Dr. Thomas Claßen (Dipl.-Geogr.) Bielefeld School of Public Health, Dept. 7 Environment & Health

1. Nature Conservation and Preventative Health Protection in Germany – a strong Partnership?Identification of common fields of action in the context of recent paradigmatic changes Dr. Thomas Claßen (Dipl.-Geogr.) Bielefeld School of Public Health, Dept. 7 Environment & Health Naturally better – how protected landscapes can help deliver health and wellbeing outcomes Spring Seminar of the EUROPARC Atlantic Isles Section, 26 March 2009, Wallingford / UK

2. Assumptions about the human-nature-relationship • People perceive their environment consciously and unconsciously, and it has great influence on human physical and mental health • Nature in a wider sense has positive effects on human well-being • People are sensitized to the requirements of protecting our natural resources (e.g. biodiversity) • Due to alienation, some people develop very curious ways of how to experience nature „Back to nature“ ? Cartoon in a German psychological journal (April 2003)

3. Opinion of a “mountain romantic”?: „Thousands of tired, nerve-shaken, over-civilized people are beginning to find out that going to the mountains is going home; that wilderness is a necessity; and that mountain parks and reservations are useful not only as fountains of timber and irrigating rivers, but as fountains of life.” John Muir (originator of the national park idea, 19th century)

4. Assumptions regarding nature conservation • Measures of (health-oriented) environmental protection nowadays are of great acceptance throughout the German society. • Concrete measures of nature conservation, however, often still face lack of acceptance. • For 20 years, there has been a strategic and conceptional paradigmaticchange from bioecologic-ethical to „modern“ understanding of nature conservation as a societal approach for human health & wellbeing, too. • In this respect, nature conservation is looking for strategic alliances. • Could linkage to health and wellbeing (as a positive topic for society) contribute to image promotion and better acceptance of nature conservation?

5. What is Health? Health: “...is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” (WHO, 1946) or: „… is a status of balance between risk factorsand protecting factors (resources), which happens if a human being succeeds in managing the interior (physical and mental) as well as the exterior (social and material) requirements.“ (Hurrelmann & Franzkowiak, 2006: 52, translated from German)  Salutogenetic Principle: a resource-oriented and preventive model identifying health-promoting determinants (resources and competencies) for human life (Antonovsky 1987)

6. Assumptions regarding the health sector • Health sector in general nowadays faces severe challenges due to:- newly identified health risks- demographic change- rapidly increasing costs in health care • Public Health sector opens up to other disciplines, including environment and natural resources sciences(e.g. Environment and Health Action Programme) • But what about nature & health? • Problem in German public health sector: pathogenetic perspective vs. salutogenetic perspective

7. Environment and Nature as health resource - Sociologic / Public Health model describing health status Environment and Nature as potential health risk - nature sciences / medical model describing health and disease status Model of Preventative Health Protection Preventative Health Protection Health (promotion) Disease (prevention) Function of Nature Conservation? Burden Resources ecological health promotion, environmental management - aim: promote health by use of environment and nature environmental medicine &environmental hygiene, health protection - aim: prevent/reduce health risks from environment and nature Salutogenetic perspective Pathogenetic perspective

8. While searching for synergies and obstacles … …in 2004, a pilot study was initiated by the German Federal Agency for Nature Conservation. objectives: • Are there any (potential) fields of actionbetween nature conservation and preventive health protection? • If so, are they realized and used synergistically, or do links occur by accident? • Are there any horizontal or vertical communication barriers? If so, what are the reasons for these obstacles? • What are the opportunities for initiating better co-operation between both topics, if this co-operation makes sense?

9. Approach of the pilot study • Synopsis of basic considerations and scientific concepts at the interface between nature conservation and health • Assumptions regarding the perception of nature (conservation) and health in the public • Conducting an inquiry of identified opinion leaders and stakeholders (experts)  standardized survey (254 Pers./institutions) semi-structured expert interviews (20 Pers.) • Statistical analyses (quantitative) and (semi-)qualitative analyses • Identification of projects, programmes, strategies of good practice • Identification and analysis of strengths and weaknesses of previous strategies and concepts • Highlighting recommendations

10. Postal inquiry • Information on the addressee • Questions about the complex ofhealth • Questions about the complex of nature conservation • Questions about potential links • Information on the person • Notes on the questionnaire • Inquiry: 12/04 – 02/05 response: N=158 (62,2%) • Interviews:02/05 – 04/05(N=18)

11. Connections to institutions, federations, associations etc.

12. Collaboration in programmes or projects

13. Points of contact with the EHAP or the (local) Agenda 21 „Agenda 21 is of interest for sure, since Agenda 21 has its own chapter on health. […] nevertheless where I work […] and in most parts of environmental protection, Agenda 21 is always discussed without this health aspect. It‘s sort of excluded in the discussion on sustainability.“ (UG5, question 5 I, answered in question 3 I)

14. Exchange, networking, dialogue structures

15. Hiding behind responsibilities? ‚They do not affect us, and in this respect I do not know them.‘ (G 5, question 3/4 I) Another example: ‚With respect to nature conservation […] there is no organisational opinion.‘ (G 3, question 2 I) But when asked to the own opinion: ‚We badly need health promoting environmental and living-conditions. I need health-oriented prevention of bad conditions for giving everybody the opportunity to promote his own health. An in this respect, without any doubt there is a strong link between nature conservation and health protection.‘ (G 3, question 5 I)

16. Opportunities for co-operation? ‚There are topics, […] where nature conservation for sure takes profit from being one prerequisite for human health, and where on the other hand preventive health protection can take profit of the fact that it easily realized in a more or less natural environment. In this respect health sector should be interested in certain measures of nature conservation [...] when aiming at keeping us healthy.’ (G 7, question 11/12 I) ‚The topic has not been communicated inside the federations yet because the linkages are not clear at all to them. Nature conservation, environment protection, health, these are totally divided worlds by now.‘ (NU3; question 6 I)

17. obstacles and barriers ‚Each ministry, each federal agency faces this compulsion for justificating the own work […]. It is always of high importance to present oneself in front of the minister, the boss and especially the public as the one and only ministry or agency doing really positive things. This fact often hinders co-operation.‘ (UG5, question 6 I) ‚The personal factor is a fact. […] If you face a blocking person in the ‚right‘ position, the whole topic is dead, no matter about other surrounding circumstances. And if you face someone who is willing to co-operate, then this person will manage, no matter about other surrounding circumstances.“ (UG5, question 6 I)

18. Actors network: communication barriers

19. Potential subjects and fields for action I • Protection of Drinking-water- and spa-wells and nature conservation • Sustainable use of medicinal plants and other alternative methods • Promotion of urban green as a health-promoting resource, environm. justice • Healthy nutrition and sustainable food production, • Cure and wellness focusing on outdoor-activities (e.g. outdoor-wellness) • Physical activity in nature as a task of health promotion

20. Potential subjects and fields for action II • Complementary medicine and Kneipp therapies • Territories for nature experience, health promotion and therapies • Large-scale nature preserves as spaces for health precaution • Public relations and environmental education • Therapeutic / health promoting Landscapes…

21. Conclusion of the pilot study • There are definitely numerous fields of action between nature conservation and preventive health protection! • Perception of the people occurs unconsciouslywhen thinking about nutrition, the „good from nature“, stress relaxation in nature etc. • Persistent opinion of some experts in nature conservation that it is an ethically reasonable duty or that it is not strong enough for being perceived as a good partner • Clear communication barriers due to divided responsibilities and often even the need of profiling the own ministry or department (creatorship?) • Substantial lack of co-operation and communication between the disciplines in science, politics and planning • Willingnessor careful expectation of the experts, in particular of those from interdisciplinary fields or on a regional level • What can be done?

22. Follow-up study (2006-2008) 3 German nature parks involved

23. press releases newspaper articles interviews Project presentations High relevance in the media

24. Project no. III: internetbased portal Information system „Nature Conservation and Health“ overview and detailed texts (incl. references) • Non-experts • Interested public • Children • Experts • Actors in nature conservation & tourism • Actors in health sector literature database project database glossary web-GIS

25. Conclusion • Financial and personnel resources are more limited than ever! • Both topics are in need of strategic partners for meeting their goals! objectives: • Horizontal and vertical integration of strategies and concepts of nature conservation and preventative health protection • Reduction of the immanent deficit of information by improved target group communication • Reduction of situations with rivalry or conflicts • Reduction of thinking only in responsibilities and competencies • Remember: „Sustainable Development is Healthy Development!“

26. Thank you very much for your attention! These projects were granted by the German Federal Agency for Nature Conservation, financed by the German Federal Ministry of the Environment, Nature Conservation and Nuclear Safety project I & II were carried out by the Institute for Hygiene and Public Health of the University of Bonn

27. Interested in the topic??? The project documentation (in German) has been published: Claßen, Kistemann & Schillhorn (2005): Naturschutz und Gesundheitsschutz: Identifikation gemeinsamer Handlungsfelder. Bonn – Bad Godesberg (= Schriftenreihe „Naturschutz und Biologische Vielfalt“, H. 23) 228 pages ISBN: 3-7843-3923-9 Price: 16,- € My dissertation (in German) may be downloaded: Claßen, T. (2008): Naturschutz und vorsorgender Gesundheitsschutz: Synergie oder Konkurrenz? Bonn. http://hss.ulb.uni-bonn.de/diss_online/math_nat_fak/2008/classen_thomas

28. Approach of the pilot study • Synopsis of basic considerations and scientific concepts at the interface between nature conservation and health • Assumptions regarding the perception of nature (conservation) and health in the public • Conducting an inquiry of identified opinion leaders and stakeholders (experts)  standardized survey (254 Pers./institutions) semi-structured expert interviews (20 Pers.) • Statistical analyses (quantitative) and (semi-)qualitative analyses • Identification of projects, programmes, strategies of good practice • Identification and analysis of strengths and weaknesses of previous strategies and concepts • Highlighting recommendations

29. Scientific linkages between nature (conservation) & health • from nature- and perception psychology(e.g. Biophilia vs. Biophobia, Attention-Restoration-Theory) • links to nature in medicine and public health science(e.g. complementary medicine, Kneippian techings, Healing Gardens, health determinants concept)  • ecosystem science and health(e.g. ecosystem health vs. conservation medicine, research on biodiversity and on climate effects) • environment-orientedhealth protection and ecologicalhealth promotion(e.g. importance of urban green, integral water body management) • recreation, nature experience and physical activity • nature- and health-oriented regional development(e.g. role of large-scale nature preserves, healthy regions) • therapeutic health enhancing landscapes

30. Development of therapeutic or preventative landscapes • Ideal with above-average density of: • Landscape elements that enhance the mental well-being, • Specific health care facilities, • Comprehensive offers for nature experience and health promotion, • Graded lodging facilities, • Spiritual centres, • Spas and certificated locations for recreation, • Barrier-free offers, • and measurable success in sustainable regional development, in particular in the field of integrated planning procedures

31. Farm „Canitz“ of Leipzig Waterworks Relationship between nature conservation and health protection Apparent synergies Health because of nature • Biodiversity, nature- and phytomedicine for pharmaceutical uses • Nature products as anti-allergics • Orientation by nature as protection against natural hazards • Nature for mental health, recreation, sports, therapies, health protection • Organic farming as means of consumer protection (e.g. Drinking-water)

32. International Standard for Sustainable Wild Collection of Medicinal and Aromatic Plants (ISSC-MAP) Relationship between nature conservation and health protection Apparent disturbances or rivalry Health risks due to nature • Allergies from natural products • Disruption of well-being and health risks due to nature conservation But on the other side: • „Health delusion“ causing disruption of sensitive parts of nature • Exploitation of natural genetic resources