“I'm always entirely happy when I'm here!” Urban blue enhancing human health and well-being in Cologne and Düsseldorf, Germany

Obesogenic environments as major determinants of a disease: It is time to re-shape our cities

Obesity rates are increasing in almost all high- and low-income countries, and population-based approaches are necessary to reverse this trend. The current global efforts are focused on identifying the root causes of obesity and developing effective methods for early diagnosis, screening, treatment, and long-term management, both at an individual and health system level. However, there is a relative lack of effective options for early diagnosis, treatment, and long-term management, which means that population-based strategies are also needed. These strategies involve conceptual shifts towards community- and environment-focused approaches. This review aimed to provide evidence on how environmental factors contribute to the risk of obesity and how reshaping cities can help slow down obesity prevalence rates and improve long-term management.

The impact of outdoor blue spaces on the health of the elderly: A systematic review

Research on natural health has identified the potential benefit of outdoor blue spaces for human health and wellbeing. However, the existing evidence has relatively limited attention to the elderly. This study aims to review the available evidence on outdoor blue spaces and health outcomes among older individuals and identify knowledge gaps. In accordance with the PRISMA guidelines, specific keywords were used to search for articles published in English from inception to October 2023. Five databases (Scopus, PubMed, Web of Science, CINAHL, and PsycINFO) were searched, and 22 studies were identified in this review. We classified articles based on elderly health as general health (e.g., self-reported, perceived health and wellbeing), physical health (e.g., physical activity, physical function index), and mental health and wellbeing (e.g., depression). The findings indicated a positive correlation between outdoor blue space and the health of the elderly. In terms of the characteristics of exposure to outdoor blue spaces, direct contact (e.g., sensory-based) has not been well documented compared to indirect contact (e.g., distance, percentage, region-based). Although encouraging, the available body of evidence is limited and lacks consistency. Future research is needed to provide complementary evidence between outdoor blue spaces and elderly health.

How do weather conditions and environmental characteristics influence aesthetic preferences of freshwater environments?

Freshwater (inland) blue space environments provide a range of public health benefits to visitors. However, health related exposure outcomes are dynamic and can vary depending on several factors, including the environmental characteristics of freshwater environments and their surroundings. Developing and managing inland blue spaces to promote health and wellbeing therefore requires an understanding of whether specific freshwater attributes, and prevailing weather conditions, enhance or devalue landscape aesthetics. The aim of this study was to utilise a mixed-methods research approach to investigate aesthetic preferences of inland blue spaces. A three-phase data collection method was adopted involving (i) analysis of a national-scale landscape image dataset; in combination with (ii) a national-scale online survey; and (iii) a series of in-person focus groups. We found environmental characteristics associated with the waterbody itself, as well as the characteristics of the nearby green space, to have a significant impact on the overall aesthetic appeal of inland blue spaces. Strong preference was demonstrated for inland blue spaces perceived to be of a high environmental quality and which have a natural, rather than human-modified, appearance. The findings highlight the need to conserve the quality of both the waterbody and waterside environment to encourage frequent recreational use and maintain the beneficial public health outcomes associated with inland blue spaces.

Psychological distance and physical distance induced residents' heterogeneous willingness to pay for transboundary watershed ecosystem services in the Wei River Basin, China

Under the framework of payment for transboundary watershed ecosystem services (ESs), identifying midstream and downstream residents' preference and willingness to pay (WTP) for ESs provided by the upstream is crucial for sustainable watershed management. The residents' preferences and WTP are not evenly distributed within the watershed. This study uses a choice experiment assessing the spatial impact of physical distance (including residents' watershed location and distance to waterbody) and psychological distance on residents' preference and WTP for the Wei River Basin ESs. The results showed that midstream and downstream residents' preference and WTP for the ecological attributes have a significant distance-decay effect, either the physical distance to the upstream exit or physical and psychological distance to the waterbody. However, compared with the residents in the midstream, the residents downstream have a stronger preference and WTP for upstream ecological governance. Besides, the distance-decay effect differs between urban and rural residents. There is a psychological distance-decay effect in rural residents' preference for water quality and a physical distance-decay effect in their preference for water quantity, entertainment area, and cost; there is a physical distance decay effect in urban residents' preference for entertainment areas. The above differences lead to heterogeneity in WTP and total economic value (TEV) for ESs. When calculating the TEV of the transboundary watershed ES and charging the public, policymakers should consider the location of the residents, the physical and psychological distance to the water body, and the difference between urban and rural areas.

Shaping the healthy subject in gentrified spaces: Two case studies in Barcelona (Spain)

Several studies have analysed the impact of gentrification on health. However, a more in-depth examination of the constitutive role of health discourses in shaping spaces is required. This article explores the links between the gentrification process and the subjectification of healthy subjects through a critical discourse analysis of 35 walking interviews and a visual semiotic analysis of 140 shopfronts. Health is put forth as a super value to justify market interference in the configuration of urban space and class privilege based on the health products and healthy practices that have undergone a process of elitisation.

Therapeutic landscapes, networks, and health and wellbeing during the COVID-19 pandemic: A mixed-methods study among female domestic workers

The COVID-19 pandemic has had profound impacts on access to and use of therapeutic landscapes and networks, especially for people who are vulnerable due to economic, social, and work-related disadvantage. For one such vulnerable population, Indonesian female domestic workers (FDWs) in Hong Kong, this study employed a mixed methods approach to examine the associations between perceptions of therapeutic landscapes (TLs), therapeutic networks (TNs), subjective wellbeing, and self-rated health during the COVID-19 pandemic. Data from an online survey were analyzed via structural equation modeling (SEM) and confirmatory factor analysis (CFA) to investigate the direct and indirect associations between TLs, TNs, and health and wellbeing. The findings demonstrate little or no association among FDWs' perceptions of TLs and TNs and FDWs' self-rated health and subjective wellbeing, except for a negative total association between TL and subjective wellbeing. Using insights gleaned from thematic analysis of in-depth interviews with FDWs, we suggest that these unexpected findings are mainly due to restricted access to public places, reduced social gatherings, and the fact that employers rarely granted days off during the lockdown. Although processes at the employer and municipal scales limited FDWs' access to therapeutic places, increased use of digital communications and spaces provided an important source of social and emotional support during the pandemic.

Applying an ecosystem services framework on nature and mental health to recreational blue space visits across 18 countries

The effects of 'nature' on mental health and subjective well-being have yet to be consistently integrated into ecosystem service models and frameworks. To address this gap, we used data on subjective mental well-being from an 18-country survey to test a conceptual model integrating mental health with ecosystem services, initially proposed by Bratman et al. We analysed a range of individual and contextual factors in the context of 14,998 recreational visits to blue spaces, outdoor environments which prominently feature water. Consistent with the conceptual model, subjective mental well-being outcomes were dependent upon on a complex interplay of environmental type and quality, visit characteristics, and individual factors. These results have implications for public health and environmental management, as they may help identify the bluespace locations, environmental features, and key activities, that are most likely to impact well-being, but also potentially affect recreational demand on fragile aquatic ecosystems.

Creating equitable and sustainable opportunities for nature immersion to support restoration from stress within mental health nursing: A critical interpretive synthesis

In the face of global environmental changes threatening health, and despite increased calls for nurses to broker access to nature-based well-being interventions for people with mental health difficulties, there is a surprising absence of literature examining the nature-nursing relationship, inhibiting its inclusion within nursing curricula and practice. This critical interpretive synthesis supports the notion that nature immersion has the capacity to increase positive affect, reduce negative affect, provide restoration from everyday stress, promote meaning-making, enhance belonging, and foster an interest in caring for the natural world. Yet, critical examination of the literature reveals multiple social and environmental inequalities and unmasks latent anthropocentric, gendered, and colonialist thinking, which threatens the delivery of equitable and just sustainable practice. Recommendations are made for a transdisciplinary, systemic approach, which recognizes and responds to our shared humanity and vulnerability in pursuit of planetary health.

Urban Blue Spaces as Therapeutic Landscapes: "A Slice of Nature in the City"

Urban blue spaces are defined as all natural and manmade surface water in urban environments. This paper draws on how the concepts of experienced, symbolic, social, and activity space combine to position urban blue spaces as therapeutic landscapes. We conducted 203 intercept interviews between 12 October 2019 and 10 November 2019. Although safety concerns had health-limiting impacts, interacting with the Glasgow Canal and surrounding landscape was predominantly perceived as health-enhancing. Our findings build on current evidence, which has suggested that urban blue spaces, particularly canals, may foster therapeutic properties, contributing to healthier city environments. Further research is required to understand better the interconnectedness of urban blue spaces and health and how such spaces can be best developed and managed to improve the health outcomes of local populations.

Exploring the influence of residential courtyard space landscape elements on people's emotional health in an immersive virtual environment

A good residential courtyard space not only brings people a psychological feeling of emotional pleasure but also attracts people to actively engage in more physical activities, which is of great significance to improving people's physical and mental health. Green vegetation and fitness facilities as the most preferred landscape elements in residential courtyard spaces and their effects on people's emotional health have not been further investigated. In this research, a virtual experiment was constructed in a residential courtyard space in Chengdu City, China, and electrodermal sensors were used to measure the real-time emotional changes of people in different virtual scenarios to analyze the effects of two landscape elements, green vegetation and fitness facilities, on people's emotional health, and the differences of such effects among different genders and ages. The results confirm that the combination of virtual reality technology and wearable physiological sensor measurement technology could effectively identify health-promoting landscape elements in urban environments; In residential courtyard spaces, green vegetation is more emotionally healthy than fitness facilities, and fitness facilities have better emotional health benefits for men and people over 30 years of age. The results of the study provide a quantitative basis for the healthier design and transformation of residential courtyard spaces for both green vegetation and fitness facilities.

Linking the nonmaterial dimensions of human-nature relations and human well-being through cultural ecosystem services

Nature contributes substantially to human well-being through its diverse material and nonmaterial contributions. However, despite the growing literature on the nonmaterial dimensions of human-nature relations, we lack a systematic understanding of how they are linked with human well-being. Here, we use the concept of cultural ecosystem services (CESs) as a lens to explore this interface. Through a systematic review of the peer-reviewed literature, we elicit the unique pathways and mechanisms linking individual CESs and constituents of human well-being, as well as their relative effects. Subsequently, we identify their complex interactions through latent class analysis and multiple correspondence analysis, which delineate five major assemblages that reflect synergies and trade-offs at the interface of CESs and human well-being. We critically discuss key research trends and gaps and propose directions for future research and practice to leverage the potential of the nonmaterial contributions of nature for human well-being and sustainability more broadly.

A Qualitative Study on Emotions Experienced at the Coast and Their Influence on Well-Being

Coastal environments are increasingly shown to have a positive effect on our health and well-being. Various mechanisms have been suggested to explain this effect. However, so far little focus has been devoted to emotions that might be relevant in this context, especially for people who are directly or indirectly exposed to the coast on a daily basis. Our preregistered qualitative study explored how coastal residents experience the emotions they feel at the coast and how they interpret the effect these emotions have on them. We conducted semi-structured interviews with a purposive sample of eight Belgian coastal residents aged 21–25 years old. The interviews were analyzed with the approach of interpretative phenomenological analysis. Five superordinate themes were identified and indicate that, for our participants, the coast represents a safe haven (1) in which they can experience emotional restoration (2), awe (3), and nostalgia (4). These emotional states are accompanied with adaptive emotion regulating strategies (5), such as reflection and positive reappraisal, that may facilitate coping with difficult thoughts and feelings. Our study demonstrates the importance of investigating specific emotions and related processes triggered at the coast and how these could contribute to the therapeutic value of the coast.

Effects of Landscape Types and Complexity Along Path on Mental Restoration

AIM

This study checked the effects of landscape types and complexity along path in urban green spaces on perceived restorativeness, so as to provide guidance for path landscape design.

BACKGROUND

Paths in urban green spaces are not only the connections between places but also places for visitors reducing mental stress and seeking psychological well-being. However, there is a lack of evidence-based research on the effects of landscape composition along the path on restorative quality, failing to provide a cohesive guideline for practice.

METHODS

Fourteen videos representing the popular path landscapes in urban green spaces were produced using computer software by adding or/and deleting elements and controlling environmental components. The restorative quality of these videos was measured by Short-version Revised Restoration Scale (SRRS). Statistical analysis was employed to treat the data and checked the effects of different landscape types and complexity on restorative quality.

RESULTS

(1) A significant difference in restorative quality between 14 path landscapes was found, comparatively, the path containing lawn or(and) forest was much better than that containing bamboo and waterscape, and bamboo was a negative predictor of restorative quality; (2) waterscape generally reduced the restorative quality of vegetated path landscape, especially when the landscape possessed higher restorative quality; (3) path landscape complexity had a weak influence on restorative quality.

CONCLUSIONS

This study explains how path landscapes affect mental restoration of users, and these findings contribute to enhancing the restorative quality of urban green spaces and have applications for path landscape design.

'Therapeutic landscape' experiences - redefining their relationship with the everyday

Feelings of removal from, and connection to, everyday life, are central to much of the 'therapeutic landscapes' literature, and to understanding of what makes 'therapeutic landscapes' 'therapeutic'. This paper develops understanding of the relationship between the everyday and 'therapeutic landscape' experiences, by exploring the origins of feelings of removal and connection. Data collected through a phenomenological approach (fieldwork sites: Buddhist meditation retreats, and non-Buddhist walking groups and conservation volunteering groups), targeted at capturing highly detailed information, demonstrates that both feelings of removal from, and connection to, the everyday, are bound-up with the everyday itself, with who we are and where we come from, and moreover, that these feelings exist alongside one another.

Developing an Approach for Assessing Urban Blue-Green Spaces Towards Sustainable Urban Growth Through Retrospective Cyber Metrics Analysis of Operational Estimations Approaches

Urban blue-green spaces provide us abundant social, environmental, and economic benefits, but the disparities often exist in their distribution and accessibility. Traditionally urban blue-green spaces are a consolidation of “blue-green infrastructure” within urban areas. Several urban features like parks, forests, gardens, visible water, such as parks, rivers, canals, reservoirs, ponds, lakes, fountains, etc. are categorized or considered under the blue-green spaces and these are very much crucial for various urban ecosystem services. These play a significant role for all stakeholders of the urban community. Thus, everyone must ensure the equitable number of blue-green spaces for all. Recently, several rules and regulations towards the safeguarding of urban blue-green spaces have been outlined. The work presents a methodological framework to develop an approach towards sustainable urban growth with the help of urban blue-green spaces assessments. The current work has attempted to examine the linkage between issues of the urban blue-green spaces for restoring the required infrastructures. It can be utilised for all sustainable urban development for urban planning and design projects to play a pivotal role. The work emphasizes more to develop a methodological framework to analyze the urban blue-green spaces for augmentation with a theoretical framework. It is expected that the advancement of a problem cum objectives-driven approach will help to design an impact-driven approach for planned and concrete action.

Restorative benefits of urban green space: Physiological, psychological restoration and eye movement analysis

Urban life is associated with a range of health risks. However, urban green spaces have been found to promote health recovery and reduce mental stress. This study sought to assess the influence of the spatial and environmental characteristics of urban green space on environmental restoration. We measured physiological and psychological changes among 60 participants to evaluate the restorative benefits of 12 green spaces in Shenyang. The Perceived Restorativeness Scale and two physiological measures (heart rate variation and skin conductance response) were used to analyze the effects of spatial characteristics on restorative benefits. In addition, eye-tracking was used to explore the influence of environmental components on restorative benefits. The results revealed that, although there were slight differences between physiological and psychological findings, both confirmed that urban green space had a restorative benefit. Partially-open green spaces with a high degree of naturalness had more positive effects than open green spaces with a high degree of hard paved spaces. Eye movement analysis results revealed that trees and shrubs, as well as water, had a positive effect on the environmental restoration benefits, whereas buildings and paving had a negative effect. Among environmental features, trees and shrubs, water, and buildings exerted the strongest effects on environment restoration. In the future, combining spatial characteristics and environmental components will aid improvement of the restorative qualities of urban green space.

Transcendent Experiences Among Pilgrims to Lourdes: A Qualitative Investigation

Millions of pilgrims visit Lourdes each year, often seeking revitalisation rather than miraculous cures. We sought to understand the phenomenon of transcendent experiences. We spoke with 67 pilgrims including assisted pilgrims, young volunteers and medical staff. About two in five reported a transcendent experience: some felt they had communicated or had close contact with a divine presence, while others reported a powerful experience of something intangible and otherworldly. Transcendent experiences are an important feature of pilgrimage to Lourdes and the place offers the faithful a means of connecting with the divine, with nature and with the self.

Proximity to freshwater blue space and type 2 diabetes onset: the importance of historical and economic context

Salutogenic effects of living near aquatic areas (blue space) remain underexplored, particularly in non-coastal and non-urban areas. We evaluated associations of residential proximity to inland freshwater blue space with new onset type 2 diabetes (T2D) in central and northeast Pennsylvania, USA, using medical records to conduct a nested case-control study. T2D cases (n=15,888) were identified from diabetes diagnoses, medication orders, and laboratory test results and frequency-matched on age, sex, and encounter year to diabetes-free controls (n=79,435). We calculated distance from individual residences to the nearest lake, river, tributary, or large stream, and residence within the 100-year floodplain. Logistic regression models adjusted for community socioeconomic deprivation and other confounding variables and stratified by community type (townships [rural/suburban], boroughs [small towns], city census tracts). Compared to individuals living ≥1.25 miles from blue space, those within 0.25 miles had 8% and 17% higher odds of T2D onset in townships and boroughs, respectively. Among city residents, T2D odds were 38-39% higher for those living 0.25 to <0.75 miles from blue space. Residing within the floodplain was associated with 16% and 14% higher T2D odds in townships and boroughs. A post-hoc analysis demonstrated patterns of lower residential property values with nearer distance to the region's predominant waterbody, suggesting unmeasured confounding by socioeconomic disadvantage. This may explain our unexpected findings of higher T2D odds with closer proximity to blue space. Our findings highlight the importance of historic and economic context and interrelated factors such as flood risk and lack of waterfront development in blue space research.

Evaluating the literature of therapeutic landscapes with an emphasis on the search for the dimensions of health: A systematic review

Health geography emphasizes landscape capacity as a perspective for examining health dimensions. Much of this emphasis is on the concept of therapeutic landscapes. In the last two decades, changes in the therapeutic landscapes concerning health, as well as why and how the development of the emphasis on the dimensions of the health in the landscape in proportion to the temporal-spatial course of literature in this field can be considered. The framework of the present study is based on a systematic review of therapeutic landscapes in the geography of health in the last two decades. This systematic literature review followed the PRISMA guidelines. Searching for "Therapeutic Landscapes" term at Science Direct and PubMed, screening, 56 eligible articles were selected in the journal Social Science and Medicine, and Health and Place. The results of the systematic review, aiming to search for the health dimensions of the therapeutic landscape, and recognize main gaps, identified three main issues: scale and range of users of therapeutic landscapes, the position importance of experiences in therapeutic landscapes, therapeutic landscapes as the holistic paradigm. The results of the research show that in recent years, attention to multiple dimensions of health, especially non-physical relationships of therapeutic landscapes and multiple dimensions of health, has been considered more and more by researchers. Personal-social perceptions and experiences are also continually evolving, so the concept of therapeutic landscapes and its relationship to health is considered living and dynamic.

Health, Wellness, and Place Attachment During and Post Health Pandemics

Therapeutic landscapes encapsulate healing and recovery notions in natural and built environmental settings. Tourists’ perceptions determine their decision making of health and wellness tourism consumption. Researchers struggle with the conceptualization of the term ‘therapeutic landscapes’ across disciplines. Drawing on extant literature searched in nine databases, this scoping review identifies different dimensions of therapeutic landscapes. Out of identified 178 literature sources, 124 met the inclusion criteria of identified keywords. We review the contribution and the potential of environmental psychology in understanding tourist behavior to promote health and wellness tourism destinations in a post COVID-19 context. We develop and propose a conceptual framework comprising: (1) perceived goodness of therapeutic landscapes, (2) health and wellness consumption, (3) COVID-19 pandemic perceived health and wellness risk, (4) place attachment, and (5) re-visitation. We propose measurement scales and discuss implications and major issues in the immediate and post the COVID-19 pandemic to inform future research.

Therapeutic Qualities and Sustainable Approach to Heritage of the City. The Coastal Strip in Gdańsk, Poland

In this paper, the case of the Coastal Strip in Gdańsk is presented. Gdańsk has natural and cultural heritage of great value and is included on Tentative list of UNESCO World Heritage List as “Gdansk—Town of Memory and Freedom”. The Coastal Strip is a rare example of landscape with natural dunes located within walking distance from densely populated residential districts. Therefore, the economic pressure for urban development is extremely strong. At the same time, the rise of social awareness about potential consequences of urbanization brought numerous efforts by local activists and researchers to prevent further development of the Coastal Strip. This study consisted of assessment of therapeutic qualities of The Coastal Strip using a conceptual framework—a universal standard for health promoting places. The results demonstrated that The Coastal Strip is a health-promoting place, thus adding new research-based evidence against plans for urban development of that area.

Characteristics of urban streets in relation to perceived restorativeness

The research on the restorative capacity of various environments has been growing exponentially in recent years. However, previous researchers mainly focus on urban green spaces, natural environments or urban landscapes. The streetscapes which have a close tie with residents' daily life and may have an essential effect on people's psychological wellbeing have not attracted extensive attention from academic research, failing to provide a cohesive guideline for streetscape design. To address this gap, this paper conducted an experiment to explore the relationship between restorative quality and streetscape characteristics, in which 30 photographs representing the various streetscapes in Xuzhou in eastern China, were used as stimuli, and the restorative qualities of these photographs were measured through online surveys. The results indicated that: (1) the streetscape with higher rate of plants in the view and diverse species of plants implied a high restorative capacity; (2) less non-motor vehicles and clear traffic signs painted on the streets are the other promoters of the restorative capacity of streetscapes. These findings contribute new knowledge about the role of streetscape characteristics to enhance the restorative potential and have applications for designers and urban managers.

Environmental amenities of urban rivers and residential property values: A global meta-analysis

Environmental amenities and disamenities of urban rivers and their capitalization in property prices have been a major subject of empirical investigation in the hedonic price method (HPM) literature for several decades. Primary studies across the globe have nonetheless adopted varying valuation scenarios and modelling approaches. And systematic variation has been shown in homeowners' marginal willingness-to-pay (WTP) for urban rivers' amenities and disamenities, ranging between -12.2% and 63.58% price premium. To identify which valuation scenarios, socio-economic variables, and modelling characteristics might affect the quantification of urban rivers' impacts on property values, we conducted a very first meta-analysis of existing evidence to extract additional information concerning the heterogeneity in WTP estimates pertaining to urban rivers' environmental amenities and disamenities. A total of 53 observations from 30 primary studies that adopted HPM to provide WTP estimates for three prominent valuation scenarios, i.e., proximity, view and water quality, were synthesized using a random effects model. Our meta-analysis results revealed several important factors in explaining the heterogeneity in empirical WTP estimates pertaining to urban rivers' environmental amenities/disamenities. First, while all three valuation scenarios could capture urban rivers' impacts on residential property values, river view was associated with the greatest premium, followed by river water quality, and river proximity the least. Second, we found that WTP estimates were significantly higher after the year of 2000, indicating the widespread and successful river restoration and rehabilitation projects in the 21st century has driven up homeowners' environmental perception and appreciation of urban rivers' amenities, especially their clear depreciation of negative environmental disamenities, to a high level. Third, our results showed that homeowners' valuation of urban rivers was not sensitive to the macro-geographical locations of their residences, suggesting a universal overall appreciation/depreciation of urban rivers across varying cultures and societies. Instead, household income level and population density should be systematically controlled if value transfer across countries is necessary. The findings of this meta-analysis could help refine urban rivers' attributes to be incorporated into HPM studies so as to adequately quantify people's sophisticated valuation of intertwined amenities and disamenities. On the practical front, our results supported two arguments from a very utilitarian point of view. First, it appears that the visual impacts might be prioritized for river restoration projects, such as through careful revegetation of riparian areas using native species. This could harbor rich diversity of ecological functions and in the meantime maximize environmental amenities that homeowners would like to pay for. And second, cost-effective river restoration in urbanized contexts should be prioritized in densely populated areas over places with relatively low population densities. This approach might maximize the number of people who can enjoy rivers for a given budget.

Experiences of the Urban Green Local Environment as a Factor for Well-Being among Adults: An Exploratory Qualitative Study in Southern Sweden

The amount and quality of greenness in the local outdoor environment has repeatedly been linked to human well-being. Different types of green areas are likely required in order to meet the various needs of people throughout the course of their lives and with regard to individual social and economic living conditions. The aim of the present study was to increase the understanding of different pathways between green environments, well-being and health. We conducted 16 interviews to explore perceptions and experiences among adults residing in a semi-urban to urban area and derived categories and subcategories from the data using content analysis. We identified six categories; promoting activities, supporting social contacts, stimulating sensory impressions, providing a retreat, offering ways to influence and creating a sense of coherence, and we recognized that the availability to, and contrasts between and maintenance of the environment were experienced as prerequisites for health-promoting properties of the green local environment. The results illustrate a rich variety in potential pathways through which the green local environment may promote well-being. The study highlights the need to plan the local environment from multiple perspectives, as well as carefully considering prerequisites of various kinds in order for the green environment to support health across the life-course.

Identifying indicators of aesthetics in the Great Barrier Reef for the purposes of management

The aesthetic appreciation of natural places is one of the most fundamental ways in which people relate to their environment. It provides wellbeing, an opportunity for recreation and reflection, a sense of place, and cultural enrichment. It also motivates people to take care of natural places and to conserve them for current and future appreciation. Aesthetically valuable places also support significant economic activity. However, there is little guidance available to assist environmental managers and policy-makers to consider and integrate aesthetic values into decision-making processes. In this study, we present an approach for developing robust and practical indicators of aesthetic value to enable environmental managers to consider, assess and report on aesthetic condition and trend. We demonstrate its utility using the case of the Great Barrier Reef, a region currently undergoing significant social, economic and environmental change and an area formally protected, in part, for its aesthetic values. A qualitative scoping study with 30 key informants identified over 180 potential qualities contributing to reef aesthetics. We tested five for their utility in capturing key aspects of the coral reef aesthetic: (i) coral cover, (ii) coral pattern, (iii) coral topography, (iv) fish abundance, and (v) visibility. We asked 1,417 online Australians to aesthetically rate 50 out of 181 underwater coral reef images that varied in relation to these five attributes. Coral topography, fish abundance, and visibility were significantly correlated with aesthetic ratings, whilst coral cover and coral pattern were not. We also tested for demographic patterns in aesthetic ratings. Our pilot study has demonstrated that readily measurable characteristics of coral reefs can provide useful indicators of aesthetic quality, opening up opportunities for coral reef managers and policymakers to assess and track changes in aesthetics in ways that are relevant to the public. There is considerable scope to further advance capacity for monitoring and managing aesthetic values of coral reefs through additional research that resolves nuances in the meanings associated with aesthetics in coral reef settings.

Wetland areas' direct contributions to residents' well-being entitle them to high cultural ecosystem values

Wetlands in urban areas will be crucial to counteract the effects of climate change, for example, by improving flood protection and regulating local climate. To gain acceptance for larger-scale creation of wetlands, total values must be identified and revealed. Provisioning and regulating ecosystem services can be described as the quantitative effect, but cultural ecosystem services require other assessments. This study sought to determine whether peri-urban and urban wetland areas contribute to the well-being and quality of life of nearby residents, and to capture their value relative to two other types of green areas (i.e., parks and urban forests). A postal questionnaire survey, based on validated environmental psychology instruments, was distributed to residents in three municipalities with wetland areas of different structures and locations. In these municipalities, respondents (n = 474; response rate = 40%) reported that the wetland area contributed to several quality-of-life aspects, such as encountering nature and experiencing beauty. The areas also facilitated activities that support well-being, were perceived to have high restorative qualities, and evoked positive affective responses. All wetland areas were rated high on most of the measured concepts, but their value relative to other green areas differed possibly depending on the accessibility of the wetland and the availability of other green areas. The location and extent to which the wetland area was integrated in the residential area determined what quality-of-life aspects were most satisfied. Wetland areas can be ascribed cultural ecosystem service values based on how residents perceive their contribution to their quality of life. These values can be added to those of provisioning and regulating ecosystem services, forming the basis for planning urban environments.

[A protocol for evaluating the probability of the recreational use of rivers and its application in risk analysis]

Contaminated waters constitute health risks not only due to direct consumption, but also in recreational use. Risk analysis strategies aim to reduce the instances of contaminations and must include the population's perceptions and willingness to assume risks. A rapid and simple method was developed to evaluate the probability of use of recreational waters. Interviews were conducted in municipalities with different ecological conditions, in order to define the factors used by people to decide to use, or otherwise, river waters. After analyzing the results, the "Índice de Probabilidade de Uso Recreativo de Águas (I-PURA)" was elaborated and tested. The index was then employed at 26 river locations representing five of the nine hydrographic regions of Rio de Janeiro state. The frequency of use, water contamination and a Habitat Assessment Visual Index (IAH) was also measured. The I-PURA was correlated with the frequency of use. Furthermore, the I-PURA was not correlated with IAH, showing that user perceptions are different from purely ecological aspects. This tool offers useful information for risk assessment and environmental management. Sites with a high probability of use, or observed use, that are highly contaminated should be prioritized for interventions.

Cities and Mental Health

BACKGROUND

More than half of the global population currently lives in cities, with an increasing trend for further urbanization. Living in cities is associated with increased population density, traffic noise and pollution, but also with better access to health care and other commodities.

METHODS

This review is based on a selective literature search, providing an overview of the risk factors for mental illness in urban centers.

RESULTS

Studies have shown that the risk for serious mental illness is generally higher in cities compared to rural areas. Epidemiological studies have associated growing up and living in cities with a considerably higher risk for schizophrenia. However, correlation is not causation and living in poverty can both contribute to and result from impairments associated with poor mental health. Social isolation and discrimination as well as poverty in the neighborhood contribute to the mental health burden while little is known about specific interactions between such factors and the built environment.

CONCLUSION

Further insights on the interaction between spatial heterogeneity of neighborhood resources and socio-ecological factors is warranted and requires interdisciplinary research.

Monetary Valuation of Urban Forest Attributes in Highly Developed Urban Environments: An Experimental Study Using a Conjoint Choice Model

It is important to integrate user preferences and demands into the design, planning, and management of urban forests. This is particularly important in highly urbanized areas where land is extremely limited. Based on a survey with 600 participants selected by quota sampling in Seoul, Korea, we developed a conjoint choice model for determining the preferences of urban dwellers on urban forest attributes, the levels of attributes, and the preferences for particular attributes. Then, the preferences were transformed into monetary values. The results indicated that urban dwellers preferred broadleaved forests over coniferous forests, soil-type pavement materials over porous elastic pavement materials on trails, and relatively flat trails over trails with steep slopes. The model indicated that participants were willing to pay an additional 11.42 USD to change coniferous forest to broadleaved forest, 15.09 USD to alter porous elastic pavement materials on trails to soil-type pavement materials on trails, and 23.8 USD to modify steeply sloping trails to relatively flat trails. As previously reported, considerable distance decay effects have been observed in the user preferences for urban forests. We also found a significant difference in the amount of the mean marginal willingness to pay among sociodemographic subgroups. In particular, there were significant positive responses from the male group to changes in urban forest attributes and their levels in terms of their willingness to pay additional funds. By contrast, the elderly group had the opposite response. In this study, we were not able to integrate locality and spatial variation in user preferences for urban forests derived from locational characteristics. In future studies, the role of limiting factors in user preferences for urban forests and their attributes should be considered.

Associations between Living Near Water and Risk of Mortality among Urban Canadians

BACKGROUND

Increasing evidence suggests that residential exposures to natural environments, such as green spaces, are associated with many health benefits. Only a single study has examined the potential link between living near water and mortality.

OBJECTIVE

We sought to examine whether residential proximity to large, natural water features (e.g., lakes, rivers, coasts, "blue space") was associated with cause-specific mortality.

METHODS

Our study is based on a population-based cohort of nonimmigrant adults living in the 30 largest Canadian cities [i.e., the 2001 Canadian Census Health and Environment Cohort) (CanCHEC)]. Subjects were drawn from the mandatory 2001 Statistics Canada long-form census, who were linked to the Canadian mortality database and to annual income-tax filings, through 2011. We estimated associations between living within of blue space and deaths from several common causes of death. We adjusted models for many personal and contextual covariates, as well as for exposures to residential greenness and ambient air pollution.

RESULTS

Our cohort included approximately 1.3 million subjects at baseline, 106,180 of whom died from nonaccidental causes during follow-up. We found significant, reduced risks of mortality in the range of 12-17% associated with living within of water in comparison with living farther away, among all causes of death examined, except with external/accidental causes. Protective effects were found to be higher among women and all older adults than among other subjects, and protective effects were found to be highest against deaths from stroke and respiratory-related causes.

CONCLUSIONS

Our findings suggest that living near blue spaces in urban areas has important benefits to health, but further work is needed to better understand the drivers of this association. https://doi.org/10.1289/EHP3397.

[What potential do geographic information systems have for population-wide health monitoring in Germany? : Perspectives and challenges for the health monitoring of the Robert Koch Institute]

Geographic information systems (GISs) are computer-based systems with which geographical data can be recorded, stored, managed, analyzed, visualized and provided. In recent years, they have become an integral part of public health research. They offer a broad range of analysis tools, which enable innovative solutions for health-related research questions. An analysis of nationwide studies that applied geographic information systems underlines the potential this instrument bears for health monitoring in Germany. Geographic information systems provide up-to-date mapping and visualization options to be used for national health monitoring at the Robert Koch Institute (RKI). Furthermore, objective information on the residential environment as an influencing factor on population health and on health behavior can be gathered and linked to RKI survey data at different geographic scales. Besides using physical information, such as climate, vegetation or land use, as well as information on the built environment, the instrument can link socioeconomic and sociodemographic data as well as information on health care and environmental stress to the survey data and integrate them into concepts for analyses. Therefore, geographic information systems expand the potential of the RKI to present nationwide, representative and meaningful health-monitoring results. In doing so, data protection regulations must always be followed. To conclude, the development of a national spatial data infrastructure and the identification of important data sources can prospectively improve access to high quality data sets that are relevant for the health monitoring.

Natural environments and subjective wellbeing: Different types of exposure are associated with different aspects of wellbeing

Despite growing interest in the relationships between natural environments and subjective wellbeing (SWB), previous studies have various methodological and theoretical limitations. Focusing on urban/peri-urban residents (n=7272) from a nationally representative survey of the English population, we explored the relationships between three types of exposure: i) 'neighbourhood exposure', ii) 'visit frequency', and iii) 'specific visit'; and four components of SWB: i) evaluative, ii) eudaimonic, iii) positive experiential and iv) negative experiential. Controlling for area and individual level socio-demographics and other aspects of SWB, visit frequency was associated with eudaimonic wellbeing and a specific visit with positive experiential wellbeing. People who visited nature regularly felt their lives were more worthwhile, and those who visited nature yesterday were happier. The magnitude of the association between weekly nature visits and eudaimonic wellbeing was similar to that between eudaimonic wellbeing and life circumstances such as marital status. Findings are relevant for policies to protect and promote public access to natural environments.

Developing the urban blue: Comparative health responses to blue and green urban open spaces in Germany

Recently, new perspectives upon healthy urban open spaces propose that open spaces can be regarded as urban green or blue spaces. However, there has so far been very little research into blue environments and their benefits for mental well-being. Our article focuses on the effects of water in cities, "urban blue" (as compared to "urban green"), on human health and well-being. To assess the mental well-being of visitors, we conducted qualitative semi-standardised interviews (n=113), asking which differences in well-being occur when visiting urban green and blue spaces in high-density areas of the inner city in Dusseldorf and Cologne, Germany. Although we found many similarities, some health-enhancing effects for users turned out to be prominent for urban blue in the four conceptual therapeutic landscape dimensions: experienced, symbolic, social and activity space. These effects include enhanced contemplation, emotional bonding, participation, and physical activity. The results suggest that urban blue as a health-promoting factor needs more detailed and accurate determination and examination of its general and local health-enhancing effects.

Adding Natural Areas to Social Indicators of Intra-Urban Health Inequalities among Children: A Case Study from Berlin, Germany

Research suggests that there is a relationship between the health of urban populations and the availability of green and water spaces in their daily environment. In this paper, we analyze the potential intra-urban relationships between children's health determinants and outcomes and natural areas in Berlin, Germany. In particular, health indicators such as deficits in viso-motoric development in children are related to environmental indicators such as the natural area cover, natural area per capita and distance to natural areas; however, these indicators are also correlated with social determinants of health. The methodological approach used in this study included bivariate and multivariate analyses to explore the relations between health inequalities and social, socio-economic, and land use parameters. The results on a sub-district level indicated that there was a correlation between natural areas and social health determinants, both of which displayed a certain intra-urban spatial pattern. In particular, a lower percentage of natural area cover was correlated with deficits in viso-motoric development. However, results with percentage of natural area cover and per capita natural area with childhood overweight were not conclusive. No significant correlation was found for percentage of natural area cover and overweight, while significant negative correlation values were found between overweight and per capita natural area. This was identified particularly in the districts that had lower social conditions. On the other hand, the districts with the highest social conditions had the comparatively lowest levels of complete measles immunization. This study may facilitate public health work by identifying the urban areas in which the strengthening of health resources and actions should be prioritized and also calls for the inclusion of natural areas among the social health indicators included in intra-urban health inequality tools.

Seeking everyday wellbeing: The coast as a therapeutic landscape

Recent research suggests coastal environments may promote human health and wellbeing. This article explores the diverse coastal experiences sought out by residents of two towns in south west England to promote and preserve their personal wellbeing in the context of their everyday lives. It draws on the findings of an in-depth interpretive study conducted from May to November 2013 that examined the relative contribution of varied green and blue space experiences to individual wellbeing through the life course. Personalised activity maps produced using accelerometer and Global Positioning System (GPS) data were used to guide in-depth geo-narrative interviews with a purposive sample of 33 participants. This was combined with a subset of nine case study go-along interviews in places deemed therapeutic by the participants themselves, offering deeper insight into the lived experiences and relationships playing out within such places. Situated in a novel adaptation of the therapeutic landscapes framework, this article explores how symbolic, achievement-oriented, immersive and social experiences contributed to participants' sense of wellbeing in their local coastal areas. Participants expressed particularly strong and often enduring connections to the local coastline, with different coastal stretches perceived to cater for varied therapeutic needs and interests, at multiple scales and intensities. The findings suggest the need for greater acknowledgement of people's emotional, deeply embodied and often shared connections to the coast within coastal management policy and practice, both nationally and internationally. Importantly, such efforts should recognise the fluid, dynamic nature of this land-sea boundary, and the valued therapeutic experiences linked to this fluidity.

Blue space geographies: Enabling health in place

Drawing from research on therapeutic landscapes and relationships between environment, health and wellbeing, we propose the idea of 'healthy blue space' as an important new development Complementing research on healthy green space, blue space is defined as; 'health-enabling places and spaces, where water is at the centre of a range of environments with identifiable potential for the promotion of human wellbeing'. Using theoretical ideas from emotional and relational geographies and critical understandings of salutogenesis, the value of blue space to health and wellbeing is recognised and evaluated. Six individual papers from five different countries consider how health can be enabled in mixed blue space settings. Four sub-themes; embodiment, inter-subjectivity, activity and meaning, document multiple experiences within a range of healthy blue spaces. Finally, we suggest a considerable research agenda - theoretical, methodological and applied - for future work within different forms of blue space. All are suggested as having public health policy relevance in social and public space.

Energy expenditure on recreational visits to different natural environments

Physical inactivity poses a significant challenge to physical and mental health. Environmental approaches to tackle physical inactivity have identified natural environments as potentially important public health resources. Despite this, little is known about characteristics of the activity involved when individuals visit different types of natural environment. Using Natural England's Monitor of Engagement with the Natural Environment Survey, we examined 71,603 English respondents' recreational visits to natural environments in the past week. Specifically, we examined the intensity of the activities they undertook on the visits (METs), the duration of their visit, and the associated total energy expenditure (MET minutes). Visits to countryside and urban greenspace environments were associated with more intense activities than visits to coastal environments. However, visits to coastal environments were associated with the most energy expenditure overall due to their relatively long duration. Results differed by the urbanity or rurality of the respondent's residence and also how far respondents travelled to their destination. Knowledge of what types of natural environment afford the highest volumes and intensities of physical activity could inform landscape architecture and exercise prescriptions. Isolating activity-supporting characteristics of natural environments that can be translated into urban design is important in providing physical activity opportunities for those less able to access expansive environments.

Stable and destabilised states of subjective well-being: dance and movement as catalysts of transition

The pursuit of subjective well-being has become an important object of policy and personal action, which within geography has been engaged largely by those with an interest in health. But to date, geography has given little attention to the ways in which subjective well-being changes and in particular, the ways in which it may be understood as both stable and amenable to change. Similarly, the field of arts and health asserts the value of participation in the creative arts for enhancing subjective well-being, but has also hardly addressed how this may come about. The paper explores stability and change in well-being through a case study of a dance and movement intervention in an English primary school. We draw on Deleuze and Guattari's notions of assemblages and of striated and smooth space to explore how participation in the arts may enable escape from habituated practices. This exploration expands the scope of geographies of health towards capturing the moments and processes through which transitions in subjective well-being may occur. The study indicates the need for greater attention to gentler and gendered forms of transition.