Tackling Health Inequalities through Green and Blue Infrastructure
Incidence rate ratios for all-cause mortality (A) and deaths from circulatory disease (B) in income-deprivation quartiles 2–4, relative to income deprivation quartile 1 (least deprived), stratified by exposure to green space
There is evidence to suggest that access to quality green and blue infrastructure and nature reduces the chances of ill health including Type 2 Diabetes[3], Cardiovascular Disease[4] and Mental Health illness[5]. Access to quality green and blue space enables specific health benefits such as psychological relaxation and stress alleviation, increased physical activity, reduced exposure to air pollutants, noise and excess heat.[6]
These findings are both common sense and evidence based. An added enormous bonus is that if we create and curate quality green open spaces, we can also have a positive impact on our planet and on the rest of the natural world.
Green and Blue and Health Inequality
Unfortunately, people from more disadvantaged communities are less likely to have access to quality green and blue infrastructure, e.g. the most deprived urban areas have five times fewer public parks and lower quality green spaces than the most affluent areas[7]
These same communities will also be more affected by the impact of the climate crisis, e.g. heatwaves, floods, water and food insecurity, air pollution and vector borne disease.
This is something we can change and there are many examples across the country which demonstrate the art of the possible including The Green Estate Community Interest Company. The team has regenerated over 42 hectares of no-go wasteland into beautiful, adaptive and resilient award winning landscapes with naturalistic design, sustainable drainage systems and foraging opportunities for local communities. Now a flourishing social enterprise with around 70 staff, 30 plus local volunteers and 20 other on-site community enterprises. Kingfishers, badgers, butterflies and many other species thrive alongside the many thousands of people living in and visiting the area.
Green Context in the UK
The climate and ecological crisis in Britain is well documented and the excellent ‘Wild Isles’ narrated by Sir David Attenborough is shining a spotlight on the scale of the issue. The UK is one of the most nature depleted countries in the world, more than one in seven native species face extinction and more than 40% are in decline.
At a national level there is some activity from Natural England including the ‘Green Infrastructure Framework’ and ‘Biodiversity Net Gain’. These initiatives and policies tend not to focus more heavily on the most disadvantaged places and sometimes they potentially actively divert away, e.g. the ‘Off-Site Bio-diversity Net Gain’ policy.
Over in health and care ‘Green Social Prescribing’ is being used as a frame to engage the health system and patients and nature-based interventions such as green care and ecotherapy have been used in relation to mental health. There is also NHS Forests, Nature Recovery Rangers and there is some fantastic work with more vulnerable communities.
Joined up Green Blue Health Care
The evidence is clear that green and blue infrastructure and connecting with nature is good for health and good for reducing health inequalities.
At the same time we are recognising the importance of tackling the climate and ecological crisis and creating more quality green and blue infrastructure to support our wildlife.
The questions are:
How can we more fully join up these two important policies and practices at a national and local level with an emphasis in resources on more disadvantaged and often more urbanised places and communities?
How do we get the Department of Health and Social Care and Natural England in the room together at a national level and the Integrated Care Boards/Partnerships in a room with the Parks and Planning Departments at a local level?
And most importantly how do we work in partnership with communities to co-design activities which enable greater engagement and access in quality green and blue spaces?
With thanks to the excellent Centre for Sustainable Healthcare for delivery of the Green Spaces and Health Course which I would totally recommend.
[1] https://apps.who.int/iris/bitstream/handle/10665/342931/9789289055666-eng.pdf
[2] https://pubmed.ncbi.nlm.nih.gov/29982151/
[3] https://bmjopen.bmj.com/content/4/12/e006076
[7]https://www.designcouncil.org.uk/fileadmin/uploads/dc/Documents/urban-green-nation-summary1_0.pdf
