Director of Public Health Annual Report 2018: Healthy places

There is a strong body of evidence that shows that being in contact with the natural environment is vital for our mental wellbeing and physical health at all ages. People with access to good quality green space have better mental and physical health and every 10% increase in green space is associated with a reduction in disease equivalent to a gain of 5 years of life.

The natural environment also helps mitigate some of the threats to our health from air pollution, noise pollution and extreme weather events including heat waves and flooding and provides a host of social and economic benefits. Green space and views of green space encourage social connections in communities, helps children concentrate at school and helps people recover more quickly in hospital. Many studies have shown the importance of incorporating green spaces into the design of towns, cities and housing developments.

People with access to good quality green space have better self-rated health and are less likely to be overweight and obese. Natural landscaping and surroundings have been shown to positively influence people’s attitudes and motivations to be physically active and as a result people living near green spaces are more likely to be physically active with all the benefits that being active provides.

Living within 500m of green spaces increases the likelihood of doing at least 30 minutes of physical activity per day. The creation or improvement of a park or open space leads to an increase in local peoples’ activity levels by up to 48%.

People also make more walking trips to local amenities such as shops and cafes when they perceive there are many natural features along the route including roadside trees. In less green neighbourhoods people judge distances to be further than they are which may discourage walking.

Undertaking physical activity in green spaces appears to offer additional health benefits compared to physical activity in indoor settings, with a greater positive effect on mental health. Experiments have shown walking in natural environments results in an increase in positive emotions and a fall in blood pressure. For people with depression, exercising in the natural environment has been associated with greater feelings of positivity, increased energy and decreases in tension, confusion, anger and depression compared to exercising indoors.

The strong positive impact that exposure to green spaces has on people’s mental wellbeing and mental health extends beyond just doing exercise outdoors. Clinical studies have shown that within 5 minutes of viewing a nature setting, positive changes occur in blood pressure, heart rate, muscle tension and brain activity.

Caring for natural landscapes has been shown to improve self-reported health and depressive symptoms. Exposure to green spaces reduces stress levels and depression, especially in more deprived communities.

Studies have also shown that areas with higher amounts of green space have lower levels of hospital admissions for mental health conditions, even after adjusting for other factors such as how urbanised an area is and the level of deprivation. Furthermore, when people do become unwell, being close to or having a view of greenery can help with recovery. Patients in hospital recovering from surgery have a shorter recovery time, reduced need for pain medication and lower anxiety if they can look out over green and open spaces.

Buckinghamshire has over 43 hectares of open access land and a Right of Way network that spans over 3300km.

There are 1270km of promoted recreational routes across Bucks.

The ability to participate in safe outdoor play is one of the most important benefits of green spaces for young people. It helps their physical and social development and keeps them healthy. Open spaces enable children to play freely and develop their imagination and creativity and interact with the natural environment. Play enables children to socialise and meet others from different backgrounds, contributing to a strong sense of community and helping to foster community cohesion.

Green spaces encourage children to be more physically active with benefits for their health. Parks with shaded areas have been shown to increase teenage girls’ activity levels and girls’ activity levels more than doubled in areas conducive to walking.

Studies show that children living in deprived areas with more green spaces were less likely to be overweight and obese than children living in comparable areas with less green space.

Exposure to green spaces within and around schools is also good for children’s learning, improving their levels of attention and educational attainment. Travelling to school via green routes has also been linked to better memory and attention.

Green spaces also might be important at the very start of life. Pregnant women who live closer to green spaces have lower risk of low birthweight babies. For every 10% increase in green space within 100m of the home, there is an increase of up to 436g in average baby weight. The effect is greater among women with lower levels of education. The effect also extends to green space that is further from the home. Having more green space within 500m of the home still has an important positive impact on birth weight.

Living close to green and open spaces is particularly important for older people, reflecting the fact that they spend a larger proportion of their time in their local neighbourhood compared to other age groups.

Research has shown that older people who lived near parks, tree-lined streets and spaces for taking walks showed greater longevity over a 5 year period and that walking in natural surroundings can boost immunity, lower stress indicators and reduced depression.

Studies have also shown the benefits of gardening for healthy ageing. Physical health was better and perceived stress levels decreased significantly among those aged 50-88 years who maintained a community garden plot compared to those who exercised indoors.

The benefits of green space are also seen for people with dementia where access to gardens improves socialisation and sleep, reduced agitation and aggression and the risk of experiencing injuries. Quality of life measures for people with dementia, their families and staff appear to improve at long term care facilities with therapeutic gardens.

Well-designed environments can encourage social interaction and facilitate the building of well- connected communities. Good natural landscaping encourages greater use of outdoor areas by residents and well managed green common spaces are very important in promoting the development of social ties in housing developments. Studies have shown that more social activities occurred in green common spaces than treeless spaces of the same size. Older adults who have more exposure to green common spaces report a stronger sense of unity among residents and a stronger sense of belonging to the neighbourhood. There is less graffiti, vandalism and littering in outdoor spaces with natural landscapes than in comparable plant- less spaces and residents in these areas also report fewer acts of domestic aggression, property crime and violence.

Natural landscaping can help mitigate the threats to our health from air and noise pollution, flooding and heat waves. Urban greening is the process of landscaping developed areas to incorporate green infrastructure such as trees, green walls, green roofs and drainage measures.

Climate change is bringing more extreme weather events such as the heat wave that resulted in an extra 35,000 deaths across Europe in 2003.

The risk to health of heat waves is particularly marked in urban areas which are prone to the ‘urban heat island’ effect - a phenomenon where built up areas absorb and trap heat meaning temperatures can be as much as 5° Celsius higher than rural surroundings.

The urban heat island effect can be mitigated by urban greening, using green roofs, green walls, living architecture and tree lined streets. Trees can help reduce the urban heat island effect and reduce air temperatures by 1-2° Celsius.

The lower temperatures can reduce the risk of heat exhaustion, which is especially a risk in vulnerable populations such as the very young and older people. The shading effect of trees around buildings has also been estimated to reduce heating and cooling costs by 20% and use of air conditioning by up to 30% thus helping save costs, energy and reducing greenhouse gases. Green roofs also improve the energy efficiency of homes by offering additional insulation. Installing a green roof can reduce the need for cooling in the summer as temperatures under a green roof are up to 15°C cooler in summer. In winter temperatures under a green roof are 4.5°C warmer, reducing the need for heating. For older people, this can help with winter warmth and avoid fuel poverty.

Urban environments are also more at risk of flooding, due to surface run-off from paved over areas. Street trees are able to absorb up to 60% of rain water, with mature trees soaking up between 50 and 100 gallons of rainwater during a storm. This reduces surface run-off and acts as a flood prevention measure. Green roofs offer similar flood protection as they can absorb up to 90% of rainwater. Rainwater absorbed by trees and green roofs is then released gradually, reducing the risk of flooding.

Urban greening is an effective strategy to improve health by improving air quality and reducing levels of noise pollution. Whilst all trees and greenery absorb air pollutants, the effect is greatest in built up areas where pollution is highest. The traffic on our streets and roads contributes to approximately 50% of air pollutants, with the highest levels in built up areas. Urban trees and greenery are able to improve air quality by absorbing airborne particulates and can cut pollution from fine particulate matter by as much as 25%.

It is not only air pollution that urban greening can improve. The insulation properties of green roofs extend to noise insulation, with some green roofs able to reduce noise in the home from external sounds by up to half. Living on a street with trees can also help to reduce the level noise pollution by creating a natural sound barrier.

It is estimated that the direct health impact of noise pollution costs the UK economy over £1 billion per year. Noise pollution is associated with poor sleep and stress, increased blood pressure and increased risk of conditions such as heart attack, stroke and dementia. Children exposed to noise have poorer concentration and for every 5 decibel increase in average noise that children are exposed to, reading age decreases by two months.

In addition to the benefits described above in relation to reducing impacts of heat events, flooding and noise, residents living in areas with trees have a stronger sense of community and experience less crime and have a greater life expectancy. Living on a street with 10 extra trees improves happiness to the same extent as being seven years younger.

Residents living in housing with nearby trees and greenery have been shown to be more able to cope with major life events compared to those living in homes with more barren surroundings e.g. surrounded by concrete. Green walls also offer the opportunity to provide greenery in very small spaces, using vertical surfaces to grow plants. Green walls can also be effective ways of bringing the natural environment into indoor spaces, offering the benefits to people whilst they are inside. Having greenery indoors in hospitals and schools can improve recovery times for patients and reduce symptoms from conditions such as attention deficit and hyperactivity disorder among children.

The visual impact of green walls in public places can lower blood pressure, reduce stress and promote physical activity through creating an alluring and inviting environment. Green walls and greenery in workplaces has been linked to increased productivity, reduce common symptoms such as cough and tiredness and has been linked to improving health and food literacy.

Urban greening can also offer benefits to employees, employers and the economy. Studies have shown that having views of nearby nature can improve worker productivity and reduce stress and potentially reduce sickness absence.