1. The research centre for inclusive access to outdoor environments Edinburgh College of Art/Heriot-Watt University

2. OPENspace is concerned with access to the outdoor environment for everyone: for disabled people, for people from ethnic minorities, for children and their carers, for older people and for economically or socially disadvantaged groups. 2

3. Health and Outdoor Environments Some fundamental questions we are interested in exploring: Are there any measurable health benefits associated with 'natural' environments? If so, is looking at images of them (or even just thinking about them) as beneficial as looking at the real thing from a window or actually being in the natural environment? How much nature is 'enough' to get a benefit? 3

4. Health and Outdoor Environments More fundamental questions we are interested in exploring: Are there any measurable health benefits to being (and doing things) outdoors rather than indoors? If so, what qualities of the outdoor environment are associated (best correlated) with health benefits? 4

5. Can ‘nature’ affect clinical outcomes? Comparing recovery records of gall bladder surgery patients with different bedside views (Ulrich, 1984) 5 Bedside view of trees Shorter hospital stays Fewer minor post-op complications Fewer doses of strong narcotic pain dugs needed More positive outlook (based on staff evaluation notes) Bedside view of brick wall Longer hospital stays More minor complications (e.g. persistent headaches, nausea) Needed more doses of narcotic pain drugs More negative outlook (based on staff evaluation notes)

6. Contributory Factors to General Well-being Mental Health Physical Health Spiritual Health Social Well Being 6

7. Phase 1 Subjects watched a 10-minute film on the prevention of workplace accidents, which showed distressing scenes of (simulated) injury. Phase 2 Subjects were told to imagine they were relaxing while looking at the environment on a film of: traffic pedestrian mall nature Stress Recovery Experiment R.Ulrich, 1991 7

8. 8 From Ulrich 1991: Change in skin conductance during stress and recovery

9. 9 From Ulrich 1991: Change in pulse transit time during stress and recovery

10. 10 From Ulrich 1991: Change in muscle tension during stress and recovery

11. Hospital Study-NHS Journal, 2000 Two groups of patients in a) orthopaedic and b) psychiatric wards moved to newly refurbished units Old wards compared with New wards Same treatment regimes/ same staff Questionnaires to patients leaving hospital Focus groups with staff Medication levels/length of stay 11

12. Results - NHS Journal, 2000 Patients on newer wards rated the environment, their treatment and the staff more positively 12 Orthopaedic Unit surgery - same length stay non-surgery - shorter stay in hospital fewer analgesics - in number and dosage for class A drugs (morphine) slight increase in lower level pain-killing drugs Psychiatric Unit Shorter Stays (14% reduction) Less time in intensive care Fewer threats/outbursts Better progress -79% v 60% made good progress

13. Healthy Outdoor Exercise Walking the way to Health Initiative (WHI) of British Heart Foundation and Countryside Agency (started 2000. 50% of people participating in an exercise gym scheme drop out after 6 months The reason cited by 80% of cardiovascular patients for staying with the pilot walk programme was “being in the countryside or a green space” “It could be argued that the natural environment has a competitive edge in exercise promotion as it leads to better adherence” (WHI Regional Case Officer, 2002) 13

14. Areas of potential interest 1 Exercise, health and the environment –outdoor activity versus indoor activity –embodied experiences of exercising outdoors Stress and therapeutic environments –exercise –recreational activity –therapeutic environments 14

15. Areas of potential interest 2 Patient recovery and the environment –rehabilitation treatment of mental health patients –convalescence of hospital based patients Prescriptive measures and well-being –exercise as an alternative to medication /hospitalisation for specific health problems –exercise and outdoor activities as a preventative measure to sustain good health 15

16. Does the environment matter? Environment Quantitative Air Quality Ventilation/wind speed Temperature Sound levels Illuminance Qualitative Light - sunshine/shade/cloud Colour/Texture/Materials Sounds (cars, birdsong) Space/design Nature - plant materials etc Interactive PrivacyControl People Behaviour Recovery rates Number analgesics taken Performance/actions/tasks Psychological Preferences Perceptions Moods Satisfactions Physiological Heart rate/pulse rate/GSR 16

17. Why might you want to collaborate with us? We have experience in eliciting people’s responses to outdoor environments in ways that take into account the multivariate nature of such places We have experience of the processes involved in design, management and analysis of outdoor places Why might we want to collaborate with you? We want to study subjects in different (well-defined) prior states of health We want assistance to identify and apply appropriate measures of health benefit associated with being in different environments We want to produce a robust experimental design 17