The health benefits of greenspaces have demanded the attention of policymakers since the 1800s. Although much evidence suggests greenspace exposure is beneficial for health, there exists no ...systematic review and meta-analysis to synthesise and quantify the impact of greenspace on a wide range of health outcomes.
To quantify evidence of the impact of greenspace on a wide range of health outcomes.
We searched five online databases and reference lists up to January 2017. Studies satisfying a priori eligibility criteria were evaluated independently by two authors.
We included 103 observational and 40 interventional studies investigating ~100 health outcomes. Meta-analysis results showed increased greenspace exposure was associated with decreased salivary cortisol −0.05 (95% CI −0.07, −0.04), heart rate −2.57 (95% CI −4.30, −0.83), diastolic blood pressure −1.97 (95% CI −3.45, −0.19), HDL cholesterol −0.03 (95% CI −0.05, <-0.01), low frequency heart rate variability (HRV) −0.06 (95% CI −0.08, −0.03) and increased high frequency HRV 91.87 (95% CI 50.92, 132.82), as well as decreased risk of preterm birth 0.87 (95% CI 0.80, 0.94), type II diabetes 0.72 (95% CI 0.61, 0.85), all-cause mortality 0.69 (95% CI 0.55, 0.87), small size for gestational age 0.81 (95% CI 0.76, 0.86), cardiovascular mortality 0.84 (95% CI 0.76, 0.93), and an increased incidence of good self-reported health 1.12 (95% CI 1.05, 1.19). Incidence of stroke, hypertension, dyslipidaemia, asthma, and coronary heart disease were reduced. For several non-pooled health outcomes, between 66.7% and 100% of studies showed health-denoting associations with increased greenspace exposure including neurological and cancer-related outcomes, and respiratory mortality.
Greenspace exposure is associated with numerous health benefits in intervention and observational studies. These results are indicative of a beneficial influence of greenspace on a wide range of health outcomes. However several meta-analyses results are limited by poor study quality and high levels of heterogeneity. Green prescriptions involving greenspace use may have substantial benefits. Our findings should encourage practitioners and policymakers to give due regard to how they can create, maintain, and improve existing accessible greenspaces in deprived areas. Furthermore the development of strategies and interventions for the utilisation of such greenspaces by those who stand to benefit the most.
•Greenspace exposure is associated with wide ranging health benefits across 143 included studies.•Meta-analysis showed statistically significant reductions in diastolic blood pressure, salivary cortisol and heart rate.•Meta-analysis found statistically significant decreases in incidence of diabetes, all-cause and cardiovascular mortality.•A number of meta-analyses were limited by poor study quality and high levels of heterogeneity.•Greenspace and street greenery may form part of a multi-faceted approach to improve a wide range of health outcomes.
► We develop a framework which documents relationships between greenspace and health. ► The framework highlights key mediators which underpin the relationship. ► Moderators affect the relationship, ...such as socio-economic status and greenspace type. ► The framework can be used to inform and improve planning of research studies.
A growing body of evidence investigates whether access to greenspace, such as parks and woodland, is beneficial to well-being. Potential health benefits of greenspace exposure include opportunity for activities within the space and psychological benefits of viewing and interacting with nature. However, empirical research evidence on the effects of greenspace exposure shows mixed findings. Hence we suggest that the key questions of “if, why and how?” greenspace influences health remain largely unanswered. We argue that researchers have inadequately considered the causal pathways which drive the relationship. In particular, an improved understanding is needed of potential mediators and moderators. In this paper we draw on social–ecological theories and a review of the literature to develop a novel theoretical framework which summarises current knowledge about hypothetical causal pathways between access to greenspace and health outcomes. The framework highlights how mediators – such as use of greenspace and perceptions of the living environment – drive associations between access and both physical and psychological health outcomes. We propose key moderators based on evidence that associations between greenspace and health differ by demographic factors such as gender, ethnicity and socio-economic status, living context, greenspace type and climate. We discuss the evidence for how and why these factors act as moderators and consider the implications which arise from this improved understanding of the relationship between greenspace and health. In conclusion, we discuss how the framework can be used to inform planning of research studies, and how it may be developed in the future as more evidence emerges.
Progress in mobile health (mHealth) technology has enabled the design of just-in-time adaptive interventions (JITAIs). We define JITAIs as having three features: behavioural support that directly ...corresponds to a need in real-time; content or timing of support is adapted or tailored according to input collected by the system since support was initiated; support is system-triggered. We conducted a systematic review of JITAIs for physical activity to identify their features, feasibility, acceptability and effectiveness.
We searched Scopus, Medline, Embase, PsycINFO, Web of Science, DBLP, ACM Digital Library, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and the ISRCTN register using terms related to physical activity, mHealth interventions and JITAIs. We included primary studies of any design reporting data about JITAIs, irrespective of population, age and setting. Outcomes included physical activity, engagement, uptake, feasibility and acceptability. Paper screening and data extraction were independently validated. Synthesis was narrative. We used the mHealth Evidence Reporting and Assessment checklist to assess quality of intervention descriptions.
We screened 2200 titles, 840 abstracts, 169 full-text papers, and included 19 papers reporting 14 unique JITAIs, including six randomised studies. Five JITAIs targeted both physical activity and sedentary behaviour, five sedentary behaviour only, and four physical activity only. JITAIs prompted breaks following sedentary periods and/or suggested physical activities during opportunistic moments, typically over three to four weeks. Feasibility challenges related to the technology, sensor reliability and timeliness of just-in-time messages. Overall, participants found JITAIs acceptable. We found mixed evidence for intervention effects on behaviour, but no study was sufficiently powered to detect any effects. Common behaviour change techniques were goal setting (behaviour), prompts/cues, feedback on behaviour and action planning. Five studies reported a theory-base. We found lack of evidence about cost-effectiveness, uptake, reach, impact on health inequalities, and sustained engagement.
Research into JITAIs to increase physical activity and reduce sedentary behaviour is in its early stages. Consistent use and a shared definition of the term 'JITAI' will aid evidence synthesis. We recommend robust evaluation of theory and evidence-based JITAIs in representative populations. Decision makers and health professionals need to be cautious in signposting patients to JITAIs until such evidence is available, although they are unlikely to cause health-related harm.
PROSPERO 2017 CRD42017070849.
Despite emerging evidence that access to greenspace is associated with longer life expectancy, little is understood about what causal mechanisms may explain this relationship. Based on ...social-ecological theories of health, greenspace has multifaceted potential to influence mortality but the potential alternative mediating pathways have not been empirically tested. This study evaluates relationships between access to greenspace, walking and mortality. Firstly, we test for an association between access to greenspace and self-reported levels of walking using a survey of 165,424 adults across England collected during 2007 and 2008. Negative binomial regression multilevel models were used to examine associations between greenspace access and self reported number of days walked in the last month, in total and for recreational and health purposes, after controlling for relevant confounders. Secondly we use an area level analysis of 6781 middle super output areas across England to examine if recreational walking mediates relationships between greenspace access and reduced premature mortality from circulatory disease. Results show clear evidence of better greenspace access being associated with higher reported recreational walking. There were between 13% and 18% more days of recreational walking in the greenest quintile compared with the least green after adjustment for confounders. Tests for mediation found no evidence that recreational walking explain the associations between greenspace and mortality. Futhermore, whilst the relationship between greenspace access and walking was observed for all areas, the relationship between greenspace access and reduced mortality was only apparent in the most deprived areas. These findings indicate that the association between greenspace and mortality, if causal, may be explained by mediators other than walking, such as psychosocial factors. Future research should concentrate on understanding the causal mechanisms underlying observed associations.
•This study examines relationships between greenspace access, walking and mortality.•Better greenspace access was associated with higher levels of recreational walking.•Better greenspace access was associated with lower mortality only in deprived areas.•Walking did not meditate relationships between greenspace and mortality.
A wide range of environmental factors have been related to active ageing, but few studies have explored the impact of weather and day length on physical activity in older adults. We investigate the ...cross-sectional association between weather conditions, day length and activity in older adults using a population-based cohort in England, the European Prospective Investigation into Cancer and Nutrition (EPIC) Norfolk study.
Physical activity was measured objectively over 7 days using an accelerometer and this was used to calculate daily total physical activity (counts per minute), daily minutes of sedentary behaviour and light, moderate and vigorous physical activity (LMVPA). Day length and two types of weather conditions, precipitation and temperature, were obtained from a local weather station. The association between these variables and physical activity was examined by multilevel first-order autoregressive modelling.
After adjusting for individual factors, short day length and poor weather conditions, including high precipitation and low temperatures, were associated with up to 10% lower average physical activity (p<0.01) and 8 minutes less time spent in LMVPA but 15 minutes more sedentary time, compared to the best conditions.
Day length and weather conditions appear to be an important factor related to active ageing. Future work should focus on developing potential interventions to reduce their impact on physical activity behaviours in older adults.
Between 2018 and 2019, Cornwall Archaeological Unit undertook two projects at Mount’s Bay, Penwith. The first involved the excavation of a Bronze Age barrow and the second, environmental augur core ...sampling in Marazion Marsh. Both sites lie within an area of coastal hinterland, which has been subject to incursions by rising sea levels. Since the Mesolithic, an area of approximately 1 kilometer in extent between the current shoreline and St Michael’s Mount has been lost to gradually rising sea levels. With current climate change, this process is likely to occur at an increasing rate. Given their proximity, the opportunity was taken to draw the results from the two projects together along with all available existing environmental data from the area.For the first time, the results from all previous palaeoenvironmental projects in the Mount’s Bay area have been brought together. Evidence for coastal change and sea level rise is discussed and a model for the drowning landscape presented. In addition to modeling the loss of land and describing the environment over time, social responses including the wider context of the Bronze Age barrow and later Bronze Age metalwork deposition in the Mount’s Bay environs are considered. The effects of the gradual loss of land are discussed in terms of how change is perceived, its effects on community resilience, and the construction of social memory and narratives of place.The volume presents the potential for nationally significant environmental data to survive, which demonstrates the long-term effects of climate change and rising sea levels, and peoples’ responses to these over time.
A causal link has been invoked between inter-hemispheric albedo, cross-equatorial energy transport and the double-Intertropical Convergence Zone (ITCZ) bias in climate models. Southern Ocean cloud ...biases are a major determinant of inter-hemispheric albedo biases in many models, including HadGEM2-ES, a fully coupled model with a dynamical ocean. In this study, targeted albedo corrections are applied in the Southern Ocean to explore the dynamical response to artificially reducing these biases. The Southern Hemisphere jet increases in strength in response to the increased tropical-extratropical temperature gradient, with increased energy transport into the mid-latitudes in the atmosphere, but no improvement is observed in the double-ITCZ bias or atmospheric cross-equatorial energy transport, a finding which supports other recent work. The majority of the adjustment in energy transport in the tropics is achieved in the ocean, with the response further limited to the Pacific Ocean. As a result, the frequently argued teleconnection between the Southern Ocean and tropical precipitation biases is muted. Further experiments in which tropical longwave biases are also reduced do not yield improvement in the representation of the tropical atmosphere. These results suggest that the dramatic improvements in tropical precipitation that have been shown in previous studies may be a function of the lack of dynamical ocean and/or the simplified hemispheric albedo bias corrections applied in that work. It further suggests that efforts to correct the double ITCZ problem in coupled models that focus on large-scale energetic controls will prove fruitless without improvements in the representation of atmospheric processes.
We aim to explore the barriers to accessing primary care for socio-economically disadvantaged older people in rural areas.
Using a community recruitment strategy, fifteen people over 65 years, living ...in a rural area, and receiving financial support were recruited for semi-structured interviews. Four focus groups were held with rural health professionals. Interviews and focus groups were audio-recorded and transcribed. Thematic analysis was used to identify barriers to primary care access.
Older people's experience can be understood within the context of a patient perceived set of unwritten rules or social contract-an individual is careful not to bother the doctor in return for additional goodwill when they become unwell. However, most found it difficult to access primary care due to engaged telephone lines, availability of appointments, interactions with receptionists; breaching their perceived social contract. This left some feeling unwelcome, worthless or marginalised, especially those with high expectations of the social contract or limited resources, skills and/or desire to adapt to service changes. Health professionals' described how rising demands and expectations coupled with service constraints had necessitated service development, such as fewer home visits, more telephone consultations, triaging calls and modifying the appointment system.
Multiple barriers to accessing primary care exist for this group. As primary care is re-organised to reduce costs, commissioners and practitioners must not lose sight of the perceived social contract and models of care that form the basis of how many older people interact with the service.
The latest Hadley Centre climate model, HadGEM2‐ES, includes Earth system components such as interactive chemistry and eight species of tropospheric aerosols. It has been run for the period 1860–2100 ...in support of the fifth phase of the Climate Model Intercomparison Project (CMIP5). Anthropogenic aerosol emissions peak between 1980 and 2020, resulting in a present‐day all‐sky top of the atmosphere aerosol forcing of −1.6 and −1.4 W m−2 with and without ammonium nitrate aerosols, respectively, for the sum of direct and first indirect aerosol forcings. Aerosol forcing becomes significantly weaker in the 21st century, being weaker than −0.5 W m−2 in 2100 without nitrate. However, nitrate aerosols become the dominant species in Europe and Asia and decelerate the decrease in global mean aerosol forcing. Considering nitrate aerosols makes aerosol radiative forcing 2–4 times stronger by 2100 depending on the representative concentration pathway, although this impact is lessened when changes in the oxidation properties of the atmosphere are accounted for. Anthropogenic aerosol residence times increase in the future in spite of increased precipitation, as cloud cover and aerosol‐cloud interactions decrease in tropical and midlatitude regions. Deposition of fossil fuel black carbon onto snow and ice surfaces peaks during the 20th century in the Arctic and Europe but keeps increasing in the Himalayas until the middle of the 21st century. Results presented here confirm the importance of aerosols in influencing the Earth's climate, albeit with a reduced impact in the future, and suggest that nitrate aerosols will partially replace sulphate aerosols to become an important anthropogenic species in the remainder of the 21st century.
Key Points
Aerosol forcing is currently at its peak and will decrease strongly in the future
Nitrate aerosols partially replace sulfate as the dominant man‐made species
Nitrate aerosols decelerate the decrease in aerosol forcing in the 21st century
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