1. Dr Jo Barton University of Essex How Does Greenspace Contribute to Healthy, Thriving Communities?

2. Outline Theories linking nature and health Greenspaces and healthy communities – what does the evidence show? Reducing health inequalities Obesity Crime Facilitates activity – ‘Green exercise’ Green Exercise research findings Opportunities for new public health delivery structures

3. Our relationship with nature has changed....

4. Theory Linking Nature and Health “an innate sensitivity to and need for other living things – as we have co-existed for thousands of generations” Hardwired into our genetic makeup Evolved with affiliation for nature, urban settings not part of our genetic history Wilson (1984)

5. Attention Restoration Theory We engage in 2 types of attention 1.Involuntary – requires minimal effort 2.Voluntary (directed)– requires focus & energy, is susceptible to mental fatigue Nature – conducive to involuntary engagement, replenishes our mental fatigue, helps us recover from stress, restores concentration levels Kaplan & Kaplan (1989)

6. Health Value of Greenspaces 80% of worlds population live in urban areas Quality of physical environment promotes good health and wellbeing Protect and improve natural environment = protect and enhance people’s health Accessibility and design affects behaviour

7. Greenspaces and Healthy Communities Greenspace Reduces property crime violent crime levels of aggression Provides a sense of belonging Enhances social cohesion Reduces social isolation Improves social networking Encourages intergenerational links Reduces stress Perceived Cortisol Restores mental fatigue Improves mental health and wellbeing Self-esteem Mood Reduces health inequalities Facilitates activity Improves physical health Lowers BP Increases HRV Reduces obesity

8. Greenspace Reduces Health Inequalities Mitchell & Popham (2008)

9. Is Greenery Associated with Obesity? (N = 6919) Greenery Odds Ratio Ellaway & Macintyre (2005) > x3 40% less

10. Greenspaces and Crime Highest vegetation: 52% less total crimes 48% less property crimes 56% less violent crimes Supports ART hypothesis Kuo & Sullivan (2001)

11. Greenspace Facilitates Activity - ‘Green Exercise’ Good access to greenspace increases likelihood of being physically active by 24% Green Exercise – synergistic health benefit? Laboratory studies — Analysing concept in controlled setting — Rural vs. urban views — SE, mood improve more with green views Pretty et al., (2005)

12. Viewing Nature Improves Recovery From Stress Viewing nature prior to a stressor can increase HRV (indicator of better health and an adaptable CV system) Enhances recovery from a stressor Gladwell et al., (2012)

13. Underlying Cognitive Mechanisms? Visual sensation study – to what extent does the colour green contribute to the GE effect? Better mood & lower ratings of perceived exertion in green condition (even though exercise intensity the same) Akers et al., (2012) Green (unedited) Grey (achromatic) Red (filter)

14. A ‘Dose of Nature’ Multi-study analysis on change in SE & mood, 10 case studies, n=1252 Aim: Assess the optimal dose(s) of GE for mental well-being Type, duration and intensity of activity? Type of green space? Participant characteristics? Barton & Pretty (2012)

15. TMD = Total Mood Disturbance (indicator of overall mood)

16. Dose response data for the effect of exposure duration on TMD (*p<0.01; **p<0.001; ***p<0.0001, bars=95% Cis; TMD=Total Mood Disturbance) Dose response data for the effect of exposure duration on self-esteem (*p<0.01; **p<0.001; ***p<0.0001, bars=95% CIs;

17. Figure 7: Change in self-esteem scores over the duration of the project (*indicates significantly different from pre-wilderness trail, p<0.05) N.B. Low scores=high self-esteem Therapeutic Intervention - Longer Term Shifts in Self-Esteem Barton et al., (2011)

18. TurnAround and Control Group Mindfulness and Self-Esteem Scores Note: A lower score= better self- esteem, error bars represent =1SD. * indicates a better self- esteem in the turnaround group (P<0.05) Note: A higher score=more mindful qualities, error bars represent =1SD. * indicates a significantly higher mindfulness score in the TA group (P<0.05) Barton et al., (2012)

19. What are the Opportunities for New Public Health Delivery Structures? Using the environment to promote WB & initiate behaviour change Greening communities Schools Workplace Retirement/care homes New housing developments Engaging vulnerable groups Responsibility still with individual but we can provide them with the tools and environment to facilitate behaviour change

20. Green Infrastructure for Children Early encounters vital for creating meaning and establishing identity Concerns that children today spend too little time outside Disconnections mean – Reductions in ecological literacy – Misunderstandings about food – Reductions in cognitive capacity The virtual is replacing the real (Pyle 2002)

21. Greenspaces Facilitate Physical Activity Figure 1: Mean + SD of time spent in MVPA on the school playground and field (* indicates a higher MVPA on the field (P<0.001) Figure 2: Mean + SD of time spent in MVPA during urban and rural orienteering (* indicates a higher rural MVPA (P<0.01) Children Adolescents * Wood et al., (2012)

22. Mean + SD of time spent in MVPA during indoor and outdoor cycling (*MVPA significantly greater outdoors compared to indoors (P<0.05)). Wood et al., (2012)

23. Workplace Health – Walks4Work Lunchtime walking interventions – nature/built Nature walks: ↓ heart age by 1.5 yr, built ↓ 0.15 yrs Significantly ↓ BP & ↑ negative mood compared to built Significantly ↓ perceived stress (i.e. people thought they were coping better with stress) Active lunch break (walking & socialising in greenspaces) increases productivity and workplace wellness Brown and Gladwell (2012)

24. Nature Deprivation.... If nature is important, then deprivation will create problems.... Physical benefits of nature in urban areas (microclimate effects) Design of built & natural environment matters for mental health The ‘green’ element often not considered essential in urban planning & regeneration Perception of the importance of nature?

25. Losing Connections.... In urban areas – nearby nature is important (e.g. Parks & open spaces, street trees, gardens, allotments, community gardens) Source of stress Malign influence on social networks & social mechanisms Sense of place - Important part of personal identity created through interactions in specific places

26. Conclusion - Research Findings to Date 1.Acute GE has mental health benefits: Self-esteem & mood 2.Benefits for all types of: Green spaces (imp of nearby nature) Activities Durations (5 mins – all day) People (Vulnerable, ill, disaffected & disadvantaged seem to benefit more) 3.Green spaces facilitate activity & improve social capital: Need accessible green spaces in towns & cities

27. Conclusions 4.Need to think of Natural Health Service to complement NHS - Green places can be therapeutic, self-medicate with nature? 5.Green exercise & green care suggest increasing need for: Green Design/ Infrastructure - Incorporate more green views and greenspace in urban design. Create memories (future benchmarks to behaviour) Green Education – Ecoliteracy, creative unstructured play (free- range children), sense of place

28. “I can go into the hills and enjoy peace and quiet, the exercise and relax. My troubles take a back seat on a day like today” Any questions? www.greenexercise.org