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Patwary MM, Bardhan M, Browning MHEM, Astell-Burt T, van den Bosch M, Dong J, Dzhambov AM, Dadvand P, Fasolino T, Markevych I, McAnirlin O, Nieuwenhuijsen MJ, White MP, Van Den Eeden SK. The economics of nature's healing touch: A systematic review and conceptual framework of green space, pharmaceutical prescriptions, and healthcare expenditure associations. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 914:169635. [PMID: 38159779 DOI: 10.1016/j.scitotenv.2023.169635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
Green spaces play a crucial role in promoting sustainable and healthy lives. Recent evidence shows that green space also may reduce the need for healthcare, prescription medications, and associated costs. This systematic review provides the first comprehensive assessment of the available literature examining green space exposure and its associations with healthcare prescriptions and expenditures. We applied Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to search MEDLINE, Scopus, and Web of Science for observational studies published in English through May 6, 2023. A quality assessment of the included studies was conducted using the Office of Health Assessment and Translation (OHAT) tool, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) assessment was used to evaluate the overall quality of evidence. Our search retrieved 26 studies that met the inclusion criteria and were included in our review. Among these, 20 studies (77 % of the total) showed beneficial associations of green space exposure with healthcare prescriptions or expenditures. However, most studies had risks of bias, and the overall strength of evidence for both outcomes was limited. Based on our findings and related bodies of literature, we present a conceptual framework to explain the possible associations and complex mechanisms underlying green space and healthcare outcomes. The framework differs from existing green space and health models by including upstream factors related to healthcare access (i.e., rurality and socioeconomic status), which may flip the direction of associations. Additional research with lower risks of bias is necessary to validate this framework and better understand the potential for green space to reduce healthcare prescriptions and expenditures.
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Affiliation(s)
- Muhammad Mainuddin Patwary
- Environment and Sustainability Research Initiative, Khulna, Bangladesh; Environmental Science Discipline, Life Science School, Khulna University, Khulna, Bangladesh.
| | - Mondira Bardhan
- Environment and Sustainability Research Initiative, Khulna, Bangladesh; Department of Park, Recreation and Tourism Management, Clemson University, Clemson, SC, USA
| | - Matthew H E M Browning
- Department of Park, Recreation and Tourism Management, Clemson University, Clemson, SC, USA.
| | - Thomas Astell-Burt
- School of Architecture, Design, and Planning, University of Sydney, Australia
| | - Matilda van den Bosch
- ISGlobal, Barcelona, Spain; European Forest Institute, Biocities Facility, Rome, Italy; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jiaying Dong
- Department of Park, Recreation and Tourism Management, Clemson University, Clemson, SC, USA; School of Architecture, Clemson University, Clemson, SC, USA
| | - Angel M Dzhambov
- Research Group "Health and Quality of Life in a Green and Sustainable Environment", Strategic Research and Innovation Program for the Development of MU - Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria; Environmental Health Division, Research Institute at Medical University of Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria; Department of Hygiene, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria; Institute of Highway Engineering and Transport Planning, Graz University of Technology, Graz, Austria
| | - Payam Dadvand
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Iana Markevych
- Research Group "Health and Quality of Life in a Green and Sustainable Environment", Strategic Research and Innovation Program for the Development of MU - Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria; Environmental Health Division, Research Institute at Medical University of Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria; Institute of Psychology, Jagiellonian University, Krakow, Poland
| | - Olivia McAnirlin
- Department of Park, Recreation and Tourism Management, Clemson University, Clemson, SC, USA
| | - Mark J Nieuwenhuijsen
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Mathew P White
- Cognitive Science Hub, University of Vienna, Vienna, Austria
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Feng X, Navakatikyan M, Eckermann S, Astell-Burt T. Show me the money! Associations between tree canopy and hospital costs in cities for cardiovascular disease events in a longitudinal cohort study of 110,134 participants. ENVIRONMENT INTERNATIONAL 2024; 185:108558. [PMID: 38490071 DOI: 10.1016/j.envint.2024.108558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/10/2024] [Accepted: 03/03/2024] [Indexed: 03/17/2024]
Abstract
Health benefits from urban greening are assumed to translate into reduced healthcare expenditure, yet few studies have tested this. A total of 110,134 participants in the Sax Institute's 45 and Up Study in the Australian cities of Sydney, Newcastle, or Wollongong were linked with hospital cost data for cardiovascular disease (CVD) events (e.g., acute myocardial infarctions) up to 30 June 2018. Associations between percentages of total green space, tree canopy, and open grass within 1.6 km of participants homes and annual per person measured CVD-related hospital costs were analysed using generalised linear model (GLM) with gamma density as a component of a two-part mixture model, adjusting for confounders. Overall, 26,243 participants experienced a CVD-related hospitalisation. Incidence was lower among participants with 10 % more tree canopy (OR 0.98, 95 %CI 0.96, 0.99), but not with higher total green space or open grass percentages. Total costs of hospitalisations per year were lower with 10 % more tree canopy (means ratio 0.96, 95 %CI 0.95, 0.98), but also higher with 10 % more open grass (means ratio 1.04, 95 %CI 1.02, 1.06). It was estimated that raising tree canopy cover to 30 % or more for individuals with currently less than 10 % could lead to a within-sample annual saving per person of AU$ 193 overall and AU$ 569 for those who experienced one or more CVD-related hospital admissions. This projects to an estimated annual health sector cost reduction of AU$ 19.3 million per 100,000 individuals for whom local tree canopy cover is increased from less than 10 % to 30 % or higher. In conclusion, this longitudinal study is among the first to analyse measured healthcare cost data in relation to urban green space in general, and with differentiation between major types of greenery relevant to urban planning policies in cities around the world. In sum, this study advances an increasingly important and international focus of research by reporting on the lower burden of CVD and fewer associated hospitalisations stemming from upstream investments that protect and restore urban tree canopy, which not only translates into substantial reduced costs for the health sector, but also helps to create regenerative cities and flourishing communities.
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Affiliation(s)
- Xiaoqi Feng
- School of Population Health, University of New South Wales, Sydney, NSW, Australia; George Institute of Global Health, Sydney, NSW, Australia; Population Wellbeing and Environment Research Lab (PowerLab), Sydney, NSW, Australia
| | - Michael Navakatikyan
- School of Population Health, University of New South Wales, Sydney, NSW, Australia; Population Wellbeing and Environment Research Lab (PowerLab), Sydney, NSW, Australia
| | - Simon Eckermann
- School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), Sydney, NSW, Australia; School of Architecture, Design and Planning, University of Sydney, Sydney, NSW, Australia; School of Health and Society, University of Wollongong, Wollongong, NSW, Australia.
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Maddock JE, Johnson SS. Spending Time in Nature: The Overlooked Health Behavior. Am J Health Promot 2024; 38:124-148. [PMID: 38126319 DOI: 10.1177/08901171231210806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Jay E Maddock
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, Center for Health and Nature, College Station, TX, USA
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Browning MHEM, Hanley JR, Bailey CR, Beatley T, Gailey S, Hipp JA, Larson LR, James P, Jennings V, Jimenez MP, Kahn PH, Li D, Reuben A, Rigolon A, Sachs NA, Pearson AL, Minson CT. Quantifying Nature: Introducing NatureScore TM and NatureDose TM as Health Analysis and Promotion Tools. Am J Health Promot 2024; 38:126-134. [PMID: 38126317 PMCID: PMC10876217 DOI: 10.1177/08901171231210806b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Matthew H. E. M. Browning
- Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, SC, USA
- NatureQuantTM, Inc., Eugene, OR, USA
| | | | | | - Timothy Beatley
- School of Architecture, University of Virginia, Charlottesville, VA, USA
| | - Samantha Gailey
- Department of Forestry, Michigan State University, East Lansing, MI, USA
- Space, Health and Community Lab, Charles Stewart Mott Department of Public Health, Michigan State University, East Lansing, MI, USA
| | - J. Aaron Hipp
- Department of Parks, Recreation & Tourism Management, North Carolina State University, Raleigh, NC, USA
| | - Lincoln R. Larson
- Department of Parks, Recreation & Tourism Management, North Carolina State University, Raleigh, NC, USA
| | - Peter James
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Viniece Jennings
- School of the Environment, Florida Agricultural and Mechanical University, Tallahassee, FL, USA
| | | | - Peter H. Kahn
- Department of Psychology & School of Environmental and Forest Sciences, University of Washington, Seattle, WA, USA
| | - Dongying Li
- Department of Landscape Architecture and Urban Planning, Texas A&M University, College Station, TX, USA
| | - Aaron Reuben
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - Alessandro Rigolon
- Department of City & Metropolitan Planning, The University of Utah, Salt Lake City, UT, USA
| | - Naomi A. Sachs
- Department of Plant Science and Landscape Architecture, University of Maryland, College Park, MD, USA
| | - Amber L. Pearson
- Charles Stewart Mott Department of Public Health, Michigan State University, East Lansing, MI, USA
| | - Christopher T. Minson
- NatureQuantTM, Inc., Eugene, OR, USA
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
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Ryan SC, Sugg MM, Runkle JD. Association between urban greenspace, tree canopy cover and intentional deaths: An exploratory geospatial analysis. URBAN FORESTRY & URBAN GREENING 2023; 86:128015. [PMID: 37693117 PMCID: PMC10486201 DOI: 10.1016/j.ufug.2023.128015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Greenspaces can provide restorative experiences, offer opportunities for outdoor recreation, and reduce mental fatigue; all of which may improve community health and safety. Yet few studies have examined the neighborhood-level benefits of greenspace in reducing violent deaths. This study explored the association between three distinct greenspace metrics: public greenspace quantity, public greenspace accessibility, neighborhood tree canopy cover, and intentional deaths (i.e., homicides and suicides). Generalized linear models and spatial error models investigated the association between greenspace, tree canopy and intentional deaths in three geographically distinct cities in North Carolina. Results revealed that increased neighborhood greenspace accessibility and tree canopy cover were associated with reduced intentional deaths in all three urban areas. Neighborhood greenspace accessibility was the most protective factor across all study areas. The relationship between neighborhood greenspace accessibility and intentional deaths was more significant for non-firearm deaths as compared to firearm deaths, indicating that weapon type may be an important consideration for neighborhood greenspace interventions. Compared to predominantly White neighborhoods, predominantly Black neighborhoods had higher rates of homicide in Asheville and Durham and higher rates of suicide in Charlotte. Future policy and research should focus on improving equitable access to existing and future greenspaces, especially in primarily Black neighborhoods.
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Affiliation(s)
- Sophia C Ryan
- Department of Geography and Planning, Appalachian State University, Boone, North Carolina
| | - Margaret M. Sugg
- Department of Geography and Planning, Appalachian State University, Boone, North Carolina
| | - Jennifer D. Runkle
- North Carolina Institute for Climate Studies, North Carolina State University, Raleigh, North Carolina
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Yeager R, Browning MHEM, Breyer E, Ossola A, Larson LR, Riggs DW, Rigolon A, Chandler C, Fleischer D, Keith R, Walker K, Hart JL, Smith T, Bhatnagar A. Greenness and equity: Complex connections between intra-neighborhood contexts and residential tree planting implementation. ENVIRONMENT INTERNATIONAL 2023; 176:107955. [PMID: 37196566 PMCID: PMC10367429 DOI: 10.1016/j.envint.2023.107955] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/19/2023]
Abstract
Associations between neighborhood greenness and socioeconomic status (SES) are established, yet intra-neighborhood context and SES-related barriers to tree planting remain unclear. Large-scale tree planting implementation efforts are increasingly common and can improve human health, strengthen climate adaptation, and ameliorate environmental inequities. Yet, these efforts may be ineffective without in-depth understanding of local SES inequities and barriers to residential planting. We recruited 636 residents within and surrounding the Oakdale Neighborhood of Louisville, Kentucky, USA, and evaluated associations of individual and neighborhood-level sociodemographic indicators with greenness levels at multiple scales. We offered no-cost residential tree planting and maintenance to residents within a subsection of the neighborhood and examined associations of these sociodemographic indicators plus baseline greenness levels with tree planting adoption among 215 eligible participants. We observed positive associations of income with Normalized Difference Vegetation Index (NDVI) and leaf area index (LAI) within all radii around homes, and within yards of residents, that varied in strength. There were stronger associations of income with NDVI in front yards but LAI in back yards. Among Participants of Color, associations between income and NDVI were stronger than with Whites and exhibited no association with LAI. Tree planting uptake was not associated with income, education, race, nor employment status, but was positively associated with lot size, home value, lower population density, and area greenness. Our findings reveal significant complexity of intra-neighborhood associations between SES and greenness that could help shape future research and equitable greening implementation. Results show that previously documented links between SES and greenspace at large scales extend to residents' yards, highlighting opportunities to redress greenness inequities on private property. Our analysis found that uptake of no-cost residential planting and maintenance was nearly equal across SES groups but did not redress greenness inequity. To inform equitable greening, further research is needed to evaluate culture, norms, perceptions, and values affecting tree planting acceptance among low-SES residents.
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Affiliation(s)
- Ray Yeager
- Christina Lee Brown Envirome Institute, University of Louisville. 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Division of Environmental Medicine, Department of Medicine, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Superfund Research Center, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Center for Integrative Environmental Health Sciences, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA.
| | - Matthew H E M Browning
- Department of Parks, Recreation, and Tourism Management, Clemson University, Sirrine 120B, Clemson, SC, USA
| | - Elizabeth Breyer
- Texas A&M University, Department of Geography. Building 0443, 797 Lamar St, College Station, TX 77843, USA
| | - Alessandro Ossola
- Department of Plant Sciences, University of California Davis. PES-1238, One Shields Avenue, Davis, CA 95616, USA
| | - Lincoln R Larson
- College of Natural Resources, North Carolina State University. Biltmore Hall 4008L, Raleigh, NC 27695, USA
| | - Daniel W Riggs
- Christina Lee Brown Envirome Institute, University of Louisville. 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Division of Environmental Medicine, Department of Medicine, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Superfund Research Center, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA
| | - Alessandro Rigolon
- Department of City and Metropolitan Planning, The University of Utah. 375 S 1530 E, RM 204 ARCH, Salt Lake City, UT, 84112, USA
| | - Christopher Chandler
- North American Cities Network, The Nature Conservancy. 308 Central Ave, Pewee Valley, KY 40056, USA
| | - Daniel Fleischer
- Hyphae Design Laboratory, 942 Clay Street, Oakland, CA 94607, USA
| | - Rachel Keith
- Christina Lee Brown Envirome Institute, University of Louisville. 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Division of Environmental Medicine, Department of Medicine, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Superfund Research Center, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA
| | - Kandi Walker
- Christina Lee Brown Envirome Institute, University of Louisville. 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Department of Communication, University of Louisville, 2301 South 3rd Street, Louisville, KY 40292, USA
| | - Joy L Hart
- Christina Lee Brown Envirome Institute, University of Louisville. 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Superfund Research Center, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Department of Communication, University of Louisville, 2301 South 3rd Street, Louisville, KY 40292, USA
| | - Ted Smith
- Christina Lee Brown Envirome Institute, University of Louisville. 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Division of Environmental Medicine, Department of Medicine, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Superfund Research Center, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA
| | - Aruni Bhatnagar
- Christina Lee Brown Envirome Institute, University of Louisville. 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Division of Environmental Medicine, Department of Medicine, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Superfund Research Center, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Center for Integrative Environmental Health Sciences, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA
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Vancampfort D, Brunner E, McGrath RL, Hemmings L, Van Damme T. Correlates of sedentary behavior in people with fibromyalgia: A systematic review. Int J Rheum Dis 2023; 26:841-849. [PMID: 36972974 DOI: 10.1111/1756-185x.14678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 02/22/2023] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Understanding the correlates of sedentary behavior (SB) is important in the development of interventions which reduce and interrupt SB in people with fibromyalgia (PwF). This systematic review aimed to investigate the correlates of SB in PwF using the socio-ecological model. METHODS Three databases (Embase, CINAHL and PubMed) were search from inception until July 21, 2022 using "sedentary" or different types of SB and "fibromyalgia" or "fibrositis" as keywords. The data collected was then analyzed using summary coding. RESULTS Out of 23 SB correlates retrieved from 7 reports (n = 1698), no correlates were consistently reported (ie, reported in 4 or more studies). Higher pain intensity was the most commonly reported barrier for reducing/interrupting SB (reported in 3 reports). Other reported barriers to reducing/interrupting SB were experiencing physical and mental fatigue, a more severe disease impact, and a lack of motivation to be physically active (all reported in 1 study). A better experienced social and physical functioning and more vitality were facilitators for reducing/interrupting SB (all reported in 1 study). To date, in PwF no correlates of SB at the interpersonal, environmental and policy levels have been explored. CONCLUSION Research on correlates of SB in PwF is still in its infancy. The current preliminary evidence suggests that clinicians should consider physical and mental barriers when aiming to reduce or interrupt SB in PwF. Further research on modifiable correlates at all levels of the socio-ecological model is required to inform future trials aiming to modify SB in this vulnerable population.
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Affiliation(s)
- Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Emanuel Brunner
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department Gesundheit, Ostschweizer Fachhochschule, St. Gallen, Switzerland
- Institut für Therapie und Rehabilitation, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Ryan L McGrath
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, New South Wales, Australia
| | - Laura Hemmings
- University of Birmingham, School of Sport and Exercise Sciences, Birmingham, UK
| | - Tine Van Damme
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Center KU Leuven, Kortenberg, Belgium
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