt existing ways of considering children and nature and reject the view that humans are superior to nature. The “Closing the Gap Through Rewilding, Interacting, and Overcoming” chapter serves as a short introduction to the section. Thus, aside from providing an overview of each of the chapters herein it offers an orientation that might assist readers in connecting ideas throughout the entire section. What does become clear is that the work for education and educators going forward is likely to be substantial, these are not chapters interested in tweaking what currently exists.

Planetary Health: Protecting Nature to Protect Ourselves

2020 / Health and well-being

Human health depends on the health of the planet. Earth’s natural systems—the air, the water, the biodiversity, the climate—are our life support systems. Yet climate change, biodiversity loss, scarcity of land and freshwater, pollution and other threats are degrading these systems. The emerging field of planetary health aims to understand how these changes threaten our health and how to protect ourselves and the rest of the biosphere. Planetary Health: Protecting Nature to Protect Ourselves provides a readable introduction to this new paradigm. With an interdisciplinary approach, the book addresses a wide range of health impacts felt in the Anthropocene, including food and nutrition, infectious disease, non-communicable disease, dislocation and conflict, and mental health. It also presents strategies to combat environmental changes and its ill-effects, such as controlling toxic exposures, investing in clean energy, improving urban design, and more. Chapters are authored by widely recognized experts. The result is a comprehensive and optimistic overview of a growing field that is being adopted by researchers and universities around the world. Students of public health will gain a solid grounding in the new challenges their profession must confront, while those in the environmental sciences, agriculture, the design professions, and other fields will become familiar with the human consequences of planetary changes. Understanding how our changing environment affects our health is increasingly critical to a variety of disciplines and professions. Planetary Health is the definitive guide to this vital field.

Relatively Wild Urban Parks can Promote Human Resilience and Flourishing: A Case Study of Discovery Park, Seattle, Washington

2020 / Health and well-being, Urban

Human interaction with nature is vital for physical health and mental well-being, and positions a community to be resilient to urban stressors. Yet urban development continues to put pressures on natural areas within urban boundaries. As a case in point, Seattle’s largest park, Discovery Park, of over 500 acres, is often under threat of some form of development. The central question of this study was whether the benefits to visitors of Discovery Park depend, in no small measure, on the park’s very size and relative wild landscape. Toward addressing this question, 320 participants provided written narratives (through our web portal) about the meaningful ways in which they interacted with nature at Discovery Park. Each individual narrative was then analyzed and coded using an Interaction Pattern (IP) approach, which provides characterizations of human-nature interaction that have ontogenetic and phylogenetic significance. Results revealed 520 Interaction Patterns (IPs). The most frequently occurring IPs clustered under the keystone IPs of Encountering Wildlife (27%), Following Trails (14%), Walking to Destination Spots in Nature (8%), Gazing out at the Puget Sound or Mountains (6%), Walking Along Edges of Beach or Bluffs (5%), and Walking with Dogs (4%). Results also revealed that visitors’ meaningful interactions with nature in Discovery Park depended on the park’s relative wildness. For example, (a) 77% of participants’ IPs depended on Discovery Park’s relative wildness; (b) of the participants who specified an especially meaningful experience with nature, 95% of them had an interaction that depended on Discovery Park’s relative wildness; and (c) of the participants whose IPs were linked to other aspects of the nature in the park or to their own positive mental states, 95 and 96%, respectively, had an interaction that depended on Discovery Park’s relative wildness. Discussion focuses on how human interaction with large and relatively wild urban parks helps reverse the trend of environmental generational amnesia, and a domination worldview, and thus should be prioritized in urban planning.

Research Note: Residential Distance and Recreational Visits to Coastal and Inland Blue Spaces in Eighteen Countries

2020 / Blue spaces, Health and well-being, Recreation

Figure 1. Given residential locations (correct to three decimal degrees) of the 15,216 respondents included in analysis. The map of Spain includes respondents resident in the autonomous city of Melilla. Respondents resident in the Canary Islands, Azores, and Madeira are not displayed. Varied categorisations of residential distance to bluespace in population health studies make comparisons difficult. Using survey data from eighteen countries, we modelled relationships between residential distance to blue spaces (coasts, lakes, and rivers), and self-reported recreational visits to these environments at least weekly, with penalised regression splines. We observed exponential declines in visit probability with increasing distance to all three environments and demonstrated the utility of derived categorisations. These categories may be broadly applicable in future research where the assumed underlying mechanism between residential distance to a blue space and a health outcome is direct recreational contact.

Returning to our Roots: Tribal Health and Wellness Through Land-Based Healing

2020 / Health and well-being, Indigenous communities

Background Settler colonialism has severely disrupted Indigenous ancestral ways of healing and being, contributing to an onslaught of health disparities. In particular, the United Houma Nation (UHN) has faced large land loss and trauma, dispossession, and marginalization. Given the paucity of research addressing health for Indigenous individuals living in Louisiana, this study sought to co-identify a United Houma Nation health framework, by co-developing a community land-based healing approach in order to inform future community-based health prevention programs. Methods This pilot tested, co-designed and implemented a land-based healing pilot study among Houma women utilizing a health promotion leadership approach and utilized semi-structured interviews among 20 UHN women to identify a UHN health framework to guide future results. Results The findings indicated that RTOR was a feasible pilot project. The initial themes were Place Environmental/land trauma Ancestors Spirituality/mindfulness Cultural continuity Environment and health The reconnection to land was deemed feasible and seen as central to renewing relationships with ancestors (aihalia asanochi taha), others, and body. This mindful, re-engagement with the land contributed to subthemes of developing stronger tribal identities, recreating ceremonies, and increased cultural continuity, and transforming narratives of trauma into hope and resilience. Based on these findings a Houma Health (Uma Hochokma) Framework was developed and presented. Conclusions Overall, this study found that land can serve as a feasible therapeutic site for healing through reconnecting Houma tribal citizens to both ancestral knowledges and stories of resilience, as well as viewing self as part of a larger collective. These findings also imply that revisiting historically traumatic places encouraged renewed commitment to cultural continuity and health behaviors—particularly when these places are approached relationally, with ceremony, and traumatic events tied to these places, including climate change and environmental/land trauma, are acknowledged along with the love the ancestors held for future generations.

The Affective Benefits of Nature Exposure: What’s Nature Got to Do with It?

2020 / Green spaces, Health and well-being

Figure 1. Hypotheses & analyses overview for study 2. Nature interactions have been demonstrated to produce reliable affective benefits. While adults demonstrate strong preferences for natural environments over urban ones, it is not clear whether these affective benefits result from exposure to nature stimuli per se, or result from viewing a highly preferred stimulus. In one set of studies (Study 1 and 2), state affect before and after image viewing was examined as a function of both preference level (high, low, very high, or very low aesthetic value) and environment type (nature or urban). When aesthetic value was matched, no differences in affect change were found between environments. However, affect change was predicted by individual participants’ ratings for the images. The largest affective benefits occurred after viewing very high aesthetic nature images, but Study 2 lacked an equivalently preferred urban image set. In a second set of studies (Study 3 and 4), new sets of very highly preferred images in categories other than nature scenes (urban scenes and animals) were employed. As before, individual differences in preference for the images (but not image category) was predictive of changes in affect. In Study 5, the nature and urban images from Study 1 were rated on beauty to assess whether the stimuli’s preference ratings were capturing anything other than simple aesthetics. Results showed that beauty/aesthetics and preference (‘liking’) were nearly identical. Lastly, a replication of Study 2 (Study 6) was conducted to test whether priming preference accounted for these benefits, but this was not the case. Together, these results suggest that nature improves affective state because it is such a highly preferred environment.

Health Benefits of Contact With Nature

2019 / Health and well-being

Sara Perrins and Dr. Gregory Bratman of the University of Washington, College of Forest Resources, prepared this report for the Recreation and Conservation Office. This study was directed by the Washington State Legislature in Section 304 (3) of the 2018 operating budget, as stated: Section 304 (3) $125,000 of the general fund—state appropriation for fiscal year 2019 is provided solely for the board to conduct or contract for a study of the economic and health benefits of trail-based activities, including hiking, walking, and bicycling. The information gathered will assist in decision-making regarding the allocation of dedicated resources and investment in Washington’s trail networks. Additionally, the information will aid in increasing and leveraging economic benefits in the development of public-private partnerships aimed at stewardship and growth connected to Washington’s trail networks. The study may include, but is not limited to, analysis of the number of people in the state who hike, bike, and walk annually, economic contribution, environmental and social benefits, and mental and physical health outcomes. The study may also include regional case studies. As appropriate, the analysis must incorporate data from the state comprehensive outdoor recreation plan and federal initiatives to integrate outdoor recreation into GDP accounting. To allow for a collaborative process, the board must create an advisory committee of appropriate agencies and stakeholders, including hiking and bicycling groups. The board must report the results of the study to the appropriate fiscal and policy committees of the legislature by October 1, 2019. This specific look at health effects and nature contact accompanies an economic study conducted by EcoNorthwest in 2019 titled Economic, Environmental, and Social Benefits of Recreation Trails in Washington State.

Managed Retreat as a Strategy for Climate Change Adaptation in Small Communities: Public Health Implications

2019 / Climate, Health and well-being

Table 1. Characteristics of selected case studies of managed retreat in small communities In coming decades, sea level rise associated with climate change will make some communities uninhabitable. Managed retreat, or planned relocation, is a proactive response prior to catastrophic necessity. Managed retreat has disruptive health, sociocultural, and economic impacts on communities that relocate. Health impacts include mental health, social capital, food security, water supply, sanitation, infectious diseases, injury, and health care access. We searched peer-reviewed and gray literature for reports on small island or coastal communities at various stages of relocation primarily due to sea level rise. We reviewed these reports to identify public health impacts and barriers to relocation. We identified eight relevant small communities in the USA (Alaska, Louisiana, and Washington), Panama, Fiji, Papua New Guinea, Solomon Islands, and Vanuatu. Affected populations range from 60 to 2700 persons and are predominantly indigenous people who rely on subsistence fishing and agriculture. Few reports directly addressed public health issues. While some relocations were successful, barriers to relocation in other communities include place attachment, potential loss of livelihoods, and lack of funding, suitable land, community consensus, and governance procedures. Further research is needed on the health impacts of managed retreat and how to facilitate population resilience. Studies could include surveillance of health indicators before and after communities relocate due to sea level rise, drought, or other environmental hazards. Lessons learned may inform relocation of both small and large communities affected by climate change.

Nature and Mental Health: An Ecosystem Service Perspective

2019 / Ecosystem services, Health and well-being

Figure 1. A conceptual model for mental health as an ecosystem service. A growing body of empirical evidence is revealing the value of nature experience for mental health. With rapid urbanization and declines in human contact with nature globally, crucial decisions must be made about how to preserve and enhance opportunities for nature experience. Here, we first provide points of consensus across the natural, social, and health sciences on the impacts of nature experience on cognitive functioning, emotional well-being, and other dimensions of mental health. We then show how ecosystem service assessments can be expanded to include mental health, and provide a heuristic, conceptual model for doing so.

Social-Ecological and Technological Factors Moderate the Value of Urban Nature

2019 / Ecosystem services, Green spaces, Health and well-being, Urban

Figure 1. Actions lead to changes in the value of urban ecosystem services, defined by a change in human well-being, which may be different for different groups of people, hence the importance of considering equity. The relationships between actions and value are moderated by social, ecological or technological factors. For each action that leads to a change in value, there may also be co-benefits (for example, positive impacts on other sustainability goals) and disservices (for example, unintended negative consequences). Finally, decision-makers require the ability to compare the net value of urban ecosystem services relative to substitutes or alternative interventions designed to meet the same goals. Urban nature has the potential to improve air and water quality, mitigate flooding, enhance physical and mental health, and promote social and cultural well-being. However, the value of urban ecosystem services remains highly uncertain, especially across the diverse social, ecological and technological contexts represented in cities around the world. We review and synthesize research on the contextual factors that moderate the value and equitable distribution of ten of the most commonly cited urban ecosystem services. Our work helps to identify strategies to more efficiently, effectively and equitably implement nature-based solutions.

Natural Outdoor Environments and Mental Health: Stress as a Possible Mechanism

2017 / Green spaces, Health and well-being

Fig. 1. Adjusted models for exposure to NOE (both residential availability and contact with NOE) and average evening week values of mental health. Note: Linear regression models (coefficient and 95% CI reported) for all the outcomes with the exception of sleep quality that was modelled as a Poisson model (IRR and 95% CI reported). Models include neighbourhood socioeconomic status, city, gender, age and education level as covariates. Estimates in italics indicate that contact with NOE is statistically significantly associated to the outcome in the expected direction. * Statistically significant associations (p-value≤ 0.05). NOE for Natural Outdoor Environments. Introduction: Better mental health has been associated with exposure to natural outdoor environments (NOE). However, comprehensive studies including several indicators of exposure and outcomes, potential effect modifiers and mediators are scarce. Objectives: We used novel, objective measures to explore the relationships between exposure to NOE (i.e. residential availability and contact) and different indicators of mental health, and possible modifiers and mediators. Methods: A nested cross-sectional study was conducted in: Barcelona, Spain; Stoke-on-Trent, United Kingdom; Doetinchem, Netherlands; Kaunas, Lithuania. Participants’ exposure to NOE (including both surrounding greenness and green and/or blue spaces) was measured in terms of (a) amount in their residential environment (using Geographical Information Systems) and (b) their contact with NOE (using smartphone data collected over seven days). Self-reported information was collected for mental health (psychological well-being, sleep quality, vitality, and somatisation), and potential effect modifiers (gender, age, education level, and city) and mediators (perceived stress and social contacts), with additional objective NOE physical activity (potential mediator) derived from smartphone accelerometers. Results: Analysis of data from 406 participants showed no statistically significant associations linking mental health and residential NOE exposure. However, NOE contact, especially surrounding greenness, was statistically significantly tied to better mental health. There were indications that these relationships were stronger for males, younger people, low-medium educated, and Doetinchem residents. Perceived stress was a mediator of most associations, and physical activity and social contacts were not. Conclusions: Our findings indicate that contact with NOE benefits mental health. Our results also suggest that having contact with NOE that can facilitate stress reduction could be particularly beneficial.

Nature Contact and Human Health: A Research Agenda

2017 / Green spaces, Health and well-being

Figure 1. A spectrum of forms of nature contact. Background At a time of increasing disconnectedness from nature, scientific interest in the potential health benefits of nature contact has grown. Research in recent decades has yielded substantial evidence, but large gaps remain in our understanding. Objectives We propose a research agenda on nature contact and health, identifying principal domains of research and key questions that, if answered, would provide the basis for evidence-based public health interventions. Discussion We identify research questions in seven domains: a) mechanistic biomedical studies; b) exposure science; c) epidemiology of health benefits; d) diversity and equity considerations; e) technological nature; f) economic and policy studies; and g) implementation science. Conclusions Nature contact may offer a range of human health benefits. Although much evidence is already available, much remains unknown. A robust research effort, guided by a focus on key unanswered questions, has the potential to yield high-impact, consequential public health insights.

The Importance of Children Interacting with Big Nature

2017 / Children, Development, Health and well-being

Figure 1. A smoggy day in Beijing. The problem of environmental generational amnesia is that nature gets increasingly diminished and degraded, but children of each generation perceive the environment into which they are born as normal. Thus, across generations, the baseline shifts downward for what counts as healthy nature. One solution is to broaden and deepen children’s interactions with nature, and whenever possible, with big nature. To convey how this solution looks in practice, we draw from our observational data of children in a forest nature preschool to identify patterns of interaction with nature and illustrate how these interaction patterns may help children develop environmental capabilities, values, knowledge, intimacies, and relationships.

“I’m Stronger than I Thought”: Native Women Reconnecting to Body, Health, and Place

2016 / Health and well-being, Indigenous communities

This community-based research applied principles of wilderness experience programming and Indigenous knowledges in an exploratory intervention designed to address health disparities in a tribal community. Drawing on historical trauma frameworks, tribal members rewalked the Trail of Tears to consider its effect on contemporary tribal health. Qualitative data from tribal members suggest that engagement with place and experiential learning, particularly the physical and emotional challenge of the Trail, facilitated changes in health beliefs, attitudes, and behaviors. Deep engagement outside of traditional health service settings should be considered in interventions and may be particularly effective in promoting positive health behaviors in Native communities.

Living in Cities, Naturally

2016 / Health and well-being, Stress, Urban

Figure 1. Together with ecological benefits such as climate change mitigation and the protection of biological diversity, the renaturing of cities opens opportunities for people to engage with features and processes of the natural world; for example, when tending plants in a community garden. Natural features, settings, and processes in urban areas can help to reduce stress associated with urban life. In this and other ways, public health benefits from, street trees, green roofs, community gardens, parks and open spaces, and extensive connective pathways for walking and biking. Such urban design provisions can also yield ecological benefits, not only directly but also through the role they play in shaping attitudes toward the environment and environmental protection. Knowledge of the psychological benefits of nature experience supports efforts to better integrate nature into the architecture, infrastructure, and public spaces of urban areas.

Nature Experience Reduces Rumination and Subgenual Prefrontal Cortex Activation

2015 / Anxiety, Health and well-being, Urban

Figure 1. The impact of nature experience on self-reported rumination and blood perfusion to the sgPFC. (A) Change in self-reported rumination (postwalk minus prewalk) for participants randomly assigned to take a 90-min walk either in a natural setting or in an urban setting. (B) A time-by-environment interaction in blood perfusion was evident in the sgPFC. F map of significant interactions at a threshold of P < 0.05, FWE corrected for multiple comparisons. (C) Change in blood perfusion (postwalk minus prewalk) for participants randomly assigned to take a 90-min walk either in a natural setting or in an urban setting. Error bars represent SE within subjects: *P < 0.05, ***P < 0.001. Significance More than 50% of people now live in urban areas. By 2050 this proportion will be 70%. Urbanization is associated with increased levels of mental illness, but it’s not yet clear why. Through a controlled experiment, we investigated whether nature experience would influence rumination (repetitive thought focused on negative aspects of the self), a known risk factor for mental illness. Participants who went on a 90-min walk through a natural environment reported lower levels of rumination and showed reduced neural activity in an area of the brain linked to risk for mental illness compared with those who walked through an urban environment. These results suggest that accessible natural areas may be vital for mental health in our rapidly urbanizing world. Abstract Urbanization has many benefits, but it also is associated with increased levels of mental illness, including depression. It has been suggested that decreased nature experience may help to explain the link between urbanization and mental illness. This suggestion is supported by a growing body of correlational and experimental evidence, which raises a further question: what mechanism(s) link decreased nature experience to the development of mental illness? One such mechanism might be the impact of nature exposure on rumination, a maladaptive pattern of self-referential thought that is associated with heightened risk for depression and other mental illnesses. We show in healthy participants that a brief nature experience, a 90-min walk in a natural setting, decreases both self-reported rumination and neural activity in the subgenual prefrontal cortex (sgPFC), whereas a 90-min walk in an urban setting has no such effects on self-reported rumination or neural activity. In other studies, the sgPFC has been associated with a self-focused behavioral withdrawal linked to rumination in both depressed and healthy individuals. This study reveals a pathway by which nature experience may improve mental well-being and suggests that accessible natural areas within urban contexts may be a critical resource for mental health in our rapidly urbanizing world. Related Media Nature May Be Key to Strengthening Our Attention (November 28, 2023) Stanford researchers find mental health prescription: Nature (June 30, 2015)

Safeguarding Human Health in the Anthropocene Epoch

2015 / Climate, Health and well-being

Figure 1: Services provided by natural systems. Adapted from the Millennium Ecosystem Assessment. Far-reaching changes to the structure and function of the Earth’s natural systems represent a growing threat to human health. And yet, global health has mainly improved as these changes have gathered pace. What is the explanation? As a Commission, we are deeply concerned that the explanation is straightforward and sobering: we have been mortgaging the health of future generations to realise economic and development gains in the present. By unsustainably exploiting nature’s resources, human civilisation has flourished but now risks substantial health effects from the degradation of nature’s life support systems in the future. Health effects from changes to the environment including climatic change, ocean acidification, land degradation, water scarcity, overexploitation of fisheries, and biodiversity loss pose serious challenges to the global health gains of the past several decades and are likely to become increasingly dominant during the second half of this century and beyond. These striking trends are driven by highly inequitable, inefficient, and unsustainable patterns of resource consumption and technological development, together with population growth. We identify three categories of challenges that have to be addressed to maintain and enhance human health in the face of increasingly harmful environmental trends. Firstly, conceptual and empathy failures (imagination challenges), such as an over-reliance on gross domestic product as a measure of human progress, the failure to account for future health and environmental harms over present day gains, and the disproportionate effect of those harms on the poor and those in developing nations. Secondly, knowledge failures (research and information challenges), such as failure to address social and environmental drivers of ill health, a historical scarcity of transdisciplinary research and funding, together with an unwillingness or inability to deal with uncertainty within decision making frameworks. Thirdly, implementation failures (governance challenges), such as how governments and institutions delay recognition and responses to threats, especially when faced with uncertainties, pooled common resources, and time lags between action and effect. Although better evidence is needed to underpin appropriate policies than is available at present, this should not be used as an excuse for inaction. Substantial potential exists to link action to reduce environmental damage with improved health outcomes for nations at all levels of economic development. This Commission identifies opportunities for action by six key constituencies: health professionals, research funders and the academic community, the UN and Bretton Woods bodies, governments, investors and corporate reporting bodies, and civil society organisations. Although better evidence is needed to underpin appropriate policies than is available at present, this should not be used as an excuse for inaction. Substantial potential exists to link action to reduce environmental damage with improved health outcomes for nations at all levels of economic development. This Commission identifies opportunities for action by six key constituencies: health professionals, research funders and the academic community, the UN and Bretton Woods bodies, governments, investors and corporate reporting bodies, and civil society organisations. Depreciation of natural capital and nature’s subsidy should be accounted for so that economy and nature are not falsely separated. Policies should balance social progress, environmental sustainability, and the economy. To support a world population of 9–10 billion people or more, resilient food and agricultural systems are needed to address both undernutrition and overnutrition, reduce waste, diversify diets, and minimise environmental damage. Meeting the need for modern family planning can improve health in the short term—eg, from reduced maternal mortality and reduced pressures on the environment and on infrastructure. Planetary health offers an unprecedented opportunity for advocacy of global and national reforms of taxes and subsidies for many sectors of the economy, including energy, agriculture, water, fisheries, and health. Regional trade treaties should act to further incorporate the protection of health in the near and long term. Several essential steps need to be taken to transform the economy to support planetary health. These steps include a reduction of waste through the creation of products that are more durable and require less energy and materials to manufacture than those often produced at present; the incentivisation of recycling, reuse, and repair; and the substitution of hazardous materials with safer alternatives. Despite present limitations, the Sustainable Development Goals provide a great opportunity to integrate health and sustainability through the judicious selection of relevant indicators relevant to human wellbeing, the enabling infrastructure for development, and the supporting natural systems, together with the need for strong governance. The landscape, ecosystems, and the biodiversity they contain can be managed to protect natural systems, and indirectly, reduce human disease risk. Intact and restored ecosystems can contribute to resilience (see panel 1 for glossary of terms used in this report), for example, through improved coastal protection (eg, through wave attenuation) and the ability of floodplains and greening of river catchments to protect from river flooding events by diverting and holding excess water. The growth in urban populations emphasises the importance of policies to improve health and the urban environment, such as through reduced air pollution, increased physical activity, provision of green space, and urban planning to prevent sprawl and decrease the magnitude of urban heat islands. Transdisciplinary research activities and capacity need substantial and urgent expansion. Present research limitations should not delay action. In situations where technology and knowledge can deliver win–win solutions and co-benefits, rapid scale-up can be achieved if researchers move ahead and assess the implementation of potential solutions. Recent scientific investments towards understanding non-linear state shifts in ecosystems are very important, but in the absence of improved understanding and predictability of such changes, efforts to improve resilience for human health and adaptation strategies remain a priority. The creation of integrated surveillance systems that collect rigorous health, socioeconomic, and environmental data for defined populations over long time periods can provide early detection of emerging disease outbreaks or changes in nutrition and non-communicable disease burden. The improvement of risk communication to policy makers and the public and the support of policy makers to make evidence-informed decisions can be helped by an increased capacity to do systematic reviews and the provision of rigorous policy briefs. Health professionals have an essential role in the achievement of planetary health: working across sectors to integrate policies that advance health and environmental sustainability, tackling health inequities, reducing the environmental impacts of health systems, and increasing the resilience of health systems and populations to environmental change. Humanity can be stewarded successfully through the 21st century by addressing the unacceptable inequities in health and wealth within the environmental limits of the Earth, but this will require the generation of new knowledge, implementation of wise policies, decisive action, and inspirational leadership.

Nature and Health

2014 / Green spaces, Health and well-being, Stress

Figure 1: Some pathways through which the natural environment can affect the health of broad segments of populations. Urbanization, resource exploitation, and lifestyle changes have diminished possibilities for human contact with nature in many societies. Concern about the loss has helped motivate research on the health benefits of contact with nature. Reviewing that research here, we focus on nature as represented by aspects of the physical environment relevant to planning, design, and policy measures that serve broad segments of urbanized societies. We discuss difficulties in defining “nature” and reasons for the current expansion of the research field, and we assess available reviews. We then consider research on pathways between nature and health involving air quality, physical activity, social cohesion, and stress reduction. Finally, we discuss methodological issues and priorities for future research. The extant research does describe an array of benefits of contact with nature, and evidence regarding some benefits is strong; however, some findings indicate caution is needed in applying beliefs about those benefits, and substantial gaps in knowledge remain.

Positive Health Effects of the Natural Outdoor Environment in Typical Populations in Different Regions in Europe (PHENOTYPE): A Study Programme Protocol

2014 / Green spaces, Health and well-being

Figure 1. Interdependencies of different parts of the PHENOTYPE project. Introduction 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 Natural Outdoor 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. Aims and Methods The PHENOTYPE project explores the proposed underlying mechanisms at work (stress reduction/restorative function, physical activity, social interaction, exposure to environmental hazards) and examines the associations with health outcomes for different population groups. It implements conventional and new innovative high-tech methods to characterise the natural environment in terms of quality and quantity. Preventive as well as therapeutic effects of contact with the natural environment are being covered. PHENOTYPE further addresses implications for land-use planning and green space management. The main innovative part of the study is the evaluation of possible short-term and long-term associations of green space and health and the possible underlying mechanisms in four different countries (each with quite a different type of green space and a different use), using the same methodology, in one research programme. This type of holistic approach has not been undertaken before. Furthermore there are technological innovations such as the use of remote sensing and smartphones in the assessment of green space. Conclusions The project will produce a more robust evidence base on links between exposure to natural outdoor environment and human health and well-being, in addition to a better integration of human health needs into land-use planning and green space management in rural as well as urban areas.