Public park attributes, park visits, and associated health status
Introduction
Greenspaces (GS) within cities provide several health-promoting functions. The potential pathways affecting health have been summarised into three domains: reducing harm (e.g. mitigation of environmental stressors such as air pollution, noise and heat); restoring capacities (e.g. stress recovery) and building capacities (e.g. providing opportunities for physical activity and social contact) (Markevych et al., 2017). The preponderance of evidence exploring the relationship between health and GS investigate either proximity to, or scale of, locally accessible GS. However, an emerging body of evidence has turned to examine actual use of GS (Carter and Horwitz, 2014, White et al., 2019). Where the use of GS provides salutary benefits, evidence concerning the particular characteristics and features which encourage or dissuade public use of GS is required to inform planners and policymakers. Thus, it is important to understand people’s preferences for GS and their habits in using green infrastructure.
We present an original study which responds to a planning and policy-relevant research gap, involving two simultaneous investigations. Firstly, using a revealed preferences approach we investigate the relationship between visits to GS and three health indicators - self-rated general health, cardiovascular health and a measure of mental well-being from a primary survey conducted in Ireland in spring 2018. Within the same framework of analysis, we also examine individual’s preferences for GS attributes using choice experiment (CE) methodology, through which the utility provided by each single attribute is evaluated separately. Using this approach we assess the potential increase in the average number of visits to parks for different arrangements of GS, which are expected to be health promoting. Our study presents an innovative combination of structural equation modelling of the GS-health relationship and a stated preference valuation of GS attributes.
The term ‘Emerald Isle’ is synonymous with Ireland, yet as the country urbanises, like much of the developed and developing world, Ireland’s population may be less exposed to green natural environments. Over half of the world’s population lived in urban areas in 2015, and by 2050, two in every three people are predicted to be urban-dwellers (Nations, 2014). In response to this trend, the contribution of urban parks and GS to health and mental well-being has attracted significant attention in the international literature. The balance of evidence suggests a positive association between GS and health and wellbeing. However, some gaps in knowledge remain. The literature investigating the health effects from the ‘dose’ of GS (i.e. contact with, or visits) is relatively nascent compared to a vast body of evidence that examines the influence of the amount of GS in one’s local-area. The application of CE methodologies to assess the prioritisation of GS and attributes is also underexplored.
This study notes a dearth of Irish evidence in this increasingly prolific area. One Irish investigation examined the influence of distance to urban GS on obesity among over 50s (Dempsey, Lyons, & Nolan, 2018), finding a U-shaped relationship. While not directly measuring a health outcome, a study of visiting behaviours in Dublin parks found that walking and jogging or sports were significant predictors of frequency of visits (Burrows, O’Mahony, & Geraghty, 2018). In a somewhat related study, Brereton, Clinch, and Ferreira (2008) demonstrated that location-specific factors directly impacted life satisfaction in Ireland. Spatial variables such as proximity to coast, landfill sites, international airports and major roads influenced well-being, though proximity to GS was not investigated.
This lack of evidence is especially remarkable given that Dublin, Ireland’s capital city, is home to Western Europe’s largest enclosed urban park, The Phoenix Park (which spans 1,752 acres). Despite this, policymaking in Ireland has drawn on the findings of international literature, and a suite of recent documents recognise the importance of access to GS including the Healthy Ireland Framework (Department of Health, 2013), the national physical activity plan (Department of Health & Department of Transport, Tourism & Sport, 2016) and the national obesity policy (Department of Health, 2016). Ireland’s current mental health strategy did not recognise the contribution of natural/green environments to mental health (Departmentof Health, 2006), perhaps due to the lack of evidence of this association prior to the document’s publication in 2006. The study presented in this paper, of the link between health, GS use and GS attributes which employs domestic data can help strengthen the policy resolve.
The following sections provide a brief overview of the findings of the existing international evidence assessing the influence of GS on general self-reported health, cardiovascular health and mental well-being. The relatively small body of evidence concerning attributes/qualities of GS is also summarised.
A strong positive effect between the amount of GS in one’s living environment and perceived health has been found in studies from the Netherlands (de Vries et al., 2016, Maas et al., 2006) and in England (Mitchell & Popham, 2007). However, local GS was not associated with self-rated health among a study of chronically-ill Dutch people (Wolfe, Groenewegen, Rijken, & De Vries, 2014). A differential influence of residential GS on self-reported health in New York was found according to the type of GS (Reid, Clougherty, Shmool, & Kubzansky, 2017), where the beneficial health associations of trees was greater than that for grass. More recent scholarly attention has turned to exploring the ‘dosage’ of GS/nature required to affect health, which incorporates visits to or time spent exposed to greenness (Cox et al., 2017, Shanahan et al., 2015, Shanahan et al., 2016, White et al., 2019). An English study (White et al., 2019) found that spending at least 120 min each week in natural environments was associated with good self-rated health. However, a previous study did not find an association between self-reported physical health and greater frequency and time spent in nearby nature in Southern England (Cox et al., 2017).
Circulatory disease is a leading cause of death and disability worldwide, attributable to 29% of deaths in Ireland in 2018 (Office, 2018). Evidence suggests that GS exposure and/or use may reduce cardiovascular morbidity and mortality. In Rio de Janeiro, Silveira and Junger (2018) found mortality rates for ischaemic heart and cerebrovascular diseases were inversely associated with GS exposure, controlling for socio-economic status and air pollution. Moreover, a protective effect of GS was greater for census areas with lower socio-economic levels. A Lithuanian study (Tamosiunas et al., 2014) found that distance to GS did not influence the prevalence of coronary heart disease or stroke, however, more intensive use of GS was linked to a reduced risk of cardiovascular disease. For Perth, Australia, Pereira et al. (2012) found that residents of neighbourhoods with high variable greenness had lower odds of self-reported heart disease/stroke and circulatory-related hospitalisations. In an ecological study of the population of England, neighbourhoods with the least green areas were associated with an elevated risk of circulatory disease (Mitchell & Popham, 2008).
GS offers mental health and well-being benefits documented in numerous evidence reviews (Gascon et al., 2015, Houlden et al., 2018, Lee and Maheswaran, 2011, World Health Organization, 2016). In a systematic review of 50 studies examining the relationship between GS and mental wellbeing of adults (Houlden et al., 2018), 17 included studies examined the effect of GS visits on mental well-being. The varying quality of studies and inconsistency of results relating to visitation led the authors to conclude that evidence of this association was limited. By contrast, the same review concluded that for 21 included studies which explored the correlation between well-being and the amount of local-area GS, there was ‘adequate evidence’ of an association between urban local-area GS, life satisfaction and lower mental distress scores.
A dose-response relationship between greenness/nature and mental health is suggested, with higher doses associated with higher mental well-being (Coldwell & Evans, 2018), lower levels of depression (Shanahan et al., 2016) and lower stress (Hazer et al., 2018, Jiang et al., 2014). In a study of four European cities, Van den Berg et al. (2016) found consistent positive associations between purposeful visits to GS and mental health and vitality. Associations were stronger for groups with low educational attainment and little childhood nature experience. In a study using smartphone data collected over one week from study participants across four European cities, Triguero-Mas et al. (2017) found that contact with nature, particularly greenness, benefited mental health.
The design and upkeep of parks have been recognised as fundamental to population health, with qualitative and quantitative studies finding park features as influential for park use (Kaczynski et al., 2008, McCormack et al., 2010). Kaczynski et al. (2008) studied the relative importance of distance to parks, their size and features, finding only the number of features persisted as significant predictors of physical activity, with the presence of trails and wooded areas important. Larger parks were associated with greater use (Giles-Corti et al., 2005), as was the presence of walking loops (Cohen et al., 2017) and organized activities (Cohen et al., 2010). Aesthetic attributes such as water features and trees also promoted use (McCormack et al., 2010), with inland waterscapes/blue spaces identified as salutogenic (Völker & Kistemann, 2011). Visitor amenities such as toilets, cafes, children’s playgrounds, picnic areas, sports and dog-walking facilities were found to encourage park visitation (Chen et al., 2018, McCormack et al., 2010).
The aim of the paper presented here is to contribute to closing the gap in knowledge on the influence of GS to health and well-being in Ireland, and more broadly, to advance the methodological approach by employing CE to assess the attributes of GS which influence visitation.
Section snippets
Data
Data originated from a face-to-face survey conducted by a professional survey company, which collected a sample of 1,050 adults living in Irish urban areas stratified by age, gender, education and place of residence. The survey was designed to be representative of the population of urban residents in Ireland. A pre-test of the survey was administered in February 2018, while the main survey was undertaken between April and May. The questionnaire was composed of 39 questions organised into 5
Summary statistics
Descriptive statistics of the model variables are reported in Table 3. Respondents reported an average of 7.6 visits to GS in the prior 4 weeks, with a large variability (standard deviation = 8.32). The distribution of distances of respondents’ houses from parks was highly skewed, where the mean distance was 11.98 kilometres and the median 210 metres. This is because some Irish small towns are in the countryside and have no public parks. The sample was gender-balanced (50% of respondents were
Discussion
As cities become more congested and are challenged to meet good air quality standards there is a growing interest in urban public GS as sources of restoration and ecosystem services provision. The literature also highlights the role of public parks for individual health. The results of this study are consistent with the wider extant literature, finding that park visits are associated with better health outcomes. The paper also contributes new insights on how attributes of public GS themselves
Conclusion
GS within cities are important to people for restoration and leisure activities. In this paper, we investigate the relationship between health and public park visits, as well as, preferences for attributes of public parks that increase the likelihood of visiting. A structural model involving two-step estimation is used to provide consistent estimates of the effect of visits on three self-reported measures of individual health. Additionally, a panel negative binomial model is used to model
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
CRediT authorship contribution statement
Gianluca Grilli: Data curation, Formal analysis, Funding acquisition, Writing - original draft. Gretta Mohana: Conceptualization, Writing - original draft, Writing - review & editing. John Curtisa: Funding acquisition, Writing - original draft, Supervision, Project administration.
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