ArticlePDF Available

Domestic gardens and self-reported health: A national population study

Authors:

Abstract and Figures

Background: There is a growing recognition of the health benefits of the natural environment. Whilst domestic gardens account for a significant proportion of greenspace in urban areas, few studies, and no population level studies, have investigated their potential health benefits. With gardens offering immediate interaction with nature on our doorsteps, we hypothesise that garden size will affect general health-with smaller domestic gardens associated with poorer health. Methods: A small area ecological design was undertaken using two separate analyses based on data from the 2001 and 2011 UK census. The urban population of England was classified into 'quintiles' based on deprivation (Index of Multiple Deprivation) and average garden size (Generalised Land Use Database). Self-reported general health was obtained from the UK population census. We controlled for greenspace exposure, population density, air pollution, house prices, smoking, and geographic location. Models were stratified to explore the associations. Results: Smaller domestic gardens were associated with a higher prevalence of self-reported poor health. The adjusted prevalence ratio of poor self-reported general health for the quintile with smallest average garden size was 1.13 (95% CI 1.12-1.14) relative to the quintile with the largest gardens. Additionally, the analysis suggested that income-related inequalities in health were greater in areas with smaller gardens. The adjusted prevalence ratio for poor self-reported general health for the most income deprived quintile compared against the least deprived was 1.72 (95% CI 1.64-1.79) in the areas with the smallest gardens, compared to 1.31 (95% CI 1.21-1.42) in areas with the largest gardens. Conclusions: Residents of areas with small domestic gardens have the highest levels of poor health/health inequality related to income deprivation. Although causality needs to be confirmed, the implications for new housing are that adequate garden sizes may be an important means of reducing socioeconomic health inequalities. These findings suggest that the trend for continued urban densification and new housing with minimal gardens could have adverse impacts on health.
This content is subject to copyright. Terms and conditions apply.
Brindleyetal. Int J Health Geogr (2018) 17:31
https://doi.org/10.1186/s12942-018-0148-6
RESEARCH
Domestic gardens andself-reported
health: anational population study
Paul Brindley1* , Anna Jorgensen1 and Ravi Maheswaran2
Abstract
Background: There is a growing recognition of the health benefits of the natural environment. Whilst domestic
gardens account for a significant proportion of greenspace in urban areas, few studies, and no population level stud-
ies, have investigated their potential health benefits. With gardens offering immediate interaction with nature on our
doorsteps, we hypothesise that garden size will affect general health—with smaller domestic gardens associated with
poorer health.
Methods: A small area ecological design was undertaken using two separate analyses based on data from the 2001
and 2011 UK census. The urban population of England was classified into quintiles based on deprivation (Index of
Multiple Deprivation) and average garden size (Generalised Land Use Database). Self-reported general health was
obtained from the UK population census. We controlled for greenspace exposure, population density, air pollution,
house prices, smoking, and geographic location. Models were stratified to explore the associations.
Results: Smaller domestic gardens were associated with a higher prevalence of self-reported poor health. The
adjusted prevalence ratio of poor self-reported general health for the quintile with smallest average garden size was
1.13 (95% CI 1.12–1.14) relative to the quintile with the largest gardens. Additionally, the analysis suggested that
income-related inequalities in health were greater in areas with smaller gardens. The adjusted prevalence ratio for
poor self-reported general health for the most income deprived quintile compared against the least deprived was
1.72 (95% CI 1.64–1.79) in the areas with the smallest gardens, compared to 1.31 (95% CI 1.21–1.42) in areas with the
largest gardens.
Conclusions: Residents of areas with small domestic gardens have the highest levels of poor health/health inequal-
ity related to income deprivation. Although causality needs to be confirmed, the implications for new housing are
that adequate garden sizes may be an important means of reducing socioeconomic health inequalities. These find-
ings suggest that the trend for continued urban densification and new housing with minimal gardens could have
adverse impacts on health.
Keywords: Domestic gardens, Greenspace, General health, UK census, Health inequalities
© The Author(s) 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License
(http://creat iveco mmons .org/licen ses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium,
provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creat iveco mmons .org/
publi cdoma in/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Background
There is a growing evidence base demonstrating health
and wellbeing benefits from exposure to natural envi-
ronments (often referred to generically as ‘greens-
pace’). In contrast and despite their prevalence, the
role of domestic gardens remains unclear, with rela-
tively few studies, and no population level studies,
exploring their contribution for health. This research
seeks to address this disparity.
Domestic gardens contribute a large proportion of
the total urban area (for example, 23% in Sheffield,
UK [1] and 36% in Dunedin, New Zealand [2]). Cou-
pled with this is the trend over time which has seen
increases in the development of garden space into
domestic and other uses (e.g. house extensions and
new dwellings). In England over the four-year period
since 2013, over 4600 hectares of garden were con-
verted to other uses [3]. Despite their widespread
Open Access
International Journal of
Health Geographics
*Correspondence: p.brindley@sheffield.ac.uk
1 Department of Landscape, University of Sheffield, The Arts Tower,
Western Bank, Sheffield S10 2TN, UK
Full list of author information is available at the end of the article
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 2 of 11
Brindleyetal. Int J Health Geogr (2018) 17:31
prevalence, domestic gardens are, however, surpris-
ingly under-researched [4]. This is most likely due to
their heterogeneity and lack of available secondary
data for these frequently small and private spaces.
Many studies of health and greenspace do not include
domestic gardens. Frequently, private gardens are
either aggregated with all other greenspace measures
[5, 6]; combined within an urban category [7, 8]; or
excluded from analysis entirely [912].
The reported health benefits of greenspace more
generally are diverse—including reducing obesity; pro-
moting mental health (for example by reducing the risk
of stress, tendency to psychiatric morbidity, psycho-
logical distress, depressive symptoms, clinical anxiety,
depression and mood disorders); affecting birth out-
comes; educational performance and academic attain-
ment; influencing physiological health (for example
cancer, diabetes, cardiovascular outcomes); improv-
ing general health; and ultimately affecting mortality
[8, 9, 1315]. Furthermore, it has been suggested that
health inequalities are worse in areas with less greens-
pace [9]. Proposed possible salutogenic mechanisms
include: physical activity; social contact; psychological
pathways (stress, cognitive, affective); reduced air pol-
lution; and immunological function/regulation [8].
The potential health effects arising from domes-
tic gardens may be the same as those outlined above.
However, they may also have a distinctive role. Gar-
dens, due to their close proximity to the home, provide
the opportunity for people to have an immediate and
sustained contact with nature [1]. Residents have an
autonomy over the garden and a level of privacy which
they cannot possess in public greenspaces [16]. There
is also a symbiosis between the garden as a physi-
cal space and the activity of gardening. Furthermore,
evidence suggests that spending time in the garden is
associated with increased perceptions of social cohe-
sion between neighbours [17]. Importantly, people
who lack a private garden do not compensate with
more frequent visits to public greenspaces [18].
Health benets ofdomestic gardens
e evidence for the health benefits of domestic gardens
remains mixed and inconclusive. No statistical difference
was found by two studies investigating the relationship
between greenspace and mental health when analysis
was repeated including and excluding domestic gardens
from their total greenspace measures [5, 6]. In a study
of the association between greenspace and perceived
general health, some analyses demonstrated a positive
health effect associated with having a garden, but in oth-
ers the effects were not significant [19]. A recent study
of the North West of England found that in urban areas
the proportion of land classified as domestic gardens in
Lower-layer Super Output Areas (LSOA: a geographic
unit commonly used for reporting small area statistics
in England containing an average population of approxi-
mately 1500) was more closely associated with lower
levels of health deprivation (as measured by the English
index of multiple deprivation) than the proportion of
land classified as greenspace [20].
Whilst the effect of domestic gardens upon mood or
anxiety remains uncertain [21, 22], there is support for
gardens reducing stress [21, 2327]. It seems likely, how-
ever, that contact with nature in domestic gardens leads
to both hedonic (positive emotional states) and eudai-
monic (meaning of life) wellbeing benefits associated
with a sense of nature connectedness [28]. ere is also
strong evidence concerning the health benefits of garden-
ing, as an activity. A recent review found support for gar-
dening improving physical and mental health, and social
wellbeing [29].
Any benefits may not be universal, and the type of
garden is likely to be critical [30]. e size of the garden
and diversity of features (e.g. a lawn, water, and so forth)
were associated with increases in perceived restorative-
ness (recovery in ability to concentrate) [31]. People with
larger gardens were more likely to have increased tree
cover and spend more time in the garden [32], which
might contribute to enhanced health benefits.
Potential hypothesised pathways between average gar-
den size and poor general health could be categorised as:
Gardening [29]: areas with larger average gardens
might contain populations that are more likely to
have increased levels of gardening;
Other individual/household level exposure: individu-
als with access to larger gardens might derive positive
health benefits related to the size of the garden, for
example: increased time spent within larger gardens
[32]. Other mechanisms include enhanced potential
to undertake physical exercise [33] within larger gar-
dens; physiological benefits from views [34] within
their own garden—possibly related to larger gardens
having a greater diversity of garden features [31] or
increased tree coverage [32]; an enhanced feeling of
‘being away’—a key characteristic of psychologically
restorative environments [35]; physiological benefits
from increased tranquillity (and reduced noise levels)
[36] or enhanced biodiversity [37, 38] associated with
larger gardens.
Population level impact: benefits may accrue
from living in an area of larger gardens even if the
individual(s) themselves do not have access to a large
garden, for example through reduced air pollution
[34], more regulated temperatures [39], physiological
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 3 of 11
Brindleyetal. Int J Health Geogr (2018) 17:31
benefits from views [34] of other people’s gardens, or
enhanced biodiversity in the area in general [37, 38].
Our hypothesis is that domestic gardens may have a
beneficial effect on general health and specifically that
areas with smaller gardens may exhibit higher levels of
poor self-reported general health (even after accounting
for differences in socio-economic characteristics, such as
deprivation).
Methods
Study area
e geographical area for the study was England. We
used LSOAs as the spatial units for analysis. Rural areas
are likely to have close proximity to a wide range of
natural environments. However, we wanted to focus on
households whose domestic garden potentially offers the
most immediate contact with nature. According to the
2011 Census of Population 82.4% of England’s population
live in urban areas. For these reasons only those LSOAs
defined as urban (by the UK Office for National Statis-
tics’ 2001 Rural–Urban Classification) were used in our
analysis.
Our data included Census of Population for two time
periods: 2001 and 2011. erefore, we included all 26,455
urban LSOAs in 2001 but could only include a subset of
urban LSOAs in 2011. is was because LSOA bounda-
ries changed during the period. Some LSOAs were split
while others were merged to take account of population
changes and new developments. We used 25,766 urban
LSOAs in 2011 (95% of urban LSOAs in 2011) which
remained unchanged in order to maintain comparability
between analyses based on the two censuses.
Study design
is study implemented a population (ecological) study
design using routinely accessible secondary datasets. We
examined the association between average domestic gar-
den size and self-reported general health in urban census
areas in England. Furthermore, we explored the health-
inequalities associated with varying garden size.
Data
Self-reported general health was obtained from the UK
census in both 2001 and 2011 at the LSOA scale. e use
of the two time periods was to explore if patterns were
consistent, thus adding a degree of robustness to find-
ings. A number of studies have shown that self-reported
general health are a reliable measure of objectively meas-
ured health outcomes [4042]. In 2001 people were
asked to assess whether their health was good, fairly good
or not good. In 2011 the question was asked on a five-
point scale: very good, good, fair, bad or very bad. Two
separate independent measures of poor health were con-
structed using (1) the ‘not good’ health category from the
2001 census and (2) the aggregation of ‘bad’ and ‘very
bad’ health categories from the 2011 census.
Indirect standardisation was undertaken for broad age
(0–15; 16–34; 35–49; 50–59; 60–64; 65–84; and over 84)
and sex categories. ese data formed the dependent var-
iables for our two models (Model One: 2001 health data;
Model Two: 2011 health data). Self-reported general
health from the census has been used within a number of
similar population (ecological) studies [8, 12].
Domestic gardens and greenspace measurements
were obtained from the Generalised Land Use Database
(GLUD). GLUD is a national classification developed
by the Office for National Statistics which allocates all
identifiable land features on Ordnance Survey Mas-
terMap into simplified categories. MasterMap for the
whole country is an extremely large digital database and
the simplified classification has transformed it for use in
country wide statistical analyses.
GLUD provides the total area for nine land use cat-
egories in every English LSOA. e land categories are:
domestic buildings, non-domestic buildings, roads,
paths, rail, gardens (domestic), greenspace, water, other
land uses. We used both the total greenspace and domes-
tic garden measures from GLUD. e garden extent was
converted into an average garden size measurement by
dividing the total garden size in the LSOA by the num-
ber of households recorded by the census. GLUD is only
available for the years 2000 and 2005. We used the 2000
GLUD to compare against the 2001 health data and the
2005 GLUD for the 2011 health data. Due to GLUD 2005
relating to 2001 LSOA boundary definitions only those
LSOAs whose boundaries did not change in the period
2001–2011 were used within analysis for Model Two.
A number of similar studies have used GLUD as their
source of land cover data [8, 9, 12, 20].
We adjusted for area characteristics that were plausibly
associated with general health. e income, employment
and education domains of the English Index of Multiple
Deprivation (EIMD) were used, for 2004 (the first EIMD
available for LSOAs, for comparison with the 2001 health
data) and 2010 (the closest time period to the 2011 health
data). All three EIMD domains have commonly been col-
lectively used to adjust for socio-economic deprivation
[8, 9, 12].
Due to potential associations with general health,
we also controlled for the levels of pollution, smoking,
population density, house price and geographic region.
Pollution data consisted of 1 km gridded estimates of
Particulate Matter of ten microns in diameter or smaller
(PM10) modelled by the UK’s Department for Environ-
ment, Food and Rural Affairs in the years 2004 and 2010
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 4 of 11
Brindleyetal. Int J Health Geogr (2018) 17:31
and assigned to LSOAs by the population weighted aver-
age for each LSOA (where the population represented
the census headcounts at unit postcode level). A proxy
for smoking was obtained using the number of lung can-
cer hospital admissions for the period 1st April 2002 to
31st March 2014 [43]. e ratio of observed to expected
counts was calculated for each LSOA, with expected
counts adjusted for age and sex. e same smoking
proxy data were used in both models. Population den-
sity was calculated for each LSOA in 2001 and 2011, as
the resident population from the census divided by the
LSOA area. e average house price at the LSOA level
was generated from HM Land Registry Price Paid Data
for the years 2004 and 2010. A standard z-score method
was implemented to adjust for differences in house type
(detached, semi-detached, terraced, flat and other) and
geographic district. e nine Regions of England were
included to account for any geographic differences at this
scale. ese confounders have been commonly included
in numerous similar greenspace ecological studies [9, 10,
12, 44].
All independent data were classified into quintiles. e
average garden size within the LSOAs (hectares) resulted
in the following quintiles: 0.00–0.009; 0.010–0.017;
0.018–0.021; 0.022–0.029; and 0.030–0.233.
Analysis
Negative binomial regression was used to test whether
there was an independent association between aver-
age domestic garden size and self-reported poor health,
after controlling for the confounding factors previously
described. e dependent variable was the total num-
ber of people reporting poor health, whilst the offset was
the number expected given the age and sex composition
(indirect standardisation). Poisson models were rejected
due to over dispersion. Analysis was undertaken within
SAS version 9.4.
In addition to the main analysis described above, we
also explored whether the association between poor self-
reported general health and deprivation varied by aver-
age garden size (utilising the approach of previous similar
work [9]). is was achieved using a sequence of models
stratified by the average garden size quintile (for exam-
ple the first model explored the relationship between
deprivation quintile and general health in the quintile
with the smallest average garden sizes, the second model
explored the same relationship for people in the second
smallest average garden size quintile, and so forth). Mod-
els were adjusted for the same confounders as previously
described.
Sensitivity analysis
e following sensitivity analysis was undertaken to
ensure robustness of our findings. Separate exploratory
analysis was undertaken for each age band within Model
One (0–15; 16–34; 35–49; 50–59; 60–64; 65–84; and 85
and over). To confirm that associations between average
garden size and socio-economic status were accounted
for (in addition to the house price and deprivation varia-
bles within the main models), average income at the Mid-
dle-layer Super Output Area (MSOA) level (2004/2005)
and the most frequent ACORN classification (a post-
code-level consumer classification that segments the UK
population based on a plethora of household and individ-
ual level data) within the LSOA were also analysed.
Testing also included replacing the hospital admissions
for lung cancer variable used in the main models with
modelled estimated smoking prevalence at the MSOA
scale (2003–2005 data for Model One and 2006–2008 for
Model Two). is was undertaken to assess the robust-
ness of the hospital admissions data as a proxy for smok-
ing. Finally, the proportion of LSOA area consisting
of garden (from GLUD) was used as a variable instead
of the average garden size in case estimates were influ-
enced by converting our garden metric to an average
measurement.
Results
Table1 presents means (SD) for variables used in Model
One. e 26,455 LSOAs in English urban areas included
in the study covered 81% of the total population of
England.
e independent relationship between average domes-
tic garden size and self-reported poor general health,
after controlling for confounding factors and deprivation,
is shown in Fig.1. It clearly shows a higher adjusted prev-
alence ratio for populations residing in areas of smaller
average garden size. e adjusted prevalence ratio for
poor health in Model One was 1.13 (95% CI 1.12–1.14)
for the quintile with the smallest average garden sizes
compared against the quintile with the largest average
gardens, when accounting for deprivation and confound-
ers. A similar ratio was evident for the later time period
(Model Two) where the adjusted prevalence ratio was
1.12 (95% CI 1.11–1.13) for the same quintiles.
Table2 contains the prevalence ratios for all variables
for both models. Whilst average garden size appears to
be playing an important role, the effects of total greens-
pace upon poor health (when accounting for confound-
ers) are not evident. A significant positive relationship
between greenspace and poor health only transpired if
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 5 of 11
Brindleyetal. Int J Health Geogr (2018) 17:31
the average garden variable was removed—and the effect
was modest (adjusted prevalence ratio of 1.03, 95% CI
1.02–1.03—data not shown). is finding is considered
further within the discussion. ere was no significant
interaction between average garden size and total greens-
pace (p = 0.251).
Significant interaction was found between average
garden size and all three-deprivation terms (p values
< 0.001). Exploring health inequalities, Fig. 2a high-
lights the interaction between income-deprivation and
average garden size for Model One. e adjusted preva-
lence ratio for self-reported poor health for the most
income-deprived quintile versus the least deprived was
1.72 (95% CI 1.64–1.79) in the quintile with the smallest
average garden size, whereas it was 1.31 (95% CI 1.21–
1.42) in the quintile with the largest average gardens. A
similar pattern was evident when testing interactions
using data from Model Two (data not shown). It should,
however, be noted that similar interactions are not pre-
sent for the other deprivation domains (employment—
Fig.2b, or education—Fig.2c).
Sensitivity analysis results
Separate exploratory analysis for each age and sex band
(Additional file1: TableS1) demonstrated that the asso-
ciation between garden size and poor self-reported gen-
eral health was generally consistent through age and sex.
e effect of garden size was not statistically significant
Table 1 Characteristics ofEnglish urban lower-layer super output areas used withinmodel one
Variable Mean SD
Average domestic garden size within the LSOA (hectares), 2000/2001 0.02 0.01
% of LSOA covered by domestic gardens [as used within sensitivity analysis] from GLUD 2000 29.06 15.93
% of LSOA covered by total greenspace (excludes gardens) from GLUD 2000 33.77 24.32
IMD Income score for the LSOA, 2004 0.15 0.12
IMD Education score for the LSOA, 2004 0.11 0.08
IMD Employment score for the LSOA, 2004 23.68 19.53
Average house price Z-score for LSOAs, 2004 0.09 0.54
Population density within the LSOA, 2001 (people per hectare) 47.19 38.57
Average pollution from particular matter (of ten microns in diameter or smaller) in the LSOA, 2004 21.79 2.97
Ratio of observed to expected lung cancer hospital admissions (01/04/2002–31/03/2014) 1.07 0.82
The percentage of people reporting ‘poor health’ from the 2001 Census of Population at the LSOA level 8.90 3.42
Fig. 1 Strength of association between general health and average garden size, accounting for confounders (with 95% CI)
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 6 of 11
Brindleyetal. Int J Health Geogr (2018) 17:31
Table 2 Regression results: association betweengeneral health andmodelled output
Variable Quintile Model one Model two
Adjusted
prevalence ratio 95% CI Adjusted
prevalence ratio 95% CI
Total greenspace 1 Least green 0.99 0.977, 0.995 0.99 0.983, 1.005
2 0.98 0.976, 0.993 0.99 0.982, 1.002
3 0.99 0.979, 0.995 1.00 0.987, 1.006
4 0.99 0.978, 0.992 1.00 0.989, 1.007
5 Most green 1 1
Average domestic garden size 1 Smallest gardens 1.13 1.119, 1.138 1.12 1.106, 1.128
2 1.09 1.077, 1.093 1.05 1.042, 1.061
3 1.07 1.058, 1.073 1.05 1.038, 1.055
4 1.05 1.041, 1.054 1.04 1.028, 1.045
5 Largest gardens 1 1
Income deprivation 1 Most deprived 1.44 1.422, 1.461 1.69 1.659, 1.715
2 1.30 1.281, 1.310 1.43 1.413, 1.453
3 1.21 1.197, 1.219 1.29 1.276, 1.305
4 1.11 1.105, 1.121 1.15 1.143, 1.164
5 Least deprived 1 1
Employment deprivation 1 Most deprived 1.45 1.429, 1.465 1.55 1.522, 1.570
2 1.29 1.280, 1.306 1.36 1.341, 1.376
3 1.19 1.180, 1.199 1.24 1.228, 1.256
4 1.11 1.098, 1.114 1.14 1.135, 1.155
5 Least deprived 1 1
Education deprivation 1 Most deprived 1.23 1.215, 1.240 1.31 1.294, 1.327
2 1.17 1.157, 1.177 1.23 1.214, 1.240
3 1.13 1.123, 1.140 1.17 1.161, 1.183
4 1.09 1.082, 1.096 1.11 1.106, 1.124
5 Least deprived 1 1
Population density 1 Highest density 1.01 1.002, 1.024 1.04 1.026, 1.053
2 1.00 0.995, 1.014 1.01 1.000, 1.022
3 1.01 0.998, 1.015 1.01 1.000, 1.020
4 1.01 1.002, 1.016 1.00 0.994, 1.011
5 Lowest density 1 1
Pollution (PM10) 1 Highest pollution 1.08 1.076, 1.093 1.08 1.065, 1.087
2 1.05 1.040, 1.056 1.05 1.044, 1.061
3 1.04 1.036, 1.050 1.05 1.038, 1.054
4 1.04 1.030, 1.043 1.03 1.026, 1.041
5 Lowest pollution 1 1
Smoking proxy: lung cancer hospital
admissions (2002–2014) 1 H ighest ‘smoking’ 1.03 1.018, 1.032 1.04 1.034, 1.051
2 1.02 1.016, 1.029 1.03 1.024, 1.040
3 1.02 1.012, 1.024 1.02 1.016, 1.031
4 1.01 1.007, 1.019 1.02 1.015, 1.030
5 Lowest ‘smoking’ 1 1
Average house prices 1 Lowest prices 1.03 1.027, 1.042 1.06 1.046, 1.064
2 1.02 1.017, 1.030 1.04 1.031, 1.047
3 1.02 1.016, 1.029 1.03 1.022, 1.038
4 1.02 1.009, 1.021 1.02 1.016, 1.031
5 Highest prices 1 1
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 7 of 11
Brindleyetal. Int J Health Geogr (2018) 17:31
for poor general health of females aged 0–15, 16–34, and
85 and over. Effects were strongest for ages 35–49 and
50–59 (regardless of sex).
e stability of the relationship between garden
size and poor health was maintained when additional
socio-economic variables were added (Additional file 1:
Table S2). is sensitivity analysis was undertaken to
ensure that the association was not unduly influenced by
garden size acting as a proxy for other socio-economic
characteristics (such as income). e similarity of out-
put between both the average garden size (Models One
and Two) and the proportion of the LSOA that is gar-
den (sensitivity analysis—Additional file1: TableS2d) is
encouraging and demonstrates robustness.
Discussion
is is the first national population study to explore the
relationship between domestic garden size and health.
Our results support our hypothesis that there is an asso-
ciation between health and average domestic garden size.
Furthermore, it suggests that income-related inequali-
ties in poor self-reported health are greater in areas with
smaller average gardens. Our work should act as a moti-
vation for future studies in this area.
Published work has established strong support for the
health benefits of greenspace. Whilst there are fewer
studies specifically focussing on the role of gardens; our
study supports the notion of health benefits accruing
from gardens. e strongest evidence from existing liter-
ature concerns their psychological effects through restor-
ativeness and stress reduction [21, 2326], although a
recent review of gardening was able to support a link with
physical and mental health, and social wellbeing [29].
Whilst existing evidence has demonstrated the pow-
erful relationship between greenspace and health
inequalities in terms of mortality [9], our study was able
to find similar support for self-reported general health
inequalities relative to average garden size and income
deprivation. e results for employment and educational
deprivation, however, were less clear. is said, the pat-
tern of the relationship (for both employment and educa-
tional deprivation) between the socio-economic category
and each garden size was consistent.
Whilst we acknowledge that some ecological studies
have found stronger health benefits from greenspace
[9], in common with other studies [8] we report a rela-
tively modest effect (when accounting for a wide range
of confounders). Our findings corroborate the previ-
ously cited recent study in which domestic gardens
appear to mitigate poor health more effectively than
greenspace [20]. Whilst both studies utilise natural
environment data from GLUD (as used extensively in
the literature) [8, 9, 12, 20], it is important to note that
such data makes no distinction between different types
of greenspace and no allowance for varying greenspace
quality. is modest effect for greenspace must also
be taken within the context of our study’s aims, which
are centred on the role of gardens and not greenspace
per se. e function of the greenspace variable within
our model was to account for geographic differences in
greenspace coverage rather than to specifically explore
the health effects of greenspace. Our paper demon-
strates, however, that the role of domestic gardens is
likely to be at least as important as greenspace for influ-
encing general health.
Building on existing studies, for example demonstrat-
ing psychological benefits associated with increasing
species richness (biodiversity) of urban greenspaces
[37], further work is required to investigate the possible
effects of quality of garden space on health.
Table 2 (continued)
Variable Quintile Model one Model two
Adjusted
prevalence ratio 95% CI Adjusted
prevalence ratio 95% CI
Region of England East Midlands 0.95 0.938, 0.955 0.97 0.956, 0.977
East of England 0.87 0.857, 0.873 0.88 0.875, 0.893
London 0.90 0.887, 0.904 0.96 0.945, 0.966
North East 1.03 1.020, 1.041 1.08 1.065, 1.092
North West 1.04 1.029, 1.044 1.09 1.078, 1.098
South East 0.87 0.859, 0.873 0.90 0.891, 0.908
South West 0.92 0.914, 0.930 0.94 0.934, 0.954
West Midlands 0.96 0.952, 0.967 1.00 0.994, 1.013
Yorkshire and The Humber 1 1
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 8 of 11
Brindleyetal. Int J Health Geogr (2018) 17:31
Our population study draws on the power of large
datasets to investigate the relationship between garden
size and poor health and to assess how this association
varied between areas with differing socio-economic
status. It used robust health data from a reliable source.
e study was hypothesis driven and based upon the
existing literature.
Like any ecological, small-area study of this nature,
there are a number of limitations. Firstly, correlation
does not necessarily imply causation. Whilst we have
found a clear association, our study cannot confirm
whether there is a causal link. Testing causation would
require a range of further work, including cohort stud-
ies. e garden size measure might be associated with
other risk factors that are not controlled for within
our models. Average garden size is likely to be strongly
associated with socio-economic position. Whilst sensi-
tivity analysis has been undertaken to explore this pos-
sibility, and we have adjusted for socio-economic and
other potential confounders, residual or unmeasured
confounding could potentially explain the observed
link. It is argued, however, that stratified studies like
this one, offer the best possible protection against the
effects of residual cofounding in ecological investiga-
tions [9]. Our findings do not highlight which of the
proposed mechanisms through which garden size
might influence health and further work is required to
explore this.
Secondly, the role of the ecology fallacy should be
considered. Given that associations are based on data
aggregated to bounded units (in this instance LSOAs),
one should not presume that the same associations will
hold at the individual level. is is important given that
an individual’s garden size may or may not correspond
with the average garden size in their LSOA (considered
further below).
irdly, whilst our study analyses two separate time
periods (Model One and Two), there is no means of
knowing the extent to which individuals’ garden size
may have changed—affecting their longer-term general
health.
ere are a number of other limitations specific to the
work presented here. ere have been changes within
data throughout the study period. Most notably the ques-
tions concerning general health in the UK Census have
been modified. In 2001 the question related to period
prevalence—asking residents about their health over the
last 12months—whilst in 2010 the measure was one of
point prevalence. e three category question in 2001
became five categories. Whilst the EIMD (2004–2010)
was generally unchanged, certain variables and weight-
ings were altered. Our study, however, is not concerned
with trends and treats each model independently. e
fact that both models produce relatively similar out-
put, despite these changes, is encouraging and supports
robustness within the models.
Whilst our measure of average garden size is both sim-
ple and easily interpretable, it is not without limitation.
Primarily, it pays no regard to the distribution (or vari-
ety) of garden sizes within the area. e difficultly here
is that data (such as GLUD) only provide aggregates (for
example to LSOAs) and do not contain information for
individual plots. erefore, two LSOAs may have the
same average garden size but may contain very different
patterns of garden exposure across their populations.
In part, this was the rationale behind also including an
alternative garden measure (using the proportion of the
LSOA area consisting of garden) within the sensitiv-
ity analysis to check the robustness of our findings (see
Additional file1: TableS2d). e similarity between out-
put for both variants is encouraging. Preference for the
average garden size measure remains because the pro-
portion of LSOA that is garden will potentially be influ-
enced by the denominator—depending on the total size
of the LSOA. Further work is needed to explore alterna-
tive garden measures that might potentially reflect the
distribution of garden sizes.
It is possible that including lung cancer as a confounder
could inadvertently over-adjust effects, as people with
lung cancer may be more likely to self-report their gen-
eral health as poor. Given the relatively small numbers
involved at the LSOA scale and the relatively modest
adjusted prevalence ratios associated with the lung can-
cer proxy (see Table2), however, the potential effects of
over-adjustment are likely to be small.
Whilst the two separate models provide indications
for different time periods—data are not always available
for directly comparable periods. GLUD was only avail-
able for the years 2000 and 2005. Associating the 2005
GLUD data to 2011 health data leaves a considerable but
unavoidable time gap. For this reason, we should be less
confident in the findings of Model Two. Given the simi-
larity between the model output, however, the results
are encouraging. Whilst current work focuses on general
health, further investigations are required that account
Fig. 2 Prevalence ratios for general health in deprivation quintiles (relative to income group 1—least deprived), stratified by average garden size
(with 95% CI)
(See figure on next page.)
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 9 of 11
Brindleyetal. Int J Health Geogr (2018) 17:31
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 10 of 11
Brindleyetal. Int J Health Geogr (2018) 17:31
for the quality of domestic gardens and to explore the
association with mortality.
Conclusions
In conclusion, our findings demonstrate the association
between average domestic garden size and self-reported
general health, which persist even when accounting for a
multitude of socio-economic confounders. We have been
able to show differences in health inequalities between
populations exposed to similar levels of income depriva-
tion but who reside in areas of different average garden
size. e relationship between these health inequalities
and the domains of employment or education depriva-
tion are, however, less transparent and require further
investigation.
Whilst affected by the limitations associated with any
ecological design, the paper contributes to the early stage
evidence base for this topic and clearly demonstrates the
requirement for follow-up research. Given the diversity
within domestic gardens, further work exploring the dif-
ferent components of gardens that may provide health
benefits, alongside the mechanisms by which gardens
and garden size may affect health benefits, are important
areas of future research.
Even though causality needs confirmation, our work
suggests that domestic garden size should be taken into
account when planning new housing, as once built, there
will be little scope for making changes. is is against a
backdrop of continuing urban densification in which
there remains little or no incentive for housing devel-
opers to provide larger domestic gardens. e potential
health effects of domestic gardens need to be seriously
taken on-board by planners and policy makers alike. Gar-
den size might be an important factor to help alleviate
poor general health.
Additional le
Additional le1. Supplementary tables.
Authors’ contributions
PB, AJ and RM declare that they have participated in the design, analysis and
writing of this study. All authors read and approved the final manuscript.
Author details
1 Department of Landscape, University of Sheffield, The Arts Tower, Western
Bank, Sheffield S10 2TN, UK. 2 Public Health GIS Unit, School of Health
and Related Research, University of Sheffield, Regent Court, 30 Regent Street,
Sheffield S1 4DA, UK.
Competing interests
The authors declare that they have no competing interests.
Acknowledgements
We would like to thank the anonymous reviewers for their helpful comments.
Availability of data and materials
Data available in a public (institutional, general or subject specific) reposi-
tory that does not issue datasets with DOIs (non-mandated deposition).
England’s census data (including health data) used to support the findings
of this study are publically available from NOMIS, https ://www.nomis web.
co.uk/ (last accessed 04/07/2018). The land cover data were extracted from
GLUD (2000 and 2005) which can be found from the UK Government, https
://data.gov.uk/datas et/land_use_stati stics _gener alise d_land_use_datab ase
(last accessed 04/07/2018). The deprivation data are available from the UK
Government, https ://www.gov.uk/gover nment /colle ction s/engli sh-indic es-
of-depri vatio n (last accessed 04/07/2018). The house price data are available
from HM Land Registry, https ://www.gov.uk/gover nment /colle ction s/price
-paid-data (last accessed 04/07/2018). The air pollution data are available from
the Department for Environment, Food and Rural Affairs (Defra), https ://uk-air.
defra .gov.uk/data/pcm-data (last accessed 04/07/2018). The average income
data at MSOA level are available from the Office for National Statistics (ONS)
website—https ://data.gov.uk/datas et/7dec3 388-30d6-4b8c-8510-de15c
bb8f7 65/house hold-earni ngs-estim ates-model -based -estim ates-of-incom
e-for-msoas (last accessed 04/07/2018). The smoking data at MSOA level are
available for 2003–2005 from the Healthy Lifestyle Behaviours: Model Based
Estimates [https ://data.gov.uk/datas et/6c3ea 32d-1726-4faf-8c40-13db0
3bde4 c2/healt hy-lifes tyle-behav iours (last accessed 04/07/2018)] and from
the Expected prevalence of smoking: over 16s, developed by the Association
of Public Health Observatories (APHO) for the 2006–2008 data [https ://nasci
s.digit al.nhs.uk/Jsna/ViewB yAlph abet.aspx (last accessed 04/07/2018)]. Geo-
graphic boundaries are available from the Office for National Statistics (ONS)
Geoportal, http://geopo rtal.stati stics .gov.uk/ (last accessed 04/07/2018). The
work contains National Statistics data © Crown copyright and database right
2017. Acorn data: © CACI Limited 1979—2016 (http://doi.org/10.5255/UKDA-
SN-7381-2 (last accessed 04/07/2018]).
Consent for publication
Not applicable.
Ethics committee approval
This research has received ethical approval from the University of Sheffield
(Application Reference No.: 011072).
Funding
This work was supported by the Natural Environment Research Council, ESRC,
BBSRC, AHRC and Defra (NE/N013565/1). The funder of the study had no role
in study design, data collection, data analysis, data interpretation, or writing of
the report. All authors had full access to all the data in the study.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in pub-
lished maps and institutional affiliations.
Received: 12 April 2018 Accepted: 14 July 2018
References
1. Gaston K J, Warren PH, Thompson K, Smith RM. Urban domestic gardens
(IV): the extent of the resource and its associated features. Biodivers
Conserv. 2005;14:3327–49.
2. Mathieu R, Freeman C, Aryal J. Mapping private gardens in urban areas
using object-oriented techniques and very high-resolution satellite
imagery. Landsc Urban Plan. 2007;81:179–92.
3. LUCS. Land Use Change Statistics Live Tables—Table P361 Land use
based change: land changing use by all previous uses. London: Ministry
of Housing, Communities & Local Government; 2018.
4. Holbrook A. The Green We Need: an investigation of the benefits of green
life and green spaces for urban-dwellers’ physical, mental and social
health. Castle Hill: Nursery and Garden Industry Australia; 2008.
5. White MP, Alcock I, Wheeler BW, Depledge MH. Would you be happier liv-
ing in a greener urban area? A fixed-effects analysis of panel data. Psychol
Sci. 2013;24:920–8. https ://doi.org/10.1177/09567 97612 46465 9.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 11 of 11
Brindleyetal. Int J Health Geogr (2018) 17:31
6. Alcock I, White MP, Wheeler BW, Fleming LE, Depledge MH. Longitudinal
effects on mental health of moving to greener and less green urban
areas. Environ Sci Technol. 2014;48:1247–55.
7. Maas J, van Dillen SME, Verheij RA, Groenewegen PP. Social contacts as
a possible mechanism behind the relation between green space and
health. Health Place. 2009;15:586–95.
8. Wheeler BW, Lovell R, Higgins SL, White MP, Alcock I, Osborne NJ, et al.
Beyond greenspace: an ecological study of population general health
and indicators of natural environment type and quality. Int J Health
Geogr. 2015;14:17.
9. Mitchell R, Popham F. Effect of exposure to natural environment
on health inequalities: an observational population study. Lancet.
2008;372:1655–60.
10. Richardson E, Pearce J, Mitchell R, Day P, Kingham S. The association
between green space and cause-specific mortality in urban New
Zealand: an ecological analysis of green space utility. BMC Public Health.
2010;10:240.
11. Nutsford D, Pearson AL, Kingham S. An ecological study investigat-
ing the association between access to urban green space and mental
health. Public Health. 2013;127:1005–11. https ://doi.org/10.1016/j.
puhe.2013.08.016.
12. Mitchell R, Popham F. Greenspace, urbanity and health: relationships in
England. J Epidemiol Community Health. 2007;61:681–3.
13. James P, Banay RF, Hart JE, Laden F. A review of the health benefits of
greenness. Curr Epidemiol Rep. 2015;2:131–42. https ://doi.org/10.1007/
s4047 1-015-0043-7.
14. Lovell R. Natural England access to evidence notes EIN017-021 (internet).
Worcester: Natural England; 2016. http://valui ng-natur e.net/news/natur
al-engla nd-healt h-and-natur al-envir onmen t-evide nce-briefi ngs.
15. Lee ACK, Maheswaran R. The health benefits of urban green spaces: a
review of the evidence. J Public Health. 2011;33:212–22.
16. Cameron RWF, Blanuˇ T, Taylor JE, Salisbury A, Halstead AJ, Henricot B,
et al. The domestic garden—its contribution to urban green infrastruc-
ture. Urban For Urban Green. 2012;11:129–37.
17. Cox DTC, Shanahan DF, Hudson HL, Fuller RA, Anderson K, Hancock S,
et al. Doses of nearby nature simultaneously associated with multiple
health benefits. Int J Environ Res Public Health. 2017;14:172.
18. Grahn P, Stigsdotter UA. Landscape planning and stress. Urban For Urban
Green. 2003;2:1–18.
19. De Vries S, Verheij RA, Groenewegen PP, Spreeuwenberg P. Natural
environments—healthy environments? An exploratory analysis of
the relationship between green space and health. Environ Plan A.
2003;35:1717–31.
20. Dennis M, James P. Evaluating the relative influence on population health
of domestic gardens and green space along a rural–urban gradient.
Landsc Urban Plan. 2017;157:343–51. https ://doi.org/10.1016/j.landu
rbpla n.2016.08.009.
21. Rodiek S. Influence of an outdoor garden on mood and stress in older
persons. J Ther Hortic. 2002;XIII:13–21.
22. Marcus C, Barnes M, Marcus CC. Gardens in healthcare facilities: uses,
therapeutic benefits, and design recommendations. Concord: Center for
Health Design; 1995.
23. Ottosson J, Grahn P. A comparison of leisure time spent in a garden with
leisure time spent indoors: on measures of restoration in residents in
geriatric care. Landsc Res. 2005;30:23–55.
24. Stigsdotter UA, Grahn P. A garden at your doorstep may reduce stress—
private gards as restorative environments in the city. In: Proceedings of
the Open Space: People Space, Scotland; 2004.
25. Stigsdotter UA. A garden at your workplace may reduce stress. In: Dilani
A, editor. Design & health III - Health promotion through environmental
design (Proceeding). Stockholm: International Academy for Design and
Health; 2004. p. 147–57.
26. Nielsen TS, Hansen KB. Do green areas affect health? Results from a Dan-
ish survey on the use of green areas and health indicators. Health Place.
2007;13:839–50.
27. Roe JJ, Ward Thompson C, Aspinall PA, Brewer MJ, Duff EI, Miller D, et al.
Green space and stress: evidence from cortisol measures in deprived
urban communities. Int J Environ Res Public Health. 2013;10:4086–103.
28. Capaldi CA, Elizabeth HP, John KN, Dopko RL. Flourishing in nature: a
review of the benefits of connecting with nature and its application as a
wellbeing intervention. Int J Wellbeing. 2015;5:1–16.
29. Soga M, Gaston KJ, Yamaura Y. Gardening is beneficial for health: a meta-
analysis. Prev Med Rep. 2016;5:92–9.
30. Stigsdotter UA, Grahn P. What makes a garden a healing garden. J Ther
Hortic. 2002;13:60–9.
31. Cervinka R, Schwab M, Schönbauer R, Hämmerle I, Pirgie L, Sudkamp
J. My garden—my mate? Perceived restorativeness of private gardens
and its predictors. Urban For Urban Green. 2016;16:182–7. https ://doi.
org/10.1016/j.ufug.2016.01.013.
32. Lin BB, Gaston KJ, Fuller RA, Wu D, Bush R, Shanahan DF. How green is
your garden?: urban form and socio-demographic factors influence yard
vegetation, visitation, and ecosystem service benefits. Landsc Urban Plan.
2017;157:239–46.
33. Mytton OT, Townsend N, Rutter H, Foster C. Green space and physical
activity: an observational study using Health Survey for England data.
Health Place. 2012;18:1034–41. https ://doi.org/10.1016/j.healt hplac
e.2012.06.003.
34. Cameron RWF. Green space and well-being. In: Cameron RWF,
Hitchmough J, editors. Environmental horticulture: science and manage-
ment of green landscapes. Wallingford: CABI; 2016. p. 73–121.
35. Kaplan S. The restorative benefits of nature: toward an integrative frame-
work. J Enivron Psychol. 1995;15:169–82.
36. Gidlöf-Gunnarsson A, Öhrström E. Noise and well-being in urban residen-
tial environments: the potential role of perceived availability to nearby
green areas. Landsc Urban Plan. 2007;83:115–26.
37. Fuller RA, Irvine KN, Devine-Wright P, Warren PH, Gaston KJ. Psychological
benefits of greenspace increase with biodiversity. Biol Lett. 2007;3:390–4.
38. Marselle M, Irvine KN, Dallimer M. Review of the mental health and
wellbeing benefits of biodiversity. In: Marselle M, Korn H, Stadler J, Irvine
KN, Bonn A, editors. Biodiversity and health in the face of climate change.
Cham: Springer; 2018.
39. Wolch JR, Byrne J, Newell JP. Urban green space, public health, and
environmental justice: the challenge of making cities ‘just green enough’.
Landsc Urban Plan. 2014;125:234–44. https ://doi.org/10.1016/j.landu
rbpla n.2014.01.017.
40. Short ME, Goetzel RZ, Pei X, Tabrizi MJ, Ozminkowski RJ, Gibson TB, et al.
How accurate are self-reports? Analysis of self-reported health care utili-
zation and absence when compared with administrative data. J Occup
Environ Med. 2009;51:786–96.
41. Mavaddat N, Kinmonth AL, Sanderson S, Surtees P, Bingham S, Khaw KT.
What determines self-rated health (SRH)? A cross-sectional study of SF-36
health domains in the EPIC-Norfolk cohort. J Epidemiol Community
Health. 2011;65:800–6.
42. Kyffin RG, Goldacre MJ, Gill M. Mortality rates and self reported
health: database analysis by English local authority area. Br Med J.
2004;329:887–8.
43. Maheswaran R, Green MA, Strong M, Brindley P, Angus C, Holmes J. Alco-
hol outlet density and alcohol related hospital admissions in England: a
national small-area level ecological study. Addiction. 2018. https ://doi.
org/10.1111/add.14285 .
44. Richardson E, Mitchell R. Gender differences in relationships between
urban green space and health in the United Kingdom. Soc Sci Med.
2010;71:568–75.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
1.
2.
3.
4.
5.
6.
Terms and Conditions
Springer Nature journal content, brought to you courtesy of Springer Nature Customer Service Center GmbH (“Springer Nature”).
Springer Nature supports a reasonable amount of sharing of research papers by authors, subscribers and authorised users (“Users”), for small-
scale personal, non-commercial use provided that all copyright, trade and service marks and other proprietary notices are maintained. By
accessing, sharing, receiving or otherwise using the Springer Nature journal content you agree to these terms of use (“Terms”). For these
purposes, Springer Nature considers academic use (by researchers and students) to be non-commercial.
These Terms are supplementary and will apply in addition to any applicable website terms and conditions, a relevant site licence or a personal
subscription. These Terms will prevail over any conflict or ambiguity with regards to the relevant terms, a site licence or a personal subscription
(to the extent of the conflict or ambiguity only). For Creative Commons-licensed articles, the terms of the Creative Commons license used will
apply.
We collect and use personal data to provide access to the Springer Nature journal content. We may also use these personal data internally within
ResearchGate and Springer Nature and as agreed share it, in an anonymised way, for purposes of tracking, analysis and reporting. We will not
otherwise disclose your personal data outside the ResearchGate or the Springer Nature group of companies unless we have your permission as
detailed in the Privacy Policy.
While Users may use the Springer Nature journal content for small scale, personal non-commercial use, it is important to note that Users may
not:
use such content for the purpose of providing other users with access on a regular or large scale basis or as a means to circumvent access
control;
use such content where to do so would be considered a criminal or statutory offence in any jurisdiction, or gives rise to civil liability, or is
otherwise unlawful;
falsely or misleadingly imply or suggest endorsement, approval , sponsorship, or association unless explicitly agreed to by Springer Nature in
writing;
use bots or other automated methods to access the content or redirect messages
override any security feature or exclusionary protocol; or
share the content in order to create substitute for Springer Nature products or services or a systematic database of Springer Nature journal
content.
In line with the restriction against commercial use, Springer Nature does not permit the creation of a product or service that creates revenue,
royalties, rent or income from our content or its inclusion as part of a paid for service or for other commercial gain. Springer Nature journal
content cannot be used for inter-library loans and librarians may not upload Springer Nature journal content on a large scale into their, or any
other, institutional repository.
These terms of use are reviewed regularly and may be amended at any time. Springer Nature is not obligated to publish any information or
content on this website and may remove it or features or functionality at our sole discretion, at any time with or without notice. Springer Nature
may revoke this licence to you at any time and remove access to any copies of the Springer Nature journal content which have been saved.
To the fullest extent permitted by law, Springer Nature makes no warranties, representations or guarantees to Users, either express or implied
with respect to the Springer nature journal content and all parties disclaim and waive any implied warranties or warranties imposed by law,
including merchantability or fitness for any particular purpose.
Please note that these rights do not automatically extend to content, data or other material published by Springer Nature that may be licensed
from third parties.
If you would like to use or distribute our Springer Nature journal content to a wider audience or on a regular basis or in any other manner not
expressly permitted by these Terms, please contact Springer Nature at
onlineservice@springernature.com
... Recently, a plethora of observational and experimental evidence has indicated that access to green spaces engenders numerous positive health outcomes, including better subjective general health (Brindley, Jorgensen, & Maheswaran, 2018), improved mental health and cognitive function (Dadvand et al., 2015;, reduced cardiovascular morbidity (Fan et al., 2020), healthy weight maintenance (Huang et al., 2020), improved physical functioning (de Keijzer et al., 2019), and increased longevity (Ji et al., 2019). Better access to green spaces may also help to reduce inequalities in physical (Mitchell & Popham, 2008) and mental health outcomes (Mitchell, Richardson, Shortt, & Pearce, 2015) as most socially disadvantaged and ethnic minority populations disproportionately benefit from their salutogenic impacts. ...
... An additional reason for inconsistencies in previous results is that a wide range of different approaches and definitions was used in the study of greenness-health association. The vast majority of previous studies were conducted in urban and high-income settings, and assumed a linear association between residential greenness and health outcomes (de Vries, Verheij, Groenewegen, & Spreeuwenberg, 2003;Brindley et al., 2018). Only a very limited number of studies have examined a non-linear association between residential greenness and health (Sarkar et al., 2019;Ji et al., 2019). ...
... We adjusted for a range of individual-and household-level confounding covariates based on previous literature Huang et al., 2021;Ji et al., 2019;Brindley et al., 2018;Fan et al., 2020;Mitchell & Popham, 2008). The 2015 mini-census database supplied data on individuals' sex (female vs male), age (60-69 vs 70-79 vs >= 80 years), marital status (single or divorced or widowed vs married), hukou status (local hukou vs non-local hukou), education (no schooling vs elementary or secondary school vs senior high school vs college or above), household car ownership (did not have vs had a car valued under ¥ 200,000 vs had a car valued over ¥ 200,000), basic endowment insurance (did not have vs had), basic medical insurance (did not have vs had), housing construction time (before 1990 vs after 1990), and housing area per capita. ...
Article
While a plethora of evidence has suggested the existence of salutogenic effects of exposure to residential greenness, including mitigating residents’ exposure to environmental stressors (the mitigation effect), relevant evidence of these effects in a Chinese context remains limited and inconsistent. This study explored the association between residential greenness and older adults’ self-rated general health (SGH) in China, particularly focusing on the potential non-linear association, using the microdata sample from the Chinese one-percent national population sample survey. We further examined whether the association varied significantly according to neighbourhood urbanicity and individual socio-demographic characteristics, and investigated whether residential greenness can mitigate against the detrimental effects of air pollution, higher temperature, and outdoor light pollution at night on older adults’ health. We found that higher residential greenness was positively associated with the odds of reporting good health, and a greenness-SGH inverted U-shaped relationship was observed, with a turning point at an NDVI value of 0.40. The greenness-SGH association was stronger for older adults who resided in urban areas, were female, older (>= 80 years), were single or divorced or widowed, had elementary or secondary school education, and lived in households with a car valued over ¥ 200,000. We also found that greenness can help mitigate the adverse effects of air pollution and outdoor light pollution at night on older adults’ SGH. Our findings suggest that providing green infrastructure in a residential environment can promote older people’s health through mitigating the hazards of environmental contaminants in a rapidly urbanizing and developing country.
... The present research showed that access to private outdoor space was perceived as beneficial to health and wellbeing for those with a pre-existing health condition during the pandemic and provides further support for private green spaces as health-supporting environments [55,56,69,70]. It also extends the literature by exploring the types of nature engagement and ways in which they support health and wellbeing in a vulnerable subpopulation during a public health crisis. ...
Article
Full-text available
The importance of natural environments in supporting health and wellbeing has been well evidenced in supporting positive mental and physical health outcomes, including during periods of crisis and stress. Given the disproportionate impacts of the COVID-19 pandemic have been greatest for those who are most vulnerable, understanding the role of natural environment and alternative forms of nature engagement in supporting health and wellbeing for vulnerable groups is important. This study explored how nature engagement supported health and wellbeing in those with a pre-existing health condition during the first UK lockdown. Semi-structured interviews were conducted with 17 adults with a pre-existing health condition and analysed using Interpretative Phenomenological Analysis (IPA). Four themes were identified: COVID-19 versus nature; Nature as an extension and replacement; Nature connectedness; and Therapeutic nature. The findings show the importance of nature in supporting health and wellbeing in those with a pre-existing health condition through engagement with private and public natural environments, micro-restorative opportunities, nature connection as an important pathway, and the therapeutic benefits of nature engagement. The present research extends the evidence-base beyond patterns of nature engagement to a deeper understanding of how those with existing health conditions perceived and interacted with nature in relation to their health and wellbeing during the first UK lockdown. Findings are discussed in relation to health supporting environments, micro-restorative opportunities, and policy implications
... The outcome variable was self-rated general health (SGH), which is an indicator strongly linked to objectively measured health outcomes, such as illnesses and mortality (Lima-Costa et al., 2012); it has been applied previously to test the health benefits of green and blue spaces (Brindley et al., 2018;Gascon et al., 2017;Hooyberg et al., 2020;Huang et al., 2019Huang et al., , 2021bPasanen et al., 2019;White et al., 2013). The 2015 China's one-percent population sample survey asked a single question "Over the past month, how would you rate your health in general?" with four potential responses: "good", "fair", "poor", and "not able to take care of myself". ...
Article
A growing body of research indicates that exposure to outdoor blue spaces is associated with better physical and mental health. However, few studies have explored the associations between different blue space indicators (e.g., amount of and proximity to freshwater and seawater) and general health. Moreover, research has rarely attempted to address the residential selection bias associated with the salutogenic effect of access to blue spaces. Therefore, this study explores the associations between the amount (percentage of blue space within a 1 km circular buffer) of and proximity (Euclidean distance to the edge of the nearest blue space) to blue space and older adults' general health across the entire country of China using the micro-data sample of one-percent national population sample survey in 2015. It adds to the existing literature by taking into account the neighbourhood selection mechanism for different housing tenures and examining the salutogenic effect of blue spaces separately for public housing residents and private housing residents. The results indicated that greater neighbourhood seawater coverage and living near a coastline were associated with better general health among older adults in both private and public housing, while the percentage of freshwater blue spaces within neighbourhoods and the distance to freshwater blue spaces were associated with better general health among private housing residents only. The blue spaces-general health associations were stronger among urban participants, participants in deprived neighbourhoods, males, participants aged under 80 years, and low- and medium-educated participants. Our findings indicated that living near the coast was beneficial to older adults’ health, and residential selection bias confounded the association between freshwater blue spaces and health.
... Because private garden designs are highly heterogeneous, further research is required into the specific characteristics of gardens that most effectively provide well-being effects. Brindley et al. (2018) found garden size to be associated with self-reported general health and Cervinka et al. (2016) demonstrated that participants' perceptions of their own gardens as restorative spaces increased with garden size and the number of natural features present in their garden. Several studies suggest that the biodiversity of natural environments is an important driver of well-being (e. g., Carrus et al., 2015;Fuller et al., 2007) but the evidence is limited and somewhat inconsistent (Marselle et al., 2019). ...
Article
Private gardens have an enormous impact on urban biodiversity, making individual householder behavior critical to the conservation and enhancement of biodiversity in urban areas. Nature connectedness is considered to be a prerequisite for proenvironmental behavior, but how it manifests in private gardens is largely unexplored. Nature connectedness has also been found to be associated with several well-being dimensions. The present study investigates the associations between nature connectedness, biodiversity of private gardens, and mental well-being during the Covid-19 lockdown, a stressful period in many people’s lives. Hierarchical regression analyses were used to analyze data from an online survey of private gardeners in two cities, one in Germany and one in New Zealand, in May 2020, approximately two months after the beginning of the first Covid-19 lockdown. Garden characteristics explained a significant amount of variance in depression symptoms during the Covid- 19 lockdown. In light of rising pressures on urban green spaces, the findings point to the importance of private garden qualities for mental health and well-being. Nature connectedness emerged as a significant predictor of feature richness, a measure of the heterogeneity of habitats that support wildlife, and plant growth form richness in people’s gardens in both city samples. Nature connectedness was also a significant predictor of the extent to which people experienced positive emotions during the Covid-19 lockdown but not negative emotions and depression symptoms. Our results suggest that nature connectedness can provide benefits for both the environment and people through its positive association with private garden biodiversity and positive emotions.
... As noted earlier, we identified 62 articles that met the inclusion criteria (Astell-Burt et al., 2014;Bezold et al., 2017;Björk et al., 2008;Boncinelli et al., 2015;Brindley et al., 2018;Chaparro, 2018;Coppel and Wüstemann, 2017;Crouse et al., 2017;Cummins and Fagg, 2012;Cunningham-Myrie et al., 2018;Dadvand et al., 2016Dadvand et al., , 2018Donovan et al., 2018;Dzhambov et al., 2018;Egorov et al., 2017;Eldeirawi et Vienneau et al., 2017;Wall et al., 2012;Wang et al., 2017;Wen and Kowaleski-Jones, 2012;Wen and Maloney, 2011;Wilhelm Stanis et al., 2014;Wolch et al., 2011;Xu et al., 2017;B.-Y. Yang et al., 2019a,b;Y. ...
Article
A growing literature shows that green space can have protective effects on human health. As a marginalized group, women often have worse life outcomes than men, including disparities in some health outcomes. Given their marginalization, women might have “more to gain” than men from living near green spaces. Yet, limited research has deliberately studied whether green space-health associations are stronger for women or men. We conducted a systematic review to synthesize empirical evidence on whether sex or gender modifies the protective associations between green space and seven physical health outcomes (cardiovascular disease, cancer, diabetes, general physical health, non-malignant respiratory disease, mortality, and obesity-related health outcomes). After searching five databases, we identified 62 articles (including 81 relevant analyses) examining whether such effect modification existed. We classified analyses based on whether green space-health were stronger for women, no sex/gender differences were detected, or such associations were stronger for men. Most analyses found that green space-physical health associations were stronger for women than for men when considering study results across all selected health outcomes. Also, women showed stronger protective associations with green space than men for obesity-related outcomes and mortality. Additionally, the protective green space-health associations were slightly stronger among women for green land cover (greenness, NDVI) than for public green space (parks), and women were also favored over men when green space was measured very close to one's home (0–500 m). Further, the green space-health associations were stronger for women than for men in Europe and North America, but not in other continents. As many government agencies and nongovernmental organizations worldwide work to advance gender equity, our review shows that green space could help reduce some gender-based health disparities. More robust empirical studies (e.g., experimental) are needed to contribute to this body of evidence.
Article
Full-text available
Nature’s mental health benefits are well-established in the literature, but there is little research on which types and characteristics of urban greenery are most relevant for mental well-being in general, and during the COVID-19 pandemic in particular. This study examined the link between having a (green) garden or a green view from the main window of the home, as well as the perceived quantity and quality of neighbourhood green areas and streetscape greenery, and the self-reported change in mental well-being since the onset of the COVID-19 pandemic. Adults residing in the Netherlands (N = 521, 67% female) completed an online survey in December 2020 and January 2021. It included items on the frequency of contact with the aforementioned outdoor spaces, as well as their quantity, natural features, and quality. Hierarchical regression analyses revealed that the quantity of the greenery mattered, but the quality was more strongly associated with well-being. In particular, well-maintained, attractive, and varied streetscape greenery was just as relevant as a garden with diverse plants. This beneficial association between streetscape greenery and mental well-being was stronger for female participants. Understanding the benefits of the different types and characteristics of urban greenery, and who they are most relevant for, can assist policymakers and planners in designing cities that promote health and resilience.
Article
To examine the impact of residential design on children's out‐of‐school, outdoor activities, 149 urban, upper‐primary‐school children were surveyed about their activities and opinions. Findings indicate children participate in outdoor activities unsupervised in yards that provide busy families quick, convenient access to safe greenspace without the need to drive or closely supervise. The research concluded that government policies are required to ensure residential developments provide yards with usable greenspace, leafy streetscapes and safe, walkable access to local facilities. Increased public awareness and understanding of the benefits of greenspace close to home and the importance of children's independent mobility must be prioritised.
Conference Paper
Full-text available
Cities resulted more vulnerable to major global challenges, such as climate change and the pandemic. Historical districts are even more fragile due to the compactness of the urban structure and the high concentration of cultural heritage. Considering the urgency of these issues, urban resilience strategies has been a key topic in research for several decades. However, these strategies are often based on standardised actions, easily applicable to peripheral or recent areas, but not suitable for historical centres. Overcoming these limitations requires a change of perspective and the re-placing of cultural specificities at the very centre. A culture-base methodological approach is presented in this contribution. To further explore the topic, the case study of Milan (Italy) was investigated. In this study, we analyse the specific urban and architectural features of the historical centre and we focus on the role of residential courtyards.
Article
The objectives of this study were to: (i) determine, by distance from home, the proportion of time children spent in natural space (NS), private gardens (PG) and natural space/private garden (NS/PG); (ii) calculate availability of these environments surrounding homes, and (iii) explore variation in availability and use by socio-economic status (SES). Detailed mobility data for 10/11-year-old children (n = 667) were obtained. Children wore GPS devices and locations were spatially joined to UK national mapping data (Ordnance Survey) to identify if each one was within NS, PG or NS/PG. Euclidean distance between GPS points and home was measured and discretised into 100 m bands (100 m to 800 m). Children spent 15% of their total outdoor, non-school wear time in NS, but 41% in NS/PG. Both time spent in NS & NS/PG and its distance from home varied by SES. Children living in the most deprived areas spent 17% of their total wear time in NS/PG within 100 m from home, and 4.4% in NS/PG over 800 m from home. In contrast, children from the least deprived areas spent 19% of wear time in NS/PG less than 100 m from home and 10.7% in NS/PG over 800 m from home. An increase in the availability of NS and NS/PG around the home was weakly associated with increased use. NS and PG provide a key location that children spend their outdoor time, particularly in areas close to home for those from more deprived areas. Children from the least deprived areas have greater exposure to NS, most of which occurs away from home.
Article
Urban green spaces and the biodiversity therein have been associated with human health and well-being benefits, but the contribution of domestic gardens to those benefits is insufficiently known. Using data from a cross-sectional sample (n = 587) of domestic garden owners in Flanders and Brussels (northern Belgium), associations between residential green space quality in and around domestic gardens, green space related activities and socioeconomic background variables of the gardeners, and self-reported health (stress and depression) were investigated with structural equation models. Socioeconomic security was associated with lower stress and depression. Nature relatedness and green space in the neighbourhood of the house were associated with higher exposure to green space, which was in turn negatively associated with stress and depression. Garden quality, indicated by biodiversity values and size, and nature relatedness were associated with being active in the garden, which was in turn associated with lower values of depression, but not stress. Nature relatedness seems to play a key role in the pathway linking gardens to improved health. Improving biodiversity and ecosystems services in gardens may increase exposure to green space and help to restore and enhance nature relatedness. This, in turn, could potentially improve human health and well-being, and contribute to the conservation of biodiversity in urban environments.
Chapter
Full-text available
Little is known about the contribution that biodiversity has on mental health and well-being. To date, only one systematic review has investigated the health and well-being benefits from contact with biodiversity (Lovell et al. J Toxicol Environ Health B Crit Rev 17(1):1–20, 2014). The number of research studies investigating the health and well-being effects of biodiversity has increased since this publication. Here, we provide an update, focusing on the impact of biodiversity on mental health and well-being. Our objectives are to: (i) identify and describe the literature published after 2012; and (ii) synthesise all results from Lovell et al. (J Toxicol Environ Health B Crit Rev 17(1):1–20, 2014) and the more recently published literature to assess whether biodiversity influences mental health and well-being. Sixteen recently published studies met the inclusion criteria. The literature is varied with different study designs, measures of biodiversity, mental health and well-being. The synthesis of results was drawn from 24 studies: nine from Lovell et al. (J Toxicol Environ Health B Crit Rev 17(1):1–20, 2014) and 15 identified by this chapter. There is some evidence to suggest that biodiversity promotes better mental health and well-being. However, more studies reported non-significant results. The evidence is not yet of the extent necessary to characterise the role of biodiversity in relation to mental health or well-being. Future interdisciplinary research directions are discussed.
Article
Full-text available
Background and aims: Excessive alcohol consumption has a substantial impact on public health services. A key element determining alcohol availability is alcohol outlet density. This study investigated the relationship between on-trade and off-trade outlets and hospital admission rates in local neighbourhoods. Design: National small-area level ecological study. Setting and participants: All 32 482 lower layer super output census areas (LSOAs) in England (42 227 108 million people aged 15+ years). Densities for six outlet categories (outlets within a 1-km radius of residential postcode centroids, averaged for all postcodes within each LSOA) were calculated. Measurements: Main outcome measures were admissions due to acute or chronic conditions wholly or partially attributable to alcohol consumption from 2002/03 to 2013/14. Findings: There were 1 007 137 admissions wholly, and 2 153 874 admissions partially, attributable to alcohol over 12 years. After adjustment for confounding, higher densities of on-trade outlets (pubs, bars and nightclubs; restaurants licensed to sell alcohol; other on-trade outlets) and convenience stores were associated with higher admission rate ratios for acute and chronic wholly attributable conditions. For acute wholly attributable conditions, admission rate ratios were 13% (95% confidence interval = 11-15%), 9% (7-10%), 12% (10-14%) and 10% (9-12%) higher, respectively, in the highest relative to the lowest density categories by quartile. For chronic wholly attributable conditions, rate ratios were 22% (21-24%), 9% (7-11%), 19% (17-21%) and 7% (6-9%) higher, respectively. Supermarket density was associated with modestly higher acute and chronic admissions but other off-trade outlet density was associated only with higher admissions for chronic wholly attributable conditions. For partially attributable conditions, there were no strong patterns of association with outlet densities. Conclusions: In England, higher densities of several categories of alcohol outlets appear to be associated with higher hospital admission rates for conditions wholly attributable to alcohol consumption.
Article
Full-text available
Exposure to nature provides a wide range of health benefits. A significant proportion of these are delivered close to home, because this offers an immediate and easily accessible opportunity for people to experience nature. However, there is limited information to guide recommendations on its management and appropriate use. We apply a nature dose-response framework to quantify the simultaneous association between exposure to nearby nature and multiple health benefits. We surveyed ca. 1000 respondents in Southern England, UK, to determine relationships between (a) nature dose type, that is the frequency and duration (time spent in private green space) and intensity (quantity of neighbourhood vegetation cover) of nature exposure and (b) health outcomes, including mental, physical and social health, physical behaviour and nature orientation. We then modelled dose-response relationships between dose type and self-reported depression. We demonstrate positive relationships between nature dose and mental and social health, increased physical activity and nature orientation. Dose-response analysis showed that lower levels of depression were associated with minimum thresholds of weekly nature dose. Nearby nature is associated with quantifiable health benefits, with potential for lowering the human and financial costs of ill health. Dose-response analysis has the potential to guide minimum and optimum recommendations on the management and use of nearby nature for preventative healthcare.
Article
Full-text available
There is increasing evidence that gardening provides substantial human health benefits. However, no formal statistical assessment has been conducted to test this assertion. Here, we present the results of a meta-analysis of research examining the effects of gardening, including horticultural therapy, on health. We performed a literature search to collect studies that compared health outcomes in control (before participating in gardening or non-gardeners) and treatment groups (after participating in gardening or gardeners) in January 2016. The mean difference in health outcomes between the two groups was calculated for each study, and then the weighted effect size determined both across all and sets of subgroup studies. 22 case studies (published after 2001) were included in the meta-analysis, which comprised 74 comparisons between control and treatment groups. Most studies came from the United States, followed by Europe, Asia, and the Middle East. Studies reported a wide range of health outcomes, such as reductions in depression, anxiety and body mass index, as well as increases in life satisfaction, quality of life and sense of community. Meta-analytic estimates showed a significant positive effect of gardening on the health outcomes both for all and sets of subgroup studies, whilst effect sizes differed among eight subgroups. Although Egger's test indicated the presence of publication bias, significant positive effects of gardening remained after adjusting for this using trim and fill analysis. This study has provided robust evidence for the positive effects of gardening on health. A regular dose of gardening can improve public health.
Article
Full-text available
Studies have repeatedly affirmed the positive links between human and environmental health but few have sufficiently addressed the complexity brought about by the range of urbanity, population and both green space and domestic gardens cover associated human settlements. With the global population increasingly residing in cities, the relevance of urbanisation, local population and discrete types of green space provision on measures of health, remains a research imperative. To explore this complexity, a series of regression models were employed to quantify the mitigation of local health deprivation by green space and domestic gardens, across a four-stage rural-urban gradient, controlling for household income and local population. The population-standardised quantification of green space provision offered greater interpretive power than did a simple measure of land cover density. Domestic gardens, of the two green land-cover types, provided the most convincing mitigating effect on health deprivation. The findings call for increased acknowledgement of urban gardens in local health promotion, and a closer consideration of local population in planning green space provision and management.
Article
Domestic (ȁ8privateȁ9) gardens constitute a substantial proportion of ȁ8green spaceȁ9 in urban areas and hence are of potential significance for the maintenance of biodiversity in such areas. However, the size and nature of this resource and its associated features are poorly known. In this study, we provide the first detailed audit, using domestic gardens in the city of Sheffield as a model study system. Domestic gardens, the mean area of which was 151 m2, cover approximately 33 km2 or 23% of the predominantly urban area of the city. The smaller gardens contribute disproportionately to this total because, although individually they add little, they are large in number. Conversely, the regions of the city with proportionately more garden area contribute most to the total garden area of the city, although such regions are limited in number. Based on the findings of a telephone based survey, 14.4% of dwellings with gardens were estimated to have ponds, 26% to have nest-boxes, 29% to have compost heaps, 48% to hold trees more than 3 m tall, and 14% of dwellings were estimated to be home to one or more cats. Whilst the absolute frequency of these features is low to moderate, by extrapolation they nonetheless yield estimates for domestic gardens in Sheffield of a total of 25,200 ponds, 45,500 nest boxes, 50,750 compost heaps, 360,000 trees, and a population of 52,000 domestic cats. These results are considered in the context of the role of gardens in urban areas as habitats for wildlife and the implications for housing policy.
Article
From the increasing number of people living in urban areas to the continued degradation of the natural environment, many of us appear to be physically and psychologically disconnected from nature. We consider the theoretical explanations and present evidence for why this state of affairs might result in suboptimal levels of hedonic and eudaimonic wellbeing by reviewing the large body of research on the mental health benefits of connecting with nature. The advantages of contact with nature as a potential wellbeing intervention are discussed, and examples of how this research is being applied to reconnect individuals to nature and improve wellbeing are given. We conclude by considering the limitations of, and proposing future directions for, research in this area. Overall, evidence suggests that connecting with nature is one path to flourishing in life.
Book
This book reflects contemporary thinking and is supported by scientific evidence to show the role, value and application of horticulture in the landscape.
Article
Private yards provide city residents with access to ecosystem services that can be realized through passive (vegetation availability) and active (time spent in yards: frequency and duration) means. However, urban densification is leading to smaller yards with less vegetation. Here, we examine how urban form and socio-demographic factors affect the potential ecosystem service benefits people can gain via passive (e.g. climate regulation) and active (e.g. recreation) pathways. Two measures of vegetation cover (0.15–2 m, >2 m) are used as a proxy for passive ecosystem service benefits, and two measures of yard use (use frequency, total time spent across a week) are used for active ecosystem service benefits. We use survey and GIS data to measure personal and physical predictors that could influence these variables for 520 residents of detached housing in Brisbane, Australia. We found house age and yard size were positively correlated with vegetation cover, and people with a greater nature relatedness and lower socio-economic disadvantage also had greater vegetation cover. Yard size was an important predictor of yard use, as was nature relatedness, householder age, and presence of children in the home. Vegetation cover showed no relationship, indicating that greater cover alone does not promote ecosystem service delivery through the active use pathway. Together our results show that people who have higher nature relatedness may receive greater benefits from their yards via both passive and active means as they have more vegetation available to them in their yards and they interact with this space more frequently and for longer time periods.