Exploring research requirements

By Denise Hewlett with Debra Gray, Richard Gunton, Sheela Agarwal, Chris Skelly, Philip Weinstein and Martin Breed and Tom Munro.

Green spaces and natural environments are known to be beneficial to our health, but research gaps remain to be explored.

For decades, there has been a rise in the number of pandemics globally. These have had significant impacts on people’s health and wellbeing, on health services, and on national economies. This crisis is made all the more urgent with the unfolding outcomes of COVID-19, which has accelerated the importance of well-planned natural environments in rural and urban areas, and their positive impact on health and wellbeing. UK policies emphasise the use of green space to improve people’s health and wellbeing, in part reflecting financial imperatives to reduce pressure on the National Health Service, but this approach can also be related to important economic consequences, since any decrease in people’s ill-health is also likely to enhance productivity. (1)

The idea that nature is good for our health has long been recognised. Together with concerns about widening health inequalities, an ageing population, and the sheer concentration of people living in cities, research worldwide has produced increasing evidence, particularly in urban contexts, about the importance of green space to people’s health. (2) Despite more limited research in rural areas, it is now widely accepted that green space, characterised by openness, presence of water, sounds of nature, lessdisturbed environments, certain habitats, and (as an emerging hypothesis) biodiverse soils, can all have a positive effect on people’s health and wellbeing. (3)

Understanding the relationship between health, wellbeing and green spaces is imperative for contributing to evidence-based decision making, and is particularly important in health professions, most notably in the realm of social prescribing. However, determining just how green spaces affect people’s health is hugely complex, challenged by factors including people’s lifestyles, their behaviours, where they live, and how leisure time is spent. The complexity of such social, economic, and environmental determinants of health, warrants inter- and cross-disciplinary enquiries among planning professionals, landscape managers, public health practitioners, and scientists. (4) Such collaborations can lead not only to assessments of the value of green spaces to our health, but could also provide for findings that can be applied in professional practice.

© Gordon Plant / Unsplash

From some perspectives, however, the links between green spaces and health have been considered to have reached maturity. (5) Nonetheless, determining ‘cause and effect’ is still beyond our scientific reach, and additional research gaps remain:

• Simplistic conceptualisations of ‘greenspace’ are often evident in research on the relationship between green spaces and health, resulting in indistinguishable forms of green space being reported. This hinders our understanding of geographical complexities, such as the relative effects of different types of green spaces, of their environmental characteristics and ecological condition. 6 We have limited knowledge of the importance of biodiversity, particularly in rural spaces, and how the range of landscape characters, configurations, and uses (e.g. agricultural, pastoral), or how their microbial diversity, or ecological condition, specifically affect people’s health and wellbeing;

• Simplistic or limited measurements of health used are also evident. For example, single measures of psychological distress have been used. This approach hinders our understanding of the breadth of possible health outcomes, factors that affect our health, and the possible interactions between these: all of which is needed to increase our understanding of how people’s access to green spaces improves their personal health and wellbeing;

• Communities living in rural and in coastal areas are under-studied, despite the fact that in the UK, nearly 10 million people (17% of the population 7 ) live in these areas that are characterised by complicated health patterns. 8 Existing health datasets are not compiled at a sufficiently fine-grained spatial scale, calling for further research at more local levels to better understand the complex health experiences of residents in both rural and coastal locations;

• Increasing evidence supports a strong case for microbiological diversity playing an important role in improving human health, through enhancing immune status and helping to ameliorate disease risk. As such, it has been argued to be potentially a key factor required to provide answers to just how green spaces might affect people’s health. 9 Yet, although there is a growing consensus on our ability to act, our knowledge is limited and focuses on urban populations; (10)

• There are still major gaps in knowledge and understanding about the economic value of greenspaces. (11) In particular, there is limited quantification of the economic contribution of the intangible elements, or non-use values, of greenspaces. That which exists focuses primarily on green interventions in peri-urban and urban environments as opposed to rural greenspaces, whose economic benefits tend to be assumed rather than determined, particularly if these areas hold protected status. This neglect is surprising given that assessing the value of changes to our natural capital, and the ecosystem services it provides, is becoming fundamental to deciding how and where funds should be spent to restore, maintain, and manage the natural environment.

• The impact of greenspaces on labour productivity, especially in rural areas, is also poorly understood. Except for a study of green space and health in the Netherlands, most research focuses on buildings and office environments. (12) These studies suggest employees work better and more productively in greener, more attractive environments, and that productivity is potentially higher as they experience lower stress levels, which reduces sickness and absenteeism. Researching this relationship assumes added importance given that recent research suggests that UK rural communities are less productive than their rural equivalents in Europe. It is therefore surprising that health and wellbeing’s impact on sickness and presenteeism is not more central to discussions about improving productivity in rural England, and that the impact of greenspaces and their environmental quality on productivity per se, and indirectly on economic wellbeing, does not feature at all.

© Gordon Plant / Unsplash

• Finally, few studies have examined concurrently the multiple factors affecting health and wellbeing, amongst which as discussed above, environmental, social, and economic factors are important.

Given these gaps, it is clear that further research is needed to improve the evidence base required for strategic and policy decisions about the role green spaces in urban and in rural areas play in health, wellbeing and labour productivity. Addressing these gaps requires us to recognise the heterogeneity of green spaces, and of rural landscapes, including their distinctive landscape types, characters, and ecological condition, and to examine a broad set of physical, psychological and social, health and wellbeing outcomes. Moreover, our review highlights the need for critical evaluations of the interactions between natural capital and associated non-use values, in order to provide a more nuanced understanding of the effects of green spaces on health and wellbeing, and labour productivity. Nonetheless, while understanding the utility value of natural greenspaces to communities will help prioritise investment and management decisions, research in this area continues to spotlight the inherent value of both nature and human wellbeing.

Professor Denise Hewlett, is a trustee for the NAAONB, member of the IUCN, sits on IUCN's Global Taskforce for Protected Areas and COVID19 and is Director of PeopleScapes Research Group at University of Winchester(UoW). PeopleScapes is an interdisciplinary group of social, economic, health and environmental scientists, working with practitioners from public, private, and charitable sectors. It includes Dr Debra Gray and Dr Richard Gunton of UoW, Professor Sheela Agarwal at University of Plymouth, Professor Philip Weinstein, Dr Martin Breed and Dr Chris Skelly of the Healthy Urban Microbiome Initiative (HUMI) and Tom Munro of the Dorset Area of Outstanding Natural Beauty.