Access to Urban Green Space in Cities of the Global South: A Systematic Literature Review

Global priorities for climate change and mental health research

BACKGROUND

Compared with other health areas, the mental health impacts of climate change have received less research attention. The literature on climate change and mental health is growing rapidly but is characterised by several limitations and research gaps. In a field where the need for designing evidence-based adaptation strategies is urgent, and research gaps are vast, implementing a broad, all-encompassing research agenda will require some strategic focus.

METHODS

We followed a structured approach to prioritise future climate change and mental health research. We consulted with experts working across mental health and climate change, both within and outside of research and working in high, middle, and low-income countries, to garner consensus about the future research priorities for mental health and climate change. Experts were identified based on whether they had published work on climate change and mental health, worked in governmental and non-governmental organisations on climate change and mental health, and from the professional networks of the authors who have been active in the mental health and climate change space.

RESULTS

Twenty-two experts participated from across low- and middle-income countries (n = 4) and high-income countries (n = 18). Our process identified ten key priorities for progressing research on mental health and climate change.

CONCLUSION

While climate change is considered the biggest threat to global mental health in the coming century, tackling this threat could be the most significant opportunity to shape our mental health for centuries to come because of health co-benefits of transitioning to more sustainable ways of living. Research on the impacts of climate change on mental health and mental health-related systems will assist decision-makers to develop robust evidence-based mitigation and adaptation policies and plans with the potential for broad benefits to society and the environment.

Quantifying the response of surface urban heat island to urban greening in global north megacities

Urban heat island, a phenomenon that urban temperature is higher than the rural area nearby, affects directly citizens' human health and well-being. However, the cooling effect from urban green space (UGS) and the attribution of the different land processes to surface urban heat island intensity (SUHI) under different background climates remains unclear. The coarse-grained model was used to estimate summer SUHI in three different background climatic zones and for seven agglomerations (BTH, JP, LD, NAAC, NAGL, YZ, UQ). Results indicate that (1) the temperate zone had the highest daytime SUHI (0-10 °C), while the arid zone has the lowest daytime SUHI (-1-2 °C). In both temperate and cold zone, the daytime SUHI was higher than the nighttime SUHI. The SUHI in downtown was higher (more than 2 °C) than in the suburbs. (2) The increasing precipitation can enhance daytime SUHI while can weaken nighttime SUHI in all three climatic zones. The increasing temperature tends to enhance SUHI in both daytime and nighttime (exclude UQ). (3) The cooling effects of UGS in daytime SUHI were highly dependent on the background climate (cold > temperate > arid). (4) The nighttime SUHI could be effectively offset when UGSFs were greater than 0.48, 0.82, 0.97, 0.95 in NAAC, NAGL, YZ, and UQ. This article highlights the different feedback of urban green space to UHII and supports green infrastructure intervention as an effective means of reducing urban heat stress at urban agglomeration scales.

Rethinking the urban physical environment for century-long lives: from age-friendly to longevity-ready cities

In response to increasing life expectancies and urbanization, initiatives for age-friendly cities seek to facilitate active and healthy aging by strengthening supports and services for older people. While laudable, these efforts typically neglect early-life exposures that influence long-term well-being. With a focus on the urban physical environment, we argue that longevity-ready cities can accomplish more than initiatives focused solely on old age. We review features of cities that cumulatively influence healthy aging and longevity, discuss the need for proactive interventions in a changing climate, and highlight inequities in the ambient physical environment, especially those encountered at early ages, that powerfully contribute to disparities in later life stages. Compared with strategies aimed largely at accommodating older populations, longevity-ready cities would aim to reduce the sources of disadvantages across the life course and simultaneously improve the well-being of older people.

Assessing Inequalities in Wellbeing at a Neighbourhood Scale in Low-Middle-Income-Country Secondary Cities and Their Implications for Long-Term Livability

To ensure future sustainability, cities need to consider concepts of livability and resident wellbeing alongside environmental, economic and infrastructure development equity. The current rapid urbanization experienced in many regions is leading to sustainability challenges, but also offers the opportunity to deliver infrastructure supporting the social aspects of cities and the services that underpin them alongside economic growth. Unfortunately, evidence of what is needed to deliver urban wellbeing is largely absent from the global south. This paper contributes to filling this knowledge gap through a novel interdisciplinary mixed methods study undertaken in two rapidly changing cities (one Thai and one Kenyan) using qualitative surveys, subjective wellbeing and stress measurements, and spatial analysis of urban infrastructure distribution. We find the absence of basic infrastructure (including waste removal, water availability and quality) unsurprisingly causes significant stress for city residents. However, once these services are in place, smaller variations (inequalities) in social (crime, tenure) and environmental (noise, air quality) conditions begin to play a greater role in determining differences in subjective wellbeing across a city. Our results indicate that spending time in urban greenspaces can mitigate the stressful impacts of city living even for residents of informal neighborhoods. Our data also highlights the importance of places that enable social interactions supporting wellbeing-whether green or built. These results demonstrate the need for diversity and equity in the provision of public realm spaces to ensure social and spatial justice. These findings strengthen the need to promote long term livability in LMIC urban planning alongside economic growth, environmental sustainability, and resilience.

The equigenic effect of greenness on the association between education with life expectancy and mortality in 28 large Latin American cities

BACKGROUND

Recent studies highlight the equigenic potential of greenspaces by showing narrower socioeconomic health inequalities in greener areas. However, results to date have been inconsistent and derived from high-income countries. We examined whether urban greenness modifies the associations between area-level education, as a proxy for socioeconomic status, and life expectancy and cause-specific mortality in Latin American cities.

METHODS

We included 28 large cities, >137 million inhabitants, in nine Latin American countries, comprising 671 sub-city units, for 2012-2016. Socioeconomic status was assessed through a composite index of sub-city level education, and greenness was calculated using the normalized difference vegetation index. We fitted multilevel models with sub-city units nested in cities, with life expectancy or log(mortality) as the outcome.

FINDINGS

We observed a social gradient, with higher levels of education associated with higher life expectancy and lower cause-specific mortality. There was weak evidence supporting the equigenesis hypothesis as greenness differentially modified the association between education and mortality outcomes. We observed an equigenic effect, with doubling magnitudes in the violence-related mortality reduction by education in areas with low greenness compared to medium-high greenness areas among men (16% [95% CI 12%-20%] vs 8% [95% CI 4%-11%] per 1 SD increase in area-level education). However, in contradiction to the equigenesis hypothesis, the magnitude in cardiovascular diseases (CVD) mortality reduction by education was stronger in areas with medium-high greenness compared to areas with low greenness (6% [95% CI 4%-7%] vs 1% [95% CI -1%-3%] and 5% [95% CI 3%-7%] vs 1% [95% CI -1%-3%] per 1 SD increase in area-level education, in women and men, respectively). Similarly, each 1-SD increase in greenness widened the educational inequality in life expectancy by 0.15 years and 0.20 years, in women and men, respectively. The equigenic effect was not observed in violence-related mortality among women and in mortality due to communicable diseases, maternal, neonatal and nutritional conditions (CMNN).

INTERPRETATION

Our results confirm socioeconomic health inequalities in Latin American cities and show that the equigenic properties of greenspace vary by health outcome. Although mixed, our findings suggest that future greening policies should account for local social and economic conditions to ensure that greenspaces provide health benefits for all, and do not further exacerbate existing health inequalities in the region.

FUNDING

Wellcome Trust (Grant, 205177/Z/16/Z).

Neighbourhood green space and health disparities in the global South: Evidence from Cali, Colombia

Increasing attention has been given to the role of green space in reducing health disparities. However, robust evidence to support decision making is lacking in the global South. We investigate the relationship between green space and health as well as its underlying mechanism in Cali, Colombia. Results indicate that neighbourhood greenness is associated with enhanced self-rated 'good' health and reduced physical and mental distress. The health benefits of green space appear to be stronger for people living in wealthier neighbourhoods than those in poor neighbourhoods. Results highlight the importance of considering health disparities for future green infrastructure planning in the global South context.

Neighborhood greenspace and cardiometabolic risk factors: Cross-sectional and longitudinal analysis in ELSA-Brasil participants

Greater neighborhood greenspace has been associated with better cardiometabolic risk factors, especially in high-income countries. This cross-sectional and longitudinal study assessed this association in approximately 2000 participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) residing in Belo Horizonte, a large Brazilian capital city. Neighborhood greenspace was studied through the Normalized Difference Vegetation Index (NDVI) and two additional types, percentages of tree cover and herbaceous cover. Multivariable logistic regression models estimated the cross-sectional and longitudinal associations of neighborhood greenspace with three metabolic factors - (i) obesity, (ii) abdominal obesity, and (iii) low HDL-cholesterol - after adjustment for individual sociodemographic factors and neighborhood average household income per capita. Cross-sectional results showed that higher neighborhood greenspace was associated with lower odds of obesity, abdominal obesity and low HDL-c. However, neighborhood greenspace was not associated with the incidence of any of these risk factors. The percentage of tree cover seemed to contribute more to the associations found with NDVI than the percentage of herbaceous cover. The results support the evidence that increased neighborhood greenspace contributes to maintain a better cardiometabolic health.

Contextual influences on chronic illness: A multi-level analysis in the twin cities of Ramallah and Al Bireh in the occupied Palestinian Territory

The features of the urban environment can support human health as well as harm it, but less is known about such influences in the context of middle eastern countries. The association between green space and the political classifications of the urban environment and the risk of chronic illness was investigated in a novel setting, the twin cities of Ramallah and Albireh in the occupied Palestinian territory. We used a generalised multi-level regression analysis to link the 2017 census data with Geographic Information System data. We modelled individuals at level one (n = 54693) and areas of residence at level two (n = 228), adjusting for individual demographic and socio-economic characteristics.

The proportions of ‘mixed’ trees in residential areas had a significant inverse association with the risk of chronic illness. On the political dimension, only living in a refugee camp had a significant positive association with chronic illness; however, this was largely explained and rendered non-significant when green space variables were entered into the models. Our ability to differentiate between several types of green space was important, as findings demonstrated that not all types were associated with reduced risk of chronic illness. Our results from a middle eastern setting add to the largely Western existing evidence, that trees in urban settings are important and beneficial to human health. Researchers and policymakers should pay more attention to the health consequences of refugee camps but also the role of trees in benefiting individuals' health in such a disadvantaged context.

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The study explored the urban political and environmental impacts on health in the Palestinian context.

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Living in a refugee camp is positively associated with the risk of chronic illness, over and above individual characteristics.

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Residential areas mixed trees are inversely associated with chronic illness, and explained the association with refugee camps.

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Not all types of green space are associated with a reduced risk of chronic illness.

Green space and mortality in European cities: a health impact assessment study

BACKGROUND

Natural outdoor environments including green spaces play an important role in preserving population health and wellbeing in cities, but the number of deaths that could be prevented by increasing green space in European cities is not known. We aimed to estimate the number of natural-cause deaths among adult residents that could be prevented in cities in 31 European countries, if the WHO recommendation for universal access to green space was achieved.

METHODS

In this health impact assessment study we focused on adult residents (aged ≥20 years; n=169 134 322) in 978 cities and 49 greater cities, in 31 European countries. We used two green space proxies: normalised difference vegetation index (NDVI), and percentage of green area (%GA). The exposure was estimated at a fine grid-cell level (250 m × 250 m) and the preventable mortality burden for 2015 was estimated at the local city-level.

FINDINGS

For 2015 we found that meeting the WHO recommendation of access to green space could prevent 42 968 (95% CI 32 296-64 177) deaths annually using the NDVI proxy (ie, 20% [95% CI 15-30] of deaths per 100 000 inhabitants-year), which represents 2·3% (95% CI 1·7-3·4) of the total natural-cause mortality and 245 (95% CI 184-366) years of life lost per 100 000 inhabitants-year. For the %GA proxy 17 947 (95%CI 0-35 747) deaths could be prevented annually. For %GA the number of attributable deaths were half of that of the NDVI and results were non-significant due to the exposure response function considered. The distribution of NDVI and %GA varied between cities and was not equally distributed within cities. Among European capitals, Athens, Brussels, Budapest, Copenhagen, and Riga showed some of the highest mortality burdens due to the lack of green space. The main source of uncertainty for our results was the choice of the age-structures of the population for the NDVI analysis, and exposure-response function for the %GA analysis.

INTERPRETATION

A large number of premature deaths in European cities could be prevented by increasing exposure to green space, while contributing to sustainable, liveable and healthy cities.

FUNDING

GoGreenRoutes, Internal ISGlobal fund, and the United States Department of Agriculture Forest Service.

Latin American cities with higher socioeconomic status are greening from a lower baseline: evidence from the SALURBAL project

The characteristics of urban green space have context-dependent associations with socioeconomic status (SES). Latin American cities provide a unique but understudied context to assess the green space-SES associations. We measured the quantity and quality of green space as greenness from satellite-derived Normalized Difference Vegetation Index, and we modeled the relationship between greenness and SES in 371 major Latin American cities between 2000 and 2010. We found that SES was negatively associated with average greenness at city and sub-city scales, which could be explained by urbanization generally improving SES while reducing the provision of green space. About 82% of the cities and 64% of the sub-cities experienced greening or increases in greenness over time. Although with lower average greenness, cities with higher SES had greater greening; however, it was the opposite for sub-cities. We suggest that greening is more likely to take place in peripheral sub-cities where SES tends to be lower. The findings challenge the belief that places with higher SES have better access to environmental resources and amenities; instead, this relationship is context dependent.

Envisioning Happy Places for All: A Systematic Review of the Impact of Transformations in the Urban Environment on the Wellbeing of Vulnerable Groups

Urban planning and design can impact mental health, but it is unclear how ever-growing and changing cities can sustain the psychological wellbeing of vulnerable groups, who are among the most mentally sensitive to spatial inequalities. This systematic review synthesised quantitative and qualitative studies on urban design interventions and their impact on wellbeing in vulnerable groups. Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, we searched five online databases from inception to May 2020. A total of 10 papers were included. We found mixed evidence of benefits for wellbeing linked to urban regeneration projects or focused interventions (green spaces, transport, security). Interventions that were centred around participation, sustainable living, and quality of design (e.g., perceived sense of safety) were associated with increased residential satisfaction and wellbeing, particularly among low-income communities and women. Risk of bias was low to medium, but there was high methodological heterogeneity; studies were mainly from Western countries, and none of the included studies investigated the experiences of people with disabilities, migrants, or racial minorities. This review highlights the importance of inclusive and sustainable design interventions to create happy places for all strata of society, although further investigation is warranted.

Planning for Informal Urban Green Spaces in African Cities: Children’s Perception and Use in Peri-Urban Areas of Luanda, Angola

Urbanization has placed considerable constraints on the preservation and maintenance of formal green spaces in African cities. This situation has given attention to the potentials of informal green spaces (IGS). While studies on IGS in African cities is only emerging, scholarly and policy attention to children’s perceptions and use of IGS within Africa’s spatially expansive urbanism is limited. This study explores children’s perceptions, use, barriers, willingness, and suggestions for improving IGS in the peri-urban area of Funda in Luanda. Based on semi-structured interviews and focused-group discussions, the study revealed that, while IGS offered different ecosystem services, not all IGS were accessible to children, due to safety concerns, maintenance conditions, and parental restrictions. Children’s interest in maintenance activities and suggestions for improving IGS reflected their independent identities, sense of place, and cognitive capacity to contribute to planning their community. The paper submits that the potential role of IGS in Africa’s peri-urban areas can be improved by taking into account children’s agency and experiential knowledge of community spaces. For this reason, there is a need to recognize and engage children as co-producers of community knowledge and interventions.

Evaluating the association between urban green spaces and subjective well-being in Mexico city during the COVID-19 pandemic

This paper examines the association between the frequency of use of urban green spaces (UGS) and the subjective well-being (SWB) of Mexico City's residents during the COVID-19 pandemic. We conducted an online survey (N = 1954) regarding individuals' perceptions and use of UGS and their SWB, evaluated through the short version of the Warwick-Edinburgh mental well-being scale. Multilevel mixed-effects regression analyses were performed to investigate the association between the frequency of UGS use and SWB, including individual and municipal level characteristics as covariates. Our results suggest that respondents who used UGS once or more per week during the pandemic reported higher SWB scores (8.7%) than those with zero visits. These findings have public policy implications that could enhance the role of UGS in urban environments during times of crisis.

How Are Urban Green Spaces and Residential Development Related? A Synopsis of Multi-Perspective Analyses for Leipzig, Germany

The relationship between urban green spaces (UGS) and residential development is complex: UGS have positive and negative immediate impacts on residents’ well-being, residential location choice, housing, and land markets. Property owners and real estate agents might consider how prospective clients perceive UGS and act accordingly, while urban planners influence UGS location and management as well as aim at steering the built environment. Typically, studies focus on one of these perspectives at a time. Here, we provide a synopsis of results from studies, taking different perspectives for a single case study: Leipzig, Germany. We summarise and discuss the findings of eight studies on UGS and residential development. In detail, these studies focus on spatial pattern analysis, hedonic pricing analysis, mixed-methods studies on experts’ perspectives, surveys, and choice experiments exploring residents’ perceptions of UGS. We reflect on the feasibility of deriving a synthesis out of these independent studies and to what extent context matters. We conclude that both triangulating of data and methods, as well as long-term and context-sensitive studies are needed to explain the interlinkages between UGS and residential development and their context dependency.

Snapshot of the Use of Urban Green Spaces in Mexico City during the COVID-19 Pandemic: A Qualitative Study

The present qualitative research explores the factors that have influenced the use of urban green spaces (UGS) in Mexico City during the COVID-19 pandemic and the implications of their usage on residents' well-being. This study was conducted using a combination of solicited audio and written diaries, photography, and in-depth interviews with 16 participants, aged 22 to 58. The article provides a critical reflection on the incentives and deterrents to the UGS use of participants while social distancing measures were in place. The results show that in Mexico City: (1) participants' lack of access to UGS has hampered their use, mainly among those of low-income neighborhoods; (2) UGS size did not directly impact participants' UGS use during the pandemic; and (3) women were deterred from accessing UGS due to safety concerns related to the fear of violence. Overall, the results suggest that UGS use has served as a coping mechanism to decrease the effects of stress and isolation caused by the pandemic, increasing users' physical and mental well-being. This study's conclusions can help develop future citizen participation tools that are useful for resilience in urban design, as they provide interesting insights into the perceptions of residents, such as the most valued characteristics of UGS.

Associations between Greenspace and Gentrification-Related Sociodemographic and Housing Cost Changes in Major Metropolitan Areas across the United States

Neighborhood greenspace may attract new residents and lead to sociodemographic or housing cost changes. We estimated relationships between greenspace and gentrification-related changes in the 43 largest metropolitan statistical areas (MSAs) of the United States (US). We used the US National Land Cover and Brown University Longitudinal Tracts databases, as well as spatial lag models, to estimate census tract-level associations between percentage greenspace (years 1990, 2000) and subsequent changes (1990–2000, 2000–2010) in percentage college-educated, percentage working professional jobs, race/ethnic composition, household income, percentage living in poverty, household rent, and home value. We also investigated effect modification by racial/ethnic composition. We ran models for each MSA and time period and used random-effects meta-analyses to derive summary estimates for each period. Estimates were modest in magnitude and heterogeneous across MSAs. After adjusting for census-tract level population density in 1990, compared to tracts with low percentage greenspace in 1992 (defined as ≤50th percentile of the MSA-specific distribution in 1992), those with high percentage greenspace (defined as >75th percentile of the MSA-specific distribution) experienced higher 1990–2000 increases in percentage of the employed civilian aged 16+ population working professional jobs (β: 0.18, 95% confidence interval (CI): 0.11, 0.26) and in median household income (β: 0.23, 95% CI: 0.15, 0.31). Adjusted estimates for the 2000–2010 period were near the null. We did not observe evidence of effect modification by race/ethnic composition. We observed evidence of modest associations between greenspace and gentrification trends. Further research is needed to explore reasons for heterogeneity and to quantify health implications.

Green Space and Health Equity: A Systematic Review on the Potential of Green Space to Reduce Health Disparities

Disadvantaged groups worldwide, such as low-income and racially/ethnically minoritized people, experience worse health outcomes than more privileged groups, including wealthier and white people. Such health disparities are a major public health issue in several countries around the world. In this systematic review, we examine whether green space shows stronger associations with physical health for disadvantaged groups than for privileged groups. We hypothesize that disadvantaged groups have stronger protective effects from green space because of their greater dependency on proximate green space, as they tend to lack access to other health-promoting resources. We use the preferred reporting items for systematic reviews and meta-analyses (PRISMA) method and search five databases (CINAHL, Cochrane, PubMed, Scopus, and Web of Science) to look for articles that examine whether socioeconomic status (SES) or race/ethnicity modify the green space-health associations. Based on this search, we identify 90 articles meeting our inclusion criteria. We find lower-SES people show more beneficial effects than affluent people, particularly when concerning public green spaces/parks rather than green land covers/greenness. Studies in Europe show stronger protective effects for lower-SES people versus higher-SES people than do studies in North America. We find no notable differences in the protective effects of green space between racial/ethnic groups. Collectively, these results suggest green space might be a tool to advance health equity and provide ways forward for urban planners, parks managers, and public health professionals to address health disparities.

Socioeconomic Differences in Walking Time of Children and Adolescents to Public Green Spaces in Urban Areas-Results of the German Environmental Survey (2014-2017)

Public green spaces have a high potential for a positive impact on people's health and wellbeing, especially in urban areas. Studies on environmental justice indicate socially unequal access possibilities to urban green spaces. This article presents results on associations between individual socioeconomic position (SEP) and walking time from home to public green spaces in young people living in urban areas with more than 20,000 inhabitants in Germany. Data were derived from the German Environmental Survey for Children and Adolescents 2014-2017 (GerES V), the environmental module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2). The sample comprises 1149 participants aged 3 to 17 years. A total of 51.5% of the participants reach a public green space on foot within five and 72.8% within ten minutes from home. The lower the participant's SEP, the longer the walking time. Logistic regression models controlling for age group, sex, migration background, and region of residence show that participants with a low SEP have a significantly higher risk (odds ratio = 1.98; 95% confidence interval: 1.31-2.99) of needing more than ten minutes to walk from home to a public green space than participants with a high SEP. GerES V data indicate that young people living in urban areas in Germany do not equally benefit from the health-promoting potential of green spaces, which is an important aspect of environmental health inequalities.

Perceived biodiversity, sound, naturalness and safety enhance the restorative quality and wellbeing benefits of green and blue space in a neotropical city

Urban land cover expansion and human population growth are accelerating worldwide. This is resulting in the loss and degradation of green and blue spaces (e.g. parks, waterways, lakes) in cities, which provide resources to sustain biodiversity and improve human wellbeing. The specific characteristics of these spaces (e.g. sounds, species, safety) that enhance or detract from wellbeing are underexplored, yet this knowledge is needed to inform urban planning, management and policies that will ultimately benefit both people and biodiversity. Research of this kind is rarely conducted in the Global South, where rapid urbanisation threatens biodiversity-rich ecosystems of worldwide significance. Here, we examine how perceptions of green, waterway, and dense urban spaces relate to wellbeing in Georgetown, Guyana. Specifically, we use mediation models to test how perceptions of sound, bird species richness, naturalness, and safety concerns contribute to sites being perceived as restorative which, subsequently, influences wellbeing. We assess the accuracy of these site perceptions with objective measures of sound (using a bioacoustic sound index), bird species richness, and percent coverage of vegetation, water, and impervious surfaces. Results showed that if sites were perceived as species rich, containing natural sounds like birdsong, natural rather than artificial, and safe, they were perceived as more restorative, resulting in improved wellbeing. In general, people's perceptions were consistent with objective measures. Green, compared with waterway and dense urban sites, contained more biophonic sounds, higher species richness, greater vegetation and water coverage. Although waterways were biodiverse, they were dominated by anthrophonic sounds, so were perceived as artificial and non-restorative. We shed light on how city planners might augment specific characteristics to improve the wellbeing of urban dwellers, with implications for biodiversity conservation. Our findings provide a scientific evidence base for urban design and management plans that could deliver multiple co-benefits, particularly in biodiversity-rich cities in neotropical regions.

Designing Age-Friendly Communities: Exploring Qualitative Perspectives on Urban Green Spaces and Ageing in Two Indian Megacities

The World Health Organization and the United Nations have increasingly acknowledged the importance of urban green space (UGS) for healthy ageing. However, low- and middle-income countries (LMICs) like India with exponential ageing populations have inadequate UGS. This qualitative study examined the relationships between UGS and healthy ageing in two megacities in India. Participants were recruited using snowball sampling in New Delhi and Chennai and semi-structured interviews were conducted with consenting participants (N = 60, female = 51%; age > 60 years; fluent in English, Hindi, or Tamil). Interviews were recorded, transcribed, translated, and analysed using inductive and thematic analysis. Benefits of UGS included community building and social capital, improved health and social resilience, physical activity promotion, reduced exposure to noise, air pollution, and heat. Poorly maintained UGS and lack of safe, age-friendly pedestrian infrastructure were identified as barriers to health promotion in later life. Neighbourhood disorder and crime constrained older adults' use of UGS in low-income neighbourhoods. This study underscores the role of UGS in the design of age-friendly communities in India. The findings highlight the benefits of UGS for older adults, particularly those living in socially disadvantaged or underserved communities, which often have least access to high-quality parks and green areas.

Spatial Equity of Public Parks: A Case Study of Kabul City, Afghanistan

Accessibility, the size of the land area, the design and build quality, and the number of parks and their correlation with population density are key elements in fostering ecological spatial equity within cities. This study analyzed different spatial equity attributes of existing parks in Kabul City using onsite observations, measurement analyses, and mapping and buffering of satellite imagery using computer-aided design methods. The results revealed that, presently, 309 ha of urban land is covered by parks, which accounts for 0.78% of the total land area of 394.78 km2. On average, a quarter of city residents can access a park with basic amenities within 300 to 600 m of their residence, and parks currently provide a land coverage distribution per resident of 0.69 m2. However, the majority of parks lack certain amenities like playground and sports facilities desired by different user groups. This article also explored the inequitable distribution of parks at the city scale, underlining the scarcity or concentration of parks in certain areas and stressing the importance of allocating additional land for park provision.

Urban Development and Population Pressure: The Case of Młynówka Królewska Park in Krakow, Poland

Green areas are necessary components of contemporary cities. They have a positive impact on the climate, ecological balance and resilience of the city structure, and provide numerous benefits to inhabitants. However, progressing urbanisation and a rise in urban population leads to increasing pressure on existing green spaces. Since the beginning of the twenty-first century, but especially over the past decade, the number of new developments in Krakow has been successively increasing. New multi- and single-family housing complexes are built not only in peripheral areas, but also as infilling and development of areas closer to the historical city centre. Simultaneously, the number of urban green spaces has increased only insignificantly. This paper analyses the example of Młynówka Królewska Park, located in the western part of Krakow, Poland. It focuses on city expansion processes and their relationship with public greenery. Furthermore, his study examines spatial and demographic issues that may have an impact on accessibility of the park area. The study was based on statistical data, analyses of recent planning documents, procedures and practices, as well as research performed in situ. The results indicate that the population pressure in the area under analysis changed significantly. According to the results, a correlation can be found between the latest urban development and population dynamics.

How Are Green Spaces Distributed among Different Social Groups in Urban China? A National Level Study

The study analyzes the distributional equity of urban green space (UGS) among different social groups across all urban areas in China. Urban green space is measured in two ways: Park area per capita and vegetation coverage ratio within 1.6 km and 3.2 km featuring different ecosystem services they provide. Multiple regression analyses are conducted to assess relationships between different groups (children, the elderly, and migrant populations) and distributed UGS. Largely consistent to other national level studies, the nationwide analytical results indicate emerging social inequality of UGS during the urbanization of China, with a few nuances. A bi-fold pattern is observed in our case: Whilst areas with higher portions of children and senior people have less parks and high vegetation coverage, a marginalized group—internal migrant people, have more parks and low vegetation coverage in their vicinities. The results of regression analyses in different regions further shed light on revealing disparities of UGS in areas with varying socioeconomic development levels, geographical features, and urbanization paces. The implication of the study informs the decision makers to incorporate spatial patterns of social groups into green space guidance and evaluation for the purpose of promoting more equal development of UGS.

Towards a Standard Framework to Identify Green Infrastructure Key Elements in Dense Mediterranean Cities

Present-day dense cities are increasingly affected by the impacts associated with climate change. The recurrence of extreme climate events is projected to be intensified in cities in the next decades, especially in the most vulnerable areas of the world, such as the Mediterranean region. In this context, the urban green infrastructure (UGI) is presented as a nature-based solution that directly contributes to climate change mitigation in Mediterranean compact cities and improves health, social, welfare, and environmental conditions for inhabitants. This research sets out a manageable framework to define, locate, and categorize more functional green urban and peri-urban areas in a dense Mediterranean city. It takes spatial distribution, extension, and the capacity to improve inhabitants’ wellbeing through the provision of ecosystem services as classification criteria. Results show a scenario with a greater functional green surface available for the citizens to be managed. Identified areas have been categorized as cores, nodes, links, and green spaces defined as “other” areas. In particular, the latter play a significant role at social, structural, and ecological levels. The study showcases that rethinking urban design and strategic decision-making around these areas can enhance green equity in Mediterranean dense cities, their capacity to better deal with environmental extremes, and the inhabitants’ engagement with a culture of sustainability and wellbeing.

Associations of greenness with gestational diabetes mellitus: The Guangdong Registry of Congenital Heart Disease (GRCHD) study

Gestational diabetes mellitus (GDM) is associated with adverse short- and long-term health outcomes among mothers and their offspring. GDM affects 0.6%-15% of pregnancies worldwide and its incidence is increasing. However, intervention strategies are lacking for GDM. Previous studies indicated a protective association between greenspace and type 2 diabetes mellitus (T2DM), while few studies have explored the association between greenness and GDM. This study aimed to investigate the association between residential greenness and GDM among women from 40 clinical centers in Guangdong province, south China. The study population comprised 5237 pregnant mothers of fetuses and infants without birth defects, from 2004 to 2016. There were n = 157 diagnosed with GDM according to World Health Organization criteria. We estimated residential greenness using the Normalized Difference Vegetation Index (NDVI), derived from satellite imagery using a spatial-statistical model. Associations between greenness during pregnancy and GDM were assessed by confounder-adjusted random effects log-binomial regression models, with participating centers as the random effect. One interquartile increments of NDVI_250m, NDVI_500m and NDVI_1000m were associated with 13% (RR = 0.87, 95%CI: 0.87-0.87), 8% (RR = 0.92, 95%CI: 0.91-0.92) and 3% (RR = 0.97, 95%CI: 0.97-0.97) lower risks for GDM, respectively. However, NDVI_3000m was not significantly associated with GDM (RR = 0.96, 95%CI: 0.78-1.19). The risk for GDM decreased monotonically with greater NDVI. The protective effect of greenness on GDM was stronger among women with lower socioeconomic status and in environments with a lower level air pollutants. Our results suggest that greenness might provide an effective intervention to decrease GDM. Greenness and residential proximity to greenspace should be considered in community planning to improve maternal health outcomes.

Park use, perceived park proximity, and neighborhood characteristics: Evidence from 11 cities in Latin America

This study examines how park use may be associated with perceived park proximity, neighborhood-built environment and perceived social disorder in Latin American cities. The study uses self-reported data from the 2016 CAF survey, including 7,970 urban residents from 11 cities across Latin America. Results show positive graded associations between perceived park proximity and use, holding all others constant. Additional factors that were found to be associated with park use are neighborhood formality and related built-environment characteristics, including paved streets and sidewalks. Park use was mostly unrelated to perceived social disorder, with the exception of indigence, with which it is was positively associated. Stronger associations between park proximity and use were observed among those who reported higher prevalence of indigence or begging in their household block. These findings stress the importance of perceived park proximity in enhancing their use in urban Latin America, and challenge the role of social disorder and crime as a barrier for park use.

From XS to XL Urban Nature: Examining Access to Different Types of Green Space Using a ‘Just Sustainabilities’ Framework

Different types of urban green spaces provide diverse benefits for human health and environmental sustainability, but most studies on access to green space focus on neighborhood parks, with less work on smaller or larger green spaces. In this study, we examined sociodemographic differences in access to green spaces of different sizes for 14,385 census block groups in 12 U.S. cities using a ‘just sustainabilities’ framework. We classified green spaces into street-level greenery (XS), neighborhood parks (S–L; walking and cycling access), and large parks (XL; walking, cycling, and driving access). We ran spatial filtering models at the census block group level using different thresholds based on transportation modes. We uncovered a complex picture of inequality, with consistent injustices for XS green space, and fewer injustices for S–L and XL green space based on socioeconomic status and age, and some instances of just distributions for S–L and XL green space based on race/ethnicity. Our findings present a concerning picture for ‘just sustainabilities’: the green space type that is most often part of sustainability and climate adaptation strategies—street greenery—is unjustly distributed, likely as a result of structural racism in U.S. institutions. By examining multimodal access to green spaces of different sizes, this study helps urban greening professionals develop more just and sustainable strategies.

A Proposed Planning Concept for Public Open Space Provision in Saudi Arabia: A Study of Three Saudi Cities

Public open spaces (POS) have an essential positive impact on cities and their residents. These spaces play a critical role in enhancing users’ physical, mental, and social wellbeing. In addition, POS improve city resilience and economic value, and act as part of the city’s visual amenities. The Kingdom of Saudi Arabia is taking many approaches to enhance quality of life in all its cities through initiatives such as increasing the POS area per capita. Several studies have examined the importance of the accessibility of POS in addressing users’ needs. In this study, we measured the per capita area and accessibility of POS in the three megacities Riyadh, Dammam, and Jeddah. We also collected data on user preferences for the use of POS through semi-structured interviews, observations, and an online questionnaire. This study suggests that the country needs to establish its own POS planning approach based on users’ desires and behaviors when using POS, as well as the country’s social characteristics, and to depend not only on standard international planning approaches. The paper recommends considering the possibility of increasing POS by creating typologies of these spaces based on each city’s landscape characteristics. This proposal will have a major impact on city planning and design in Saudi Arabia. In addition, it will make the Saudi cities livable and have a positive impact on the physical, mental, and social wellbeing of the population.

Park Proximity and Use for Physical Activity among Urban Residents: Associations with Mental Health

Increasing global urbanization limits interaction between people and natural environments, which may negatively impact population health and wellbeing. Urban residents who live near parks report better mental health. Physical activity (PA) reduces depression and improves quality of life. Despite PA's protective effects on mental health, the added benefit of urban park use for PA is unclear. Thus, we examined whether park-based PA mediated associations between park proximity and mental distress among 3652 New York City residents (61.4% 45 + years, 58.9% female, 56.3% non-white) who completed the 2010-2011 Physical Activity and Transit (PAT) random-digit-dial survey. Measures included number of poor mental health days in the previous month (outcome), self-reported time to walk to the nearest park from home (exposure), and frequency of park use for sports, exercise or PA (mediator). We used multiple regression with bootstrap-generated 95% bias-corrected confidence intervals (BC CIs) to test for mediation by park-based PA and moderation by gender, dog ownership, PA with others, and perceived park crime. Park proximity was indirectly associated with fewer days of poor mental health via park-based PA, but only among those not concerned about park crime (index of moderated mediation = 0.04; SE = 0.02; 95% BC CI = 0.01, 0.10). Investment in park safety and park-based PA promotion in urban neighborhoods may help to maximize the mental health benefits of nearby parks.

Analytical approaches to testing pathways linking greenspace to health: A scoping review of the empirical literature

BACKGROUND

Inadequate translation from theoretical to statistical models of the greenspace - health relationship may lead to incorrect conclusions about the importance of some pathways, which in turn may reduce the effectiveness of public health interventions involving urban greening. In this scoping review we aimed to: (1) summarize the general characteristics of approaches to intervening variable inference (mediation analysis) employed in epidemiological research in the field; (2) identify potential threats to the validity of findings; and (3) propose recommendations for planning, conducting, and reporting mediation analyses.

METHODS

We conducted a scoping review, searching PubMed, Scopus, and Web of Science for peer-reviewed epidemiological studies published by December 31, 2019. The list of potential studies was continuously updated through other sources until March 2020. Narrative presentation of the results was coupled with descriptive summary of study characteristics.

RESULTS

We found 106 studies, most of which were cross-sectional in design. Most studies only had a spatial measure of greenspace. Mental health/well-being was the most commonly studied outcome, and physical activity and air pollution were the most commonly tested intervening variables. Most studies only conducted single mediation analysis, even when multiple potentially intertwined mediators were measured. The analytical approaches used were causal steps, difference-of-coefficients, product-of-coefficients, counterfactual framework, and structural equation modelling (SEM). Bootstrapping was the most commonly used method to construct the 95% CI of the indirect effect. The product-of-coefficients method and SEM as used to investigate serial mediation components were more likely to yield findings of indirect effect. In some cases, the causal steps approach thwarted tests of indirect effect, even though both links in an indirect effect were supported. In most studies, sensitivity analyses and proper methodological discussion of the modelling approach were missing.

CONCLUSIONS

We found a persistent pattern of suboptimal conduct and reporting of mediation analysis in epidemiological studies investigating pathways linking greenspace to health; however, recent years have seen improvements in these respects. Better planning, conduct, and reporting of mediation analyses are warranted.

Urban Green Space Distribution Related to Land Values in Fast-Growing Megacities, Mumbai and Jakarta–Unexploited Opportunities to Increase Access to Greenery for the Poor

Many studies on disparities in the distribution of urban green space (UGS) focus on the quantity and accessibility of designated open spaces. However, when all types of UGS, including unmanaged green areas, are accounted for, claims of green space distributive injustice become more complicated. We conducted a preliminary investigation questioning the common Global North assumption that the poor have less access to the benefits of green space, using the cities of Mumbai and Jakarta as case studies as, in their respective countries, wealth inequality has grown at a higher rate than in other Asian countries. We employed four sets of geospatial data to analyze green space distribution patterns and probe the relationship with UGS inequity in different land value districts. We found that the lower land value districts had more vegetation coverage with a higher vegetation density, mainly due to a large quantity of unmanaged greenery. The relationship between the status of urban development and the land values in a district is not necessarily reflective of the UGS distribution once unmanaged vegetation is considered. We conclude by discussing ways to optimize the use of unmanaged UGS as a socioecological asset for poorer districts, and we point to the practical consequences of incorporating the study’s findings into policy and planning towards the creation of ecologically inclusive cities.

E. M. Browning M, Rigolon A. Noncommunicable Diseases, Park Prescriptions, and Urban Green Space Use Patterns in a Global South Context: The Case of Dhaka, Bangladesh

Urban green space use is often associated with improved physical and mental health and lower noncommunicable disease (NCDs) burdens. Factors that influence green space visits have been documented in cities of the Global North, but evidence of urban green space use patterns for cities in the Global South is scarce. The aim of this study is to investigate factors influencing urban green space use patterns in Dhaka, Bangladesh, a megacity of the Global South, with a particular focus on how poor health condition and healthcare professionals' prescriptions to exercise outdoors (park prescriptions-ParkRx) impact the green space use of middle-aged adults. We collected green space characteristics and use factors (i.e., availability, accessibility, attractiveness, and attachment), health condition, ParkRx, and urban green space use intensity (i.e., frequency and duration) via a self-reported questionnaire from 169 middle-aged residents of Dhaka. We used multivariate modeling to estimate the association of green space characteristics, health condition, and ParkRx with use intensity. We further applied a mediation analysis to determine the influence of ParkRx on the relationship between residents' poor health conditions and use intensity. We found that green space availability and accessibility did not significantly influence use intensity, but attractiveness was negatively associated with use intensity. Green space use intensity was significantly and positively associated with attachment to the green space, poor health condition (i.e., having noncommunicable diseases), and ParkRx. ParkRx significantly mediated the relationship between health condition and use intensity. We observed limited supply, poor access, and low attractiveness when studying the urban green spaces in Dhaka, but these qualities did not affect use intensity, as found in many case studies in the Global North. In contrast, urban green space use intensity in our case study is mostly dependent on poor health condition and park prescriptions.

Analysis of spatial equity and access to urban parks in Ilam, Iran

Adequate number of parks and amount of land allocated to those parks, to provide equal access for all city residences, are important factors in achieving cities to spatial equity. The purpose of this study was to analyze availability, distribution and accessibility of urban parks in the city of Ilam, Iran. In this research, descriptive statistics and buffering techniques in GIS were used. Our findings show that in Ilam, the indexes of park coverage and per capita park area are 2.13% and 1.91 m² respectively, that are much lower than those of Iranian standards. Only slightly over a third of Ilam residents live within 200 m of a park. Parks are disproportionately agglomerated in the northern half of the city. Whilst 30.4% of the city's surface area, where 27.3% of the city's population reside, is not covered by park service areas, some other parts benefit from 13 park service areas. The index of per capita access to parks for 34.8% of Ilam population that reside in 32.7% of Ilam surface area, is less than 1.5 m². The city in general suffers from a shortage of parks, but this, in particular, is severe in the city center and in the southern parts, highlighting the need for allocation of more lands for park provision.

Can Simulated Nature Support Mental Health? Comparing Short, Single-Doses of 360-Degree Nature Videos in Virtual Reality With the Outdoors

Nature exposure in virtual reality (VR) can provide emotional well-being benefits for people who cannot access the outdoors. Little is known about how these simulated experiences compare with real outdoor experiences. We conduct an experiment with healthy undergraduate students that tests the effects of 6 min of outdoor nature exposure with 6 min of exposure to a 360-degree VR nature video, which is recorded at the outdoor nature exposure location. Skin conductivity, restorativeness, and mood before and after exposure are measured. We find that both types of nature exposure increase physiological arousal, benefit positive mood levels, and are restorative compared to an indoor setting without nature; however, for outdoor exposure, positive mood levels increase and for virtual nature, they stay the same. The nature-based experience shows benefits above and beyond the variance explained by participants' preferences, nature and VR experiences, and demographic characteristics. Settings where people have limited access to nature might consider using VR nature experiences to promote mental health.

The effect of urban green space on uncertainty stress and life stress: A nationwide study of university students in China

OBJECTIVE

The aim of this study is to investigate the impacts of urban green space on stress among Chinese university students.

METHODS

Participants were 11,954 students from 50 universities in 42 cities. Each student completed the Global Health Professional Student Survey (GHPSS) on Tobacco Control in China. Regional variables were retrieved from the National Bureau of Statistics database. Both unadjusted and adjusted methods were used in the logistic regression analysis.

RESULTS

Almost one third of the students (31.1%) suffered from high levels of uncertainty and life stress. The multilevel logistic regression model showed that while certain individual and environmental factors, such as higher family income, having parents with a professional occupation and urban home location, reduced uncertainty stress among students, so did the effects of green space. This was particularly important for reducing uncertainty stress but also had some effects on life stress.

CONCLUSIONS

The findings support a wider body of literature on the positive effects of green space on stress and mental health. Future studies need to pay greater attention not only to intra-urban differences in student use of green space, but also to how the natural environment features in stress management policies in Chinese universities.

Nature and mental health: An ecosystem service perspective

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 Inequalities in Environmental Resources of Green and Blue Spaces: A Review of Evidence in the WHO European Region

Residential green and blue spaces and their potential health benefits have received increasing attention in the context of environmental health inequalities, because an unequal social distribution of these resources may contribute to inequalities in health outcomes. This systematic review synthesised evidence of environmental inequalities, focusing on availability and accessibility measures of green and blue spaces. Studies in the World Health Organisation (WHO) European Region published between 2010 and 2017 were considered for the review. In total, 14 studies were identified, where most of them (n = 12) analysed inequalities of green spaces. The majority had an ecological study design that mostly applied deprivation indices on the small area level, whereas cross-sectional studies on the individual level mostly applied single social measures. Ecological studies consistently showed that deprived areas had lower green space availability than more affluent areas, whereas mixed associations were found for single social dimensions in cross-sectional studies on the individual level. In order to gain more insights into how various social dimensions are linked to the distribution of environmental resources within the WHO European Region, more studies are needed that apply comparable methods and study designs for analysing social inequalities in environmental resources.

School Green Space and Its Impact on Academic Performance: A Systematic Literature Review

Background: Scholars and policymakers have criticized public education in developed countries for perpetuating health and income disparities. Several studies have examined the ties between green space and academic performance, hypothesizing that green space can foster performance, and, over time, help reduce such disparities. Although numerous reviews have analyzed the link between nature and child health, none have focused on academic achievement. Methods: We identified 13 peer-reviewed articles that examined associations between academic outcomes, types of green spaces, and distances in which green spaces were measured around schools. Results: Of the 122 findings reported in the 13 articles, 64% were non-significant, 8% were significant and negative, and 28% were significant and positive. Positive findings were limited to greenness, tree cover, and green land cover at distances up to 2000 m around schools. End-of-semester grades and college preparatory exams showed greater shares of positive associations than math or reading test scores. Most findings regarding writing test scores were non-significant, and moderation effects of socioeconomic status, gender, and urbanization showed mixed results. Conclusions: The extant literature on green space and academic performance is small, shows mixed results, and mostly includes articles using observational, school-level research designs. Regardless, there is sufficient evidence to warrant further research on this topic, including effect moderation and mechanistic pathways.

Assessing Spatial Equity and Accessibility of Public Green Spaces in Aleppo City, Syria

This paper examines the accessibility of urban green spaces within the Syrian city of Aleppo before the civil war using an environmental justice approach by indicating the current state of the parameters proximity and quantity in relation to the socioeconomic status of the inhabitants. Therefore, we conducted the average nearest neighbour analysis, facilities over and under coverage analysis, network analysis and a one-way analysis of variance (ANOVA) test followed by a post-hoc Tukey honestly significant difference (HSD) test. The findings clearly indicate that the spatial pattern of the distribution of public parks facilities was significantly clustered (p-value < 0.0001), with a z-score of −16.4. Several neighbourhoods within the western and central parts of the city were identified to have a higher density of facilities, while the majority of the neighbourhoods located in the marginal parts in eastern Aleppo (low income) lack access to urban green spaces. The hierarchy-wise analysis reveals a strong deficit of urban green spaces at lower hierarchies, for example pocket parks and neighbourhood parks, while access to quarter parks and district parks is high. The urban green spaces at higher hierarchies are located in high and middle socioeconomic status areas. Regarding social segregation in park distribution and their accessibility, the data showed that high income neighbourhoods enjoy a significantly higher percentage of park facilities. The approach presented in this paper offers a generic method for the future development of public green spaces for balanced and sustainable planning.