Health, place and nature How outdoor environments influence health and well-being

1. Health, place and natureHow outdoor environments influence health and well-being 

2. Health Map  From Barton and Grant, 2006 [adapted from Whitehead and Dahlgren, 1991]From Barton and Grant, 2006 [adapted from Whitehead and Dahlgren, 1991]

3. Outdoor environment and health Areas covered in the knowledge base and presentation.Areas covered in the knowledge base and presentation.

4. Challenges to health Healthy life expectancy Health inequalities are increasing - Since 1995-97, the gap in life expectancy between the England average and the poorest areas has increased by 2% for males and 11%for females. Challenges to health Healthy life expectancy Although life expectancy in the UK is increasing, healthy life expectancy is increasing at a slower rate. Between 1981 and 2002, life expectancy at birth rose for both males (by 5.1 years to 76.0) and females (by 3.7 years to 80.5). However, during this period healthy life expectancy rose by only 2.8 and 3.2 years for males and females respectively. So while people are living for longer, they are also suffering poor health for longer � and this is particularly apparent in males Health inequalities are increasing Since the 1995-97 baseline, the relative gap in life expectancy between England and the fifth of areas with the worst health and deprivation indicators has increased by two per cent for males and by eleven per cent for females. Challenges to health Healthy life expectancy Although life expectancy in the UK is increasing, healthy life expectancy is increasing at a slower rate. Between 1981 and 2002, life expectancy at birth rose for both males (by 5.1 years to 76.0) and females (by 3.7 years to 80.5). However, during this period healthy life expectancy rose by only 2.8 and 3.2 years for males and females respectively. So while people are living for longer, they are also suffering poor health for longer � and this is particularly apparent in males Health inequalities are increasing Since the 1995-97 baseline, the relative gap in life expectancy between England and the fifth of areas with the worst health and deprivation indicators has increased by two per cent for males and by eleven per cent for females.

5. Incidence of certain diseases are increasing: Mental illness - In Great Britain, mental health disorders affect about 1 in 6 of the adult population Obesity related ill health - In England in 2005 nearly a quarter of men and women were obese Diabetes - Between 1994-2003 in England the prevalence of diabetes in men increased by nearly two-thirds and in women has almost doubled Challenges to health Challenges to health Incidence of certain diseases are increasing: - Mental illness: In Great Britain, mental health disorders affect about 1 in 6 of the adult population - Obesity related ill health: In England in 2005 nearly a quarter of men and women were obese - Diabetes: Between 1994-2003 in England the prevalence of diabetes in men has increased by nearly two-thirds and in women has almost doubled Challenges to health Incidence of certain diseases are increasing: - Mental illness: In Great Britain, mental health disorders affect about 1 in 6 of the adult population - Obesity related ill health: In England in 2005 nearly a quarter of men and women were obese - Diabetes: Between 1994-2003 in England the prevalence of diabetes in men has increased by nearly two-thirds and in women has almost doubled

6. The cost of ill health Table shows costs of some health problems in EnglandTable shows costs of some health problems in England

7. Principles of sustainable development From Securing the Future � delivering UK sustainable development strategy [UK Government, 2005]From Securing the Future � delivering UK sustainable development strategy [UK Government, 2005]

8. Outdoor environment and health

9. Natural spaces Natural spaces Exposure to natural spaces has been found to have positive benefits for mental and physical health: - A Dutch study found that, when assuming a causal relationship between greenspace and health, a 10 per cent increase in greenspace in the living environment can lead to a decrease in health complaints equivalent to a reduction of in age of five years. [de Vries et al, 2003] - An Australian review of the empirical, theoretical and anecdotal evidence concluded that contact with nature specifically impacts positively on blood pressure, cholesterol, outlook on life and stress reduction [Maller et al, 2005] - The natural environment has also been found to benefit well-being; a literature review concluded that the human response to nature includes feelings of pleasure and interest and a reduction in anger and anxiety [Rohde and Kendle, 1994] Natural spaces Exposure to natural spaces has been found to have positive benefits for mental and physical health: - A Dutch study found that, when assuming a causal relationship between greenspace and health, a 10 per cent increase in greenspace in the living environment can lead to a decrease in health complaints equivalent to a reduction of in age of five years. [de Vries et al, 2003] - An Australian review of the empirical, theoretical and anecdotal evidence concluded that contact with nature specifically impacts positively on blood pressure, cholesterol, outlook on life and stress reduction [Maller et al, 2005] - The natural environment has also been found to benefit well-being; a literature review concluded that the human response to nature includes feelings of pleasure and interest and a reduction in anger and anxiety [Rohde and Kendle, 1994]

10. Chicago Urban public housing residents in Chicago  -Residents living in the building without trees and grass reported more procrastination in facing their problems and assessed their issues as more severe, less soluble and more long standing than the residents living in greener surroundings [Kuo 2001] Urban public housing residents in Chicago -Residents living in the building without trees and grass reported more procrastination in facing their problems and assessed their issues as more severe, less soluble and more long standing than the residents living in greener surroundings [Kuo 2001]

11. Outdoor environment and health

12. Air pollution and road traffic Air pollution - from road transport has decreased by about 50% in the last decade [Defra 2007] - in 2005 was estimated to reduce life expectancy by 7-8 months and cost an estimated �8.5-20.2 billion/annum [Defra 2007] - adverse health effects include: mortality, asthma, rhinitis, cardiovascular disease, cancer and lowering of male fertility [WHO, 2005] Road traffic - in 2006, 258,404 people were killed or injured in road accidents in the UK. Of these 3,172 people were killed [Defra 2007/DfT 2007] - increasing the number of people cycling and walking improves road safety, as a motorist is less likely to be involved in a collision [Jacobsen 2003]Air pollution - from road transport has decreased by about 50% in the last decade [Defra 2007] - in 2005 was estimated to reduce life expectancy by 7-8 months and cost an estimated �8.5-20.2 billion/annum [Defra 2007] - adverse health effects include: mortality, asthma, rhinitis, cardiovascular disease, cancer and lowering of male fertility [WHO, 2005] Road traffic - in 2006, 258,404 people were killed or injured in road accidents in the UK. Of these 3,172 people were killed [Defra 2007/DfT 2007] - increasing the number of people cycling and walking improves road safety, as a motorist is less likely to be involved in a collision [Jacobsen 2003]

13. Outdoor environment and health

14. Noise Noise - In addition to annoyance and sleep disturbance, persistent environmental noise can have negative impacts on health, such as heart disease, hearing impairment and impacts on mental health [Stansfeld et al. 2000] - In residents living around four European airports (including Heathrow), blood pressure levels rose with higher noise levels [Haralabidis, 2008] Noise - In addition to annoyance and sleep disturbance, persistent environmental noise can have negative impacts on health, such as heart disease, hearing impairment and impacts on mental health [Stansfeld et al. 2000] - In residents living around four European airports (including Heathrow), blood pressure levels rose with higher noise levels [Haralabidis, 2008]

15. Floods Floods - The number of people at high risk from future coastal and river flooding in England and Wales could double from 1.6 million today, to over 3 million by 2080 [Foresight 2004] - Health impacts of flooding include respiratory illnesses, reduced resistance to infections, stomach upsets, high blood pressure and psychological distress [Environment Agency, 2005] Floods - The number of people at high risk from future coastal and river flooding in England and Wales could double from 1.6 million today, to over 3 million by 2080 [Foresight 2004] - Health impacts of flooding include respiratory illnesses, reduced resistance to infections, stomach upsets, high blood pressure and psychological distress [Environment Agency, 2005]

16. Physical activity Physical activity can reduce the risk of developing: -heart disease, cancers, type II diabetes, osteoporosis; and -promote psychological well-being. [WHO] In England in 2006, 60% of men and 72% of women failed to achieve 30 minutes of moderate activity five times a week. [Information Centre for Health and Social Care, 2008] Inactivity costs approximately �8.2 billion/year. [Department of Health, 2004] The health impact of this inactivity in terms of coronary heart disease is comparable to that of smoking. [Killoran et al, 2006] Physical activity can reduce the risk of developing: -heart disease, cancers, type II diabetes, osteoporosis; and -promote psychological well-being. [WHO] In England in 2006, 60% of men and 72% of women failed to achieve 30 minutes of moderate activity five times a week. [Information Centre for Health and Social Care, 2008] Inactivity costs approximately �8.2 billion/year. [Department of Health, 2004] The health impact of this inactivity in terms of coronary heart disease is comparable to that of smoking. [Killoran et al, 2006]

17. Social capital Social capital Getting out and meeting people (social contact and social capital) has been shown to help people live longer and be healthier physically (e.g. lower risk of stroke) and mentally (e.g. less depression). [Berkman, 2000; Kawachi, 1996; Diener and Seligman, 2002] Conversely, people with fewer social networks and emotional support may be more likely to be obese, experience less well-being and more mental health problems and be at a greater risk of pregnancy complications. [Wilkinson and Marmot, 2003] A study in Finland found that men with fewer social connections were at higher risk of all-cause mortality and heart disease. [Kaplan, 1998] Social capital Getting out and meeting people (social contact and social capital) has been shown to help people live longer and be healthier physically (e.g. lower risk of stroke) and mentally (e.g. less depression). [Berkman, 2000; Kawachi, 1996; Diener and Seligman, 2002] Conversely, people with fewer social networks and emotional support may be more likely to be obese, experience less well-being and more mental health problems and be at a greater risk of pregnancy complications. [Wilkinson and Marmot, 2003] A study in Finland found that men with fewer social connections were at higher risk of all-cause mortality and heart disease. [Kaplan, 1998]

18. Outdoor environment and health

19. Accessibility Local facilities create opportunities for social interaction and physical activity Accessibility - Local facilities create opportunities for social interaction [RCEP, 2007] - Because of transport difficulties: 1 in 4 young people have not attended a job interview; 1.4 million people missed, turned down or chose not to seek medical help [Social Exclusion Unit, 2003] - The location and accessibility of shops and services may influence the obesogenic environment i.e. the role environmental factors may play in determining both energy intake and expenditure [NICE, 2008]- Between 1995 and 2000, Britain lost approximately one-fifth of its local services, including corner shops, post offices and banks and it predicted that we will lose a further third over the next decade. This social and economic decline can result in car dependency in more isolated communities, hitting the most vulnerable in society, who are less likely to have access to a car, the hardest. [Nef, 2002; ONS, 2007]Accessibility - Local facilities create opportunities for social interaction [RCEP, 2007] - Because of transport difficulties: 1 in 4 young people have not attended a job interview; 1.4 million people missed, turned down or chose not to seek medical help [Social Exclusion Unit, 2003] - The location and accessibility of shops and services may influence the obesogenic environment i.e. the role environmental factors may play in determining both energy intake and expenditure [NICE, 2008]- Between 1995 and 2000, Britain lost approximately one-fifth of its local services, including corner shops, post offices and banks and it predicted that we will lose a further third over the next decade. This social and economic decline can result in car dependency in more isolated communities, hitting the most vulnerable in society, who are less likely to have access to a car, the hardest. [Nef, 2002; ONS, 2007]

20. Outdoor environment and health

21. Mixed land-use & street design Mixed land-use - A study in Galway found that people living in mixed use, walkable neighbourhoods had higher levels of social capital compared to those in more suburban car-oriented neighbourhoods. [Leyden, 2003] - A Canadian study found that in neighbourhoods of mixed income, the less affluent had better health and quality of life compared to those living in less affluent neighbourhoods. [Hou and Myles, 2004] Street design - The design and layout of towns and cities can encourage or discourage physical activity. [NICE, 2008] - An American study found that residents of highly walkable neighbourhoods engage in 70 minutes more physical activity a week, than those in less walkable neighbourhoods. This equates to walking three miles more per week; over the course of one year this could result in 1.8kg of weight loss. [Saelens et al., 2003] Mixed land-use - A study in Galway found that people living in mixed use, walkable neighbourhoods had higher levels of social capital compared to those in more suburban car-oriented neighbourhoods. [Leyden, 2003] - A Canadian study found that in neighbourhoods of mixed income, the less affluent had better health and quality of life compared to those living in less affluent neighbourhoods. [Hou and Myles, 2004] Street design - The design and layout of towns and cities can encourage or discourage physical activity. [NICE, 2008] - An American study found that residents of highly walkable neighbourhoods engage in 70 minutes more physical activity a week, than those in less walkable neighbourhoods. This equates to walking three miles more per week; over the course of one year this could result in 1.8kg of weight loss. [Saelens et al., 2003]

22. Outdoor environment and health

23. Safety and incivilities Safety and incivilities - Perceived neighbourhood disorder is associated with poorer mental health. [Clark et al., 2007] - People are more likely to use outdoor space if it considered safe: - An English study found that people who felt safe in their neighbourhoods were more likely to be physically active. [Harrison et al., 2007] - Residents in areas with high levels of graffiti, litter and dog mess were 50 per cent less likely to be physically active and 50 per cent more likely to be overweight/obese. [Ellaway et al.,2005] - Perceptions of road safety can influence mode of transport and levels of physical activity. [Crombie 2002] Safety and incivilities - Perceived neighbourhood disorder is associated with poorer mental health. [Clark et al., 2007] - People are more likely to use outdoor space if it considered safe: - An English study found that people who felt safe in their neighbourhoods were more likely to be physically active. [Harrison et al., 2007] - Residents in areas with high levels of graffiti, litter and dog mess were 50 per cent less likely to be physically active and 50 per cent more likely to be overweight/obese. [Ellaway et al.,2005] - Perceptions of road safety can influence mode of transport and levels of physical activity. [Crombie 2002]

24. Outdoor environment and health

25. Natural spaces Natural spaces Greenspace can facilitate social contact: -A study in Chicago found that 83% more individuals engaged in social activity in green areas than barren spaces. [Sullivan et al., 2004] Local access to safe natural greenspace and attractive scenery is associated with high levels of physical activity within communities. [Bird, 2007] - A European study found that people who live in areas with high levels of greenery were 3 times more likely to be physically active and 40% less likely to be overweight/obese. [Ellaway et al., 2005] - A Norwegian study found children�s play to be more vigorous outdoors than indoors; children who play regularly in natural areas were fitter and had better coordination, balance and agility. [Fjortoft, 2004] - The more attractive parks and urban green spaces become, the more people are likely to use them for physical activity. [CABE, 2007] - �Green� exercise can lead to a significant improvement in self-esteem and mood. [Pretty et al.,2007] Natural spaces Greenspace can facilitate social contact: -A study in Chicago found that 83% more individuals engaged in social activity in green areas than barren spaces. [Sullivan et al., 2004] Local access to safe natural greenspace and attractive scenery is associated with high levels of physical activity within communities. [Bird, 2007] - A European study found that people who live in areas with high levels of greenery were 3 times more likely to be physically active and 40% less likely to be overweight/obese. [Ellaway et al., 2005] - A Norwegian study found children�s play to be more vigorous outdoors than indoors; children who play regularly in natural areas were fitter and had better coordination, balance and agility. [Fjortoft, 2004] - The more attractive parks and urban green spaces become, the more people are likely to use them for physical activity. [CABE, 2007] - �Green� exercise can lead to a significant improvement in self-esteem and mood. [Pretty et al.,2007]

26. Virtuous circle Adapted from Claiming the Health Dividend: Unlocking the benefits of NHS spending [King�s Fund, 2002]Adapted from Claiming the Health Dividend: Unlocking the benefits of NHS spending [King�s Fund, 2002]

27. Next steps Have this discussion with: � Planners � Architects � Transport planners, and � Public health professionalsAt a national, regional and/or local level. Use the principles of sustainable development as a framework for decision making.

28. For more informationwww.sd-commission.org.uk/health