Healthy Green Spaces - Healthy People

1. Healthy Green Spaces - Healthy People Dawn Griffiths Senior Adviser – Natural England Tel: 07900 608051

2. Content of presentation • Policy background • Evidence and examples • Conclusions

3. PUBLIC HEALTH WHITE PAPER 2010 Healthy lives; healthy people. The environment (natural and built) is explicitly recognised as a determinant of health The quality of the environment around us also affects any community. Pollution, air quality, noise, the availability of green and open spaces” (Sec 1.16, P17). “ When the immediate environment is unattractive, it is difficult to make physical activity and contact with nature part of everyday life” (Sec 1.37, P20). Local communities will be empowered to “design communities for active aging and sustainability”. This will include protecting green spaces, volunteer led walk programmes, promoting community ownership of green spaces and improved access to land. (Sec 3, P31).

4. NEWP outlines specific actions that will help to improve health, wellbeing and quality of life • Local Nature Partnerships and the Health and Wellbeing Boards should actively seek to engage each other in their work • The natural environment, will be a crucial consideration in developing joint strategic needs assessments and joint health and wellbeing strategies

5. Reducing health inequalities Marmot Review 2010: Fair Society, Healthy Lives “Create and develop healthy and sustainable places and communities” - one of 6 recommendations health inequalities arise from social inequalities (education, employment, standard of living), plus where people live has an impact. • People living closer to green space had lower death rates and less heart disease. • A Lancet study in Glasgow found that amongst lower income groups 1,300 extra deaths occurred each year in areas where the provision of green space was poor (University of Glasgow, 2008). • Mitchell R, Popham F.Effect of exposure to natural environment on health inequalities: an observational population study. Lancet 2008;

6. New health system since 1 April 2013 Public Health England, created to oversee new ‘Public Health Outcomes Framework’ to aid local commissioning groups in reducing health inequalities. The Outcomes Framework states that ‘Public health contributions would be made locally, led by local authorities’ • 200+ Clinical Commissioning Groups (CCGs) taken over role from PCTs • Health and Wellbeing Boards - fora where leaders work together to improve the health and wellbeing of their local population and reduce health inequalities. In each top tier and unitary authority. • H&WB Boards to prepare Joint Strategic Needs Assessments (JSNAs) considering the needs for the whole community plus wider social, environmental and economic factors that impact on health and wellbeing. • Meet the needs identified by JSNAs, H&WB Boards will prepare Health and Wellbeing Strategies.

7. Public Health Outcomes Framework (PHOF) 1.16 - Utilisation of greenspace for exercise/health reasons • Inclusion of this indicator is recognition of the significance of accessible green space as a wider determinant of public health. • Provides a new opportunity to embed greenspace and natural environments within a local authority priority programme through delivery of advice and evidence

8. What do we mean by the ‘natural environment’?

9. How does natural green space contribute to health and wellbeing? Increases physical activity: • provides space for physical activity. • provides a destination to walk • provides challenges for hard physical activity. Improves mental health and wellbeing: • reduction in stress • helps concentration • provides a sense of belonging and self worth • reduces symptoms of aggression and crime Provides opportunity for social integration: • increases social contact • increases creative play with children Provides services and systems that are vital for healthy lives and also help mitigate against the negative health impacts resulting from climate change

10. Levels of engagement and indirect positive effects If nature is within close proximity, there are health benefits via any of the following three levels of engagement: • simply viewing it through a window (Ulrich 1984; Pretty et al. 2005) • being in its presence (De Vries et al. 2003) • or actively taking part in green activities and wilderness trails (Davis‐Berman & Berman 1989; Hartig et al. 2003; Pretty et al. 2007).

11. Life expectancy in the London Borough of Brent • Male life expectancy decreases with each tube stop as the train heads into London • South Kenton residents have 10 years more life expectancy than those in Harleston • The Lancet study showed socio-economic factors to be a primary cause, but also highlighted lack of green space as significant

12. Access to green space in Bristol • In Bristol, lack of access to green space correlates with low household income, low educational achievement and poor health

13. Monitor of Engagement with the Natural Environment (MENE) • In 2009 Natural England, Defra and the Forestry Commission commissioned TNS Research International to undertake the Monitor of Engagement with the Natural Environment (MENE). • MENE is a three year face-to-face, in-home omnibus survey undertaking about 40,000 interviews per year (around 800 respondents every week). • It includes comprehensive information on visits to the natural environment and collects data on the types of places visited, demographic profile of visitors, motivations, outcomes and activities.

14. Monitor of Engagement with the Natural Environment (MENE) Where do Where did people visit during 10/11?pl visit? Other coastline 4% or 0.11 bn. visits Seaside resort/ town 7% or 0.17 bn. visits 4% 7% Countryside 53% or 1.3 bn. visits 53% Green space in a town or city 0.92 bn. visits 37%

15. MENE - Levels of physical activity by frequency of visits Frequent visitors (%) Infrequent visitors (%) Non-visitors (%) Number of days undertake 30 mins+ of physical activity • There is a relationship between visits to the natural environmentand levels of physical activity. • Frequent visitor – at least once a week (53% of population) • Infrequent visitor – twice a month or less often (37% of population) • Non-participants – not visited in the last 12 months (9% of population)

16. Who visits green space (in towns and cities) within two miles of their starting point? • Those in the bottom 10% IMD were twice as likely to visit greenspace within 2 miles of their starting point compared to those in the top 10% • BME communities were twice as likely to visit greenspace within 2 miles of their starting point compared to respondents from white communities. • 17% of people who visited greenspace within two miles of their starting point consider themselves to be disabled or to have a longstanding illness.

17. Access to Nature • Access to Nature was a scheme run by Natural England and funded by the Big Lottery Fund. • It aimed to encourage more people to enjoy the outdoors • The projects have produced lots of useful case studies available on Natural England's website

18. Walking for Health • Led by Macmillan Cancer Care and the Ramblers • Now been running for over 14 years • Over 600 led walking schemes nationally and thousands of walking opportunities • Led by trained volunteers www.walkingforhealth.org.uk

19. Neighbourhoods Green • Neighbourhoods Green (NG) is a partnership initiative improving open space for residents of social housing • The website at http://www.neighbourhoodsgreen.org.uk provides case studies, self help guides and information on funding and training • Current projects include food growing, outdoor education, tree planting, wildflower meadows and the engagement and ownership of residents to develop, create and in some cases help manage green space

20. Conclusions • There is a strong policy context and evidence base for the provision of accessible greenspace • There is clear evidence that access to green space benefits health and reduces health care costs • Those living in areas of high health inequality are likely to have the least access to green space • The emerging Health and Wellbeing Strategies can help provide the framework for addressing this complex issue

21. The healing gift of space “We all need space; unless we have it, we cannot reach that sense of quiet in which whispers of better things come to us gently” Octavia Hill 1888