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Ambra Burls

Senior lecturer Anglia Ruskin University

Correspondence to:

Ambra BurlsInstitute of Health andSocial CareAnglia Ruskin University Bishop Hall LaneChelmsford CM1 1SQ

a.burls@btopenworld.com

RESEARCH

journal

of public mental healthvol 6 • issue 3

Drawing on the author’s multi-method research on the viability of specific ecotherapy practitioner training and curriculum design,this paper debates how the use of ecotherapeutic approaches canprovide a two-pronged system to achieve both individual health (at micro level) and public andenvironment health outcomes (at macro level).The research sought the views of service users,practitioners and educationalists through use of interviews,focus groups,a nominal group,and anethnographic case study group.This research raised other considerations:namely,that people seekingpersonal recovery also,through stewardship of green spaces,may achieve unanticipated social capitaland natural capital outcomes and thereby meet current multi-disciplinary policy targets.This addedsocial value has not been previously considered as an important dimension in people’s well-beingand recovery from ill health or social exclusion.Such outcomes emerge from the idea of green spacesbecoming a ‘product’delivered to the community by people whose pursuit of personal recovery alsodirectly contributes to improved public mental health.

People and green spaces:promoting public health andmental well-being throughecotherapy

here is growing evidence that thequality of our relationship with natureimpacts on our mental health. Morethan 80% of people in the UK live inurban areas (DEFRA, 2004), and thereis evidence that ‘less green nature means reducedmental well-being, or at least less opportunity torecover from mental stress’ (Pretty

et al,

2005a; p2).This evidence does not, however, seem to havegreatly influenced town and country planners; norhas it predisposed the establishment of public healthpolicies that are inclusive of nature.This situation seems to require a concerted effortand more broad-spectrum solutions (English Nature,2003a). John Sorrell, chair of the Commission forArchitecture and the Built Environment (CABE),affirms that ‘a positive and creative relationshipbetween all concerned is of critical importance’, andthat this would ‘enable agencies, organisations andindividuals with different objectives… to worktogether to a common and successful end’ (Sorrell,2006; p254). Morris

et al

(2006) assert the need fora more strategic public health approach. Theyhighlight that ‘in Western societies, the relevance of the environment to health has become obscured…[and] even when this is not the case, the perspectiveis usually narrow, centring on specific toxic,infectious or allergenic agents in particularenvironmental compartments’ (p889). Theyemphasise the need for shared concerns acrossdisciplines and sectors.Barton and Grant (2006) have presented anupdated version of the World Health Organization(WHO) health map, introducing the globalecosystem, natural environment and biodiversity tothe range of determinants of health and well-beingin our neighbourhoods. They state that concernsabout physical and mental health problems and

Keywords

ecohealthecotherapy biophiliasocial capitalnatural capital

journal

of public mental healthvol 6 • issue 3

People and green spaces:promoting public health and mental well-being through ecotherapy

inequalities have forced town planning to takeaccount of factors previously divorced from healthagendas. The map (figure 1) was designed to be a‘dynamic tool’ to ‘provide a focus for collaborationacross practitioner professions and across topics’(p253) directly related to sustainable developmentof healthy neighbourhoods. National and international policy supports theinclusion of the natural environment in holistichealth promotion. For example, the WHOTwenty Steps for Developing Healthy CitiesProjects (WHO, 1997) document sets out a multi-pronged planning strategy based on intersectorialaction, alongside health awareness and healthypublic policy, community participation andinnovation. Similarly, the WHO Health ImpactAssessment Toolkit for Cities (WHO, 2005a)offers a means to quantify the benefits of greenspaces in terms of:

greater involvement in the processes of makingpolicy and decisions

potential to extend the democratic process,especially to excluded groups in society

empowerment

the development of skills

consideration of how to reduce sources of disadvantage or inequality

the development and provision of services thatbetter meet the needs of local people.These actions would pave the way towards morecomprehensive public mental health policies.However, they would be served well by the inclusionof the concept of ecohealth.

The concept of ecohealth

Ecological perspectives have played a part in healthpromotion models and constructs of health(Hancock & Perkins, 1985; Kickbusch, 1989). Thesehave informed the development of health promotionstrategies and practices such as healthy cities, schoolsand work places. But St Leger (2003) remarks thateven these holistic frameworks put more emphasis onhealth promotion as a way of addressing specificmortality and morbidity outcomes, and that there isgenerally a tendency to work with the immediateproblems of the individual. Specific actions areaimed at creating change in behaviours and lifestyles, but rarely include the bringing about of tangible change in the natural world around us.

Figure 1:

The determinants of health and well-being in our neighbourhoods (Barton & Grant,2006)

journal

of public mental healthvol 6 • issue 3

People and green spaces:promoting public health and mental well-being through ecotherapy

Butler and Friel (2006) report that ‘since 1986,the evidence linking health to ecological andenvironmental factors (such as climate change,biodiversity loss, and the mental health benefits of exposure to nature) has strengthened considerably,stimulating a new discipline, sometimes called“ecohealth”’. They believe, however, that‘paradoxically, recognition of the importance of environmental and ecological factors hassimultaneously declined among proponents of health promotion’ (p1692). They expose the‘abandonment of ecology’ by health promoters, inmuch the same way as exponents of ecopsychology(Roszak

et al,

1995) denounced the same‘abandonment’ by contemporary psychology andmost prevailing therapy models.The way we might start to reverse this process ismore to do with healing and health care than it is todo with traditional environmental education orsocial policy. ‘Healing means to “become whole” andEcotherapy aims to break down the disconnectionbetween self and other’ (Footprint Consulting,2006). Ecohealth widens the relationship betweenhealth and our ecosystem, bringing ecologicalfactors such as biodiversity into play and thusstressing the importance of the relationshipsbetween human and non-human species. Inconsidering humans as a part of the global biosphere,this concept inevitably brings the sustainability of our civilisation, and therefore human health, intothe systemic, interacting forces that regulate life(Vernadsky, 1998). These concepts are furtherstrengthened by such policies as the Ottawa Charter(1986), which declares: ‘The fundamentalconditions and resources for health are peace,shelter, education, food, income, a stable eco-system, sustainable resources, social justice andequity.’ This implies the existence of synergiesbetween health promotion activities and the well-being of communities, individuals and theenvironment in which they live. But it also meansthat the environment needs to be cared for andsafeguarded by the people in order for both tobenefit. The remit of ecohealth should be to deliversocial, economic and environmental goals in anintegrated way. This health promotion socio-ecological strategy may well prove to be a refined‘joined up approach’ for all operative aspects of mental health promotion, including improvedcommunity participation, safer and healthiercommunities and neighbourhoods, successfulpartnerships in the betterment of public health, thesustainable use of green spaces and the conservationof wildlife.

Green spaces for health

There is already considerable anecdotal, theoreticaland empirical evidence that contact with nature isa real asset in the promotion of health for people(see table 1 (Maller

et al,

2006)). Such contact withnature should therefore implicitly be highly valuedas part of public health strategies.Concrete steps are needed to revitalisecommunities in the spirit of social capital and topromote social inclusiveness. Natural England(English Nature, 2003b) recommends that‘provision should be made of at least 2ha of accessible natural greenspace per 1000 population,and that no person should live more than 300m (orfive minute walking distance) from their nearestarea of natural greenspace’ (p2). For people to findphysical and mental health benefits from greenspaces on a regular basis (ie. three or more times perweek), these need to be local. The concept of ‘nearby nature’ for health (Kaplan & Kaplan, 1989;Kuo & Sullivan, 2001; Taylor

et al,

2001; Wells,2000) can and should be supported by statutory andvoluntary health and social care providers. Accessto ‘nearby’ natural green space resources shouldbecome an important target in a climate of aspiration to meet both the therapeutic andecological values intrinsic in such resources.Whichever way one might want to look at thischallenge, it requires both sides of the social andecological equation to be involved in providingpeople with real opportunities to experience contactwith nature and actual access to gardens, parks andnatural spaces.The report Green Spaces Better Places (UrbanGreen Spaces Task Force, 2002) also evidences thebenefits of partnership working. Developing localstrategic partnerships reinforces improvements of green spaces as a resource for health, but also bringsabout a greater sense of ownership, fosteringcommunity cohesion and achieving particularobjectives, such as greater access. This has a directimpact on empowerment, collective creativesolutions to problems and achievement of commongoals by all partners. Some initiatives such as GreenGyms (Reynolds, 2002; Yerrell, 2004) and PocketParks (Northamptonshire County Council, 2002)have already procured many communities withpositive outcomes.Maller and colleagues (Maller

et al,

2002) havereferred to Brown’s ‘triple bottom line concept’. Thisdemands the enhancement of ‘individual andcommunity health, well-being, and welfare byfollowing a path of economic development that doesnot impair the welfare of future generations;