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FORESTS AND TREES
FOR HUMAN HEALTH:
PATHWAYS, IMPACTS, CHALLENGES
AND RESPONSE OPTIONS
A Global Assessment Report
Editors: Cecil Konijnendijk, Dikshya Devkota,
Stephanie Mansourian and Christoph Wildburger
IUFRO World Series Vol. 41
Funding support for this publication was provided by the German Federal Ministry for Economic Cooperation and
Development, the Ministry for Foreign Affairs of Finland, the United States Forest Service and the Austrian Federal
Ministry of Agriculture, Forestry, Regions and Water Management. The views expressed within this publication
do not necessarily reect the ofcial policy of the governments represented by these institutions/agencies or the
institutions to whom the authors are afliated.
Publisher:
International Union of Forest Research Organizations (IUFRO)
IUFRO World Series Vol. 41
Forests and Trees
for Human Health:
Pathways, Impacts, Challenges
and Response Options
A Global Assessment Report
Editors: Cecil Konijnendijk, Dikshya Devkota,
Stephanie Mansourian and Christoph Wildburger
Recommended catalogue entry:
Cecil Konijnendijk, Dikshya Devkota, Stephanie Mansourian & Christoph Wildburger (eds.), 2023.
Forests and Trees for Human Health: Pathways, Impacts, Challenges and Response Options.
A Global Assessment Report.
IUFRO World Series Volume 41. Vienna. 232p.
ISBN 978-3-903345-20-1
Published by:
International Union of Forest Research Organizations (IUFRO)
Available from:
IUFRO Headquarters
Secretariat
Marxergasse 2
1030 Vienna
Austria
Tel +43 (0)1 877 01 51-0
E-mail ofce@iufro.org
www.iufro.org
Layout: Eugénie Hadinoto
Illustrations: Karin Grönberg, pp.20, 21, 203, 204, 205, 206, 207
Cover photographs: Olya Humeniuk, John Parrotta, Sital Uprety
Printed in Austria by Eigner Druck, Tullner Straße 311, 3040 Neulengbach, Austria
5
Preface
Since its establishment in 2007, the Global Forest Expert Panels (GFEP) initiative of the Collaborative Part-
nership on Forests (CPF) has been effectively linking scientic knowledge with political decision-making
on forests. GFEP responds to critical forest-related policy concerns by consolidating available scientic
knowledge and expertise on these issues at the global level. It provides decision-makers with the most
relevant, objective and accurate information and thus makes essential contributions to increasing the
quality and effectiveness of international forest governance.
This report titled, “Forests and Trees for Human Health: Pathways, Impacts, Challenges and Re-
sponse Options”, presents the results of the eighth global scientific assessment undertaken within
the framework of GFEP. All GFEP assessments are prepared by internationally recognized scientists
from varied professional backgrounds and geographical contexts. The publications are presented to
stakeholders across relevant international policy fora to support more coherent policies on the role
of forests in addressing the environmental, social and economic challenges reflected in the United
Nations Sustainable Development Goals (SDGs).
In recent years, global public health challenges have taken centre stage. The COVID-19 pandemic
has created severe healthcare disruptions and reversed decades of health and economic improve-
ments. In addition to infectious diseases, the surge of non-communicable diseases has also become
a major public health threat. Global factors, including urbanisation and climate change, further
exacerbate such adverse effects on human health.
Forests have immense potential to contribute to the mental, physical and social health and well-
being of humans. Forests, trees and green spaces can provide nutritious food and medicines, sup-
port climate change mitigation and adaptation, filter air and water pollutants and offer areas of
recreation. At the same time, poor practices of conservation and management of forests can result
in adverse effects on human health with the emergence of zoonotic diseases, forest fires and aller-
gic outcomes. This report consolidates available scientific evidence on the interlinkages between
forests and human health and identifies trade-offs, synergies, and opportunities for strengthening
policies, programmes and activities to enhance the positive health impacts of forests in diverse
populations and settings.
The vast potential of forests, and nature, to contribute to positive health outcomes is increasingly
recognised and promoted by policy processes at the international level. For example, the recently
agreed Kunming-Montreal Biodiversity Framework calls for the adoption of integrative approaches
such as One Health and ‘Good health and wellbeing for all’ is the third goal of the 2030 Agenda for
Sustainable Development. Scientific reports like this are important tools for supporting policymak-
ers and stakeholders in their ambition to ensure sustainable development that takes into consider-
ation the health of humans, other species and the planet as a whole.
I would like to thank the Chair of the Global Forest Expert Panel on Forests and Human Health
Cecil Konijnendijk, GFEP Coordinator Christoph Wildburger, GFEP Editor Stephanie Mansourian, and
GFEP Project Manager Dikshya Devkota for their excellent work in guiding the assessment process
and in leading the development of this publication. It is my sincere hope that those with a respon-
sibility for implementing the SDGs at all levels will find this report a useful source of information
and inspiration.
Alexander Buck
IUFRO Executive Director
5
7
Acknowledgements
This publication is the product of the collaborative work of scientic experts within the framework of
the Global Forest Expert Panel (GFEP) on Forests and Human Health, who served in different capacities
as panel members and authors. We express our sincere gratitude to all of them:
Thomas Astell-Burt, Nicole Bauer, Agnes van den Berg, Gregory N. Bratman, Matthew H.M.E. Browning,
Matilda van den Bosch, Victoria Bugni, Payam Dadvand, Djibril S. Dayamba, Geoffrey Donovan, Xiaoqi
Feng, Elaine Fuertes, Emma Gibbs, Nelson Grima, Sarah Laird, Serge Morand, Cristina O’Callaghan-Gordo,
Unnikrishnan Payyappallimana, Ranaivo Rasolofoson, Roseline Remans, David Rojas-Rueda, Giovanni
Sanesi, Joshitha Sankam, Charlie Shackleton, Patricia Shanley, Shureen Faris Abdul Shukor, Giuseppina
Spano, Margarita Triguero-Mas, Liisa Tyrväinen, Sjerp de Vries and Bo-Yi Yang.
Without their continued efforts and commitments, the preparation of this publication would not have
been possible. We are also grateful to the institutions and organisations to which the authors are afliated
for enabling them to contribute their expertise to this assessment. At the same time, we wish to note
that the views expressed within this publication do not necessarily reect the ofcial policy of these
institutions and organisations.
We acknowledge and sincerely thank the reviewers of the report, whose valuable comments have
greatly improved this publication: Christos Gallis, Christopher Golden, Qing Li, Michelle Kondo, Kjell
Nilsson, Abi Tamim Vanak, Benedict Wheeler, Maxine Whittaker, Kathleen Wolf and the Food and
Agriculture Organization of the United Nations (FAO).
We also gratefully acknowledge the generous nancial and in-kind support provided by the German
Federal Ministry for Economic Cooperation and Development, the Ministry for Foreign Affairs of Finland,
the United States Forest Service and the Austrian Federal Ministry of Agriculture, Forestry, Regions and
Water Management.
Our special thanks go to the IUFRO Secretariat for providing indispensable administrative and technical
support. Furthermore, we would like to thank the member organisations of the Collaborative Partnership
on Forests (CPF) for their in-kind contributions and overall guidance to the assessment.
Stephanie Mansourian
Content Editor
Christoph Wildburger
GFEP Programme Coordinator
Dikshya Devkota
GFEP Project Manager
Cecil Konijnendijk
Panel Chair
9
Contents
Preface .................................................................................................................................... 5
Acknowledgements ................................................................................................................ 7
Acronyms, Units and Symbols ............................................................................................ 10
1. Introduction .................................................................................................................... 13
Coordinating lead author: Cecil Konijnendijk
Lead authors: Dikshya Devkota, Stephanie Mansourian and Christoph Wildburger
2. Framing the Interrelations Between Forests and Human Health ................................. 25
Coordinating lead author: Matilda van den Bosch
Lead authors: Agnes van den Berg, Payam Davand, Xiaoqi Feng, Serge Morand, Roseline Remans, Liisa Tyrväinen
and Sjerp de Vries
Contributing authors: Emma Gibbs and Joshitha Sankam
3. The Health and Wellbeing Effects of Forests and Natural Environments ..................... 77
Coordinating lead authors: Payam Dadvand and Sjerp de Vries
Lead authors: Nicole Bauer, Djibril S. Dayamba, Xiaoqi Feng, Serge Morand, Unnikrishnan Payyappalli,
Roseline Remans, Ranaivo Rasolofoson, Charlie Shackleton, Patricia Shanley, Liisa Tyrväinen,
Agnes van den Berg and Matilda van den Bosch
Contributing authors: Thomas Astell-Burt, Gregory Bratman, Matthew H. M. E. Browning, Geoffrey Donovan,
Elaine Fuertes, Cristina O'Callaghan-Gordo, David Rojas-Rueda, Giovanni Sanesi, Giuseppina Spano,
Margarita Triguero-Mas and Bo-Yi Yang
4. Forests for Human Health – Understanding the Contexts, Characteristics,
Links to Other Benets and Drivers of Change ........................................................... 125
Coordinating lead authors: Liisa Tyrväinen and Cecil Konijnendijk
Lead authors: Nicole Bauer, Djibril S. Dayamba, Serge Morand, Unnikrishnan Payyappallimana, Roseline Remans,
Charlie Shackleton, and Patricia Shanley
Contributing authors: Victoria Bugni and Sarah Laird
5. Response Options: Access, Spatial Dimensions, Design,
Communication and Economics .................................................................................. 163
Coordinating lead authors: Agnes van den Berg and Cecil Konijnendijk
Lead authors: Shureen Faris Abdul Shukor, Ranaivo Rasolofoson and Patricia Shanley
Contributing authors: Victoria Bugni and Nelson Grima
6. Key Messages and Conclusions ................................................................................... 201
Coordinating lead author: Cecil Konijnendijk
Lead authors: Agnes van den Berg, Matilda van den Bosch, Payam Dadvand, Dikshya Devkota,
Stephanie Mansourian, Liisa Tyrväinen, Sjerp de Vries and Christoph Wildburger
Appendices ......................................................................................................................... 217
Appendix 1: Glossary of Terms and Denitions
Appendix 2: List of Panel Members, Authors and Reviewers
9
1010
ACRONYMS, UNITS AND SYMBOLS
AD Alzheimer’s Disease
ADHD Attention Decit-Hyperactivity
Disorder
AIDS Acquired Immunodeciency
Syndrome
AMR Antimicrobial Resistance
ART Attention Restoration Theory
ASD Autism Spectrum Disorders
BMD Bone Mineral Density
BMI Body Mass Index
CBD Convention on Biological Diversity
CD Communicable Diseases
CICES Common International Classication
of Ecosystem Services
CITRO Center of Tropical Research
Investigations
CNS Connectedness to Nature Scores
COP Conference of the Parties
COPD Chronic Obstructive Pulmonary
Disease
CPF Collaborative Partnership on Forests
CRF Climate Resilience Framework
CVD Cardiovascular Disease
DALYs Disability-Adjusted Life Years
DEFRA Department for Environment, Food
and Rural Affairs
DOHaD Developmental Origins of Health
and Disease
EEG Electroencephalography
EFI European Forest Institute
EIA Environmental Impact Assessment
ES Ecosystem Service
EU European Union
EVI Enhanced Vegetation Index
FAO Food and Agriculture Organization
of the United Nations
FLR Forest Landscape Restoration
fMRI functional Magnetic Resonance
Imaging
FRA Forest Resources Assessment
GBD Global Burden of Disease
GBF Global Biodiversity Framework
GBIF Global Biodiversity Information
Facility
GHQ General Health Questionnaire
GPS Global Positioning System
HIA Health Impact Assessment
HDI Human Development Index
HeReS-C Health Restoration Soundscapes
Criteria
HIC High Income Country
IPAQ International Physical Activity
Questionnaire
IPBES Intergovernmental Science-Policy
Platform on Biodiversity and
Ecosystem Services
IPCC Intergovernmental Panel on
Climate Change
IPLC Indigenous Peoples and
Local Communities
IQ Intelligence Quotient
IUCN International Union for Conservation
of Nature
LDL Low-Density Lipoproteins
LiDAR Light Detection and Ranging
LMICs Low- and Middle-Income Countries
MEA Millennium Ecosystem Assessment
MERS Middle East Respiratory Syndrome
MT Metric Tonnes
NCD Noncommunicable Disease
NDVI Normalised Difference Vegetation
Index
NiV Nipah Virus
NLCD National Landcover Database
NTFP Non-Timber Forest Product
NWFP Non-Wood Forest Product
NYC New York City
OECM Other Effective area-based
Conservation Measure
OHHLEP One Health High-Level Expert Panel
PES Payment for Ecosystem Services
PM Particulate Matter
POMS Prole of Mood States
PSD Perceived Sensory Dimension
PTSD Post-Traumatic Stress Disorder
QoL Quality of Life
RCT Randomised Controlled Trial
RRI Rights and Resources Initiative
RS Remote Sensing
SARS Severe Acute Respiratory Disease
SAVI Soil Adjusted Vegetation Index
SDG Sustainable Development Goal
SES Socio-Economic Status
SESH Social-Ecological System Health
SRT Stress Reduction Theory
TEK Traditional Ecological Knowledge
TNC The Nature Conservancy
UK United Kingdom of Great Britain and
Northern Ireland
UNDP United Nations Development
Programme
1111
UNECE United Nations Economic
Commission for Europe
UNEP United Nations Environment
Programme
UNESCO United Nations Educational, Scientic
and Cultural Organization
UNFF United Nations Forum on Forests
USA United States of America
UV Ultraviolet
VCF Vegetation Continuous Fields
WEF World Economic Forum
WHO World Health Organization
WHOQOL WHO Quality of Life
WOAH World Organisation for Animal Health
WWF Worldwide Fund for Nature
ZIKV Zika Virus
1
13
Chapter 1
Introduction
Coordinating Lead Author: Cecil Konijnendijk
Lead Authors: Dikshya Devkota, Stephanie Mansourian and Christoph Wildburger
TABLE OF CONTENTS
1.1 Importance of Forests and Trees for Human Health ............................................................................. 14
1.2 Public Health Challenges .......................................................................................................................... 15
1.3 Current State of Forests ............................................................................................................................ 15
1.4 Global and Policy Context ........................................................................................................................ 16
1.5 Scope of the Assessment .......................................................................................................................... 18
1.6 Introducing the Global Forest Expert Panel on Forests and Human Health ....................................... 19
1.7 Structure of the Report ............................................................................................................................. 19
1.8 References .................................................................................................................................................. 22
14
1. INTRODUCTION
1.1 Importance of Forests and Trees
for Human Health
Forests, trees and green spaces1, hereinafter ‘forests
and trees’ for short, provide multiple goods and
services that contribute to human health. These in-
clude medicines, nutritious foods and other non-
wood forest products (NWFPs). Globally, at least 3.5
billion people use NWFPs, including medicinal
plants (FAO, 2020a; 2020b) which are particular-
ly important for vulnerable groups and Indig-
enous Peoples and local communities (IPLCs).
During periods of crises, such as the COVID-19 pan-
demic, demand for forest products typically in-
creases amongst these groups (FAO, 2020a; Kuuwill
et al., 2022). Forests and trees also contribute to
better health by playing a role in climate change
mitigation and adaptation, contributing to regulat-
ing the carbon cycle, but also moderating the mi-
cro-climate, ltering pollutants from the air and
protecting settlements against the effects of ex-
treme events such as droughts and ash oods.
They offer areas for recreation, contributing to our
overall mental and physical wellbeing and make
the places where we live, work, study and play,
healthy and liveable. In urban areas, not having ac-
cess to forests, trees and other green spaces can
result in poor mental, physical, social, as well as
spiritual, health (van den Bosch and Bird, 2018).
1 All terms that are dened in the glossary of this report (Appendix 1) appear in italics the rst time they are mentioned.
The link between forests, trees and health
can also be negative, for example, when zoonotic
diseases emerge from forests or when forest res
threaten people’s health. The Intergovernmental
Science-Policy Platform on Biodiversity and Eco-
system Services (IPBES) stressed the intricate links
between biodiversity in general and pandemics,
with overexploitation of forests and wildlife as an
important contributing factor (IPBES, 2020). Ac-
cording to global data released by WHO, wildres
and volcanic activity affected 6.2 million people
between 1998 and 2017 causing 2,400 deaths from
suffocation, injuries and burns (WHO, 2022b).
The relationship between forests and health is
multifaceted and often modulated by other factors
such as the ways in which humans manage for-
ests and wildlife, or the presence of forest roads
which open up access to forests and increase
human-wildlife encounters. Pandemics such as
the recent COVID-19 one can be traced back to
microbes carried by animal reservoirs, but their
emergence as pandemics is the result of human
activities leading to global environmental changes
that drive biodiversity loss and climate change,
including land-use change, agricultural expansion
and intensication, and wildlife trade and con-
sumption (IPBES, 2020). Land-use change alone
(which includes deforestation) is estimated to have
caused the emergence of more than 30% of new
diseases since 1960 (IPBES, 2020).
Figure 1.1
A visualisation of the benefits and contributions to the Sustainable
Development Goals (SDGs) of inner forests, nearby forests and faraway forests
Source: Cities4Forests, 2022
15
1. INTRODUCTION
1.2 Public Health Challenges
According to the United Nations’ estimates, less
than half of the global population is covered by
essential health services (WHO, 2022c). In addi-
tion, the COVID-19 pandemic has created fur-
ther healthcare disruptions, which could reverse
decades of health improvements, particularly
in low-income countries where healthcare sys-
tems and populations are more vulnerable. Al-
though the overall morbidity and mortality related
to infectious diseases have declined over the last
decades, there has been a recent surge in zoonot-
ic diseases, such as COVID-19, Severe Acute Res-
piratory Disease (SARS), Middle East Respiratory
Syndrome (MERS), Ebola, malaria and the avian
u due to environmental and climate disruptions.
Illness and deaths from such diseases are likely
to spike in the future. For instance, the range of
the malaria-bearing mosquito (Anopheles spp.) is
expected to greatly increase in the next decades
due to climate change (Rupasinghe et al., 2022).
Even with global warming staying under 2°C, the
potential occasions for transmission of diseases
from wildlife to humans are liable to double by
2070 (Carlson et al., 2022).
In addition to infectious diseases, non-com-
municable diseases are a major public health
threat. Due to a shift in risk factors for poor
health, the prevalence of chronic diseases such
as diabetes, cancer, cardiovascular conditions,
immune system disorders and depression has in-
creased across the world (GBD 2017 Risk Factor
Collaborators, 2018). Contemporary risk factors,
especially in high- and middle-income countries
but increasingly also in low-income areas, are
dominated by lifestyle related behaviours, such
as insufcient physical activity, chronic stress,
social isolation and poor diets (The Lancet, 2019).
Environmental factors, such as urbanisation, bi-
odiversity loss and climate change have result-
ed in major threats to human health, through
air pollution, noise and extreme weather events,
such as heatwaves, oods, hurricanes and pe-
riods of drought (which in turn threaten food
supplies) (WHO, 2022a) among others. A WHO
(2016) assessment on the links between human
health and environment highlights that prema-
ture death and disease can be prevented through
healthier environments. No less than 24% of
global deaths (and 28% of deaths among children
under ve) are due to modiable environmental
factors (WHO, 2016).
Climate change is an issue of major concern
also from a public health perspective. Many ex-
treme weather events and their consequences on
human health can be linked to climate change
(WHO, 2020).
1.3 Current State of Forests
The loss and degradation of forests have a negative
impact on the provision of crucial ecosystem ser-
vices (i.e., the direct and indirect benets humans
derive from ecosystems – MEA, 2005; FAO, 2020b).
The most recent Global Forest Resources Assess-
ment (FRA) observed that 10 million ha of forests
continued to be lost each year between 2015 and
2020 (FAO, 2020b). Although forest loss continues
at a signicant rate, a general decrease in the
overall rate of net forest loss has been observed
over the decade 1990-2020 (from 7.8million ha
per year in the decade 1990-2000 to 5.2millionha
per year in 2000-2010 to 4.7millionha per year
in 2010-2020) due to reduced levels of deforest-
ation in some countries combined with increas-
es in afforestation, reforestation and natural ex-
pansion of forests in other areas. Global gures
hide regional differences, with for example, the
rate of forest loss in Africa steadily rising since
1990 (FAO, 2020b). Furthermore, changes in the
amount of forest area do not paint the full pic-
ture, as the integrity and quality of forests, and
their functional capacity are crucial for the pro-
vision of ecosystem services. Forest degradation,
which is much harder to dene and measure, is
assumed to be much higher than deforestation.
Estimates suggest that human-induced degra-
dation affects 34% of agricultural land globally
(FAO, 2022). Moreover, with the world’s human
population continuing to grow, the per capita
area of forest is decreasing. According to the FRA
(FAO, 2020b), based on data from 2015, the world
has a total forest area of 4.06 billion hectares,
representing 31% of the total global land area. At
the time of publication, this amounted to 0.52 ha
per person – although forests are not distribut-
ed equally among the world’s peoples or geogra-
phies. There is often a lack of forests in urban ar-
eas where most of the world’s population live
(and where forest benets are invaluable), typi-
cally because urbanisation often results in for-
est loss and degradation, notably, through urban
sprawl.
The predominant drivers of forest loss differ
by geographical region. However, the main dri-
vers around the globe are the production of com-
modities (in particular soy, cattle and palm oil),
forestry, shifting cultivation and re (Curtis et al.,
2018), and climate change accentuates the impact
of these drivers. Ongoing urbanisation is also, to a
lesser extent, a driver of forest loss, although some
16
1. INTRODUCTION
cities across the world have made attempts to en-
hance their forest and tree cover in recognition of
the benets these provide to urban dwellers.
The FRA 2020, and the recent State of the
World’s Forests report (FAO, 2022), also highlight
that forests are exposed to many disturbances
that can adversely affect their health and vitali-
ty and reduce their ability to provide a full range
of goods and ecosystem services. Disturbance and
threats include, for example, insects, diseases and
extreme weather events – with the latter damag-
ing 40 million ha of forests in 2015, primarily in
the temperate and boreal regions. That same year,
forest res affected about 98 million hectares of
forests (FAO, 2022). Tropical forests were especially
hard hit, with 4% of their total area being burnt
that year alone.
1.4 Global and Policy Context
The Millennium Ecosystem Assessment (MEA)
released in 2005, set the stage for a better un-
derstanding of the contributions that nature
provides people (MEA, 2005; Diaz et al., 2018).
Since then, the Inter-governmental Science-Pol-
icy Platform on Biodiversity and Ecosystem Ser-
vices (IPBES) was established in 2012 to “strength-
en the science-policy interface for biodiversity
and ecosystem services for the conservation and
sustainable use of biodiversity, long-term human
well-being and sustainable development” (IPBES
online; Diaz et al., 2018). Through its research
outputs, the IPBES has contributed to improving
our understanding of the role of nature in pro-
viding benets to humans, and consequently, the
role that ongoing nature destruction is playing in
increasing health hazards, notably through forest
res and the spread of pathogens (IPBES, 2018).
There is growing research in, and recognition
of, the impacts of forests, trees and green spaces
on human health. A 2015 state-of-knowledge re-
port highlighted the important links between bio-
diversity more broadly and human health, dis-
cussing for example, zoonotic diseases, impacts at
different scales and for different parts of the hu-
man population, and the many linkages between
biodiversity and health (Romanelli et al., 2015).
The World Health Organization (WHO) is increas-
ingly calling for actions that address the essential
links between human health, environmental fac-
tors and climate change. A report from the 72nd
World Health Assembly, held in 2019, introduced
a new global strategy on health, environment and
climate change aiming to transform the way envi-
ronmental health risks are tackled by accounting
for health in all policies, and scaling up disease
prevention and health promotion (WHO, 2020).
The State of the World’s Forests report (FAO, 2022)
is one of the rst higher-level assessments and
policy reports that pays more than eeting atten-
tion to the important human health impacts of
forests. The report states that trees, forests and
sustainable forestry can help the world recover
from the COVID-19 pandemic and combat loom-
ing environmental crises, such as climate change
and biodiversity loss. It also highlights that for this
to happen, societies must better recognise the con-
siderable value of forests and their crucial roles in
building inclusive, resilient and sustainable econ-
omies. The report recognises that the application
of a broader framework for understanding human
health in a wider planetary context is still in its in-
fancy. Beatty et al. (2022) recently released a scien-
tic report that illustrates the evidence connect-
ing forests and human health. The report explores
ve categories of potential interactions between
forests and human health: noncommunicable dis-
eases like cancer and diabetes; environmental ex-
posures; food and nutrition; physical hazards; and
infectious diseases.
Several international policy processes and
commitments have called for the inclusion of
forests to contribute to human wellbeing, although
the focus has often been more broadly on biodi-
versity. In 2012, the report ‘Our Planet, Our Health,
Our Future’ jointly issued by several United Na-
tions organisations and conventions, called for
joint consideration of biological diversity, climate
change and desertication from a human health
perspective (Patz et al., 2012). The Convention on
Biological Diversity (CBD) states that it is “alarmed
by the continued loss of biodiversity and the threat
that this poses to human well-being" and the re-
cently adopted Kunming-Montreal Global Biodi-
versity Framework (GBF) highlights the urgent
need to reduce environmental degradation to re-
duce health risks and the implementation of ho-
listic approaches such as the One Health Approach
(CBD, 2022). Target 12 specically aims to increase
the area, quality, connectivity, access and benets
of urban green spaces in improving human health
and well-being. Additionally, the Quadripartite
partnership on One Health between the Food and
Agriculture Organization of the United Nations
(FAO), the WHO, the World Organization for Ani-
mal Health (WOAH) and the United Nations En-
vironment Programme (UNEP) advocates for the
implementation of a One Health approach and ad-
dresses the health risks of deforestation and land
degradation in several activities of its Joint Plan for
Action (FAO et al., 2022). In 2020, a group of experts
convened under the IPBES to assess the state of
17
1. INTRODUCTION
knowledge and provide policy options on COVID-19
and other zoonoses, including on the role of for-
ests, reduced deforestation and increased restora-
tion (IPBES, 2020). In other global processes, the
16th session of the UN Forum on Forests (UNFF 16)
expressed concern that biodiversity loss and eco-
system degradation were driving zoonotic diseases
for which we have no resistance, and issued a call
to build momentum to halt illegal and unsustain-
able forest practices to reduce the risk of future
threats to human wellbeing (ECOSOC, 2021).
The Global Forest Goals (United Nations, 2021)
highlight that forests in different settings, from ur-
ban areas to natural landscapes, provide livelihoods
and multiple products and services to communi-
ties. For example, the initiative Cities4Forests de-
veloped an overview of the forest continuum, from
urban centres, through peri-urban and rural areas,
to remote natural areas, calling these inner, near-
by and faraway forests, and linking them to vari-
ous benets and Sustainable Development Goals
(SDGs; see Figure 1.1). The State of the World’s For-
ests report (FAO, 2022) highlights three pathways
for securing and enhancing the essential roles of
forests: halting deforestation and maintaining for-
ests; restoration; and sustainable use. The latter
also relates to the need for a broader integrated
sustainable land management perspective.
Forests can enhance and maintain water quality, which is crucial for human health
Photo © Dikshya Devkota
18
1. INTRODUCTION
The implementation of the United Nation’s
Agenda 2030 for Sustainable Development and
its 17 SDGs aim to strengthen the momentum for
combatting pressing challenges to enable a sus-
tainable development for all. The third SDG speci-
cally focuses on health and aims to “Ensure
healthy lives and promote well-being for all at all
ages”. Linkages between human health and forests
can be found in several SDG targets, for example:
target 3.3 “end the epidemics of AIDS [Acquired
Immunodeciency Syndrome], tuberculosis, malar-
ia and neglected tropical diseases and combat
hepatitis, water-borne diseases and other commu-
nicable diseases”; target 3.4 “reduce by one third
premature mortality from noncommunicable
diseases through prevention and treatment and
promote mental health and well-being”; target 3.9
“substantially reduce the number of deaths and
illnesses from hazardous chemicals and air, water,
and soil pollution and contamination”; and target
11.7 “universal access to safe, inclusive and ac-
cessible, green and public spaces, in particular for
women and children, older persons and persons
with disabilities” (United Nations, 2015). Moreover,
promoting the interlinkages between forests and
human health can directly or indirectly contribute
to achieving all SDGs (FAO, 2020a). A recent study
(Katila et al., 2019) analysed potential impacts of
SDG implementation on forests and forestry. The
authors state that understanding the potential im-
pacts of SDGs on forests, forest-related livelihoods
and forest-based options to generate progress to-
wards achieving the SDGs, as well as related trade-
offs and synergies, is crucial for reaching these
goals. Another study on forest landscape restora-
tion (FLR) demonstrated how the broadening agen-
da of FLR meant that it could support the achieve-
ment of many SDGs (Mansourian, 2018). Although
global environmental governance systems have in-
creasingly acknowledged the health-environment
nexus, explicit interlinking of forests and human
health is still limited.
To tackle health challenges by recognising that
human health is closely related to the health of
other species, ecosystems and the planet as a
whole, novel and more integrative health frame-
works have been developed. The State of the
World’s Forests 2022 report notes that the imple-
mentation of novel frameworks is still not opti-
mal and that “it has become apparent, however,
that addressing the ecosystem-health dimension
through responsible land-use planning and the
greater involvement of the forest and wildlife
sectors as well as natural-resource managers is
equally important. Continuous monitoring and
surveillance, data-sharing and evidence-based
decision-making are essential for minimising im-
pacts and adjusting policies over time and as con-
ditions change” (FAO, 2022). The report introduces
a ‘One Health’ perspective, in recognition of the
interlinkages between the health of humans and
that of other living beings, and ecosystems.
1.5 Scope of the Assessment
Understanding of the net impacts of forests on
human health is still incomplete and only a few
policies and initiatives have made a tangible ef-
fort to prioritise the multifaceted role of forests
in maintaining or improving human health in a
sustainable manner. In urban areas, especially in
high-income countries, it has become increasingly
common to consider the positive impacts of for-
ests, trees and green spaces on mental, physical
and social health, even though the evidence base
is still not complete. Elsewhere, aspects such as
zoonotic diseases and food and nutrition have re-
ceived more, although still insufcient, attention.
Initiatives are often fragmented, unsustainable
and not always evidence-based, or focus on only
one or a few aspects of the many forest-health
relations.
This assessment highlights that although the
various impacts – often positive, but in some cases
potentially negative – of forests on human health
and wellbeing are increasingly being studied and
acknowledged, these impacts are not reected
in relevant policies, programmes and activities,
thus preventing adequate integration in ongoing
and future strategies. In addition, despite a recent
surge in research, there are still substantial knowl-
edge gaps on the impacts that forests have on
human health and wellbeing. The present Expert
Panel aims to assess the current state of knowl-
edge and highlight knowledge gaps, while also
identifying trade-offs, synergies and opportunities
for strengthening policies, programmes and spe-
cic activities to enhance positive health impacts
of forests on urban, rural and forest-dependent com-
munities.
The purpose of this assessment is to assess ex-
isting evidence on the linkages between forests,
trees outside forests and green spaces on the one
hand, and human health on the other.
This assessment takes a multi-layered per-
spective to the human-forest relationship in ur-
ban, rural and forest-dependent communities. It
aims to assess and interpret the evidence around
the interdependence between the health of for-
ests and that of people. The focus is on forest and
19
1. INTRODUCTION
tree-based environments, considered broadly, and
including trees outside forests and green spaces
in urban areas. In this assessment, we take a prag-
matic social-ecological systems approach based on
the concept that social and ecological systems
are interrelated and interdependent (Berkes and
Folke, 1998). We build upon three inuential inter-
connecting concepts that are particularly relevant
for assessing the forest-human health interaction:
One Health; Planetary Health; and EcoHealth.
1.6 Introducing the Global Forest Expert Panel
on Forests and Human Health
This report presents the ndings of the GFEP as-
sessment on Forests and Human Health, which
was in operation from mid-2021 through early
2023. In the frame of the IUFRO-led Joint Initiative
of the Collaborative Partnership on Forests (CPF),
the GFEP on Forests and Human Health had as its
task to carry out a comprehensive global assess-
ment of available scientic information on the
interactions between forests and human health
and to prepare a report to inform relevant interna-
tional policy processes and the discussions on the
2030 Agenda for Sustainable Development.
More specically, the assessment addresses the
following main thematic elements:
• The different dimensions of the relationships
between forests and human health, including
benets and challenges;
• Synergies and trade-offs between human
health, and the conservation, restoration and
sustainable management of forest ecosys-
tems, their biodiversity (including wildlife), as
well as trees in other land-uses; and
• Response options relevant to policy context,
including governance frameworks, in econom-
ic, health, socio-cultural and environmental
domains at various levels (sub-national, na-
tional, regional and international).
The GFEP on Forests and Human Health com-
prises 16 scientists from various disciplines with
recognised expertise in the assessment topics, in-
cluding forestry, ecology, landscape design, envi-
ronmental psychology, and medicine and public
health. The Expert Panel was further supported by
16 contributing authors. Panel members and con-
tributing authors are from across the globe and
represent different genders.
The Expert Panel decided to take a broad view
of forests, trees and green spaces, and to look at
these in diverse contexts. The focus is on urban,
rural, as well as forest-dependent communities.
Equally the Panel takes a broad perspective of
human health, including all aspects of physical,
mental, spiritual and social health and wellbe-
ing of people, while also considering links to the
health of other beings and ecosystems.
1.7 Structure of the Report
The next chapter offers a framework for the re-
mainder of the report and introduces relevant
transdisciplinary concepts, such as One Health
and Planetary Health. It also provides an over-
view of key health aspects and pathways through
which forests and trees are linked to human
health. Next, Chapter 3 provides a comprehensive
overview of the current evidence on the impacts
of forests and trees on human health at different
life stages. It also provides insights into current
knowledge gaps and research needs. Chapter 4
investigates how specic forest types, settings
and characteristics are linked to different health
impacts. This chapter also discusses synergies
and trade-offs between human health impacts of
forests and other ecosystem services and bene-
ts provided by forests. Although health benets
may go hand-in-hand with other benets of for-
ests, there are also cases where different benets
may be in conict. Chapter 5 offers an overview of
different response options that can enhance the
positive health impacts of forests and trees, while
also minimising negative impacts. The chapter
presents response options related to accessibili-
ty and management, spatial aspects, design, gov-
ernance and economics, and communications.
Chapter 6, presents a summary and conclusion
of the report, while also providing key messages
for decision-makers and identifying important
knowledge gaps.
20
1. INTRODUCTION
21
1. INTRODUCTION
22
1. INTRODUCTION
1.8 References
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Folse, M. and Cody, A. 2022. The Vitality of Forests:
Illustrating the evidence connecting forests and human
health, Washington DC: Worldwide Fund for Nature.
Berkes, F. and Folke, C. 1998. Linking social and ecological
systems for resilience and sustainability. In: Berkes,
F. and Folke, C. (eds.) Linking Social and Ecological
Systems: Management Practices and Social Mechanisms
for Building Resilience. Cambridge: Cambridge
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Carlson, C. J., Albery, G. F., Merow, C., Trisos, C. H.,
Zipfel, C. M., Eskew, E. A., Olival, K. J., et al. 2022.
Climate change increases cross-species viral
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CBD 2022. Kunming-Montreal Biodiversity Framework,
Montreal: Convention on Biological Diversity.
Cities4Forests. 2022. A Call to Action on Forests and
Climate [Online]. Cities4forests. Available: https://
cities4forests.com/ [Accessed 2 January 2022].
Curtis, P. G., Slay, C. M., Harris, N. L., Tyukavina, A. and
Hansen, M. C. 2018. Classifying drivers of global
forest loss. Science, 361(6407), 1108-1111.
Díaz, S., Pascual, U., Stenseke, M., Martín-López,
B., Watson, R. T., Molnár, Z., Hill, R., et al. 2018.
Assessing nature’s contributions to people. Science,
359(6373), 270-272.
ECOSOC 2021. United Nations Forum on Forests Report
on the sixteenth session, New York: United Nations
Economic and Social Council.
FAO 2020a. Forests for human health and well-being –
Strengthening the forest–health–nutrition nexus, Rome:
Food and Agriculture Organization of the United
Nations.
FAO 2020b. Global Forest Resources Assessment 2020: Main
report, Rome: Food and Agriculture Organization of
the United Nations.
FAO 2022. The State of the World’s Forests 2022. Rome:
Food and Agriculture Organization of the United
Nations.
FAO, UNEP, WHO and WOAH 2022. One Health Joint Plan
of Action (2022–2026): Working Together for the Health
of Humans, Animals, Plants and the Environment,
Rome: FAO, UNEP, WHO and WOAH.
GBD 2017. Risk Factor Collaborators 2018. Global,
regional, and national comparative risk assessment
of 84 behavioural, environmental and occupational,
and metabolic risks or clusters of risks for 195
countries and territories, 1990–2017: a systematic
analysis for the Global Burden of Disease Study
2017. The Lancet, 392(10159), 1923-1994.
IPBES online. Work programme - IPBES rolling out
work programme up to 2030 [Online]. Bonn:
Intergovernmental Science-Policy Platform on
Biodiversity and Ecosystem Services Available:
https://ipbes.net/work-programme [Accessed 5
February 2023].
IPBES 2018. Summary for policymakers of the assessment
report on land degradation and restoration of the
Intergovernmental Science-Policy Platform on
Biodiversity and Ecosystem Services. In: Scholes, R.,
Montanarella, L., Brainich, A., Barger, N., Ten Brink,
B., Cantele, M., Erasmus, B., Fisher, J., Gardner, T.
and Holland, T. G. (eds.). Bonn, Germany: IPBES
Secretariat.
IPBES 2020. Workshop Report on Biodiversity and Pandemics
of the Intergovernmental Platform on Biodiversity and
Ecosystem Services. Daszak P., Amuasi J., das Neves
C.G., Hayman D., Kuiken T., Roche B., Zambrana-
Torrelio C., Buss P., Dundarova H., Feferholtz Y.,
Földvári G., Igbinosa E., Junglen S., Liu Q., Suzan G.,
Uhart M., Wannous C., Woolaston K., Mosig Reidl P.,
O’Brien K., Pascual U., Stoett P., Li H. and H.T. Ngo,
Bonn: IPBES Secretariat.
Katila, P., Colfer, C. P., Jong, W., Galloway, G., Pacheco, P.
and Winkel, G. (eds.) 2019. Sustainable Development
Goals: Their Impacts on Forests and People, Cambridge:
Cambridge University Press.
Kuuwill, A., Kimengsi, J. N. and Campion, B. B. 2022.
Pandemic-induced shocks and shifts in forest-
based livelihood strategies: learning from COVID-19
in the Bia West District of Ghana. Environmental
Research Letters, 17, 064033.
Mansourian, S., 2018. In the eye of the beholder:
Reconciling interpretations of forest landscape
restoration. Land Degradation & Development, 29(9),
2888-2898.
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Ecosystems and Human Wellbeing: A framework for
assessment. Washington DC: Island Press.
Patz, J., Corvalan, C., Horwitz, P., Campbell-Lendrum,
D., Watts, N., Maiero, M., Olson, S., et al., 2012. Our
planet, our health, our future. Human health and the
Rio conventions: biological diversity, climate change and
desertification. Geneva: WHO.
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Maiero, M., Karesh, W. B., Hunter, D. and Golden,
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23
1. INTRODUCTION
Rupasinghe, R., Chomel, B. B. and Martínez-López, B.
2022. Climate change and zoonoses: A review of the
current status, knowledge gaps, and future trends.
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van den Bosch, M. and Bird, W. (eds.) 2018. The Oxford
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improve lives and wellbeing sustainably through healthy
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World Health Organization. Available: https://www.
who.int/news-room/fact-sheets/detail/climate-
change-and-health. [Accessed 5 June 2022].
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Geneva: World Health Organizations (WHO).
Available: https://www.who.int/health-topics/
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who.int/health-topics/universal-health-coverage.
[Accessed 5 June 2022].
24
2
25
Chapter 2
Framing the Interrelations between Forests and Human Health
Coordinating Lead Author: Matilda van den Bosch
Lead Authors: Agnes van den Berg, Payam Davand, Xiaoqi Feng, Serge Morand, Roseline Remans,
Liisa Tyrväinen and Sjerp de Vries
Contributing Authors: Emma Gibbs and Joshitha Sankam
TABLE OF CONTENTS
2.1 Introduction ................................................................................................................................................. 26
2.2 Multidimensional States of Forests and Human Health ........................................................................ 29
2.3 Ecocentrism, Traditional Ecological Knowledge, and the Reciprocal Relation Between Human
and Forest Health ....................................................................................................................................... 29
2.4 What is Health? ........................................................................................................................................... 31
2.5 Multifactorial Determinants and Modiers ............................................................................................. 33
2.6 Human Health and the Environment - Central Frameworks and a Systems Approach ..................... 36
2.7 Framing the Health Impacts of Forests .................................................................................................... 43
2.8 Conclusion ................................................................................................................................................... 51
2.9 References .................................................................................................................................................... 52
2. FRAMING THE INTERRELATIONS BETWEEN FORESTS AND HUMAN HEALTH
26
Abstract
There is no such thing as human health without a healthy planet. Forests are a central part of
the planet’s ecosystems and, as such, understanding human-forest interdependence is central to
achieving optimal health for all, now and for future generations.
Contemporary human health challenges differ across the globe. In high-income countries, there
is a dominance of non-communicable diseases that, to some extent, are related to a disconnect
from, and unhealthy interactions with, forests. In other parts of the world, health is related to
interactions with forests through, for example, nutrition and other services provided by forests or
through infectious diseases, such as malaria, that are in turn all impacted by forest management
and practices.
Planetary health approaches provide a way of considering environmental protection as an in-
herent part of the solution to health. In this context, forests play an important role. Positive inter-
actions with healthy forest ecosystems can contribute to various services, such as promotion of
healthier lifestyles, prevention of disease and livelihoods.
This chapter denes common concepts and discusses the need for systems thinking when ad-
dressing the complex and dynamic relationships between forests and human health, including the
importance of acknowledging voices and knowledge from Indigenous peoples and local commu-
nities. It outlines the consequences of urbanisation and humans’ disconnect from nature as well
as various theories, pathways and mechanisms that support evidence on positive health impacts
of forests. Finally, it provides a framework that brings together the information provided in the re-
mainder of the report.
2.1Introduction
In many parts of the world, humans are increas-
ingly disconnected from nature. This disconnect
has resulted in a loss of recognition that, as a spe-
cies, we are merely one small element in a much
larger system. In so-called modern societies there
also seems to be a lack of understanding that if
any part of this system is broken, everything, in-
cluding humans, will be affected. In many parts
of the world, we are now starting to see the dire
consequences of this failed understanding. Iron-
ically, the harmful consequences of Western life-
styles are predominantly experienced by those
populations who have remained connected to
their surrounding natural environments, for ex-
ample, forest-dependent communities2.
In an inuential review from 2012 entitled “A
symbiotic view of life: we have never been individ-
uals” – Gilbert et al. (2012) argue that human beings
should not be considered as individual entities but
rather as ecosystems living in continuous sym-
biotic and interactive relations with animals and
plants around us. For example, we carry at least
300-fold more microbial genes than human genes,
and microbial cells clearly outnumber the human
cells of a body (O'Hara and Shanahan, 2006). Nev-
ertheless, over the last centuries an increasingly
2 All terms that are dened in the glossary of this report (Appendix 1) appear in italics the rst time they are mentioned
anthropocentric worldview has come to dominate,
inuencing how we consider ourselves and how we
relate to the environment around us (Kortenkamp
and Moore, 2001; Goralnik and Nelson, 2012). This
has resulted in major achievements in economics,
human health and social welfare, but this progress
has come at the cost of natural resource depletion
and global environmental change (Whitmee et al.,
2015). In turn, these environmental changes are
affecting human health. A paradigm shift in our
thinking and our collective worldview is therefore
urgently needed, including to better recognise the
interrelation between forests and human health.
Acknowledging this interrelation to its full extent
signies that when we discuss impacts on the
health of forests and ecosystems in this report,
we implicitly connect them to a direct or indirect
impact on human health. We use a multi-layered
perspective reecting our understanding of the
human-forest relationship in urban, rural and for-
est-dependent communities as multidimensional.
By doing so, we provide the best possible assess-
ment and interpretation of the evidence around
the interdependence between the health of forests
and the health of people as it stands today.
This chapter provides a framework for the re-
mainder of the report (Figure 2.1), introducing vari-
ous concepts that will be used throughout the text.
2. FRAMING THE INTERRELATIONS BETWEEN FORESTS AND HUMAN HEALTH
27
The chapter addresses the need for a paradigm
shift in our scientic thinking around forests and
human health. It outlines denitions of human
and forest health, and modiers that act in the re-
lation between them. Further information on such
modiers is provided in Chapter 3. We introduce
central frameworks, such as Planetary Health, One
Health, and EcoHealth. These frameworks, and in-
teractions between them, are referred to through-
out the report. Adding to this system thinking, we
also present resilience approaches as they relate to
forest and human health interactions, including
drivers and solutions, which are further discussed
in Chapter 4. Finally, to provide a background to
the evidence presented in this report, the chapter
reviews the history and development of forest and
human health research, including aspects of na-
ture disconnection. In Appendix 2 we outline com-
mon research designs, methods, measurements
and indicators.
Figure 2.1 introduces a model for the rest of the
report, including the synthesis of our ndings and
expert assessment. The framework builds upon a
systems approach related to Planetary Health, One
Health and Ecohealth, and brings together a diver-
sity of pathways that connect forests and human
health from an ecological and human health per-
spective. The model thereby brings together key el-
ements that are used across the report, including:
(1) the use of typologies to note that different char-
acteristics of forests and of population groups can
inuence the types, directions and extent of for-
est-human health interactions in multiple ways;
(2) the concept of ecosystem services and how
they connect to different pathways that affect hu-
man health; (3) a life cycle approach to consider
multiple and diverse inuences on human health
and wellbeing across the life course; and (4) a clear
two-way, dynamic nature of interactions between
forests and human health where forests inuence
human health and where human health-related
behaviours and response options also inuence
forests and ecosystems.
A boy and a girl sitting on a tree stem in the forest on a sunny summer day
Photo © Olya Humeniuk
2. FRAMING THE INTERRELATIONS BETWEEN FORESTS AND HUMAN HEALTH
28
Global
health
Wellbeing
Forest management,
policies and incentives
Health care, policies
and incentives
Gobal trends:
climate change, forest loss , vulnerability and
restoration, urbanization, population growth,
pandemics, conflicts
Anthropogenic impact
Response options
One Health
Planetary health
Ecohealth
Effect modifiers
Socio-economic status, gender, ethnicity,
urbanity & rurality, forest characteristics
Rural forests and
agroforestry
Remote/ Large
wi