34 Quantifying the health and wellbeing benefits of nature Mardie Townsend Introduction Despite advancing technology, human health remains inherently dependent on ecosystems. One needs only to consider recent ‘natural’ disasters, such as floods and bushfires, including the associated loss of life and injury, to recognise this truth. Nevertheless, the predominant approach to human health continues to be the so-called ‘medical model’ – dependent largely on medical professionals and pharmacological interventions – with limited consideration of the ecosystem context, especially in developed nations. Yet a much broader definition of health was adopted in 1946 by the World Health Organisation (WHO): “A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Similarly the term ‘wellbeing’ was defined by the U.S. Centres for Disease Control (2013): “A valid population outcome measure beyond morbidity, mortality, and economic status that tells us how people perceive their life is going from their own perspective.” Taken together, these two definitions put paid to the idea that health is a purely clinical matter. The relationship between nature and health There are two key ways in which the environment affects human health: through its quality and its accessibility. But in an age when practitioners and policy makers expect claims to be substantiated by evidence before they will adopt changes, can we quantify the health benefits of ‘nature’? When the WHO states that more than 25% of the world’s disease is attributable to environmental factors, it is referring only to the quality of the environment in which people live, or more particularly to environmental degradation. For example, air pollution is responsible for approximately 3.3 million deaths per year globally, and 1.1 billion people worldwide live without access to clean water, resulting in millions dying from diarrhoeal diseases. Australian research has shown that environmental degradation is also associated with poor mental health. And climate change, through such events as heatwaves, severe storms, droughts, flooding and landslides, even at this stage is contributing to hundreds of thousands of deaths per year worldwide. The importance of the accessibility of the natural environment is less widely recognised. Yet increasingly, it is being understood that human health is undermined when we experience environmental deprivation: when we have no green spaces to enjoy, no pets or gardens to nurture, no nearby or accessible conservation areas. Since the 1980s, Wilson (1984) and others have argued that humans are dependent both physiologically and psychologically on nature and that the separation of humans from nature, associated with urban living, undermines human health and wellbeing. It causes a breakdown in the bond between people and the natural environment and results in diminished physical activity, increased obesity, Vitamin D deficiency and mental health problems. Among children, this separation from nature has been referred to by US journalist Richard Louv (2005) as “nature deficit disorder”. According to Louv, our children’s awareness of the natural environment is skewed so that they have few opportunities to build an intimate relationship with nature but at the same time are acutely aware of the global threats to the environment. Thus, their fears concerning the future are exacerbated by their lack of access to the calming influence of nature contact. The Australian context The Australian context in which this environmental deprivation is being played out is one where: • Cardiovascular disease contributes 18% of the total burden of disease; • 3 in 5 adults and 1 in 4 children are overweight or obese; • In 2007-8, 62% of adults failed to meet the national physical activity guidelines; • Medibank Private estimated that, in 2008, physical inactivity in Australia was costing $13.8 billion annually; • Diabetes is on the rise, with an estimated 3.3 million Australians predicted to suffer Type 2 diabetes by 2031; • 45% of Australians aged 16-85 have experienced a mental disorder; and • Annual mental illness costs in Australia have been estimated at $20 billion. Section 2. Perspectives on natural systems
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Quantifying the health and wellbeing benefits of nature Mardie Townsend
IntroductionDespite advancing technology, human health remains inherently dependent on ecosystems. One needs only to consider recent ‘natural’ disasters, such as floods and bushfires, including the associated loss of life and injury, to recognise this truth.
Nevertheless, the predominant approach to human health continues to be the so-called ‘medical model’ – dependent largely on medical professionals and pharmacological interventions – with limited consideration of the ecosystem context, especially in developed nations. Yet a much broader definition of health was adopted in 1946 by the World Health Organisation (WHO):
“A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
Similarly the term ‘wellbeing’ was defined by the U.S. Centres for Disease Control (2013):
“A valid population outcome measure beyond morbidity, mortality, and economic status that tells us how people perceive their life is going from their own perspective.”
Taken together, these two definitions put paid to the idea that health is a purely clinical matter.
The relationship between nature and healthThere are two key ways in which the environment affects human health: through its quality and its accessibility. But in an age when practitioners and policy makers expect claims to be substantiated by evidence before they will adopt changes, can we quantify the health benefits of ‘nature’?
When the WHO states that more than 25% of the world’s disease is attributable to environmental factors, it is referring only to the quality of the environment in which people live, or more particularly to environmental degradation. For example, air pollution is responsible for approximately 3.3 million deaths per year globally, and 1.1 billion people worldwide live without access to clean water, resulting in millions dying from diarrhoeal diseases. Australian research has shown that environmental degradation is also associated with poor mental health. And climate change, through such events as heatwaves, severe storms, droughts, flooding and landslides, even at this stage is contributing to hundreds of thousands of deaths per year worldwide.
The importance of the accessibility of the natural environment is less widely recognised. Yet increasingly, it is being understood that human health is undermined when we experience environmental deprivation: when we have no green spaces to enjoy, no pets or gardens to nurture, no nearby or accessible conservation areas. Since the 1980s, Wilson (1984) and others have argued that humans are dependent both physiologically and psychologically on nature and that the separation of humans from nature, associated with urban living, undermines human health and wellbeing. It causes a breakdown in the bond between people and the natural environment and results in diminished physical activity, increased obesity, Vitamin D deficiency and mental health problems. Among children, this separation from nature has been referred to by US journalist Richard Louv (2005) as “nature deficit disorder”. According to Louv, our children’s awareness of the natural environment is skewed so that they have few opportunities to build an intimate relationship with nature but at the same time are acutely aware of the global threats to the environment. Thus, their fears concerning the future are exacerbated by their lack of access to the calming influence of nature contact.
The Australian contextThe Australian context in which this environmental deprivation is being played out is one where:
• Cardiovascular disease contributes 18% of the total burden of disease;
• 3 in 5 adults and 1 in 4 children are overweight or obese;
• In 2007-8, 62% of adults failed to meet the national physical activity guidelines;
• Medibank Private estimated that, in 2008, physical inactivity in Australia was costing $13.8 billion annually;
• Diabetes is on the rise, with an estimated 3.3 million Australians predicted to suffer Type 2 diabetes by 2031;
• 45% of Australians aged 16-85 have experienced a mental disorder; and
• Annual mental illness costs in Australia have been estimated at $20 billion.
Section 2. Perspectives on natural systems
Valuing Nature | Protected Areas and Ecosystem Services 35There is substantial evidence that contact with the natural world may be directly beneficial to both mental and physical health. Photo: © Penelope Figgis
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Evidence quantifying the health and wellbeing benefits of natureAgainst this worrying trajectory of health indicators the evidence is clear that access to quality public open space (which is a key way in which people gain access to nature) is associated with increased physical activity, reduced obesity and improved mental health. For example, a study in Western Australia found that recreational walking increased by 17.6 minutes each week for each type of additional recreational destination (Giles-Corti et al., 2013). Similarly, Australian research has shown that the likelihood of obesity is 22% lower in areas classified as having high greenness (Pereira et al., 2013). Dutch research has shown that even an increase in streetscape greenery is associated with better perceived health, fewer acute health-related complaints and better mental health status (De Vries et al., 2013). In New Zealand, research has shown an association between access to green space and the need for treatment for anxiety and mood disorders, with a 4% reduction in treatment for every 1% increase in useable or total green space (Nutsford et al., 2013). And many studies, including of at-risk adolescents and those experiencing post-traumatic stress disorder, such as military veterans, have shown beneficial mental health outcomes of extended engagement in ‘wilderness’ activities.
Quantifying the health and wellbeing benefits of natureIt is clear from existing evidence that nature contact, whether via urban parks, gardens or more remote and pristine areas, is beneficial for human health – physically, mentally, socially, spiritually. However, at a time when governments are increasingly driven by $ values and empirical data, there is a need for more research to provide clear, quantitative data on the ‘value’ of parks and protected areas.
While it is not simple to ascribe values to the health benefits of protected areas and ecosystems, there are a number of potential measures which can be used to quantify the benefits. These include: avoided health care costs, Disability Adjusted Life years (DALYs), Willingness-to-Pay (WTP), cost-benefit analysis and Health Impact Assessment (HIA). Both DALYs and WTP have been used to demonstrate clear links between environmental degradation and health, so it is plausible that they could also be used to assess the impacts of environmental deprivation. But whatever methodology we use, we need to be cautious, both about the claims we make and about how they may be used by others. We need to ensure that both the intrinsic and the instrumental value of nature is acknowledged and protected.
©Photo: J Fitzsimons
Valuing Nature | Protected Areas and Ecosystem Services 37
References Centers for Disease Control and Prevention (2013). Well-being concepts. Health-Related Quality of Life (HRQOL). Available at: http://www.cdc.gov/hrqol/wellbeing.htm [Accessed 25th August 2014].
de Vries, S., van Dillen, S.M.E., Groenewegen, P.P. and Spreeuwenberg, P. (2013). Streetscape greenery and health: Stress, social cohesion and physical activity as mediators. Social Science & Medicine 94, 26-33.
Giles-Corti, B., Bull, F., Knuiman, M., McCormack, G., Van Niel, K., Timperio, A., Christian, H., Foster, S., Divitini, M., Middleton, N. and Boruff, B. (2013). The influence of urban design on neighbourhood walking following residential relocation: Longitudinal results from the RESIDE study. Social Science & Medicine 77, 20-30.
Louv, R. (2005). Last Child in the Woods: Saving Our Children from Nature-Deficit Disorder, Algonquin Books of Chapel Hill. Chapel Hill, North Carolina.
Nutsford, D., Pearson, A.L. and Kingham, S. (2013). An ecological study investigating the association between access to urban green space and mental health. Public Health 127, 1005-1011.
Pereira, G., Christian, H., Foster, S., Boruff, B., Bull, F., Knuiman, M. and Giles-Corti, B. (2013). The association between neighbourhood greenness and weight status: an observational study in Perth Western Australia. Environmental Health 12, 49.
Wilson, E.O. (1984). Biophilia. Harvard University Press, Cambridge, Mass. World Health Organization (1946). Constitution of the World Health Organization, World Health Organization, New York.
Linkshttp://parkweb.vic.gov.au/__data/assets/pdf_file/0018/313821/HPHP-deakin-literature-review.pdf
https://www.deakin.edu.au/health/hsd/research/niche/hns/document/Beyond-Blue-To-Green-Literature-Review.pdf
Mardie TownsendHonorary Associate Professor Mardie Townsend Health, Nature and Sustainability Research Group, School of Health and Social Development, Deakin University 221 Burwood Highway, Burwood VIC 3125, Australia.
Dr Mardie Townsend is an Honorary Associate Professor in the School of Health and Social Development at Deakin University, Melbourne, where her research interests focus on the health impacts of human contact with the ‘natural’ environment, and of ecological and social sustainability. With Parks Victoria and other organisations, Mardie leads research on such topics as: the motivations for and benefits of environmental volunteering; the use of nature-based therapies; the role of parks and green spaces in promoting wellbeing; and the mental health benefits of contact with nature.
Cape Pillar. Photo: © Parks Tasmania
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