Green Space, Health and Well-being: A Review Ronald Macfarlane Manager, Healthy Public Policy The Ontario Public Health Conference Pre-conference Workshop 24 March 2015, Toronto

Acknowledgements  Tara Zupancic, Habitus Research  Marianne Kingsley, Toronto Public Health  Timothy Jason, Living Research  Paul LeBel, Parralax Communications  EcoHealth Collaborative partners:  York Public Health Unit  Simcoe Muskoka Public Health Unit  David Suzuki Foundation  Toronto Region Conservation Authority  Credit Valley Conservation Authority  Ontario Health Agency for Protection and Promotion

Built Environment & Health: Air Quality  Air quality in Toronto has improved, but it is still an important contributor to ill health  Impact of air pollution in Toronto  1,300 premature deaths, and  3,550 hospitalizations per year (TPH 2014)  Transportation is the major source of air pollution

Built Environment & Health: Physical Activity  Physical inactivity and obesity are risk factors for many chronic diseases  About 45% of the Toronto adult population were overweight or obese in 2012  51% of Toronto adults were moderately active or higher during leisure time and transportation in 2012  People on lower income are less active (TPH 2013)

Built Environment & Health: Mental Health  Growing recognition of the burden on society due to poor mental health  The overall burden of mental illness and addictions is more than 1.5 times that of all cancers and more than seven times that of all infectious diseases (ICES 2012)

Built Environment & Health: Challenges  Increasing urbanisation and urban sprawl  Increasing pressures on green space  A changing climate

Improving the Built Environment  Promote cycling, walking and transit  Promote a built form that supports active living  Mixed use  Connectivity  Density  Build resilience to climate change

Question  Does green space play a role in maintaining health in a more dense and growing city?  What are the characteristics of green space that are important for health?

What is green space?  Green space in urban and peri- urban areas include:  Natural areas  Parks  Community gardens  Playgrounds  Street trees  Front and back yards

Views of nature  Ulrich (1984):  Patients with the tree view had shorter postoperative hospital stays and fewer post-operative complications  The role of nature in healing has influenced design of health-care facilities Source: Ulrich (1984)

Summary of findings  106 studies published since 2000 included in the review  2 of 3 studies found lower all-cause mortality with higher green space  1 of 2 studies found lower morbidity with higher green space  7 of 9 reported better general health with higher green space

Green Space and Well-being  28 of 39 studies showed improved well-being with more green space  Mental health (26 studies showed a positive association)  Frequent access to even small neighbourhood green space  Reduces stress and anxiety (19/23 +ve)  Increases social support

Green Space and Physical Activity  Physical Activity (17 studies)  Some evidence to suggest increased green space is associated with increased physical activity  Overall findings have been mixed  Some evidence of a positive benefit of a walk or run in a natural environment  Improved self-esteem and mood Shutterstock:bikeriderlondo n

Other Health Outcomes & Green Space  Green space may also have a positive impact on:  Healthy weights (11/22 +ve)  ADD/ADHD (3/3 +ve)  Cardiovascular health (3/5 +ve)  Respiratory health (1/2 +ve)  Birth outcomes (8/8 +ve) Courtesy of Jesse Colin Jackson Source: Jesse Colin Jackson

Green Space and Equity  Nearby green space may offer greater health benefits in low- income, high-density neighbourhoods

Quality of Green Space  It is not only the amount, but also the quality, of green space that is important for health

Negative Impacts of Green Space  Few studies address the link between green space and adverse health outcomes  Asthma  Pollen allergies  Poisonous plants found in natural areas  Contact dermatitis  Ingestion Wikimedia Commons

Conclusions  The overall strength of evidence related to the impacts of green space on health is weak to moderate  Small and large green spaces are of value  Good maintenance of green spaces increases their beneficial health impacts  The association between green space and better health is likely stronger for disadvantaged populations

Thank you