Toward improved public health outcomes from urban nature

Exploring the equitable inclusion of diverse voices in urban green design, planning and policy development: a scoping review protocol

INTRODUCTION

Despite the increasingly evidenced positive impacts of green space on human physical and mental health, green spaces remain inequitably distributed across different socioeconomic groups. Urban planning and design should prioritise the development and maintenance of urban green spaces, especially for vulnerable and marginalised populations while thinking about protecting them from the effects of green gentrification. This scoping review will explore how the concepts of equity, diversity and inclusion are integrated into the design, the planning and policy development of urban green spaces. Also, we will explore what are the efforts made to incorporate equity, diversity, and inclusion concepts into the planning, design and policy development of urban green spaces to make them equitable for vulnerable and marginalised populations.

METHODS AND ANALYSIS

This protocol is based on the methodology developed by Arksey and O'Malley and improved by Levac et al. The search will be done in conjunction with a professional librarian, to include studies in all languages. The review will include multidisciplinary databases: Ovid MEDLINE, Ovid EMBASE, CINAHL, Web of Science and GeoBase. The search will be done from each database's inception to February 2024. We will present our results narratively and will conduct a thematic analysis using the urban green equity framework. This framework will guide our understanding of the interplay between the spatial distribution of urban green spaces and the recognition of diverse voices in urban greening decision-making.

ETHICS AND DISSEMINATION

This scoping review will not require ethical approval since it will be collected from publicly available documents. The results of this scoping review will be presented as a scientific article, social media and public health or environmental conferences organised by environmental organisations or academic institutions.

The Dynamic Relationship between Social Cohesion and Urban Green Space in Diverse Communities: Opportunities and Challenges to Public Health

Social cohesion is a key factor within social determinants of health and well-being. Urban green spaces can provide environments that potentially facilitate meaningful and positive social interactions that promote social cohesion, equity, human health, and well-being. However, the lack of integration of existing research on social cohesion, urban green spaces, and public health in diverse (e.g., racially and ethnically) communities limits culturally relevant strategies to address health disparities. In this manuscript, we synthesize research on the potential of urban green spaces to promote social cohesion and public health in historically excluded communities. Particularly, we explore the development of social cohesion as it relates to the social environment, built environment, leisure opportunities, green space maintenance, safety, and green gentrification. We highlight key factors and their application to meet opportunities and challenges to social and public health. A conceptual framework is presented to provide an overview and illustrate connections found in the literature.

Having a tree in front of one's home is associated with GREATER subjective wellbeing in adult residents in Melbourne, Australia, and Toronto, Canada

While urban trees can be important determinants of human health and wellbeing in world cities, the specific influence of nearby urban trees upon human wellbeing has not been adequately explored. While many studies have associated urban greenery abundance with wellbeing scores, many measures of urban greenery do not specify the type of vegetation or the impact of co-location. Here we fill this gap by associating self-reported measures of the presence of nearby trees (tree in front of one's home) with validated subjective wellbeing (SWB) scores. We also tested for the mediating role of what people thought about trees and nature, with a focus on the values people associate with urban trees and nature relatedness (NR). We used electronic panel survey data based on a demographic and geographical representative sample of more than 3400 residents living in Toronto, Canada, and Melbourne, Australia. We analysed these data using regression-based mediation and path analyses. We found that having a tree in front of one's home was strongly and positively associated with SWB scores in both cities with similar results (Melbourne, β = 0.17, p < 0.05; Toronto, β = 0.18, p < 0.05), while accounting for NR, values associated with urban trees, and demographics (e.g., age, education, home ownership). The mediating role of NR and values was small. The specific pathways of association between tree in front of one's home, SWB, NR, and values, varied by city, when accounting for demographics. We discuss how increasing the abundance of nearby urban trees in cities may also increase human wellbeing.

Residential greenness for mitigating impacts of extreme heat events on depression and supporting mental health

Background

Residential green spaces (RGS) are a crucial aspect of urban life, which provide residents with a positive living environment both for mental and physical well-being. However, extreme heat events caused by global warming and local urban heat island effects are threatening the public health of rapidly growing populations. This is especially true for mental health. Depression is a mental illness that can be impacted by extreme heat events, i.e., heatwaves.

Objective

This study aimed to investigate the potential for residential green spaces (RGS) to alleviate depression by reducing heat stress sensitivity during extreme heat events.

Methods

We conducted a literature review using scientometric analysis with CiteSpace to summarize existing research on the relationships between RGS, depression, and heatwaves. We proposed a conceptual framework for the relationship between RGS and depression, and that extreme heat events may be an important contributor to depression.

Results

Our review found that RGS can provide ecosystem services that lower ambient temperatures through evaporative cooling, radiation reflection, humidity regulation, and shading. Different types of RGS, i.e., small green spaces, green roofs, green walls, and street trees, have varying cooling capacities. The mechanisms by which RGS alleviate depression during heatwaves involve green space composition, exposure, physical activity, social contacts, and cohesion. And we proposed a conceptual framework for the relationship between RGS and depression, and that extreme heat events may be an important contributor to depression.

Conclusion

We present a multidimensional RGS evaluation roadmap to inform green space design for reducing depression during heatwaves. Establishing RGS multidimensional evaluation can guide future research on leveraging RGS to build resilience against extreme heat and improve public mental health.

Nature-based solutions: Establishing a comprehensive framework for addressing urban waterlogging management

Due to the impact of global climate change, many cities in China have been hit by severe rainstorms, leading to increasingly frequent urban waterlogging disasters. In recent years, nature-based solutions (NbS) have received widespread attention and recognition, providing new ideas and approaches to addressing urban waterlogging issues. First, this article reviews the development process and concept of NbS and analyzes its core ideas and principles. Second, it analyzes the guiding role of NbS in urban waterlogging management and compares the commonalities and differences between NbS and three related waterlogging concepts. To ensure that urban waterlogging management is operational and dynamic, and that there is effective communication among stakeholders, this article proposes a comprehensive framework for the application of NbS in urban waterlogging management. Finally, this article analyzes the opportunities and potential of NbS applied to urban environmental issues. Integr Environ Assess Manag 2023;19:1414-1421. © 2023 SETAC.

Group Nature-Based Mindfulness Interventions: Nature-Based Mindfulness Training for College Students with Anxiety

The mental health crisis across college campuses is accelerating, with anxiety listed as the top mental health issue for undergraduate college students. Although evidence suggests the COVID-19 pandemic escalated the mental health crisis on college campuses, pre-COVID-19 anxiety among college students was on the rise. Research supports Mindfulness Based Interventions (MBIs) to reduce anxiety among college students. Additionally, exposure to natural environments, which are accessible to students on college campuses, is effective in reducing anxiety. While brief nature-based mindfulness interventions appear effective in reducing anxiety among college students, these interventions are often offered in isolation without social interaction among group members and lack intentional integration of mindfulness and nature-related theories. The purpose of this work is to describe a framework for integrating the use of Mindfulness and Attention Restoration Theory (ART) in an innovative psychoeducational group intervention, Nature-Based Mindfulness Training © (NBMT), for college students with anxiety. In conclusion, we argue for the need to intentionally integrate mindfulness and nature into nature-based mindfulness interventions as an effective and sustainable means to reduce anxiety. Limitations and areas for future research are described.

Green Spaces with Fewer People Improve Self-Reported Affective Experience and Mood

Calm and quiet green spaces provide health benefits for urban residents. Yet as cities become more densely populated, increasing public users to green spaces may reduce or moderate these benefits. We examine how increased pedestrian density in a green street changes self-reported wellbeing. We use a between subject experimental design that added public users as confederates in randomly selected periods over three weeks. We collect data on mood and affective response from pedestrians moving through the green street (n = 504), with and without our public user treatment in randomly selected periods. Mood and affective response are improved when experiencing the green street with fewer people. We find that an increased number of public users in the green space has a negative effect on mood, especially among women. We provide experimental evidence that self-reported wellbeing in urban green spaces depends on social context, and that there are gender inequities associated with changes in affective response. Although we only measure immediate impacts, our results imply that the health benefits of green spaces may be limited by the total number of users. This research contributes additional evidence that greener cities are also healthier cities, but that the benefits may not be equally shared between women and men and will depend on the social context of use.

Residential green environments are associated with human milk oligosaccharide diversity and composition

Increased exposure to greener environments has been suggested to lead to health benefits in children, but the associated mechanisms in early life, particularly via biological mediators such as altered maternal milk composition, remain largely unexplored. We investigated the associations between properties of the mother's residential green environment, measured as (1) greenness (Normalized Difference Vegetation index, NDVI), (2) Vegetation Cover Diversity (VCDI) and (3) Naturalness Index (NI), and human milk oligosaccharides (HMOs), known for their immune- and microbiota-related health effects on the infant (N = 795 mothers). We show that HMO diversity increases and concentrations of several individual HMOs and HMO groups change with increased VCDI and NI in residential green environments. This suggests that variation in residential green environments may influence the infant via maternal milk through modified HMO composition. The results emphasize the mediating role of breastfeeding between the residential green environments and health in early life.

Connecting the health of country with the health of people: Application of "caring for country" in improving the social and emotional well-being of Indigenous people in Australia and New Zealand

Emerging evidence from the western literature suggests an increasing focus on applying nature-based interventions for mental health improvements. However, in Indigenous communities, caring for country has always been central to the Indigenous way of life. Knowing that nature-based interventions effectively improve mental health outcomes, this review collated evidence on the application of caring for country in improving social and emotional well-being (SEWB) of Indigenous peoples in Australia and New Zealand. Three studies from Australia and one from New Zealand, explored the role of country or whenua (land) in the lives of Indigenous people. Participation in caring-for country activities was associated with lower levels of psychological distress and strengthened guardianship relationship with country, which positively affected SEWB. This systematic review offers preliminary evidence on the role of caring for country activities in improving the SEWB of Indigenous peoples and highlights the need for strengths-based approaches to improve the SEWB of Indigenous peoples.

Funding

None.

Mapping the gaps between cooling benefits of urban greenspace and population heat vulnerability

We provide a novel method to assess the heat mitigation impacts of greenspace though studying the mechanisms of ecosystems responsible for benefits and connecting them to heat exposure metrics. We demonstrate how the ecosystem services framework can be integrated into current practices of environmental health research using supply/demand state-of-the-art methods of ecological modeling of urban greenspace. We compared the supply of cooling ecosystem services in Boston measured through an indicator of high resolution evapotranspiration modeling, with the demand for benefits from cooling measured as a heat exposure risk score based on exposure, hazard and population characteristics. The resulting evapotranspiration indicator follows a pattern similar to conventional greenspace indicators based on vegetation abundance, except in warmer areas such as those with higher levels of impervious surface. We identified demand-supply mismatch areas across the city of Boston, some coinciding with affordable housing complexes and long term care facilities. This novel ES-framework provides cross-disciplinary methods to prioritize urban areas where greenspace interventions can have the most impact based on heat-related demand.

From urban greenspace to health behaviors: An ecosystem services-mediated perspective

Urban greenspace can provide important health benefits for urban residents, but knowledge about the potential mechanisms remains unclear, and it is challenging in promoting health behaviors through design and management practices. This study proposed a hypothetical model that assumed ecosystem services as mediating factors between urban greenspace and health behaviors. An urban park in Beijing was selected as a case area to test the hypothesis and identify the ecosystem services-mediated pathways. Results based on spatial explicit mapping and multivariate statistical analysis confirmed the hypothesis and showed that urban greenspaces contribute to health behaviors in varying degrees through the delivery of health behaviors-related ecosystem services. The promotion effect was mainly mediated by cultural services, which is much more obvious than regulating services. We identified the importance of different properties of inner urban greenspace in promoting health behaviors through ecosystem services-mediated pathways. Green elements, especially tree canopy shaded ground, were found to contribute the most to health behaviors in the pathways, and slightly higher than facilities and grey elements. To promote health benefits, the design and arrangement of facilities and grey elements in urban greenspace is suggested to be cooperated with green elements for enhancing multiple ecosystem services. The findings will enhance the understanding of potential theoretical pathways from urban greenspace to health benefits, and support health promotion-oriented design and management practices.

The Effect of Physical Activity Interventions Carried Out in Outdoor Natural Blue and Green Spaces on Health Outcomes: A Systematic Review

In the last few years, interest about the natural environment and its influences on health conditions has been growing. In particular, physical activity interventions carried out in blue and green environment are being investigated as a potential strategy to increase health outcomes in people with and without chronic conditions. Many recent studies reported positive results, but a high number of these studies were focused on people with mental or physical disorders. In this scenario, the present systematic review, conducted according to the PRISMA statement, was aimed at investigating the existing evidence regarding the effects of physical activity interventions carried out in green-blue space settings involving healthy people. A literature search was performed through PubMed, Cochrane, Cinahl, and Psychinfo, and the quality of each study was assessed. Out of 239 identified articles, 75 full texts were screened. Six eligible studies showed an improvement in health outcomes, such as well-being, mood, and physical performance, in the experimental group compared with the control group. No exhaustive conclusion can be drawn based on available evidence. However, this systematic review highlighted the need to extend this kind of intervention to reveal more robust evidence that green and blue exercises benefit health.

Physical Activity Behavior, Motivation and Active Commuting: Relationships with the Use of Green Spaces in Italy

Many benefits of physical activity (PA) are observed with weekly average volumes of 150–300 min at moderate intensity. Public parks may be an attraction for many people living in the city and could help to achieve the recommended dose of PA. The present study aims to understand the motivation that drives people to a park and evaluate the amount of PA practiced by park-goers. A questionnaire was anonymously administered to 383 voluntary visitors to the Arcoveggio park (Bologna), aged 18–70 years. Sixty-one percent of participants practiced outdoor PA. Differences in park use between sexes and age groups were found. PA was higher in men than in women and in the 18–30 age group than in other age groups. Most participants travelled to the park in an active way (86.4%), resulting in easier attainment of the recommended amount of PA (64.5%). The main motivations for using the park were related to relaxation, performing PA, or both. According to a multiple regression model, the time per week spent at the park, the method of getting there, and the kind of PA were significant explanatory variables of the amount of PA practiced. In particular, the highest number of minutes of PA was achieved by those who travelled to the park by running, while those using vehicles presented the lowest number. All initiatives to promote active commuting and activities in the urban park represent an important strategy to improve health, supporting adults to lead an active lifestyle.

Residential green space and air pollution are associated with brain activation in a social-stress paradigm

We examined the influence of three major environmental variables at the place of residence as potential moderating variables for neurofunctional activation during a social-stress paradigm. Data from functional magnetic resonance imaging of 42 male participants were linked to publicly accessible governmental databases providing information on amount of green space, air pollution, and noise pollution. We hypothesized that stress-related brain activation in regions important for emotion regulation were associated positively with green space and associated negatively with air pollution and noise pollution. A higher percentage of green space was associated with stronger parietal and insular activation during stress compared with that in the control condition. More air pollution was associated with weaker activation in the same (but also extended) brain regions. These findings may serve as an important reference for future studies in the emerging field of “neuro-urbanism” and emphasize the importance of environmental factors in urban planning.

Why Urban Ecology Matters in Ethiopia

Three concurrent global environmental trends are particularly apparent: human population growth, urbanization, and climate change. Especially in countries such as Ethiopia in the Global South, all three are impacted by, and in turn have bearing upon, social justice and equity. Combined, these spatial and social factors reduce wellbeing, leading to increasing urgency to create urban environments that are more livable, resilient, and adaptive. However, the impacts on, and of, non-human urban residents, particularly on the ecosystem services they provide, are often neglected. We review the literature using the One Health theoretical framework and focusing on Ethiopia as a case-study. We argue for specific urban strategies that benefit humans and also have spillover effects that benefit other species, and vice versa. For example, urban trees provide shade, clean the air, help combat climate change, create more livable neighborhoods, and offer habitat for many species. Similarly, urban neighborhoods that attract wildlife have characteristics that also make them more desirable for humans, resulting in improved health outcomes, higher livability, and enhanced real-estate values. After summarizing the present state of knowledge about urban ecology, we emphasize components relevant to the developing world in general and pre- COVID-19 pandemic Ethiopia in particular, then expand the discussion to include social justice and equity concerns in the built environment. Prior to the ongoing civil war, Ethiopia was beginning to invest in more sustainable urbanization and serve as a model. Especially in light of the conflict and pandemic, much more will need to be done.

(Re) thinking urban mental health from the periphery of São Paulo in times of the COVID-19 pandemic

Urban mental health studies traditionally search for causal relationships between elements of the city and the prevalence of mental disorders. This paper discusses the importance of (re)thinking the 'lived urban experience' from the perspective of city residents about how the immediate environment affects their mental health and how people cope with inequalities. A participatory-action research was implemented in a peripheral area of São Paulo - Brazil, in which volunteers from the territory made phone calls to neighbours to provide emotional support during the COVID-19 pandemic. Weekly supervision meetings were held between volunteers and researchers to discuss the experiences shared by community counterparts. Narratives have shown that the lived experience in the city is mediated by multiple layers of 'urban insecurities'. These difficulties pressured people to organise and resist in face of pervasive inequalities as well as to respond to unfolding experiences of social suffering. We highlight the potential of participatory methodologies to observe the ways in which subjects face their structural issues and the suffering that emerge in these circumstances. The understanding of how these conflicts are lived at a subjective level can support studies that are wondering about the mechanisms of how social conflicts 'get under the skin'.

Habitat Segregation Patterns of Container Breeding Mosquitos: The Role of Urban Heat Islands, Vegetation Cover, and Income Disparity in Cemeteries of New Orleans

Aedes aegypti and Aedes albopictus are important pathogen-carrying vectors that broadly exhibit similar habitat suitability, but that differ at fine spatial scales in terms of competitive advantage and tolerance to urban driven environmental parameters. This study evaluated how spatial and temporal patterns drive the assemblages of these competing species in cemeteries of New Orleans, LA, applying indicators of climatic variability, vegetation, and heat that may drive habitat selection at multiple scales. We found that Ae. aegypti was well predicted by urban heat islands (UHI) at the cemetery scale and by canopy cover directly above the cemetery vase. As predicted, UHI positively correlate to Ae. aegypti, but contrary to predictions, Ae. aegypti, was more often found under the canopy of trees in high heat cemeteries. Ae. albopictus was most often found in low heat cemeteries, but this relationship was not statistically significant, and their overall abundances in the city were lower than Ae. aegypti. Culex quinquefasciatus, another important disease vector, was also an abundant mosquito species during the sampling year, but we found that it was temporally segregated from Aedes species, showing a negative association to the climatic variables of maximum and minimum temperature, and these factors positively correlated to its more direct competitor Ae. albopictus. These findings help us understand the mechanism by which these three important vectors segregate both spatially and temporally across the city. Our study found that UHI at the cemetery scale was highly predictive of Ae. aegypti and strongly correlated to income level, with low-income cemeteries having higher UHI levels. Therefore, the effect of excessive heat, and the proliferation of the highly competent mosquito vector, Ae. aegypti, may represent an unequal disease burden for low-income neighborhoods of New Orleans that should be explored further. Our study highlights the importance of considering socioeconomic aspects as indirectly shaping spatial segregation dynamics of urban mosquito species.

Green infrastructure can limit but not solve air pollution injustice

Outdoor air pollution contributes to millions of deaths worldwide yet air pollution has differential exposures across racial/ethnic groups and socioeconomic status. While green infrastructure has the potential to decrease air pollution and provide other benefits to human health, vegetation alone cannot resolve health disparities related to air pollution injustice. We discuss how unequal access to green infrastructure can limit air quality improvements for marginalized communities and provide strategies to move forward.

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.

Attitudes towards Green Urban Space: A Case Study of Two Italian Regions

Green spaces are defined as open spaces of ground, covered by vegetation, including parks and gardens. This kind of environment is linked to many positive effects and its importance is growing due to increasing urbanization. Understanding what drives people to use green urban space is fundamental to creating appropriate campaigns to develop the use of such spaces and improve the citizens’ quality of life. A questionnaire on the attitude towards green space was developed and submitted to people from two Italian regions. Emilia-Romagna and Veneto are two regions in the North of Italy with different territorial policies. Three hundred and ten surveys were collected (167 in Emilia-Romagna and 143 in Veneto). Significant differences were observed between regions, age groups and in relation to the kind of work (p < 0.05). People from Emilia-Romagna have higher scores of attitudes towards green space than people from Veneto, underlining the importance of territorial policies. Moreover, younger participants (18–30 years) seem to be less attracted to green urban space. Being an employee seems to influence the attitude towards green space. Particular attention should be given to subjects of the younger age groups and to the number of hours spent at work. This could be an important element for future research, so that political action can be implemented with these categories in mind.

Sustaining planetary health through systems thinking: Public health's critical role

Understanding and responding to adverse human health impacts of global environmental change will be a major priority of 21st century public health professionals. The emerging field of planetary health aims to face this challenge by studying and promoting policies that protect the health of humans and of the Earth's natural systems that support them. Public health, drawing on its experience of guiding policies to improve population health, has contributed to planetary health's development. Yet, few public health practitioners are familiar with planetary health's systems-oriented approaches for understanding relationships between economic development, environmental degradation, and human health. In this narrative review, we present key planetary health concepts and show how systems thinking has guided its development. We discuss historical approaches to studying impacts of economic development on human health and the environment. We then review novel conceptual frameworks adopted by planetary health scientists to study and forecast impacts of policies that influence human health and Earth's natural systems at varying spatiotemporal scales. We conclude by presenting examples of how applying the "Doughnut" model (an economic framework where the needs of people are met without overshooting the world's ecological limits) could guide policies for promoting health co-benefits to humans and natural systems.

Discovering and Applying the Urban Rules of Life to Design Sustainable and Healthy Cities

The city and its urban biome provides an extreme laboratory for studying fundamental biological questions and developing best practices for sustaining biodiverse and well-functioning ecological communities within anthropogenic built environments. We propose by studying urban organisms, urban biotic communities, the urban biome, and the interactions between the urban biome and peri-urban built and natural environments, we can (1) discover new 'rules of life' for the structure, function, interaction, and evolution of organisms;(2) use these discoveries to understand how novel emerging biotic communities affect and are affected by anthropogenic environmental changes in climate and other environmental factors; and (3) apply what we have learned to engage residents of the urban biome, and design cities that are more biologically diverse, are provided with more and better ecosystem services, and are more equitable and healthier places to live. The built environment of the urban biome is a place that reflects history, economics, technology, governance, culture, and values of the human residents; research on and applications of the rules of life in the urban biome can be used by all residents in making choices about the design of the cities where they live. Because inhabitants are directly invested in the environmental quality of their neighborhoods, research conducted in and about the urban environment provides a great opportunity to engage wide and diverse communities of people. Given the opportunity to engage a broad constituency - from basic researchers to teachers, civil engineers, landscape planners, and concerned citizens - studying the translation of the rules of life onto the urban environment will result in an integrative and cross-cutting set of questions and hypotheses, and will foster a dialogue among citizens about the focus of urban biome research and its application toward making more equitable, healthy, livable, sustainable, and biodiverse cities.

The Benefits and Limits of Urban Tree Planting for Environmental and Human Health

Many of the world’s major cities have implemented tree planting programs based on assumed environmental and social benefits of urban forests. Recent studies have increasingly tested these assumptions and provide empirical evidence for the contributions of tree planting programs, as well as their feasibility and limits, for solving or mitigating urban environmental and social issues. We propose that current evidence supports local cooling, stormwater absorption, and health benefits of urban trees for local residents. However, the potential for urban trees to appreciably mitigate greenhouse gas emissions and air pollution over a wide array of sites and environmental conditions is limited. Consequently, urban trees appear to be more promising for climate and pollution adaptation strategies than mitigation strategies. In large part, this is due to space constraints limiting the extent of urban tree canopies relative to the current magnitude of emissions. The most promising environmental and health impacts of urban trees are those that can be realized with well-stewarded tree planting and localized design interventions at site to municipal scales. Tree planting at these scales has documented benefits on local climate and health, which can be maximized through targeted site design followed by monitoring, adaptive management, and studies of long-term eco-evolutionary dynamics.

Growing Biodiverse Urban Futures: Renaturalization and Rewilding as Strategies to Strengthen Urban Resilience

How are our cities using nature-based solutions to confront the challenges posed by a warming climate, the loss of biodiversity and major resource depletion? This article discusses the opportunities and benefits of applying the concepts of regreening and rewilding of cities. The article engages with key sources and summarizes the background and development of regreening and nature-based solutions and important policies, concerns and perspectives of international and national organizations. It introduces the integration of nature-based solutions (NBS) as a strategy in urban planning with the aim to strengthen urban resilience and to slow down the biodiversity decline. Rewilding areas in cities has become a powerful strategy to bring back butterflies, insects, birds, and wildlife. In contrast to highly managed parks and gardens, these rewilding initiatives are leaving allotted spaces mostly uncultivated and self-regulated. Contact to nature is essential for human existence, urban wellbeing, and good quality of life. Green spaces in cities—big or small—all contribute to the health and wellbeing of residents. However, many cities do not offer residents easy access to green space within the city. Improving the better distribution of and access to green spaces and extending gardens and parks is likely to deliver a large number of benefits, such as: ecosystem services, better water management for enhanced urban flood control, slowing down the biodiversity loss, contributing to food security, and restoring damaged ecosystems. Furthermore, additional green space and NBS help to keep cities cool during heatwaves and improve the urban microclimate. Rewilding has emerged as an important part of new public parks and gardens. The next step is to up-scale citywide climate intervention strategies deployed to keep cities cool. However, as the discussion of this article shows, it is essential that the design of these NBS strategies is fully integrated with other complementary planning interventions and seeks synergies across all sectors.

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.

Impact of Different Types of Physical Activity in Green Urban Space on Adult Health and Behaviors: A Systematic Review

This systematic review aimed to investigate the type of physical activity carried out in green urban spaces by the adult population and to value its impact on the population’s health. Additionally, another purpose was to examine if the presence of outdoor gyms in green urban spaces can promote participation in physical activity among adults. Searches of electronic databases, with no time restrictions and up to June 2020, resulted in 10 studies meeting the inclusion criteria. A quantitative assessment is reported as effect size. Many people practiced walking activity as a workout, which showed improvements in health. Walking is the most popular type of training due to its easy accessibility and it not requiring equipment or special skills. Outdoor fitness equipment has been installed in an increasing number of parks and has become very popular worldwide. Further, outdoor fitness equipment provides free access to fitness training and seems to promote physical activity in healthy adults. However, other studies about outdoor fitness equipment efficiency are needed. People living near to equipped areas are more likely to perform outdoor fitness than those who live further away. The most common training programs performed in green urban spaces included exercises with free and easy access, able to promote physical health and perception.

Nature Exposure and Its Effects on Immune System Functioning: A Systematic Review

Given the drastic changes in our lifestyles and ecosystems worldwide, the potential health effects of natural environments have grown into a highly pervasive topic. Recent scientific findings suggest beneficial effects from nature exposure on human immune responses. This review aims at providing a comprehensive overview of literature published on immunomodulatory effects of nature exposure by inhalation of natural substances. A systematic database search was performed in SCOPUS and PubMed. The quality and potential bias of included studies (n = 33) were assessed by applying the EPHPP (Effective Public Health Practice Project) tool for human studies and the ARRIVE (Animal Research: Reporting of In Vivo Experiments) and SYRCLE (Systematic Review Centre for Laboratory Animal Experimentation) tools for animal studies. The synthesis of reviewed studies points to positive effects of nature exposure on immunological health parameters; such as anti-inflammatory, anti-allergic, anti-asthmatic effects or increased NK (natural killer) cell activity. Decreased expression of pro-inflammatory molecules, infiltration of leukocytes and release of cytotoxic mediators are outcomes that may serve as a baseline for further studies. However, partially weak study designs evoked uncertainties about outcome reproducibility and key questions remain open concerning effect sizes, duration of exposure and contributions of specific vegetation or ecosystem types.

Implications of Low Carbon City Sustainability Strategies for 2050

Cities and urban areas are critical nodes of societal resource flows, responsible for both global and local sustainability implications. They are complex systems and understanding the implications of potential actions by cities is critical for progress towards sustainability. In this paper the future implications of sustainability strategies are assessed for 10 European cities by comparing two scenarios for 2050: a business-as-usual (BAU) and a post-carbon/sustainability scenario (PC2050) (generated by city stakeholders). The effects of the scenarios are assessed using a mixed methodology: a semi-quantitative sustainability indicator analysis, energy and greenhouse gas (GHG) emissions (both production-based and consumption-based accounting (PBA and CBA)), land-use spatial modelling, and cost–benefit analysis. The paper highlights the clear benefits of PC2050 with improved sustainability indicator results, reduced land sprawl (which averages 16% in BAU) and positive cost–benefit results. Nonetheless, inequality and segregation are a common concern. In addition, whilst PBA indicates a significant decrease (average decrease from 4.7 to 1.3 tCO2eq per capita) CBA demonstrates rising overall emissions from an average of 11 to 14.8 tCO2eq per capita. This is linked to rising affluence and consumption trends despite local improvements in GHG emissions, which highlights a need for cities to address consumption-based emissions.

Urban Trees and Human Health: A Scoping Review

The urban forest is a green infrastructure system that delivers multiple environmental, economic, social and health services, and functions in cities. Environmental benefits of urban trees are well understood, but no review to date has examined how urban trees affect human health. This review provides a comprehensive summary of existing literature on the health impacts of urban trees that can inform future research, policy, and nature-based public health interventions. A systematic search used keywords representing human health, environmental health, and urban forestry. Following screening and appraisal of several thousand articles, 201 studies were conceptually sorted into a three-part framework. Reducing Harm, representing 41% of studies, includes topics such as air pollution, ultraviolet radiation, heat exposure, and pollen. Restoring Capacities, at 31%, includes attention restoration, mental health, stress reduction, and clinical outcomes. Building Capacities, at 28%, includes topics such as birth outcomes, active living, and weight status. The studies that were reviewed show substantial heterogeneity in purpose and method yet indicate important health outcomes associated with people’s exposure to trees. This review will help inform future research and practice, and demonstrates why urban forest planning and management should strategically promote trees as a social determinant of public health.

Nature Relatedness of Recreational Horseback Riders and Its Association with Mood and Wellbeing

Connectedness to nature and nature contact can provide many benefits to humans, like stress reduction, recovery from illness, and increased positive emotions. Likewise, recreational horseback riding is a widespread sports activity with the potential to enhance physical and psychological health. Yet, the influence of connectedness to nature on the wellbeing of older aged recreational horseback riders has not been investigated so far. The aim of the present study therefore was to explore the relationship between nature relatedness and physical, psychological and social wellbeing and happiness. The study sample was composed of Austrian recreational horseback riders aged 45 years and older, who were compared with dog owners and people without pets (n = 178). We found significantly higher nature relatedness, significantly higher overall wellbeing and a significantly better mood rating in recreational horseback riders compared to people without pets and similar scores compared to dog owners. Physical wellbeing is correlated with overall nature relatedness in horseback riders and dog owners, but no correlation was found in people without pets. A structural equation model shows a direct relationship between nature relatedness and mood in horseback riders and an indirect relationship through pet attachment in dog owners. The results suggest the activity with horses and dogs in nature environments is a source of wellbeing, enjoyment, self-confidence and social contacts.

Land and nature as sources of health and resilience among Indigenous youth in an urban Canadian context: a photovoice exploration

BACKGROUND

Population and environmental health research illustrate a positive relationship between access to greenspace or natural environments and peoples' perceived health, mental health, resilience, and overall well-being. This relationship is also particularly strong among Canadian Indigenous populations and social determinants of health research where notions of land, health, and nature can involve broader spiritual and cultural meanings. Among Indigenous youth health and resilience scholarship, however, research tends to conceptualize land and nature as rural phenomena without any serious consideration on their impacts within urban cityscapes. This study contributes to current literature by exploring Indigenous youths' meaning-making processes and engagements with land and nature in an urban Canadian context.

METHODS

Through photovoice and modified Grounded Theory methodology, this study explored urban Indigenous youth perspectives about health and resilience within an inner-city Canadian context. Over the course of one year, thirty-eight in-depth interviews were conducted with Indigenous (Plains Cree First Nations and Métis) youth along with photovoice arts-based and talking circle methodologies that occurred once per season. The research approach was also informed by Etuaptmumk or a "two-eyed seeing" framework where Indigenous and Western "ways of knowing" (worldviews) can work alongside one another.

RESULTS

Our strength-based analyses illustrated that engagement with and a connection to nature, either by way of being present in nature and viewing nature in their local urban context, was a central aspect of the young peoples' photos and their stories about those photos. This article focuses on three of the main themes that emerged from the youth photos and follow-up interviews: (1) nature as a calming place; (2) building metaphors of resilience; and (3) providing a sense of hope. These local processes were shown to help youth cope with stress, anger, fear, and other general difficult situations they may encounter and navigate on a day-to-day basis.

CONCLUSIONS

This study contributes to the literature exploring Indigenous youths' meaning-making process and engagements with land and nature in an urban context, and highlights the need for public health and municipal agencies to consider developing more culturally safe and meaningful natural environments that can support the health, resilience, and well-being of Indigenous youth within inner-city contexts.

Perception of Urban Green Areas Associated with Sociodemographic Affiliation, Structural Elements, and Acceptance Stripes

The extensification (opposite of intensification) of urban public green spaces offers great potential for conservation. One major issue for the long-term success of such a measure is, however, its acceptance by the urban population. This contribution presents the results of an image-based online questionnaire that we set to elucidate the role of sociodemographic affiliations regarding the perception of urban green areas. We also asked whether acceptability can be increased by the presence of additional structural elements (sculptures, benches) and “acceptance stripes”, i.e., stripes regularly mowed only at the margins of a natural green space. Regarding structural elements, 40- to 60-year-olds consistently rejected intensely maintained lawns and perceived a lawn as positive only in combination with a sculpture. A regularly mowed acceptance stripe resulted in a positive perception of natural meadows by people with an affinity for city life, classified based on their actual place of residence and/or their social dimension including aspects such as sense of place, familiarity, profession, and interests. Thus, decision-making processes of policy makers must be evaluated together with the urban population and should be assessed multidimensionally, i.e., by considering various criteria (e.g., ecological, social, and aesthetic aspects) in order to meet the requirements of residents and achieve an increase in biodiversity.

Conservation value of small reserves

The importance of large reserves has been long maintained in the scientific literature, often leading to dismissal of the conservation potential of small reserves. However, over half the global protected-area inventory is composed of protected areas that are <100 ha, and the median size of added protected area is decreasing. Studies of the conservation value of small reserves and fragments of natural area are relatively uncommon in the literature. We reviewed SCOPUS and WOK for studies on small reserve and fragment contributions to biodiversity conservation and ecosystem services, and fifty-eight taxon-specific studies were included in the review. Small reserves harbored substantial portions (upward of 50%) of regional species diversity for many taxa (birds, plants, amphibians, and small mammals) and even some endemic, specialist bird species. Unfortunately, small reserves and fragments almost always harbored more generalist and exotic species than large reserves. Community composition depended on habitat quality, surrounding land use (agricultural vs. urban), and reserve and fragment size, which presents opportunities for management and improvement. Small reserves also provided ecosystem services, such as pollination and biological pest control, and cultural services, such as recreation and improved human health. Limitations associated with small reserves, such as extinction debt and support of area-sensitive species, necessitate a complement of larger reserves. However, we argue that small reserves can make viable and significant contributions to conservation goals directly as habitat and indirectly by increasing landscape connectivity and quality to the benefit of large reserves. To effectively conserve biodiversity for future generations in landscapes fragmented by human development, small reserves and fragments must be included in conservation planning.

Nature-based solutions for hydro-meteorological hazards: Revised concepts, classification schemes and databases

Hydro-meteorological hazards (HMHs) have had a strong impact on human societies and ecosystems. Their impact is projected to be exacerbated by future climate scenarios. HMHs cataloguing is an effective tool to evaluate their associated risks and plan appropriate remediation strategies. However, factors linked to HMHs origin and triggers remain uncertain, which pose a challenge for their cataloguing. Focusing on key HMHs (floods, storm surges, landslides, droughts, and heatwaves), the goal of this review paper is to analyse and present a classification scheme, key features, and elements for designing nature-based solutions (NBS) and mitigating the adverse impacts of HMHs in Europe. For this purpose, we systematically examined the literature on NBS classification and assessed the gaps that hinder the widespread uptake of NBS. Furthermore, we critically evaluated the existing literature to give a better understanding of the HMHs drivers and their interrelationship (causing multi-hazards). Further conceptualisation of classification scheme and categories of NBS shows that relatively few studies have been carried out on utilising the broader concepts of NBS in tackling HMHs and that the classification and effectiveness of each NBS are dependent on the location, architecture, typology, green species and environmental conditions, as well as interrelated non-linear systems. NBS are often more cost-effective than hard engineering approaches used within the existing systems, especially when taking into consideration their potential co-benefits. We also evaluated the sources of available data for HMHs and NBS, highlighted gaps in data, and presented strategies to overcome the current shortcomings for the development of the NBS for HMHs. We highlighted specific gaps and barriers that need to be filled since the uptake and upscaling studies of NBS in HMHs reduction is rare. The fundamental concepts and the key technical features of past studies reviewed here could help practitioners to design and implement NBS in a real-world situation.

Wetlands for Wellbeing: Piloting a Nature-Based Health Intervention for the Management of Anxiety and Depression

Nature-based health interventions (NBIs) for the treatment of poor mental health are becoming increasingly common, yet evidence to support their effectiveness is lacking. We conduct a pilot study of a six-week intervention, aiming to engage individuals with wetland nature for the treatment of anxiety and/or depression. We employed a mixed methods design, using questionnaires, focus groups and semi-structured interviews to evaluate the intervention from the perspective of participants (n = 16) and healthcare professionals (n = 2). Results demonstrate significant improvements in mental health across a range of indicators, including mental wellbeing (Warwick and Edinburgh Mental Wellbeing Scale), anxiety (Generalised Anxiety Disorder-7), stress (Perceived Stress Scale) and emotional wellbeing (Positive and Negative Affect Schedule). Participants and healthcare professionals cited additional outcomes including improved physical health and reduced social isolation. The wetland site provided a sense of escape from participants’ everyday environments, facilitating relaxation and reductions in stress. Wetland staff knowledge of the natural world, transportation and group organisation also played a considerable role in the intervention’s success. These aspects should be considered in future and existing NBIs to maximise benefits to participants. We propose NBIs based in wetlands are an effective therapy option for individuals diagnosed with anxiety and/or depression.

Greening Blocks: A Conceptual Typology of Practical Design Interventions to Integrate Health and Climate Resilience Co-Benefits

It is increasingly evident that exposure to green landscape elements benefits human health. Urban green space in cities is also recognized as a crucial adaptation response to changes in climate and its subsequent effects. The exploration of conceptual and practical intersections between human health, green spaces, and climate action is needed. Evidence-based guidance is needed for stakeholders, practitioners, designers, and citizens in order to assess and manage urban green spaces that maximize co-benefits for both human health and climate resilience. This paper proposes interventions that provide strategic green space enhancement at the neighborhood and block scale. We propose eight tangible green space interventions and associated metrics to integrate climate resilience and population health co-benefits into urban green space design and planning: View from within, Plant entrances, Bring nature nearby, Retain the mature, Generate diversity, Create refuge, Connect experiences, and Optimize green infrastructure. These interventions represent a hierarchy of functional design concepts that respond to experiential qualities and physical/psychological dimensions of health, and which enhance resilience at a range of social scales from the individual to the neighborhood. The interventions also reveal additional research needs in green space design, particularly in neighborhood-level contexts.

Goals, beneficiaries, and indicators of waterfront revitalization in Great Lakes Areas of Concern and coastal communities

Cleanup of Great Lakes Areas of Concern (AOCs) restores environmental benefits to waterfront communities and is an essential condition for revitalization. We define waterfront revitalization as policies or actions in terrestrial waterfront or adjacent aquatic areas that promote improvements in human socioeconomic well-being while protecting or improving the natural capital (the stocks of natural assets, biodiversity) that underlies all environmental, social, and economic benefits. Except for economic measures such as development investments, visitation rates, or commercial activity, evidence of waterfront revitalization in the Great Lakes is mostly anecdotal. We offer a perspective on waterfront revitalization that links indicators and metrics of sustainable revitalization to community goals and human beneficiaries. We compiled environmental, social, economic, and governance indicators and metrics of revitalization, many of which are based on or inspired by Great Lakes AOC case studies and community reutilization or sustainability plans. We highlight the role of indicators in avoiding unintended consequences of revitalization including environmental degradation and social inequity. Revitalization indicators can be used in planning for comparing alternative designs, and to track restoration progress. The relevancy of specific indicators and metrics will always depend on the local context.

Green Infrastructure Solutions to Health Impacts of Climate Change: Perspectives of Affected Residents in Detroit, Michigan, USA

Cities worldwide are incorporating green infrastructure to mitigate climate change and achieve health cobenefits. However, green infrastructure projects are often distributed inequitably based on race and class. Residents’ perspectives are necessary to develop and enact effective and equitable ‘green’ strategies to address climate change and its health impacts. This study reports findings from interviews and ethnographic observations with diverse residents of Detroit, Michigan, USA, who have experience with both green infrastructure projects and intense weather events (flooding). Residents expressed widespread support for green infrastructure solutions, while also sharing concerns about unintended health consequences from unsatisfactory governance of green spaces and climate change itself. Residents also held differing perspectives regarding their responsibility for, and capacity to enact, these solutions compared to businesses, city government, and nonprofit organizations. These findings illuminate key factors that city governments and partnering institutions should incorporate into planning processes with residents to achieve greater environmental justice through green infrastructure strategies to mitigate climate change and related health impacts.

Structural Characteristics of Tree Cover and the Association with Cardiovascular and Respiratory Health in Tampa, FL

Urban tree cover can provide several ecological and public health benefits. Secondary datasets for Tampa, FL, including sociodemographic variables (e.g., race/ethnicity), health data, and interpolated values for features of tree cover (e.g., percent canopy and leaf area index) were analyzed using correlation and regression. Percent canopy cover and leaf area index were inversely correlated to respiratory and cardiovascular outcomes, yet only leaf area index displayed a significant association with respiratory conditions in the logistic regression model. Percent racial/ethnic minority residents at the block group level was significantly negatively correlated with median income and tree density. Leaf area index was also significantly lower in block groups with more African-American residents. The percentage of African Americans (p = 0.101) and Hispanics (p < 0.001) were positively associated with respiratory outcomes while population density (p < 0.001), percent canopy (p < 0.01), and leaf area index (p < 0.01) were negatively associated. In multivariate models, higher tree density, leaf area index, and median income were significantly negatively associated with respiratory cases. Block groups with a higher proportion of African Americans had a higher odds of displaying respiratory admissions above the median rate. Tree density and median income were also negatively associated with cardiovascular cases. Home ownership and tree condition were significantly positively associated with cardiovascular cases.

Beyond Assuming Co-Benefits in Nature-Based Solutions: A Human-Centered Approach to Optimize Social and Ecological Outcomes for Advancing Sustainable Urban Planning

Urbanization deletes and degrades natural ecosystems, threatens biodiversity, and alienates people from the experience of nature. Nature-based solutions (NbS) that are inspired and supported by nature have the potential to deliver multifunctional environmental and social benefits to address these challenges in urban areas under context-specific conditions. NbS implementation often relies on a one-size-fits-all approach, although interventions that maximize one benefit (e.g., biodiversity conservation) may have no influence on, or even negatively affect, others (e.g., social justice). Furthermore, the current pathways from NbS to various benefits do not rely on a deep understanding of the underlying processes, prohibiting the identification of optimal solutions that maximize synergies across pathways. We present a comprehensive socio-ecological framework that addresses these issues by recognizing that cities are human-dominated environments that are foremost built and maintained to support humans. Our framework demonstrates how we can use experiments and niche species models to understand and predict where species will be and where people will be healthy and happy in a comparable manner. This knowledge can then be integrated into decision support tools that use optimization algorithms to understand trade-offs, identify synergies, and provide planners with the tools needed to tailor context-specific NbS to yield greener, more resilient cities with happier people and reduced inequality.

Exploring the Relevance of Green Space and Epidemic Diseases Based on Panel Data in China from 2007 to 2016

Urban green space has been proven effective in improving public health in the contemporary background of planetary urbanization. There is a growing body of literature investigating the relationship between non-communicable diseases (NCDs) and green space, whereas seldom has the correlation been explored between green space and epidemics, such as dysentery, tuberculosis, and malaria, which still threaten the worldwide situation of public health. Meanwhile, most studies explored healthy issues with the general green space, public green space, and green space coverage, respectively, among which the different relevance has been rarely explored. This study aimed to examine and compare the relevance between these three kinds of green space and incidences of the three types of epidemic diseases based on the Panel Data Model (PDM) with the time series data of 31 Chinese provinces from 2007 to 2016. The results indicated that there exists different, or even opposite, relevance between various kinds of green space and epidemic diseases, which might be associated with the process of urban sprawl in rapid urbanization in China. This paper provides a reference for re-thinking the indices of green space in building healthier and greener cities.

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.

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.

Association between the living environment and the risk of arterial hypertension and other components of metabolic syndrome

Background

Metabolic syndrome (MS) is characterized by numerous metabolic risk factors. We investigated the associations between a long-term exposure to ambient air pollution and the residential distance to green spaces (GS) and major roads with the development of arterial hypertension (AH) and some components of MS. These associations were assessed among persons living in private and multi-story houses (MH).

Methods

We selected 1354 participants for the population study from MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease Program). The exposures to PM10, PM2.5, and NO2 levels were assessed by using the LUR models for Kaunas City.

Results

In the participants who lived in MH, the residential distance to a major road closer than 200 m and the residential exposure to PM10 and PM2.5 levels above the median were associated with a higher risk of AH (the adjusted relative risks (RRs), respectively, were 1.41(1.10–1.81), 1.19(1.01–1.42) and 1.27(1.07–1.52)). In these participants, the residential exposure to a PM10 level above the median was associated with a higher risk of reduced high density lipoprotein (RHDL) (RR = 1.46(1.05–2.05)). A negative impact of the traffic air pollutants on the incidence of AH, RHDL cholesterol and high triglyceride levels was observed only in the participants who lived in MH.

Nature-Based Interventions for Improving Health and Wellbeing: The Purpose, the People and the Outcomes

Engagement with nature is an important part of many people's lives, and the health and wellbeing benefits of nature-based activities are becoming increasingly recognised across disciplines from city planning to medicine. Despite this, urbanisation, challenges of modern life and environmental degradation are leading to a reduction in both the quantity and the quality of nature experiences. Nature-based health interventions (NBIs) can facilitate behavioural change through a somewhat structured promotion of nature-based experiences and, in doing so, promote improved physical, mental and social health and wellbeing. We conducted a Delphi expert elicitation process with 19 experts from seven countries (all named authors on this paper) to identify the different forms that such interventions take, the potential health outcomes and the target beneficiaries. In total, 27 NBIs were identified, aiming to prevent illness, promote wellbeing and treat specific physical, mental or social health and wellbeing conditions. These interventions were broadly categorized into those that change the environment in which people live, work, learn, recreate or heal (for example, the provision of gardens in hospitals or parks in cities) and those that change behaviour (for example, engaging people through organized programmes or other activities). We also noted the range of factors (such as socioeconomic variation) that will inevitably influence the extent to which these interventions succeed. We conclude with a call for research to identify the drivers influencing the effectiveness of NBIs in enhancing health and wellbeing.

Correcting common misconceptions to inspire conservation action in urban environments

Despite repeated calls to action, proposals for urban conservation are often met with surprise or scepticism. There remains a pervasive narrative in policy, practice, and the public psyche that urban environments, although useful for engaging people with nature or providing ecosystem services, are of little conservation value. We argue that the tendency to overlook the conservation value of urban environments stems from misconceptions about the ability of native species to persist within cities and towns and that this, in turn, hinders effective conservation action. However, recent scientific evidence shows that these assumptions do not always hold. Although it is generally true that increasing the size, quality, and connectivity of habitat patches will improve the probability that a species can persist, the inverse is not that small, degraded, or fragmented habitats found in urban environments are worthless. In light of these findings we propose updated messages that guide and inspire researchers, practitioners, and decision makers to undertake conservation action in urban environments: consider small spaces, recognize unconventional habitats, test creative solutions, and use science to minimize the impacts of future urban development.

Building Healthy Community Environments: A Public Health Approach

Environmental quality has a profound effect on health and the burden of disease. In the United States, the environment-related burden of disease is increasingly dominated by chronic diseases. At the local level, public health practitioners realize that many policy decisions affecting environmental quality and health transcend the authorities of traditional health department programs. Healthy decisions about the built environment, including housing, transportation, and energy, require broad collaborative efforts. Environmental health professionals have an opportunity to address the shift in public health burden toward chronic diseases and play an important role in the design of healthy communities by bringing data and tools to decision makers. This article provides a guide for community leaders to consider the public health effects of decisions about the built environment. We present a conceptual framework that represents a shift from compartmentalized solutions toward an inclusive systems approach that encourages partnership across disciplines and sectors. We discuss practical tools to assist with environmental decision making, such as Health Impact Assessments, environmental public health tracking, and cumulative risk assessment. We also identify priorities in research, practice, and education to advance the role of public health in decision making to improve health, such as the Health Impact Assessment, as a core competency for environmental health practitioners. We encourage cross-disciplinary communication, research, and education that bring the fields of planning, transportation, and energy in closer collaboration with public health to jointly advance the systems approach to today's environmental challenges.

Research challenges for cultural ecosystem services and public health in (peri-)urban environments

Urbanization is a global trend, and consequently the quality of urban environments is increasingly important for human health and wellbeing. Urban life-style is typically associated with low physical activity and sometimes with high mental stress, both contributing to an increasing burden of diseases. Nature-based solutions that make effective use of ecosystem services, particularly of cultural ecosystem services (CES), can provide vital building blocks to address these challenges. This paper argues that, the salutogenic, i.e. health-promoting effects of CES have so far not been adequately recognised and deserve more explicit attention in order to enhance decision making around health and wellbeing in urban areas. However, a number of research challenges will need to be addressed to reveal the mechanisms, which underpin delivery of urban CES. These include: causal chains of supply and demand, equity, and equality of public health benefits promoted. Methodological challenges in quantifying these are discussed. The paper is highly relevant for policy makers within and beyond Europe, and also serves as a review for current researchers and as a roadmap to future short- and long-term research opportunities.