Biodiversity and Human Health: What Role for Nature in Healthy Urban Planning?

Abstract

It is well known that nature is good for human health and well-being. However, there is little understanding or articulation of this link among built environment professionals. The purpose of the paper is to explore the literature for evidence of the health benefits of urban nature and biodiversity. The key question is whether there is an added health value to urban biodiversity policies. If there is, what can planners and other built environment professionals learn about the role of nature in healthy urban planning? The paper has three parts: the first discusses health and its determinants before examining policy on health and biodiversity in the urban setting. The second looks at the literature on nature and health. Attention is given here to the ecological services provided by nature as well as the benefits that derive from human interaction with nature. The final section sets out some initial thoughts about the implications of the paper's findings for urban planners and built environment professionals. The paper demonstrates that there are clear, documented, links between human health and nature, particularly in the urban setting. Together the results suggest that planners and built environment professionals could have a profound impact on community well-being by promoting urban nature and urban biodiversity in all new development.

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Brown, Caroline and Grant, Marcus (2005) Biodiversity & human
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1
Biodiversity & human health: what role for nature in healthy
urban planning?
Caroline Brown & Marcus Grant
Published as: Brown, Caroline and Grant, Marcus (2005) Biodiversity & human health: What role for
nature in healthy urban planning? Built Environment, 31 (4). pp. 326-338.
Caroline Brown, Senior Research Fellow, School of the Built Environment, Napier
University, Edinburgh, EH10 5 DT
Marcus Grant, Senior Research Fellow, Centre for Environment & Planning, Faculty of
the Built Environment, University of the West of England, Bristol, BS16 1QY
Abstract
It is well known that nature is good for human health and well-being. However, there is
little understanding or articulation of this link among built environment professionals. The
purpose of the paper is to explore the literature for evidence of the health benefits of
urban nature and biodiversity. The key question is whether there is an added health
value to urban biodiversity policies. If there is, then what can planners and other built
environment professionals learn about the role of nature in healthy urban planning?
The paper has three parts: the first discusses health and its determinants before
examining policy on health and biodiversity in the urban setting. The second part of the
paper looks at the literature on nature and health. Attention is given here to the
ecological services provided by nature as well as the benefits that derive from human
interaction with nature. The final section of the paper sets out some initial thoughts about
the implications of the paper’s findings for urban planners and built environment
professionals.
The paper demonstrates that there are clear, documented, links between human health
and nature, particularly in the urban setting. Together the results suggest that planners
and built environment professionals could have a profound impact on community well-
being by promoting urban nature and urban biodiversity in all new development.

2
Introduction
‘Man did not weave the web of life; he is merely a strand in it.
Whatever he does to the web, he does to himself.’
Attributed to Chief Seattle, 1854
That nature is important for human well-being is evident in many ways. From the
mounting body of scientific evidence on the harm that we may be doing to human health
through undermining global biospheric processes to simple observations such as the
tendency for city dwellers to seek out leafy and green places to live. Our contemporary
cities, however, are not blessed with good quality habitats for wildlife, and urban nature
is struggling. A recent report on urban environments in England and Wales revealed that
there is intense pressure on wildlife in urban areas as a result of pollution, development
and insensitive design (Environment Agency, 2002). Local plant extinctions increase
with population density, suggesting that urbanism is as much a threat to biodiversity as
intensive agriculture (Thompson & Jones, 1999). The result is a tendency for the quality
of wildlife to reduce with proximity to city centres through habitat loss, fragmentation and
disturbance (Environment Agency, 2002). Given that more than 80% of people in the
European Union live in urban areas (Expert Group on the Urban Environment, 1996) and
an increasing proportion of the world’s population are urban dwellers, then the
significance of the issue of the urban nature and health link is all too apparent.
Despite growing interest in the relationship between nature and well-being, there is little
understanding or articulation of this link among built environment professionals. The
purpose of this paper is thus to explore the literature for evidence of the health benefits
of urban nature and biodiversity. The focus is on interactions in the urban environment at
a day-to-day level and at a local scale. The key question is whether there is an added
health value to urban biodiversity policies. If there is, then what can planners and other
built environment professionals learn about the role of nature in healthy urban planning?
The paper has three parts. The first begins by discussing health and its determinants,
before considering something of the policy context relevant to both health and

3
biodiversity in the urban setting. The second part of the paper examines the literature on
nature and health. Attention is given here to the ecological services provided by nature,
as well as the benefits that derive from human ‘experiences’ of nature in both active and
passive settings. The final section of the paper draws conclusions from the first two
sections, and sets out some initial thoughts about the implications for urban planners
and built environment professionals.
The health-nature link
Before beginning to unravel the literature for evidence about the link between urban
nature and human health, it is important to understand the concepts at the centre of this
paper. The term health has a range of meanings and associated methods of
measurement. Most familiar of these perhaps is the medical and healthcare view of
health as the absence of disease. Medical indicators thus measure health through
factors such as infant mortality, life expectancy and the incidence of diseases such as
coronary heart disease and cancer. Defining health in this way has commonly been
referred to as a negative definition.
However, over the past decade or so there has been a shift in the meaning and
ownership of the term ‘health’. The trend is towards broadening the definition and taking
a more holistic definition such as that set out by the original Charter of the World Health
Organisation in 1946. This stated that ‘Health is not only the absence of disease but a
state of physical, mental and social well-being’ (WHO, 1946). The Agenda 21 agreement
set out at the Rio Earth Summit in 1992 restated this broad view of human health and
made clear that the delivery of health is not solely the responsibility of health authorities.
Municipal (local) government also has a role to play as ‘...health ultimately depends on
the ability to manage successfully the interaction between the physical, spiritual,
biological and economic/social environment.’ [Agenda 21:Report of the United Nations
Conference on Environment and Development, Rio de Janeiro, 3-14 June 1992, Chapter
6: Protecting and Promoting Human Health Para 6.3] (UNEP, 1992)
The influence of the urban environment on human health implied in the above text, has
been confirmed by the work of Whitehead & Dahlgren (1991) among others. In their
work on health inequality, these authors developed a holistic model of the main

4
determinants of health (see also Barton’s paper in this issue). This captures a complex
multilayered system where the final health of an individual is determined by four strata of
influence with the environment as the outer level.
In the late 1990s the model of health determinants was advanced with further research
into details of the social factors (see for example: Marmot & Wilkinson, 1999). The World
Health Organisation has taken this forward through its healthy cities campaign (WHO,
1998) and the publication ‘Healthy Urban Planning’ (Barton & Tsourou, 2000). Taken as
a whole these developments started to articulate the role of planning and urban
management in health improvement and to bring to light a gap in our knowledge of the
link between nature and health.
Figure 1: Source: Barton, Grant & Guise (2003)
The ecosystem model of a neighbourhood illustrated in figure 1, can be used to indicate
the interrelationship between people’s health and the urban realm. Here it is possible to
see that community and healthy activities can be supported or frustrated by the form of
the built environment, as can the relationships between people and natural resources.
Together these models, and the other work discussed above, demonstrate that health is
not only the preserve of the health sector. Stott (2000) estimates that 80% of our health
is determined by policies and activities outside the health sector.

5
In 2003, the National Health Service in the UK reviewed the effects that natural
environments can have on health (Henwood, 2003). The report, coming from a discipline
at the forefront of evidence based policy, analyses the evidence demonstrating a link
between health and the natural environment. However, its most important contribution
may lie in comments about the desire for precise measurement in the field. It calls for
more qualitative interpretation of the meanings and implications of findings. Henwood
writes ‘…changes to more intangible aspects of well-being (e.g. sense of comfort,
rootedness, restored mental vigour) and to the fabric of communities that are health
sustaining or enhancing are important issues for consideration’ (Henwood, 2003, p13).
Nature and Health: the policy context
Policy on health and biodiversity provides further clues as to the nature of the link
between these two phenomena, and the current priorities of built environment
practitioners and policy makers.
As one might expect, the view of human health as a socially and environmentally
influenced phenomenon is reflected in health policy at various levels. Both the UK
government and the European Commission have incorporated this approach into health
policy (see for example: DoH 1999, CIEH 2003 and CEC 2003). The UK government’s
health White Paper, ‘Saving Lives: Our Healthier Nation’ for example, states that: ‘the
social, economic and environmental factors tending towards poor health are potent’
(DoH, 1999). However the White Paper straddles the negative or holistic definition of
health divide. This paper broke away from a narrow medical and health service delivery
model in that it accepted a wider responsibility for health. However in places, the text
struggles though to break out of a negative definition of health, (health as the absence of
disease), with little mention of well-being or fulfilment. Interestingly however, the four
main causes of preventable premature death targeted in the white paper - cancer,
coronary heart disease and stroke, accidents and suicide - all have strong environmental
elements.
While government policies generally recognise the role of the environment in
determining human health, they have little to say about the specific role of nature or
biodiversity in this equation. Also as it has been noted, health policy tends to concentrate
on removing or reducing the negative influences on health, and says nothing about

6
harnessing positive factors. The European Commission’s communication on
environment and health is a good example of this. Despite its title, it concentrates solely
on health threats caused by environmental factors such as air pollution and noise, and
makes links to the laws and regulations that govern these nuisances. Surprisingly the
communication says nothing about the positive role that the environment in general, and
nature in particular can play in human health. Thus while health policy is beginning to
recognise the importance of nature to health, there is almost no emphasis - in policy at
least - on nature as a way of improving health and well-being.
In contrast to the health sector, policy and good practice guidance on nature and
biodiversity is fairly good at making claims for positive links between health and well-
being. Almost all UK documents on this topic include one or two general statements
about the value of nature and biodiversity for health or well-being. Thus, the UK
biodiversity strategy (DEFRA, 2002), planning policy guidance on nature conservation
(ODPM, 2004) and the English forestry strategy (Forestry Commission, 1999) all contain
positive statements about the role of nature and biodiversity in human well-being. The
following is typical of these documents:
‘Biodiversity is vital for quality of life; from the simple pleasure of birdsong to life-saving
cancer drugs from yew trees. It is a life-support system which provides for all our needs
whether practical or spiritual’ (ALGE and the South West Biodiversity Partnership,
2000:1).
Despite the links that are made between health and quality of life, it is apparent that
policy and guidance on nature conservation relies on the intrinsic value of biodiversity to
make the case for its protection and promotion. The benefits of nature – whether in
relation to aesthetics, economics, investment or well-being - are only mentioned in very
general terms and do not underpin arguments for delivering more and better habitats.
The result is a focus on protecting existing habitats rather than a strong argument for
enriching degraded environments, or creating new habitats. If nature is good for us, then
surely more nature is better?
A recent report by CABE Space on the value of open space has begun the process of
making explicit, and providing evidence for, the many benefits that open space provides
to the humans that live and work around them. The report observes: ‘…there is
increasing evidence that ‘nature’ in the urban environment is good for both physical and

7
mental health. Natural views promote a drop in blood pressure and are shown to reduce
feelings of stress.’ (CABE Space, 2004:7). The report stops short of making policy or
practice recommendations, but concentrates on collecting and presenting the evidence
for the benefits of open space – including the benefits of urban nature and biodiversity.
So to conclude, policy and good practice guidance in health and nature conservation do
make explicit, albeit in a general sense, the links between health and nature. However,
neither sector traces the principle through into policy or practice.
Nature and Health: the research literature
In contrast to the relatively limited field of policy documents on nature and health, there
is a large body of research literature covering this topic. This literature spans a number
of subject areas including: landscape design; medicine; education and development;
urban design; town planning; psychology; and, environmental health. In gathering
material for this study, we concentrated on literature that provides evidence for the
health benefits of urban nature and biodiversity. The objective was to look for clues
about the impacts and health benefits of implementing policy on urban greening and
habitat creation.
The evidence we discovered falls into three distinct groups, and the following discussion
is structured accordingly. The first part of the discussion examines the ecological
services provided by nature to urban dwellers. These services derive from the presence
and functioning of plants and other organisms, and includes the cooling effect of trees on
the urban climate for example. The second part of the discussion concentrates on the
benefits that derive from experiential human interaction with nature. This is a broad field
that takes in a number of key theories including E. O. Wilson’s biophilia (Wilson, 1984)
and Kaplan’s restorative environments (Kaplan, 1992) as well as a range of related
studies. Experiential interaction of humans with nature can usefully be divided into two
groups: those dealing with active contact such as gardening or activity in a natural
setting; and those dealing with more passive interaction with nature such as the view
from an office window.

8
Environmental Services
It is well known that the process of photosynthesis in plants involves the uptake of
carbon dioxide and the release of oxygen into the atmosphere. This is particularly
significant in the context of climate change, and there is much discussion about the role
of trees and plants in global atmospheric processes. Photosynthesis, and its associated
plant metabolism and physiology, is also important at the local level, and a number of
authors have noted the role of urban vegetation, particularly trees, in improving air
quality.
There are a number of dimensions to the air hygiene functions provided by urban trees
and plants. The first is in maintaining balance between atmospheric gases. Nicholson-
Lord (2003) claims that many cities have as little as 10-12% oxygen in the atmosphere
compared with a more normal 20-21%. The causes of this deoxygenation include both
pollution and the absence of vegetation (Nicholson-Lord, 2003). As urban trees have a
role to play in increasing or maintaining levels of oxygen and reducing CO
2
(Woolley,
2003), it is clear that a programme of urban greening will have positive impacts on local
air quality. As oxygen is important in cellular health as well as respiratory and brain
function, the link with human health and well-being is clear. Increasing the amount of
nature in cities – particularly in those areas most denuded of greenery – should be a
priority for health policy as well as environmental policy.
In addition to their role as oxygenators, trees and plants of all kinds act as
bioaccumulators extracting both particulates and chemicals from the atmosphere.
Woolley (2003) and others (see for example: CABE Space, 2004; Bolund &
Hunhammar, 1999) mention the ability of trees to trap particulates and absorb sulphur
e.g. a mature Douglas Fir is able to absorb 19.5kg of atmospheric sulphur per annum.
Studies show that both parkland trees and street trees are able to remove up to 85% of
dust from the air in summer and 40% in winter (Woolley, 2003). Such dramatic impacts
are particularly significant in the context of rising rates of asthma and respiratory illness
both of which are exacerbated by pollution and particulates. Although urban air quality is
much improved since the early 20
th
century, air pollution brought forward between 12000
and 24000 deaths each year in Great Britain during the mid 1990s (Environment
Agency, 2002). Increasing urban tree cover could thus play a part in tackling urban air
quality and reducing the health burden of respiratory illness in modern society.

9
Urban trees and open spaces also have a role to play in the movement and circulation of
air in cities. Differences in air temperature between green open spaces and the
neighbouring built environment result in a park breeze as air flows from the cooler parts
into the surrounding streets (CABE Space, 2004). The cooling effect of vegetation is not
simply confined to urban parks, but is also linked to the amount of vegetation in a
neighbourhood. Studies have shown where 50% of an area is covered by gardens,
parks and street trees, temperatures are reduced by 7°c when compared to areas with
only 15% vegetative cover (CABE Space, 2004). Even individual trees have an impact,
with localised cooling as a result of transpiration (Woolley, 2003) and shade. Sitting in
the shade is equivalent to wearing a sun protection factor of between six and ten
(Nicholson-Lord, 2003).
The issue of temperature and cooling may not seem particularly important in relation to
human health and well-being, but it can be a matter of life and death. In the summer of
2003, the extreme heat of the European summer is estimated to have caused around
35,000 deaths (Hillman, 2004). Many of those affected by the heat were living in
European cities – and cities, generally, are 5-9 c warmer than the countryside that
surrounds them thanks to the urban heat island effect (Nicholson-Lord, 2003).
The evidence mentioned above shows that the presence of nature in towns and cities
has the potential to make a considerable difference to urban air quality, air movement
and local temperature. There is little here that considers the role of biodiversity in
delivering these benefits, or even considers the role of particular tree species. However,
the studies do show that the capacity of trees to reduce particulates and pollutants is
related to the total leaf area of the tree (Bolund & Hunhammar, 1999). This means that
conifers are best at trapping dust and particulates, although they tend to be sensitive to
other forms of air pollution. Deciduous trees on the other hand are better at absorbing
gases, although the autumnal fall of their leaves means that their ability to absorb
pollutants and to generate oxygen through photosynthesis varies between seasons.
There is some evidence about the role of biodiversity in human health and well-being.
Walters (2004) describes the way in which the disruption of habitats around New Jersey
is contributing to a rise in the incidence of Lyme disease. As the forest habitat is
fragmented and disturbed the diversity of mammal species declines, increasing the

10
probability that newly hatched ticks will bite mice or chipmunks. These two species
transmit Lyme disease to more than 90% of the ticks that feed on them, in contrast to an
infection rate of only 10% from other forest mammals (e.g. possums, raccoons etc). The
problem is that as the habitat is disturbed, the diversity of species in the forest declines
and the density of mice and chipmunks in the area increases. When this happens, then
the incidence of Lyme disease in humans also rises. Walters develops the concept of
ecodemics – disease outbreaks facilitated by human degradation of ecosystems. This
has strong resonance with the statement attributed to Chief Seattle at the head of this
paper. If nature does provide ecological services that are inseparable from a healthy
human habitat, then we will start to see deteriorating health as the biosphere loses its
diversity. This is often viewed as a global problem with little action to be taken at the
local level, but the brief review of ecological services afforded above, indicated that
these services are also important to health in an urban setting.
Experiential Interaction
Aside from the ecological services that nature provides, humans also derive benefit from
their active and passive interaction with plants and animals. We all know that nature is
good for us. Why else do we hanker after country retreats, spend time and money
camping, walking, gardening or watching TV programmes about nature, wildlife and
gardening?
The underlying theory for the human affinity for nature is known as biophilia, E.O.
Wilson’s evolutionary explanation for man’s affinity with the environment (Pretty et al,
2003; Frumkin, 2001). Wilson defined biophilia as ‘the connections that human beings
subconsciously seek with the rest of life’, and argued that they are determined by a
biological need, developed through evolutionary processes because we have coexisted
in the closest relationship with the natural world for so many millennia. In the context of
well-being, elements of this concept have been usefully extended by the work on
‘restorative environments’ and ‘nearby nature’ by Kaplan & Kaplan (1989) and others in
a programme of empirical research going back some 25 years.
Empirical studies examining the experiential interaction of humans with nature can be
divided into two groups: those dealing with activity in a natural environment such as
gardening and walking; and those dealing with more passive interaction such as the

11
view from an office window. The distinction between these two is sometimes a little
fuzzy, but they are explored in turn below.
Active Experiential Services
Studies of the active interaction of humans in or with nature cover a number of distinct
fields with various levels of human activity and different intensity of interaction with the
natural environment. A broad schema for representing these differences can be found in
Figure 2. It needs to be borne in mind that even while focussing on active interaction of
humans in or with nature, the benefits of passive experience will also be taking place.
Human activity level
Low
Medium
High
sometimes even
aerobic
Interaction
with
nature
Low
intensity
Walking
Hill walking,
outdoor sports
e.g golf
Trim trails, outdoor
sports e.g. football
High
intensity
Birdwatching
Gardening
‘Green gyms’,
Conservation
volunteering e.g.
hedge laying, reed
cutting, woodland
thinning
Figure 2. Different levels of human activity and interaction with nature in various
outdoor pursuits
Many sports are played outdoors and the recreation itself holds health benefits. However
the focus of this paper is to examine the effect of nature on health. One of most well-
established areas for promotion of health benefits of activity in natural settings relates to
the rewards of gardening and horticulture. Aldridge & Sempik (2002) among others have
examined this in detail, reviewing the evidence for the benefits of social and therapeutic
horticulture. Such work shows the considerable benefit that particular groups –
psychiatric patients, prison inmates, students with learning difficulties – derive from

12
working with plants. Studies in this field tend to concentrate on the mental health
benefits of therapeutic horticulture, and show that participants benefit from enhanced
self-esteem and self-confidence, recovery from depression and reduced aggression
(Aldridge & Sempik, 2002). The benefits are such that gardening and horticultural
projects are used therapeutically in a number of settings including prisons and hospitals.
Recently, following the lead set by Government health policy linking the role of personal
choices with diseases related to sedentary lifestyles, the role of outdoor exercise is
receiving more attention with several synoptic literature reviews. Pretty et al. (2003)
review the complementary role of nature with exercise and diet in promoting well-being.
In a report for the Royal Society for the Protection of Birds, Bird (2004) surveys policy
and empirical work whilst reviewing whether green space and biodiversity can increase
levels of physical activity. Although his work is the only study attempting to explicitly
address biodiversity, the links he finds between biodiversity and activity are in the main
indirect especially in the urban setting. Interest in the health and outdoor activity area is
also leading to practical projects which in time will yield further data. The Forestry
Commission and Department of Health are backing the implementation and evaluation
of a woodland and health project in the West Midlands (Interface NRM Ltd, 2004) and
the British Trust for Conservation Volunteers are supporting a growing ‘Green Gym’
movement. A ‘Green Gym’ aims to give people the health benefits of exercise whilst
taking part in conservation activities such as tree planting, creating or restoring nature
areas, hedge laying or constructing dry stone walls. It has been recognised that through
the contact with nature and the outdoor setting, the benefits go far wider than just those
afforded by physical exertion and exercise (Humphreys, 2003).
In the US, a strand of work has shown the benefits of wilderness experiences on
individuals. Living in or visiting wilderness landscapes can have a profound effect, and a
number of studies have shown the benefit of such experiences to specific study groups
such as reports that psychiatric patients, emotionally disturbed children and adolescents,
bereaved persons, rape and incest survivors, and patients with cancer, end stage renal
disease, post-traumatic stress syndrome, addiction disorders and other ailments (as
reviewed in Henwood, 2003). These studies report the positive (mainly mental health)
benefits of wilderness experience where people enter a landscape rather than just view
it. Benefits all seem to relate to a holistic concept of health such as reporting renewed
sense of vigour and energy, self-awareness, feelings of awe and comfort at connection

13
with nature, improved sense of coping and ability to assert personal control (Henwood,
2003).
Henwood goes on to say that the number and variety of accounts of people benefiting in
different ways from contact with nature suggest that such experiences can bolster
mental health. These benefits span both illness recovery and the more general project of
promoting public health (Frumkin, 2001).
Contact with nature has been shown elsewhere to have physiological as well as
psychological benefits. For example, studies show pet owners have lower levels of minor
ailments than non pet-owners (Frumkin, 2001) and quickly reduce their blood pressure
and heart rate following contact with their pets. A very different study in Japan showed
that retired people who walked everyday in tree-lined and leafy surroundings lived longer
than people who walked in less green surroundings (Takano, Nakamura & Watanabe,
2002). Such studies demonstrate that nature – whether in the form of pets or green
surroundings – have a very direct effect on human health.
The final strand of evidence for the health benefits of active interaction with nature has
only recently emerged. This concerns the benefits of green spaces as a setting for
exercise and activity. In the UK there is tremendous concern about rising rates of obesity
and falling activity rates and Nicholson-Lord (2003) tells us that lack of exercise costs
the national health service 2-3% of its budget. In response to such concerns two key
initiatives have emerged in recent years: Health Walks and Green Gyms. Health Walks
can be ‘prescribed’ by doctors, with patients attending organised and accompanied
walks in the local area. The Green Gym is a similar idea with participants engaging in
practical conservation tasks (as mentioned earlier). In both cases evaluations have
shown that participants in these initiatives were more likely to continue with exercise
than those on more traditional gym based regimes. Initial findings from Health Walks and
Green Gym schemes suggest that drop-out rates are low, and that participants value
meeting new people and being outside in addition to the exercise element of such
programmes (Forestry Commission, 2004). Study of these initiatives is at an early stage,
and as yet there has been no clinical evaluation of the health benefits afforded to
participants. However, anecdotal and research evidence suggests that there are distinct
if not easily quantifiable benefits for people who have access to parks, woodlands and
forests (Forestry Commission, 2004).

14
Although this literature documents numerous examples of health benefits from activities
undertaken in natural settings, there is little direct assessment of the role that
biodiversity plays in mediating these benefits. Settings range from the biodiversity
richness of wilderness parks to those not reliant on biodiversity at all, e.g. contact with
pets or street trees. It is clear that both contact just with nature and contact with
biodiverse nature both have a health effect, though a model for the relationship between
the two has yet to be established.
Passive Experiential Services
There is evidence to suggest that health services can be derived through passive, which
includes unconscious, experience of nature. Passive interactions with nature can be
classified as:
i) nature as setting; such as walking in a park rather than along a treeless street;
ii) visual contacts with nature; such as a view of trees or plants from a window;
iii) implied visual contacts with nature; such as landscape painting;
iv) other sensory contacts with nature; such smell and sound, bird song and leaves
rustling in the wind.
Prominent in the field of exploring passive interactions with nature are Kaplan & Kaplan
and particularly useful is their concept of nearby nature (Kaplan & Kaplan, 1989). Nearby
nature is a concept based on the passive experience of nature in day-to-day living, both
indoors and out-of-doors. It encompasses vegetation from a vase of cut flowers on a
table to a plant in a window box or a street tree or neighbourhood park. The relationship
to the human subject may be direct or indirect such as a view through a window.
Following extensive research based on an analysis of reactions to slides and
photographs, the Kaplans have concluded that ‘nature’ is a critical component of how
people experience the environment (Kaplan, 1992). In particular, what is essential to
perception is the presence of vegetation and the context created by it. The focus is on
plants in general, not specific plants. In this sense at first the relationships seems to be
independent of biodiversity. However they found that the degree to which the setting is
‘natural’ is important in determining the degree of psychological response. In their work
(see also Kaplan, 1991), the term ‘natural’ is explored mainly in its visual and physical
dimensions, being akin to a sense of naturalness in the arrangement of the various
elements in the landscape both botanical and geo-physical. In very broad terms this can

15
sometimes have a positive correlation with biological diversity in that a monoculture or
simple setting is on the whole less likely to be as biodiverse as an arrangement with
more complexity. The Kaplans view the lack of provision of access to nature as a basic
misunderstanding of the human condition, ‘Nature is not merely an amenity, luxury, frill
or decoration. The availability of nearby nature meets an essential for human need’
(Kaplan, 1992:132).
Ulrich & Parson (1992) provide a survey of the mechanisms for health related benefits.
They identify in the literature three main areas of thought in relation to these
mechanisms: psychological and physiological effects; evolutionary theories; and learning
theories. All these mechanisms promote health through reducing stress. A stress
reaction is the process of responding physiologically, physiologically and behaviourally
to a situation that it taxing or threatens well-being (Evans & Cohen, 1987).
Several empirical studies have been undertaken under semi-controlled conditions.
Findings indicate a role for vegetation in stress reduction. For example, Hartig, Mang &
Evans (1987) found that out of listening to music, a walk in an urban setting and a walk
in nature, the latter was more conducive to recovery after a stressful task. Ulrich (1981)
found that alpha wave brain activity (associated with relaxation) was higher when
subjects viewed slides of urban scenes including nature as opposed to those without any
natural elements. Heerwagen (1990) found that patients in a dentist waiting room felt
calmer and had a lower heart rate when looking at pictures of natural scenes as
opposed to a blank wall.
Further evidence of the positive effects of passive interactions with nature exists in
studies of enhanced educational performance, improved medical recovery (Ulrich,
1984), improved concentration and self-discipline in girls (Taylor, Kuo & Sullivan, 2002)
and reduced crime and fear of crime. Nature may just be a backdrop to city life – a view
through a window, an incidental context when commuting, a visual stimulus in a waiting
room. Typical of a new wave of empirical field studies in this area is Hartig et al. (2003).
As part of the study on 112 young adults, it was shown that sitting in a room with a tree
view promoted a drop in blood pressure and reduced feelings of stress. However it is
important to note that in all studies reviewed to date, the authors have not found prima
facie evidence for a direct link between biodiversity and the described effects. Exotic
vegetation, species poor vegetation and even merely videos or images of nature, in

16
some circumstances, seem to be enough to reduce stress. The only link to biodiversity
may be through some evidence, discussed above, that links complexity and
‘naturalness’ to preferred settings. It is worth stating however, that none of the studies
examined included biodiversity per se as parameter to be tested.
Conclusions: nature and healthy urban planning
This paper began with two questions: is there added health value to urban biodiversity
policies; and, what can planners and others learn about the role of nature in healthy
urban planning? In response to these questions the paper has drawn together a variety
of evidence about the health benefits of urban nature. Together this evidence has shown
that the presence of nature has profound psychological and physiological benefits for
humans – affecting healing, heart rate, concentration, levels of stress, blood pressure
and mental well-being.
Thus an inherent conclusion is that there is very good evidence to show that urban
greening would have a beneficial impact on human health and well-being. As urban
biodiversity is an extension of policies on urban nature and green space, then these
conclusions also hold true for policies on biodiversity. However, it is unclear whether
biodiversity brings greater health dividends than straightforward ‘nature’. There has been
little work on this dimension of the health-nature relationship at the urban scale.
However, at larger scales including the global scale links are better understood. Walters
(2004) work on ecodemics shows that habitat disruption can be related to ill-health for
humans such as the incidence of Lyme disease in New Jersey.
Given that there is good evidence for the health benefits of nature in urban area, there is
no reason not to pursue biodiversity at the same time as nature in the urban setting.
Human interventions in the environment have reduced biodiversity. Now, increasing
biodiversity is a national target and every area has, or is preparing, a local biodiversity
action plan, although planners and other built environment professionals have much to
learn about the role of nature in providing healthy urban settings. The evidence set out
above shows that nature has a key role in human health – not only through direct effects
on healing, heart rate and so on - but also as a result of its ability to temper other factors
affecting health such as air quality and extreme temperature. Current policy approaches

17
to urban biodiversity, open space, air quality and health fail to recognise or promote the
positive role of nature in well-being and in delivering outcomes in terms of Government
health policy. Given the health benefits of urban nature, local authorities could make
good use of their powers under the local government act, which permits authorities in
England & Wales ‘to do anything they consider likely to promote or improve economic,
social or environmental well-being of their area…’ (DETR, 2001, p. 4). It is not hard to
imagine how tree planting programmes, changes to planning policy and joint ventures
with local wildlife and conservation groups could begin to effect a change in the urban
landscape. All new developments would have tree-lined streets; planning policy would
prevent the loss of gardens to off-street parking; and agencies would work together to
create new habitats and enriched environments in all urban regeneration and new
development. Following this line of thought, health benefits would become central to
these activities and would be built in to projects from the start. This contrasts starkly with
current practice where there is a limp idea that ‘greening’ is ‘a good thing’, and where
these type of interventions are bolted-on to the initial programme.
Despite the convincing reasons for prioritising biodiversity in all urban planting schemes,
there are numerous barriers. These include a mix of institutional and commercial trends
in the landscape industry and landscape architecture profession. A current initiative
‘Flora locale’ funded partly by DEFRA and English Nature aims to promote good practice
in the use and sourcing of native flora for all projects that have wildlife in mind. Another
barrier is the yawning gap between biodiversity policy and implementation in urban
areas. There is highly developed evidence based biodiversity policy in the UK. However,
outside designated areas, the will and expertise to promote and deliver increased
biodiversity are limited. For new developments planning officers are relied on to appraise
landscape proposals. In terms of management, implementation is often left to the
contract sector or an emasculated parks department where biodiversity is either of no
concern or simply a luxury that cannot be afforded.
Whatever the barriers, there are tremendous benefits to be gained from greening our
urban places. The proposed move to a new spatial planning system offers a glimmer of
hope. There will be a wider range of spatial sectoral policies to be legitimately included
in and co-oriented by the planning process. Those responsible for implementing local
biodiversity area action plans should use the ‘front loading’ of the new planning system
to make sure that biodiversity interests, which after all has no economic or social

18
disbenefit, are correctly addressed in new planning frameworks. All development must
seek to raise the ‘background level’ of biodiversity and capacity for wildlife to live in our
towns and cities. Promoters of all new developments should be required to demonstrate
how their proposals will play their part. We must insist on healthier streets,
neighbourhoods and retail areas which are created to brim with biodiversity. If one of the
goals of the planning system is sustainability (ODPM, 2005) then nature has a sectoral
role to play alongside, retail, housing and transport in the planning and development of
the built environment.
‘Our personal health, and the health of our economy and human society, depends on the
continuous supply of various ecological services that would be extremely costly or
impossible to replace.’
Convention on biological diversity, 2002, p4

19
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