Under the influence of economic, environmental, and social structural changes, urban space expands and contracts to varying degrees and the everyday urban landscape changes in response. Over the past 20 years, a large number of cities in China have undergone a brief but rapid urban expansion and are moving toward shrinking cities. Most of these cities are now facing social problems such as an aging population and a high prevalence of chronic diseases. Therefore, the “therapeutic” role and impact of everyday landscapes in these cities need to be examined in the context of urban development processes through appropriate assessment methods. Therefore, this study applies the ANP-mV model to examine the therapeutic nature of everyday urban landscapes in different development periods, with the aim of enhancing the health and well-being of people with chronic diseases. Firstly, this study uses the city of Jinzhou in Northeast China as an example to develop a framework for assessing the therapeutic nature of everyday urban landscapes based on the health care needs of people with chronic diseases; secondly, it examines the therapeutic nature of the former Jinzhou Suburban Riverfront Forest Park as it has developed and evolved over the past 16 years; finally, it explores place-making and regeneration strategies for therapeutic landscapes from the perspectives of dynamic impact and sustainable development to enhance chronic illness patients’ well-being. At the theoretical level, this study contributes by providing a methodology and research ideas for examining the “therapeutic” nature of everyday urban landscapes and proposing further development plans for renewal, constructing a framework for assessing therapeutic landscapes, and elucidating the relationship between networks of influence and the relative importance of various assessment dimensions/elements. At the practical application level, the contribution of this study is to provide local policymakers with a key decision basis for the future development planning of the East Lake Forest Park. The aim is to explore landscape creation and regeneration strategies for the East Lake Forest Park in the context of Jinzhou's progressive move toward a shrinking city, in order to sustain the well-being of the chronically ill.
1. Introduction
Previous research has repeatedly documented the restorative effects of place on health and well-being [1, 2] and has developed a number of framework concepts such as the biophilia hypothesis, the Attention Restoration Theory, and the concept of healing landscapes [3]. Under the concept of therapeutic landscapes, scholars have examined many types of landscapes associated with healing or rehabilitation, including natural landscapes such as villages, mountains, and lakes that have a reputation for healing [4, 5]. There are also everyday landscapes, such as places and residential areas where medical services are provided, and libraries [6, 7]. Then, there are urban landscapes, such as urban public green spaces and streets, and social networks [8, 9]. In humanist and cultural ecology theories, the formation of therapeutic landscapes is dynamic and the landscape can be seen as an evolving process where “therapeutic” is examined in the context of changing environmental, social, and economic conditions [10]. Yan and He [8] argue that it is important to explore the evolution of therapeutic landscapes, i.e., how therapeutic landscapes change over time.
Realistic experience shows that the development of local productivity, changes in social structure, and the introduction of macrogovernance policies can have a vital impact on the evolution of the urban landscape. When the landscape style changes, it will inevitably lead to discussions about endowing the landscape with healing properties or maintaining the healing properties of the place. Examples include exploring and understanding the creation of restorative and therapeutic spatial places for refugees or dislocated farmers in urban distribution and resettlement planning [9, 11, 12], exploring longevity villages as tourist destinations as the health tourism industry grows [8], and exploring design strategies for healing and therapeutic gardens in senior communities or medical buildings as we move toward a healthy aging society [13]. It is worth noting that as urban economies develop, populations grow, and the quality of life improves, cities at all levels in many regions experience varying degrees of expansion, and the landscape of former suburban areas will evolve significantly under the influence of multiple factors. For local urban dwellers, villages, green spaces, forests, and parks in the suburbs are often seen as therapeutic and healing landscapes that combine physical and nonphysical levels [14, 15].
Due to the economic downturn of cities, industrial transformation, and an aging population, the rate of urban expansion into suburban areas has generally slowed down in recent years, and more emphasis has been placed on the planning concept of “transformation” rather than “new construction/rebuilding,” with more emphasis on the inner development of cities, microrenewal, and adaptive improvement of urban space. Even in China, where the built-up area has grown exponentially over the past 30 years, spatial expansion is no longer the dominant form of urban development, and many cities are facing a shift from “incremental planning” to “stock planning” [16]. In China, in particular, a large number of small and medium-sized cities are now moving toward shrinking cities after urban expansion, with serious urban population loss and an increasing trend toward aging [17].
Concerned with the development of these cities, scholars and practitioners have proposed a range of urban regeneration and development strategies that can be summarized in three main development planning directions: regrowth, urban islands, and dedensification and greening [18]. Regardless of the development strategy, what needs to be acknowledged is the irreversibility of urban shrinkage, and that urban growth and decline, like life cycles, are seen as natural processes of urban change, requiring planning managers to shift a commonly accepted perception [19]. Scholars have suggested that local policymakers should examine whether sprawling urban landscapes meet the real needs of the current population and improve urban green space networks to increase the livability and attractiveness of cities, thereby mitigating population loss and enhancing economic vitality [20–22].
In contrast to China's Tier 1-2 cities, there is a large demand for healthcare in small and medium-sized cities that have undergone a brief and rapid urban expansion and are now gradually shrinking. Perhaps due to its unique natural environment and dietary habits, Northeast China has long been a region with a high prevalence of chronic diseases such as cardiovascular disease, diabetes, and gout [23, 24]. In many cities in Northeast China, there is widespread and strong awareness of the need for chronic disease patients to go outdoors for physical, mental, and spiritual healing [25]. Through ongoing observations and interviews over many years, this study considers that people with chronic illnesses in the region value rely more on outdoor blue, green, and white spaces for healing and therapy in appropriate seasonal and climatic conditions. In the cities of Jinzhou in Liaoning Province and Jiamusi in Heilongjiang Province, for example, outside of the extreme weather days in the northeast, large numbers of people regularly enter urban squares, parks, and waterfront streets where people can gather and relax on an almost daily basis to enjoy the healing and therapeutic effects of the landscape through a variety of health behaviors and activities. Therefore, as cities shift from sprawl to contraction and respond to the current needs of the population to continue to enhance the health and well-being of people with chronic diseases, the former suburban landscape needs to be reexamined not only for its therapeutic qualities but also for new place-making strategies in urban regeneration. However, much of the previous research has focused on examining the positive effects of landscape environments on patients [26, 27] and explaining the formation and evolution of therapeutic landscapes. Few scholars have integrated urban development and planning concepts in a public health context, examining the therapeutic nature of an evolving landscape and exploring how to shape therapeutic landscapes for sustainable well-being in urban regeneration.
In summary, this study uses the city of Jinzhou in Liaoning Province, China, as a case study. The city has experienced a brief and rapid urban expansion and is now shifting to a shrinking city with significant population loss and an aging trend. The city has a high prevalence of chronic diseases in the northeast and is generally representative of healthcare resources and the development of the built-up areas. The purpose of this study is to develop a framework for assessing the therapeutic nature of everyday urban landscapes based on the health care needs of people with chronic diseases, examine the therapeutic nature of the former Jinzhou Suburban Riverfront Forest Park as it has developed and evolved over the past 16 years, and explore strategies for place-making and regeneration of therapeutic landscapes for the well-being of people with chronic diseases from a dynamic impact and continuous development perspective. The design of this study is shown in Figure 1. Firstly, this study uses a literature review to initially extract the elements of therapeutic assessment for everyday urban landscapes and then, through focus group interviews, constructs a framework for assessing the therapeutic landscape of the East Lake Forest Park in Linghe District, Jinzhou City, based on the health care needs of people with chronic illnesses. Secondly, a network analysis method (ANP) was applied to assign weights to the assessment elements based on expert opinion, and a modified VIKOR technique was applied to examine the therapeutic landscape of Jinzhou City's Donghu Forest Park for people with chronic diseases over the past 16 years, in conjunction with interviews and questionnaires administered by the public. Finally, based on the results of the assessment and analysis, strategies for the creation and renewal of the therapeutic landscape of the East Lake Forest Park are explored in the context of Jinzhou's progressive move toward a shrinking city, in order to sustain the well-being of people with chronic diseases.