scispace - formally typeset
Open accessJournal ArticleDOI: 10.3390/IJERPH18052563

Green Space and Health Equity: A Systematic Review on the Potential of Green Space to Reduce Health Disparities.

04 Mar 2021-International Journal of Environmental Research and Public Health (MDPI AG)-Vol. 18, Iss: 5, pp 2563
Abstract: Disadvantaged groups worldwide, such as low-income and racially/ethnically minoritized people, experience worse health outcomes than more privileged groups, including wealthier and white people. Such health disparities are a major public health issue in several countries around the world. In this systematic review, we examine whether green space shows stronger associations with physical health for disadvantaged groups than for privileged groups. We hypothesize that disadvantaged groups have stronger protective effects from green space because of their greater dependency on proximate green space, as they tend to lack access to other health-promoting resources. We use the preferred reporting items for systematic reviews and meta-analyses (PRISMA) method and search five databases (CINAHL, Cochrane, PubMed, Scopus, and Web of Science) to look for articles that examine whether socioeconomic status (SES) or race/ethnicity modify the green space-health associations. Based on this search, we identify 90 articles meeting our inclusion criteria. We find lower-SES people show more beneficial effects than affluent people, particularly when concerning public green spaces/parks rather than green land covers/greenness. Studies in Europe show stronger protective effects for lower-SES people versus higher-SES people than do studies in North America. We find no notable differences in the protective effects of green space between racial/ethnic groups. Collectively, these results suggest green space might be a tool to advance health equity and provide ways forward for urban planners, parks managers, and public health professionals to address health disparities.

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Topics: Health equity (61%), Public health (55%), Disadvantaged (54%) ... read more
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Open accessJournal ArticleDOI: 10.3390/IJERPH18094790
Abstract: There is extensive empirical literature on the association between exposure to nature and health. In this narrative review, we discuss the strength of evidence from recent (i.e., the last decade) experimental and observational studies on nature exposure and health, highlighting research on children and youth where possible. We found evidence for associations between nature exposure and improved cognitive function, brain activity, blood pressure, mental health, physical activity, and sleep. Results from experimental studies provide evidence of protective effects of exposure to natural environments on mental health outcomes and cognitive function. Cross-sectional observational studies provide evidence of positive associations between nature exposure and increased levels of physical activity and decreased risk of cardiovascular disease, and longitudinal observational studies are beginning to assess long-term effects of nature exposure on depression, anxiety, cognitive function, and chronic disease. Limitations of current knowledge include inconsistent measures of exposure to nature, the impacts of the type and quality of green space, and health effects of duration and frequency of exposure. Future directions include incorporation of more rigorous study designs, investigation of the underlying mechanisms of the association between green space and health, advancement of exposure assessment, and evaluation of sensitive periods in the early life-course.

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Topics: Exposure assessment (52%), Mental health (51%)

6 Citations


Open accessJournal ArticleDOI: 10.1289/EHP8888
Howard Frumkin1Institutions (1)
Abstract: Background: Since the dawn of cities, the built environment has both affected infectious disease transmission and evolved in response to infectious diseases. COVID-19 illustrates both dynamics. The...

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5 Citations


Open accessJournal ArticleDOI: 10.1016/J.TRD.2021.103095
Dongsheng He1, Dongsheng He2, Yi Lu3, Bo Xie2  +1 moreInstitutions (4)
Abstract: Extensive evidence from cross-sectional studies has revealed a positive link between greenspace access and walking behaviors. However, the inherent weaknesses of the cross-sectional research design have provided little causal inference. In this natural experimental study, we assessed the effects of a large-scale greenway intervention (i.e., the opening of East Lake greenway) on walking behaviors in Wuhan, China. Longitudinal survey data on 1,020 participants were collected before and after the intervention in 2016 and 2019, respectively. The results of the mixed-effect difference-in-difference (DID) models showed that the greenway intervention had a significantly positive effect on the walking time, especially for residents living within two kilometers from the greenway. Furthermore, women and socio-economically disadvantaged people benefited most from the greenway implementation regarding walking time. Our findings provided compelling evidence that public investment in transportation infrastructure (e.g., greenway) effectively promotes walking behaviors and mitigates social inequities in physical activity.

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2 Citations


Open accessJournal ArticleDOI: 10.1016/J.LANDURBPLAN.2021.104233
Abstract: Greenspace in urban areas may have greater protective health effects than elsewhere. Urban dwellers experience more environmental harmful exposures, attentional demands, and stressors than their suburban/rural counterparts. In this systematic review, we synthesize the results of studies that examined how the greenspace and health relationship varies by urbanicity. We searched for articles in April 2019 that found positive associations between greenspace and physical health. Included articles tested for effect modification by urbanicity among one or more (of eight total) outcomes relevant to health and environmental equity. We coded results as 1 = stronger association in more urban areas, −1 = stronger association in less urban areas, or 0 = no difference. We found 57 analyses in 37 articles that met our inclusion criteria. Among these analyses, 50.9% showed no difference, 38.6% showed a stronger association for more urban areas, and 10.5% showed a stronger association for less urban areas. More urban areas had stronger associations for cardiovascular-related, birth, and mortality outcomes and for greenspace measured within 500 m. Stronger greenspace-health associations in more urban areas might be explained in part by the mechanistic pathways underlying these associations. Greenspace can reduce harms from environmental exposures (i.e., air pollution, noise, heat, and artificial light at night) in addition to alleviating attentional demands, reducing chronic stressors, and promoting healthy behavior - factors which might be more necessary, prevalent, or stronger in urban areas. These potential explanations warrant further investigation. The findings of this review inform public health policy and planning professionals who are attempting to make cities livable for all residents.

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2 Citations


Open accessJournal ArticleDOI: 10.1016/S2542-5196(21)00229-1
Abstract: Summary Background Natural outdoor environments including green spaces play an important role in preserving population health and wellbeing in cities, but the number of deaths that could be prevented by increasing green space in European cities is not known. We aimed to estimate the number of natural-cause deaths among adult residents that could be prevented in cities in 31 European countries, if the WHO recommendation for universal access to green space was achieved. Methods In this health impact assessment study we focused on adult residents (aged ≥20 years; n=169 134 322) in 978 cities and 49 greater cities, in 31 European countries. We used two green space proxies: normalised difference vegetation index (NDVI), and percentage of green area (%GA). The exposure was estimated at a fine grid-cell level (250 m × 250 m) and the preventable mortality burden for 2015 was estimated at the local city-level. Findings For 2015 we found that meeting the WHO recommendation of access to green space could prevent 42 968 (95% CI 32 296–64 177) deaths annually using the NDVI proxy (ie, 20% [95% CI 15–30] of deaths per 100 000 inhabitants-year), which represents 2·3% (95% CI 1·7–3·4) of the total natural-cause mortality and 245 (95% CI 184–366) years of life lost per 100 000 inhabitants-year. For the %GA proxy 17 947 (95%CI 0–35 747) deaths could be prevented annually. For %GA the number of attributable deaths were half of that of the NDVI and results were non-significant due to the exposure response function considered. The distribution of NDVI and %GA varied between cities and was not equally distributed within cities. Among European capitals, Athens, Brussels, Budapest, Copenhagen, and Riga showed some of the highest mortality burdens due to the lack of green space. The main source of uncertainty for our results was the choice of the age-structures of the population for the NDVI analysis, and exposure-response function for the %GA analysis. Interpretation A large number of premature deaths in European cities could be prevented by increasing exposure to green space, while contributing to sustainable, liveable and healthy cities. Funding GoGreenRoutes, Internal ISGlobal fund, and the United States Department of Agriculture Forest Service.

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1 Citations


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Open accessJournal ArticleDOI: 10.1371/JOURNAL.PMED.1000097
David Moher1, David Moher2, Alessandro Liberati3, Jennifer Tetzlaff1  +1 moreInstitutions (4)
21 Jul 2009-PLOS Medicine
Abstract: David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses

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Topics: Systematic review (53%)

53,418 Citations


Open accessJournal ArticleDOI: 10.1016/S0140-6736(08)61690-6
Michael Marmot1, Sharon Friel1, Ruth Bell1, Tanja A. J. Houweling1  +1 moreInstitutions (1)
08 Nov 2008-The Lancet
Abstract: The Commission on Social Determinants of Health, created to marshal the evidence on what can be done to promote health equity and to foster a global movement to achieve it, is a global collaboration of policy makers, researchers, and civil society, led by commissioners with a unique blend of political, academic, and advocacy experience. The focus of attention is on countries at all levels of income and development. The commission launched its final report on August 28, 2008. This paper summarises the key findings and recommendations; the full list is in the final report.

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Topics: Social determinants of health (62%), Health equity (58%), Social equality (56%) ... read more

6,783 Citations


Open accessJournal ArticleDOI: 10.1016/J.LANDURBPLAN.2014.01.017
Abstract: a b s t r a c t Urban green space, such as parks, forests, green roofs, streams, and community gardens, provides crit- ical ecosystem services Green space also promotes physical activity, psychological well-being, and the general public health of urban residents This paper reviews the Anglo-American literature on urban green space, especially parks, and compares efforts to green US and Chinese cities Most studies reveal that the distribution of such space often disproportionately benefits predominantly White and more affluent communities Access to green space is therefore increasingly recognized as an environmental justice issue Many US cities have implemented strategies to increase the supply of urban green space, especially in park-poor neighborhoods Strategies include greening of remnant urban land and reuse of obsolete or underutilized transportation infrastructure Similar strategies are being employed in Chinese cities where there is more state control of land supply but similar market incentives for urban greening In both contexts, however, urban green space strategies may be paradoxical: while the creation of new green space to address environmental justice problems can make neighborhoods healthier and more esthetically attractive, it also can increase housing costs and property values Ultimately, this can lead to gentrification and a displacement of the very residents the green space strategies were designed to ben- efit Urban planners, designers, and ecologists, therefore, need to focus on urban green space strategies that are 'just green enough' and that explicitly protect social as well as ecological sustainability © 2014 Elsevier BV All rights reserved

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Topics: Green economy (61%), Urban planning (61%), Urban density (59%) ... read more

1,773 Citations


Journal ArticleDOI: 10.2190/986L-LHQ6-2VTE-YRRN
Abstract: In 1984, the 32 member states of the World Health Organization European Region took a remarkable step forward in agreeing unanimously on 38 targets for a common health policy for the Region. Not only was equity the subject of the first of these targets, but it was also seen as a fundamental theme running right through the policy as a whole. However, equity can mean different things to different people. This article looks at the concepts and principles of equity as understood in the context of the World Health Organization's Health for All policy. After considering the possible causes of the differences in health observed in populations--some of them inevitable and some unnecessary and unfair--the author discusses equity in relation to health care, concentrating on issues of access to care, utilization, and quality. Lastly, seven principles for action are outlined, stemming from these concepts, to be borne in mind when designing or implementing policies, so that greater equity in health and health care can be promoted.

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Topics: Health policy (66%), Social determinants of health (64%), Health care (63%) ... read more

1,600 Citations


Open accessJournal ArticleDOI: 10.1146/ANNUREV-PUBLHEALTH-032013-182443
Abstract: Urbanization, resource exploitation, and lifestyle changes have diminished possibilities for human contact with nature in many societies. Concern about the loss has helped motivate research on the health benefits of contact with nature. Reviewing that research here, we focus on nature as represented by aspects of the physical environment relevant to planning, design, and policy measures that serve broad segments of urbanized societies. We discuss difficulties in defining “nature” and reasons for the current expansion of the research field, and we assess available reviews. We then consider research on pathways between nature and health involving air quality, physical activity, social cohesion, and stress reduction. Finally, we discuss methodological issues and priorities for future research. The extant research does describe an array of benefits of contact with nature, and evidence regarding some benefits is strong; however, some findings indicate caution is needed in applying beliefs about those benefits,...

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Topics: Nature connectedness (56%), Green exercise (53%)

1,479 Citations


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