1. Rhoi gwerth ar natur Valuing Nature
Dr Llinos Haf Spencer
Dr Mary Lynch
Prof. Rhiannon Tudor Edwards
Rhoi gwerth ar natur Valuing Nature
Gwerthusiad economaidd o lefydd gwyrdd a glas
Economic evaluation of green and blue spaces

2. Teitl y gwaith ymchwil / Title of the research
Adolygiad systematig o astudiaethau gwerthuso economaidd o fannau gwyrdd a glas wrth wella iechyd y boblogaeth: Ystyriaethau methodolegol ac agenda ymchwil Geiriau allweddol: gwerthfawrogi natur, iechyd y cyhoedd, gweithgaredd corfforol, mannau gwyrdd, mannau glas, gwerthusiad economaidd
A systematic review of economic evaluation studies estimating the value of green and blue spaces in improving population health: Methodological considerations and a research agenda Keywords: economic evaluation, green spaces, blue spaces, valuing nature, public health benefits.

3. Galeri / Gallery Mary Rhiannon & Jazz Lisa & Llinos
Ger y Fenai/By the Menai Straits
Lisa & Llinos
Llanberis

4. 5 ffordd i gadw’n iach 5 ways to wellbeing
Cysylltu gydag eraill
Bod yn actif
Cymryd sylw
Dysgu
Rhoi
(Aked & Thompson Sam, 2008; Bragg, Wood, Barton, & Pretty, 2015; Pretty, Peacock, Sellens, & Griffin, 2005).
Connecting with others
Being active
Taking notice
Keep learning
Giving
(Aked & Thompson Sam, 2008; Bragg, Wood, Barton, & Pretty, 2015; Pretty, Peacock, Sellens, & Griffin, 2005).

5. Parc Penbedw / Birkenhead Park

6. Iechyd y boblogaeth / Population Health National Survey for Wales 2016-17: Population Health
Yng Nghymru
In Wales
Mae 59% o’r boblogaeth dros eu pwysau neu yn ordew.
Mae dynion yn fwy tebygol o fod dros eu pwysau na merched.
Mae’r cyfraddau o oedolion sydd dros eu pwysau neu yn ordew yn cynyddu gyda difreintiedd. Mae bod yn ordew yn fwy tebygol mewn pobl canol oed.
Mae oedolion canol oed (45-74) yn fwy tebygol o fod dros eu pwysau neu yn ordew (66 i 67%)
Mae gan ddau o bob pump oedolyn sy’n byw yng Nghymru bwysau corfforol iach (39%).
59% of the population are either overweight or obese.
Men were more likely to be overweight or obese than women.
Rates of adults who were overweight or obese increased with the level of deprivation. Obesity was most prevalent in middle age.
Middle aged adults (aged 45 to 74) were most likely to be overweight or obese (66 to 67%).
Two in five adults living in Wales were classified as having a healthy body weight (39%).

7. Mae 54% o'r boblogaeth yn cyflawni'r canllawiau a argymhellir ar gyfer gweithgaredd corfforol. Mae 32% o'r boblogaeth yn anweithgar. Mae dynion yn fwy tebygol o fod yn weithgar o'u cymharu â merched. Roedd anweithgarwch ar ei huchaf ymysg oedolion hŷn ac oedolion mewn ardaloedd mwy difreintiedig.
Ymddygiad Iechyd mewn mannau gwyrdd a glas Health behaviours- related to green and blue space National Survey for Wales : Population Health
Y cyd-destun Cymraeg
Welsh context
Mae 54% o’r boblogaeth yn dilyn y canllawiau ar gyfer iechyd corfforol.
Mae 32% o’r boblogaeth yn segur.
Mae dynion yn fwy tebygol na marched o fod yn actif.
Mae anweithgarwch ar ei uchaf ymysg oedolion sydd yn byw yn yr ardaloedd mwyaf difreintiedig.
54% of the population are achieving the recommended guidelines for physical activity.
32% of the population are inactive.
Men are more likely to be active compared with females.
Inactivity was highest among older adults and adults in more deprived areas.

8. Dangosodd 10% o oedolion lai na dau o'r pum ymddygiad ffordd iach o fyw.
Ymddygiadau byw yn iach Multiple healthy lifestyle behaviours National Survey for Wales : Population Health
Peidio ysmygu
Peidio yfed mwy na’r canllawiau
Bwyta 5 llysieuyn neu ffrwyth y diwrnod blaenorol
Bod yn actif yn gorfforol am o leiaf 150 munud yn ystod yr wythnos blaenorol
Cynnal pwysau iach/BMI
Canlyniadau
Dangosodd 10% o oedolion lai na dau o’r pum ymddygiad byw yn iach
Mae dangos dau neu fwy ymddygiad byw yn iach wedi eu cysylltu gydag oed (yn well rhwng 45 a 65 oed, ac wedyn yn gostwng)
Not Smoking
Not drinking above weekly guidelines
Eating five or more portions of fruit and vegetables the previous day
Physically active for at least 150 minutes in the previous week
Maintaining a healthy weight / body mass index
Results
10% of adults exhibited fewer than two of the five healthy lifestyle behaviours
Displaying two or more healthy lifestyle behaviours linked with age peaking at (45-65) and then decreasing

9. Y gost o beidio byw mewn ffordd iach Cost of unhealthy lifestyle behaviours
Mae cost diffyg ymarfer corff yng Nghymru tua £650 miliwn y flwyddyn (LlC,2009)
Mae gordewder yn costio tua £86 miliwn i’r Llywodraeth bob blwyddyn ac mae hyn tua 1.5% o wariant iechyd yng Nghymru (LlCC, 2011).
Mae diabetes yn costio dros 1.5 milliwn yr awr neu 10% o gyllid iechyd Cymru a Lloegr. Mae hyn yn golygu bod £25,000 yn cael ei wario ar diabetes bob munud.
Mae tua £14 billiwn yn cael ei wario bob blwyddyn ar drin diabetes a’i gymhlethdodau, gyda’r costau ar drin y cymhlethdodau yn cynrychioli y gost uchaf.
Mae nifer y pobl gydag diabetes yn debygol o godi i 4 miliwn o unigolion erbyn 2025.
Ffynhonnell: Diabetes UK:
Cost of physical inactivity to Wales is around £650 million per year (WG,2009)
Obesity is estimated to cost the NHS in Wales nearly £86 million and 1.5% of total healthcare expenditure in Wales. (WAG, 2011).
Diabetes costs the NHS is over 1.5 million an hour or 10% of the NHS budget for Wales and England and equates to over £25,000 being spent on diabetes every minute.
In total, an estimated £14 billion is spent a year on treating diabetes and its complications, with the cost of treating complications representing the higher cost.
The prevalence of diabetes is estimated to rise to 4 million individuals by 2025.
Source: Diabetes UK:

10. Strategaethau atal ffordd afiach o fyw Lifestyle prevention strategies
Mae’r DU yn gwario tua £638m ar raglenni atal gordewder.
Efallai byddai treth ar siwgr yn gallu ychwanegu £300m i £1bn y flwyddyn. Byddai hyn yn gallu cael ei ddefnyddio i ariannu ymyrriadau iechyd cyhoeddus.
Byddai 20% treth yn y DU ar ddiodydd sy’n llawn siwgr yn gallu atal 3.7 milliwn o bobl rhag fynd yn ordew dros y degawd nesaf. (O’Dowd, 2015)
Arbed 10 million y flwyddyn i’r GIG erbyn 2025.
UK spent only around £638m on obesity prevention programmes.
Estimates suggest the introduction of a sugar tax could raise £300m to £1bn a year, which could be used to fund public health measures.
20% tax in the UK on full sugar soft drinks would prevent 3.7 million people becoming obese over the next decade. (O’Dowd, 2015)
Save the NHS 10 million a year by 2025.

11. Iechyd Meddwl / Mental Health
Cyd-destun y DU Mae gan 23% o’r rhai sydd ag afiechyon yn Lloegr, broblemau iechyd meddwl. Oherwydd hyn mae Iechyd Cyhoeddus Lloegr ar hyn o bryd yn rhestru lles a iechyd meddwl fel y prif flaenorieath (Iechyd Cyhoeddus Lloegr, 2016). Cyd-destun Cymru Yng Nghymru, gyda phoblogaeth o ychydig dros 3 miliwn, cafodd 13% eu trin am gyflwr iechyd meddwl ym 2016 (Sefydliad Iechyd Meddwl, 2016). Amcangyfrifir bod cost problemau iechyd meddwl yng Nghymru yn £7.2 biliwn bob blwyddyn (Friedli & Parsonage, 2009).
UK context With mental health comprising 23% of ill- health in England, Public Health England currently lists wellbeing and mental health as its number one health priority (Public Health England, 2016). Wales context In Wales, with a population of just over 3 million, in 2016,13% of adults were treated for a mental health condition (Mental Health Foundation, 2016). The estimated cost of mental health problems in Wales is £7.2 billion annually (Friedli & Parsonage, 2009).

12. Iechyd meddwl yng Nghymru /Mental health in Wales

13. Eryri / Snowdonia

14. Cefndir / Background
Mae mannau gwyrdd a glas yn cael effaith buddiol ar iechyd corfforol, iechyd meddwl a lles poblogaeth.
Mae yna fentrau lleol i hyrwyddo gweithgaredd corfforol, nid yn unig yn y gampfa,
Mae 50% + o boblogaeth y DU yn byw o fewn awr o Barc Cenedlaethol
Nod yr astudiaeth hon yw ymchwilio i'r dystiolaeth economaidd sy'n gysylltiedig â manteision iechyd defnyddio mannau glas a glas.
Green and blue spaces have a beneficial impact on population physical health, mental health and wellbeing.
Public health and local initiatives to promote physical activity, not only in the gym,
50%+ of the population of the UK live within an hour of a National Park
The aim of this study is to investigate the economic evidence associated with the health benefits of using green and blue spaces.

15. Mannau gwyrdd a glas yng Nghymru Green and blue spaces in Wales

16. Esiampl /An example
Willis et al., (2015) – Manteision mannau gwyrdd a iechyd: QALY a CEA o raglen iechyd meddwl. Journal of Environmental Economics and Policy Canfuwyd bod yna fudd os oedd y cleifion iechyd meddwl yn mynychu o leiaf 9 o'r 12 sesiwn gweithgaredd coedwig, ond nid pe na baent yn mynychu dim ond 7 neu lai. Gweler Tabl 4.
Willis et al., (2015) – Green space and health benefits: a QALY and CEA of a mental health programme.
Journal of Environmental Economics and Policy
Found that there was a benefit if the mental health patients attended at least 9 of the 12 forest activity sessions, but not if they attended only 7 or less. See Table 4.

17. Coetir yn yr Alban A woodland in Scotland

18. Cost per QALY at £426 per user per year (£)
Tabl 4/Table 4 (Wallis et al., 2015): QALY change and cost-effectiveness
Mean QALY change
Cost per QALY at £426 per user per year (£)
Those completing pre-and post- questionnaires (n=73), attending an average of 9.55 sessions
0.0495
£8,600
All participants (n=335), attending 7.16 sessions
0.0371
£11,480

19. Nod yr ymchwil / Research goal
Aim
The aim of this study is to investigate the economic evidence associated with the health benefits of using green and blue spaces.
Objectives
To determine the body of evidence that is available on economic evaluations exploring natural environments.
To examine the health benefits of natural environments.
To explore the literature to estimate the value of access to natural environments (use and non use value) to understand the Total Economic Value (TEV) of green and blue spaces.
Nod
Nod yr astudiaeth hon yw ymchwilio i'r dystiolaeth economaidd sy'n gysylltiedig â manteision iechyd defnyddio mannau gwyrdd a mannau glas.
Amcanion
Penderfynu ar y corff o dystiolaeth sydd ar gael ar werthusiadau economaidd sy'n archwilio amgylcheddau naturiol.
Archwilio manteision iechyd amgylcheddau naturiol.
Archwilio'r llenyddiaeth i amcangyfrif gwerth mynediad at amgylcheddau naturiol (defnydd a gwerth di-ddefnydd) i ddeall Cyfanswm y Gwerth Economaidd (TEV) o fannau gwyrdd a mannau glas.

20. Methodoleg / Methodology
Mae adolygiad systematig yn unol â chanllawiau PRISMA yn cael ei gynnal.
Chwilir am erthyglau a adolygir gan gymheiriaid gan ddefnyddio cronfeydd data economaidd iechyd, craffu ar restrau cyfeirio, arbenigwyr a llenyddiaeth llwyd i ateb y cwestiynau ymchwil canlynol:
Beth yw'r dystiolaeth economaidd ar fuddion iechyd a lles mannau gwyrdd neu las?
Beth yw'r offer safonol sydd ar gael ar gyfer arfarnu ymyriadau iechyd a lles yn seiliedig ar natur?
A systematic literature search in line with PRISMA guidelines is being conducted.
Peer-reviewed articles are sought using health economic databases, scrutiny of reference lists, experts and grey literature to answer the following research questions:
What is the economic evidence on the health and wellbeing benefits of green or blue space?
What are the available standard tools for evaluating nature based health and wellbeing interventions?

21. Cynllun yr ymchwil / Research design
Review follows the University of York Centre for Research and Dissemination (York CRD) principles for conducting searches and extracting data. (Centre for Reviews and Dissemination, 2009)
PICO framework
Inclusion criteria
Time limit
Literature written in English or Welsh language
Exclusion criteria
Literature before 1970
Literature not in the English language
Grey literature
Mae'r adolygiad yn dilyn egwyddorion Canolfan Ymchwil a Lledaenu Efrog (York CRD) Prifysgol Efrog ar gyfer cynnal chwiliadau a thynnu data. (Canolfan Adolygiadau a Lledaenu, 2009)
Fframwaith PICO
Meini prawf cynhwysiant
Terfyn amser
Llenyddiaeth a ysgrifennwyd yn Saesneg neu yn Gymraeg
Meini prawf gwahardd
Llenyddiaeth cyn 1987
Llenyddiaeth ddim yn yr iaith Saesneg
Llenyddiaeth lwyd

22. Offeryn tystiolaeth / Evidence synthesis tool
Populations
Intervention
Comparison
Outcomes
Any outdoor space which may enhance wellbeing and health.
Any nature based intervention or initiative to improve health and wellbeing.
Any nature based intervention or initiative.
Any economic evaluations assessing health and wellbeing outcomes.

23. Cronfeydd data / Databases Archwiliad terfynol/ Final search
CRONFA DDATA/ DATABASE
Titles / Titles (n)
Teitlau cytunwyd arnynt/ Agreed titles (n)
PubMed 82 14
Cochrane Library 1
Science Direct
Covered by Web of Science
CINAHL
130 51
ASSIA
161 49
PsycINFO
585 98
Web of Science
614
175
NHS EED
DARE
TOTAL
1573
388

24. Canlyniada cychwynnol / Preliminary results
Mae 388 o bapurau a adolygwyd gan gymheiriaid yn cwrdd â'r meini prawf cynhwysiant a gwahardd.
Canlyniadau cynnar - mae gan leoedd gwyrdd a glas werth
Themâu sy'n dod i'r amlwg-
Manteision ar gyfer iechyd corfforol a meddyliol
Ymyriadau therapig
Effaith tirluniau gwyrdd / amgylcheddau dinesig, gwledig ac arfordirol
Gweithgareddau corfforol mewn amgylcheddau naturiol
Gwerthusiad economaidd- 11 o bapurau a adolygwyd gan gymheiriaid
Amcangyfrif gwerth WTP / QALY gwerth ariannol o nwyddau cyhoeddus.
388 peer reviewed papers meet the inclusion and exclusion criteria.
Early results- green and blue spaces have value
Emerging themes-
Benefits for physical and mental health
Theraputic interventions
Impact of green/blue landscapes urban, rural and coastal environments
Physical activities in natural environnments
Economic evaluation- 11 peer reviewed papers
Estimating the monetary value WTP/QALY’s value of public goods.

25. Ar-waith / Ongoing work
Mae'r holl bapurau perthnasol sy'n bodloni'r meini prawf cynhwysiad cychwynnol yn cael eu gwerthuso'n feirniadol am ansawdd methodolegol gan ddefnyddio rhestr wirio Rhaglen Sgiliau Arfarnu Beirniadol (CASP).
Bydd cwestiynau'r adolygiad yn cael sylw
Cynhyrchir crynodeb naratif o'r canlyniadau ar gyfer costau sy'n gysylltiedig â gwerthfawrogi natur o ran defnyddio mannau glas a gwyrdd ar gyfer buddion iechyd.
Os canfyddir astudiaethau unffurf, bydd meta-ddadansoddiadau hefyd yn cael eu cynnal.
All relevant papers meeting the initial inclusion criteria are being critically appraised for methodological quality using a Critical Appraisal Skills Programme (CASP) checklist.
The review questions will be addressed
A narrative summary of results for costs associated with valuing nature in terms of using green and blue spaces for health benefits will be produced.
If homogenous studies are found, meta-analyses will also be conducted.

26. Critical Appraisal Tools (CASP)

27. Casgliadau / Conclusions
Disgrifir offer safonol ar gyfer gwerthuso'r dystiolaeth economaidd sy'n ymwneud â mannau gwyrdd a glas a manteision iechyd mewn tablau tystiolaeth economaidd
cost-effeithiolrwydd
cost cyfleustodau
dadansoddiadau cost-budd
Budd ar ôl buddsoddiad
Budd cymdeithasol ar ôl buddsoddiad
Crëir offeryn tystiolaeth-economaidd newydd os nad oes un eisoes yn bodoli
Standard tools for evaluating the economic evidence relating to green and blue spaces and health benefits will be described in economic evidence tables
cost-effectiveness
cost utility
cost-benefit analyses
return on investment
social return on investment
A new economic-evidence tool will be created if none already exist 

28. Arfordir cymru / The Welsh coast

29. Cyfeiriadau / References
Baker, P. R. A., Francis, D. P., Soares, J., Weightman, A. L., & Foster, C. (2011). Community wide interventions for increasing physical activity ( Review ) Community wide interventions for increasing physical activity. The Cochrane Library, (4), 4–6.
Fjeldsoe, B., Neuhaus, M., Winkler, E., & Eakin, E. (2011). Systematic review of maintenance of behavior change following physical activity and dietary interventions. Health Psychology, 30(1), 99–
Friedli, L., & Parsonage, M. (2009). Promoting mental health and preventing mental illness: the economic case for investment in Wales. Retrieved from Mental Health Report (English).pdf
Hunter, R. F., Christian, H., Veitch, J., Astell-Burt, T., Hipp, J. A., & Schipperijn, J. (2015). The impact of interventions to promote physical activity in urban green space: A systematic review and recommendations for future research. Social Science and Medicine, 124, 246–
Public Health England. (2016). Briefing for local enterprise partnerships on health and work , worklessness and economic growth About Public Health England.
Willis, K., Crabtree, B., Osman, L. M., & Cathrine, K. (2016). Green space and health benefits: a QALY and CEA of a mental health programme. Journal of Environmental Economics and Policy, 5(2), 163–
Welsh Government (2017) . National Survey for Wales : Population Health – Lifestyle.
Friedli, L., & Parsonage, M. (2009). Promoting mental health and preventing mental illness: the economic case for investment in Wales. Retrieved from Mental Health Report (English).pdf
Public Health England. (2016). Briefing for local enterprise partnerships on health and work , worklessness and economic growth About Public Health England.
Willis

30. Diolch am wrando Thank you for listening

31. Anyone requiring health economics support and advice can contact WHESS using the information below
WHESS Director & North Wales             Rhiannon Tudor Edwards                
           Tel: (01248) /
South West Wales                                      Pippa Anderson                           
    Tel: (01792)
South East Wales                                       Deborah Fitzsimmons
(01792)