POSTNOTE
Number 000 January 2015
Nature: Wellbeing and Health
The natural environment plays a significant role
in the maintenance of several aspects of health
and wellbeing. Contact with green spaces has
been shown to benefit mental health and
wellbeing, physical health, and education1.
This POSTnote describes the benefits of the
natural environment on health and wellbeing,
highlights the limitations of the research thus
far, and outlines relevant national and
international policy.
Background
The benefits of the natural environment on health and
general wellbeing have long been speculated, but research
on this topic has been relatively scarce. Recently, interest in
this area has increased as the UK population becomes
more urban, which coincides with the current obesity
9-10
epidemic and rise of mental health issues .
The National Centre for Social Research reported an
increase in prevalence of common mental health disorders
in the UK between 1993 and 2007, the largest was
observed in women aged 45-64, among whom the rate
10
increased by about one fifth . The obesity epidemic is a
global issue; in 1993 13% of men and 16% of women in the
UK were obese, and this rose to 24% for men and 26% for
11
women by 2011 . A further issue in the UK is air pollution,
with between 12,300 and 24,100 deaths hastened annually
13
due to pollution by ozone, particulates and sulphur dioxide .
One proposed method to combat these issues is to improve
access to urban and rural green space (Box 1).
Environmental enrichment has been used to combat various
illnesses and is now gathering more scientific support.
The Parliamentary Office of Science and Technology, 7 Millbank, London SW1P 3JA; Tel: 020 7219 2840; email: post@parliament.uk www.parliament.uk/post
Overview
! Evidence suggests that spending time in the
natural environment can improve general
wellbeing and ameliorate symptoms of some
mental and physical health disorders1-4.
! Improvements to mental health, physical
health, and wellbeing can be triggered by
rural natural environments as well as urban
green spaces1.
! In England alone, mental illness costs over
105.2 billion a year5.
! The cost to the UK economy associated with
the overweight and obese was estimated at
15.8 billion per year in 2007, including 4.2
billion in costs to the NHS6.
! Improved happiness is linked to a 12%
increase in workplace productivity7.
! Occupants of urban housing with views of
nature demonstrate reduced levels of
aggression and violence8.
Box 1. Defining The Natural Environment
There are many different definitions of nature and the natural
environment, terms which will be used interchangeably. In this
POSTnote, both rural green spaces (fields, national parks) and urban
spaces (parks, gardens) are considered as aspects of nature and the
natural environment.
Nature and Mental Wellbeing
Numerous studies have demonstrated that access to and
activity in the natural environment generally has a positive
effect on mental wellbeing (Box 2), however confidence in
the conclusions drawn is often limited by poor experimental
14
methods . Activity in non-natural environments can also
2
promote positive responses in wellbeing . In a review of
studies assessing the effects of green exercise, Coon et al.
14
found that exercise in natural environments led to
decreased feelings of tension, depression, anger and
confusion, though calmness may also decrease. The same
benefits were found in subjects after they had walked in
16
National Trust heritage sites . Other reviews have also
found that exercise in natural environments tends to lead to
improvements in self-esteem and mood, with the greatest
17
effect on self-esteem seen in the mentally ill . Additionally,
a study of 20,000 participants found reported happiness to
be, on average, significantly greater in natural or green
POSTnote 000 January 2015 Nature: Wellbeing and Health
Box 2. Defining Wellbeing
Wellbeing is a more abstract concept to define than health, and
therefore requires a specific definition. DEFRA15 define wellbeing as
follows:
A positive physical, social and mental state; it is not just
the absence of pain, discomfort and incapacity. It requires
that basic needs are met, that individuals have a sense of
purpose, that they feel able to achieve important personal
goals and participate in society. It is enhanced by
conditions that include supportive personal relationships,
strong and inclusive communities, good health, financial
and personal security, rewarding employment, and a
healthy and attractive environment.
4 patients, in comparison to 45% of patients who took a walk
environments than in urban environments . Finally, one
recent study investigated what aspect of green space
causes improvements in self-reported wellbeing. This study
found that wellbeing was enhanced the most in green
spaces that observers perceived to have the highest
number of different species, despite observers being unable
18
to accurately assess the number of species in an area .
Studies in children, however, have found that exercise in
green space raises self-esteem to the same extent as
19
exercise in urban environments . Additionally, children with
different habitual levels of physical activity enjoyed green
exercise to a more equal extent, which has the potential to
increase participation in exercise. This indicates that green
exercise is potentially a useful method by which to combat
childhood obesity.
Benefits are not only derived from rural natural areas, but
also urban green spaces. Occupants of urban housing with
views of nature reported lower levels of aggression and
violence than those in inner city housing without views of
8
nature . Additionally, exercise performed with views of
pleasant urban or rural green environments was more
1
beneficial for self-esteem and mood than exercise alone .
Furthermore, an hours rest outdoors improved concentration
and self-reported frame of mind in elderly care-home
20
residents , and even indoor horticulture has been shown to
21
improve mental wellbeing .
Nature and Mental Health
Although there is abundant evidence for the benefits of
nature on general wellbeing, the effect on diagnosed mental
health conditions has been less widely studied. The
strongest evidence supports the benefit of green activities
on the symptoms of children with ADHD (Attention Deficit
Hyperactivity Disorder), a condition that affects 5-10% of UK
22
school children . Three independent studies have
demonstrated a positive effect on attention and symptom
severity in children after participating in green outdoor
23-25
activities .
There is strong evidence to suggest that sports participation
is associated with psychological benefits in young people by
improving their control over symptoms of anxiety and
depression, and can assist in the social development of
26
young people . A further study also concluded that physical
Page 2
activity is positively associated with good mental health, and
other psychological benefits of regular physical activity
include reduced stress, reduced anxiety and reduced
27
depression . It was not investigated in these studies
whether the positive mental health benefits, which are
generated through exercise, are associated with any
specific environmental stimuli, natural or urban.
There is also a strong correlation between limited contact
with the natural environment and prevalence of depression
28
and anxiety disorder in children . Research commissioned
by the mental health charity Mind has shown that taking a
walk in nature can reduce depression scores in 71% of
1
in a shopping centre . This piece of evidence indicates that
the benefit is not gained solely from carrying out exercise,
but also depends on the environment. On the other hand,
the evidence concerning depression rates in urban versus
rural areas is conflicting, demonstrating that living close to
the natural environment is not necessarily the best or only
29
way to improve mental health .
One study of a large group of the over 60s demonstrated
that regular gardening can halve the risk of developing
30
dementia . Subsequent studies, however have shown that
this benefit on Alzheimers risk is probably gained from
31
physical exercise, rather than spending time in nature .
Finally, stress is the biggest environmental risk factor in the
32
development of mental illnesses . One study demonstrated
that spending time in a forest caused a significant reduction
in stress levels in comparison to participants who spent time
29
in an urban environment .
Nature and Physical Health
There are several mechanisms through which the natural
environment may improve physical health, with varying
degrees of scientific evidence.
A well-documented health benefit of the natural environment
is pollutant-absorption by trees (Box 3). Air pollution has
been associated with annual mortality rates through
33
respiratory and cardiovascular disease, and lung cancer .
The introduction of trees to cities has been shown to reduce
pollutant levels. A study in Canberra estimated a carbon
dioxide absorption, energy reduction and pollution mitigation
value of US$20-67 million over a 4-year period for the
34
400,000 trees planted . In a similar study in Guangzhou city
in South China, an annual value of ~US$11,000 was
35
estimated for the trees already in the city . Studies
exploring which species of tree are best for pollutant-
absorption are underway. Genetically modified trees able to
soak up a broader range of pollutants and in greater
quantities are also being developed, and may be a
36
beneficial investment .
As discussed, exposure to the natural environment can lead
to a reduction of stress. The physical effects of stress
include: high blood pressure, heart problems, diabetes, skin
37
conditions, asthma and arthritis . Stress can also worsen
POSTNOTE 000 January 2015 Nature: Wellbeing and Health
Box 3. Pollutants And Their Associated Heath Issues51
! Sulphur dioxide respiratory problems and disease
! Ozone respiratory problems, disease and infection susceptibility
! Nitrogen oxides lung irritation and infection susceptibility
! Particulates heart attacks, decreased lung function and
respiratory problems
the symptoms of illness and disease, and lead to the
37
development of mental health disorders . By reducing
stress, green spaces may also be able to ameliorate the
associated physical symptoms. Some studies have shown
that green spaces can improve recovery time from high
38
stress situations . Additionally, one study found that post-
operative recovery was faster and the requirement for
painkillers was lower in patients with a view of nature
through their window during recovery .
38
There is a growing body of research demonstrating that
exposure to the natural environment in childhood can
reinforce the immune system. This purported hygiene
hypothesis states that without sufficient childhood exposure
to natural environments and the microbes they contain, a
person is more likely to suffer immune problems later in life,
39
such as asthma and allergies . Critics claim that the
40
hypothesis is too simplistic however , while others state
that the term has been used too widely and that caution
should be exercised so as not to overstate the importance of
40
the effect . Improvements to the immune system from
exposure to the natural environment require more thorough
research.
There is conflicting evidence that the natural environment
encourages exercise. The underlying theory is that greater
access to green space will encourage more exercise and
thus improve health. Taking part in regular physical activity
has been shown to reduce the risk of heart disease, high
41
blood pressure and Type 2 diabetes . However, evidence
from the UK and overseas concerning whether the natural
environment encourages exercise is contradictory. For
example, a study carried out on adults in Bristol found a
positive correlation between exercise frequency and green
42
space availability . However, a similar study in Norwich
focusing on middle-aged adults came to the opposite
43
conclusion . Large scale studies focused on individual UK
cities need to be undertaken to determine whether green
space will have any benefit on physical health, and to which
demographics. As with mental health, the specific
component of the natural environment that is hypothesised
to stimulate positive effects in physical health has yet to be
explored.
Nature and Education
There is some evidence for a positive interaction between
exposure to the natural environment and education. Studies
show that seeing nature is important to school students and
is an effective means of relieving stress and improving
44
wellbeing .
A major benefit of exposure to natural environments in
45
education is improved attention . This exposure can be as
Page 3
simple as looking out of a window at a natural view. Earlier
investigations have established that students preferred to
carry out educational activities in rooms with windows to
45
those without . University students demonstrate a similar
46
response to natural views from their working environment .
There is also evidence that spending time in nature can
positively impact performance in academic tasks. An
improvement on proofreading scores was found in people
who had experienced holidays in a rural natural environment
compared to those who had taken an urban holiday or no
47
holiday at all . Going for a walk in a natural environment
likewise improved performance in a proofreading task,
compared to walking in an urban environment or passive
47
relaxation .
A review of 44 independent studies concluded that physical
activity was positively associated with better cognitive
48.
functioning This was particularly the case for middle
school students and younger pupils. However, this benefit
was again not necessarily associated with partaking in
physical activity outdoors.
An innovative approach to incorporating nature into
education is the use of forest schools. Forest schools are a
type of outdoor education introduced to England and Wales
in the 1990s attended by children and young adults. It is one
of the many approaches used to try and improve the
behaviour of disruptive students. They involve frequent visits
to woodland areas with a curriculum based around
understanding the complex systems in the natural
environment. The students of forest schools typically report
enjoying the lessons and feeling an improved connection
49-50
with nature . The few scientific studies investigating the
benefits of forest schools report improved confidence,
51
motivation and concentration .
Policy on the Natural Environment and
Health
There is a large suite of UK and EU policy which is
dedicated to protecting, managing and promoting the UKs
natural environment. The evidence presented in this
POSTnote suggests that this policy may therefore be
relevant to the maintenance and improvement of health and
wellbeing.
Protecting the Natural Environment
The availability of safe drinking water is of paramount
importance and the provisioning of uncontaminated water is
among the most important service provided by the natural
environment. Water quality is protected by regulating
activities such as waste management, chemical usage and
disposal, and agricultural practices, such as the application
of fertilizers, herbicides and pesticides. To an extent, the
natural environment can act as a buffer to air pollutants and
keep the air clean, although this ability is certainly not
unlimited. It is essential that air pollution is regulated.
POSTnote 000 January 2015 Nature: Wellbeing and Health
A framework of legislation exists to ensure the natural
environment is maintained so that standards for drinking
water, food production and air quality are upheld. These
52
include the Water Resources Act 1991 , the EU-wide
53
Drinking Water Directive 1998 , the Directive on
54
Environmental Quality Standards 2008 (EU) and the
55
Environmental Permitting Regulations 2010 . Additionally,
56
the National Air Quality Strategy (2007) is in place to
57
satisfy the Environment Act of 1995 , which requires
measurement and limits release of pollutants known to be
harmful to the natural environment and to people. Pollutants
covered by the Act include but are not limited to those
mentioned in Box 3.
Managing the Natural Environment
A raft of UK, EU and UN legislation and agreements are in
place in order that the natural environment may be enjoyed
by future generations. This is especially important given the
effects of changing land use, climate change and the
pressure of an increasing population. The UN Convention
58
on Biological Diversity (1992) , the EC Convention on the
Conservation of European Wildlife and Natural Habitats
59
(1979) and the EU Directive on the Conservation of
60
Natural Habitats and Wild Fauna & Flora (1992) provide a
backbone of regulation to limit any damage to the natural
environment. In addition, several key vulnerable areas and
species are protected by the Conservation of Habitats and
61
Species Regulations (2010) , maintaining a varied and
diverse environment.
Ensuring access to the natural environment is vital if it is to
provide benefits for health and wellbeing, and Government
62
policy reflects this need. The Highways Act (1980) , the
63
Wildlife and Countryside Act (1981) , the Common Land
64
and Commons Act (2006) provide ruling that allows
access to areas of common land as well as public rights of
way on private land in the UK.
Promoting the Natural Environment
A collection of policy tools and papers exists to promote
healthy living by increasing awareness of the benefits of the
natural environment. They also act as a nudge to
encourage people to take advantage of the resources and
opportunities provided by the natural environment to
improve health.
! No Health Without Mental Health, 201165 highlights
Government awareness that the natural environment can
be greatly beneficial for mental health.
! The NHS Mandate April 2013-March 201566 states that
the NHS has a duty to inform the public of the various
treatment options available, as well as steps the public
can take to look after their health, including outdoor
activity.
! The Personalised Health and Care 2020 Policy Paper,
67
2014 states that patients should be given freer choice
about the type of treatment and/or care they receive for
physical and mental health concerns.
POST is an office of both Houses of Parliament, charged with providing independent and balanced analysis of policy issues that have a basis in science and technology.
POST is grateful to XXXXXXXXXXXXXXX for researching this briefing, to XXXXXXXXXX for funding his/her parliamentary fellowship, and to all contributors and reviewers.
For further information on this subject, please contact the co-author, XXXXXXXXXX. Parliamentary Copyright 20XX. Image copyright sheknows.com
Page 4
! The Healthy Child Programme: Pregnancy and the
68
First 5 Years of Life, 2009 paper lays out
recommendations for helping parents to encourage
healthy lifestyles for young children.
! Reducing Obesity and Improving Diet, 201369. The
Government aims to reduce the level of excess weight in
adults, and to bring about a sustained decrease in the
level of excess weight in children by 2020. The
Government is committed to improving the nations
health, with the launch of Change4Life programme in
2009 that encourages healthy eating and sufficient
exercise.
! Natural England70 is committed to promoting public
access to the countryside and to promote Open Access
land, National Trails and access to the coast. In addition,
Natural England controls and has a legal responsibility to
promote and provide access to the 15 National Parks
across the UK.
There is ample policy which has the potential to improve
health and wellbeing via the protection, management and
promotion of the natural environment. However, some of the
proposed benefits to health and wellbeing provided by the
natural environment still require further investigation
Endnotes
1. Pretty, 2005. International Journal of Environmental Health Research.
15:319:337
2. Mitchell, 2013. Soc Sci Med. 4:91-130
3. Maas et al, 2006. J Epidemiol Community Health. 60:587592
4. MacKerron & Mourato, 2013. Global Environmental Change. 23:9921000
5. Centre for Mental Health, 2010. Economic and social costs of mental health
problems in 2009/10. London; 2010
6. Butland et al, 2007. Tackling obesities: future choices project report (2nd
Ed). London: Foresight Programme of the Government Office for Science.
www.bis.gov.uk/assets/bispartners/foresight/docs/obesity/17.pdf
7. Oswald et al, 2009. IZA Discussion Paper No. 4645
8. Kuo & Sullivan, 2001. Environment and Behaviour. 33:543-571
9. WHO Media Centre, 2015. Obesity and Overweight, Fact sheet 311.
http://www.who.int/mediacentre/factsheets/fs311/en/
10. Office for National Statistics, 2007. Adult Psychiatric Morbidity in England,
Results of a household survey
11. The Health and Social Care Information Centre, 2013. Statistics on Obesity,
Physical Activity and Diet - England, 2013
12. DEFRA, 2001. Public Attitudes to Quality of Life and to the Environment
(2001)
13. DEFRA, 2003. Achieving a Better Quality of Life: Review of Progress
Towards Sustainable Development. Government Annual Report 2002.
14. Coon et al, 2011. Environmental Science & Technology. 45:1761-72
15. DEFRA, 2007. Sustainable Development Indicators in your Pocket 2007.
16. Barton et al, 2009. Journal of Integrative Environmental Sciences. 6:261-78
17. Barton & Pretty, 2010. Environmental Science & Technology. 44:3947:55
18. Dallimer et al, 2012. BioScience. 62:47-55
19. Reed et al, 2013. PLOS One. 8:e69176
20. Ottoson & Grahn, 2005. Landscape Research. 30:23-55
21. Barnicle & Midden, 2003. HortTechnology. 13:81-85
22. Taylor et al, 1991. The Epidemiology of Childhood Hyperactivity. Maudsley
Monograph. London: Oxford University Press
23. Faber et al, 2001. Environment and Behaviour. 33:54-77
24. Kuo FE & Faber TA, 2004. cited in American J Public Health, 94:1580-1586.
25. Kuo FE & Faber TA, 2004, A potential Natural Treatment for Attention-Deficit
Hyperactivity disorder: Evidence from a national study. American J Public
Health, 94:9, 1580-1586
26. World Health Organisation (WHO): Factsheet on diet and physical activity for
young people on the website of the World Health Organisation
POSTNOTE 000 January 2015 Nature: Wellbeing and Health Page 5

27. Mutrie & Parfitt, 1998. Physical activity and its link with mental, social and
moral health in young people. In S. Biddle, J. Sallis and N. Cavill (Eds) Young
and Active? Young People and Health-Enhancing Physical Activity
Evidence and Implications, (London, HEA)
28. McCurdy et al, 2010. Curr Probl Pediatr Adolesc Health Care. 40:102-17
29. Lee et al, 2009. Scandinavian Journal of Forest Research, 24:227-234
30. Fabrigoule, 1995. J Am Geriatr Soc. 43:485-90
31. Rao et al, 2014. Frontiers in Aging Neuroscience, 6:61
32. World Health Organisation (WHO), 2012. Risks to mental health: an overview
of vulnerabilities and risk factors, background paper by who secretariat for the
development of a comprehensive mental health action plan
33. Pope III et al, 2002. Journal of the American Medical Association. 287:1132-
41
34. Brack, 2002. Environmental Pollution. 116(S1):S195-200
35. Jim et al, 2008. Journal of Environmental Management. 88:665-76
36. Doty et al, 2007. PNAS. 104:16816-21
37. Mcgonagle et al, 1990. American Journal of Community Psychology. 18:681-
706
38. Ulrich, 1984. Science. 224:420-1
39. Matricardi et al, 2000. Respiratory Research. 1:129-132
40. Wills-Karp et al, 2001. Nature Reviews Immunology. 1:69-75
41. Warburton et al, 2006. CMAJ. 174:801-9
42. Coombes et al, 2010. Social Science and Medicine. 70:816-22
43. Hillsdon et al, 2006. Public Health. 120:1127-32
44. Kaplan et al, 1989. The Experience of Nature: A Psychological Perspective.
Cambridge: Cambridge University Press
45. Verderber, 1986. Environment and Behaviour. 18:450-66
46. Tennessen et al, 1995. Journal of Environmental Psychology. 15:77-85
47. Hartig et al, 1991. Environment and Behaviour. 23:3-26
48. Sibley et al, 2003. Pediatric Exercise Science. 15:243-56
49. Roe et al, 2011. Urban Forestry and Urban Greening. 10:205-12
50. OBrien et al, 2007. Urban Forestry and Urban Greening. 6:249-65
51. Brunekreef et al, 2002. Lancet. 360:1233-42
52. Water Resources Act 1991
53. Drinking Water Directive 1998
54. Directive on Environmental Quality Standards 2008
55. Environmental Permitting Regulations 2010
56. National Air Quality Strategy 2007
57. Environment Act 1995
58. Convention on Biological Diversity 1992
59. Convention on the Conservation of European Wildlife and Natural Habitats
1979
60. Directive on the Conservation of Natural Habitats and Wild Fauna and Flora
1992
61. Conservation of Habitats and Species Regulations 2010
62. Highways Act 1980
63. Wildlife and Countryside Act 1981
64. Common land and Commons Act 2006
65. No Health Without Mental Health 2011
66. NHS Mandate April 2013- March 2015, November 2013
67. Personalised Health and Care 2020, 2014
68. Healthy Child Programme: Pregnancy and the First 5 Years of Life, 2009
69. Reducing Obesity and Improving Diet, 2013
70. Natural England
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/
368270/strategic-statement-of-board-role.pdf. Accesssed 29/01/2015.