A Systematic Review of the Health and Well-Being Benefits of Biodiverse Environments

Article (PDF Available)inJournal of Toxicology and Environmental Health Part B 17(1):1-20 · March 2014with91 Reads
DOI: 10.1080/10937404.2013.856361 · Source: PubMed
Abstract
Recent ecosystem service models have placed biodiversity as a central factor in the processes that link the natural environment to health. While it is recognized that disturbed ecosystems might negatively affect human well-being, it is not clear whether biodiversity is related to or can promote "good" human health and well-being. The aim of this study was to systematically identify, summarize, and synthesize research that had examined whether biodiverse environments are health promoting. The objectives were twofold: (1) to map the interdisciplinary field of enquiry and (2) to assess whether current evidence enables us to characterize the relationship. Due to the heterogeneity of available evidence a narrative synthesis approach was used, which is textual rather than statistical. Extensive searches identified 17 papers that met the inclusion criteria: 15 quantitative and 2 qualitative. The evidence was varied in disciplinary origin, with authors approaching the question using different study designs and methods, and conceptualizations of biodiversity, health, and well-being. There is some evidence to suggest that biodiverse natural environments promote better health through exposure to pleasant environments or the encouragement of health-promoting behaviors. There was also evidence of inverse relationships, particularly at a larger scale (global analyses). However, overall the evidence is inconclusive and fails to identify a specific role for biodiversity in the promotion of better health. High-quality interdisciplinary research is needed to produce a more reliable evidence base. Of particular importance is identifying the specific ecosystem services, goods, and processes through which biodiversity may generate good health and well-being.
Full Terms & Conditions of access and use can be found at
http://www.tandfonline.com/action/journalInformation?journalCode=uteb20
Download by: [University of Exeter] Date: 28 January 2016, At: 04:44
Journal of Toxicology and Environmental Health, Part B
Critical Reviews
ISSN: 1093-7404 (Print) 1521-6950 (Online) Journal homepage: http://www.tandfonline.com/loi/uteb20
A Systematic Review of the Health and Well-Being
Benefits of Biodiverse Environments
Rebecca Lovell , Benedict W. Wheeler , Sahran L. Higgins , Katherine N. Irvine
& Michael H. Depledge
To cite this article: Rebecca Lovell , Benedict W. Wheeler , Sahran L. Higgins , Katherine N.
Irvine & Michael H. Depledge (2014) A Systematic Review of the Health and Well-Being Benefits
of Biodiverse Environments, Journal of Toxicology and Environmental Health, Part B, 17:1, 1-20,
DOI: 10.1080/10937404.2013.856361
To link to this article: http://dx.doi.org/10.1080/10937404.2013.856361
View supplementary material
Published online: 05 Mar 2014.
Submit your article to this journal
Article views: 399
View related articles
View Crossmark data
Journal of Toxicology and Environmental Health, Part B, 17:1–20, 2014
Copyright © Taylor & Francis Group, LLC
ISSN: 1093-7404 print / 1521-6950 online
DOI: 10.1080/10937404.2013.856361
A SYSTEMATIC REVIEW OF THE HEALTH AND WELL-BEING BENEFITS OF
BIODIVERSE ENVIRONMENTS
Rebecca Lovell
1
, Benedict W. Wheeler
1
, Sahran L. Higgins
1
, Katherine N. Irvine
2,3
,
Michael H. Depledge
1
1
European Centre for Environment & Human Health, University of Exeter Medical School, Truro,
United Kingdom
2
James Hutton Institute, Craigiebuckler, Aberdeen, United Kingdom
3
Institute of Energy and Sustainable Development, Queens Building, De Montfort University,
Leicester, United Kingdom
Recent ecosystem service models have placed biodiversity as a central factor in the processes
that link the natural environment to health. While it is recognized that disturbed ecosystems
might negatively affect human well-being, it is not clear whether biodiversity is related to or
can promote “good” human health and well-being. The aim of this study was to systematically
identify, summarize, and synthesize research that had examined whether biodiverse environ-
ments are health promoting. The objectives were twofold: (1) to map the interdisciplinary field
of enquiry and (2) to assess whether current evidence enables us to characterize the relation-
ship. Due to the heterogeneity of available evidence a narrative synthesis approach was used,
which is textual rather than statistical. Extensive searches identified 17 papers that met the
inclusion criteria: 15 quantitative and 2 qualitative. The evidence was varied in disciplinary
origin, with authors approaching the question using different study designs and methods,
and conceptualizations of biodiversity, health, and well-being. There is some evidence to sug-
gest that biodiverse natural environments promote better health through exposure to pleasant
environments or the encouragement of health-promoting behaviors. There was also evidence
of inverse relationships, particularly at a larger scale (global analyses). However, overall the
evidence is inconclusive and fails to identify a specific role for biodiversity in the promotion
of better health. High-quality interdisciplinary research is needed to produce a more reliable
evidence base. Of particular importance is identifying the specific ecosystem services, goods,
and processes through which biodiversity may generate good health and well-being.
BIODIVERSITY AND GOOD HEALTH
AND WELL-BEING
There is increasing consensus that the
impacts of changes in biodiversity may have
important repercussions for human health and
well-being (Diaz et al., 2006; Mlambo, 2012;
Sala et al., 2009). Contemporary ecosystem
service assessments (Millennium Ecosystem
Assessment, 2005; UK National Ecosystem
Assessment, 2011) sought to formalize an
understanding of the complex interdependency
Address correspondence to Rebecca Lovell, European Centre for Environment & Human Health, University of Exeter Medical School,
Truro, TR1 3HD, United Kingdom. E-mail: r.lovell@exeter.ac.uk
of human health, society, and economies
on the natural environment. These reviews
identified biodiversity as playing a key role in
regulating and modulating ecosystem processes
and functions, and the goods and services
ecosystems provide (Balvanera et al., 2006;
Cardinale et al., 2012; Norris, 2011). Specific
and direct links between biodiversity and
human health exist (Convention on Biological
Diversity, n.d., accessed 2013; D’Agnes et al.,
2010; Huynen et al., 2004). For example,
1
Downloaded by [University of Exeter] at 04:44 28 January 2016
2 R. LOVELL ET AL.
disturbance of ecosystems and in particular
biodiversity loss may affect human health
through an increase in the spread of zoonotic
diseases (Keesing et al., 2010; Ostfeld, 2009) or
through losses of pharmacological opportunity
(Chivian and Bernstein, 2008). Disturbance of
local biodiversity has also been linked to inad-
equate nutrition (Aswani and Furusawa, 2007;
Golden et al., 2011). However, while there
is emerging evidence as to how biodiversity
relates to good health and well-being through
the supporting, regulating, and provisioning ser-
vices, it is only recently that attention has been
paid to the role of biodiversity in relation to
the cultural ecosystem services (Church et al.,
2011). Cultural ecosystem services have been
defined as the “nonmaterial” benefits that are
derived from ecosystems and are related to fac-
tors such as promotion of well-being though
aesthetics, leisure and recreation, and sense of
place (Church et al., 2011).
Substantial proportions of the world’s pop-
ulation are experiencing epidemics of noncom-
municable disease, including heart and other
circulatory diseases, diabetes type 2, and men-
tal health disorders (Beaglehole et al., 2011;
Collins et al., 2011). The management and in
some cases prevention of these disorders can
be linked to natural environments. The quan-
tity and proximity of “natural” spaces in the
local (residential) environment is related to a
reduction in the prevalence of several of these
health outcomes and their risk factors (Bowler
et al., 2010; Lachowycz and Jones, 2011; Lee
and Maheswaran, 2010; Mitchell and Popham,
2007, 2008). Active exposure to, and use of,
the natural environment is also associated with
better health (Keniger et al., 2013; Lee et al.,
2011; Thompson Coon et al., 2011). Several
studies linked health status, through both pri-
mary and secondary mechanisms, to the con-
dition and state (both “real” and “perceived”)
of the local “natural” environment (Cummins
et al., 2005; Mitchell and Popham, 2008; van
Dillen et al., 2012). Environmental degradation,
including biodiversity loss, appears to exert
adverse impacts on health, especially mental
well-being, greater than the primary adverse
impacts associated with economic decline,
nutritional threats, and pollution (Speldewinde
et al., 2009). The mechanisms underpinning
these linkages are predominantly understood,
though not exclusively, as all the services are
inherently interlinked, through the framework
of the cultural ecosystem services. For instance,
an “attractive” biodiverse natural environment
may impact on health through the encour-
agement of greater physical activity, support
tourism with wider impacts on local economies,
or provide a focus for cultural activities.
Underpinning the realization of these impacts
are the other ecosystem services, from clean air
to the nutrient cycles.
If research confirms that higher quality,
more biodiverse natural environments do pro-
mote and support better health and well-
being, then these environments might con-
tribute to reducing the prevalence of noncom-
municable disease and their respective con-
tributory risk factors, and to lowering the eco-
nomic burden on health care systems world-
wide (Beaglehole et al., 2011; Davies and
Deaville, 2008; Tzoulas and Greening, 2011;
Velarde et al., 2007). Both health and con-
servation organizations recognize this potential.
For example, the World Health Organization
(WHO) Ottawa Charter (1986) specifically
identified conservation of natural resources
(including biodiversity) as necessary for the
promotion of good health. Among environ-
mental organizations there is an increasing
focus on using natural resources to promote
human health (Bird, 2007; U.S. Environmental
Protection Agency, n.d.; European Environment
Agency, 2011). Evidence of positive impacts on
human health would potentially provide fur-
ther justification for increased support for, and
greater protection of, biodiversity within nat-
ural ecosystems (Dearborn and Kark, 2010;
Kareiva and Marvier, 2007; Mlambo, 2012).
These considerations provide important insights
for policymakers.
Although the theoretical and partially evi-
denced pathways linking biodiverse natural
environments to good health and well-being
through cultural ecosystem services and goods
are compelling, they are far from confirmed
(Norris, 2011). The aim of this systematic
Downloaded by [University of Exeter] at 04:44 28 January 2016
BIODIVERSITY AND THE PROMOTION OF GOOD HEALTH 3
review was to identify, summarize, and synthe-
size, where appropriate, all available evidence
to provide answers to three key questions:
(1) What is the state and nature of the current
body of evidence, (2) do biodiverse environ-
ments promote good health and well-being,
and (3) can any identified relationships be char-
acterized?
The topic does not appear to have been
previously addressed in a comprehensive and
systematic manner. While there are a number
of related reviews (Bowler, 2010; Brown and
Grant, 2005; Croucher et al., 2007; Dean et al.,
2011; Keniger et al., 2013; Thompson Coon
et al., 2011) none have examined the role of
biodiversity in relation to health outcomes in
a variety of contexts. The approach here was
deliberately inclusive in that all research that
was self-described as having considered this, or
that related respective environmental factors to
biodiversity, was included (Pullin and Stewart,
2006). This approach was taken in order to
describe the broad state of knowledge regard-
ing links between biodiversity and promotion of
good health and well-being.
METHODOLOGICAL APPROACH
Using robust and systematic methods, this
review includes research that specifically exam-
ined relationships between biodiversity and
health or well-being outcomes in any popula-
tion. All experimental or observational (includ-
ing qualitative) evidence that was self-described
as considering “biodiversity” was included in
the review of the state of the evidence (research
question 1); however, only papers using higher
order methodologies were incorporated in the
synthesis (research questions 2 and 3). As the
focus was on the promotion and support of
good health and well-being, the ways in which
factors such as zoonotic diseases, pathogens, or
the identification of organisms with pharmaco-
logical potential are related to biodiversity were
not considered. These have been reviewed
elsewhere (Keesing et al., 2010).
The aims and procedures of the review
can be found in the protocol (for a copy,
contact author). In brief, the objective was
to identify and consider all papers detailing
investigations undertaken using any recognized
and reliable study design, published between
January 1980 and December 2012, from any
country, providing they met the following cri-
teria: (1) an explicit (self-described, regardless
of any external assessment of the plausibility of
method) consideration of biodiversity, species
richness, and/or a setting protected because of
its biodiversity, and (2) an explicit considera-
tion of either primary health-related outcomes
including any self-report or objective measure
of physical or mental health or well-being, or
secondary health-related outcomes including
self-report or objective measures of improved
health behaviors (e.g., physical activity).
Literature was identified through structured
searches of more than 20 academic and Web
databases. In addition, 14 journals, more than
20 bibliographies and citation lists, and more
than 40 governmental or organizational web -
sites were hand searched. Suggestions for lit-
erature were elicited from leading researchers.
Key search terms were developed following
the inclusion and exclusion criteria established
for the study and included groups of terms
relating to (1) biodiversity, (2) health out-
comes, and (3) health behaviors and activities
(Supporting material). Search strategies were
modified according to the requirements o f each
database
Initial screening of titles was undertaken
by one reviewer; the inclusion criteria were
then applied to abstracts with discussion to
resolve differences in cases of disagreement.
Full text assessment was undertaken by two
of the researchers. A standardized data extrac-
tion form was used to extract key information
relating to each piece of research. “Quality,”
in terms of conduct and reporting (assessment
categories can be found in the Supporting infor-
mation), and risk of bias were assessed by four
of the reviewers using frameworks appropri-
ate to the respective study design (Centre for
Reviews and Dissemination, 2008; Downs and
Black, 1998; Wallace et al., 2004). Publications
were not excluded from the review if they were
deemed to be of “low quality.”
Downloaded by [University of Exeter] at 04:44 28 January 2016
4 R. LOVELL ET AL.
Due to the heterogeneity of the literature
selected (in terms of approach, key concepts,
designs, and methods), a form of narrative anal-
ysis was applied (Popay et al., 2006). Narrative
analysis, which adopts a textual approach to
the synthesis, is a widely recognized and val-
idated approach and is used where there are
considerable differences in terms of design,
methods, outcomes, and analysis. It was devel-
oped for use where more traditional statistical
meta-analyses were unsuitable. In applying this
analytical method during the analysis, patterns
across studies were sought according to impor-
tant factors such as design, measures of the
environment and health, and findings. Primary
quantitative evidence of any type was used
to answer research question 1; however, only
the quantitative studies that used higher order
designs (experimental, longitudinal, and com-
parative or uncontrolled before-and-after study
designs) were included in the formal synthesis
of the evidence to answer questions 2 and 3
(Higgins and Green, 2011). Qualitative studies
were included to facilitate an understanding of
perceived benefits and of potential mechanisms
of action (Dixon-Woods et al., 2006; Lorenc
et al., 2012).
The search process led to the identification
of more than 17,000 references. Screening at
title and then abstract reduced this number to
263 references. The majority of the references
initially excluded at this stage clearly did not
meet the inclusion criteria or did not report
primary research. Full text screening with the
application of the inclusion/exclusion criteria
identified 17 papers of specific relevance to this
review (Table 1). The primary reason for exclu-
sion at abstract/full text was due to a lack of the
specific consideration of biodiversity within the
environmental measures.
THE STATE AND NATURE OF EXISTING
RESEARCH INTO THE LINKS BETWEEN
BIODIVERSITY AND GOOD HEALTH
AND WELL-BEING
The 17 studies deemed relevant to the
review were varied in disciplinary origin and
included papers from ecology, epidemiology,
psychology, anthropology, public health, and
urban/landscape design. All studies stated that
they had examined, wholly or in part, the rela-
tionships between biodiversity and one or more
health or well-being outcomes. Various study
designs (Table 1) were used to examine the
central question of whether greater biodiversity
is related to better health, and included one
experimental study (Jorgensen et al., 2010),
one longitudinal comparative study (Annerstedt
et al., 2012), eight uncontrolled before-and-
after or comparative studies (Barton et al.,
2009; Björk et al., 2008; Dallimer et al., 2012;
de Jong et al., 2012; Fuller et al., 2007; Grahn
and Stigsdotter, 2010; Luck et al., 2011; Tilt
et al., 2007), four epidemiological analyses of
secondary data sets (Huby et al., 2006; Huynen
et al., 2004; Poudyal et al., 2009; Sieswerda
et al., 2001), and one each of cross-sectional
questionnaire survey (Lemieux et al., 2012),
qualitative participatory study (Pereira et al.,
2005), and ethnography (Curtin, 2009).
In general, authors hypothesized (explicitly
or implicitly) that exposure to or proximity to
environments with greater biodiversity might
exert a positive, health-promoting impact. The
majority of the selected studies assessed geo-
graphical associations (exposure or proximity)
between specific or general environments (with
differing degrees of biodiversity) and various
health or well-being outcomes. None assessed
the impacts of changes in biodiversity on health
and well-being outcomes. Several studies con-
sidered biodiversity as a variable when exam-
ining the effects of an activity (e.g., vacations,
walking, or commuting) undertaken in spe-
cific environments (Annerstedt et al., 2012;
Barton et al., 2009; Curtin, 2009; Dallimer
et al., 2012; Fuller et al., 2007; Lemieux et al.,
2012; Pereira et al., 2005; Tilt et al., 2007).
In other studies the deliberate “use” of the envi-
ronment was not considered; instead, general
relationships between the presence or proxim-
ity of environments of differing quality and the
health of populations according to residence
were investigated (de Jong et al., 2012; Huby
et al., 2006; Huynen et al., 2004; Luck et al.,
2011; Poudyal et al., 2009; Sieswerda et al.,
Downloaded by [University of Exeter] at 04:44 28 January 2016
TABLE 1. Study Characteristics
Study design Paper Objectives
Environmental
measures/data
Health outcome and
measures/data Population General result
Experimental Jorgensen et al.
(2010)
Explored the impact of the
complexity of
environment on
psychological
“restoration”
Simple visual allocation of
landscapes according to
complexity
Mood (Profile of Mood
States) and restoration
(Deep Restoration Scale)
UK, students (from
single university)
age 17–40 years,
n = 102
No clear relationships—
environmental
complexity not related to
well-being indicator
Longitudinal
comparative
Annerstedt
et al. (2012)
Explored the impact of the
presence of
environmental qualities
to mental health and
physical activity over
5-year period
Scania Green Score:
Perceived environmental
dimensions. Corine land
cover data
Self-report mental health
(GHQ-12) and physical
activity “habits”
Southern rural and
suburban area of
Sweden, age
18–80, n = 24,945
No clear relationship—no
effects of the more
“biodiverse”
environmental
dimensions
Comparative
and
uncontrolled
before and
after
Barton et al.
(2009)
Explored the impacts of
walking in high natural
value environments
None—some description of
sites
Self-report self-esteem
(Rosenberg self-esteem
scale) and mood (Profile
of Mood States)
Southeastern UK, day
visitors to sites
during sampling
period, age 19–70,
n = 137
Positive—time spent in high
value environs related to
better health scores
Björk et al.
(2008)
Explored the impact of the
presence of preferred
environmental
dimensions in promoting
health and well-being
Scania Green Score:
Perceived environmental
dimensions. Corine land
cover data
Self-report physical activity,
body mass index,
physical and
psychological health, and
“vitality” (SF36)
Southern rural and
suburban area of
Sweden, age
18–80, n = 24819
No clear relationship—but
dimensions associated
with greater species
diversity related to better
health
Dallimer et al.
(2012)
Explored the role of species
richness in riverine
environments in
promoting
health/well-being
Bird, butterfly, and plant
species richness; habitat
diversity; tree cover;
perceptions of species
richness and the ability to
identify common riparian
wildlife.
Self-report psychological
well-being
Sheffield UK, age
16–70+,usersof
green spaces during
sampling period,
n = 1108
Generally positive—greater
species diversity related
to well-being though
some individual results
indicated no or negative
relationships
de Jong et al.
(2012)
Explored associations
between environmental
dimensions and three
self-report indicators of
well-being:
neighborhood
satisfaction, physical
activity, and general
health
Scania Green Score:
Perceived environmental
dimensions. Corine land
cover data
Self-report neighborhood
satisfaction, physical
activity and general
health
Southern rural and
suburban area of
Sweden, age18-80,
n =
24,847
No clear relationship—one
dimension indicating
greater species diversity
associated with physical
activity, another
dimension negatively
associated with
neighborhood satisfaction
(Continued)
5
Downloaded by [University of Exeter] at 04:44 28 January 2016
TABLE 1. (Continued)
Study design Paper Objectives
Environmental
measures/data
Health outcome and
measures/data Population General result
Fuller et al.
(2007)
Explored the benefits of
species richness in urban
green space to human
well-being
Plant communities;
butterfly diversity; bird
species; perceived
diversity (plant, butterfly,
birds); habitat diversity;
tree cover
Self-report psychological
well-being
Sheffield UK, age
16–70+,usersof
green spaces during
sampling period,
n = 312
No clear relationships for
most results but some
positive relationships,
with greater species
diversity related to better
well-being
Grahn and
Stigsdotter
(2010)
Attempted to identify the
“dimensions” of nature
people prefer and use for
stress relief
Perceived environmental
dimensions
Self-report physiological
and mental health and
well-being
Central and southern
urban areas of
Sweden, adult (age
not given), n = 733
No clear relationship
“biodiverse”
environments not
preferred by those
experiencing stress
Luck et al.
(2011)
Examined the relationships
between biodiversity and
residents’ personal
well-being,
neighborhood
well-being, and
connection to nature.
Species richness of birds;
abundance native birds;
vegetation cover;
understory, midstory and
overstory cover;
impervious surface cover
Self- reported personal
well-being;
neighborhood
well-being;
neighborhood activity
level; general activity
level
Urban neighborhoods
in Victoria and
New South Wales
Australia, age not
given, n = 3545
Some (weakly) positive
relationships—greater
species richness
associated with better
personal and
neighborhood well-being
Tilt et al. (2007) Examined the influence of
vegetation on walking
trips and body mass
index
Normalized difference
vegetation index (NDVI);
self-report natural
features
Frequency of walking trips;
BMI
Urban neighborhoods
in Seattle USA, age
not given, n = 529
No clear
relationship—measure
associated with greater
species richness
associated with one
indicator of better health
though not with another.
Secondary
analysis of
aggregate
data
Huby et al.
(2006)
Explored the integration of
natural and social
sciences data to
understand relationships
between environment
and society (of which
mental well-being was
considered a factor)
Bird species richness;
percentage area covered
by National Park 2001;
percentage area covered
by Areas of Outstanding
Natural Beauty 2005;
percentage area covered
by Sites of Special
Scientific Interest 2005;
percentage area covered
by Special Protection
Area designation
Mental health deprivation
indicator score of English
Indices of Deprivation
Residents of rural
England aggregated
(at Super Output
Area level), no age
or n given
Positive—indicators of
biodiversity were
associated with mental
well-being
6
Downloaded by [University of Exeter] at 04:44 28 January 2016
Huynen et al.
(2004)
Explored the association
between health and
biodiversity loss at a
global scale
The proportion threatened
species as percentage of
known species; current
forest as percentage of
original forest;
percentage of land highly
disturbed by human
activities
Life expectancy at birth;
infant mortality rate;
incidence of low-weight
babies; Disability
Adjusted Life Expectancy
(DALE) calculated at
birth.
Global populations Majority of results showed
no relationship but some
were negative—greater
biodiversity had an
inverse relationship with
health and well-being
Poudyal et al.
(2009)
Examined how
environmental factors
relate to health and
well-being in United
States
Distance in mile to the
nearest entrance of
national park from the
county centroid
Life expectancy U.S. population Positive—distance to
national park (proxy for
exposure to biodiverse
environment) related to
life expectancy
Sieswerdaetal.
(2001)
Examined whether global
life expectancy is linked
to large-scale declines in
ecological integrity
Percentage of land highly
disturbed by human
activities; percentage of
threatened species;
percentage of landmass
total or partially
protected; percentage of
forest remaining since
pre-agricultural times;
and the average annual
change in forest cover.
Life expectancy Global populations No clear relationship—no
association between
indicators of biodiversity
and health and
well-being measures
Cross-sectional
survey
Lemieux et al.
(2012)
Explored the perceived
health and well-being
outcomes associated with
visiting protected areas.
None—good description of
studysites(bothIUCN
category II)
Self-report perceived health
and well-being
Ontario and Quebec,
Canada, visitors to
protected areas
during sampling
period, age
19–66+, n = 166
Positive—perception that
visiting sites associated
with psychological/
emotional and social
benefits
Qualitative
participatory
Pereira et al.
(2005)
Explored the links between
ecosystem services and
human well-being from
the perspective of a rural
mountain community in
Portugal
Assessed biodiversity
known to local residents
Community defined
measure of well-being
(criteria: very important
to unimportant for a
good life)
Sistelo region of
Portugal, local
residents, age not
given, n = 86
No clear relationship—both
positive and negative
impacts to well-being
were reported
Ethnographic (Curtin 2009) Explored the psychological
benefits of wildlife
tourism to bodiverse
environments
None—some description of
sites
Psychological impacts Anadalucia, Spain,
and Sea of Cortez,
Baja California,
wildlife tourists, age
30–70+, n = 20
Positive—experience of
wildlife in biodiverse
environments results in
perceived positive
psychological
experiences
Study design not suitable for inclusion in the synthesis of results.
7
Downloaded by [University of Exeter] at 04:44 28 January 2016
8 R. LOVELL ET AL.
2001). None of the publications reported dose-
response relationships (i.e., to environments of
greater or lesser biodiversity) within individuals
or populations.
The scales at which the relationships were
examined ranged from the local (Dallimer et al.,
2012; Fuller et al., 2007) to global (Huynen
et al., 2004; Sieswerda et al., 2001). The
specific environments considered included the
global populated landmass (Huynen et al.,
2004; Sieswerda et al., 2001), a specific nation-
state (the United States [Poudyal et al., 2009],
geographical regions in Sweden [Annerstedt
et al., 2012; Björk et al., 2008; de Jong
et al., 2012; Grahn and Stigsdotter, 2010],
the United Kingdom [Huby et al., 2006],
Australia [Luck et al., 2011], and Portugal
[Pereira et al., 2005]), and specific places,
including biodiverse sites of high natural her-
itage in the southeast of England (Barton et al.,
2009), selected urban green spaces in Sheffield,
United Kingdom (Dallimer et al., 2012; Fuller
et al., 2007), protected natural environments
in Quebec and Ontario, Canada (Lemieux
et al., 2012), Andalucía, Spain (Curtin, 2009),
California, United States (Curtin, 2009), and
urban neighborhoods in Seattle, Washington,
United States (Tilt et al., 2007). The two global
epidemiological studies included all countries
for which relevant data were available (Huynen
et al., 2004; Sieswerda et al., 2001). However,
only Sieswerda et al. (2001) actually listed
the 203 countries included in their analysis;
the countries represent a spread from devel-
oped and developing worlds, both northern
and southern hemispheres, and each conti-
nent. Two studies used hypothetical” environ-
ments to examine the impact of biodiversity:
Jorgensen et al. (2010) used photographs of
environments with differing complexity (linked
to biodiversity by the author), while Grahn
and Stigsdotter (2010) used ranked, preferred
features of natural environments.
Sample size varied considerably among the
studies, ranging from an n of 20 (Curtin, 2009)
through to the millions, or possibly billions
in the analyses of global populations (Huynen
et al., 2004; Sieswerda et al., 2001). Participant
type also differed; these included university
students (Jorgensen et al., 2010), urban park
users (Dallimer et al., 2012; Fuller et al., 2007),
wildlife tourists (Curtin, 2009), visitors to coun-
try parks and sites of natural heritage (Barton
et al., 2009; Lemieux et al., 2012), and resi-
dents of specific regions as detailed earlier. The
participants of the majority of the studies (apart
from Huynen et al., 2004; Poudyal et al., 2009;
Sieswerda et al., 2001) appeared to be adults.
Few of the studies included an explicit
articulation of the authors’ understanding and
definitions of health and well-being; simi-
larly, there was little discussion as to why
the aspects considered may relate to or be
affected by biodiversity. The conceptualizations
of health and well-being ranged from functional
approaches (life expectancy) to more holis-
tic” understandings where health encompasses
factors such as sense of place or self-esteem.
Reflecting the breadth of apparent conceptu-
alization of health and well-being, there was
considerable variation in the outcomes con-
sidered and, therefore, of the measures used
between the studies. Three of the secondary
data analyses employed life expectancy as an
indicator of general health status (Huynen et al.,
2004; Poudyal et al., 2009; Sieswerda et al.,
2001). Huynen et al. (2004) also considered
infant mortality rate, incidence of low-weight
babies, and disability-adjusted life expectancy.
Among the remaining studies the objective
and/or self-report outcomes included health
behaviors such as physical activity (Annerstedt
et al., 2012; Björk et al., 2008; de Jong et al.,
2012; Luck et al., 2011; Tilt et al., 2007),
physiological state (Tilt et al., 2007), general or
specific physical health status assessed using a
variety of scales or measures including the val-
idated Short Form 36 (Björk et al., 2008; de
Jong et al., 2012; Grahn and Stigsdotter, 2010;
Lemieux et al., 2012), general psychological or
emotional health, well-being, or status assessed
using a variety of measures or scales including
the General Health Questionnaire 12, Profile
of Mood States scale, and the Rosenberg Self-
Esteem Scale (Annerstedt et al., 2012; Barton
et al., 2009; Björk et al., 2008; Dallimer et al.,
2012; Fuller et al., 2007; Huby et al., 2006;
Jorgensen et al., 2010; Lemieux et al., 2012;
Downloaded by [University of Exeter] at 04:44 28 January 2016
BIODIVERSITY AND THE PROMOTION OF GOOD HEALTH 9
Luck et al., 2011), and community-level well-
being (de Jong et al., 2012; Luck et al., 2011;
Pereira et al., 2005).
As with understanding of health and well-
being, few of the authors articulated their con-
ceptualization and definitions of biodiversity.
Some authors appeared to have used the
term in accordance with the definition from
the Convention on Biological Diversity (n.d.;
accessed 2013), particularly in relation to diver-
sity within and between species (Dallimer et al.,
2012; Fuller et al., 2007; Luck et al., 2011).
Others, however, used the term in less spe-
cific and scientifically accepted ways, relating
“biodiversity” to similar constructs such as natu-
ral environments with greater or lesser visual or
perceived complexity or “lushness” (Annerstedt
et al., 2012; Barton et al., 2009; Björk et al.,
2008; de Jong et al., 2012). In three of the
studies biodiversity was assessed using stan-
dard ecological survey techniques (Dallimer
et al., 2012; Fuller et al., 2007; Luck et al.,
2011). Participant assessment of biodiversity
was employed as a primary measure by Pereira
et al. (2005) and as an additional measure by
both Dallimer et al. (2012) and Fuller et al.
(2007). In two studies satellite imagery data was
interpreted using the Normalized Difference
Vegetation Index (NDVI), which was related by
the authors to biodiversity and environmental
structure (Luck et al., 2011; Tilt et al., 2007).
A further three papers used the Scania Green
Score, which is an approach to the interpre-
tation of the type and structure of the natural
environment, assessed using interpreted satel-
lite imagery, according to the presence of cer-
tain “green qualities” including a biodiversity-
related factor: “lush, a place rich in species”
(Annerstedt et al., 2012; Björk et al., 2008; de
Jong et al., 2012). Several of the secondary data
analysis studies used percent land area pro-
tected as a proxy for biodiversity (Huby et al.,
2006; Poudyal et al., 2009; Sieswerda et al.,
2001). Factors such as proportion of threat-
ened species and of highly disturbed land were
used to indicate decreased biodiversity in two
studies (Huynen et al., 2004; Sieswerda et al.,
2001). In four of the studies biodiversity was
not directly assessed but the natural heritage
“value” of the environments was demonstrated
through formal designation (Barton et al., 2009;
Curtin, 2009; Lemieux et al., 2012; Pereira
et al., 2005). For instance, both study loca-
tions considered by Lemieux et al. (2012) were
International Union for Conservation of Nature
(IUCN) category II. Jorgensen et al. (2010)
visually assessed the complexity or “vegeta-
tion layers” of the four environments used in
their experimental study and suggested that
vegetal layers relate to biodiversity. Grahn and
Stigsdotter (2010) used factor analysis to code
participant reports of preferences for differ-
ent environments including biodiversity-related
factors.
Where articulated, the theoretical under-
pinnings and conceptual frameworks tended
to reflect the dominant understandings of
environment–health linkages within respective
research disciplines. Among the social science
studies, the biophilia hypothesis (Kellert and
Wilson, 1995), attention restoration (Kaplan,
1995), and psychoevolutionary stress reduc-
tion theories (Ulrich et al., 1991) were used
to describe the potentially innate connection
of humans to the natural world, indicating that
greater exposure results in better health out-
comes (Annerstedt et al., 2012; Barton et al.,
2009; Curtin, 2009; Dallimer et al., 2012; de
Jong et al., 2012; Fuller et al., 2007; Grahn
and Stigsdotter, 2010; Jorgensen et al., 2010).
Aesthetics, preferences, and connection to or
sense of place explained potential benefits in
studies that focused on use of the natural envi-
ronment for physical activity or other health
behaviors (Annerstedt et al., 2012; Barton et al.,
2009; Björk et al., 2008; Dallimer et al., 2012;
Fuller et al., 2007; Grahn and Stigsdotter, 2010;
Lemieux et al., 2012; Tilt et al., 2007). More
functional theories were discussed in the epi-
demiological publications, for instance, greater
well-being through access to sufficient natu-
ral resources (Pereira et al., 2005; Poudyal
et al., 2009; Sieswerda et al., 2001) or the
negative influence of compromised ecosystem
function (Huynen et al., 2004). A number of
the selected studies were not based within the-
oretical frameworks and did not articulate why
biodiversity may be related to better health
Downloaded by [University of Exeter] at 04:44 28 January 2016
10 R. LOVELL ET AL.
and well-being, or through which mechanisms
positive outcomes may arise.
While the reporting of key details with
regard to methodology, sample strategy and
characteristics, and precise analytical approach
was occasionally inadequate, overall the stud-
ies could be described as of acceptable quality
and in most cases the results appear reli-
able” when considered within their method-
ological paradigm (see Supplemental Material).
However, specific aspects of some studies
were of relatively low quality. Implicit (and in
some cases explicit) assumptions that greater
biodiversity did support better health and well-
being may have introduced bias in a number of
the studies.
IS THERE EVIDENCE TO SUGGEST THAT
BIODIVERSE ENVIRONMENTS
PROMOTE BETTER HEALTH AND
WELL-BEING AND CAN ANY
RELATIONSHIP IDENTIFIED BE
CHARACTERIZED?
Fourteen of the 15 quantitative studies
identified during the search process used higher
order study designs (experimental, longitudinal,
comparative or uncontrolled before-and-after
study designs). Only these 14 were included
in the quantitative assessment of links between
biodiversity and health (Tables 1, 2, and 3).
The two qualitative studies facilitated an under-
standing of the perceptions of relationships
(Tables 1 and 2).
Ten of the 16 studies included in the anal-
ysis (Tables 2 and 3) highlighted one or more
positive associations (assessed or perceived)
between biodiversity and one or more health
or well-being outcomes (Barton et al., 2009;
Björk et al., 2008; Curtin, 2009; Dallimer et al.,
2012; de Jong et al., 2012; Fuller et al., 2007;
Grahn and Stigsdotter, 2010; Huby et al., 2006;
Luck et al., 2011; Poudyal et al., 2009; Tilt
et al., 2007). Eleven of the studies reported
results that either suggested no clear relation-
ship or were inconclusive as to the direction
of the relationship (Annerstedt et al., 2012;
Björk et al., 2008; Dallimer et al., 2012; de
Jong et al., 2012; Fuller et al., 2007; Grahn
and S tigsdotter, 2010; Huynen et al., 2004;
Jorgensen et al., 2010; Pereira et al., 2005;
Sieswerda et al., 2001; Tilt et al., 2007), and
two reports suggested an inverse relationship
between biodiversity and aspects of health
(Dallimer et al., 2012; Huynen et al., 2004).
Quantitative Results
Environmental Measures There was lit-
tle consistency in the patterns of relationships
according to type of environmental/biodiversity
measure and direction of health outcome in
which to be confident (Tables 2 and 3). In the
three studies that used, arguably, the most
robust measure of biodiversity (primary eco-
logical surveys), each found some moderately
positive relationships (though not all results
were positive; many were inconclusive and one
negative) between aspects of biodiversity and
well-being outcomes (Dallimer et al., 2012;
Fuller et al., 2007; Luck et al., 2011). The
two publications considering degraded envi-
ronmental state, assessed using factors such as
percent threatened species, revealed no clear
associations with some indication of negative
relationships (Huynen et al., 2004; Sieswerda
et al., 2001). Where proximity to biodiverse or
protected environments was considered, results
tended to be moderately positive (Huby et al.,
2006; Poudyal et al., 2009; Tilt et al., 2007)
or inconclusive (Sieswerda et al., 2001). The
four studies to consider settings defined by per-
ceived environmental dimensions (with objec-
tively assessed or self-report exposure) failed to
detect clear relationships between the presence
of “lush” environments and mental or general
health and well-being (Annerstedt et al., 2012;
Björk et al., 2008; de Jong et al., 2012; Grahn
and Stigsdotter, 2010), but some positive rela-
tionships with physical activity emerged (Björk
et al., 2008; de Jong et al., 2012).
Objective Measures of Health The
Poudyal et al. (2009) analysis of secondary
aggregate data sets suggested a moderate but
significant positive association between life
expectancy and an indicator of exposure to
biodiversity in the United States. Sieswerda
Downloaded by [University of Exeter] at 04:44 28 January 2016
BIODIVERSITY AND THE PROMOTION OF GOOD HEALTH 11
TABLE 2. Trend of Results by Study Type
Study type
Some/all results positive;
greater biodiversity
associated with better
health (and vice versa)
Some/all results show no
relationship or unclear; could
be -/+ or no relationship
Some/all results negative;
greater biodiversity is not
associated with better
health (and vice versa)
Experimental Jorgensen et al. (2010)
Longitudinal survey Annerstedt et al. (2012)
Comparative and
uncontrolled before and
after
Barton et al. (2009) Björk et al. (2008) Dallimer et al. (2012)
Björk et al. (2008) Dallimer et al. (2012)
Dallimer et al. (2012) de Jong et al. (2012)
de Jong et al. (2012) Fuller et al. (2007)
Fuller et al. (2007) Grahn and Stigsdotter (2010)
Luck et al. (2011) Tilt et al. (2007)
Tilt et al. (2007)
Secondary aggregate data
analysis
Huby et al. (2006) Huynen et al. (2004) Huynen et al. (2004)
Poudyal et al. (2009) Sieswerda et al. (2001)
Participatory qualitative Pereira et al. (2005)
Ethnographic Curtin (2009)
Papers may be included more than once if variation in individual results.
TABLE 3. Trend of Results (Where Relevant) by Health and Environmental Measure
Health measure
Environmental measure
Objective health outcomes
(life expectancy etc)
Self-report, survey measured
general physical, mental or social
health and well-being
Self-report behavior
measures (e.g. physical
activity)
Area or distance based secondary
data proxies for degraded
environments
Huynen et al. (2004)
(–oooooooooo)
Sieswerda et al. (2001) (o)
Area/distance based secondary data
proxies for protected or
high-biodiversity environments
Poudyal et al. (2009) (+) Huby et al. (2006) (+) Tilt et al. (2007) (o)
Sieswerda et al. (2001) (o)
Tilt et al. (2007) (+)
Primary ecological surveys or
classification
Dallimer et al. (2012) (++++o-)
Fuller et al. (2007)
(++++oooooooo)
Luck et al. ( 2011) (++)
Exposure to environments defined
by perceived environmental
dimensions
Annerstedt et al. (2012) (o) Annerstedt et al. (2012) (o)
Björk et al. (2008) (o) Björk et al. (2008) (+)
de Jong et al. (2012) (+o) de Jong et al. (2012) (+)
Grahn and Stigsdotter (2010) (o) Tilt et al. (2007) (+)
Investigator reported biodiversity Jorgensen et al. (2010) (o)
No assessment Barton et al. (2009) (+++)
Note. Each -, o, or + symbol represents the direction of each individual result reported in the paper. Papers may be included more than
once if variation in individual results. Papers may be included more than once if two or more different approaches to environment/health
assessment used.
et al. (2001) found that initial positive asso-
ciations (between percent highly disturbed
land, percent threatened species, percent
forest remaining since pre-agricultural period,
and life expectancy at a global scale) were
lost after controlling for gross domestic prod-
uct (GDP). Similarly, Huynen et al. (2004)
reported that associations between indicators
of decreased biodiversity and infant mortality
and incidence of low-weight babies were also
lost after adjusting for socioeconomic factors.
Huynen et al. (2004) described an inverse of
the expected relationship with increases in
percent threatened species associated with
greater life expectancy and disability-adjusted
life expectancy. Tilt et al. (2007) found an
Downloaded by [University of Exeter] at 04:44 28 January 2016
12 R. LOVELL ET AL.
interactive effect with greater objective accessi-
bility related to lower body mass index (BMI),
though only in areas of higher greenness”
assessed using NDVI.
Self-Report Physical or Mental Health
and Well-Being In an experimental setting
no clear effect was evident in assessments of
psychological state after exposure to environ-
ments of differing complexity following a stres-
sor (being shown a frightening film) among
university students (Jorgensen et al., 2010).
The Huby et al. (2006) analysis of associa-
tions between mental well-being and indica-
tors of biodiversity in rural England revealed
a moderate positive association. A study con-
ducted in urban Australia found that both
personal well-being and neighborhood satisfac-
tion (termed “neighborhood well-being”) rose
in relation to greater species richness and abun-
dance and with increased vegetative cover and
density (assessed using standardized ecologi-
cal surveys) (Luck et al., 2011). There was
inconsistency in the direction of associations
between various indicators of biodiversity and
psychological well-being in the two studies that
used broadly similar methodologies and were
both carried out in urban Sheffield, United
Kingdom, though in different types of urban
green space (Dallimer et al., 2012; Fuller et al.,
2007). In both studies bird species richness
was positively associated with measures of
well-being while butterfly species richness was
shown to have no association. The findings
diverged when examining plant richness: Fuller
et al. (2007) found that enhanced well-being
was related to increased plant species rich-
ness, whereas Dallimer et al. (2012) reported
a decline in well-being under such circum-
stances. Similarly variation was observed in rela-
tion to tree cover, with Dallimer et al. (2012)
reporting a positive relationship with well-being
and Fuller et al. (2007) finding no association.
Positive associations between participant
assessment of species (bird, butterfly, and
plant) richness and self-report well-being were
detected by Dallimer et al. (2012); however,
they found no association between perceived
and actual species richness (which suggests
that the participants were unable to accurately
assess species richness). While Fuller et al.
(2007) did not specifically examine associa-
tions between perceived richness (bird, butter-
fly, and plant) and well-being, they did find
that their participants were able to accurately
assess species richness; therefore the associa-
tions between participant assessed biodiversity
and well-being may have been consistent with
those of the objective assessments.
Positive impacts on mood and self-esteem
following time spent in environments of “high
natural heritage value” (scores of individuals
newly arrived to the sites were compared with
those l eaving) were reported by Barton et al.
(2009). Hypothetical environments categorized
as “rich in species” (according to a factor anal-
ysis of reported preferences for environmen-
tal features) were found to be the preferred
place types for restoration among people who
reported higher symptoms of stress -related con-
ditions (Grahn and Stigsdotter, 2010). The three
studies using the Scania Green Score ( a method
of classifying environmental type using satel-
lite imagery and/or participant report) found
no clear associations between environments
categorized as “lush, rich in species” and
self-reported mental health (Annerstedt et al.,
2012), general health (Björk et al., 2008), or
the “vitality domain of the Short Form 36
(SF36) (Björk et al., 2008). A positive association
between objective assessment of the presence
of “lush” environmental features and neighbor-
hood satisfaction, although only for those living
in a flat or student room, was found by de Jong
et al. (2012).
Health- and Well-Being-Related
Behaviors Bjork et al. (2008) showed
that the participants with “lush” environmental
features within 300 m of the home residence
engaged in greater self-reported physical
activity than those with other environmental
feature types. Similarly, de Jong et al. (2012)
detected a positive association between “lush”
environments and physical activity, although
Annestedt et al. (2012) noted no association.
Tilt et al. (2007) also found positive associations
between walking and subjective assessments
of overall greenness,” but they did not detect
a clear relationship between an objective
Downloaded by [University of Exeter] at 04:44 28 January 2016
BIODIVERSITY AND THE PROMOTION OF GOOD HEALTH 13
assessment of greenness (assessed using NDVI
and linked to biodiversity by the authors) and
walking.
Qualitative Findings
Both studies using a qualitative approach
were able to document conflicting impacts of
biodiversity on well-being. The residents of the
Sistelo region of Portugal, when questioned
regarding the importance of biodiversity to their
well-being and quality of life, reported ambi-
guity and mixed feelings: “Residents did not
immediately think of biodiversity as something
important to their well-being” (Pereira et al.,
2005, p. 53). Although biodiversity was appre-
ciated for its inherent value and beauty, this
was tempered by the perception of poten-
tial harm to their agro-pastoral practices, with
residents giving the example of wild boar dam-
aging crops. A study of wildlife tourists doc-
umented the perceived psychological bene-
fits of trips to biodiverse regions of Andalucía
and California and of wildlife closer to their
homes in the United Kingdom (Curtin, 2009).
Participants generally described highly positive
psychological, emotional, and spiritual expe-
riences: Curtin (2009) noted that the tourists
struggled to find adequate words to express the
depth of emotion and euphoria resulting from
their encounters with wildlife. However, these
experiences did occasionally result in negative
emotions, such as frustration following missed
opportunities or the fear of looking incompe-
tent in front of fellow wildlife enthusiasts. Curtin
(2009) concluded that “sharing our world with
abundant flora and fauna enhanced day-to-
day wellbeing and happiness which in turn
has significant psychological and other health
benefits” (p. 468).
REFLECTIONS ON THE HEALTH AND
WELL-BEING BENEFITS OF BIODIVERSE
ENVIRONMENTS
The aim of this review was to provide a
systematic synthesis and assessment of avail-
able evidence that examined potential linkages
between biodiversity and good health and well-
being. Despite a purposely broad and inclusive
strategy, only 17 primary research studies that
stated any intention to examine this relation-
ship were identified. All included papers were
published in the past 12 years, originated in
the developed world, and primarily focused on
relationships in Western developed countries.
The lack of a comprehensive body of research
regarding the health and well-being benefits of
specific environment types, states, or conditions
was alluded to elsewhere (Bowler et al., 2010;
Lachowycz and Jones, 2011).
The synthesis of the results of the 14 quan-
titative studies conducted using higher order
study designs (i.e., of an adequate robustness
to reliably indicate relationships, if not actually
to show cause and effect), showed that there is
some evidence to suggest that biodiverse natu-
ral environments may be associated with good
health and well-being. Nine of the 14 stud-
ies showed one or more positive relationships.
These benefits were manifest in a number of
ways: from better mental health outcomes fol-
lowing exposure, to associations with increased
health-promoting behaviors. The relationships
were most evident at a local scale, following
immediate encounters or through presumed
repeated exposures (e.g., via proximity to res-
idence), and were found across the different
study types and approaches. The findings from
the two qualitative studies suggested that the
relationships between biodiversity and aspects
of health are complicated but that awareness
of and mere presence of biodiversity evokes
positive feelings. The synthesis demonstrated,
however, that much of the evidence is inconclu-
sive (10 of the quantitative studies reported one
or more inconclusive findings) and fails to iden-
tify a specific relationship or role for biodiversity
in the promotion, or otherwise, of better health.
Further, there is some evidence (in two of the
quantitative studies) of negative relationships.
Overall, there was no clear pattern of rela-
tionship identified in relation to strength and
reliability of assessment of biodiversity, study
design, or the specific aspect of health and
well-being considered. The body of evidence
is therefore not yet of the extent or strength
Downloaded by [University of Exeter] at 04:44 28 January 2016
14 R. LOVELL ET AL.
necessary to uncover mechanisms or character-
ize the role of biodiversity in relation to health
and well-being. The review of how the evi-
dence was generated highlighted the lack of
robust experimental and controlled designs that
could elucidate the specificity, strength, and
direction of relationships. Much of the avail-
able evidence emerged from uncontrolled and
observational studies and is therefore of limited
inferential power. While the multidisciplinary
nature of the body of existing evidence is inter-
esting and of some value, the small scale and
heterogeneity of the body of evidence con-
tribute to uncertainty within the synthesis and
leave many key factors within the relationship
unclear.
In terms of ecosystem goods and services, it
is not clear through which pathway biodiversity
may foster good health and well-being (Norris,
2011). The global epidemiological studies
included in this review indicate a nonlin-
ear relationship at a national population scale
(Huynen et al., 2004; Poudyal et al., 2009;
Sieswerda et al., 2001). The authors of one of
these studies hypothesized that until a certain
threshold is reached, loss of biodiversity may
not result in direct negative impacts on health
or well-being (Sieswerda et al., 2001). By link-
ing health to the availability of exploitable
natural resources, through for example the pro-
visioning ecosystem services, the authors sug-
gest that developed societies may be able to
maintain the sustained levels of consumption
that support better health through the use of
resources outside of their nations’ borders. This
potentially further confounds the relationships
between biodiversity and socioeconomic devel-
opment (Fisher and Christopher, 2007). Local-
scale studies, which predominantly focused
on links between biodiversity within the living
environment or leisure spaces and self-report
well-being, suggest that these types of exposure
may have more linear and demonstrably pos-
itive impacts on health (Dallimer et al., 2012;
de Jong et al., 2012; Fuller et al., 2007; Tilt
et al., 2007). Mechanisms of impact are likely
to include improved quality of life, aesthetics,
and the provision of preferred spaces for stress
reduction and relaxation, factors that may be
considered as relevant to cultural ecosystem
services (Church et al., 2011). However, the
results from preference studies (not included in
this review due to having not considered links
to health) indicate that this relationship may not
be straightforward either, with some variation in
preferred environment type according to pop-
ulation characteristics and other sociocultural
factors (van den Berg and Koole, 2006).
One of the key issues that may explain
some of the variation in the evidence relates
to the definition, use, and assessment of each
of the key concepts addressed. “Biodiversity,”
“health,” and “well-being” are somewhat con-
tentious concepts, and there is acknowledged
variation in application not only between dis-
ciplines but also within them (Gaston, 2009;
Huber et al., 2011). B oth “health” and “well-
being” are complex and mutable concepts
(Huber et al., 2011), and this is reflected in
the variety of health or well-being outcomes
assessed in the different studies. This hetero-
geneity raises issues in comparability: Is it jus-
tifiable to compare evidence based on BMI
scores with that based on subjective well-being
derived from a sense of place? The evidence as
to whether biodiversity is related to good health
is further confounded by the questionable effi-
cacy and validity of the measures used to assess
the health or well-being o utcome intended.
Further, the approach taken to character-
ize the physical environment varied greatly
and also raises questions regarding the suit-
ability of the approaches taken to the assess-
ment of biodiversity and comparability of dif-
fering conceptions and measures of biodiversity
across disciplines. It appears that the term
“biodiversity” is not necessarily used accord-
ing to its formal, scientific definition outside
of the biological, ecological, and conserva-
tion sciences. As with health, various aspects
of biodiversity were assessed using an assort-
ment of different measures, which may not
be cross-comparable or, indeed, valid. The
question of cross-study comparability is high-
lighted by a study by Dallimer et al. (2012)
where variance in health outcome accord-
ing to whether biodiversity was participant or
expert assessed was found. Biodiversity is a
Downloaded by [University of Exeter] at 04:44 28 January 2016
BIODIVERSITY AND THE PROMOTION OF GOOD HEALTH 15
complex and multifaceted environmental con-
cept, encompassing many dimensions that may
vary in their impact on human health and
well-being (Fischer and Young, 2007; Mace
et al., 2012). For instance, there may be dif-
fering impacts stemming from species richness
and abundance, or from ecosystem diversity.
Clearly it is not, as the results of this review
indicated, as simple as the uncritical assertion,
which has been made elsewhere, that greater
biodiversity results in better health. Ecosystems
with low levels of biodiversity occur naturally,
estuaries being one example, but are not asso-
ciated with adverse health outcomes. Indeed,
humans appear to congregate in such locali-
ties and may benefit from doing so (Wheeler
et al., 2012). Similarly, increase in biodiversity,
particularly in urban or amenity landscapes,
may have negative consequences for health and
well-being.
IMPLICATIONS AND OPPORTUNITIES
FOR FUTURE RESEARCH
Mace et al. (2012) suggested that new
approaches are needed if one is to advance
understanding of the role and processes
through which biodiversity may promote bet-
ter human health and well-being. At the most
basic level, this field of study demands truly
interdisciplinary research, with integration of
social, health, and natural sciences. Of particu-
lar importance is identifying the specific ecosys-
tem services, goods, and processes through
which biodiversity may impact on good health
and well-being. It is likely that the relationships
between human health and biodiversity are
multidimensional and subject to numerous con-
founders. For example, habitat destruction, pol-
lution, and climate change all result in changes
in biodiversity, but also affect human health
and well-being in numerous ways. There is not
always a simple relationship between these fac-
tors and biodiversity; in some cases biodiversity
may be increased while human health is
adversely affected. Similarly, it is crucial to iden-
tify the potential mechanisms through which
exposure to biodiverse environments may result
in biochemical and physiological changes nec-
essary to manifest as improvements in physical
and mental health (Depledge et al., 2011).
Future research conducted using the most
robust approaches to the assessment of
biodiversity and health, with a greater emphasis
on longitudinal and experimental designs, mak-
ing use of mixed methodologies (i.e., drawing
on techniques and approaches from the natu-
ral and social sciences, and wider humanities),
and with adequate controlling and sampling
strategies would strengthen the evidence base
and allow for a more nuanced understanding
of these complex relationships. In addition, the
purposeful use of natural experiments, where
researchers take opportunities offered though
policy change, new projects and programs, or
other interventions, could provide meaning-
ful and valuable evidence. Regarding specific
focus, future research could consider potential
variation in the impacts of biodiverse environ-
ments in relation to:
Population type and, in particular, according
to certain sociodemographic factors (though
it should be noted that sociodemographics
were considered as potential confounding
factors in a number of the studies: Björk
et al., 2008; Luck et al., 2011; Poudyal et al.,
2009). Previous research indicated that the
benefits of proximity to natural environments
are not distributed equally among socioeco -
nomic groups (Maas et al., 2009; Richardson
and Mitchell, 2010).
Sociocultural determinants. Preference stud-
ies indicated that environmental responses
and perceptions also vary across populations
and that this may be driven by sociocul-
tural factors (van den Berg and Koole, 2006).
It is feasible that this variation might affect
any potential health or well-being benefits of
biodiverse environments.
Geographical or landscape context. It is pos-
sible that the impacts of biodiverse envi-
ronments may be mediated by the type of
landscape in which the study environment
is situated. For instance, although an urban
brownfield site may be relatively biodiverse,
any beneficial impacts may be affected by
Downloaded by [University of Exeter] at 04:44 28 January 2016
16 R. LOVELL ET AL.
perceptions of safety, restrictions on use or
access, or lack of awareness of the value
of the particular environment (Angold et al.,
2006). Latitude, season, or weather may also
act as mediatory factors.
Type and frequency of and reason for expo-
sure. The majority of the studies included
in this review assessed only proximal rela-
tionships and were unable to ascertain the
relevance of active or passive engagement
with an environment. Valuable contextual
information regarding frequency and justifi-
cation of the use of environments was missing
from a number of the studies (Barton et al.,
2009; Dallimer et al., 2012; Fuller et al.,
2007). It is feasible that health benefits may
vary between users who travel specifically to
an environment for leisure use and people
passing through on a daily commute.
Time frame of impacts. It is not clear when
exposure to biodiverse environments might
subsequently affect health or well-being,
nor for how long those benefits might be
expected to last.
CONCLUDING OBSERVATIONS
Both public health and conservation sci-
ences have called for greater clarity regarding
the role of the environment in determining
good human health and well-being. This review
responds through a systematic examination of,
first, the nature and state of existing research,
and second, the evidence for the direction and
characteristics of any links between biodiversity
and good human health and well-being. It was
shown that the current body of evidence is
multidisciplinary and has been produced using
a variety of different approaches and methods.
Although much of the evidence was inconclu-
sive, 10 of the studies included in this review
indicated that exposure to or use of biodiverse
environments does have some association
with various indicators of better health and
well-being. However, uncertainty remains and
relationships are, as of yet, not characteriz-
able. The lack of a definitive conclusion as to
whether biodiversity is causally related to
better health and well-being among human
populations is due to a number of factors:
(1) small body of evidence, (2) heterogeneity
of research design, methodological approach,
and measures (both environmental and health),
(3) suitability of the research design, meth-
ods, and measures to assess the relationships,
and (4) complexity and multidimensionality of
any link between biodiversity and good health.
Currently there is not enough strong and reli-
able evidence to robustly inform environmental
or health policy; however, the existing “weight
of evidence” does suggest that there is value
in continuing to explore associations between
biodiverse environments and good health and
well-being, and to bear this potential relation-
ship in mind during future policy development.
FUNDING
Thanks are due to J. Thompson-Coon
for advising on the protocol and extraction
forms, to R. Garside for advice on synthesis,
and to Popay et al. (2006) for permission to
use the ESRC-funded Narrative Synthesis guid-
ance. The European Centre for Environment
and Human Health (part of the University
of Exeter Medical School) is in part financed
by the European Regional Development Fund
Programme 2007 to 2013 and European Social
Fund Convergence Programme for Cornwall
and the Isles of Scilly.
SUPPLEMENTAL MATERIAL
Supplemental material for this article can
be accessed at DOI: 10.1080/10937404.2013.
856361 The study protocol may be requested
from the author, and the search strategy and
quality assessments (Supporting Material 1 and
2) are available online. The authors are solely
responsible for the content and functionality of
these materials. Queries (other than absence of
the material) should be directed to the corre-
sponding author.
Downloaded by [University of Exeter] at 04:44 28 January 2016
BIODIVERSITY AND THE PROMOTION OF GOOD HEALTH 17
REFERENCES
Angold,P.G.,J.P.Sadler,M.O.Hill,A.
Pullin, S. Rushton, K. Austin, E. Small, B.
Wood, R. Wadsworth, R. Sanderson, and
K. Thompson. 2006. Biodiversity in urban
habitat patches. Sci. Total. Environ. 360:
196–204.
Annerstedt, M., P.O. Ostergren, J. Bjork, P.
Grahn, E. Skarback, and P. Wahrborg. 2012.
Green qualities in the neighbourhood and
mental health—Results from a longitudinal
cohort study in Southern Sweden. BMC
Public Health 12: 337.
Aswani, S., and T. Furusawa. 2007. Do marine
protected areas affect human nutrition and
health? A comparison between villages in
Roviana, Solomon Islands. Coastal Manage.
35: 545–565.
Balvanera, P., A. B. Pfisterer, N. Buchmann,
J.S. He, T. Nakashizuka, D. Raffaelli, and B.
Schmid. 2006. Quantifying the evidence for
biodiversity effects on ecosystem functioning
and services. Ecol. Lett. 9: 1146–1156.
Barton, J., R. Hine, and J. Pretty. 2009. The
health benefits of walking in green spaces
of high natural and heritage value. J. Integr.
Environ. Sci. 6: 61–278.
Beaglehole, R., R. Bonita, R. Horton, C.
Adams, G. Alleyne, P. Asaria, V. Baugh, H.
Bekedam, N. Billo, S. Casswell, M. Cecchini,
R. Colagiuri, S. Colagiuri, T. Collins, S.
Ebrahim, M. Engelgau, G. Galea, T. Gaziano,
R. Geneau, A. Haines, J. Hospedales, P. Jha,
A. Keeling, S. Leeder, P. Lincoln, M. McKee,
J. Mackay, R. Magnusson, R. Moodie, M.
Mwatsama, S. Nishtar, B. Norrving, D.
Patterson, P. Piot, J. Ralston, M. Rani, K. S.
Reddy, F. Sassi, N. Sheron, D. Stuckler, I. Suh,
J. Torode, C. Varghese, and J. Watt. 2011.
Priority actions for the non-communicable
disease crisis. Lancet 377: 1438–1447.
Bird, W. 2007. Natural thinking: Investigating
the links between the natural environment,
biodiversity and mental health. Sandy, UK:
Royal Society for the Protection of Birds.
Björk, J., M. Albin, P. Grahn, H. Jacobsson,
J. Ardö, J. Wadbro, P.-O. Östergren, and
E. Skärbäck. 2008. Recreational values
of the natural environment in relation
to neighbourhood satisfaction, physical
activity, obesity and wellbeing. J. Epidemiol.
Commun. Health 62: e2.
Bowler, D. 2010. The importance of nature for
health: Is there a specific benefit of con-
tact with green space? Systematic review.
Bangor, UK: Collaboration for Environmental
Evidence.
Bowler, D., L. Buyung-Ali, T. Knight, and A.
Pullin. 2010. A systematic review of evidence
for the added benefits to health of exposure
to natural environments. BMC Public Health
10: 456.
Brown, C., and M. Grant. 2005. Biodiversity
and human health: What role for nature in
healthy urban planning? Built Environ. 31:
326–338.
Cardinale, B. J., J. E. Duffy, A. Gonzalez, D. U.
Hooper, C. Perrings, P. Venail, A. Narwani,
G. M. Mace, D. Tilman, D. A. Wardle, A. P.
Kinzig, G. C. Daily, M. Loreau, J. B. Grace, A.
Larigauderie, D. S. Srivastava, and S. Naeem.
2012. Biodiversity loss and its impact on
humanity. Nature 486: 59–67.
Centre for Reviews and Dissemination. 2008.
Systematic reviews: CRD’s guidance for
undertaking reviews in health care. York, UK:
University of York.
Chivian, E., and A. Bernstein 2008. Sustaining
life: How human health depends on
biodiversity. Oxford, UK: Oxford University
Press.
Church, A., J. Burgess, and N. Ravenscroft.
2011. Cultural services. UK national ecosys-
tem assessment. Cambridge, UK: UNEP-
WCMC.
Collins, P. Y., V. Patel, S. S. Joestl, D. March, T. R.
Insel, A. S. Daar, I. A. Bordin, E. J. Costello,
M. Durkin, C. Fairburn, R. I. Glass, W. Hall, Y.
Huang, S. E. Hyman, K. Jamison, S. Kaaya, S.
Kapur, A. Kleinman, A. Ogunniyi, A. Otero-
Ojeda, M.-M. Poo, V. Ravindranath, B. J.
Sahakian,S.Saxena,P.A.Singer,D.J.Stein,
W. Anderson, M. A. Dhansay, W. Ewart, A.
Phillips, S. Shurin, and M. Walport. 2011.
Grand challenges in global mental health.
Nature 475 :27–30.
Convention on Biological Diversity. n.d. Article
2. Use of terms. UNEP. http://www.cbd.int/
convention/articles/default.shtml?a=cbd-02
(accessed 2013).
Downloaded by [University of Exeter] at 04:44 28 January 2016
18 R. LOVELL ET AL.
Croucher, K., L. Myers, and J. Bretherton.
2007. The links between green space and
health: A critical literature review.Stirling,
UK: Greenspace Scotland.
Cummins, S., M. Stafford, S. Macintyre,
M. Marmot, and A. Ellaway. 2005.
Neighbourhood environment and its
association with self-rated health: Evidence
from Scotland and England. J. Epidemiol.
Commun. Health 59: 207–213.
Curtin, S. 2009. Wildlife tourism: The intan-
gible, psychological benefits of human–
wildlife encounters. Curr. Issues Tourism 12:
451–474.
D’Agnes, L., H. D’Agnes, J. B. Schwartz, M.
L. Amarillo, and J. Castro. 2010. Integrated
management of coastal resources and human
health yields added value: A compara-
tive study in Palawan (Philippines). Environ.
Conserv. 37: 398–409.
Dallimer, M., K. Irvine, A. Skinner, Z. Davies,
J. Rouquette, L. Maltby, P. Warren,
P. Armsworth, and K. Gaston. 2012.
Biodiversity and the feel-good factor:
Understanding associations between self-
reported human well-being and species
richness. BioScience 62: 47–55.
Davies, P., and J. Deaville. 2008. Natural
heritage: A pathway to health. Newtown,
Wales, UK: Institute of Rural Health for
CCGC/CCW.
de Jong, K., M. Albin, E. Skärbäck, P. Grahn,
and J. Björk. 2012. Perceived green qualities
were associated with neighborhood satisfac-
tion, physical activity, and general health:
Results from a cross-sectional study in sub-
urban and rural Scania, southern Sweden.
Health Place 18: 1374–1380.
Dean, J., K. van Dooren, and P. Weinstein. 2011.
Does biodiversity improve mental health in
urban settings? Med. Hypoth. 76: 877–880.
Dearborn, D. C., and S. Kark. 2010. Motiva-
tions for conserving urban biodiversity.
Conserv. Biol. 24: 432–440.
Depledge, M . H., R. J. Stone, and W. J. Bird.
2011. Can natural and virtual environments
be used to promote improved human health
and wellbeing? Environ. Sci. Technol. 45:
4660–4665.
Diaz, S., J. Fargione, F. S. Chapin 3rd, and
D. Tilman. 2006. Biodiversity loss threatens
human well-being. PLoS Biol. 4: e277.
Dixon-Woods, M., S. Bonas, A. Booth, D. R.
Jones, T. Miller, A. J. Sutton, R. L. Shaw, J. A.
Smith, and B. Young. 2006. How can system-
atic reviews incorporate qualitative research?
A critical perspective. Qual. Res. 6: 27–44.
Downs, S. H., and N. Black. 1998. The feasi-
bility of creating a checklist for the assess-
ment of the methodological quality both
of randomised and non-randomised studies
of health care interventions. J. Epidemiol.
Community Health 52: 377–384.
European Environment Agency. 2011. Forests,
health and climate change. Copenhagen,
Denmark.
Fischer, A., andJ. C. Young. 2007.Understanding
mental constructs of biodiversity: Implications
for biodiversity management and conserva-
tion. Biol. Conserv. 136: 271–282.
Fisher, B., and T. Christopher. 2007. Poverty
and biodiversity: Measuring the overlap of
human poverty and the biodiversity hotspots.
Ecol. Econ. 62: 93–101.
Fuller, R. A., K. N. Irvine, P. Devine-
Wright, P. H. Warren, and K. J. Gaston.
2007. Psychological benefits of green space
increase with biodiversity. Biol. Lett.3:
390–394.
Gaston, K. J. 2009. Biodiversity. In Conservation
science and action, ed. W. J. Sutherland,
1–19. Oxford, UK: Blackwell.
Golden,C.D.,L.C.H.Fernald,J.S.Brashares,
B. J. R. Rasolofoniaina, and C. Kremen. 2011.
Benefits of wildlife consumption to child
nutrition in a biodiversity hotspot. Proc. Natl.
Acad. Sci. USA 108: 19653–19656.
Grahn, P., and U. K. Stigsdotter. 2010. The rela-
tion between perceived sensory dimensions
of urban green space and stress restoration.
Landscape Urban Plan. 94: 264–275.
Higgins, J., and S. Green, editors. 2011.
Cochrane handbook for systematic reviews of
interventions, Version 5.1.0. The Cochrane
Collaboration http://handbook.cochrane.
org/.
Huber, M., J. A. Knottnerus, L. Green, H. v. d.
Horst, A. R. Jadad, D. Kromhout, B. Leonard,
Downloaded by [University of Exeter] at 04:44 28 January 2016
BIODIVERSITY AND THE PROMOTION OF GOOD HEALTH 19
K. Lorig, M. I. Loureiro, J. W. M. van der
Meer, P. Schnabel, R. Smith, C. van Weel,
and H. Smid. 2011. How should we define
health? Br. Med. J. 343: d4163.
Huby,M.,S.Cinderby,A.M.Crowe,S.
Gillings, C. J. McClean, D. Moran, A. Owen,
and P. C. L. White. 2006. The association
of natural, social and economic factors with
bird species richness in rural England. J.
Agric. Econ. 57: 295–312.
Huynen, M., P. Martens, and R. S. De Groot.
2004. Linkages between biodiversity loss and
human health: A global indicator analysis.
Int. J. Environ. Health Res. 14: 13–30.
Jorgensen, A., E. Wilson, and A. van den
Berg. 2010. Evaluating stress relief in urban
green and open spaces: Does perceived
naturalness make a difference? Paper pre-
sented at ‘Trees and Forests in British
Society’ Conference, April 13–15, Heriott
Watt University, Edinburgh, UK.
Kaplan, S. 1995. The restorative benefits of
nature: Toward an integrative framework. J.
Environ Psychol. 15: 169–182.
Kareiva, P., and M. Marvier. 2007. Conversation
for the people—Pitting nature and
biodiversity against people makes little
sense. Many conservationists now argue that
human health and well-being should be
central to conservation efforts. Sci. Am. 297:
50–57.
Keesing, F., L. K. Belden, P. Daszak, A. Dobson,
C. D. Harvell, R. D. Holt, P. Hudson, A.
Jolles, K. E. Jones, C. E. Mitchell, S. S. Myers,
T. Bogich, and R. S. Ostfeld. 2010. Impacts
of biodiversity on the emergence and trans-
mission of infectious diseases. Nature 468:
647–652.
Kellert, S., and E. O. Wilson 1995. The bio-
philia hypothesis. Washington, DC: Island
Press.
Keniger,L.E.,K.Gaston,K.N.Irvine,andR.A.
Fuller. 2013. What are the benefits of inter-
acting with nature? Int. J. Environ. Res. Public
Health 10: 913–935
Lachowycz, K., and A. P. Jones. 2011. Green
space and obesity: A systematic review of the
evidence. Obesity Rev. 12: e183–e189.
Lee, A. C. K., and R. Maheswaran. 2010. The
health benefits of urban green spaces: A
review of the evidence. J. Public Health 33:
212–222.
Lee, J., B. J. Park, Y. Tsunetsugu, T. Ohira, T.
Kagawa, and Y. Miyazaki. 2011. Effect of
forest bathing on physiological and psycho-
logical responses in young Japanese male
subjects. Public Health 125: 93–100.
Lemieux, C. J., P. F. Eagles, D. S. Slocombe,
S. T. Doherty, S. J. Elliott, and S. E. Mock.
2012. Human health and wellbeing motiva-
tions and benefits associated with protected
area experiences: An opportunity for trans-
forming policy and management in Canada.
Parks 18: 71–86.
Lorenc, T., M. Pearson, F. Jamal, C. Cooper,
and R. Garside. 2012. The role of systematic
reviews of qualitative evidence in evaluat-
ing interventions: A case study. Res. Synthesis
Methods 3: 1–10.
Luck, G. W., P. Davidson, D. Boxall, and L.
Smallbone. 2011. Relations between urban
bird and plant communities and human well-
being and connection to nature. Conserv.
Biol. 25: 816–826.
Maas, J., R. A. Verheij, S. de Vries, P.
Spreeuwenberg, F. G. Schellevis, and P. P.
Groenewegen. 2009. Morbidity is related
to a green living environment. J. Epidemiol.
Commun. Health 63: 967–973.
Mace, G. M., K. Norris, and A. H. Fitter. 2012.
Biodiversity and ecosystem services: A mul-
tilayered relationship. Trends Ecol. Evol. 27:
19–26.
Millennium Ecosystem Assessment. 2005.
Ecosystems and human well-being: Synthesis.
Washington DC.
Mitchell, R., and F. Popham. 2007. Green
space, urbanity and health: Relationships in
England. J. Epidemiol. Commun. Health 61:
681–683.
Mitchell, R., and F. Popham. 2008. Effect of
exposure to natural environment on health
inequalities: An observational population
study. Lancet 372: 1655–1660.
Mlambo, M. 2012. The urgent need for human
well-being elements in biodiversity research.
Biodivers. Conserv. 21: 1149–1151.
Norris, K. 2011. Biodiversity in the context of
ecosystem services; UK national ecosystem
assessment. Cambridge, UK: UNEP-WCMC.
Downloaded by [University of Exeter] at 04:44 28 January 2016
20 R. LOVELL ET AL.
Ostfeld, R. S. 2009. Biodiversity loss and the
rise of zoonotic pathogens. Clin. Microbiol.
Infect. 15: 40–43.
Pereira, E., C. Queiroz, H. M. Pereira, and
L. Vicente. 2005. Ecosystem services and
human well-being: A participatory study in a
mountain community in Portugal. Ecol. Soc.
10: 41–64.
Popay, J., H. Roberts, A. Sowden, M. Petticrew,
L. Arai, M. Rodgers, N. Britten, K. Roen, and
S. Duffy. 2006. Guidance on the conduct
of narrative synthesis in systematic reviews.
Version 1. Lancaster, UK: ESRC Methods
Programme.
Poudyal,N.C.,D.G.Hodges,J.M.Bowker,
and H. K. Cordell. 2009. Evaluating nat-
ural resource amenities in a human life
expectancy production function. For. Policy
Econ. 11: 253–259.
Pullin, A., and G. Stewart. 2006. Guidelines for
systematic review in conservation and envi-
ronmental management. Conserv. Biol. 20:
1647–1656.
Richardson, E. A., and R. Mitchell. 2010.
Gender differences in relationships between
urban green space and health in the United
Kingdom. Social Sci. Med. 71: 568–575.
Sala, O. E., L. A. Meyerson, and C. Parmesan
2009. Biodiversity change and human health:
From ecosystem services t o spread of disease.
Washington, DC: Island Press.
Sieswerda, L. E., C. L. Soskolne, S. C. Newman,
D. Schopflocher, and K. E. Smoyer. 2001.
Toward measuring the impact of ecological
disintegrity on human health. Epidemiology
12: 28–32.
Speldewinde, P. C., A. Cook, P. Davies,
and P. Weinstein. 2009. A relationship
between environmental degradation and
mental health in rural Western Australia.
Health Place 15: 880–887.
Thompson Coon, J., K. Boddy, K. Stein, R.
Whear, J. Barton, and M. H. Depledge.
2011. Does participating in physical activ-
ity in outdoor natural environments have
a greater effect on physical and mental
wellbeing than physical activity indoors? A
systematic review. Environ. Sci. Technol. 45:
1761–1772
Tilt, J., T. Unfried, and B. Roca. 2007. Using
objective and subjective measures of neigh-
borhood greenness and accessible destina-
tions for understanding walking trips and
BMI in Seattle, Washington. Am. J. Health
Promotion 21: 371–379.
Tzoulas, K., and K. Greening. 2011. Urban
ecology and human health. In Urban ecol-
ogy, ed. J. Niemela, 263–271. Oxford, UK:
Oxford University Press.
UK National Ecosystem Assessment. 2011. The
UK National Ecosystem Assessment: Synthesis
of the key findings. Cambridge, UK: UNEP-
WCMC.
Ulrich, R. S., R. F. Simons, B. D. Losito, E.
Fiorito, M. A. Miles, and M. Zelson. 1991.
Stress recovery during exposure to natural
and urban environments. J. Environ. Psychol.
11: 201–230.
U.S. Environmental Protection Agency.
n.d. What is open space/green space?
Washington, DC: U.S. EPA. http://www.epa.
gov/region1/eco/uep/openspace.html
van den Berg, A. E., and S. L. Koole. 2006. New
wilderness in the Netherlands: An investiga-
tion of visual preferences for nature develop-
ment landscapes. Landscape Urban Plan. 78:
362–372.
vanDillen,S.M.E.,S.deVries,P.P.
Groenewegen, and P. Spreeuwenberg. 2012.
Green space in urban neighbourhoods and
residents’ health: Adding quality to quantity.
J. Epidemiol. Commun. Health 66: e8.
Velarde,M.D.,G.Fry,andM.Tveit.
2007. Health effects of viewing landscapes—
Landscape types in environmental psychol-
ogy. Urban For. Urban Green. 6: 199–212.
Wallace, A., K. Croucher, D. Quilagars, and
S. Baldwin. 2004. Meeting the challenge:
Developing systematic reviewing in social
policy. Policy Polit. 32: 455–470.
Wheeler, B. W., M. White, W. Stahl-Timmins,
and M. H. Depledge. 2012. Does living
by the coast improve health and wellbeing?
Health Place 18: 1198–1201.
World Health Organization. 1986. The
Ottawa charter for health promotion
.
First International Conference on Health
Promotion, Ottawa, Canada.
Downloaded by [University of Exeter] at 04:44 28 January 2016
    • "As cities become denser, urban greenspaces might become smaller or more segregated. However, recent reviews illustrate that a broad range of urban greenspaces, or 'urban nature' all in all, enhances the liveability of cities by underpinning a range of ecosystem services and benefits to physical health, psychological wellbeing and social cohesion (Elmqvist et al., 2013; Haase et al., 2014; Jorgensen and Gobster, 2010; Kabisch et al., 2015; Keniger et al., 2013; Lovell et al., 2014; Shanahan et al., 2015). Smaller or more segregated greenspaces would also reduce the access of urban people to related ecosystem services and at the same time would impair the contribution of these spaces to biodiversity conservation (Beninde et al., 2015; Ives et al., 2016; Kowarik, 2011; McKinney, 2008; Shwartz et al., 2014a). "
    [Show abstract] [Hide abstract] ABSTRACT: Many researchers and policymakers from various disciplines highlight the role of urban biodiversity in delivering ecosystem services to enhance human wellbeing in a rapidly urbanising world. This suggests powerful synergies between approaches that are often disciplinarily separated, aiming either at human wellbeing or biodiversity conservation. Strategies towards liveable and biodiverse cities would gain support from insights into the people-biodiversity interface in cities. Yet, the question of which scale of biodiversity (from ecosystems to genes) benefits urban people in general and different socio-cultural groups in particular, remains largely open. To assess the current scientific knowledge as well as potential for further research, we systematically reviewed literature on people’s perception and valuation of urban biodiversity (200 studies). We also quantified the outcomes of studies in terms of the effects of biodiversity on valuation for studies that addressed biodiversity valuation below the ecosystem scale. We found that the current literature is critically biased in four ways. (1) Most studies cover temperate climates, while regions with the most pronounced urban growth are underrepresented. (2) Studies focus on urban forests and parks while important informal greenspaces are largely neglected. (3) Biodiversity is mostly addressed at the ecosystem scale (habitat or land-use types) while diversity at the species community or gene scale—key issues in biodiversity conservation—is covered to a much lesser extent. Most studies below the ecosystem scale show positive biodiversity effects, but universal patterns are not apparent due to the scarcity and low comparability of research. (4) Almost no studies consider the cultural diversity of urban residents by systematically targeting people from different socio-economic and cultural backgrounds or specific age groups. Our review reveals critical knowledge gaps about the people-biodiversity interface in cities, both in approaching cultural and biological diversity (‘biocultural diversity’). This shows unexploited opportunities and future directions in linking usually separated strategies on enhancing human wellbeing and biodiversity conservation in sustainable cities.
    Full-text · Article · Jul 2016
    • "Indeed, this is understandable, because many species cannot be detected without specialist training (e.g., because they are difficult to identify) or without a great deal of effort (e.g., because of their elusive behavior). When unpicking the people–biodiversity paradox, researchers should consider using a suite of more resolved biodiversity metrics (e.g., abundance, evenness, and functional diversity) to determine the ecological quality of environmental green spaces (Lovell et al. 2014). Explicit consideration of the complexity associated with human well-being and biodiversity It is possible that the emerging people–biodiversity paradox is a result of the multidimensionality of both biodiversity and human well-being, making it difficult to account for and measure the complex social and ecological characteristics that may influence the outcome of interactions (Hartig et al. 2014). "
    [Show abstract] [Hide abstract] ABSTRACT: Global phenomena, including urbanization, agricultural intensification, and biotic homogenization, have led to extensive ecosystem degradation, species extinctions, and, consequently, a reduction in biodiversity. However, although it is now widely asserted in the research, policy, and practice arenas that interacting with nature is fundamental to human health and well-being, there is a paucity of nuanced evidence characterizing how the living components of nature, biodiversity, play a role in this accepted truth. Understanding these human–biodiversity relationships is essential if the conservation agenda is to be aligned successfully with that of public health by policymakers and practitioners. Here, we show that an apparent “people–biodiversity paradox” is emerging from the literature, comprising a mismatch between (a) people’s biodiversity preferences and how these inclinations relate to personal subjective well-being and (b) the limited ability of individuals to accurately perceive the biodiversity surrounding them. In addition, we present a conceptual framework for understanding the complexity underpinning human–biodiversity interactions.
    Full-text · Article · Apr 2016 · BioScience
    • "Indeed, this is understandable, because many species cannot be detected without specialist training (e.g., because they are difficult to identify) or without a great deal of effort (e.g., because of their elusive behavior). When unpicking the people–biodiversity paradox, researchers should consider using a suite of more resolved biodiversity metrics (e.g., abundance, evenness, and functional diversity) to determine the ecological quality of environmental green spaces (Lovell et al. 2014). Explicit consideration of the complexity associated with human well-being and biodiversity It is possible that the emerging people–biodiversity paradox is a result of the multidimensionality of both biodiversity and human well-being, making it difficult to account for and measure the complex social and ecological characteristics that may influence the outcome of interactions (Hartig et al. 2014). "
    [Show abstract] [Hide abstract] ABSTRACT: Global phenomena, including urbanization, agricultural intensification, and biotic homogenization, have led to extensive ecosystem degradation, species extinctions, and, consequently, a reduction in biodiversity. However, although it is now widely asserted in the research, policy, and practice arenas that interacting with nature is fundamental to human health and well-being, there is a paucity of nuanced evidence characterizing how the living components of nature, biodiversity, play a role in this accepted truth. Understanding these human–biodiversity relationships is essential if the conservation agenda is to be aligned successfully with that of public health by policymakers and practitioners. Here, we show that an apparent “people–biodiversity paradox” is emerging from the literature, comprising a mismatch between (a) people's biodiversity preferences and how these inclinations relate to personal subjective well-being and (b) the limited ability of individuals to accurately perceive the biodiversity surrounding them. In addition, we present a conceptual framework for understanding the complexity underpinning human–biodiversity interactions.
    Full-text · Article · Apr 2016
Show more