This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Podcast: Local green spaces and mental health
In this podcast, Helen Saul, Editor in Chief of NIHR Evidence, and study author Sarah Rodgers, Professor of Health Informatics, University of Liverpool, discuss the impact of local green spaces on people's mental health.
Podcast transcript: Local green spaces are linked with better mental health
[Music]
0.08
Helen Saul: Welcome to this podcast from the NIHR on the impact of green spaces on our mental health. Living near to green and blue spaces, such as parks, lakes, or beaches, is associated with better mental health. But exactly why is not clear. It could be that these spaces themselves reduce stress levels, encourage us to exercise and socialise, and improve air quality. Or it might just be that people living in these areas are wealthier and therefore healthier than others in the population.
Today we’ll be discussing a huge study that set out to untangle these effects.
My name is Helen Saul, and I’m the editor in chief of the NIHR Evidence website. I am speaking with author Professor Sarah Rodgers. Perhaps you’d like to introduce yourself, Sarah.
0.58
Sarah Rodgers: Hello, Helen! So I am, as you said, a Professor of health informatics at the University of Liverpool, and I’ve got a background in geography and epidemiology. So, I thought this study seemed appropriate for me and my background, thinking about how the environment impacts health.
1.18
Helen Saul: There’s obviously previous research on green spaces and mental health. Why was this study needed?
1.27
Sarah Rodgers: Existing studies mainly had small cohorts of people, so, a few 100 or 1,000 and assessed changes over a short period of time. And they didn’t really focus that much on the socio-economic inequalities as well. And so because those studies were cross sectional, we aren’t really sure if the person’s health caused them to move to a different environment because of their general life chances being impacted by poor health, for example, and wanting, you know, to have to stay in the middle of an urban city where they didn’t want to be, or they’ve proactively been able to move out to a green and nicer place already.
2.08
Helen Saul: So how did you address this in your study?
2.11
Sarah Rodgers: So, yeah. So, the way we set up our current study allowed us to be sure that the exposure to green or blue space came before the outcome, so we could test more precisely if the green or blue spaces were preventing the ill health. And I think that was a really useful advance. So, what we were able to do was use the household linkages from people’s homes and then link the environment around their home to their health records. So, in this case we linked to the GP records in Wales for about 2 million people. So, we were looking for their health conditions over time, monthly or quarterly, we can do that. And then this was with anonymised data, which means that all the identifiers, so their names and addresses were removed. And so, the researchers access the data without ever knowing who the person is or where they live.
3.05
Helen Saul: And you were looking both at people’s immediate surroundings at home and their potential access to green spaces?
3.13
Sarah Rodgers: Yes, that’s right. So, we thought that if we looked at a short distance from home, and we looked at the greenness, we called that ambient greenness around the home, within about 2 or 300 metres, people could actually see this from their front door, so they wouldn’t have to make any effort to get the benefits from it, it would just be there. But then we also looked at their access within about a mile of home. So that in that case, that’s their sort of potential to access those green spaces because we weren’t sure whether they actually would have visited that space at that time.
3.52
Helen Saul: So, what did you find? How did these two measures relate to mental health?
3.58
Sarah Rodgers: That was really interesting. We found quite a strong association with the ambient greenness. So, when we looked at the routinely collected health data for more than 2 million adults, we saw that people’s home surroundings and their potential to access green or blue spaces was associated with a reduction in anxiety or depression that they reported to their general practitioner.
So, having the top third amount of greenness immediately from their sort of front door reduced their likelihood of anxiety or depression by 20%. So, they were a fifth less likely to need to go to their GP for help. And then we saw some reduction, a smaller reduction, but still a reduction of 7% in terms of the potential to access these green or blue spaces within a longer distance from home. So, for every 360 metres to their nearest space, there was a 7% increased likelihood of a common mental health disorder, the anxiety or depression.
5.04
Helen Saul: And did the results differ for people who had a previous mental health diagnosis and those who didn’t?
5.11
Sarah Rodgers: Yes, so they were different, we wanted to make, to kind of look back at people, firstly, who’d had an anxiety and depression episode a long time ago to see what impacts this has had. And we found that adults who’d had an old diagnosis of up to 8 years earlier had an even lower chance of having a common mental health disorder. So, this was 32% less, compared to 16% for those who didn’t have that old historical diagnosis.
5.44
Helen Saul: That’s a huge difference within, presumably, a vulnerable population.
5.51
Sarah Rodgers: Yes, yes, that is, it is quite a massive difference, and we think this is a big advance because of how we structured the data, and how we were able to use all of those data more precisely to be able to look at their health condition and see whether their preceding exposure to green or blue spaces had an impact potentially on their health conditions.
6.17
Helen Saul: You also looked at different groups of the population. Which groups did you find were most likely to benefit from green surroundings and better potential access?
6.27
Sarah Rodgers: So, we looked at different stratifications of deprivation. So, what we found was there was an association of common mental health disorders and the likelihood of potential green blue space access. For adults living in the most deprived areas, that was a 10% reduction. And that was a stronger association than for those living in the least deprived areas which only saw a 6% reduction. So that indicates that there are really great benefits, greater benefits to mental health for people living in the deprived areas with more green or blue spaces. So, they had, you know fewer overall resources, but they had these green or blue spaces that they were taking, potentially, taking some advantage of which is good to see.
7.23
Helen Saul: Well, it’s very interesting that the people who needed it most benefited most.
7.29
Sarah Rodgers: Yes, definitely, it’s really interesting to see those patterns in terms of deprivation and inequalities, and to know that there is the potential to have nicer spaces making an impact on people who need these spaces the most.
What I’m trying to do now is work with local government and different stakeholders. So, when they are designing new spaces, we are trying to work out how we can help our local government engage with the local community, to empower the local community, to co-design those spaces with the people who need them the most, and maybe even so design those spaces with those people in mind, with those people themselves.
8.29
And that’s what we’re doing with this new UK Prevention Research Partnership called Groundswell that I’m involved with. So, we’re taking the data a step forward and looking on the ground and working with people designing those spaces. So, I think the impact of the NIHR project that we were funded for is a really good baseline, and that’s helping us now to work on the ground with people about this co-design element.
9.00
Helen Saul: Well, we’d like to wish you the best of luck with that important work, Sarah, and thank you very much for joining me today and for your description of an incredible study.
This is an episode of the NIHR podcast, I’m Helen Saul, and thank you for listening. If you have thoughts or comments on this or any other episodes, please contact us at evidence@nihr.ac.uk, and do visit our website, which is evidence.nihr.ac.uk.
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Researchers analysed data on more than 2 million people in Wales over 10 years to explore the impact of green spaces on mental health. They linked information about people’s mental health with information about the greenness of their home’s immediate surroundings and how close they lived to green or blue spaces (such as parks, lakes, and beaches). They found that people had a lower risk of anxiety and depression if:
- their home’s immediate surroundings (within 200-300 metres) were greener
- they could access green and blue spaces nearby.
The researchers say that local authorities could improve the mental health of their community by increasing the greenery in their towns and cities and improving access to green and blue spaces.
More information on mental health can be found on the NHS website.
The issue: how do green spaces impact mental health?
Green and blue spaces could improve mental health through the opportunities they provide to socialise and exercise; it could also be that these spaces improve air quality. But other factors, such as wealth, may explain this difference. Wealthier people tend to have better mental health and live in areas with more green space; it is unclear whether the improvement is linked with the wealth or the greenness.
This study aimed to tease out the impact of green and blue spaces alone, regardless of wealth or other factors. Researchers analysed how living in areas with more green space, or how close the nearest green and blue space was to someone’s house (access), affected people’s mental health. They also considered if the effect of green space on mental health differed between more and less wealthy areas.
What’s new?
The study was based on the GP records of 2.3 million people from Wales (aged 16 and older) from 2008 – 2019. The researchers searched anonymised patient records for a diagnosis of anxiety or depression, and for their home address(es). Each year, the researchers rated the greenness (trees, parks and gardens, for instance) of each person’s immediate home surroundings using satellite images. This was greenness that people could see from their front door; it required no effort to access. They also measured how close people’s houses were to green and blue spaces (within 1,600 metres), and the number of these spaces, using survey maps for each person, each year.
People who died or moved away from Wales were excluded from the study. If they moved within Wales, they were still included (along with the greenness of their new location). The researchers adjusted the results according to sex, age, deprivation and other factors.
Both measures of greenness (home surroundings, and local green and blue spaces) reduced the risk of anxiety and depression. The researchers found that:
- the highest level of greenness of home surroundings was associated with 20% less anxiety and depression than the middle level; the middle level with 20% less than the lowest level
- every 10% increase in access to green and blue spaces was linked with a 7% reduction in risk of anxiety and depression
- people in poorer areas benefitted more (10% reduced risk of anxiety and depression) from access to green and blue spaces than those in richer areas (6% reduced risk).
Every additional 360 metres from the nearest green or blue space was linked with a 5% higher risk of anxiety and depression. People with a previous diagnosis (anxiety and depression before 2008) benefitted more than others from green home surroundings, but not from greater access to green spaces.
Why is this important?
This is the largest, most comprehensive study to show that a green home environment, and access to green and blue spaces, protect against anxiety and depression. These findings support local authorities’ and policymakers’ efforts to add green spaces to towns and cities, and to increase access to them. This could improve the wellbeing of everyone, but especially those in deprived areas where the positive effects of green spaces were greatest.
A strength of the study was that it linked individual health records, to measurements taken over time of the greenness of home surroundings, and access to green and blue spaces. It therefore accounted for house moves or removal of a public green space, for example. The long follow up period (10 years) meant that changes in people’s mental health could be detected reliably.
People in poorer areas benefitted most from good access to green spaces, possibly because people in poorer areas are less able than others to make use of green and blue spaces further from home.
The study relied on primary care records to assess anxiety or depression; some people may have had either condition without seeking help from their GP. The quality of green spaces in terms of lighting, safety, or cleanliness, was not explored. It may be that living beside a poorly maintained park, for example, is not beneficial to mental health.
What’s next?
The researchers say increased greenery in towns and cities could improve mental health in the population, especially for people in more deprived areas and those with a history of anxiety and depression. Green and blue spaces have other benefits such as improving air quality, and providing habitats for wildlife.
The researchers suggest that policymakers and communities work together to improve access to these spaces and to ensure that the spaces meet people’s needs, and are well-maintained, for example. Green spaces that are accessible and safe, with security measures and ramps for wheelchair users, for example, are likely to bring most benefit.
The researchers are working with local communities on a project called GroundsWell, which is co-designing green and blue spaces with the aim of improving access. Another project, Healthy Urban Places, is bringing together researchers, communities, local governments, and other organisations to co-produce research on what makes a healthy place. For example, what features are most important for health, and how changes to local areas can improve health and reduce inequalities.
What have I learned?
You may be interested to read
This is a summary of: Geary RS, and others. Ambient greenness, access to local green spaces, and subsequent mental health: a 10-year longitudinal dynamic panel study of 2·3 million adults in Wales. Lancet Planetary Health 2023; 7: E809 – 818.
An NIHR Evidence Summary on how open spaces improve wellbeing.
A report from the World Health Organisation on the effect of access to green spaces on health.
An NHS article on how access to green spaces can improve your mental health.
An article about the project by Beyond Greenspace.
Further work from the same group on relationships between natural environments, health and wellbeing: Rodgers SE, and others. Creating a learning health system to include environmental determinants of health: The GroundsWell experience. Learning Health Systems 2024; 8:e10461.
Funding: NIHR Public Health Research Programme Commissioned Call. The author is supported by the NIHR Applied Research Collaboration North West Coast. The study used the Secure Anonymised Information Linkage (SAIL) Databank, funded by Health and Care Research Wales.
Conflicts of Interest: No relevant conflicts of interest.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
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